HESI Milestone 2 Practice Exam - 2026/2027 |
150 Integrated Questions | Med-Surg I + Pharm +
Fundamentals + Maternity | 100% Correct Key |
Grade A
QUESTIONS 1-150 (randomized order as on actual exam)
1 (Prioritization):
You are caring for four clients. Which do you assess FIRST?
A. Post-MI day 2, BP 160/90, no chest pain
B. 2 h post-appendectomy, pain 8/10, RR 22
C. CHF, gained 2 lbs overnight, lungs clear
D. on heparin drip, aPTT 68 sec (therapeutic 50–70)
Verified Answer: D
Rationale: aPTT 68 sec is supratherapeutic (target 50–70) → bleeding risk is immediate
physiological threat. Pain (B) and HTN (A) are important but not emergent; 2-lb gain (C)
is chronic management.
2 (SATA – Maternity/Pharm):
A postpartum client is prescribed ibuprofen 600 mg q8h for afterpains. Which
statements indicate understanding?
,A. “I’ll take it on an empty stomach.”
B. “Black stools mean I should call.”
C. “This will dry up my milk.”
D. “I can take it with my iron tablet.”
E. “No alcohol while on this.”
Verified Answers: B, D, E
Rationale: NSAID → GI bleed risk (B correct); no interaction with iron (D); alcohol ↑ GI
risk (E). A incorrect (take with food); C incorrect (no effect on lactation—decongestants
do).
3 (Calculation):
Order: Heparin 18 units/kg/h. Client 70 kg. Bag: 25,000 units in 250 mL NS. What
infusion rate (mL/h)?
A. 12.6
B. 25.2
C. 50.4
D. 100.8
Verified Answer: A
Rationale: 18 × 70 = 1,260 units/h. Concentration = 25,000 ÷ 250 = 100 units/mL. 1,260
÷ 100 = 12.6 mL/h.
,4 (Prioritization – Fundamentals):
You enter a room and find the client on the floor, conscious but pale. IV line intact, no
blood visible. FIRST action?
A. Check BP and HR
B. Call for help and stay with client
C. Re-insert IV
D. Administer oxygen
Verified Answer: B
Rationale: Safety first (call for assistance), then assess. No evidence IV is dislodged (C
unnecessary); O₂ not yet indicated.
5 (SATA – Med-Surg/Pharm):
A client with HFrEF (EF 30 %) on digoxin 0.25 mg daily and furosemide 40 mg BID
reports nausea and yellow vision. HR 52, K⁺ 3.0. Which are appropriate?
A. Hold digoxin
B. Check digoxin level
C. Give potassium supplement
D. Obtain 12-lead ECG
E. Increase furosemide
Verified Answers: A, B, C, D
, Rationale: Nausea + yellow vision + bradycardia = digoxin toxicity (therapeutic 0.8–2
ng/mL); hypokalemia potentiates toxicity. Hold digoxin (A), check level (B), correct K⁺
(C), ECG for blocks (D). Increasing diuretic (E) would worsen K⁺.
6 (Maternity):
A G2P1 at 38 weeks presents with contractions q3 min. Cervix 4 cm/90 %/0. FHR
baseline 150, moderate variability, occasional early decels. Which stage of labor?
A. Latent, phase 1
B. Active, phase 1
C. Transition, phase 1
D. Second stage
Verified Answer: B
Rationale: 4 cm with effacement ≥ 80 % = active phase (ACOG). Early decels are benign
(head compression).
7 (SATA – Infection Control):
Which require Contact Precautions?
A. Influenza
B. MRSA wound
C. C. difficile diarrhea
D. Varicella
150 Integrated Questions | Med-Surg I + Pharm +
Fundamentals + Maternity | 100% Correct Key |
Grade A
QUESTIONS 1-150 (randomized order as on actual exam)
1 (Prioritization):
You are caring for four clients. Which do you assess FIRST?
A. Post-MI day 2, BP 160/90, no chest pain
B. 2 h post-appendectomy, pain 8/10, RR 22
C. CHF, gained 2 lbs overnight, lungs clear
D. on heparin drip, aPTT 68 sec (therapeutic 50–70)
Verified Answer: D
Rationale: aPTT 68 sec is supratherapeutic (target 50–70) → bleeding risk is immediate
physiological threat. Pain (B) and HTN (A) are important but not emergent; 2-lb gain (C)
is chronic management.
2 (SATA – Maternity/Pharm):
A postpartum client is prescribed ibuprofen 600 mg q8h for afterpains. Which
statements indicate understanding?
,A. “I’ll take it on an empty stomach.”
B. “Black stools mean I should call.”
C. “This will dry up my milk.”
D. “I can take it with my iron tablet.”
E. “No alcohol while on this.”
Verified Answers: B, D, E
Rationale: NSAID → GI bleed risk (B correct); no interaction with iron (D); alcohol ↑ GI
risk (E). A incorrect (take with food); C incorrect (no effect on lactation—decongestants
do).
3 (Calculation):
Order: Heparin 18 units/kg/h. Client 70 kg. Bag: 25,000 units in 250 mL NS. What
infusion rate (mL/h)?
A. 12.6
B. 25.2
C. 50.4
D. 100.8
Verified Answer: A
Rationale: 18 × 70 = 1,260 units/h. Concentration = 25,000 ÷ 250 = 100 units/mL. 1,260
÷ 100 = 12.6 mL/h.
,4 (Prioritization – Fundamentals):
You enter a room and find the client on the floor, conscious but pale. IV line intact, no
blood visible. FIRST action?
A. Check BP and HR
B. Call for help and stay with client
C. Re-insert IV
D. Administer oxygen
Verified Answer: B
Rationale: Safety first (call for assistance), then assess. No evidence IV is dislodged (C
unnecessary); O₂ not yet indicated.
5 (SATA – Med-Surg/Pharm):
A client with HFrEF (EF 30 %) on digoxin 0.25 mg daily and furosemide 40 mg BID
reports nausea and yellow vision. HR 52, K⁺ 3.0. Which are appropriate?
A. Hold digoxin
B. Check digoxin level
C. Give potassium supplement
D. Obtain 12-lead ECG
E. Increase furosemide
Verified Answers: A, B, C, D
, Rationale: Nausea + yellow vision + bradycardia = digoxin toxicity (therapeutic 0.8–2
ng/mL); hypokalemia potentiates toxicity. Hold digoxin (A), check level (B), correct K⁺
(C), ECG for blocks (D). Increasing diuretic (E) would worsen K⁺.
6 (Maternity):
A G2P1 at 38 weeks presents with contractions q3 min. Cervix 4 cm/90 %/0. FHR
baseline 150, moderate variability, occasional early decels. Which stage of labor?
A. Latent, phase 1
B. Active, phase 1
C. Transition, phase 1
D. Second stage
Verified Answer: B
Rationale: 4 cm with effacement ≥ 80 % = active phase (ACOG). Early decels are benign
(head compression).
7 (SATA – Infection Control):
Which require Contact Precautions?
A. Influenza
B. MRSA wound
C. C. difficile diarrhea
D. Varicella
