HESI Midpoint Exam 2026 Update
Comprehensive Practice Test
Instructions:
Choose the best answer for each question. Correct answers are indicated in bold following each question,
with rationales provided for key concepts.
Medical-Surgical Nursing (Questions 1-30)
1. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Which finding requires
immediate intervention?
A. O2 saturation 90%
B. Respiratory rate 22
C. Increasing drowsiness
D. Mild wheezing
Rationale: Increasing drowsiness in a COPD patient receiving oxygen may indicate rising CO2 levels
(carbon dioxide narcosis), which requires immediate intervention. Oxygen should be titrated to maintain
SpO2 at 90-92% in COPD patients .
2. A patient with heart failure reports weight gain of 3 lbs in 2 days. The nurse should:
A. Document as normal
B. Notify the provider
C. Encourage fluids
D. Decrease activity
Rationale: A 3-pound weight gain over 2 days indicates fluid retention and worsening heart failure,
requiring provider notification for possible medication adjustment .
3. A patient's potassium level is 2.9 mEq/L. What is the priority action?
A. Place on cardiac monitor
B. Administer insulin
C. Restrict fluids
D. Encourage ambulation
,Rationale: Hypokalemia (K+ <3.5 mEq/L) can cause life-threatening dysrhythmias. Cardiac monitoring is
the priority to detect and treat arrhythmias early .
4. Following a thyroidectomy, which assessment finding is the priority?
A. Signs of hypocalcemia (tetany, numbness)
B. Mild hoarseness
C. Temperature 99.2°F
D. Blood pressure 130/80 mmHg
Rationale: Post-thyroidectomy, the priority is monitoring for hypocalcemia due to possible parathyroid
gland damage or removal. Tetany, numbness, and tingling require immediate intervention .
5. A chest tube becomes disconnected from the drainage system. What is the nurse's first action?
A. Clamp the chest tube
B. Place the end of the tube in sterile water
C. Notify the provider
D. Apply a dry dressing
Rationale: If a chest tube disconnects, immediately place the end in sterile water to create a water seal
and prevent pneumothorax until a new system can be attached .
6. Which symptom is a classic myocardial infarction (MI) presentation in women?
A. Crushing chest pain
B. Jaw pain
C. Left arm radiation
D. Substernal chest pressure
Rationale: Women often present with atypical MI symptoms including jaw pain, back pain, nausea, and
extreme fatigue rather than classic crushing chest pain .
7. A client has altered renal function and is being treated at home. The most accurate indicator of fluid
balance during weekly visits is:
A. Intake and output records
B. Changes in mucous membranes
C. Skin turgor
D. Weekly weight
,Rationale: Daily or weekly weight measurement is the most accurate indicator of fluid balance in clients
with renal dysfunction. Each kilogram (2.2 lbs) weight change equals approximately 1 liter of fluid gain
or loss .
8. Which information is a priority to reinforce to an older client after intravenous pyelography?
A. Eat a light diet for the rest of the day
B. Rest for 24 hours since the test is tiring
C. Drink fluids every hour for the next 2 days
D. Measure urine output and notify provider if it decreases
Rationale: After IV pyelography with contrast dye, monitoring for decreased urine output is essential to
detect contrast-induced nephropathy, especially in older adults .
9. A nurse assesses a young adult in the emergency room following a motor vehicle accident. Which
neurological sign is of most concern?
A. Flaccid paralysis
B. Pupils fixed and dilated
C. Diminished spinal reflexes
D. Reduced sensory responses
Rationale: Fixed and dilated pupils indicate severe brainstem injury or herniation and require immediate
intervention .
10. A client with heart failure has a prescription for digoxin. Why is adequate dietary potassium
important?
A. Hypokalemia with digoxin can predispose to dysrhythmias
B. Hypokalemia may lead to oliguria
C. Hypokalemia causes irritability and anxiety
D. Hypokalemia alters consciousness
Rationale: Hypokalemia increases myocardial sensitivity to digoxin, significantly increasing the risk of
life-threatening dysrhythmias .
