HESI Midpoint Exam Practice Test 2026
Instructions: Choose the best answer for each question. The correct answer is indicated in the Correct
Answer section following each question, along with a rationale.
Medical-Surgical Nursing
1. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Which finding requires
immediate intervention?
A. O2 sat 90%
B. RR 22
C. Increasing drowsiness
D. Mild wheezing
Correct Answer: C. Increasing drowsiness
Rationale: In patients with COPD, the drive to breathe is often stimulated by low oxygen levels (hypoxic
drive). A high flow of oxygen can eliminate this drive, leading to hypoventilation, carbon dioxide
retention (hypercapnia), and increasing drowsiness or lethargy, which indicates a critical emergency.
2. A patient with heart failure reports a weight gain of 3 lbs in 2 days. The nurse should:
A. Document as normal
B. Notify the healthcare provider
C. Encourage fluids
D. Decrease activity
Correct Answer: B. Notify the healthcare provider
*Rationale: A rapid weight gain of 2-3 lbs in 24-48 hours is a classic sign of fluid retention and worsening
heart failure. The healthcare provider needs to be notified immediately for potential medication
adjustments, such as increasing diuretics.*
3. A patient's potassium level is 2.9 mEq/L. What is the nurse's priority action?
A. Place the patient on a cardiac monitor
B. Administer insulin as ordered
C. Restrict oral fluids
D. Encourage ambulation
Correct Answer: A. Place the patient on a cardiac monitor
Rationale: Severe hypokalemia (low potassium) can lead to life-threatening cardiac dysrhythmias. The
priority is to monitor the cardiac rhythm continuously while preparing to administer potassium
replacement.
4. What is the priority assessment for a patient 24 hours post-operative following a thyroidectomy?
A. Assess for a positive Trousseau's sign
B. Assess for hoarseness
C. Check the patient's temperature
D. Monitor blood pressure
Correct Answer: A. Assess for a positive Trousseau's sign
Rationale: A thyroidectomy puts the patient at risk for accidental removal or damage to the parathyroid
glands, which regulate calcium. A positive Trousseau's sign (carpopedal spasm) or Chvostek's sign
, indicates hypocalcemia, which can lead to life-threatening laryngospasm. While hoarseness (B) is
important to assess for laryngeal nerve damage, airway compromise from hypocalcemia is the higher
priority.
5. A patient's chest tube becomes disconnected from the drainage system. What is the nurse's first
action?
A. Clamp the chest tube immediately
B. Place the end of the tube in sterile water
C. Notify the healthcare provider
D. Apply a dry, sterile dressing over the disconnection site
Correct Answer: B. Place the end of the tube in sterile water
Rationale: The immediate priority is to prevent a tension pneumothorax by re-establishing a water seal.
Placing the end of the tube in a bottle of sterile water creates a temporary water seal, preventing air
from entering the pleural space until a new system can be set up. Clamping (A) can cause a tension
pneumothorax if the air leak is ongoing.
6. A classic symptom of a myocardial infarction (MI) in women is:
A. Crushing substernal chest pain
B. Jaw pain
C. Left arm numbness
D. Bradycardia
Correct Answer: B. Jaw pain
Rationale: Women often present with atypical MI symptoms such as jaw or back pain, profound fatigue,
nausea, or indigestion, rather than the classic "crushing chest pain" seen more commonly in men.
7. A patient is admitted with new-onset confusion and has an oxygen saturation of 88%. What should
the nurse do first?
A. Call the provider for a stat chest x-ray.
B. Apply supplemental oxygen.
C. Recheck the saturation in 30 minutes.
D. Raise the head of the bed.
Correct Answer: B. Apply supplemental oxygen.
Rationale: The ABCs (Airway, Breathing, Circulation) guide priority actions. This patient is hypoxic and
showing signs of cerebral hypoxia (confusion). The immediate intervention is to apply oxygen to improve
oxygenation to the brain and other vital organs.
8. A patient with cirrhosis has an ammonia level of 150 mcg/dL. Which medication does the nurse
anticipate administering?
A. Furosemide
B. Lactulose
C. Magnesium citrate
D. Phytonadione (Vitamin K)
Correct Answer: B. Lactulose
Rationale: Elevated ammonia levels in liver failure lead to hepatic encephalopathy. Lactulose works by
acidifying the colon, trapping ammonium and promoting its excretion in the stool, thereby lowering
serum ammonia levels.
