HESI MED SURG Exam (Latest
2026/2027 Update) Evolve Elsevier
Complete Q&A with Verified Answers
and Detailed Rationales RN Exit and
HESI MED SURG Exam (Latest 2026/2027 Update) |
Comprehensive Examination
HESI MED SURG Exam (Latest 2026/2027 Update) Evolve
Elsevier Complete Q&A with Verified Answers and Detailed
Rationales RN Exit and Proctored Medical Surgical Nursing
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI MED SURG Exam (Latest 2026/2027
Update) Evolve Elsevier Complete Q&A with Verified Answers
and Detailed Rationales RN Exit and Proctored Medical
Surgical Nursing Prep A+ Graded. Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
Which finding most strongly indicates early septic shock rather than
cardiogenic shock in a patient with hypotension and tachycardia?
A. Elevated central venous pressure with distended neck veins
B. Warm, flushed extremities with widened pulse pressure
C. Bilateral crackles with an S3 gallop
D. Narrow pulse pressure with cool, mottled skin
Correct Answer: B - Warm, flushed extremities with widened
pulse pressure
RATIONALE
Early septic shock is distributive: vasodilation causes warm flushed
skin and a widened pulse pressure before decompensation.
Cardiogenic shock produces elevated CVP, crackles, S3, and cool
mottled skin from low cardiac output. Options A, C, and D all reflect
cardiogenic physiology.
Question 2
A patient receiving continuous IV heparin for pulmonary embolism has an
aPTT of 98 seconds (therapeutic range 60-80). Which action is most
appropriate?
A. Increase the infusion rate per protocol
B. Stop the infusion and prepare to administer protamine sulfate
C. Hold the next dose and recheck aPTT in 6 hours
D. Reduce the infusion rate per the heparin nomogram
Correct Answer: D - Reduce the infusion rate per the heparin
nomogram
Page 2
, RATIONALE
An aPTT of 98 seconds represents supratherapeutic anticoagulation
without frank bleeding, so the heparin nomogram directs reducing the
rate and rechecking. Protamine is reserved for serious bleeding or
overdose reversal. Holding without rate adjustment or increasing the
rate would be unsafe.
Question 3
Which arterial blood gas pattern is most consistent with a patient experiencing
an acute exacerbation of COPD with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.34, PaCO2 55, HCO3 29
C. pH 7.50, PaCO2 42, HCO3 32
D. pH 7.28, PaCO2 30, HCO3 14
Correct Answer: B - pH 7.34, PaCO2 55, HCO3 29
RATIONALE
Chronic CO2 retention with acute exacerbation yields compensated
respiratory acidosis: low pH, elevated PaCO2, and elevated HCO3
from renal compensation. Option A is respiratory alkalosis, C is
metabolic alkalosis, and D is metabolic acidosis with respiratory
compensation.
Question 4
Which assessment finding in a patient with acute kidney injury most urgently
requires provider notification?
A. Urine output of 30 mL/hr over the past 4 hours
B. Serum potassium of 6.4 mEq/L with peaked T waves
C. BUN of 45 mg/dL and creatinine of 2.8 mg/dL
D. Blood pressure of 148/88 mm Hg
Correct Answer: B - Serum potassium of 6.4 mEq/L with peaked
T waves
Page 3
, RATIONALE
Hyperkalemia with peaked T waves signals impending lethal
dysrhythmia and requires immediate intervention (calcium gluconate,
insulin/glucose, kayexalate). Rising BUN/creatinine and mild
hypertension are expected in AKI. Urine output of 30 mL/hr is at the
lower limit but not emergent.
Question 5
A patient with a new ileostomy has a stoma that is dark purple, edematous, and
without output 24 hours postoperatively. Which interpretation is correct?
A. This is an expected finding in the immediate postoperative period
B. The stoma is ischemic and the surgeon must be notified immediately
C. The stoma requires immediate manual dilation
D. The patient should be started on a clear liquid diet to stimulate output
Correct Answer: B - The stoma is ischemic and the surgeon must
be notified immediately
RATIONALE
A healthy stoma is beefy red and moist; dark purple or black
discoloration indicates ischemia/necrosis requiring urgent surgical
evaluation. Edema alone may be expected, but color change is not.
Dilation and diet advancement are inappropriate in this scenario.
Question 6
Which intervention is the priority when a patient with a chest tube following
thoracotomy suddenly develops crepitus around the insertion site and tracheal
deviation?