11. A client is admitted for first and second-degree burns on the face, neck, anterior chest, and hands.
The nurse's priority is to:
A. Cover areas with dry sterile dressings
B. Assess for dyspnea or stridor
C. Initiate intravenous therapy
D. Administer pain medication
, Rationale: Burns to the face, neck, and chest pose high risk for airway compromise from edema. Airway
assessment is always the priority .
12. While caring for a client admitted with myocardial infarction (MI) 2 days ago, the nurse notes
today's temperature is 101.1°F (38.5°C). The appropriate nursing intervention is:
A. Call the health care provider immediately
B. Administer acetaminophen as ordered as this is normal at this time
C. Send blood, urine, and sputum for culture
D. Increase the client's fluid intake
Rationale: Low-grade fever (99-101°F) is common 24-72 hours post-MI due to inflammatory response to
myocardial tissue necrosis .
13. A client diagnosed with Zollinger-Ellison syndrome requires reinforcement of which most
important information?
A. It involves tumors called gastrinomas in the pancreas or duodenum
B. It is critical to report any findings of peptic ulcers promptly
C. Treatment consists of medications to reduce acid and possible surgery
D. Peptic ulcers may occur at unusual areas of the stomach or intestine
Rationale: In Zollinger-Ellison syndrome, prompt reporting of ulcer symptoms is critical because gastrin-
secreting tumors cause severe, recurrent, and complicated peptic ulcers that can lead to hemorrhage or
perforation .
14. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse determines the
client's blood pressure is increasing. Which action should the nurse take first?
A. Check the protein level in urine
B. Have the client turn to the left side
C. Take the temperature
D. Monitor the urine output
Rationale: Turning the client to the left side relieves pressure on the vena cava, improving venous
return, cardiac output, and potentially lowering blood pressure .
15. When reinforcing teaching about a vasectomy, which statement by the client indicates a need for
further teaching?
A. "I can stop using other contraception immediately after the procedure."
B. "This procedure doesn't impede the production of male hormones."
C. "After vasectomy, strenuous activity needs to be avoided for at least 48 hours."
Comprehensive Practice Test
Instructions:
Choose the best answer for each question. Correct answers are indicated in bold following each question,
with rationales provided for key concepts.
Medical-Surgical Nursing (Questions 1-30)
1. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Which finding requires
immediate intervention?
A. O2 saturation 90%
B. Respiratory rate 22
C. Increasing drowsiness
D. Mild wheezing
Rationale: Increasing drowsiness in a COPD patient receiving oxygen may indicate rising CO2 levels
(carbon dioxide narcosis), which requires immediate intervention. Oxygen should be titrated to maintain
SpO2 at 90-92% in COPD patients .
2. A patient with heart failure reports weight gain of 3 lbs in 2 days. The nurse should:
A. Document as normal
B. Notify the provider
C. Encourage fluids
D. Decrease activity
Rationale: A 3-pound weight gain over 2 days indicates fluid retention and worsening heart failure,
requiring provider notification for possible medication adjustment .
3. A patient's potassium level is 2.9 mEq/L. What is the priority action?
A. Place on cardiac monitor
B. Administer insulin
C. Restrict fluids
D. Encourage ambulation
,Rationale: Hypokalemia (K+ <3.5 mEq/L) can cause life-threatening dysrhythmias. Cardiac monitoring is
the priority to detect and treat arrhythmias early .
4. Following a thyroidectomy, which assessment finding is the priority?
A. Signs of hypocalcemia (tetany, numbness)
B. Mild hoarseness
C. Temperature 99.2°F
D. Blood pressure 130/80 mmHg
Rationale: Post-thyroidectomy, the priority is monitoring for hypocalcemia due to possible parathyroid
gland damage or removal. Tetany, numbness, and tingling require immediate intervention .
5. A chest tube becomes disconnected from the drainage system. What is the nurse's first action?
A. Clamp the chest tube
B. Place the end of the tube in sterile water
C. Notify the provider
D. Apply a dry dressing
Rationale: If a chest tube disconnects, immediately place the end in sterile water to create a water seal
and prevent pneumothorax until a new system can be attached .
