HESI RN Med-Surg (v1, v2, v3, V4, V5, V6)
2026/2027+ PAST PAPERS FROM 2023,2024,2025
WITH DETAILED RATIONALES, SCREENSHOOTS AND
PICTURES
,Table of Contents
HESI RN Medical-Surgical V1 ............. 3
HESI RN Medical-Surgical V2 ......... 99
HESI RN Medical-Surgical V3 ...... 140
HESI RN Medical-Surgical V4 ......... 297
HESI RN Medical-Surgical V5 ....... 482
HESI RN Medical-Surgical V6 ...... 718
PAST PAPERS FROM 2023,2024,2025
WITH DETAILED RATIONALES,
SCREENSHOOTS AND PICTURES ... 767
,HESI RN Medical-Surgical V1
Question 1
A client with heart failure suddenly develops pink-tinged frothy sputum, severe dyspnea, and anxiety.
Which action should the nurse take first?
A. Increase IV fluids.
B. Place the client in high Fowler's position.
C. Obtain a sputum sample.
D. Administer PRN antianxiety medication.
Correct Answer:
B. Place the client in high Fowler's position.
Expert Rationale:
Pink-tinged frothy sputum, severe dyspnea, and anxiety indicate acute pulmonary edema, a life-
threatening complication of heart failure. High Fowler's position improves oxygenation by allowing
maximal lung expansion and decreases venous return to the heart, reducing pulmonary congestion. This
is a rapid, nurse-initiated intervention that directly addresses the immediate respiratory compromise.
Increasing IV fluids would worsen pulmonary edema, obtaining a sputum sample delays essential
intervention, and antianxiety medication does not address the underlying oxygenation problem.
Explanation of Incorrect Options:
• A. Increasing IV fluids would worsen fluid overload and pulmonary edema.
• B. Correct. High Fowler's position improves oxygenation and reduces venous return.
• C. Obtaining a sputum sample is not the priority and delays essential intervention.
• D. Administering an antianxiety medication does not address the underlying pulmonary edema and
hypoxemia.
Test-Taking Tip:
Pink frothy sputum + severe dyspnea = acute pulmonary edema. Position first (high Fowler's) to improve
breathing, then administer oxygen and diuretics per orders.
DIF: Application
REF: Not provided in the source material.
OBJ: Prioritize respiratory distress interventions.
TOP: Cardiac / Respiratory Failure / Safety
Question 2
A postoperative client has a blood pressure of 88/52, a heart rate of 132/min, and cool, clammy skin.
Which action is priority?
A. Increase oral fluids.
B. Check urine sample.
C. Notify the provider.
D. Reposition the client for comfort.
Correct Answer:
C. Notify the provider.
, Expert Rationale:
Hypotension, tachycardia, and cool, clammy skin indicate shock (likely hypovolemic or hemorrhagic) in a
postoperative client. The priority is rapid provider notification so that fluid resuscitation, blood products,
and further diagnostic evaluation can be initiated promptly. Increasing oral fluids is inadequate for shock,
checking a urine sample is not the priority, and repositioning for comfort does not address the life-
threatening condition.
Explanation of Incorrect Options:
• A. Oral fluids are inadequate for a client in shock and may be contraindicated.
• B. Checking a urine sample is not the priority in shock.
• C. Correct. These findings indicate shock and require immediate provider notification.
• D. Repositioning for comfort does not address the life-threatening condition.
Test-Taking Tip:
Post-op hypotension + tachycardia + cool, clammy skin = shock. Notify the provider immediately for fluid
resuscitation and further intervention.
DIF: Analysis
REF: Not provided in the source material.
OBJ: Recognize early signs of shock.
TOP: Post-operative Complications / Safety
Question 3
A client with COPD becomes confused and drowsy. ABGs show pH 7.28, PaCO₂ 65, PaO₂ 60. What action
should the nurse anticipate?
A. Withhold oxygen.
B. Prepare for possible ventilation support.
C. Encourage pursed-lip breathing only.
D. Decrease fluid intake.
Correct Answer:
B. Prepare for possible ventilation support.
Expert Rationale:
The client has respiratory acidosis (pH 7.28, elevated PaCO₂ 65) with confusion and drowsiness,
indicating CO₂ narcosis and impending respiratory failure. Ventilatory support (non-invasive or invasive)
is likely needed. Withholding oxygen would worsen hypoxemia, pursed-lip breathing alone is insufficient
for this severity, and decreasing fluids is not indicated.
Explanation of Incorrect Options:
• A. Withholding oxygen would worsen hypoxemia and is dangerous.
• B. Correct. CO₂ narcosis with declining mental status requires ventilatory support.
• C. Pursed-lip breathing alone is insufficient for severe respiratory acidosis.
• D. Decreasing fluid intake does not address the respiratory failure.
Test-Taking Tip:
COPD + confusion + high CO₂ = CO₂ narcosis → prepare for ventilatory support (BiPAP or intubation).
