HESI Med-Surg Final Exam (2025-2026) | 300+ Verified Q&A, NGN Case Studies &
Rationales
Crush the HESI Med-Surg exam with this massive 2026 study guide featuring over 300 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.
Question 1
A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at
2L/min via nasal cannula. The nurse notes the patient is becoming increasingly lethargic
and difficult to arouse. Which action should the nurse take first?
A. Increase the oxygen flow to 4L/min
B. Perform an immediate neurological assessment
C. Lower the oxygen flow rate and monitor respiratory status
D. Position the patient in high-Fowler's position
Correct Answer: C. Lower the oxygen flow rate and monitor respiratory status
Rationale: Patients with chronic hypercapnia (COPD) rely on a "hypoxic drive" to
breathe. Providing excessive oxygen can suppress this drive, leading to hypoventilation,
CO2 narcosis, and lethargy.
Question 2
A nurse is reviewing the morning laboratory results for a patient prescribed Furosemide.
Which value requires the most immediate intervention?
A. Sodium: 136 mEq/L
B. Potassium: 2.8 mEq/L
C. Blood Glucose: 110 mg/dL
D. Magnesium: 1.9 mEq/L
Correct Answer: B. Potassium: 2.8 mEq/L
,Rationale: Furosemide is a loop diuretic that causes significant potassium excretion. A
level of 2.8 is critically low (Normal: 3.5–5.0) and increases the risk for lethal cardiac
arrhythmias.
Question 3
During the assessment of a patient 4 hours post-thyroidectomy, the nurse notes the
patient has a high-pitched "crowing" sound on inspiration. This finding is indicative of:
A. Normal post-operative snoring
B. Laryngeal nerve damage or edema
C. Excessive oral secretions
D. Developing atelectasis
Correct Answer: B. Laryngeal nerve damage or edema
Rationale: Stridor (a crowing sound) is a medical emergency indicating upper airway
obstruction. Following thyroid surgery, this is caused by swelling or tetany from
hypocalcemia.
Question 4
A patient is admitted with a diagnosis of Acute Pancreatitis. Which task is most
appropriate for the nurse to delegate to an Unlicensed Assistive Personnel (UAP)?
A. Explain the importance of NPO status
B. Measure the patient's abdominal girth
C. Obtain and record the patient's daily weight
D. Evaluate the patient's response to pain medication
Correct Answer: C. Obtain and record the patient's daily weight
Rationale: UAPs can perform standardized data collection like weighing. Assessment
(girth), teaching (NPO), and evaluation (medication response) require the clinical
judgment of an RN.
Question 5
A patient with a femur fracture suddenly becomes confused and develops a petechial
rash across the chest. What is the nurse's priority action?
A. Notify the Rapid Response Team
B. Apply supplemental oxygen via mask
C. Prepare for an emergency head CT
D. Perform a complete skin assessment
,Correct Answer: B. Apply supplemental oxygen via mask
Rationale: These are classic signs of Fat Embolism Syndrome. The priority is to
support oxygenation, as the fat globules cause acute respiratory distress and pulmonary
obstruction.
Question 6
Which laboratory value is most important for the nurse to monitor in a patient with
Chronic Kidney Disease (CKD) who is receiving Epoetin Alfa?
A. White blood cell count
B. Serum Creatinine
C. Hematocrit and Hemoglobin
D. Platelet count
Correct Answer: C. Hematocrit and Hemoglobin
Rationale: Epoetin alfa is used to treat anemia in CKD by stimulating RBC production.
Monitoring H&H ensures the therapy is effective and prevents levels from rising too
high, which increases stroke risk.
Question 7
A patient with a chest tube has continuous bubbling in the water seal chamber. What is
the nurse's first action?
A. Increase the wall suction pressure
B. Inspect the tubing and connections for an air leak
C. Document the finding as a normal occurrence
D. Clamp the tube near the patient's chest wall
Correct Answer: B. Inspect the tubing and connections for an air leak
Rationale: While intermittent bubbling occurs with breathing, continuous bubbling
indicates an air leak in the system that must be located and secured.
