HESI Midpoint Exam Practice Test 2026
This exam is divided into sections covering Medical-Surgical Nursing, Fundamentals, and specialty areas
like Pediatrics and Psychiatric/Maternal Health.
Section 1: 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
*(Rationale: Increasing drowsiness in a COPD patient can be a sign of carbon dioxide (CO2)
narcosis, a dangerous condition caused by over-oxygenation.)*
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 provider
C. Encourage fluids
D. Decrease activity
(Rationale: A rapid weight gain indicates fluid retention, a key sign of worsening heart failure
that requires medical intervention.)
3. A client's potassium level is 2.9 mEq/L. What is the priority action?
A. Place the client on a cardiac monitor
B. Give insulin
C. Restrict fluids
D. Encourage ambulation
(Rationale: Hypokalemia (low potassium) can lead to life-threatening cardiac dysrhythmias.
Cardiac monitoring is the priority.)
4. In a post-operative thyroidectomy patient, what is the priority assessment?
A. Calcium level
B. Hoarseness
C. Temperature
D. Blood pressure
(Rationale: Assessing for hypocalcemia is critical due to the risk of damaging the parathyroid
glands during surgery, which can lead to tetany.)
5. A chest tube becomes disconnected from the drainage system. What is the nurse's first
action?
A. Clamp the tube
B. Place the end in sterile water
C. Notify the provider
D. Apply a dry dressing
, (Rationale: Placing the end in sterile water creates a water seal, preventing air from entering the
pleural space and causing a pneumothorax.)
6. What is a classic symptom of a myocardial infarction (MI) in women?
A. Crushing chest pain
B. Jaw pain
C. Left arm numbness
D. Diaphoresis
(Rationale: Women often present with atypical MI symptoms such as jaw or back pain, nausea,
and extreme fatigue, rather than the classic crushing chest pain.)
7. A client has altered renal function. The most accurate indicator of fluid balance during weekly
home health visits is:
A. Difference in intake and output
B. Changes in mucous membranes
C. Skin turgor
D. Weekly weight
(Rationale: Daily or weekly weight is the most objective and reliable indicator of fluid gain or
loss, especially in clients with renal issues.)
8. The nurse assesses a 72-year-old client admitted for right-sided congestive heart failure.
Which finding would the nurse anticipate?
A. Decreased urinary output
B. Jugular vein distention
C. Pleural effusion
D. Bibasilar crackles
(Rationale: Right-sided heart failure results in systemic backup of blood, leading to jugular vein
distention, peripheral edema, and hepatomegaly.)
9. A client with heart failure is on digoxin. Why is adequate potassium intake important?
A. Hypokalemia can predispose the client to digoxin toxicity and dysrhythmias.
B. Hypokalemia may lead to oliguria.
C. Hypokalemia may cause irritability and anxiety.
D. Hypokalemia sometimes alters consciousness.
(Rationale: Low potassium levels potentiate the effects of digoxin, increasing the risk of toxicity
and dangerous heart rhythms.)
10. A nurse assesses a young adult in the ER after an MVA. 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 are a classic sign of severe brain stem damage or herniation,
indicating a critical, life-threatening condition.)
This exam is divided into sections covering Medical-Surgical Nursing, Fundamentals, and specialty areas
like Pediatrics and Psychiatric/Maternal Health.
Section 1: 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
*(Rationale: Increasing drowsiness in a COPD patient can be a sign of carbon dioxide (CO2)
narcosis, a dangerous condition caused by over-oxygenation.)*
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 provider
C. Encourage fluids
D. Decrease activity
(Rationale: A rapid weight gain indicates fluid retention, a key sign of worsening heart failure
that requires medical intervention.)
3. A client's potassium level is 2.9 mEq/L. What is the priority action?
A. Place the client on a cardiac monitor
B. Give insulin
C. Restrict fluids
D. Encourage ambulation
(Rationale: Hypokalemia (low potassium) can lead to life-threatening cardiac dysrhythmias.
Cardiac monitoring is the priority.)
4. In a post-operative thyroidectomy patient, what is the priority assessment?
A. Calcium level
B. Hoarseness
C. Temperature
D. Blood pressure
(Rationale: Assessing for hypocalcemia is critical due to the risk of damaging the parathyroid
glands during surgery, which can lead to tetany.)
5. A chest tube becomes disconnected from the drainage system. What is the nurse's first
action?
A. Clamp the tube
B. Place the end in sterile water
C. Notify the provider
D. Apply a dry dressing
, (Rationale: Placing the end in sterile water creates a water seal, preventing air from entering the
pleural space and causing a pneumothorax.)
6. What is a classic symptom of a myocardial infarction (MI) in women?
A. Crushing chest pain
B. Jaw pain
C. Left arm numbness
D. Diaphoresis
(Rationale: Women often present with atypical MI symptoms such as jaw or back pain, nausea,
and extreme fatigue, rather than the classic crushing chest pain.)
7. A client has altered renal function. The most accurate indicator of fluid balance during weekly
home health visits is:
A. Difference in intake and output
B. Changes in mucous membranes
C. Skin turgor
D. Weekly weight
(Rationale: Daily or weekly weight is the most objective and reliable indicator of fluid gain or
loss, especially in clients with renal issues.)
8. The nurse assesses a 72-year-old client admitted for right-sided congestive heart failure.
Which finding would the nurse anticipate?
A. Decreased urinary output
B. Jugular vein distention
C. Pleural effusion
D. Bibasilar crackles
(Rationale: Right-sided heart failure results in systemic backup of blood, leading to jugular vein
distention, peripheral edema, and hepatomegaly.)
9. A client with heart failure is on digoxin. Why is adequate potassium intake important?
A. Hypokalemia can predispose the client to digoxin toxicity and dysrhythmias.
B. Hypokalemia may lead to oliguria.
C. Hypokalemia may cause irritability and anxiety.
D. Hypokalemia sometimes alters consciousness.
(Rationale: Low potassium levels potentiate the effects of digoxin, increasing the risk of toxicity
and dangerous heart rhythms.)
10. A nurse assesses a young adult in the ER after an MVA. 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 are a classic sign of severe brain stem damage or herniation,
indicating a critical, life-threatening condition.)
