2026 HESI
RN
MED SURG EXAM
CONTAINS
• Pharmacology principles and medication safety
• Respiratory medications (asthma and COPD)
• Cardiovascular medications
• Anticoagulants and bleeding precautions
• Endocrine and metabolic medications
• Diabetes management and insulin therapy
• Neurologic and psychiatric medications
• Pain management and opioid safety
• Anti-infective medications
• Gastrointestinal medications
• Hematologic medications
• Vitamins, supplements, and herbal interactions
,A 68-year-old male client is admitted to the telemetry unit with a diagnosis of acute decompensated
heart failure (ADHF). The client reports severe dyspnea at rest and orthopnea. Upon assessment, the
nurse notes bilateral crackles in the lungs, 3+ pitting edema in the lower extremities, and jugular vein
distension (JVD). The client’s vital signs are: BP 85/50 mm Hg, HR 125 beats/min, RR 30 breaths/min,
SpO2 88% on room air. Which physician order should the nurse implement first?
A) Administer furosemide (Lasix) 20 mg IV push.
B) Initate high-flow oxygen therapy via non-rebreather mask.
C) Obtain a 12-lead electrocardiogram (ECG).
D) Insert a Foley catheter to monitor strict intake and output.
Correct Answer: B) Initiate high-flow oxygen therapy via non-rebreather mask.
Explanation / Rationale:
The client is exhibiting signs of severe respiratory distress and hypoxia (SpO2 88%). The ABCs (Airway,
Breathing, Circulation) priority framework dictates that hypoxia, an immediate life-threat, must be
addressed first. While furosemide is essential for fluid overload in heart failure, it does not
immediately correct the oxygen saturation. An ECG is important to assess for dysrhythmias but is
secondary to correcting hypoxia. A Foley catheter is a helpful tool for monitoring diuresis but is not the
priority over maintaining oxygenation.
A nurse is caring for a client who is 3 days post-myocardial infarction (MI). The client suddenly reports
feeling "a crushing sensation" in their chest that radiates to their left arm and jaw. They appear
diaphoretic and anxious. The client is currently prescribed nitroglycerin tablets SL. Which action
should the nurse take first?
A) Take the client’s vital signs.
B) Administer one nitroglycerin tablet sublingually.
C) Notify the primary healthcare provider immediately.
D) Obtain a 12-lead ECG.
Correct Answer: B) Administer one nitroglycerin tablet sublingually.
Explanation / Rationale:
,In a client with a history of MI experiencing sudden chest pain, angina is the primary suspicion.
Nitroglycerin is the first-line treatment to relieve myocardial ischemia by causing vasodilation, which
decreases cardiac workload and oxygen demand. It should be administered immediately while other
assessments are ongoing. If the pain does not improve after 3 doses spaced 5 minutes apart,
emergency services should be contacted. However, the first immediate nursing action is to administer
the prescribed medication to alleviate the ischemia.
A client with end-stage renal disease is receiving hemodialysis. During the treatment, the client
complains of nausea, dizziness, and a "pounding" headache. The nurse observes the client is restless
and has significant hypertension. Which complication does the nurse suspect?
A) Disequilibrium syndrome.
B) Air embolism.
C) Hemolysis.
D) Hypotension.
Correct Answer: A) Disequilibrium syndrome.
Explanation / Rationale:
Disequilibrium syndrome is caused by the rapid removal of urea and other osmotically active particles
from the blood. This creates an osmotic gradient that causes water to shift into the brain (cerebral
edema). Manifestations include headache, nausea, vomiting, restlessness, hypertension, seizures, and
potentially coma. This occurs most often at the initiation of dialysis or in clients who are new to
dialysis. Air embolism typically presents with sudden respiratory distress, chest pain, and stroke-like
symptoms (e.g., hemiplegia). Hemolysis would present with pink or red urine returning to the dialyzer.
Hypotension is a common complication but is opposite to the hypertension seen here.
A client with type 2 diabetes mellitus is admitted with a diagnosis of diabetic ketoacidosis (DKA). The
nurse notes a fruity odor on the client’s breath. Which physiological process causes this specific sign?
A) Metabolism of fat for energy (lipolysis).
