HESI PN Medical-Surgical Exam Study
Guide (2026) | 400 Highlightable
Questions with Explanatory Rationales
Excel on your licensure assessments with
this high-yield, 400-question practice exam
modeled directly after the 2026 HESI PN
Medical-Surgical exam blueprint. Every
multiple-choice question features a verified
correct answer and an in-depth clinical
rationale enclosed in clean brackets,
making the entire document completely
digital-highlighter friendly. This premium
guide delivers master-level practical nursing
coverage across essential testing
categories, including fluid and electrolyte
stabilization, perioperative nursing priorities,
cardiovascular hemodynamics, and critical
pharmacology safety boundaries.
, 1.A practical nurse (PN) is collecting data from a client who is 2 hours post-operative
following an abdominal cholecystectomy. Which of the following findings is the
priority for the PN to report to the charge nurse?
A) Client reports severe incisional pain rated at 8 on a 0-to-10 scale.
B) The surgical dressing has a 2-cm area of serosanguineous drainage.
C) Urinary output is 20 mL over the past hour via an indwelling catheter.
D) The client's respiratory rate is 22/min with shallow breathing.
Answer: C) Urinary output is 20 mL over the past hour via an indwelling catheter.
Rationale: Urine output less than 30 mL/hr is a critical indicator of inadequate renal
perfusion, which could signify internal hemorrhage, hypovolemia, or acute kidney injury.
Under the ABC (Airway, Breathing, Circulation) framework, monitoring circulatory
indicators takes priority over expected post-operative pain or minor serosanguineous
staining on a dressing.
2. A PN is reviewing the laboratory results of a client who has a prescription for daily
furosemide. The client's potassium level is 2.9 mEq/L. Which of the following continuous
monitoring assessments should the PN prioritize?
A) Inspecting the lower extremities for deep pitting edema.
B) Auscultating the chest for an irregular apical pulse.
C) Measuring hourly capillary blood glucose levels.
D) Checking the deep tendon reflexes for hyperreflexia.
Answer: B) Auscultating the chest for an irregular apical pulse.
Rationale: A serum potassium level of 2.9 mEq/L indicates severe hypokalemia, a well-
documented adverse effect of loop diuretics like furosemide. Hypokalemia increases
myocardial excitability, placing the client at a high risk for lethal cardiac arrhythmias.
The PN must monitor for pulse irregularities, muscle weakness, and reporting needs.
3. A practical nurse is reinforcing discharge teaching with a client who has a new
permanent cardiac pacemaker. Which of the following statements by the client indicates
a correct understanding of the safety guidelines?
A) "I can safely assist my spouse with an upcoming MRI scan next week."
B) "I must count my pulse for one minute every morning and report any drops."
C) "I will need to avoid using our kitchen microwave oven entirely."
D) "I must lift my arm high above my shoulder daily to prevent stiffness."
Answer: B) "I must count my pulse for one minute every morning and report any
drops."
Rationale: Clients with a new pacemaker must count their pulse daily for one full minute
and notify their provider immediately if the rate drops below the programmed minimum
setting. Traditional microwave ovens are safe to use. MRI scans are strictly
contraindicated due to magnetic interference risks, and lifting the affected arm above
the shoulder must be avoided for the first few weeks to prevent lead displacement.
,4. A PN is caring for a client who has a chest tube connected to a water-seal drainage
system. The PN notes continuous, rapid bubbling in the water-seal chamber. How
should the PN interpret this finding?
A) The system is functioning normally and evacuating air from the pleural space.
B) The lung has completely re-expanded and the chest tube is ready for removal.
C) There is an external system air leak that requires immediate troubleshooting.
D) The suction control column pressure setting is adjusted too high.
Answer: C) There is an external system air leak that requires immediate
troubleshooting.
Rationale: While intermittent bubbling in the water-seal chamber is normal during
expiration or coughing in a client with a pneumothorax, continuous, vigorous bubbling
indicates an active air leak somewhere in the drainage tubing connection or at the chest
insertion site. This requires rapid identification to prevent atmospheric air from
collapsing the lung.
