HESI Medical Surgical Nursing Exam
(Latest 2026/2027 Update) Complete
Practice Test with Verified Answers
and Detailed Rationales Evolve
HESI Medical Surgical Nursing Exam (Latest 2026/2027 |
Comprehensive Examination
HESI Medical Surgical Nursing Exam (Latest 2026/2027
Update) Complete Practice Test with Verified Answers and
Detailed Rationales Evolve Elsevier HESI RN Exit and Med
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Exam (Latest
2026/2027 Update) Complete Practice Test with Verified
Answers and Detailed Rationales Evolve Elsevier HESI RN Exit
and Med Surg Specialty 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
A client with acute decompensated heart failure (HFrEF) develops oliguria,
hypotension, and a rising creatinine after diuresis. Which parameter best
indicates that the current diuretic regimen is producing harmful over-diuresis
rather than effective decongestion?
A. Urine output of 0.6 mL/kg/hr with a rising BUN:creatinine ratio
B. Serum sodium of 134 mEq/L with a stable body weight
C. Brain natriuretic peptide (BNP) trending downward
D. Central venous pressure decreasing from 16 to 10 cm H2O
Correct Answer: A - Urine output of 0.6 mL/kg/hr with a rising
BUN:creatinine ratio
RATIONALE
Oliguria (<0.5-0.7 mL/kg/hr) with a rising BUN:creatinine ratio
signals prerenal azotemia from excessive diuresis and reduced renal
perfusion. Falling BNP and CVP reflect successful decongestion, and
mild hyponatremia alone is not evidence of over-diuresis.
Question 2
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
After initiating an insulin infusion, which laboratory trend most directly
indicates that the underlying ketoacidosis is resolving rather than merely
reflecting glucose clearance?
A. Serum glucose declining from 500 to 250 mg/dL
B. Anion gap closing with a rising serum bicarbonate
C. Urine ketones remaining large on dipstick
D. Serum potassium decreasing from 5.2 to 4.0 mEq/L
Correct Answer: B - Anion gap closing with a rising serum
bicarbonate
Page 2
, RATIONALE
Resolution of DKA is defined by closure of the anion gap and
normalization of serum bicarbonate, reflecting clearance of ketone
bodies. Falling glucose alone can occur before ketoacidosis resolves,
and urine ketones may remain positive due to beta-hydroxybutyrate
conversion.
Question 3
A client with acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding most strongly contraindicates alteplase administration
according to current 2026 stroke guidelines?
A. Blood pressure of 178/96 mm Hg that responds to IV labetalol
B. Platelet count of 130,000/mm³
C. Intracranial hemorrhage on non-contrast CT
D. History of type 2 diabetes managed with metformin
Correct Answer: C - Intracranial hemorrhage on non-contrast
CT
RATIONALE
Intracranial hemorrhage on CT is an absolute contraindication to
thrombolysis. Moderate hypertension can be treated and is not
absolute, mild thrombocytopenia is not disqualifying, and diabetes is
not a contraindication.
Question 4
A client with chronic kidney disease (CKD) stage 5 presents with fatigue,
pruritus, and muscle cramps. Which laboratory pattern most specifically
indicates the need for immediate renal replacement therapy rather than
continued medical management?
A. Creatinine 6.8 mg/dL and eGFR 12 mL/min/1.73 m²
B. Hemoglobin 9.8 g/dL and ferritin 120 ng/mL
Page 3
, C. Potassium 6.9 mEq/L with ECG changes
D. Phosphate 5.6 mg/dL and calcium 8.8 mg/dL
Correct Answer: C - Potassium 6.9 mEq/L with ECG changes
RATIONALE
Severe hyperkalemia with ECG changes is a life-threatening
indication for emergent dialysis. Elevated creatinine, anemia, and mild
mineral abnormalities are expected in CKD stage 5 but do not
mandate immediate renal replacement.
Question 5
A client with cirrhosis and ascites is receiving spironolactone and furosemide.
Which assessment finding most urgently suggests impending hepatic
encephalopathy rather than simple diuretic effect?
A. Serum potassium of 3.4 mEq/L
B. Asterixis and reversal of sleep-wake cycle
C. Urine output of 1.2 L over 24 hours
D. Weight loss of 1 kg over 48 hours
Correct Answer: B - Asterixis and reversal of sleep-wake cycle
RATIONALE
Asterixis and sleep-wake reversal are early signs of hepatic
encephalopathy due to ammonia accumulation. Hypokalemia,
adequate urine output, and gradual weight loss are expected diuretic
effects, not encephalopathy indicators.
Question 6
A client is receiving a blood transfusion and develops fever, chills, and flank
pain within 15 minutes. Which action should the nurse take first?
