HESI Med-Surg Final Exam (2025-2026) | 400+ Verified Q&A, NGN Case Studies &
Rationales
Crush the HESI Med-Surg exam with this massive 2026 study guide featuring over 400 verified
questions and Next-Generation (NGN) case studies. This review masters high-yield clinical
domains, including cardiac arrhythmias, acid-base imbalances, and complex prioritization
strategies using the ABC and Maslow’s frameworks. Designed to help you achieve a 900+
score, it provides detailed expert rationales and "HESI Hints" to ensure you are fully prepared
for the Evolve Elsevier proctored final.
1. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of
6.4 mEq/L. Which rhythm change is the priority for the nurse to monitor on the
EKG?
A. U-waves
B. Inverted T-waves
C. Peaked T-waves
D. ST-segment elevation
• Answer: C
• Rationale: Hyperkalemia (K+ > 5.0) causes peaked T-waves and widened QRS
complexes. U-waves and inverted T-waves are signs of hypokalemia.
2. A nurse is assessing a patient with Left-Sided Heart Failure. Which finding
should the nurse expect to document?
A. Peripheral edema
B. Jugular Venous Distention (JVD)
C. Pulmonary crackles and dyspnea
D. Hepatomegaly
• Answer: C
• Rationale: Left-sided failure affects the lungs (Left = Lungs). Right-sided failure
causes systemic backup like JVD and peripheral edema.
3. Which clinical manifestation is the EARLIEST sign of increased intracranial
pressure (ICP)?
. Sluggish pupillary response
B. Decerebrate posturing
,C. Change in Level of Consciousness (LOC)
D. Cushing’s Triad
• Answer: C
• Rationale: Agitation, restlessness, or confusion are the very first signs of rising
ICP. Cushing's Triad is a very late sign.
4. A patient is prescribed Warfarin (Coumadin) for Atrial Fibrillation. Which
laboratory value should the nurse monitor to evaluate the medication’s
effectiveness?
A. PTT
B. Platelet count
C. PT/INR
D. Hemoglobin
• Answer: C
• Rationale: Warfarin is monitored via PT/INR. Heparin is monitored via PTT.
5. A nurse is caring for a patient with an occlusive chest tube. The nurse notes
continuous bubbling in the water seal chamber. What is the nurse's priority
action?
A. Increase the suction pressure
B. Check the system for an air leak
C. Document this as a normal finding
D. Clamp the tube immediately
• Answer: B
• Rationale: Intermittent bubbling is normal during expiration/coughing, but
continuous bubbling indicates a leak in the system or at the insertion site.
6. A patient presents with a "beefy red tongue" and reports numbness in the
fingers. Which condition should the nurse suspect?
A. Iron Deficiency Anemia
B. Pernicious Anemia
C. Aplastic Anemia
D. Sickle Cell Anemia
• Answer: B
• Rationale: Glossitis (beefy red tongue) and neurological symptoms are hallmark
signs of Vitamin B12 deficiency (Pernicious Anemia).
,7. What is the priority nursing intervention for a patient experiencing Autonomic
Dysreflexia?
A. Lower the head of the bed
B. Administer a bolus of IV fluids
C. Sit the patient upright (High-Fowler’s)
D. Prepare for emergency intubation
• Answer: C
• Rationale: The first action is to sit the patient up to lower the dangerously high
blood pressure, then check for the trigger (usually a full bladder).
8. A patient has a serum sodium level of 118 mEq/L. Which safety precaution is
the priority?
A. Cardiac monitoring
B. Seizure precautions
C. Bleeding precautions
D. Strict bedrest
• Answer: B
• Rationale: Severe hyponatremia (<120) puts the patient at extreme risk for
cerebral edema and seizures.
9. The nurse is caring for a patient with suspected Acute Pancreatitis. Which
physical assessment finding supports this diagnosis?
A. Pain at McBurney’s Point
B. Positive Cullen’s Sign
C. Positive Murphy’s Sign
D. Blumberg’s Sign
• Answer: B
• Rationale: Cullen’s sign (periumbilical bruising) indicates retroperitoneal
bleeding common in severe pancreatitis. Murphy’s sign is for cholecystitis.
10. Which medication is the antidote for Magnesium Sulfate toxicity?
A. Naloxone
B. Vitamin K
C. Protamine Sulfate
D. Calcium Gluconate
• Answer: D
, • Rationale: Calcium Gluconate must be at the bedside for any patient receiving
Magnesium Sulfate.
11. A nurse is assessing a patient with a fractured femur. The patient suddenly
becomes restless and the nurse notes petechiae on the chest. What is the priority
nursing action?
A. Call for a STAT EKG
B. Administer oxygen via non-rebreather mask
C. Increase the IV rate
D. Perform a neurological assessment
• Answer: B
• Rationale: Restlessness and petechiae after a long-bone fracture indicate Fat
Embolism Syndrome. Oxygenation is the ABC priority.
12. A patient with Type 1 Diabetes is found sweaty, shaky, and oriented. The
blood glucose is 55 mg/dL. What should the nurse do first?
A. Administer Glucagon IM
B. Give 15g of simple carbohydrates (e.g., orange juice)
C. Administer 1 unit of Regular Insulin
D. Give a complex carbohydrate (e.g., crackers and cheese)
• Answer: B
• Rationale: Use the "Rule of 15" for conscious patients. Glucagon is for
unconscious patients.
13. Which acid-base imbalance should the nurse expect in a patient with a
massive opioid overdose?
A. Respiratory Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
• Answer: C
• Rationale: Opioids cause respiratory depression, leading to CO2 retention
(acidosis).
14. A nurse is assessing a patient with Cushing’s Syndrome. Which group of
findings is expected?