B) Accumulation of urea in the blood.
C) Hyperglycemia causing dehydration.
D) Ketosis due to protein breakdown.
, Correct Answer: A) Metabolism of fat for energy (lipolysis).
Explanation / Rationale:
In DKA, there is an absolute or relative insulin deficiency. Without sufficient insulin, glucose cannot
enter cells for energy. The body switches to metabolizing fat (lipolysis) for fuel. A byproduct of fat
metabolism is ketones (acetoacetate, beta-hydroxybutyrate, and acetone). Acetone is excreted via the
lungs, creating a characteristic "fruity" breath odor. While hyperglycemia is present, the smell is
specifically caused by the ketones.
A client is recovering from a total knee arthroplasty (TKA). The nurse is teaching the client about the
use of a continuous passive motion (CPM) machine. Which statement by the client indicates a need
for further teaching?
A) "The machine will help my knee bend and straighten slowly."
B) "I should tell the nurse if my leg feels painful while in the machine."
C) "I will keep the machine on for 24 hours a day to get the best results."
D) "The machine is set to my specific range of motion limits."
Correct Answer: C) "I will keep the machine on for 24 hours a day to get the best results."
Explanation / Rationale:
CPM is typically used for a set number of hours per day (e.g., 2-4 hours), not continuously for 24 hours.
Prolonged use without a break can cause venous stasis, compromise circulation, and increase pain and
swelling. The other statements demonstrate correct understanding: the machine promotes flexion and
extension, pain should be reported (as it may indicate complications), and limits are set to prevent
injury. Using it 24/7 is unsafe and indicates a need for correction.
The nurse is planning care for a client who underwent a traditional open cholecystectomy. Which
intervention should the nurse include in the plan to prevent respiratory complications?
A) Encourage the client to cough and deep breathe every 2 hours while splinting the incision with a
pillow.
B) Maintain the client in the supine position with a head-of-bed (HOB) flat for 12 hours.
C) Instruct the client to avoid drinking fluids for 4 hours post-operatively to prevent vomiting.
D) Apply an abdominal binder to support the incision and prevent splinting.
RN
MED SURG EXAM
CONTAINS
• Pharmacology principles and medication safety
• Respiratory medications (asthma and COPD)
• Cardiovascular medications
• Anticoagulants and bleeding precautions
• Endocrine and metabolic medications
• Diabetes management and insulin therapy
• Neurologic and psychiatric medications
• Pain management and opioid safety
• Anti-infective medications
• Gastrointestinal medications
• Hematologic medications
• Vitamins, supplements, and herbal interactions
,A 68-year-old male client is admitted to the telemetry unit with a diagnosis of acute decompensated
heart failure (ADHF). The client reports severe dyspnea at rest and orthopnea. Upon assessment, the
nurse notes bilateral crackles in the lungs, 3+ pitting edema in the lower extremities, and jugular vein
distension (JVD). The client’s vital signs are: BP 85/50 mm Hg, HR 125 beats/min, RR 30 breaths/min,
SpO2 88% on room air. Which physician order should the nurse implement first?
A) Administer furosemide (Lasix) 20 mg IV push.
B) Initate high-flow oxygen therapy via non-rebreather mask.
C) Obtain a 12-lead electrocardiogram (ECG).
D) Insert a Foley catheter to monitor strict intake and output.
Correct Answer: B) Initiate high-flow oxygen therapy via non-rebreather mask.
Explanation / Rationale:
The client is exhibiting signs of severe respiratory distress and hypoxia (SpO2 88%). The ABCs (Airway,
Breathing, Circulation) priority framework dictates that hypoxia, an immediate life-threat, must be
addressed first. While furosemide is essential for fluid overload in heart failure, it does not
immediately correct the oxygen saturation. An ECG is important to assess for dysrhythmias but is
secondary to correcting hypoxia. A Foley catheter is a helpful tool for monitoring diuresis but is not the
priority over maintaining oxygenation.
A nurse is caring for a client who is 3 days post-myocardial infarction (MI). The client suddenly reports
feeling "a crushing sensation" in their chest that radiates to their left arm and jaw. They appear
diaphoretic and anxious. The client is currently prescribed nitroglycerin tablets SL. Which action
should the nurse take first?
