HESI RN Medical-Surgical Nursing Review –
2025–2026 (Next-Gen Focus) Focus: System-
based assessment, prioritization, clinical
reasoning, and safe interventions for adult
patients.
HESI RN Medical-Surgical Nursing Review – 2025–2026 (Next-Gen Focus)
Focus: System-based assessment, prioritization, clinical reasoning, and safe interventions for
adult patients.
Cardiovascular System
1. A client with heart failure is prescribed Furosemide (Lasix) 40 mg IV daily. Which finding
indicates to the nurse that the medication is effective?
a) Increased urine specific gravity
b) Weight loss of 1 kg (2.2 lb) in 24 hours ✓
c) Relief from chest pain
d) Heart rate of 58 bpm
2. Four hours after admission for a suspected myocardial infarction (MI), a client's cardiac
monitor shows ventricular tachycardia. The client is awake but anxious. What is the nurse's
priority action?
a) Administer prescribed Morphine sulfate.
b) Prepare for immediate defibrillation. ✓
c) Check the client's potassium level.
d) Begin cardiopulmonary resuscitation (CPR).
3. A client with an arterial line has a blood pressure of 190/110 mm Hg. To ensure an accurate
reading, the nurse should first:
a) Administer a prn antihypertensive medication.
b) Check the transducer level and zero the system. ✓
c) Flush the arterial line with heparinized saline.
d) Compare the reading with a manual blood pressure.
,4. The nurse is caring for a client with aortic stenosis. Which client statement would be the
highest priority for follow-up?
a) "I get short of breath when I walk up a flight of stairs." ✓
b) "I have had a occasional headache in the mornings."
c) "My ankles swell a little at the end of the day."
d) "I feel my heart skip a beat sometimes when I'm resting."
5. When teaching a client about a new prescription for Warfarin (Coumadin), which
instruction is most critical?
a) "Take the medication on an empty stomach."
b) "Avoid sudden changes in your diet, especially green leafy vegetables." ✓
c) "Use a hard-bristled toothbrush for effective cleaning."
d) "It is safe to take aspirin for a headache."
Respiratory System
6. A client with COPD has a PaO2 of 50 mm Hg and is receiving O2 at 2 L/min via nasal
cannula. The client becomes somnolent. The nurse suspects oxygen-induced hypoventilation.
What is the nurse's best action?
a) Increase the oxygen flow rate to 4 L/min.
b) Stimulate the client and encourage deep breathing. ✓
c) Place the client in a supine position.
d) Prepare for endotracheal intubation.
7. A client is 24 hours post-op following a total laryngectomy. The nurse notes the client is
coughing continuously. The most appropriate initial action is to:
a) Administer an antitussive medication as ordered.
b) Suction the tracheostomy tube. ✓
c) Check the oxygen saturation.
d) Increase the room's humidification.
8. The nurse is assessing a client with a suspected pulmonary embolism. Which finding is the
most clinically significant?
a) Bilateral crackles in the lung bases.
b) Sudden onset of pleuritic chest pain and dyspnea. ✓
c) Productive cough with yellow sputum.
d) Barrel-shaped chest.
, 9. A client with pneumonia has a temperature of 102.2°F (39°C), is diaphoretic, and has a
respiratory rate of 28 breaths/minute. The priority nursing goal is to:
a) Promote airway clearance.
b) Improve gas exchange. ✓
c) Facilitate rest and comfort.
d) Maintain fluid balance.
10. Which action is essential for the nurse to take when caring for a client with a chest tube
connected to a water-seal drainage system?
a) Strip the tubes every 2 hours to maintain patency.
b) Keep the collection device at the level of the heart.
c) Clamp the tube momentarily when ambulating the client.
d) Ensure the water-seal chamber is bubbling gently. ✓
Neurological System
11. The nurse is performing a neurological assessment on a client with a head injury. Which
finding is the most critical indicator of increasing intracranial pressure (ICP)?
a) Glasgow Coma Scale score decrease from 14 to 8. ✓
b) Pupils equal and reactive to light.
c) Complaint of a headache.
d) Flexion withdrawal to painful stimulus.
12. A client with a spinal cord injury at T4 complains of a severe headache and is anxious. The
nurse notes diaphoresis and hypertension (BP 188/98 mm Hg). The nurse's priority action is
to:
a) Administer an antihypertensive medication.
b) Assess for bladder distention. ✓
c) Sit the client up to lower the blood pressure.
d) Notify the provider of a potential stroke.
13. When caring for a client who had a stroke with left-sided weakness, the nurse
demonstrates an understanding of client safety by:
a) Placing the call light on the left side of the bed.
b) Applying a restraint to the left arm.
c) Placing the bed in the lowest position. ✓
d) Assisting with ambulation on the client's strong side.
