1|Page
HESI MED-SURG PRACTICE EXAM
[QUESTIONS 1-100] AND ANSWERS
UPDATED 2026/2027 | DETAILED
RATIONALES | ADVANCED PRACTICE
INTRODUCTION
The HESI Medical-Surgical Nursing examination evaluates a student's ability to apply nursing
knowledge to complex adult-health situations rather than simply recall isolated facts. This
practice question bank is designed for nursing students preparing for a HESI-style Medical-
Surgical examination and focuses on clinical judgment, prioritization, assessment, intervention,
pharmacology, safety, and evaluation of patient outcomes.
The questions emphasize realistic clinical scenarios involving cardiovascular, respiratory,
neurological, renal, gastrointestinal, endocrine, musculoskeletal, hematological, and
perioperative conditions. Many items require the learner to recognize subtle changes in patient
status, identify the highest-priority intervention, interpret assessment findings, and distinguish
expected findings from potentially life-threatening complications.
Each question contains four answer choices with one best answer, followed by a detailed
rationale explaining the clinical reasoning behind the correct response and why the alternatives
are less appropriate. Students should use the rationales to identify knowledge gaps rather than
simply memorize answers. The material is intended for structured review, clinical reasoning
practice, and preparation for HESI-style testing.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
ACS, heart failure, dysrhythmias,
Cardiovascular 1–15 15%
hypertension, shock, anticoagulation
COPD, asthma, pneumonia, PE, respiratory
Respiratory 16–28 13%
failure, chest tubes
Stroke, seizures, increased ICP, spinal injury,
Neurological 29–39 11%
neurological assessment
AKI, CKD, dialysis, electrolyte
Renal & Urinary 40–49 10%
abnormalities, urinary disorders
Diabetes, DKA, HHS, thyroid disorders,
Endocrine 50–59 10%
adrenal disorders
,2|Page
Approx.
Content Area Questions Key Topics
Weight
Gastrointestinal & GI bleeding, pancreatitis, cirrhosis, bowel
60–69 10%
Hepatic disorders, ostomies
Hematology & Anemia, transfusion reactions, neutropenia,
70–77 8%
Oncology chemotherapy complications
Fractures, compartment syndrome, joint
Musculoskeletal 78–84 7%
replacement, osteoporosis
Burns, pressure injuries, wound care,
Integumentary & Burns 85–89 5%
infection
Perioperative & Critical Postoperative complications, sepsis, shock,
90–95 6%
Care monitoring
Pharmacology & High-alert medications, adverse effects,
96–100 5%
Patient Safety medication safety
QUESTIONS 1–100
CARDIOVASCULAR
Q1:
A client with an acute myocardial infarction suddenly becomes restless and reports severe
shortness of breath. Assessment reveals bilateral crackles, oxygen saturation of 84%, blood
pressure 88/54 mmHg, and cool clammy skin. Which intervention should the nurse prioritize?
A) Administer the prescribed oral beta blocker
B) Apply supplemental oxygen and immediately notify the provider of suspected cardiogenic
shock
C) Encourage oral fluids to increase circulating volume
D) Place the client in a flat supine position
Rationale: The correct answer is B because the client demonstrates acute pulmonary congestion
and hypotension consistent with cardiogenic shock. Oxygenation and immediate escalation are
priorities. Option A is inappropriate because beta blockers can worsen hypotension and acute
decompensation. Option C can worsen pulmonary edema. Option D may increase respiratory
compromise; positioning that supports ventilation is preferred.
Q2:
A client with heart failure receives IV furosemide. Four hours later, the client reports weakness
and muscle cramps. The cardiac monitor shows frequent premature ventricular contractions.
Which laboratory result should the nurse anticipate?
,3|Page
A) Sodium 140 mEq/L
B) Potassium 2.9 mEq/L
C) Calcium 9.4 mg/dL
D) Magnesium 2.1 mg/dL
Rationale: The correct answer is B because loop diuretics increase urinary potassium loss.
Hypokalemia can produce muscle weakness, cramping, and ventricular dysrhythmias. Option A
represents a normal sodium concentration. Option C represents a normal calcium concentration.
Option D represents a typical normal magnesium value.
Q3:
A client receiving heparin for a pulmonary embolism develops sudden hematuria and bleeding
from the gums. Which action should the nurse take first?
A) Administer the next scheduled dose
B) Encourage increased oral fluid intake
C) Stop the heparin infusion and notify the provider
D) Administer warfarin immediately
Rationale: The correct answer is C because active bleeding in a client receiving therapeutic
anticoagulation requires immediate interruption of heparin and evaluation. Option A could
worsen hemorrhage. Option B does not correct the anticoagulant-associated bleeding. Option D
does not provide immediate reversal and could increase anticoagulant effect.
