1
HESI RN Med Surg Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Section 1: Perioperative & Fluid/Electrolyte/Acid-Base (Questions 1-20)
Q1: The nurse is providing preoperative teaching to a client scheduled for a cholecystectomy.
Which statement by the client indicates an understanding of the preoperative NPO status?
A. "I can drink water up until 2 hours before my surgery."
B. "I can have a light breakfast 6 hours before the procedure."
C. "I should not eat or drink anything for at least 6 to 8 hours before surgery."
D. "I can have coffee with cream 4 hours before arrival."
C. "I should not eat or drink anything for at least 6 to 8 hours before surgery." [CORRECT]
Correct Answer: C
Rationale: Standard preoperative NPO (nothing by mouth) status for adults is typically 6 to 8
hours for solids and 2 hours for clear liquids, though protocols vary. Option C represents the
safest standard teaching to prevent aspiration pneumonia during induction. Solid foods are
prohibited within 6-8 hours.
Q2: A client develops hyperthermia, muscle rigidity, and tachycardia during surgery. The nurse
suspects Malignant Hyperthermia (MH). What is the priority action?
A. Administer dantrolene sodium.
B. Increase the sevoflurane concentration.
C. Administer succinylcholine.
D. Administer a beta-blocker.
A. Administer dantrolene sodium. [CORRECT]
Correct Answer: A
,2
Rationale: Malignant Hyperthermia is a life-threatening hypermetabolic reaction to volatile
anesthetics (e.g., sevoflurane) and succinylcholine. Immediate treatment includes stopping
triggers, administering 100% oxygen, cooling measures, and administering dantrolene sodium,
which directly treats the muscle hypermetabolism.
Q3: Postoperative day 2, a client reports sudden shortness of breath, pleuritic chest pain, and
anxiety. The nurse assesses tachycardia and tachypnea. Which complication is the priority
suspicion?
A. Atelectasis
B. Pulmonary Embolism (PE)
C. Pneumonia
D. Wound infection
B. Pulmonary Embolism (PE) [CORRECT]
Correct Answer: B
Rationale: Sudden onset of dyspnea, chest pain, tachycardia, and anxiety in a postoperative
patient are classic signs of a PE. While atelectasis is common, it typically presents gradually with
low-grade fever and diminished breath sounds, not acute sudden distress.
Q4: Which laboratory finding is most indicative of Fluid Volume Deficit (hypovolemia)?
A. BUN/Creatinine ratio of 10:1
B. Urine specific gravity of 1.010
C. Hematocrit of 60%
D. Potassium level of 3.0 mEq/L
C. Hematocrit of 60% [CORRECT]
Correct Answer: C
Rationale: Fluid volume deficit (hypovolemia) causes hemoconcentration, leading to an elevated
hematocrit. A BUN/Cr ratio > 20:1 is also typical of prerenal azotemia due to hypovolemia. A
specific gravity of 1.010 indicates dilute urine (overhydration) and a ratio of 10:1 is normal.
,3
Q5: A client is admitted with hyponatremia (Na+ 125 mEq/L) and confusion. The nurse
anticipates the administration of which medication if the client has symptoms of severe water
intoxication?
A. 3% Hypertonic Saline
B. 0.9% Normal Saline
C. 0.45% Sodium Chloride
D. D5W
A. 3% Hypertonic Saline [CORRECT]
Correct Answer: A
Rationale: Severe symptomatic hyponatremia (e.g., seizures, confusion) requires careful
administration of hypertonic saline (3% NaCl) to increase serum sodium and reduce cerebral
edema. Isotonic saline is used for mild cases or hypovolemic hyponremia, and hypotonic
solutions would worsen the condition.
Q6: The nurse is reviewing the Electrocardiogram (ECG) of a client with hypokalemia. Which
finding is most consistent with this electrolyte imbalance?
A. Peaked T waves
B. Prominent U waves
C. Widened QRS complex
D. Shortened QT interval
B. Prominent U waves [CORRECT]
Correct Answer: B
Rationale: Prominent U waves are a hallmark sign of hypokalemia. Other signs include flattened
T waves and ST depression. Peaked T waves indicate hyperkalemia, and widened QRS indicates
severe hyperkalemia or hypermagnesemia.
Q7: A client with chronic heart failure is prescribed furosemide (Lasix). The nurse must monitor
for which electrolyte imbalance caused by this medication?
A. Hypernatremia
B. Hyperkalemia
, 4
C. Hypokalemia
D. Hypercalcemia
C. Hypokalemia [CORRECT]
Correct Answer: C
Rationale: Loop diuretics like furosemide increase the excretion of sodium, water, and
potassium. Clients taking furosemide are at high risk for hypokalemia, which can lead to cardiac
dysrhythmias. Potassium supplements or potassium-sparing diuretics are often prescribed
concurrently.
Q8: A client is admitted with Hypercalcemia. Which clinical manifestation should the nurse
expect to find?
A. Positive Chvostek's sign
B. Muscle weakness and bone pain
C. Tetany
D. Diarrhea
B. Muscle weakness and bone pain [CORRECT]
Correct Answer: B
Rationale: Hypercalcemia often causes muscle weakness, fatigue, bone pain (from bone
resorption), kidney stones, and confusion. Tetany and Chvostek's/Trousseau's signs are
associated with hypocalcemia.
Q9: Which ABG result indicates uncompensated Respiratory Acidosis?
A. pH 7.30, PaCO2 50, HCO3 26
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.30, PaCO2 50, HCO3 30
D. pH 7.50, PaCO2 30, HCO3 20
A. pH 7.30, PaCO2 50, HCO3 26 [CORRECT]
Correct Answer: A
HESI RN Med Surg Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Section 1: Perioperative & Fluid/Electrolyte/Acid-Base (Questions 1-20)
Q1: The nurse is providing preoperative teaching to a client scheduled for a cholecystectomy.