A) Take the client’s vital signs.
B) Administer one nitroglycerin tablet sublingually.
C) Notify the primary healthcare provider immediately.
D) Obtain a 12-lead ECG.
Correct Answer: B) Administer one nitroglycerin tablet sublingually.
Explanation / Rationale:
,In a client with a history of MI experiencing sudden chest pain, angina is the primary suspicion.
Nitroglycerin is the first-line treatment to relieve myocardial ischemia by causing vasodilation, which
decreases cardiac workload and oxygen demand. It should be administered immediately while other
assessments are ongoing. If the pain does not improve after 3 doses spaced 5 minutes apart,
emergency services should be contacted. However, the first immediate nursing action is to administer
the prescribed medication to alleviate the ischemia.
A client with end-stage renal disease is receiving hemodialysis. During the treatment, the client
complains of nausea, dizziness, and a "pounding" headache. The nurse observes the client is restless
and has significant hypertension. Which complication does the nurse suspect?
A) Disequilibrium syndrome.
B) Air embolism.
C) Hemolysis.
D) Hypotension.
Correct Answer: A) Disequilibrium syndrome.
Explanation / Rationale:
Disequilibrium syndrome is caused by the rapid removal of urea and other osmotically active particles
from the blood. This creates an osmotic gradient that causes water to shift into the brain (cerebral
edema). Manifestations include headache, nausea, vomiting, restlessness, hypertension, seizures, and
potentially coma. This occurs most often at the initiation of dialysis or in clients who are new to
dialysis. Air embolism typically presents with sudden respiratory distress, chest pain, and stroke-like
symptoms (e.g., hemiplegia). Hemolysis would present with pink or red urine returning to the dialyzer.
Hypotension is a common complication but is opposite to the hypertension seen here.
A client with type 2 diabetes mellitus is admitted with a diagnosis of diabetic ketoacidosis (DKA). The
nurse notes a fruity odor on the client’s breath. Which physiological process causes this specific sign?
A) Metabolism of fat for energy (lipolysis).
B) Accumulation of urea in the blood.
C) Hyperglycemia causing dehydration.
D) Ketosis due to protein breakdown.
, Correct Answer: A) Metabolism of fat for energy (lipolysis).
Explanation / Rationale:
In DKA, there is an absolute or relative insulin deficiency. Without sufficient insulin, glucose cannot
enter cells for energy. The body switches to metabolizing fat (lipolysis) for fuel. A byproduct of fat
metabolism is ketones (acetoacetate, beta-hydroxybutyrate, and acetone). Acetone is excreted via the
lungs, creating a characteristic "fruity" breath odor. While hyperglycemia is present, the smell is
specifically caused by the ketones.
A client is recovering from a total knee arthroplasty (TKA). The nurse is teaching the client about the
use of a continuous passive motion (CPM) machine. Which statement by the client indicates a need
for further teaching?
A) "The machine will help my knee bend and straighten slowly."
B) "I should tell the nurse if my leg feels painful while in the machine."
C) "I will keep the machine on for 24 hours a day to get the best results."
D) "The machine is set to my specific range of motion limits."
Correct Answer: C) "I will keep the machine on for 24 hours a day to get the best results."
Explanation / Rationale:
CPM is typically used for a set number of hours per day (e.g., 2-4 hours), not continuously for 24 hours.
Prolonged use without a break can cause venous stasis, compromise circulation, and increase pain and
swelling. The other statements demonstrate correct understanding: the machine promotes flexion and
extension, pain should be reported (as it may indicate complications), and limits are set to prevent
injury. Using it 24/7 is unsafe and indicates a need for correction.
The nurse is planning care for a client who underwent a traditional open cholecystectomy. Which
intervention should the nurse include in the plan to prevent respiratory complications?
A) Encourage the client to cough and deep breathe every 2 hours while splinting the incision with a
pillow.
B) Maintain the client in the supine position with a head-of-bed (HOB) flat for 12 hours.
C) Instruct the client to avoid drinking fluids for 4 hours post-operatively to prevent vomiting.
D) Apply an abdominal binder to support the incision and prevent splinting.