A. Weight loss, hypotension, and bronze skin
B. Moon face, buffalo hump, and hyperglycemia
Rationales
Crush the HESI Med-Surg exam with this massive 2026 study guide featuring over 400 verified
questions and Next-Generation (NGN) case studies. This review masters high-yield clinical
domains, including cardiac arrhythmias, acid-base imbalances, and complex prioritization
strategies using the ABC and Maslow’s frameworks. Designed to help you achieve a 900+
score, it provides detailed expert rationales and "HESI Hints" to ensure you are fully prepared
for the Evolve Elsevier proctored final.
1. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of
6.4 mEq/L. Which rhythm change is the priority for the nurse to monitor on the
EKG?
A. U-waves
B. Inverted T-waves
C. Peaked T-waves
D. ST-segment elevation
• Answer: C
• Rationale: Hyperkalemia (K+ > 5.0) causes peaked T-waves and widened QRS
complexes. U-waves and inverted T-waves are signs of hypokalemia.
2. A nurse is assessing a patient with Left-Sided Heart Failure. Which finding
should the nurse expect to document?
A. Peripheral edema
B. Jugular Venous Distention (JVD)
C. Pulmonary crackles and dyspnea
D. Hepatomegaly
• Answer: C
• Rationale: Left-sided failure affects the lungs (Left = Lungs). Right-sided failure
causes systemic backup like JVD and peripheral edema.
3. Which clinical manifestation is the EARLIEST sign of increased intracranial
pressure (ICP)?
. Sluggish pupillary response
B. Decerebrate posturing
,C. Change in Level of Consciousness (LOC)
D. Cushing’s Triad
• Answer: C
• Rationale: Agitation, restlessness, or confusion are the very first signs of rising
ICP. Cushing's Triad is a very late sign.
4. A patient is prescribed Warfarin (Coumadin) for Atrial Fibrillation. Which
laboratory value should the nurse monitor to evaluate the medication’s
effectiveness?
A. PTT
B. Platelet count
C. PT/INR
D. Hemoglobin
• Answer: C
• Rationale: Warfarin is monitored via PT/INR. Heparin is monitored via PTT.
5. A nurse is caring for a patient with an occlusive chest tube. The nurse notes
continuous bubbling in the water seal chamber. What is the nurse's priority
action?
A. Increase the suction pressure
B. Check the system for an air leak
C. Document this as a normal finding
D. Clamp the tube immediately
• Answer: B
• Rationale: Intermittent bubbling is normal during expiration/coughing, but
continuous bubbling indicates a leak in the system or at the insertion site.
6. A patient presents with a "beefy red tongue" and reports numbness in the
fingers. Which condition should the nurse suspect?
A. Iron Deficiency Anemia
B. Pernicious Anemia
C. Aplastic Anemia
D. Sickle Cell Anemia
• Answer: B
• Rationale: Glossitis (beefy red tongue) and neurological symptoms are hallmark
signs of Vitamin B12 deficiency (Pernicious Anemia).
,7. What is the priority nursing intervention for a patient experiencing Autonomic
Dysreflexia?
A. Lower the head of the bed
B. Administer a bolus of IV fluids
C. Sit the patient upright (High-Fowler’s)
D. Prepare for emergency intubation
• Answer: C
• Rationale: The first action is to sit the patient up to lower the dangerously high
blood pressure, then check for the trigger (usually a full bladder).
8. A patient has a serum sodium level of 118 mEq/L. Which safety precaution is
the priority?
A. Cardiac monitoring
B. Seizure precautions
C. Bleeding precautions
D. Strict bedrest
• Answer: B
• Rationale: Severe hyponatremia (<120) puts the patient at extreme risk for
cerebral edema and seizures.
9. The nurse is caring for a patient with suspected Acute Pancreatitis. Which
physical assessment finding supports this diagnosis?
A. Pain at McBurney’s Point
B. Positive Cullen’s Sign
C. Positive Murphy’s Sign
D. Blumberg’s Sign
• Answer: B
• Rationale: Cullen’s sign (periumbilical bruising) indicates retroperitoneal
bleeding common in severe pancreatitis. Murphy’s sign is for cholecystitis.
10. Which medication is the antidote for Magnesium Sulfate toxicity?
A. Naloxone
B. Vitamin K
C. Protamine Sulfate
D. Calcium Gluconate
• Answer: D
, • Rationale: Calcium Gluconate must be at the bedside for any patient receiving
Magnesium Sulfate.
11. A nurse is assessing a patient with a fractured femur. The patient suddenly
becomes restless and the nurse notes petechiae on the chest. What is the priority
nursing action?
A. Call for a STAT EKG
B. Administer oxygen via non-rebreather mask
C. Increase the IV rate
D. Perform a neurological assessment
• Answer: B
• Rationale: Restlessness and petechiae after a long-bone fracture indicate Fat
Embolism Syndrome. Oxygenation is the ABC priority.
12. A patient with Type 1 Diabetes is found sweaty, shaky, and oriented. The
blood glucose is 55 mg/dL. What should the nurse do first?
A. Administer Glucagon IM
B. Give 15g of simple carbohydrates (e.g., orange juice)
C. Administer 1 unit of Regular Insulin
D. Give a complex carbohydrate (e.g., crackers and cheese)
• Answer: B
• Rationale: Use the "Rule of 15" for conscious patients. Glucagon is for
unconscious patients.
13. Which acid-base imbalance should the nurse expect in a patient with a
massive opioid overdose?
A. Respiratory Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
• Answer: C
• Rationale: Opioids cause respiratory depression, leading to CO2 retention
(acidosis).
14. A nurse is assessing a patient with Cushing’s Syndrome. Which group of
findings is expected?
A. Weight loss, hypotension, and bronze skin
B. Moon face, buffalo hump, and hyperglycemia
