1|Page
HESI MED-SURG QUESTIONS AND
CORRECT ANSWERS — PRACTICE
QUESTION BANK 2026/2027 | DETAILED
RATIONALES
INTRODUCTION
The HESI Medical-Surgical examination evaluates a nursing student's ability to apply medical-
surgical knowledge to complex patient-care situations. It emphasizes clinical judgment,
assessment, prioritization, recognition of complications, pharmacologic management, patient
safety, and appropriate nursing interventions. HESI materials identify Medical-Surgical as an RN
specialty examination, while HESI case-study resources emphasize application of physiological,
psychosocial, management, pharmacology, and nursing concepts.
This practice bank is designed for nursing students preparing for a Medical-Surgical HESI
assessment. The questions deliberately use challenging patient scenarios rather than simple
recall. They cover cardiovascular, respiratory, neurologic, renal, endocrine, gastrointestinal,
hematologic, musculoskeletal, immune, oncology, and perioperative concepts, together with
pharmacology and clinical prioritization.
The questions are intended to strengthen clinical reasoning: identify the most urgent finding,
connect assessment data with pathophysiology, recognize deterioration, select the safest
intervention, and evaluate whether treatment is effective. Each question contains one best answer
followed by a rationale explaining the clinical reasoning behind the answer and why the
alternatives are less appropriate.
CONTENT AREA OVERVIEW
Suggested
Content Area Questions Key Topics
Weight
ACS, HF, dysrhythmias, hypertension,
Cardiovascular 1–12 12%
shock
COPD, asthma, pneumonia, PE,
Respiratory 13–23 11%
respiratory failure
Stroke, seizures, ICP, Parkinson disease,
Neurologic 24–33 10%
spinal injury
AKI, CKD, dialysis, electrolytes, urinary
Renal/Urinary 34–42 9%
disorders
Diabetes, DKA, HHS, thyroid, adrenal
Endocrine 43–51 9%
disorders
,2|Page
Suggested
Content Area Questions Key Topics
Weight
GI bleeding, pancreatitis, cirrhosis, IBD,
Gastrointestinal/Hepatic 52–60 9%
obstruction
Anemia, transfusion, neutropenia,
Hematologic/Oncology 61–68 8%
leukemia, cancer care
Fractures, compartment syndrome,
Musculoskeletal 69–75 7%
arthroplasty, osteoporosis
Sepsis, HIV, autoimmune disease,
Immune/Infectious 76–82 7%
infection control
Surgical complications, burns, shock,
Perioperative/Trauma 83–88 6%
wound care
High-alert medications, adverse effects,
Pharmacology/Safety 89–94 6%
interactions
Integrated Clinical Prioritization, delegation, deterioration,
95–100 6%
Judgment complex cases
The percentages above are a study-planning framework for this practice bank, not an official
HESI scoring blueprint.
QUESTIONS 1–100
CARDIOVASCULAR
Q1:
A client with an acute myocardial infarction received IV morphine for severe chest pain. Thirty
minutes later, the client's blood pressure decreases from 138/82 mmHg to 92/58 mmHg, heart
rate is 54/min, and oxygen saturation is 95%. Which finding requires the nurse's priority action?
A) Oxygen saturation of 95%
B) Blood pressure of 92/58 mmHg
C) Heart rate of 54/min
D) Reduced report of chest pain
Rationale: B is correct because hypotension following an acute myocardial infarction may
indicate reduced cardiac output and can be worsened by morphine-related vasodilation. The
nurse should immediately reassess perfusion and notify the provider as appropriate. A is
acceptable oxygenation. C is concerning but must be interpreted with the blood pressure and
overall perfusion. D indicates symptom improvement but does not eliminate the significance of
hypotension.
Q2:
,3|Page
A client with heart failure is receiving IV furosemide. Which assessment finding best indicates
that the medication is producing the desired therapeutic response?
A) Heart rate increases from 78 to 96/min
B) Crackles disappear and urine output increases
C) Serum sodium decreases from 138 to 130 mEq/L
D) Blood pressure increases from 128/76 to 150/88 mmHg
Rationale: B is correct because furosemide promotes sodium and water excretion, reducing
pulmonary and systemic congestion. Increased urine output accompanied by fewer crackles
indicates improved fluid status. A represents tachycardia rather than therapeutic response. C
suggests potentially excessive sodium loss. D does not indicate improved volume status and may
represent worsening cardiovascular stress.
Q3:
A client with atrial fibrillation is prescribed warfarin. Which laboratory result is most important
for the nurse to monitor?
A) Troponin
B) INR
C) Serum potassium
D) BNP
Rationale: B is correct because warfarin therapy is monitored using the INR to evaluate
anticoagulant effect and bleeding risk. A is used primarily when myocardial injury is suspected.
