HESI PN Medical-Surgical Nursing Practice Examination | 2026/2027
HESI PN Medical-Surgical Nursing Practice Examination
Elsevier Content Mastery Series® Alignment | 2026/2027
60 Questions with Correct Answers and Evidence-Based Rationales
Aligned with NCSBN NCLEX-PN Detailed Test Plan and LPN/LVN Scope of Practice
Instructions
This examination consists of 60 multiple-choice questions designed for practical nursing (PN/LVN)
students aligned with the Elsevier HESI Medical-Surgical Content Mastery Series® blueprint. Each
question has four answer options (A–D). Select the single BEST answer within the PN scope of practice.
Correct answers appear in bold cyan with evidence-based rationales. Content reflects the NCSBN
NCLEX-PN Detailed Test Plan emphasis on safe, effective care; health promotion; psychosocial integrity;
and physiological integrity. Clinical judgment items test cue recognition, analysis, prioritization, and
action within the LPN/LVN role.
Disclaimer: This practice examination is designed for educational review purposes only. It does not represent
actual HESI examination items. Prepare using authorized Elsevier HESI resources, evidence-based PN nursing
references (Linton’s Medical-Surgical Nursing for LPN/LVN), and approved review platforms.
Section I: Cardiovascular Care
1. A practical nurse is caring for a client with hypertension who takes lisinopril 10 mg PO daily. Which
finding should the PN report to the registered nurse (RN) IMMEDIATELY?
A. Blood pressure 128/82 mmHg B. Dry, persistent cough
C. Facial angioedema and difficulty swallowing D. Serum potassium 4.8 mEq/L
Correct Answer: C. Facial angioedema and difficulty swallowing
Rationale: Facial angioedema with difficulty swallowing is a life-threatening allergic reaction to ACE
inhibitors that can compromise the airway. This requires immediate RN notification and provider
intervention—it is beyond PN scope to manage independently. A dry cough is a common, non-emergent side
effect of ACE inhibitors. BP 128/82 mmHg and potassium 4.8 mEq/L are within acceptable ranges. PNs must
recognize acute changes and escalate promptly (CJMM: Recognize Cues).
2. A client with heart failure is receiving furosemide (Lasix) 40 mg IV. Which assessment finding is MOST
important for the PN to monitor and report?
A. Urine output of 80 mL in the first hour B. Serum potassium of 3.1 mEq/L
C. Weight decrease of 0.5 kg since yesterday D. Heart rate 88 bpm and regular
Correct Answer: B. Serum potassium of 3.1 mEq/L
1
, HESI PN Medical-Surgical Nursing Practice Examination | 2026/2027
Rationale: Hypokalemia (K+ 3.1 mEq/L) is a critical finding in a client receiving loop diuretics. Furosemide
causes potassium wasting, and low potassium increases the risk of fatal cardiac arrhythmias. This requires
immediate RN notification for potential potassium replacement. Urine output of 80 mL/hr indicates therapeutic
response. A weight decrease suggests effective fluid removal. Heart rate of 88 bpm is within normal limits.
3. A client is 2 days post–myocardial infarction. Which client statement indicates the need for further
discharge teaching by the PN?
A. I will take my nitroglycerin sublingually when I feel chest pain.
B. I should call 911 if my chest pain is not relieved after one nitroglycerin tablet.
C. I can stop taking my cholesterol medication once my LDL level is normal.
D. I will walk short distances daily and gradually increase my activity.
Correct Answer: C. I can stop taking my cholesterol medication once my LDL level is normal.
Rationale: Cholesterol-lowering medications (statins) must be continued indefinitely post-MI for secondary
prevention of cardiovascular events, even when lipid levels normalize. Statins stabilize plaque and reduce
inflammation. The client should never discontinue statins without provider guidance. The other statements
reflect correct understanding: sublingual nitroglycerin for angina, calling 911 after one unresolved dose, and
gradual activity increase are all appropriate post-MI behaviors.
4. A PN is caring for a client recovering from a total knee replacement. Which finding is MOST concerning
for deep vein thrombosis (DVT)?