6. Which symptom is a classic myocardial infarction (MI) presentation in women?
A. Crushing chest pain
B. Jaw pain
C. Left arm radiation
D. Substernal chest pressure
Rationale: Women often present with atypical MI symptoms including jaw pain, back pain, nausea, and
extreme fatigue rather than classic crushing chest pain .
7. A client has altered renal function and is being treated at home. The most accurate indicator of fluid
balance during weekly visits is:
A. Intake and output records
B. Changes in mucous membranes
C. Skin turgor
D. Weekly weight
,Rationale: Daily or weekly weight measurement is the most accurate indicator of fluid balance in clients
with renal dysfunction. Each kilogram (2.2 lbs) weight change equals approximately 1 liter of fluid gain
or loss .
8. Which information is a priority to reinforce to an older client after intravenous pyelography?
A. Eat a light diet for the rest of the day
B. Rest for 24 hours since the test is tiring
C. Drink fluids every hour for the next 2 days
D. Measure urine output and notify provider if it decreases
Rationale: After IV pyelography with contrast dye, monitoring for decreased urine output is essential to
detect contrast-induced nephropathy, especially in older adults .
9. A nurse assesses a young adult in the emergency room following a motor vehicle accident. Which
neurological sign is of most concern?
A. Flaccid paralysis
B. Pupils fixed and dilated
C. Diminished spinal reflexes
D. Reduced sensory responses
Rationale: Fixed and dilated pupils indicate severe brainstem injury or herniation and require immediate
intervention .
10. A client with heart failure has a prescription for digoxin. Why is adequate dietary potassium
important?
A. Hypokalemia with digoxin can predispose to dysrhythmias
B. Hypokalemia may lead to oliguria
C. Hypokalemia causes irritability and anxiety
D. Hypokalemia alters consciousness
Rationale: Hypokalemia increases myocardial sensitivity to digoxin, significantly increasing the risk of
life-threatening dysrhythmias .
11. A client is admitted for first and second-degree burns on the face, neck, anterior chest, and hands.
The nurse's priority is to:
A. Cover areas with dry sterile dressings
B. Assess for dyspnea or stridor
C. Initiate intravenous therapy
D. Administer pain medication
, Rationale: Burns to the face, neck, and chest pose high risk for airway compromise from edema. Airway
assessment is always the priority .
12. While caring for a client admitted with myocardial infarction (MI) 2 days ago, the nurse notes
today's temperature is 101.1°F (38.5°C). The appropriate nursing intervention is:
A. Call the health care provider immediately
B. Administer acetaminophen as ordered as this is normal at this time
C. Send blood, urine, and sputum for culture
D. Increase the client's fluid intake
Rationale: Low-grade fever (99-101°F) is common 24-72 hours post-MI due to inflammatory response to
myocardial tissue necrosis .
13. A client diagnosed with Zollinger-Ellison syndrome requires reinforcement of which most
important information?
A. It involves tumors called gastrinomas in the pancreas or duodenum
B. It is critical to report any findings of peptic ulcers promptly
C. Treatment consists of medications to reduce acid and possible surgery
D. Peptic ulcers may occur at unusual areas of the stomach or intestine
Rationale: In Zollinger-Ellison syndrome, prompt reporting of ulcer symptoms is critical because gastrin-
secreting tumors cause severe, recurrent, and complicated peptic ulcers that can lead to hemorrhage or
perforation .
14. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse determines the
client's blood pressure is increasing. Which action should the nurse take first?
A. Check the protein level in urine
B. Have the client turn to the left side
C. Take the temperature
D. Monitor the urine output
Rationale: Turning the client to the left side relieves pressure on the vena cava, improving venous
return, cardiac output, and potentially lowering blood pressure .
15. When reinforcing teaching about a vasectomy, which statement by the client indicates a need for
further teaching?
A. "I can stop using other contraception immediately after the procedure."
B. "This procedure doesn't impede the production of male hormones."
C. "After vasectomy, strenuous activity needs to be avoided for at least 48 hours."