C is particularly important with several cardiac medications but does not measure warfarin
effect. D is associated with ventricular stretch and heart-failure assessment.
Q4:
A client taking digoxin reports nausea and seeing yellow-green halos around lights. The apical
pulse is 52/min. What should the nurse do first?
A) Administer the scheduled dose with food
B) Hold digoxin and notify the provider
C) Encourage increased dietary sodium
D) Administer an additional dose to control the heart rate
Rationale: B is correct because nausea, visual disturbances, and bradycardia are classic
findings associated with digoxin toxicity. The medication should be withheld and the provider
notified. A could worsen toxicity. C does not treat the problem. D would increase exposure to the
medication and could be dangerous.
Q5:
, 4|Page
A client with acute pulmonary edema is extremely dyspneic and coughing pink, frothy sputum.
Which intervention should the nurse implement first?
A) Place the client supine
B) Position the client upright and administer oxygen as prescribed
C) Encourage oral fluids
D) Obtain a routine dietary history
Rationale: B is correct because upright positioning decreases venous return and improves lung
expansion, while oxygen addresses impaired oxygenation. A worsens pulmonary congestion. C
can aggravate fluid overload. D is not an immediate priority during acute respiratory
compromise.
Q6:
A client receiving heparin for a pulmonary embolism develops sudden hematuria and bleeding
from the gums. Which action is most appropriate?
A) Continue the infusion and reassess tomorrow
B) Stop the infusion and notify the provider
C) Administer aspirin
D) Encourage vigorous ambulation
Rationale: B is correct because active bleeding during heparin therapy may indicate excessive
anticoagulation. The infusion should be stopped according to protocol and the provider notified.
A risks worsening hemorrhage. C further increases bleeding risk. D is inappropriate during
active bleeding and acute thromboembolic management.
Q7:
A client with hypertension is prescribed an ACE inhibitor. Which finding should the nurse report
immediately?
A) Mild fatigue
B) Persistent dry cough
C) Facial and tongue swelling
D) Blood pressure of 128/76 mmHg
Rationale: C is correct because facial and tongue swelling may indicate angioedema, a
potentially life-threatening airway emergency associated with ACE inhibitors. B is a common
adverse effect but is generally not immediately life-threatening. A may occur but is nonspecific.
D represents controlled blood pressure.
Q8:
HESI MED-SURG QUESTIONS AND
CORRECT ANSWERS — PRACTICE
QUESTION BANK 2026/2027 | DETAILED
RATIONALES
INTRODUCTION
The HESI Medical-Surgical examination evaluates a nursing student's ability to apply medical-
surgical knowledge to complex patient-care situations. It emphasizes clinical judgment,
assessment, prioritization, recognition of complications, pharmacologic management, patient
safety, and appropriate nursing interventions. HESI materials identify Medical-Surgical as an RN
specialty examination, while HESI case-study resources emphasize application of physiological,
psychosocial, management, pharmacology, and nursing concepts.
This practice bank is designed for nursing students preparing for a Medical-Surgical HESI
assessment. The questions deliberately use challenging patient scenarios rather than simple
recall. They cover cardiovascular, respiratory, neurologic, renal, endocrine, gastrointestinal,
hematologic, musculoskeletal, immune, oncology, and perioperative concepts, together with
pharmacology and clinical prioritization.
The questions are intended to strengthen clinical reasoning: identify the most urgent finding,
connect assessment data with pathophysiology, recognize deterioration, select the safest
intervention, and evaluate whether treatment is effective. Each question contains one best answer
followed by a rationale explaining the clinical reasoning behind the answer and why the
alternatives are less appropriate.
CONTENT AREA OVERVIEW
Suggested
Content Area Questions Key Topics
Weight
ACS, HF, dysrhythmias, hypertension,
Cardiovascular 1–12 12%
shock
COPD, asthma, pneumonia, PE,
Respiratory 13–23 11%
respiratory failure
Stroke, seizures, ICP, Parkinson disease,
Neurologic 24–33 10%
spinal injury
AKI, CKD, dialysis, electrolytes, urinary
Renal/Urinary 34–42 9%
disorders
Diabetes, DKA, HHS, thyroid, adrenal
Endocrine 43–51 9%
disorders
,2|Page
Suggested
Content Area Questions Key Topics
Weight
GI bleeding, pancreatitis, cirrhosis, IBD,
Gastrointestinal/Hepatic 52–60 9%
obstruction
Anemia, transfusion, neutropenia,
Hematologic/Oncology 61–68 8%
leukemia, cancer care
Fractures, compartment syndrome,
Musculoskeletal 69–75 7%
arthroplasty, osteoporosis
Sepsis, HIV, autoimmune disease,
Immune/Infectious 76–82 7%
infection control
Surgical complications, burns, shock,
Perioperative/Trauma 83–88 6%
wound care
High-alert medications, adverse effects,
Pharmacology/Safety 89–94 6%
interactions
Integrated Clinical Prioritization, delegation, deterioration,
95–100 6%
Judgment complex cases
The percentages above are a study-planning framework for this practice bank, not an official
HESI scoring blueprint.