2025–2026 (Next-Gen Focus) Focus: System-
based assessment, prioritization, clinical
reasoning, and safe interventions for adult
patients.
HESI RN Medical-Surgical Nursing Review – 2025–2026 (Next-Gen Focus)
Focus: System-based assessment, prioritization, clinical reasoning, and safe interventions for
adult patients.
Cardiovascular System
1. A client with heart failure is prescribed Furosemide (Lasix) 40 mg IV daily. Which finding
indicates to the nurse that the medication is effective?
a) Increased urine specific gravity
b) Weight loss of 1 kg (2.2 lb) in 24 hours ✓
c) Relief from chest pain
d) Heart rate of 58 bpm
2. Four hours after admission for a suspected myocardial infarction (MI), a client's cardiac
monitor shows ventricular tachycardia. The client is awake but anxious. What is the nurse's
priority action?
a) Administer prescribed Morphine sulfate.
b) Prepare for immediate defibrillation. ✓
c) Check the client's potassium level.
d) Begin cardiopulmonary resuscitation (CPR).
3. A client with an arterial line has a blood pressure of 190/110 mm Hg. To ensure an accurate
reading, the nurse should first:
a) Administer a prn antihypertensive medication.
b) Check the transducer level and zero the system. ✓
c) Flush the arterial line with heparinized saline.
d) Compare the reading with a manual blood pressure.
,4. The nurse is caring for a client with aortic stenosis. Which client statement would be the
highest priority for follow-up?
a) "I get short of breath when I walk up a flight of stairs." ✓
b) "I have had a occasional headache in the mornings."
c) "My ankles swell a little at the end of the day."
d) "I feel my heart skip a beat sometimes when I'm resting."
5. When teaching a client about a new prescription for Warfarin (Coumadin), which
instruction is most critical?
a) "Take the medication on an empty stomach."
b) "Avoid sudden changes in your diet, especially green leafy vegetables." ✓
c) "Use a hard-bristled toothbrush for effective cleaning."
d) "It is safe to take aspirin for a headache."
Respiratory System
6. A client with COPD has a PaO2 of 50 mm Hg and is receiving O2 at 2 L/min via nasal
cannula. The client becomes somnolent. The nurse suspects oxygen-induced hypoventilation.
What is the nurse's best action?
a) Increase the oxygen flow rate to 4 L/min.
b) Stimulate the client and encourage deep breathing. ✓
c) Place the client in a supine position.
d) Prepare for endotracheal intubation.
7. A client is 24 hours post-op following a total laryngectomy. The nurse notes the client is
coughing continuously. The most appropriate initial action is to:
a) Administer an antitussive medication as ordered.
b) Suction the tracheostomy tube. ✓
c) Check the oxygen saturation.
d) Increase the room's humidification.
8. The nurse is assessing a client with a suspected pulmonary embolism. Which finding is the
most clinically significant?
a) Bilateral crackles in the lung bases.
b) Sudden onset of pleuritic chest pain and dyspnea. ✓
c) Productive cough with yellow sputum.
d) Barrel-shaped chest.
, 9. A client with pneumonia has a temperature of 102.2°F (39°C), is diaphoretic, and has a
respiratory rate of 28 breaths/minute. The priority nursing goal is to:
a) Promote airway clearance.
b) Improve gas exchange. ✓
c) Facilitate rest and comfort.
d) Maintain fluid balance.
10. Which action is essential for the nurse to take when caring for a client with a chest tube
connected to a water-seal drainage system?
a) Strip the tubes every 2 hours to maintain patency.
b) Keep the collection device at the level of the heart.
c) Clamp the tube momentarily when ambulating the client.
d) Ensure the water-seal chamber is bubbling gently. ✓
Neurological System
11. The nurse is performing a neurological assessment on a client with a head injury. Which
finding is the most critical indicator of increasing intracranial pressure (ICP)?
a) Glasgow Coma Scale score decrease from 14 to 8. ✓
b) Pupils equal and reactive to light.
c) Complaint of a headache.
d) Flexion withdrawal to painful stimulus.
12. A client with a spinal cord injury at T4 complains of a severe headache and is anxious. The
nurse notes diaphoresis and hypertension (BP 188/98 mm Hg). The nurse's priority action is
to:
a) Administer an antihypertensive medication.
b) Assess for bladder distention. ✓
c) Sit the client up to lower the blood pressure.
d) Notify the provider of a potential stroke.
13. When caring for a client who had a stroke with left-sided weakness, the nurse
demonstrates an understanding of client safety by:
a) Placing the call light on the left side of the bed.
b) Applying a restraint to the left arm.
c) Placing the bed in the lowest position. ✓
d) Assisting with ambulation on the client's strong side.