5. A PN is collecting data from a client who has a chronic history of peripheral arterial
disease (PAD). Which of the following lower-extremity physical manifestations should
the PN expect to observe?
A) Thick, dark brown pigmentation localized around the ankles.
B) Pitting pedal edema and skin that feels warm to the touch.
C) Intermittent claudication, shiny hairless skin, and thick toenails.
D) Dilated, winding superficial veins along the posterior calves.
Answer: C) Intermittent claudication, shiny hairless skin, and thick toenails.
Rationale: PAD restricts oxygenated blood flow to the lower extremities, resulting in
tissue ischemia. Expected findings include intermittent claudication (muscle pain during
ambulation), shiny, taut, hairless skin, cool skin temperature, and thickened toenails.
Edema, warmth, and dark brown staining are classic indicators of chronic venous
insufficiency rather than arterial disease.
6. A PN is collecting data from an older adult client who has type 2 diabetes mellitus and is
reporting a non-healing ulcer on the plantar surface of the foot. The client states, "I
didn't even feel it until I saw blood on my sock." The PN should recognize this as a
manifestation of which of the following complications?
A) Autonomic nephropathy
B) Peripheral neuropathy
C) Acute arterial occlusion
D) Diabetic ketoacidosis
Answer: B) Peripheral neuropathy
Rationale: Long-term hyperglycemia causes microvascular damage to peripheral
nerves, leading to sensory neuropathy. This condition diminishes a client's ability to
perceive pain, temperature, or tactile changes in the extremities, predisposing them to
silent, severe foot injuries and subsequent ulceration.
7. A PN is monitoring a client who is receiving a continuous intravenous infusion of heparin
for a deep vein thrombosis (DVT). Which of the following laboratory values indicates
that the medication is achieving its therapeutic effect?
, A) INR of 2.5
B) Prothrombin time (PT) of 12 seconds
C) aPTT of 1.5 to 2.5 times the control baseline value
D) Platelet count of 150,000/mm³
Answer: C) aPTT of 1.5 to 2.5 times the control baseline value
Rationale: Continuous intravenous heparin therapy is titrated and monitored using the
activated partial thromboplastin time (aPTT). The therapeutic goal is generally 1.5 to 2.5
times the established control baseline value. INR and PT are utilized to evaluate oral
warfarin therapy, not intravenous heparin infusion.
8. A practical nurse is caring for a client who has an acute exacerbation of asthma. Which
of the following lung sounds should the PN expect to auscultate during the assessment?
A) Low-pitched coarse crackles
B) High-pitched musical wheezing
C) Dry, grating pleural friction rubs
D) Absent breath sounds in the bases
Answer: B) High-pitched musical wheezing
Rationale: Asthma exacerbations involve bronchoconstriction, mucosal edema, and
mucus hypersecretion that severely narrow the lower airways. Air flowing through these
restricted passages produces high-pitched, musical wheezing sounds, which are most
prominent during expiration.
9. A PN is reviewing instructions with a client who has been diagnosed with
gastroesophageal reflux disease (GERD). Which of the following lifestyle modifications
should the PN reinforce?
A) Eat three high-fat, large meals daily to maintain satiety.
B) Rest in a completely flat supine position for 30 minutes after eating.
C) Avoid consuming caffeine, chocolate, peppermint, and highly acidic foods.
D) Drink a full glass of carbonated water with every evening meal.
Answer: C) Avoid consuming caffeine, chocolate, peppermint, and highly acidic
foods.
Rationale: Caffeine, chocolate, peppermint, fried or fatty foods, and citrus items directly
relax the lower esophageal sphincter (LES) and trigger gastric irritation. Clients with
GERD should also eat small, frequent meals and remain upright for at least 2 to 3 hours
after eating to minimize nocturnal reflux.
10. A PN is caring for a client who is diagnosed with a standard pelvic fracture following a
fall. Which of the following clinical findings is the priority for the PN to monitor for and
report immediately?
A) Intermittent muscle spasms in the lower thighs.
B) Ecchymosis across the lower abdominal wall.
C) Pain rated at 6 on a 0-to-10 scale during repositioning.
D) Hematuria or inability to void urine.
Answer: D) Hematuria or inability to void urine.