A. Clamp the chest tube and notify the provider
B. Reinforce the dressing with petroleum gauze
C. Assess for tension pneumothorax and prepare for emergency
decompression
D. Reposition the patient on the affected side
Page 4
2026/2027 Update) Evolve Elsevier
Complete Q&A with Verified Answers
and Detailed Rationales RN Exit and
HESI MED SURG Exam (Latest 2026/2027 Update) |
Comprehensive Examination
HESI MED SURG Exam (Latest 2026/2027 Update) Evolve
Elsevier Complete Q&A with Verified Answers and Detailed
Rationales RN Exit and Proctored Medical Surgical Nursing
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI MED SURG Exam (Latest 2026/2027
Update) Evolve Elsevier Complete Q&A with Verified Answers
and Detailed Rationales RN Exit and Proctored Medical
Surgical Nursing Prep A+ Graded. Every item uses a focused
exam stem, four response options, a keyed response, and a clear
rationale, making it easier to understand the subject, spot
distractors, and build real exam confidence.
Page 1
, Question 1
Which finding most strongly indicates early septic shock rather than
cardiogenic shock in a patient with hypotension and tachycardia?
A. Elevated central venous pressure with distended neck veins
B. Warm, flushed extremities with widened pulse pressure
C. Bilateral crackles with an S3 gallop
D. Narrow pulse pressure with cool, mottled skin
Correct Answer: B - Warm, flushed extremities with widened
pulse pressure
RATIONALE
Early septic shock is distributive: vasodilation causes warm flushed
skin and a widened pulse pressure before decompensation.
Cardiogenic shock produces elevated CVP, crackles, S3, and cool
mottled skin from low cardiac output. Options A, C, and D all reflect
cardiogenic physiology.
Question 2
A patient receiving continuous IV heparin for pulmonary embolism has an
aPTT of 98 seconds (therapeutic range 60-80). Which action is most
appropriate?
A. Increase the infusion rate per protocol
B. Stop the infusion and prepare to administer protamine sulfate
C. Hold the next dose and recheck aPTT in 6 hours
D. Reduce the infusion rate per the heparin nomogram
Correct Answer: D - Reduce the infusion rate per the heparin
nomogram
Page 2
, RATIONALE
An aPTT of 98 seconds represents supratherapeutic anticoagulation
without frank bleeding, so the heparin nomogram directs reducing the
rate and rechecking. Protamine is reserved for serious bleeding or
overdose reversal. Holding without rate adjustment or increasing the
rate would be unsafe.
Question 3
Which arterial blood gas pattern is most consistent with a patient experiencing
an acute exacerbation of COPD with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.34, PaCO2 55, HCO3 29
C. pH 7.50, PaCO2 42, HCO3 32
D. pH 7.28, PaCO2 30, HCO3 14
Correct Answer: B - pH 7.34, PaCO2 55, HCO3 29
RATIONALE
Chronic CO2 retention with acute exacerbation yields compensated
respiratory acidosis: low pH, elevated PaCO2, and elevated HCO3
from renal compensation. Option A is respiratory alkalosis, C is
metabolic alkalosis, and D is metabolic acidosis with respiratory
compensation.
Question 4
Which assessment finding in a patient with acute kidney injury most urgently
requires provider notification?
A. Urine output of 30 mL/hr over the past 4 hours
B. Serum potassium of 6.4 mEq/L with peaked T waves
C. BUN of 45 mg/dL and creatinine of 2.8 mg/dL
D. Blood pressure of 148/88 mm Hg
Correct Answer: B - Serum potassium of 6.4 mEq/L with peaked
T waves
Page 3
, RATIONALE
Hyperkalemia with peaked T waves signals impending lethal
dysrhythmia and requires immediate intervention (calcium gluconate,
insulin/glucose, kayexalate). Rising BUN/creatinine and mild
hypertension are expected in AKI. Urine output of 30 mL/hr is at the
lower limit but not emergent.
Question 5
A patient with a new ileostomy has a stoma that is dark purple, edematous, and
without output 24 hours postoperatively. Which interpretation is correct?
A. This is an expected finding in the immediate postoperative period
B. The stoma is ischemic and the surgeon must be notified immediately
C. The stoma requires immediate manual dilation
D. The patient should be started on a clear liquid diet to stimulate output
Correct Answer: B - The stoma is ischemic and the surgeon must
be notified immediately
RATIONALE
A healthy stoma is beefy red and moist; dark purple or black
discoloration indicates ischemia/necrosis requiring urgent surgical
evaluation. Edema alone may be expected, but color change is not.
Dilation and diet advancement are inappropriate in this scenario.
Question 6
Which intervention is the priority when a patient with a chest tube following
thoracotomy suddenly develops crepitus around the insertion site and tracheal
deviation?
A. Clamp the chest tube and notify the provider
B. Reinforce the dressing with petroleum gauze
C. Assess for tension pneumothorax and prepare for emergency
decompression
D. Reposition the patient on the affected side
Page 4