Q4:
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most important
for evaluating therapeutic effectiveness?
A) aPTT
B) Platelet count
C) INR
D) Serum potassium
Rationale: The correct answer is C because INR is used to monitor the therapeutic effect of
warfarin. Option A is primarily used to monitor unfractionated heparin. Option B can identify
thrombocytopenia but does not measure warfarin effectiveness. Option D evaluates electrolyte
status rather than anticoagulation.
Q5:
A client with chronic heart failure reports gaining 2.5 kg over three days and awakening at night
with shortness of breath. Which finding requires the most immediate intervention?
, 4|Page
A) Mild ankle edema
B) Fatigue after walking
C) New bilateral crackles with oxygen saturation of 86%
D) Weight gain documented at home
Rationale: The correct answer is C because hypoxemia and bilateral crackles indicate
significant pulmonary congestion and impaired gas exchange. Option A reflects fluid retention
but is less immediately threatening. Option B is common in heart failure. Option D is clinically
important but the current respiratory deterioration requires the most immediate intervention.
Q6:
A client develops chest pressure radiating to the jaw while ambulating. Which action should the
nurse take first?
A) Ask the client to walk back to bed
B) Obtain a routine dietary history
C) Stop activity, place the client at rest, and assess vital signs and cardiac status
D) Administer a prescribed stool softener
Rationale: The correct answer is C because symptoms suggest myocardial ischemia. Activity
should be stopped immediately and the client's cardiovascular status assessed. Option A
increases myocardial oxygen demand. Option B is unrelated to the acute problem. Option D has
no relevance to the immediate emergency.
Q7:
A client taking digoxin has an apical pulse of 52/min and reports nausea and yellow-green visual
halos. What should the nurse do?
A) Administer the medication with food
B) Hold digoxin and notify the provider
C) Give an additional dose to stabilize the rhythm
D) Encourage vigorous exercise
Rationale: The correct answer is B because bradycardia, gastrointestinal symptoms, and visual
disturbances are classic manifestations of digoxin toxicity. Option A does not correct toxicity.
Option C could worsen toxicity. Option D increases cardiovascular demand and is inappropriate
during suspected toxicity.
Q8:
A client with hypertension is prescribed an ACE inhibitor. Which finding requires immediate
follow-up?
HESI MED-SURG PRACTICE EXAM
[QUESTIONS 1-100] AND ANSWERS
UPDATED 2026/2027 | DETAILED
RATIONALES | ADVANCED PRACTICE
INTRODUCTION
The HESI Medical-Surgical Nursing examination evaluates a student's ability to apply nursing
knowledge to complex adult-health situations rather than simply recall isolated facts. This
practice question bank is designed for nursing students preparing for a HESI-style Medical-
Surgical examination and focuses on clinical judgment, prioritization, assessment, intervention,
pharmacology, safety, and evaluation of patient outcomes.
The questions emphasize realistic clinical scenarios involving cardiovascular, respiratory,
neurological, renal, gastrointestinal, endocrine, musculoskeletal, hematological, and
perioperative conditions. Many items require the learner to recognize subtle changes in patient
status, identify the highest-priority intervention, interpret assessment findings, and distinguish
expected findings from potentially life-threatening complications.
Each question contains four answer choices with one best answer, followed by a detailed
rationale explaining the clinical reasoning behind the correct response and why the alternatives
are less appropriate. Students should use the rationales to identify knowledge gaps rather than
simply memorize answers. The material is intended for structured review, clinical reasoning
practice, and preparation for HESI-style testing.
CONTENT AREA OVERVIEW
Approx.
Content Area Questions Key Topics
Weight
ACS, heart failure, dysrhythmias,
Cardiovascular 1–15 15%
hypertension, shock, anticoagulation
COPD, asthma, pneumonia, PE, respiratory
Respiratory 16–28 13%
failure, chest tubes
Stroke, seizures, increased ICP, spinal injury,
Neurological 29–39 11%
neurological assessment
AKI, CKD, dialysis, electrolyte
Renal & Urinary 40–49 10%
abnormalities, urinary disorders
Diabetes, DKA, HHS, thyroid disorders,
Endocrine 50–59 10%
adrenal disorders
,2|Page
Approx.