A. The calf is warm, red, and swollen compared to the other leg.
B. The client reports mild knee stiffness during range of motion.
C. The surgical incision has a thin, serous drainage.
D. The client's temperature is 37.4°C (99.3°F).
Correct Answer: A. The calf is warm, red, and swollen compared to the other leg.
Rationale: Unilateral calf warmth, redness, and edema (Homans sign may also be present) are the cardinal
signs of DVT. Post-orthopedic surgery clients are at high risk for DVT due to venous stasis and
hypercoagulability. The PN should NOT massage the affected extremity, should notify the RN immediately, and
document findings. Knee stiffness, thin serous drainage, and low-grade fever are expected postoperative
findings.
5. A client with heart failure reports increasing shortness of breath at night and needing to sleep propped up
on three pillows. Which intervention is within the PN scope?
A. Increase the client's daily furosemide dose
B. Elevate the head of bed and obtain vital signs including oxygen saturation
C. Order a chest x-ray to evaluate for pulmonary edema
D. Prescribe supplemental oxygen at 4 L via nasal cannula
Correct Answer: B. Elevate the head of bed and obtain vital signs including oxygen saturation
Rationale: Orthopnea (difficulty breathing when lying flat) and paroxysmal nocturnal dyspnea are signs of
worsening heart failure. The PN can elevate the HOB and assess vital signs including SpO2—these are within
PN scope of data collection and basic intervention. Medication adjustment, ordering diagnostics, and
prescribing oxygen require RN/provider authorization. The PN must notify the RN of these findings.
2
, HESI PN Medical-Surgical Nursing Practice Examination | 2026/2027
6. A client is receiving heparin 5,000 units subcutaneously every 8 hours for DVT prevention. Which site
should the PN use for injection?
A. The deltoid muscle in the upper arm B. The abdomen, at least 2 inches away from the
C. The gluteal muscle in the upper outer quadrant umbilicus
D. The anterior thigh, 2 inches above the knee
Correct Answer: B. The abdomen, at least 2 inches away from the umbilicus
Rationale: Subcutaneous heparin should be administered into the abdominal adipose tissue, at least 2 inches
from the umbilicus, to promote consistent absorption. The abdomen is the preferred site for low molecular
weight heparin and unfractionated heparin given subcutaneously. The PN should rotate injection sites and
avoid bruised or tender areas. The deltoid and gluteal muscles are used for intramuscular injections, and the
anterior thigh near the knee has limited subcutaneous tissue.
7. A client with a pulmonary embolism is receiving therapeutic enoxaparin (Lovenox). Which laboratory
value should the PN expect the RN to monitor?
A. Prothrombin time (PT/INR) B. Activated partial thromboplastin time (aPTT)
C. Anti-factor Xa level D. Bleeding time
Correct Answer: C. Anti-factor Xa level
Rationale: Low molecular weight heparins (enoxaparin) are monitored using anti-factor Xa levels, drawn 4
hours after injection when steady state is reached. Routine aPTT monitoring is NOT required for LMWH
(unlike unfractionated heparin). PT/INR is used to monitor warfarin therapy. Bleeding time is not a standard
monitoring parameter for anticoagulant therapy. Understanding which lab monitors each anticoagulant is
essential for PN medication administration competency.
Section II: Respiratory Care
8. A client with COPD has an oxygen saturation of 88% on room air. The client is alert and oriented with a
respiratory rate of 22/min. Which action is MOST appropriate for the PN?
A. Apply oxygen at 6 L/min via nasal cannula
B. Apply oxygen at 1–2 L/min via nasal cannula and notify the RN
C. Encourage pursed-lip breathing without oxygen
D. Prepare for endotracheal intubation
Correct Answer: B. Apply oxygen at 1–2 L/min via nasal cannula and notify the RN
Rationale: In COPD clients, oxygen should be titrated carefully to maintain SpO2 88–92%. High-flow oxygen
(6 L/min) can suppress the hypoxic respiratory drive and cause dangerous CO2 retention. Low-flow oxygen (1–
2 L/min) is the appropriate PN-initiated intervention. The PN must also notify the RN of the desaturation.
Pursed-lip breathing helps with air trapping but does not address the current hypoxemia. Intubation is
premature for this stable client.