Guide (2026) | 400 Highlightable
Questions with Explanatory Rationales
Excel on your licensure assessments with
this high-yield, 400-question practice exam
modeled directly after the 2026 HESI PN
Medical-Surgical exam blueprint. Every
multiple-choice question features a verified
correct answer and an in-depth clinical
rationale enclosed in clean brackets,
making the entire document completely
digital-highlighter friendly. This premium
guide delivers master-level practical nursing
coverage across essential testing
categories, including fluid and electrolyte
stabilization, perioperative nursing priorities,
cardiovascular hemodynamics, and critical
pharmacology safety boundaries.
, 1.A practical nurse (PN) is collecting data from a client who is 2 hours post-operative
following an abdominal cholecystectomy. Which of the following findings is the
priority for the PN to report to the charge nurse?
A) Client reports severe incisional pain rated at 8 on a 0-to-10 scale.
B) The surgical dressing has a 2-cm area of serosanguineous drainage.
C) Urinary output is 20 mL over the past hour via an indwelling catheter.
D) The client's respiratory rate is 22/min with shallow breathing.
Answer: C) Urinary output is 20 mL over the past hour via an indwelling catheter.
Rationale: Urine output less than 30 mL/hr is a critical indicator of inadequate renal
perfusion, which could signify internal hemorrhage, hypovolemia, or acute kidney injury.
Under the ABC (Airway, Breathing, Circulation) framework, monitoring circulatory
indicators takes priority over expected post-operative pain or minor serosanguineous
staining on a dressing.
2. A PN is reviewing the laboratory results of a client who has a prescription for daily
furosemide. The client's potassium level is 2.9 mEq/L. Which of the following continuous
monitoring assessments should the PN prioritize?
A) Inspecting the lower extremities for deep pitting edema.
B) Auscultating the chest for an irregular apical pulse.
C) Measuring hourly capillary blood glucose levels.
D) Checking the deep tendon reflexes for hyperreflexia.
Answer: B) Auscultating the chest for an irregular apical pulse.
Rationale: A serum potassium level of 2.9 mEq/L indicates severe hypokalemia, a well-
documented adverse effect of loop diuretics like furosemide. Hypokalemia increases
myocardial excitability, placing the client at a high risk for lethal cardiac arrhythmias.
The PN must monitor for pulse irregularities, muscle weakness, and reporting needs.
3. A practical nurse is reinforcing discharge teaching with a client who has a new
permanent cardiac pacemaker. Which of the following statements by the client indicates
a correct understanding of the safety guidelines?
A) "I can safely assist my spouse with an upcoming MRI scan next week."
B) "I must count my pulse for one minute every morning and report any drops."
C) "I will need to avoid using our kitchen microwave oven entirely."
D) "I must lift my arm high above my shoulder daily to prevent stiffness."
Answer: B) "I must count my pulse for one minute every morning and report any
drops."
Rationale: Clients with a new pacemaker must count their pulse daily for one full minute
and notify their provider immediately if the rate drops below the programmed minimum
setting. Traditional microwave ovens are safe to use. MRI scans are strictly
contraindicated due to magnetic interference risks, and lifting the affected arm above
the shoulder must be avoided for the first few weeks to prevent lead displacement.
,4. A PN is caring for a client who has a chest tube connected to a water-seal drainage
system. The PN notes continuous, rapid bubbling in the water-seal chamber. How
should the PN interpret this finding?
A) The system is functioning normally and evacuating air from the pleural space.
B) The lung has completely re-expanded and the chest tube is ready for removal.
C) There is an external system air leak that requires immediate troubleshooting.
D) The suction control column pressure setting is adjusted too high.
Answer: C) There is an external system air leak that requires immediate
troubleshooting.
Rationale: While intermittent bubbling in the water-seal chamber is normal during
expiration or coughing in a client with a pneumothorax, continuous, vigorous bubbling
indicates an active air leak somewhere in the drainage tubing connection or at the chest
insertion site. This requires rapid identification to prevent atmospheric air from
collapsing the lung.
