1
HESI Med Surg Exit Exam V2 (2025) – 300
NGN-Style Questions with Verified Answers &
Rationales | Real NCLEX Format
Question 1: NGN Case Study – Cardiac
A 64-year-old male is admitted with chest pain radiating to his left arm. He is diaphoretic
and short of breath. ECG shows ST elevation in leads II, III, and aVF. Troponin levels are
elevated.
What is the nurse’s priority action?
A. Administer morphine sulfate IV
B. Obtain informed consent for cardiac catheterization
C. Place patient on telemetry and monitor rhythm
D. Administer oxygen via nasal cannula
✅ Correct Answer: D. Administer oxygen via nasal cannula
🧠 Rationale: The priority is ABCs—oxygen helps minimize myocardial damage. While
morphine, telemetry, and consent are also important, oxygen addresses the immediate life-
threatening need: tissue perfusion. Supplemental oxygen supports oxygenation in myocardial
infarction, especially with signs of hypoxia (e.g., SOB, diaphoresis).
,2
Question 2: SATA – Respiratory
A patient with COPD is admitted for worsening dyspnea. Which nursing interventions are
appropriate? (Select all that apply)
A. Encourage pursed-lip breathing
B. Administer high-flow oxygen at 10 L/min
C. Keep patient in high Fowler’s position
D. Provide small frequent meals
E. Schedule physical therapy immediately after meals
F. Monitor oxygen saturation frequently
✅ Correct Answers: A, C, D, F
🧠 Rationale: COPD patients benefit from pursed-lip breathing and upright positioning. High
oxygen flow rates can suppress respiratory drive—use low-flow instead. Meals should be small
and not followed by exertion. Monitoring SpO2 ensures safety with oxygen titration.
Question 3: Matrix NGN – Neuro
Match the following neurological conditions with their characteristic signs.
Condition Sign/Symptom
A. Myasthenia Gravis 1. Cogwheel rigidity
B. Parkinson's 2. Diplopia, ptosis, muscle fatigue
C. Stroke (left CVA) 3. Aphasia, right-sided weakness
✅ Answers:
A→2
B→1
,3
C→3
🧠 Rationale: MG affects acetylcholine at the neuromuscular junction, causing ocular and
muscle fatigue symptoms. Parkinson’s involves basal ganglia dysfunction → rigidity and tremor.
Left CVA leads to right motor deficits and language problems.
Question 4: Priority Drag-and-Drop – GI Bleed
A 58-year-old male with cirrhosis presents with hematemesis and hypotension. Rank the
following actions in order of priority.
1. Initiate large-bore IV access
2. Monitor vital signs
3. Administer IV fluids
4. Notify healthcare provider
5. Type and crossmatch for blood
✅ Correct Order: 1 → 2 → 3 → 4 → 5
🧠 Rationale: In any GI bleed with signs of shock, large-bore IV access is the first step. Then
assess vitals, provide fluids to stabilize hemodynamics, notify provider, and prep for transfusion
if needed.
Question 5: Standalone NGN – Cardiovascular
A client on warfarin reports dark, tarry stools. What lab value should the nurse review
first?
A. Hemoglobin
B. PT/INR
, 4
C. Platelet count
D. aPTT
✅ Correct Answer: B. PT/INR
🧠 Rationale: PT/INR monitors warfarin effectiveness and bleeding risk. Tarry stools = GI
bleeding, a known complication. Although Hgb is important, INR guides immediate decisions
regarding anticoagulation reversal.
Question 6: NGN – SATA (Neuro)
Which findings should the nurse expect in a client with increased intracranial pressure
(ICP)? (Select all that apply)
A. Decreased LOC
B. Fixed and dilated pupils
C. Bradycardia
D. Hypotension
E. Projectile vomiting
✅ Correct Answers: A, B, C, E
🧠 Rationale: Classic signs of increased ICP include altered LOC, Cushing’s triad (bradycardia,
hypertension, irregular respirations), pupil changes, and vomiting. Hypotension is not typical—
increased ICP usually causes hypertension.
Question 7: NGN Case Study – GI
A 40-year-old female with a history of gallstones presents with RUQ pain, fever, and
jaundice. Labs show elevated WBCs and bilirubin. Which diagnosis is most likely?