Question 8
The nurse is assessing a patient for signs of Right-sided Heart Failure. Which finding
should the nurse expect?
A. Pulmonary crackles and wheezing
B. Orthopnea and pink frothy sputum
C. Jugular Venous Distension (JVD) and peripheral edema
D. Displacement of the apical pulse to the left
, Correct Answer: C. Jugular Venous Distension (JVD) and peripheral edema
Rationale: Right-sided failure causes blood to back up into the systemic venous
system, leading to JVD, liver enlargement, and dependent edema.
Question 9
Which medication should the nurse prepare to administer for a patient who has received
a toxic dose of Heparin?
A. Vitamin K
B. Protamine Sulfate
C. Naloxone
D. Acetylcysteine
Correct Answer: B. Protamine Sulfate
Rationale: Protamine sulfate is the specific antagonist used to reverse the
anticoagulant effects of Heparin.
Question 10
A patient is being treated for Diabetic Ketoacidosis (DKA). Which finding indicates that
the chosen interventions are effective?
A. The patient's breath has a fruity odor
B. Serum bicarbonate (HCO3) level is 24 mEq/L
C. The respiratory rate is 32 breaths per minute
D. The urine remains positive for ketones
Correct Answer: B. Serum bicarbonate (HCO3) level is 24 mEq/L
Rationale: DKA causes metabolic acidosis (low HCO3). A return to a normal
bicarbonate range (22–26) indicates the acidosis is resolving.
Question 11
A patient in Buck’s skin traction reports severe, sharp pain in the affected leg. What
should the nurse perform first?
A. Reposition the patient to the center of the bed
B. Check the alignment of the weights and ensure they hang freely
C. Administer the prescribed PRN opioid analgesic
D. Contact the orthopedic surgeon immediately
Correct Answer: B. Check the alignment of the weights and ensure they hang freely
Rationales
Crush the HESI Med-Surg exam with this massive 2026 study guide featuring over 300 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.
Question 1
A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen at
2L/min via nasal cannula. The nurse notes the patient is becoming increasingly lethargic
and difficult to arouse. Which action should the nurse take first?
A. Increase the oxygen flow to 4L/min
B. Perform an immediate neurological assessment
C. Lower the oxygen flow rate and monitor respiratory status
D. Position the patient in high-Fowler's position
Correct Answer: C. Lower the oxygen flow rate and monitor respiratory status
Rationale: Patients with chronic hypercapnia (COPD) rely on a "hypoxic drive" to
breathe. Providing excessive oxygen can suppress this drive, leading to hypoventilation,
CO2 narcosis, and lethargy.
Question 2
A nurse is reviewing the morning laboratory results for a patient prescribed Furosemide.
Which value requires the most immediate intervention?
A. Sodium: 136 mEq/L
B. Potassium: 2.8 mEq/L
C. Blood Glucose: 110 mg/dL
D. Magnesium: 1.9 mEq/L
Correct Answer: B. Potassium: 2.8 mEq/L
,Rationale: Furosemide is a loop diuretic that causes significant potassium excretion. A
level of 2.8 is critically low (Normal: 3.5–5.0) and increases the risk for lethal cardiac
arrhythmias.
Question 3
During the assessment of a patient 4 hours post-thyroidectomy, the nurse notes the
patient has a high-pitched "crowing" sound on inspiration. This finding is indicative of:
A. Normal post-operative snoring
B. Laryngeal nerve damage or edema
C. Excessive oral secretions
D. Developing atelectasis
Correct Answer: B. Laryngeal nerve damage or edema
Rationale: Stridor (a crowing sound) is a medical emergency indicating upper airway
obstruction. Following thyroid surgery, this is caused by swelling or tetany from
hypocalcemia.