Instructions: Choose the best answer for each question. The correct answer is indicated in the Correct
Answer section following each question, along with a rationale.
Medical-Surgical Nursing
1. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Which finding requires
immediate intervention?
A. O2 sat 90%
B. RR 22
C. Increasing drowsiness
D. Mild wheezing
Correct Answer: C. Increasing drowsiness
Rationale: In patients with COPD, the drive to breathe is often stimulated by low oxygen levels (hypoxic
drive). A high flow of oxygen can eliminate this drive, leading to hypoventilation, carbon dioxide
retention (hypercapnia), and increasing drowsiness or lethargy, which indicates a critical emergency.
2. A patient with heart failure reports a weight gain of 3 lbs in 2 days. The nurse should:
A. Document as normal
B. Notify the healthcare provider
C. Encourage fluids
D. Decrease activity
Correct Answer: B. Notify the healthcare provider
*Rationale: A rapid weight gain of 2-3 lbs in 24-48 hours is a classic sign of fluid retention and worsening
heart failure. The healthcare provider needs to be notified immediately for potential medication
adjustments, such as increasing diuretics.*
3. A patient's potassium level is 2.9 mEq/L. What is the nurse's priority action?
A. Place the patient on a cardiac monitor
B. Administer insulin as ordered
C. Restrict oral fluids
D. Encourage ambulation
Correct Answer: A. Place the patient on a cardiac monitor
Rationale: Severe hypokalemia (low potassium) can lead to life-threatening cardiac dysrhythmias. The
priority is to monitor the cardiac rhythm continuously while preparing to administer potassium
replacement.
4. What is the priority assessment for a patient 24 hours post-operative following a thyroidectomy?
A. Assess for a positive Trousseau's sign
B. Assess for hoarseness
C. Check the patient's temperature
D. Monitor blood pressure
Correct Answer: A. Assess for a positive Trousseau's sign
Rationale: A thyroidectomy puts the patient at risk for accidental removal or damage to the parathyroid
glands, which regulate calcium. A positive Trousseau's sign (carpopedal spasm) or Chvostek's sign
, indicates hypocalcemia, which can lead to life-threatening laryngospasm. While hoarseness (B) is
important to assess for laryngeal nerve damage, airway compromise from hypocalcemia is the higher
priority.
5. A patient's chest tube becomes disconnected from the drainage system. What is the nurse's first
action?
A. Clamp the chest tube immediately
B. Place the end of the tube in sterile water
C. Notify the healthcare provider
D. Apply a dry, sterile dressing over the disconnection site
Correct Answer: B. Place the end of the tube in sterile water
Rationale: The immediate priority is to prevent a tension pneumothorax by re-establishing a water seal.
Placing the end of the tube in a bottle of sterile water creates a temporary water seal, preventing air
from entering the pleural space until a new system can be set up. Clamping (A) can cause a tension
pneumothorax if the air leak is ongoing.
6. A classic symptom of a myocardial infarction (MI) in women is:
A. Crushing substernal chest pain
B. Jaw pain
C. Left arm numbness
D. Bradycardia
Correct Answer: B. Jaw pain
Rationale: Women often present with atypical MI symptoms such as jaw or back pain, profound fatigue,
nausea, or indigestion, rather than the classic "crushing chest pain" seen more commonly in men.
7. A patient is admitted with new-onset confusion and has an oxygen saturation of 88%. What should
the nurse do first?
A. Call the provider for a stat chest x-ray.
B. Apply supplemental oxygen.
C. Recheck the saturation in 30 minutes.
D. Raise the head of the bed.
Correct Answer: B. Apply supplemental oxygen.
Rationale: The ABCs (Airway, Breathing, Circulation) guide priority actions. This patient is hypoxic and
showing signs of cerebral hypoxia (confusion). The immediate intervention is to apply oxygen to improve
oxygenation to the brain and other vital organs.
8. A patient with cirrhosis has an ammonia level of 150 mcg/dL. Which medication does the nurse
anticipate administering?
A. Furosemide
B. Lactulose
C. Magnesium citrate
D. Phytonadione (Vitamin K)
Correct Answer: B. Lactulose
Rationale: Elevated ammonia levels in liver failure lead to hepatic encephalopathy. Lactulose works by
acidifying the colon, trapping ammonium and promoting its excretion in the stool, thereby lowering
serum ammonia levels.