Which statement by the client indicates an understanding of the preoperative NPO status?
A. "I can drink water up until 2 hours before my surgery."
B. "I can have a light breakfast 6 hours before the procedure."
C. "I should not eat or drink anything for at least 6 to 8 hours before surgery."
D. "I can have coffee with cream 4 hours before arrival."
C. "I should not eat or drink anything for at least 6 to 8 hours before surgery." [CORRECT]
Correct Answer: C
Rationale: Standard preoperative NPO (nothing by mouth) status for adults is typically 6 to 8
hours for solids and 2 hours for clear liquids, though protocols vary. Option C represents the
safest standard teaching to prevent aspiration pneumonia during induction. Solid foods are
prohibited within 6-8 hours.
Q2: A client develops hyperthermia, muscle rigidity, and tachycardia during surgery. The nurse
suspects Malignant Hyperthermia (MH). What is the priority action?
A. Administer dantrolene sodium.
B. Increase the sevoflurane concentration.
C. Administer succinylcholine.
D. Administer a beta-blocker.
A. Administer dantrolene sodium. [CORRECT]
Correct Answer: A
,2
Rationale: Malignant Hyperthermia is a life-threatening hypermetabolic reaction to volatile
anesthetics (e.g., sevoflurane) and succinylcholine. Immediate treatment includes stopping
triggers, administering 100% oxygen, cooling measures, and administering dantrolene sodium,
which directly treats the muscle hypermetabolism.
Q3: Postoperative day 2, a client reports sudden shortness of breath, pleuritic chest pain, and
anxiety. The nurse assesses tachycardia and tachypnea. Which complication is the priority
suspicion?
A. Atelectasis
B. Pulmonary Embolism (PE)
C. Pneumonia
D. Wound infection
B. Pulmonary Embolism (PE) [CORRECT]
Correct Answer: B
Rationale: Sudden onset of dyspnea, chest pain, tachycardia, and anxiety in a postoperative
patient are classic signs of a PE. While atelectasis is common, it typically presents gradually with
low-grade fever and diminished breath sounds, not acute sudden distress.
Q4: Which laboratory finding is most indicative of Fluid Volume Deficit (hypovolemia)?
A. BUN/Creatinine ratio of 10:1
B. Urine specific gravity of 1.010
C. Hematocrit of 60%
D. Potassium level of 3.0 mEq/L
C. Hematocrit of 60% [CORRECT]
Correct Answer: C
Rationale: Fluid volume deficit (hypovolemia) causes hemoconcentration, leading to an elevated
hematocrit. A BUN/Cr ratio > 20:1 is also typical of prerenal azotemia due to hypovolemia. A
specific gravity of 1.010 indicates dilute urine (overhydration) and a ratio of 10:1 is normal.
,3
Q5: A client is admitted with hyponatremia (Na+ 125 mEq/L) and confusion. The nurse
anticipates the administration of which medication if the client has symptoms of severe water
intoxication?
A. 3% Hypertonic Saline
B. 0.9% Normal Saline
C. 0.45% Sodium Chloride
D. D5W
A. 3% Hypertonic Saline [CORRECT]
Correct Answer: A
Rationale: Severe symptomatic hyponatremia (e.g., seizures, confusion) requires careful
administration of hypertonic saline (3% NaCl) to increase serum sodium and reduce cerebral
edema. Isotonic saline is used for mild cases or hypovolemic hyponremia, and hypotonic
solutions would worsen the condition.
Q6: The nurse is reviewing the Electrocardiogram (ECG) of a client with hypokalemia. Which
finding is most consistent with this electrolyte imbalance?
A. Peaked T waves
B. Prominent U waves
C. Widened QRS complex
D. Shortened QT interval
B. Prominent U waves [CORRECT]
Correct Answer: B
Rationale: Prominent U waves are a hallmark sign of hypokalemia. Other signs include flattened
T waves and ST depression. Peaked T waves indicate hyperkalemia, and widened QRS indicates
severe hyperkalemia or hypermagnesemia.
Q7: A client with chronic heart failure is prescribed furosemide (Lasix). The nurse must monitor
for which electrolyte imbalance caused by this medication?
A. Hypernatremia
B. Hyperkalemia
, 4
C. Hypokalemia
D. Hypercalcemia
C. Hypokalemia [CORRECT]
Correct Answer: C
Rationale: Loop diuretics like furosemide increase the excretion of sodium, water, and
potassium. Clients taking furosemide are at high risk for hypokalemia, which can lead to cardiac
dysrhythmias. Potassium supplements or potassium-sparing diuretics are often prescribed
concurrently.
Q8: A client is admitted with Hypercalcemia. Which clinical manifestation should the nurse
expect to find?
A. Positive Chvostek's sign
B. Muscle weakness and bone pain
C. Tetany
D. Diarrhea
B. Muscle weakness and bone pain [CORRECT]
Correct Answer: B
Rationale: Hypercalcemia often causes muscle weakness, fatigue, bone pain (from bone
resorption), kidney stones, and confusion. Tetany and Chvostek's/Trousseau's signs are
associated with hypocalcemia.
Q9: Which ABG result indicates uncompensated Respiratory Acidosis?
A. pH 7.30, PaCO2 50, HCO3 26
B. pH 7.50, PaCO2 30, HCO3 24
C. pH 7.30, PaCO2 50, HCO3 30
D. pH 7.50, PaCO2 30, HCO3 20
A. pH 7.30, PaCO2 50, HCO3 26 [CORRECT]
Correct Answer: A