3
HESI PN Medical-Surgical Nursing Practice Examination
Elsevier Content Mastery Series® Alignment | 2026/2027
60 Questions with Correct Answers and Evidence-Based Rationales
Aligned with NCSBN NCLEX-PN Detailed Test Plan and LPN/LVN Scope of Practice
Instructions
This examination consists of 60 multiple-choice questions designed for practical nursing (PN/LVN)
students aligned with the Elsevier HESI Medical-Surgical Content Mastery Series® blueprint. Each
question has four answer options (A–D). Select the single BEST answer within the PN scope of practice.
Correct answers appear in bold cyan with evidence-based rationales. Content reflects the NCSBN
NCLEX-PN Detailed Test Plan emphasis on safe, effective care; health promotion; psychosocial integrity;
and physiological integrity. Clinical judgment items test cue recognition, analysis, prioritization, and
action within the LPN/LVN role.
Disclaimer: This practice examination is designed for educational review purposes only. It does not represent
actual HESI examination items. Prepare using authorized Elsevier HESI resources, evidence-based PN nursing
references (Linton’s Medical-Surgical Nursing for LPN/LVN), and approved review platforms.
Section I: Cardiovascular Care
1. A practical nurse is caring for a client with hypertension who takes lisinopril 10 mg PO daily. Which
finding should the PN report to the registered nurse (RN) IMMEDIATELY?
A. Blood pressure 128/82 mmHg B. Dry, persistent cough
C. Facial angioedema and difficulty swallowing D. Serum potassium 4.8 mEq/L
Correct Answer: C. Facial angioedema and difficulty swallowing
Rationale: Facial angioedema with difficulty swallowing is a life-threatening allergic reaction to ACE
inhibitors that can compromise the airway. This requires immediate RN notification and provider
intervention—it is beyond PN scope to manage independently. A dry cough is a common, non-emergent side
effect of ACE inhibitors. BP 128/82 mmHg and potassium 4.8 mEq/L are within acceptable ranges. PNs must
recognize acute changes and escalate promptly (CJMM: Recognize Cues).
2. A client with heart failure is receiving furosemide (Lasix) 40 mg IV. Which assessment finding is MOST
important for the PN to monitor and report?
A. Urine output of 80 mL in the first hour B. Serum potassium of 3.1 mEq/L
C. Weight decrease of 0.5 kg since yesterday D. Heart rate 88 bpm and regular
Correct Answer: B. Serum potassium of 3.1 mEq/L
1
, HESI PN Medical-Surgical Nursing Practice Examination | 2026/2027
Rationale: Hypokalemia (K+ 3.1 mEq/L) is a critical finding in a client receiving loop diuretics. Furosemide
causes potassium wasting, and low potassium increases the risk of fatal cardiac arrhythmias. This requires
immediate RN notification for potential potassium replacement. Urine output of 80 mL/hr indicates therapeutic
response. A weight decrease suggests effective fluid removal. Heart rate of 88 bpm is within normal limits.
3. A client is 2 days post–myocardial infarction. Which client statement indicates the need for further
discharge teaching by the PN?
A. I will take my nitroglycerin sublingually when I feel chest pain.
B. I should call 911 if my chest pain is not relieved after one nitroglycerin tablet.
C. I can stop taking my cholesterol medication once my LDL level is normal.
D. I will walk short distances daily and gradually increase my activity.
Correct Answer: C. I can stop taking my cholesterol medication once my LDL level is normal.
Rationale: Cholesterol-lowering medications (statins) must be continued indefinitely post-MI for secondary
prevention of cardiovascular events, even when lipid levels normalize. Statins stabilize plaque and reduce
inflammation. The client should never discontinue statins without provider guidance. The other statements
reflect correct understanding: sublingual nitroglycerin for angina, calling 911 after one unresolved dose, and
gradual activity increase are all appropriate post-MI behaviors.
4. A PN is caring for a client recovering from a total knee replacement. Which finding is MOST concerning
for deep vein thrombosis (DVT)?