Question 4
A patient is admitted with a diagnosis of Acute Pancreatitis. Which task is most
appropriate for the nurse to delegate to an Unlicensed Assistive Personnel (UAP)?
A. Explain the importance of NPO status
B. Measure the patient's abdominal girth
C. Obtain and record the patient's daily weight
D. Evaluate the patient's response to pain medication
Correct Answer: C. Obtain and record the patient's daily weight
Rationale: UAPs can perform standardized data collection like weighing. Assessment
(girth), teaching (NPO), and evaluation (medication response) require the clinical
judgment of an RN.
Question 5
A patient with a femur fracture suddenly becomes confused and develops a petechial
rash across the chest. What is the nurse's priority action?
A. Notify the Rapid Response Team
B. Apply supplemental oxygen via mask
C. Prepare for an emergency head CT
D. Perform a complete skin assessment
,Correct Answer: B. Apply supplemental oxygen via mask
Rationale: These are classic signs of Fat Embolism Syndrome. The priority is to
support oxygenation, as the fat globules cause acute respiratory distress and pulmonary
obstruction.
Question 6
Which laboratory value is most important for the nurse to monitor in a patient with
Chronic Kidney Disease (CKD) who is receiving Epoetin Alfa?
A. White blood cell count
B. Serum Creatinine
C. Hematocrit and Hemoglobin
D. Platelet count
Correct Answer: C. Hematocrit and Hemoglobin
Rationale: Epoetin alfa is used to treat anemia in CKD by stimulating RBC production.
Monitoring H&H ensures the therapy is effective and prevents levels from rising too
high, which increases stroke risk.
Question 7
A patient with a chest tube has continuous bubbling in the water seal chamber. What is
the nurse's first action?
A. Increase the wall suction pressure
B. Inspect the tubing and connections for an air leak
C. Document the finding as a normal occurrence
D. Clamp the tube near the patient's chest wall
Correct Answer: B. Inspect the tubing and connections for an air leak
Rationale: While intermittent bubbling occurs with breathing, continuous bubbling
indicates an air leak in the system that must be located and secured.
Question 8
The nurse is assessing a patient for signs of Right-sided Heart Failure. Which finding
should the nurse expect?
A. Pulmonary crackles and wheezing
B. Orthopnea and pink frothy sputum
C. Jugular Venous Distension (JVD) and peripheral edema
D. Displacement of the apical pulse to the left
, Correct Answer: C. Jugular Venous Distension (JVD) and peripheral edema
Rationale: Right-sided failure causes blood to back up into the systemic venous
system, leading to JVD, liver enlargement, and dependent edema.
Question 9
Which medication should the nurse prepare to administer for a patient who has received
a toxic dose of Heparin?
A. Vitamin K
B. Protamine Sulfate
C. Naloxone
D. Acetylcysteine
Correct Answer: B. Protamine Sulfate
Rationale: Protamine sulfate is the specific antagonist used to reverse the
anticoagulant effects of Heparin.
Question 10
A patient is being treated for Diabetic Ketoacidosis (DKA). Which finding indicates that
the chosen interventions are effective?
A. The patient's breath has a fruity odor
B. Serum bicarbonate (HCO3) level is 24 mEq/L
C. The respiratory rate is 32 breaths per minute
D. The urine remains positive for ketones
Correct Answer: B. Serum bicarbonate (HCO3) level is 24 mEq/L
Rationale: DKA causes metabolic acidosis (low HCO3). A return to a normal
bicarbonate range (22–26) indicates the acidosis is resolving.
Question 11
A patient in Buck’s skin traction reports severe, sharp pain in the affected leg. What
should the nurse perform first?
A. Reposition the patient to the center of the bed
B. Check the alignment of the weights and ensure they hang freely
C. Administer the prescribed PRN opioid analgesic
D. Contact the orthopedic surgeon immediately
Correct Answer: B. Check the alignment of the weights and ensure they hang freely