5. A PN is collecting data from a client who has a chronic history of peripheral arterial
disease (PAD). Which of the following lower-extremity physical manifestations should
the PN expect to observe?
A) Thick, dark brown pigmentation localized around the ankles.
B) Pitting pedal edema and skin that feels warm to the touch.
C) Intermittent claudication, shiny hairless skin, and thick toenails.
D) Dilated, winding superficial veins along the posterior calves.
Answer: C) Intermittent claudication, shiny hairless skin, and thick toenails.
Rationale: PAD restricts oxygenated blood flow to the lower extremities, resulting in
tissue ischemia. Expected findings include intermittent claudication (muscle pain during
ambulation), shiny, taut, hairless skin, cool skin temperature, and thickened toenails.
Edema, warmth, and dark brown staining are classic indicators of chronic venous
insufficiency rather than arterial disease.
6. A PN is collecting data from an older adult client who has type 2 diabetes mellitus and is
reporting a non-healing ulcer on the plantar surface of the foot. The client states, "I
didn't even feel it until I saw blood on my sock." The PN should recognize this as a
manifestation of which of the following complications?
A) Autonomic nephropathy
B) Peripheral neuropathy
C) Acute arterial occlusion
D) Diabetic ketoacidosis
Answer: B) Peripheral neuropathy
Rationale: Long-term hyperglycemia causes microvascular damage to peripheral
nerves, leading to sensory neuropathy. This condition diminishes a client's ability to
perceive pain, temperature, or tactile changes in the extremities, predisposing them to
silent, severe foot injuries and subsequent ulceration.
7. A PN is monitoring a client who is receiving a continuous intravenous infusion of heparin
for a deep vein thrombosis (DVT). Which of the following laboratory values indicates
that the medication is achieving its therapeutic effect?
, A) INR of 2.5
B) Prothrombin time (PT) of 12 seconds
C) aPTT of 1.5 to 2.5 times the control baseline value
D) Platelet count of 150,000/mm³
Answer: C) aPTT of 1.5 to 2.5 times the control baseline value
Rationale: Continuous intravenous heparin therapy is titrated and monitored using the
activated partial thromboplastin time (aPTT). The therapeutic goal is generally 1.5 to 2.5
times the established control baseline value. INR and PT are utilized to evaluate oral
warfarin therapy, not intravenous heparin infusion.
8. A practical nurse is caring for a client who has an acute exacerbation of asthma. Which
of the following lung sounds should the PN expect to auscultate during the assessment?
A) Low-pitched coarse crackles
B) High-pitched musical wheezing
C) Dry, grating pleural friction rubs
D) Absent breath sounds in the bases
Answer: B) High-pitched musical wheezing
Rationale: Asthma exacerbations involve bronchoconstriction, mucosal edema, and
mucus hypersecretion that severely narrow the lower airways. Air flowing through these
restricted passages produces high-pitched, musical wheezing sounds, which are most
prominent during expiration.
9. A PN is reviewing instructions with a client who has been diagnosed with
gastroesophageal reflux disease (GERD). Which of the following lifestyle modifications
should the PN reinforce?
A) Eat three high-fat, large meals daily to maintain satiety.
B) Rest in a completely flat supine position for 30 minutes after eating.
C) Avoid consuming caffeine, chocolate, peppermint, and highly acidic foods.
D) Drink a full glass of carbonated water with every evening meal.
Answer: C) Avoid consuming caffeine, chocolate, peppermint, and highly acidic
foods.
Rationale: Caffeine, chocolate, peppermint, fried or fatty foods, and citrus items directly
relax the lower esophageal sphincter (LES) and trigger gastric irritation. Clients with
GERD should also eat small, frequent meals and remain upright for at least 2 to 3 hours
after eating to minimize nocturnal reflux.
10. A PN is caring for a client who is diagnosed with a standard pelvic fracture following a
fall. Which of the following clinical findings is the priority for the PN to monitor for and
report immediately?
A) Intermittent muscle spasms in the lower thighs.
B) Ecchymosis across the lower abdominal wall.
C) Pain rated at 6 on a 0-to-10 scale during repositioning.
D) Hematuria or inability to void urine.
Answer: D) Hematuria or inability to void urine.