A. The calf is warm, red, and swollen compared to the other leg.
B. The client reports mild knee stiffness during range of motion.
C. The surgical incision has a thin, serous drainage.
D. The client's temperature is 37.4°C (99.3°F).
Correct Answer: A. The calf is warm, red, and swollen compared to the other leg.
Rationale: Unilateral calf warmth, redness, and edema (Homans sign may also be present) are the cardinal
signs of DVT. Post-orthopedic surgery clients are at high risk for DVT due to venous stasis and
hypercoagulability. The PN should NOT massage the affected extremity, should notify the RN immediately, and
document findings. Knee stiffness, thin serous drainage, and low-grade fever are expected postoperative
findings.
5. A client with heart failure reports increasing shortness of breath at night and needing to sleep propped up
on three pillows. Which intervention is within the PN scope?
A. Increase the client's daily furosemide dose
B. Elevate the head of bed and obtain vital signs including oxygen saturation
C. Order a chest x-ray to evaluate for pulmonary edema
D. Prescribe supplemental oxygen at 4 L via nasal cannula
Correct Answer: B. Elevate the head of bed and obtain vital signs including oxygen saturation
Rationale: Orthopnea (difficulty breathing when lying flat) and paroxysmal nocturnal dyspnea are signs of
worsening heart failure. The PN can elevate the HOB and assess vital signs including SpO2—these are within
PN scope of data collection and basic intervention. Medication adjustment, ordering diagnostics, and
prescribing oxygen require RN/provider authorization. The PN must notify the RN of these findings.
2
, HESI PN Medical-Surgical Nursing Practice Examination | 2026/2027
6. A client is receiving heparin 5,000 units subcutaneously every 8 hours for DVT prevention. Which site
should the PN use for injection?
A. The deltoid muscle in the upper arm B. The abdomen, at least 2 inches away from the
C. The gluteal muscle in the upper outer quadrant umbilicus
D. The anterior thigh, 2 inches above the knee
Correct Answer: B. The abdomen, at least 2 inches away from the umbilicus
Rationale: Subcutaneous heparin should be administered into the abdominal adipose tissue, at least 2 inches
from the umbilicus, to promote consistent absorption. The abdomen is the preferred site for low molecular
weight heparin and unfractionated heparin given subcutaneously. The PN should rotate injection sites and
avoid bruised or tender areas. The deltoid and gluteal muscles are used for intramuscular injections, and the
anterior thigh near the knee has limited subcutaneous tissue.
7. A client with a pulmonary embolism is receiving therapeutic enoxaparin (Lovenox). Which laboratory
value should the PN expect the RN to monitor?
A. Prothrombin time (PT/INR) B. Activated partial thromboplastin time (aPTT)
C. Anti-factor Xa level D. Bleeding time
Correct Answer: C. Anti-factor Xa level
Rationale: Low molecular weight heparins (enoxaparin) are monitored using anti-factor Xa levels, drawn 4
hours after injection when steady state is reached. Routine aPTT monitoring is NOT required for LMWH
(unlike unfractionated heparin). PT/INR is used to monitor warfarin therapy. Bleeding time is not a standard
monitoring parameter for anticoagulant therapy. Understanding which lab monitors each anticoagulant is
essential for PN medication administration competency.
Section II: Respiratory Care
8. A client with COPD has an oxygen saturation of 88% on room air. The client is alert and oriented with a
respiratory rate of 22/min. Which action is MOST appropriate for the PN?
A. Apply oxygen at 6 L/min via nasal cannula
B. Apply oxygen at 1–2 L/min via nasal cannula and notify the RN
C. Encourage pursed-lip breathing without oxygen
D. Prepare for endotracheal intubation
Correct Answer: B. Apply oxygen at 1–2 L/min via nasal cannula and notify the RN
Rationale: In COPD clients, oxygen should be titrated carefully to maintain SpO2 88–92%. High-flow oxygen
(6 L/min) can suppress the hypoxic respiratory drive and cause dangerous CO2 retention. Low-flow oxygen (1–
2 L/min) is the appropriate PN-initiated intervention. The PN must also notify the RN of the desaturation.
Pursed-lip breathing helps with air trapping but does not address the current hypoxemia. Intubation is
premature for this stable client.
3
