HESI Med Surg II Exam (Latest
2026/2027 Update) Evolve Elsevier
Practice Questions with Verified
Answers and Detailed Rationales
HESI Med Surg II Exam (Latest 2026/2027 | Comprehensive
Examination
HESI Med Surg II Exam (Latest 2026/2027 Update) Evolve
Elsevier Practice Questions with Verified Answers and
Detailed Rationales Medical Surgical Nursing for RN Exit and
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg II Exam (Latest 2026/2027
Update) Evolve Elsevier Practice Questions with Verified
Answers and Detailed Rationales Medical Surgical Nursing for
RN Exit and Specialty Exams 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
A patient with chronic heart failure is prescribed both furosemide and
metolazone. Which assessment finding most urgently indicates a
life-threatening complication of this combination?
A. Serum potassium of 3.1 mEq/L with flattened T waves
B. Serum sodium of 134 mEq/L with mild confusion
C. Serum potassium of 6.2 mEq/L with peaked T waves
D. Serum magnesium of 1.4 mg/dL with muscle cramps
Correct Answer: A - Serum potassium of 3.1 mEq/L with
flattened T waves
RATIONALE
Sequential nephron blockade with furosemide and metolazone causes
profound hypokalemia, which can precipitate fatal dysrhythmias; a
potassium of 3.1 mEq/L with ECG changes requires immediate
intervention. Hyperkalemia (C) is not expected with these loop and
thiazide-like diuretics. Hyponatremia (B) and hypomagnesemia (D)
are concerns but less immediately life-threatening than severe
hypokalemia with ECG changes.
Question 2
A patient with acute kidney injury (AKI) secondary to rhabdomyolysis has a
serum potassium of 6.8 mEq/L and ECG changes. After administering calcium
gluconate, which intervention should the nurse anticipate next?
A. Administer sodium polystyrene sulfonate orally
B. Administer regular insulin with dextrose IV
C. Administer furosemide IV push
D. Prepare for immediate hemodialysis
Correct Answer: B - Administer regular insulin with dextrose IV
Page 2
, RATIONALE
Calcium gluconate stabilizes cardiac membranes but does not lower
potassium; insulin with dextrose shifts potassium intracellularly and is
the next emergency measure. Sodium polystyrene (A) works slowly
and is not for acute stabilization. Furosemide (C) may be used but is
less reliable in AKI. Dialysis (D) is indicated if refractory but is not
the immediate next step after calcium.
Question 3
A patient with type 1 diabetes is found unresponsive with a blood glucose of
38 mg/dL. After administering IV dextrose, which finding best indicates the
treatment has been effective?
A. Blood glucose rises to 120 mg/dL with return of consciousness
B. Blood glucose rises to 80 mg/dL with persistent confusion
C. Blood glucose rises to 200 mg/dL with diaphoresis
D. Blood glucose remains 60 mg/dL with improved alertness
Correct Answer: A - Blood glucose rises to 120 mg/dL with return
of consciousness
RATIONALE
Effective treatment of hypoglycemia requires both normalization of
blood glucose (typically >100 mg/dL) and resolution of neurologic
symptoms. Option B shows inadequate neurologic recovery. Option C
suggests overcorrection or ongoing stress response. Option D shows
insufficient glucose elevation despite some improvement.
Question 4
A patient with a new diagnosis of myasthenia gravis is started on
pyridostigmine. Which assessment finding most suggests cholinergic crisis
rather than myasthenic crisis?
A. Increased muscle weakness with bradycardia and miosis
B. Increased muscle weakness with tachycardia and mydriasis
Page 3
, C. Decreased muscle weakness with hypertension and diaphoresis
D. Decreased muscle weakness with hyperreflexia and clonus
Correct Answer: A - Increased muscle weakness with
bradycardia and miosis
RATIONALE
Cholinergic crisis results from excessive acetylcholinesterase
inhibition, producing muscarinic effects (bradycardia, miosis,
salivation, diarrhea) and nicotinic effects (weakness). Myasthenic
crisis typically presents with weakness and tachycardia without
muscarinic signs. Options B, C, and D do not fit the cholinergic
toxidrome.
Question 5
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the transfusion. Which action should the nurse take first?
A. Stop the transfusion and maintain IV access with normal saline
B. Administer acetaminophen and continue the transfusion
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen and continue the transfusion
Correct Answer: A - Stop the transfusion and maintain IV access
with normal saline
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction, which requires immediate cessation of the transfusion while
maintaining IV access for emergency treatment. Continuing or
slowing the transfusion (B, C, D) can worsen the reaction and is
unsafe. Acetaminophen is not appropriate for a suspected hemolytic
reaction.