DIF: Analysis
REF: Not provided in the source material.
2026/2027+ PAST PAPERS FROM 2023,2024,2025
WITH DETAILED RATIONALES, SCREENSHOOTS AND
PICTURES
,Table of Contents
HESI RN Medical-Surgical V1 ............. 3
HESI RN Medical-Surgical V2 ......... 99
HESI RN Medical-Surgical V3 ...... 140
HESI RN Medical-Surgical V4 ......... 297
HESI RN Medical-Surgical V5 ....... 482
HESI RN Medical-Surgical V6 ...... 718
PAST PAPERS FROM 2023,2024,2025
WITH DETAILED RATIONALES,
SCREENSHOOTS AND PICTURES ... 767
,HESI RN Medical-Surgical V1
Question 1
A client with heart failure suddenly develops pink-tinged frothy sputum, severe dyspnea, and anxiety.
Which action should the nurse take first?
A. Increase IV fluids.
B. Place the client in high Fowler's position.
C. Obtain a sputum sample.
D. Administer PRN antianxiety medication.
Correct Answer:
B. Place the client in high Fowler's position.
Expert Rationale:
Pink-tinged frothy sputum, severe dyspnea, and anxiety indicate acute pulmonary edema, a life-
threatening complication of heart failure. High Fowler's position improves oxygenation by allowing
maximal lung expansion and decreases venous return to the heart, reducing pulmonary congestion. This
is a rapid, nurse-initiated intervention that directly addresses the immediate respiratory compromise.
Increasing IV fluids would worsen pulmonary edema, obtaining a sputum sample delays essential
intervention, and antianxiety medication does not address the underlying oxygenation problem.
Explanation of Incorrect Options:
• A. Increasing IV fluids would worsen fluid overload and pulmonary edema.
• B. Correct. High Fowler's position improves oxygenation and reduces venous return.
• C. Obtaining a sputum sample is not the priority and delays essential intervention.
• D. Administering an antianxiety medication does not address the underlying pulmonary edema and
hypoxemia.
Test-Taking Tip:
Pink frothy sputum + severe dyspnea = acute pulmonary edema. Position first (high Fowler's) to improve
breathing, then administer oxygen and diuretics per orders.
DIF: Application
REF: Not provided in the source material.
OBJ: Prioritize respiratory distress interventions.
TOP: Cardiac / Respiratory Failure / Safety
Question 2
A postoperative client has a blood pressure of 88/52, a heart rate of 132/min, and cool, clammy skin.
Which action is priority?
A. Increase oral fluids.
B. Check urine sample.
C. Notify the provider.
D. Reposition the client for comfort.
Correct Answer:
C. Notify the provider.
, Expert Rationale:
Hypotension, tachycardia, and cool, clammy skin indicate shock (likely hypovolemic or hemorrhagic) in a
postoperative client. The priority is rapid provider notification so that fluid resuscitation, blood products,
and further diagnostic evaluation can be initiated promptly. Increasing oral fluids is inadequate for shock,
checking a urine sample is not the priority, and repositioning for comfort does not address the life-
threatening condition.
Explanation of Incorrect Options:
• A. Oral fluids are inadequate for a client in shock and may be contraindicated.
• B. Checking a urine sample is not the priority in shock.
• C. Correct. These findings indicate shock and require immediate provider notification.
• D. Repositioning for comfort does not address the life-threatening condition.
Test-Taking Tip:
Post-op hypotension + tachycardia + cool, clammy skin = shock. Notify the provider immediately for fluid
resuscitation and further intervention.
DIF: Analysis
REF: Not provided in the source material.
OBJ: Recognize early signs of shock.
TOP: Post-operative Complications / Safety
Question 3
A client with COPD becomes confused and drowsy. ABGs show pH 7.28, PaCO₂ 65, PaO₂ 60. What action
should the nurse anticipate?
A. Withhold oxygen.
B. Prepare for possible ventilation support.
C. Encourage pursed-lip breathing only.
D. Decrease fluid intake.
Correct Answer:
B. Prepare for possible ventilation support.
Expert Rationale:
The client has respiratory acidosis (pH 7.28, elevated PaCO₂ 65) with confusion and drowsiness,
indicating CO₂ narcosis and impending respiratory failure. Ventilatory support (non-invasive or invasive)
is likely needed. Withholding oxygen would worsen hypoxemia, pursed-lip breathing alone is insufficient
for this severity, and decreasing fluids is not indicated.
Explanation of Incorrect Options:
• A. Withholding oxygen would worsen hypoxemia and is dangerous.
• B. Correct. CO₂ narcosis with declining mental status requires ventilatory support.
• C. Pursed-lip breathing alone is insufficient for severe respiratory acidosis.
• D. Decreasing fluid intake does not address the respiratory failure.
Test-Taking Tip:
COPD + confusion + high CO₂ = CO₂ narcosis → prepare for ventilatory support (BiPAP or intubation).
DIF: Analysis
REF: Not provided in the source material.
