ShekhawatNotes1
HESI Exit Exam Comprehensive Review 2026
Med-Surg | Pharmacology | OB | Pediatrics | Mental Health | Leadership | 15 Questions
MED-SURG / FUNDAMENTALS PHARMACOLOGY OB / PEDS / MENTAL HEALTH LEADERSHIP
HESI | Med-Surg | Cardiac Question Q1
CLINICAL SCENARIO
A 58-year-old man is admitted with crushing chest pain radiating to his left arm and jaw. ECG
shows ST elevation in leads II, III, and aVF. Troponin I is elevated at 4.2 ng/mL.
Which area of the heart is MOST LIKELY affected by this myocardial infarction?
A. Anterior wall — LAD artery occlusion
B. Inferior wall — RCA occlusion
C. Lateral wall — LCX artery occlusion
D. Posterior wall — PDA occlusion
E. Septal wall — diagonal branch occlusion
CORRECT ANSWER: B — Inferior wall MI (RCA occlusion)
RATIONALE
ST elevation in leads II, III, and aVF is the classic ECG pattern for an INFERIOR wall MI, caused
by occlusion of the Right Coronary Artery (RCA). The RCA supplies the inferior wall of the left
ventricle, the right ventricle, and the SA/AV nodes. This is why inferior MI patients are at high risk
for bradycardia and heart blocks. Anterior MI (LAD) shows changes in V1-V4. Lateral MI (LCX)
shows changes in I, aVL, V5-V6. This ECG localization is extremely high yield on HESI.
HESI TIP
Memorize ECG leads by location: II, III, aVF = Inferior (RCA). V1-V4 = Anterior (LAD). I, aVL, V5-V6 =
Lateral (LCX). Inferior MI = watch for bradycardia and AV blocks. HESI tests this repeatedly.
HESI | Pharmacology Question Q2
A nurse is preparing to administer metformin 500 mg PO to a patient with Type 2 diabetes scheduled
for a contrast CT scan in 2 hours. What is the PRIORITY nursing action?
, A. Administer the metformin as scheduled and monitor blood glucose
B. Hold the metformin and notify the physician before the procedure
C. Administer the metformin with extra fluids to protect the kidneys
D. Crush the metformin and mix with contrast agent
E. Administer half the dose and reassess after the CT scan
CORRECT ANSWER: B — Hold metformin and notify physician
RATIONALE
Metformin must be HELD before and 48 hours after contrast dye administration due to the risk of
contrast-induced nephropathy leading to metformin accumulation and lactic acidosis — a
life-threatening complication. Contrast agents can cause acute kidney injury; if kidneys fail to
clear metformin, toxic accumulation occurs causing severe lactic acidosis with high mortality.
The nurse must hold the medication, notify the physician, and ensure it is restarted only after
kidney function is confirmed normal post-procedure.
HESI TIP
Metformin + contrast dye = HOLD for 48 hours before and after. Reason = lactic acidosis risk from
renal impairment. This is one of the most tested pharmacology concepts on HESI and NCLEX. Also
hold metformin if creatinine is elevated.
HESI | Med-Surg | Neuro Question Q3
CLINICAL SCENARIO
A 44-year-old woman arrives in the ED with a sudden severe headache she describes as 'the
worst headache of my life,' neck stiffness, and photophobia. Temperature is 37.9°C. BP is
162/94 mmHg.
Which condition should the nurse suspect FIRST and what is the PRIORITY action?
A. Migraine — administer sumatriptan and place in a dark quiet room
B. Subarachnoid hemorrhage — prepare for immediate CT head and neurosurgery consult
C. Meningitis — initiate droplet precautions and administer antibiotics
D. Hypertensive emergency — administer IV labetalol immediately
E. Cluster headache — administer 100% oxygen via face mask
CORRECT ANSWER: B — Subarachnoid hemorrhage — CT head immediately
HESI Exit Exam Comprehensive Review 2026
Med-Surg | Pharmacology | OB | Pediatrics | Mental Health | Leadership | 15 Questions
MED-SURG / FUNDAMENTALS PHARMACOLOGY OB / PEDS / MENTAL HEALTH LEADERSHIP
HESI | Med-Surg | Cardiac Question Q1
CLINICAL SCENARIO
A 58-year-old man is admitted with crushing chest pain radiating to his left arm and jaw. ECG
shows ST elevation in leads II, III, and aVF. Troponin I is elevated at 4.2 ng/mL.
Which area of the heart is MOST LIKELY affected by this myocardial infarction?
A. Anterior wall — LAD artery occlusion
B. Inferior wall — RCA occlusion
C. Lateral wall — LCX artery occlusion
D. Posterior wall — PDA occlusion
E. Septal wall — diagonal branch occlusion
CORRECT ANSWER: B — Inferior wall MI (RCA occlusion)
RATIONALE
ST elevation in leads II, III, and aVF is the classic ECG pattern for an INFERIOR wall MI, caused
by occlusion of the Right Coronary Artery (RCA). The RCA supplies the inferior wall of the left
ventricle, the right ventricle, and the SA/AV nodes. This is why inferior MI patients are at high risk
for bradycardia and heart blocks. Anterior MI (LAD) shows changes in V1-V4. Lateral MI (LCX)
shows changes in I, aVL, V5-V6. This ECG localization is extremely high yield on HESI.
HESI TIP
Memorize ECG leads by location: II, III, aVF = Inferior (RCA). V1-V4 = Anterior (LAD). I, aVL, V5-V6 =
Lateral (LCX). Inferior MI = watch for bradycardia and AV blocks. HESI tests this repeatedly.
HESI | Pharmacology Question Q2
A nurse is preparing to administer metformin 500 mg PO to a patient with Type 2 diabetes scheduled
for a contrast CT scan in 2 hours. What is the PRIORITY nursing action?
, A. Administer the metformin as scheduled and monitor blood glucose
B. Hold the metformin and notify the physician before the procedure
C. Administer the metformin with extra fluids to protect the kidneys
D. Crush the metformin and mix with contrast agent
E. Administer half the dose and reassess after the CT scan
CORRECT ANSWER: B — Hold metformin and notify physician
RATIONALE
Metformin must be HELD before and 48 hours after contrast dye administration due to the risk of
contrast-induced nephropathy leading to metformin accumulation and lactic acidosis — a
life-threatening complication. Contrast agents can cause acute kidney injury; if kidneys fail to
clear metformin, toxic accumulation occurs causing severe lactic acidosis with high mortality.
The nurse must hold the medication, notify the physician, and ensure it is restarted only after
kidney function is confirmed normal post-procedure.
HESI TIP
Metformin + contrast dye = HOLD for 48 hours before and after. Reason = lactic acidosis risk from
renal impairment. This is one of the most tested pharmacology concepts on HESI and NCLEX. Also
hold metformin if creatinine is elevated.
HESI | Med-Surg | Neuro Question Q3
CLINICAL SCENARIO
A 44-year-old woman arrives in the ED with a sudden severe headache she describes as 'the
worst headache of my life,' neck stiffness, and photophobia. Temperature is 37.9°C. BP is
162/94 mmHg.
Which condition should the nurse suspect FIRST and what is the PRIORITY action?
A. Migraine — administer sumatriptan and place in a dark quiet room
B. Subarachnoid hemorrhage — prepare for immediate CT head and neurosurgery consult
C. Meningitis — initiate droplet precautions and administer antibiotics
D. Hypertensive emergency — administer IV labetalol immediately
E. Cluster headache — administer 100% oxygen via face mask
CORRECT ANSWER: B — Subarachnoid hemorrhage — CT head immediately
