HESI RN Med Surg Version A &
Version B 2026/2027 Complete
Questions per Exam with Verified
Answers and Detailed Rationales
HESI RN Med Surg Version A & | Comprehensive Examination
HESI RN Med Surg Version A & Version B 2026/2027
Complete Questions per Exam with Verified Answers and
Detailed Rationales Medical Surgical Nursing RN Exit Exam
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI RN Med Surg Version A & Version B
2026/2027 Complete Questions per Exam 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 IV furosemide.
Which assessment finding best indicates that the medication is producing the
desired therapeutic effect rather than a complication?
A. Serum potassium decreased from 4.2 to 3.1 mEq/L.
B. Urine output 1,200 mL over 4 hours with decreased bibasilar crackles.
C. Blood pressure decreased from 138/82 to 96/58 mm Hg.
D. Serum creatinine increased from 1.0 to 1.6 mg/dL.
Correct Answer: B - Urine output 1,200 mL over 4 hours with
decreased bibasilar crackles.
RATIONALE
Effective loop diuresis in ADHF is evidenced by increased urine
output with resolution of pulmonary congestion (crackles).
Hypokalemia, hypotension, and rising creatinine are adverse effects,
not therapeutic endpoints.
Question 2
A patient is 6 hours post-thyroidectomy and reports circumoral tingling and
muscle twitching. Which action should the nurse take first?
A. Administer oral calcium carbonate as prescribed.
B. Prepare for emergency tracheostomy.
C. Assess for Chvostek's and Trousseau's signs and notify the provider.
D. Apply a cool compress to the incision.
Correct Answer: C - Assess for Chvostek's and Trousseau's signs
and notify the provider.
Page 2
, RATIONALE
Circumoral paresthesia and twitching suggest hypocalcemia from
parathyroid injury; confirming with Chvostek's/Trousseau's signs and
notifying the provider guides IV calcium replacement. Oral calcium is
too slow, tracheostomy addresses airway not calcium, and cool
compress is irrelevant.
Question 3
A patient with a new colostomy has a stoma that is dark purple, edematous,
and dry. Which conclusion is most accurate?
A. This is an expected finding in the first 24-48 hours.
B. The stoma is ischemic and requires immediate provider notification.
C. The stoma is prolapsed and should be manually reduced.
D. The dryness indicates dehydration and requires increased fluids.
Correct Answer: B - The stoma is ischemic and requires
immediate provider notification.
RATIONALE
A healthy stoma is pink to red, moist, and slightly edematous. Dark
purple or black coloration indicates ischemia/necrosis, a surgical
emergency requiring immediate notification. Prolapse is lengthening,
not discoloration, and dryness alone is not the priority concern.
Question 4
A patient with a traumatic brain injury has an ICP monitor reading of 22 mm
Hg. Which set of interventions is most appropriate to implement immediately?
A. Elevate head of bed 30 degrees, maintain neck midline, and administer
prescribed hypertonic saline.
B. Place in Trendelenburg, hyperventilate to PaCO2 25 mm Hg, and
restrict fluids.
C. Cluster nursing care, suction every 2 hours, and administer hypotonic
IV fluids.
Page 3
, D. Keep head flat, administer mannitol, and encourage coughing and deep
breathing.
Correct Answer: A - Elevate head of bed 30 degrees, maintain
neck midline, and administer prescribed hypertonic saline.
RATIONALE
Normal ICP is 5-15 mm Hg; 22 mm Hg requires reducing cerebral
edema. HOB 30 degrees with midline neck promotes venous drainage,
and hypertonic saline draws fluid from brain tissue. Trendelenburg,
aggressive hyperventilation, clustering care, suctioning, and hypotonic
fluids all raise ICP.
Question 5
A patient is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion.
B. Stop the transfusion, maintain IV access with normal saline, and notify
the provider and blood bank.
C. Slow the transfusion rate and reassess in 15 minutes.
D. Obtain a urine specimen and continue the transfusion at a slower rate.
Correct Answer: B - Stop the transfusion, maintain IV access
with normal saline, and notify the provider and blood bank.
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction. The priority is to stop the transfusion immediately, keep the
IV line patent with normal saline using new tubing, and notify the
provider and blood bank. Continuing or slowing the transfusion
worsens the reaction.
