HESI Medical Surgical Nursing Final
Exam (Latest 2026/2027 Update)
Comprehensive Q&A with Verified
Answers and Detailed Rationales
HESI Medical Surgical Nursing Final Exam (Latest |
Comprehensive Examination
HESI Medical Surgical Nursing Final Exam (Latest 2026/2027
Update) Comprehensive Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier HESI RN Exit Exam A+
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Final Exam
(Latest 2026/2027 Update) Comprehensive Q&A with Verified
Answers and Detailed Rationales Evolve Elsevier HESI RN Exit
Exam 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 acute decompensated heart failure is receiving furosemide.
Which set of assessment findings best indicates a therapeutic response?
A. Urine output 50 mL/hr, serum potassium 3.2 mEq/L, weight loss 1
kg/day
B. Urine output 30 mL/hr, serum potassium 4.0 mEq/L, weight loss 0.5
kg/day
C. Urine output 100 mL/hr, serum potassium 3.5 mEq/L, weight loss 2
kg/day
D. Urine output 20 mL/hr, serum potassium 5.0 mEq/L, weight loss 0.2
kg/day
Correct Answer: B - Urine output 30 mL/hr, serum potassium 4.0
mEq/L, weight loss 0.5 kg/day
RATIONALE
Therapeutic response to loop diuretics includes adequate diuresis (30
mL/hr), stable potassium (3.5-5.0 mEq/L), and gradual weight loss
(0.5-1 kg/day). Option B shows these parameters without hypokalemia
or excessive diuresis. Options A and C indicate hypokalemia, and D
shows inadequate diuresis and hyperkalemia.
Question 2
Which arterial blood gas values are most consistent with uncompensated
respiratory alkalosis?
A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
B. pH 7.30, PaCO2 50 mm Hg, HCO3- 26 mEq/L
C. pH 7.44, PaCO2 40 mm Hg, HCO3- 28 mEq/L
D. pH 7.32, PaCO2 30 mm Hg, HCO3- 18 mEq/L
Correct Answer: A - pH 7.48, PaCO2 30 mm Hg, HCO3- 24
mEq/L
Page 2
, RATIONALE
Uncompensated respiratory alkalosis is defined by an elevated pH
(>7.45), decreased PaCO2 (<35 mm Hg), and normal HCO3- (22-26
mEq/L). Option A fits this pattern. Option B represents respiratory
acidosis, C metabolic alkalosis, and D metabolic acidosis with
respiratory compensation.
Question 3
A patient with a new colostomy has a dusky, edematous stoma. Which nursing
action is the priority?
A. Apply a convex wafer to improve seal.
B. Notify the surgeon immediately.
C. Document the finding as a normal postoperative change.
D. Increase oral fluid intake to 3 L/day.
Correct Answer: B - Notify the surgeon immediately.
RATIONALE
A dusky, edematous stoma may indicate ischemia or necrosis,
requiring immediate surgical evaluation. Convex wafers can worsen
pressure; documentation without intervention is unsafe; fluid intake
does not address the vascular compromise. Prompt notification is
essential to prevent further tissue loss.
Question 4
Which instruction is most important for a patient starting levothyroxine?
A. Take the medication with breakfast to enhance absorption.
B. Expect immediate relief of fatigue within 24 hours.
C. Report palpitations, weight loss, or insomnia.
D. Double the dose if a dose is missed.
Correct Answer: C - Report palpitations, weight loss, or
insomnia.
Page 3
, RATIONALE
Levothyroxine can cause hyperthyroid symptoms if over-replaced;
patients must report palpitations, weight loss, or insomnia. It should
be taken on an empty stomach, effects take weeks, and missed doses
should not be doubled. Option C reflects critical safety monitoring.
Question 5
Which finding in a patient with acute pancreatitis requires immediate
intervention?
A. Serum lipase 300 U/L
B. Heart rate 110 beats/min
C. Calcium 7.8 mg/dL
D. Grey Turner's sign
Correct Answer: D - Grey Turner's sign
RATIONALE
Grey Turner's sign (flank ecchymosis) indicates retroperitoneal
hemorrhage and possible hemorrhagic pancreatitis, a life-threatening
complication. Lipase elevation and tachycardia are expected;
hypocalcemia is common but not immediately life-threatening.
Immediate intervention is needed for signs of hemorrhage.
Question 6
A patient with chronic kidney disease has a hemoglobin of 8.5 g/dL. Which
medication is most appropriate?
