HESI Med Surg Review Examination
(Latest 2026/2027 Update) Complete
Q&A with Verified Answers and
Detailed Rationales Medical Surgical
HESI Med Surg Review Examination (Latest 2026/2027 |
Comprehensive Examination
HESI Med Surg Review Examination (Latest 2026/2027
Update) Complete Q&A with Verified Answers and Detailed
Rationales Medical Surgical Nursing RN Exit Exam Prep A+
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Review Examination (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Medical Surgical Nursing RN Exit Exam
Prep A+ Graded Evolve Elsevier. 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 acute decompensated heart failure is receiving continuous IV
furosemide. Which assessment finding most specifically indicates a
life-threatening complication requiring immediate escalation beyond expected
diuretic response?
A. Serum potassium of 3.4 mEq/L with U waves on ECG
B. New-onset confusion with a serum sodium of 118 mEq/L
C. Urine output of 80 mL/hr with a weight loss of 0.5 kg/day
D. Blood pressure decrease from 128/76 to 112/68 mm Hg
Correct Answer: B - New-onset confusion with a serum sodium of
118 mEq/L
RATIONALE
Severe hyponatremia (Na <120 mEq/L) with new neurologic change
reflects cerebral edema and is a life-threatening emergency requiring
immediate intervention, not merely a diuretic side effect. Hypokalemia
(A) and modest BP decline (D) are expected and manageable, while
adequate diuresis (C) is therapeutic.
Question 2
Which arterial blood gas pattern, combined with the clinical picture, best
distinguishes early acute respiratory distress syndrome (ARDS) from
cardiogenic pulmonary edema?
A. PaO2/FiO2 ratio <300 with bilateral infiltrates and a normal
pulmonary artery occlusion pressure
B. PaO2/FiO2 ratio >400 with unilateral infiltrates and an elevated BNP
C. Respiratory alkalosis with a PaCO2 of 30 mm Hg and an elevated
central venous pressure
D. Metabolic acidosis with a PaO2 of 85 mm Hg and a normal chest
radiograph
Correct Answer: A - PaO2/FiO2 ratio <300 with bilateral
Page 2
,infiltrates and a normal pulmonary artery occlusion pressure
RATIONALE
ARDS is defined by acute onset, bilateral infiltrates, PaO2/FiO2 <300,
and absence of cardiogenic cause (normal PAOP 18 mm Hg). Elevated
BNP and unilateral infiltrates (B) suggest cardiogenic or focal disease,
while normal imaging (D) excludes ARDS.
Question 3
A patient with chronic kidney disease (CKD) stage 5 develops lethargy,
pericardial friction rub, and a serum potassium of 6.9 mEq/L. Which
intervention should the nurse anticipate as the immediate priority?
A. Administer oral sodium polystyrene sulfonate
B. Initiate emergency hemodialysis
C. Give IV insulin with dextrose and sodium bicarbonate
D. Restrict dietary potassium and recheck in 4 hours
Correct Answer: B - Initiate emergency hemodialysis
RATIONALE
Hyperkalemia >6.5 mEq/L with ECG/clinical instability and uremic
pericarditis in CKD stage 5 is an indication for emergent dialysis,
which definitively removes potassium. IV insulin/dextrose (C) is a
temporizing measure, oral resin (A) is too slow, and watchful waiting
(D) is unsafe.
Question 4
Which finding in a patient receiving a blood transfusion most strongly
indicates an acute hemolytic reaction rather than a febrile non-hemolytic
reaction?
A. Temperature rise of 1.5°C with chills 30 minutes into the transfusion
B. Flank pain, dark red urine, and a sudden drop in blood pressure
C. Urticaria and mild pruritus without fever
Page 3
, D. Isolated rise in temperature 4 hours after transfusion completion
Correct Answer: B - Flank pain, dark red urine, and a sudden
drop in blood pressure
RATIONALE
Acute hemolytic reaction classically presents with flank/back pain,
hemoglobinuria (dark urine), hypotension, and fever due to ABO
incompatibility. Isolated fever (A) suggests febrile non-hemolytic
reaction, urticaria (C) indicates mild allergic reaction, and delayed
fever (D) suggests delayed reaction.
Question 5
A patient with a T4 spinal cord injury develops sudden severe headache, BP
210/110 mm Hg, and bradycardia. Which action should the nurse take first?
A. Administer a prescribed antihypertensive immediately
B. Elevate the head of the bed and check for bladder distention
C. Perform a rectal examination to check for impaction
D. Apply a cooling blanket and recheck vital signs in 15 minutes
Correct Answer: B - Elevate the head of the bed and check for
bladder distention
RATIONALE
This is autonomic dysreflexia; the first action is to sit the patient
upright and identify/remove the noxious stimulus (most commonly
bladder distension). Antihypertensives (A) are used if the trigger
cannot be relieved, rectal exam (C) is itself a noxious stimulus, and
cooling (D) does not address the cause.
Question 6
Which assessment finding in a patient with a new below-knee cast most
urgently suggests compartment syndrome rather than expected post-injury
edema?