Content Area Questions Key Topics
Weight
Gastrointestinal & GI bleeding, pancreatitis, cirrhosis, bowel
60–69 10%
Hepatic disorders, ostomies
Hematology & Anemia, transfusion reactions, neutropenia,
70–77 8%
Oncology chemotherapy complications
Fractures, compartment syndrome, joint
Musculoskeletal 78–84 7%
replacement, osteoporosis
Burns, pressure injuries, wound care,
Integumentary & Burns 85–89 5%
infection
Perioperative & Critical Postoperative complications, sepsis, shock,
90–95 6%
Care monitoring
Pharmacology & High-alert medications, adverse effects,
96–100 5%
Patient Safety medication safety
QUESTIONS 1–100
CARDIOVASCULAR
Q1:
A client with an acute myocardial infarction suddenly becomes restless and reports severe
shortness of breath. Assessment reveals bilateral crackles, oxygen saturation of 84%, blood
pressure 88/54 mmHg, and cool clammy skin. Which intervention should the nurse prioritize?
A) Administer the prescribed oral beta blocker
B) Apply supplemental oxygen and immediately notify the provider of suspected cardiogenic
shock
C) Encourage oral fluids to increase circulating volume
D) Place the client in a flat supine position
Rationale: The correct answer is B because the client demonstrates acute pulmonary congestion
and hypotension consistent with cardiogenic shock. Oxygenation and immediate escalation are
priorities. Option A is inappropriate because beta blockers can worsen hypotension and acute
decompensation. Option C can worsen pulmonary edema. Option D may increase respiratory
compromise; positioning that supports ventilation is preferred.
Q2:
A client with heart failure receives IV furosemide. Four hours later, the client reports weakness
and muscle cramps. The cardiac monitor shows frequent premature ventricular contractions.
Which laboratory result should the nurse anticipate?
,3|Page
A) Sodium 140 mEq/L
B) Potassium 2.9 mEq/L
C) Calcium 9.4 mg/dL
D) Magnesium 2.1 mg/dL
Rationale: The correct answer is B because loop diuretics increase urinary potassium loss.
Hypokalemia can produce muscle weakness, cramping, and ventricular dysrhythmias. Option A
represents a normal sodium concentration. Option C represents a normal calcium concentration.
Option D represents a typical normal magnesium value.
Q3:
A client receiving heparin for a pulmonary embolism develops sudden hematuria and bleeding
from the gums. Which action should the nurse take first?
A) Administer the next scheduled dose
B) Encourage increased oral fluid intake
C) Stop the heparin infusion and notify the provider
D) Administer warfarin immediately
Rationale: The correct answer is C because active bleeding in a client receiving therapeutic
anticoagulation requires immediate interruption of heparin and evaluation. Option A could
worsen hemorrhage. Option B does not correct the anticoagulant-associated bleeding. Option D
does not provide immediate reversal and could increase anticoagulant effect.
Q4:
A client with atrial fibrillation is prescribed warfarin. Which laboratory value is most important
for evaluating therapeutic effectiveness?
A) aPTT
B) Platelet count
C) INR
D) Serum potassium
Rationale: The correct answer is C because INR is used to monitor the therapeutic effect of
warfarin. Option A is primarily used to monitor unfractionated heparin. Option B can identify
thrombocytopenia but does not measure warfarin effectiveness. Option D evaluates electrolyte
status rather than anticoagulation.
Q5:
A client with chronic heart failure reports gaining 2.5 kg over three days and awakening at night
with shortness of breath. Which finding requires the most immediate intervention?
, 4|Page
A) Mild ankle edema
B) Fatigue after walking
C) New bilateral crackles with oxygen saturation of 86%
D) Weight gain documented at home
Rationale: The correct answer is C because hypoxemia and bilateral crackles indicate
significant pulmonary congestion and impaired gas exchange. Option A reflects fluid retention
but is less immediately threatening. Option B is common in heart failure. Option D is clinically
important but the current respiratory deterioration requires the most immediate intervention.
Q6:
A client develops chest pressure radiating to the jaw while ambulating. Which action should the
nurse take first?
A) Ask the client to walk back to bed
B) Obtain a routine dietary history
C) Stop activity, place the client at rest, and assess vital signs and cardiac status
D) Administer a prescribed stool softener
Rationale: The correct answer is C because symptoms suggest myocardial ischemia. Activity
should be stopped immediately and the client's cardiovascular status assessed. Option A
increases myocardial oxygen demand. Option B is unrelated to the acute problem. Option D has
no relevance to the immediate emergency.
Q7:
A client taking digoxin has an apical pulse of 52/min and reports nausea and yellow-green visual
halos. What should the nurse do?
A) Administer the medication with food
B) Hold digoxin and notify the provider
C) Give an additional dose to stabilize the rhythm
D) Encourage vigorous exercise
Rationale: The correct answer is B because bradycardia, gastrointestinal symptoms, and visual
disturbances are classic manifestations of digoxin toxicity. Option A does not correct toxicity.
Option C could worsen toxicity. Option D increases cardiovascular demand and is inappropriate
during suspected toxicity.
Q8:
A client with hypertension is prescribed an ACE inhibitor. Which finding requires immediate
follow-up?