A. Ferrous sulfate PO
B. Epoetin alfa subcutaneously
C. Packed red blood cells transfusion
D. Folic acid PO
Correct Answer: B - Epoetin alfa subcutaneously
Page 4
Exam (Latest 2026/2027 Update)
Comprehensive Q&A with Verified
Answers and Detailed Rationales
HESI Medical Surgical Nursing Final Exam (Latest |
Comprehensive Examination
HESI Medical Surgical Nursing Final Exam (Latest 2026/2027
Update) Comprehensive Q&A with Verified Answers and
Detailed Rationales Evolve Elsevier HESI RN Exit Exam A+
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI Medical Surgical Nursing Final Exam
(Latest 2026/2027 Update) Comprehensive Q&A with Verified
Answers and Detailed Rationales Evolve Elsevier HESI RN Exit
Exam 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 acute decompensated heart failure is receiving furosemide.
Which set of assessment findings best indicates a therapeutic response?
A. Urine output 50 mL/hr, serum potassium 3.2 mEq/L, weight loss 1
kg/day
B. Urine output 30 mL/hr, serum potassium 4.0 mEq/L, weight loss 0.5
kg/day
C. Urine output 100 mL/hr, serum potassium 3.5 mEq/L, weight loss 2
kg/day
D. Urine output 20 mL/hr, serum potassium 5.0 mEq/L, weight loss 0.2
kg/day
Correct Answer: B - Urine output 30 mL/hr, serum potassium 4.0
mEq/L, weight loss 0.5 kg/day
RATIONALE
Therapeutic response to loop diuretics includes adequate diuresis (30
mL/hr), stable potassium (3.5-5.0 mEq/L), and gradual weight loss
(0.5-1 kg/day). Option B shows these parameters without hypokalemia
or excessive diuresis. Options A and C indicate hypokalemia, and D
shows inadequate diuresis and hyperkalemia.
Question 2
Which arterial blood gas values are most consistent with uncompensated
respiratory alkalosis?
A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
B. pH 7.30, PaCO2 50 mm Hg, HCO3- 26 mEq/L
C. pH 7.44, PaCO2 40 mm Hg, HCO3- 28 mEq/L
D. pH 7.32, PaCO2 30 mm Hg, HCO3- 18 mEq/L
Correct Answer: A - pH 7.48, PaCO2 30 mm Hg, HCO3- 24
mEq/L
Page 2
, RATIONALE
Uncompensated respiratory alkalosis is defined by an elevated pH
(>7.45), decreased PaCO2 (<35 mm Hg), and normal HCO3- (22-26
mEq/L). Option A fits this pattern. Option B represents respiratory
acidosis, C metabolic alkalosis, and D metabolic acidosis with
respiratory compensation.
Question 3
A patient with a new colostomy has a dusky, edematous stoma. Which nursing
action is the priority?
A. Apply a convex wafer to improve seal.
B. Notify the surgeon immediately.
C. Document the finding as a normal postoperative change.
D. Increase oral fluid intake to 3 L/day.
Correct Answer: B - Notify the surgeon immediately.
RATIONALE
A dusky, edematous stoma may indicate ischemia or necrosis,
requiring immediate surgical evaluation. Convex wafers can worsen
pressure; documentation without intervention is unsafe; fluid intake
does not address the vascular compromise. Prompt notification is
essential to prevent further tissue loss.
Question 4
Which instruction is most important for a patient starting levothyroxine?
A. Take the medication with breakfast to enhance absorption.
B. Expect immediate relief of fatigue within 24 hours.
C. Report palpitations, weight loss, or insomnia.
D. Double the dose if a dose is missed.
Correct Answer: C - Report palpitations, weight loss, or
insomnia.
Page 3
, RATIONALE
Levothyroxine can cause hyperthyroid symptoms if over-replaced;
patients must report palpitations, weight loss, or insomnia. It should
be taken on an empty stomach, effects take weeks, and missed doses
should not be doubled. Option C reflects critical safety monitoring.
Question 5
Which finding in a patient with acute pancreatitis requires immediate
intervention?
A. Serum lipase 300 U/L
B. Heart rate 110 beats/min
C. Calcium 7.8 mg/dL
D. Grey Turner's sign
Correct Answer: D - Grey Turner's sign
RATIONALE
Grey Turner's sign (flank ecchymosis) indicates retroperitoneal
hemorrhage and possible hemorrhagic pancreatitis, a life-threatening
complication. Lipase elevation and tachycardia are expected;
hypocalcemia is common but not immediately life-threatening.
Immediate intervention is needed for signs of hemorrhage.
Question 6
A patient with chronic kidney disease has a hemoglobin of 8.5 g/dL. Which
medication is most appropriate?
A. Ferrous sulfate PO
B. Epoetin alfa subcutaneously
C. Packed red blood cells transfusion
D. Folic acid PO
Correct Answer: B - Epoetin alfa subcutaneously
Page 4