Page 4
Version B 2026/2027 Complete
Questions per Exam with Verified
Answers and Detailed Rationales
HESI RN Med Surg Version A & | Comprehensive Examination
HESI RN Med Surg Version A & Version B 2026/2027
Complete Questions per Exam with Verified Answers and
Detailed Rationales Medical Surgical Nursing RN Exit Exam
INTRODUCTION
This document is an important and very helpful preparation
resource for HESI RN Med Surg Version A & Version B
2026/2027 Complete Questions per Exam 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 IV furosemide.
Which assessment finding best indicates that the medication is producing the
desired therapeutic effect rather than a complication?
A. Serum potassium decreased from 4.2 to 3.1 mEq/L.
B. Urine output 1,200 mL over 4 hours with decreased bibasilar crackles.
C. Blood pressure decreased from 138/82 to 96/58 mm Hg.
D. Serum creatinine increased from 1.0 to 1.6 mg/dL.
Correct Answer: B - Urine output 1,200 mL over 4 hours with
decreased bibasilar crackles.
RATIONALE
Effective loop diuresis in ADHF is evidenced by increased urine
output with resolution of pulmonary congestion (crackles).
Hypokalemia, hypotension, and rising creatinine are adverse effects,
not therapeutic endpoints.
Question 2
A patient is 6 hours post-thyroidectomy and reports circumoral tingling and
muscle twitching. Which action should the nurse take first?
A. Administer oral calcium carbonate as prescribed.
B. Prepare for emergency tracheostomy.
C. Assess for Chvostek's and Trousseau's signs and notify the provider.
D. Apply a cool compress to the incision.
Correct Answer: C - Assess for Chvostek's and Trousseau's signs
and notify the provider.
Page 2
, RATIONALE
Circumoral paresthesia and twitching suggest hypocalcemia from
parathyroid injury; confirming with Chvostek's/Trousseau's signs and
notifying the provider guides IV calcium replacement. Oral calcium is
too slow, tracheostomy addresses airway not calcium, and cool
compress is irrelevant.
Question 3
A patient with a new colostomy has a stoma that is dark purple, edematous,
and dry. Which conclusion is most accurate?
A. This is an expected finding in the first 24-48 hours.
B. The stoma is ischemic and requires immediate provider notification.
C. The stoma is prolapsed and should be manually reduced.
D. The dryness indicates dehydration and requires increased fluids.
Correct Answer: B - The stoma is ischemic and requires
immediate provider notification.
RATIONALE
A healthy stoma is pink to red, moist, and slightly edematous. Dark
purple or black coloration indicates ischemia/necrosis, a surgical
emergency requiring immediate notification. Prolapse is lengthening,
not discoloration, and dryness alone is not the priority concern.
Question 4
A patient with a traumatic brain injury has an ICP monitor reading of 22 mm
Hg. Which set of interventions is most appropriate to implement immediately?
A. Elevate head of bed 30 degrees, maintain neck midline, and administer
prescribed hypertonic saline.
B. Place in Trendelenburg, hyperventilate to PaCO2 25 mm Hg, and
restrict fluids.
C. Cluster nursing care, suction every 2 hours, and administer hypotonic
IV fluids.
Page 3
, D. Keep head flat, administer mannitol, and encourage coughing and deep
breathing.
Correct Answer: A - Elevate head of bed 30 degrees, maintain
neck midline, and administer prescribed hypertonic saline.
RATIONALE
Normal ICP is 5-15 mm Hg; 22 mm Hg requires reducing cerebral
edema. HOB 30 degrees with midline neck promotes venous drainage,
and hypertonic saline draws fluid from brain tissue. Trendelenburg,
aggressive hyperventilation, clustering care, suctioning, and hypotonic
fluids all raise ICP.
Question 5
A patient is receiving a blood transfusion and develops fever, chills, and flank
pain 15 minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion.
B. Stop the transfusion, maintain IV access with normal saline, and notify
the provider and blood bank.
C. Slow the transfusion rate and reassess in 15 minutes.
D. Obtain a urine specimen and continue the transfusion at a slower rate.
Correct Answer: B - Stop the transfusion, maintain IV access
with normal saline, and notify the provider and blood bank.
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction. The priority is to stop the transfusion immediately, keep the
IV line patent with normal saline using new tubing, and notify the
provider and blood bank. Continuing or slowing the transfusion
worsens the reaction.
Page 4