Page 4
(Latest 2026/2027 Update) Complete
Q&A with Verified Answers and
Detailed Rationales Medical Surgical
HESI Med Surg Review Examination (Latest 2026/2027 |
Comprehensive Examination
HESI Med Surg Review Examination (Latest 2026/2027
Update) Complete Q&A with Verified Answers and Detailed
Rationales Medical Surgical Nursing RN Exit Exam Prep A+
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Med Surg Review Examination (Latest
2026/2027 Update) Complete Q&A with Verified Answers and
Detailed Rationales Medical Surgical Nursing RN Exit Exam
Prep A+ Graded Evolve Elsevier. 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 acute decompensated heart failure is receiving continuous IV
furosemide. Which assessment finding most specifically indicates a
life-threatening complication requiring immediate escalation beyond expected
diuretic response?
A. Serum potassium of 3.4 mEq/L with U waves on ECG
B. New-onset confusion with a serum sodium of 118 mEq/L
C. Urine output of 80 mL/hr with a weight loss of 0.5 kg/day
D. Blood pressure decrease from 128/76 to 112/68 mm Hg
Correct Answer: B - New-onset confusion with a serum sodium of
118 mEq/L
RATIONALE
Severe hyponatremia (Na <120 mEq/L) with new neurologic change
reflects cerebral edema and is a life-threatening emergency requiring
immediate intervention, not merely a diuretic side effect. Hypokalemia
(A) and modest BP decline (D) are expected and manageable, while
adequate diuresis (C) is therapeutic.
Question 2
Which arterial blood gas pattern, combined with the clinical picture, best
distinguishes early acute respiratory distress syndrome (ARDS) from
cardiogenic pulmonary edema?
A. PaO2/FiO2 ratio <300 with bilateral infiltrates and a normal
pulmonary artery occlusion pressure
B. PaO2/FiO2 ratio >400 with unilateral infiltrates and an elevated BNP
C. Respiratory alkalosis with a PaCO2 of 30 mm Hg and an elevated
central venous pressure
D. Metabolic acidosis with a PaO2 of 85 mm Hg and a normal chest
radiograph
Correct Answer: A - PaO2/FiO2 ratio <300 with bilateral
Page 2
,infiltrates and a normal pulmonary artery occlusion pressure
RATIONALE
ARDS is defined by acute onset, bilateral infiltrates, PaO2/FiO2 <300,
and absence of cardiogenic cause (normal PAOP 18 mm Hg). Elevated
BNP and unilateral infiltrates (B) suggest cardiogenic or focal disease,
while normal imaging (D) excludes ARDS.
Question 3
A patient with chronic kidney disease (CKD) stage 5 develops lethargy,
pericardial friction rub, and a serum potassium of 6.9 mEq/L. Which
intervention should the nurse anticipate as the immediate priority?
A. Administer oral sodium polystyrene sulfonate
B. Initiate emergency hemodialysis
C. Give IV insulin with dextrose and sodium bicarbonate
D. Restrict dietary potassium and recheck in 4 hours
Correct Answer: B - Initiate emergency hemodialysis
RATIONALE
Hyperkalemia >6.5 mEq/L with ECG/clinical instability and uremic
pericarditis in CKD stage 5 is an indication for emergent dialysis,
which definitively removes potassium. IV insulin/dextrose (C) is a
temporizing measure, oral resin (A) is too slow, and watchful waiting
(D) is unsafe.
Question 4
Which finding in a patient receiving a blood transfusion most strongly
indicates an acute hemolytic reaction rather than a febrile non-hemolytic
reaction?
A. Temperature rise of 1.5°C with chills 30 minutes into the transfusion
B. Flank pain, dark red urine, and a sudden drop in blood pressure
C. Urticaria and mild pruritus without fever
Page 3
, D. Isolated rise in temperature 4 hours after transfusion completion
Correct Answer: B - Flank pain, dark red urine, and a sudden
drop in blood pressure
RATIONALE
Acute hemolytic reaction classically presents with flank/back pain,
hemoglobinuria (dark urine), hypotension, and fever due to ABO
incompatibility. Isolated fever (A) suggests febrile non-hemolytic
reaction, urticaria (C) indicates mild allergic reaction, and delayed
fever (D) suggests delayed reaction.
Question 5
A patient with a T4 spinal cord injury develops sudden severe headache, BP
210/110 mm Hg, and bradycardia. Which action should the nurse take first?
A. Administer a prescribed antihypertensive immediately
B. Elevate the head of the bed and check for bladder distention
C. Perform a rectal examination to check for impaction
D. Apply a cooling blanket and recheck vital signs in 15 minutes
Correct Answer: B - Elevate the head of the bed and check for
bladder distention
RATIONALE
This is autonomic dysreflexia; the first action is to sit the patient
upright and identify/remove the noxious stimulus (most commonly
bladder distension). Antihypertensives (A) are used if the trigger
cannot be relieved, rectal exam (C) is itself a noxious stimulus, and
cooling (D) does not address the cause.
Question 6
Which assessment finding in a patient with a new below-knee cast most
urgently suggests compartment syndrome rather than expected post-injury
edema?
Page 4