Page 4
2026/2027 Update) Evolve Elsevier
Practice Questions with Verified
Answers and Detailed Rationales
HESI Med Surg II Exam (Latest 2026/2027 | Comprehensive
Examination
HESI Med Surg II Exam (Latest 2026/2027 Update) Evolve
Elsevier Practice Questions with Verified Answers and
Detailed Rationales Medical Surgical Nursing for RN Exit and
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg II Exam (Latest 2026/2027
Update) Evolve Elsevier Practice Questions with Verified
Answers and Detailed Rationales Medical Surgical Nursing for
RN Exit and Specialty Exams 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
A patient with chronic heart failure is prescribed both furosemide and
metolazone. Which assessment finding most urgently indicates a
life-threatening complication of this combination?
A. Serum potassium of 3.1 mEq/L with flattened T waves
B. Serum sodium of 134 mEq/L with mild confusion
C. Serum potassium of 6.2 mEq/L with peaked T waves
D. Serum magnesium of 1.4 mg/dL with muscle cramps
Correct Answer: A - Serum potassium of 3.1 mEq/L with
flattened T waves
RATIONALE
Sequential nephron blockade with furosemide and metolazone causes
profound hypokalemia, which can precipitate fatal dysrhythmias; a
potassium of 3.1 mEq/L with ECG changes requires immediate
intervention. Hyperkalemia (C) is not expected with these loop and
thiazide-like diuretics. Hyponatremia (B) and hypomagnesemia (D)
are concerns but less immediately life-threatening than severe
hypokalemia with ECG changes.
Question 2
A patient with acute kidney injury (AKI) secondary to rhabdomyolysis has a
serum potassium of 6.8 mEq/L and ECG changes. After administering calcium
gluconate, which intervention should the nurse anticipate next?
A. Administer sodium polystyrene sulfonate orally
B. Administer regular insulin with dextrose IV
C. Administer furosemide IV push
D. Prepare for immediate hemodialysis
Correct Answer: B - Administer regular insulin with dextrose IV
Page 2
, RATIONALE
Calcium gluconate stabilizes cardiac membranes but does not lower
potassium; insulin with dextrose shifts potassium intracellularly and is
the next emergency measure. Sodium polystyrene (A) works slowly
and is not for acute stabilization. Furosemide (C) may be used but is
less reliable in AKI. Dialysis (D) is indicated if refractory but is not
the immediate next step after calcium.
Question 3
A patient with type 1 diabetes is found unresponsive with a blood glucose of
38 mg/dL. After administering IV dextrose, which finding best indicates the
treatment has been effective?
A. Blood glucose rises to 120 mg/dL with return of consciousness
B. Blood glucose rises to 80 mg/dL with persistent confusion
C. Blood glucose rises to 200 mg/dL with diaphoresis
D. Blood glucose remains 60 mg/dL with improved alertness
Correct Answer: A - Blood glucose rises to 120 mg/dL with return
of consciousness
RATIONALE
Effective treatment of hypoglycemia requires both normalization of
blood glucose (typically >100 mg/dL) and resolution of neurologic
symptoms. Option B shows inadequate neurologic recovery. Option C
suggests overcorrection or ongoing stress response. Option D shows
insufficient glucose elevation despite some improvement.
Question 4
A patient with a new diagnosis of myasthenia gravis is started on
pyridostigmine. Which assessment finding most suggests cholinergic crisis
rather than myasthenic crisis?
A. Increased muscle weakness with bradycardia and miosis
B. Increased muscle weakness with tachycardia and mydriasis
Page 3
, C. Decreased muscle weakness with hypertension and diaphoresis
D. Decreased muscle weakness with hyperreflexia and clonus
Correct Answer: A - Increased muscle weakness with
bradycardia and miosis
RATIONALE
Cholinergic crisis results from excessive acetylcholinesterase
inhibition, producing muscarinic effects (bradycardia, miosis,
salivation, diarrhea) and nicotinic effects (weakness). Myasthenic
crisis typically presents with weakness and tachycardia without
muscarinic signs. Options B, C, and D do not fit the cholinergic
toxidrome.
Question 5
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the transfusion. Which action should the nurse take first?
A. Stop the transfusion and maintain IV access with normal saline
B. Administer acetaminophen and continue the transfusion
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen and continue the transfusion
Correct Answer: A - Stop the transfusion and maintain IV access
with normal saline
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction, which requires immediate cessation of the transfusion while
maintaining IV access for emergency treatment. Continuing or
slowing the transfusion (B, C, D) can worsen the reaction and is
unsafe. Acetaminophen is not appropriate for a suspected hemolytic
reaction.
Page 4