HESI Med Surg Exit Exam V2 (2025) – 300
NGN-Style Questions with Verified Answers &
Rationales | Real NCLEX Format
Question 1: NGN Case Study – Cardiac
A 64-year-old male is admitted with chest pain radiating to his left arm. He is diaphoretic
and short of breath. ECG shows ST elevation in leads II, III, and aVF. Troponin levels are
elevated.
What is the nurse’s priority action?
A. Administer morphine sulfate IV
B. Obtain informed consent for cardiac catheterization
C. Place patient on telemetry and monitor rhythm
D. Administer oxygen via nasal cannula
✅ Correct Answer: D. Administer oxygen via nasal cannula
🧠 Rationale: The priority is ABCs—oxygen helps minimize myocardial damage. While
morphine, telemetry, and consent are also important, oxygen addresses the immediate life-
threatening need: tissue perfusion. Supplemental oxygen supports oxygenation in myocardial
infarction, especially with signs of hypoxia (e.g., SOB, diaphoresis).
,2
Question 2: SATA – Respiratory
A patient with COPD is admitted for worsening dyspnea. Which nursing interventions are
appropriate? (Select all that apply)
A. Encourage pursed-lip breathing
B. Administer high-flow oxygen at 10 L/min
C. Keep patient in high Fowler’s position
D. Provide small frequent meals
E. Schedule physical therapy immediately after meals
F. Monitor oxygen saturation frequently
✅ Correct Answers: A, C, D, F
🧠 Rationale: COPD patients benefit from pursed-lip breathing and upright positioning. High
oxygen flow rates can suppress respiratory drive—use low-flow instead. Meals should be small
and not followed by exertion. Monitoring SpO2 ensures safety with oxygen titration.
Question 3: Matrix NGN – Neuro
Match the following neurological conditions with their characteristic signs.
Condition Sign/Symptom
A. Myasthenia Gravis 1. Cogwheel rigidity
B. Parkinson's 2. Diplopia, ptosis, muscle fatigue
C. Stroke (left CVA) 3. Aphasia, right-sided weakness
✅ Answers:
A→2
B→1
,3
C→3
🧠 Rationale: MG affects acetylcholine at the neuromuscular junction, causing ocular and
muscle fatigue symptoms. Parkinson’s involves basal ganglia dysfunction → rigidity and tremor.
Left CVA leads to right motor deficits and language problems.
Question 4: Priority Drag-and-Drop – GI Bleed
A 58-year-old male with cirrhosis presents with hematemesis and hypotension. Rank the
following actions in order of priority.
1. Initiate large-bore IV access
2. Monitor vital signs
3. Administer IV fluids
4. Notify healthcare provider
5. Type and crossmatch for blood
✅ Correct Order: 1 → 2 → 3 → 4 → 5
🧠 Rationale: In any GI bleed with signs of shock, large-bore IV access is the first step. Then
assess vitals, provide fluids to stabilize hemodynamics, notify provider, and prep for transfusion
if needed.
Question 5: Standalone NGN – Cardiovascular
A client on warfarin reports dark, tarry stools. What lab value should the nurse review
first?
A. Hemoglobin
B. PT/INR
, 4
C. Platelet count
D. aPTT
✅ Correct Answer: B. PT/INR
🧠 Rationale: PT/INR monitors warfarin effectiveness and bleeding risk. Tarry stools = GI
bleeding, a known complication. Although Hgb is important, INR guides immediate decisions
regarding anticoagulation reversal.
Question 6: NGN – SATA (Neuro)
Which findings should the nurse expect in a client with increased intracranial pressure
(ICP)? (Select all that apply)
A. Decreased LOC
B. Fixed and dilated pupils
C. Bradycardia
D. Hypotension
E. Projectile vomiting
✅ Correct Answers: A, B, C, E
🧠 Rationale: Classic signs of increased ICP include altered LOC, Cushing’s triad (bradycardia,
hypertension, irregular respirations), pupil changes, and vomiting. Hypotension is not typical—
increased ICP usually causes hypertension.
Question 7: NGN Case Study – GI
A 40-year-old female with a history of gallstones presents with RUQ pain, fever, and
jaundice. Labs show elevated WBCs and bilirubin. Which diagnosis is most likely?