A. Slow the transfusion and administer acetaminophen
B. Stop the transfusion and maintain IV access with normal saline
C. Obtain a urine specimen for hemoglobinuria
Page 4
(Latest 2026/2027 Update) Complete
Practice Test with Verified Answers
and Detailed Rationales Evolve
HESI Medical Surgical Nursing Exam (Latest 2026/2027 |
Comprehensive Examination
HESI Medical Surgical Nursing Exam (Latest 2026/2027
Update) Complete Practice Test with Verified Answers and
Detailed Rationales Evolve Elsevier HESI RN Exit and Med
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Exam (Latest
2026/2027 Update) Complete Practice Test with Verified
Answers and Detailed Rationales Evolve Elsevier HESI RN Exit
and Med Surg Specialty 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
A client with acute decompensated heart failure (HFrEF) develops oliguria,
hypotension, and a rising creatinine after diuresis. Which parameter best
indicates that the current diuretic regimen is producing harmful over-diuresis
rather than effective decongestion?
A. Urine output of 0.6 mL/kg/hr with a rising BUN:creatinine ratio
B. Serum sodium of 134 mEq/L with a stable body weight
C. Brain natriuretic peptide (BNP) trending downward
D. Central venous pressure decreasing from 16 to 10 cm H2O
Correct Answer: A - Urine output of 0.6 mL/kg/hr with a rising
BUN:creatinine ratio
RATIONALE
Oliguria (<0.5-0.7 mL/kg/hr) with a rising BUN:creatinine ratio
signals prerenal azotemia from excessive diuresis and reduced renal
perfusion. Falling BNP and CVP reflect successful decongestion, and
mild hyponatremia alone is not evidence of over-diuresis.
Question 2
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA).
After initiating an insulin infusion, which laboratory trend most directly
indicates that the underlying ketoacidosis is resolving rather than merely
reflecting glucose clearance?
A. Serum glucose declining from 500 to 250 mg/dL
B. Anion gap closing with a rising serum bicarbonate
C. Urine ketones remaining large on dipstick
D. Serum potassium decreasing from 5.2 to 4.0 mEq/L
Correct Answer: B - Anion gap closing with a rising serum
bicarbonate
Page 2
, RATIONALE
Resolution of DKA is defined by closure of the anion gap and
normalization of serum bicarbonate, reflecting clearance of ketone
bodies. Falling glucose alone can occur before ketoacidosis resolves,
and urine ketones may remain positive due to beta-hydroxybutyrate
conversion.
Question 3
A client with acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding most strongly contraindicates alteplase administration
according to current 2026 stroke guidelines?
A. Blood pressure of 178/96 mm Hg that responds to IV labetalol
B. Platelet count of 130,000/mm³
C. Intracranial hemorrhage on non-contrast CT
D. History of type 2 diabetes managed with metformin
Correct Answer: C - Intracranial hemorrhage on non-contrast
CT
RATIONALE
Intracranial hemorrhage on CT is an absolute contraindication to
thrombolysis. Moderate hypertension can be treated and is not
absolute, mild thrombocytopenia is not disqualifying, and diabetes is
not a contraindication.
Question 4
A client with chronic kidney disease (CKD) stage 5 presents with fatigue,
pruritus, and muscle cramps. Which laboratory pattern most specifically
indicates the need for immediate renal replacement therapy rather than
continued medical management?
A. Creatinine 6.8 mg/dL and eGFR 12 mL/min/1.73 m²
B. Hemoglobin 9.8 g/dL and ferritin 120 ng/mL
Page 3
, C. Potassium 6.9 mEq/L with ECG changes
D. Phosphate 5.6 mg/dL and calcium 8.8 mg/dL
Correct Answer: C - Potassium 6.9 mEq/L with ECG changes
RATIONALE
Severe hyperkalemia with ECG changes is a life-threatening
indication for emergent dialysis. Elevated creatinine, anemia, and mild
mineral abnormalities are expected in CKD stage 5 but do not
mandate immediate renal replacement.
Question 5
A client with cirrhosis and ascites is receiving spironolactone and furosemide.
Which assessment finding most urgently suggests impending hepatic
encephalopathy rather than simple diuretic effect?
A. Serum potassium of 3.4 mEq/L
B. Asterixis and reversal of sleep-wake cycle
C. Urine output of 1.2 L over 24 hours
D. Weight loss of 1 kg over 48 hours
Correct Answer: B - Asterixis and reversal of sleep-wake cycle
RATIONALE
Asterixis and sleep-wake reversal are early signs of hepatic
encephalopathy due to ammonia accumulation. Hypokalemia,
adequate urine output, and gradual weight loss are expected diuretic
effects, not encephalopathy indicators.
Question 6
A client is receiving a blood transfusion and develops fever, chills, and flank
pain within 15 minutes. Which action should the nurse take first?
A. Slow the transfusion and administer acetaminophen
B. Stop the transfusion and maintain IV access with normal saline
C. Obtain a urine specimen for hemoglobinuria
Page 4