QUESTIONS 1–100
CARDIOVASCULAR
Q1:
A client with an acute myocardial infarction received IV morphine for severe chest pain. Thirty
minutes later, the client's blood pressure decreases from 138/82 mmHg to 92/58 mmHg, heart
rate is 54/min, and oxygen saturation is 95%. Which finding requires the nurse's priority action?
A) Oxygen saturation of 95%
B) Blood pressure of 92/58 mmHg
C) Heart rate of 54/min
D) Reduced report of chest pain
Rationale: B is correct because hypotension following an acute myocardial infarction may
indicate reduced cardiac output and can be worsened by morphine-related vasodilation. The
nurse should immediately reassess perfusion and notify the provider as appropriate. A is
acceptable oxygenation. C is concerning but must be interpreted with the blood pressure and
overall perfusion. D indicates symptom improvement but does not eliminate the significance of
hypotension.
Q2:
,3|Page
A client with heart failure is receiving IV furosemide. Which assessment finding best indicates
that the medication is producing the desired therapeutic response?
A) Heart rate increases from 78 to 96/min
B) Crackles disappear and urine output increases
C) Serum sodium decreases from 138 to 130 mEq/L
D) Blood pressure increases from 128/76 to 150/88 mmHg
Rationale: B is correct because furosemide promotes sodium and water excretion, reducing
pulmonary and systemic congestion. Increased urine output accompanied by fewer crackles
indicates improved fluid status. A represents tachycardia rather than therapeutic response. C
suggests potentially excessive sodium loss. D does not indicate improved volume status and may
represent worsening cardiovascular stress.
Q3:
A client with atrial fibrillation is prescribed warfarin. Which laboratory result is most important
for the nurse to monitor?
A) Troponin
B) INR
C) Serum potassium
D) BNP
Rationale: B is correct because warfarin therapy is monitored using the INR to evaluate
anticoagulant effect and bleeding risk. A is used primarily when myocardial injury is suspected.
C is particularly important with several cardiac medications but does not measure warfarin
effect. D is associated with ventricular stretch and heart-failure assessment.
Q4:
A client taking digoxin reports nausea and seeing yellow-green halos around lights. The apical
pulse is 52/min. What should the nurse do first?
A) Administer the scheduled dose with food
B) Hold digoxin and notify the provider
C) Encourage increased dietary sodium
D) Administer an additional dose to control the heart rate
Rationale: B is correct because nausea, visual disturbances, and bradycardia are classic
findings associated with digoxin toxicity. The medication should be withheld and the provider
notified. A could worsen toxicity. C does not treat the problem. D would increase exposure to the
medication and could be dangerous.
Q5:
, 4|Page
A client with acute pulmonary edema is extremely dyspneic and coughing pink, frothy sputum.
Which intervention should the nurse implement first?
A) Place the client supine
B) Position the client upright and administer oxygen as prescribed
C) Encourage oral fluids
D) Obtain a routine dietary history
Rationale: B is correct because upright positioning decreases venous return and improves lung
expansion, while oxygen addresses impaired oxygenation. A worsens pulmonary congestion. C
can aggravate fluid overload. D is not an immediate priority during acute respiratory
compromise.
Q6:
A client receiving heparin for a pulmonary embolism develops sudden hematuria and bleeding
from the gums. Which action is most appropriate?
A) Continue the infusion and reassess tomorrow
B) Stop the infusion and notify the provider
C) Administer aspirin
D) Encourage vigorous ambulation
Rationale: B is correct because active bleeding during heparin therapy may indicate excessive
anticoagulation. The infusion should be stopped according to protocol and the provider notified.
A risks worsening hemorrhage. C further increases bleeding risk. D is inappropriate during
active bleeding and acute thromboembolic management.
Q7:
A client with hypertension is prescribed an ACE inhibitor. Which finding should the nurse report
immediately?
A) Mild fatigue
B) Persistent dry cough
C) Facial and tongue swelling
D) Blood pressure of 128/76 mmHg
Rationale: C is correct because facial and tongue swelling may indicate angioedema, a
potentially life-threatening airway emergency associated with ACE inhibitors. B is a common
adverse effect but is generally not immediately life-threatening. A may occur but is nonspecific.
D represents controlled blood pressure.
Q8:
