HESI PN Med-Surg Test Bank 2026/2027
HESI PN MEDICAL-SURGICAL
TEST BANK
2026/2027 Academic Year
──────────────────────────────────────────────────
Comprehensive NGN-Style Competency Assessment
for Practical/Vocational Nursing
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Total Questions: 100 Multiple-Choice Questions (MCQ)
Testing Time: 120 Minutes (Computer-Based, Proctored)
Passing Score: 850 HESI Score or 75–80% Required
Item Types: Standard MCQ, SATA, NGN Bow-Tie, Trend Recognition, Matrix, Prioritization Scenarios
Format: Single-Best-Answer Unless Marked SATA
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, HESI PN Med-Surg Test Bank 2026/2027
Examination Overview
Domain Questions Key Topics Weight
Clinical Judgment & 15 Recognize Cues, 15%
Nursing Process Analyze Cues, Prioritize
Hypotheses, Generate
Solutions, Take Action,
Evaluate Outcomes
Safety & Infection 14 Standard Precautions, 14%
Control Isolation, Fall
Prevention, Error
Prevention, Emergency
Response
Basic Care & Comfort 16 ADLs, Pain 16%
Management,
Nutrition, Elimination,
Mobility, Rest/Sleep,
Comfort Measures
Pharmacological & 18 Medication 18%
Parenteral Therapies Administration, Side
Effects, Interactions, IV
Therapy, Dosage
Calculations, High-
Alert Medications
Reduction of Risk 15 Diagnostic Tests, Vital 15%
Potential Signs, Complication
Prevention,
Therapeutic
Procedures, Pre/Post-
Op Care
Physiological 14 Acute/Chronic 14%
Adaptation Conditions,
Fluid/Electrolytes,
Pathophysiology,
Emergency Care,
Chronic Disease
Management
Care Coordination & 8 Delegation, 8%
NGN Case Studies Interprofessional
Collaboration,
Discharge Planning,
NGN Bow-
Tie/Trend/Matrix
Items
Domain: Clinical Judgment & Nursing Process
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──────────────
1. The LPN is caring for a client who had abdominal surgery 24 hours ago. Which
assessment finding requires immediate notification of the RN?
A. Temperature of 99.2°F (37.3°C)
B. Absent bowel sounds in all four quadrants
C. Urine output of 25 mL in the past hour
D. Pain rating of 6/10 at the incision site
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, HESI PN Med-Surg Test Bank 2026/2027
Correct Answer: C
Rationale: Urine output less than 30 mL/hour in an adult indicates potential acute kidney injury or
hypovolemia and requires immediate notification. A temperature of 99.2°F (A) is within expected
postoperative range. Absent bowel sounds (B) are common at 24 hours post-op due to ileus and not an
emergency. Pain of 6/10 (D) requires intervention but is not immediately life-threatening. The LPN
must recognize cues indicating deterioration and escalate appropriately per the CJMM framework.
2. Select All That Apply: Select All That Apply: Which actions should the LPN take when
recognizing a client is experiencing anaphylaxis after medication administration?
A. Administer epinephrine per standing order or protocol
B. Maintain airway and administer high-flow oxygen
C. Position the client supine with legs elevated unless contraindicated
D. Document the reaction after the client is stabilized
Correct Answer: A,B,C,D
Rationale: Anaphylaxis is a life-threatening emergency requiring immediate action: epinephrine is
first-line treatment (A); airway management and oxygen support breathing (B); positioning supine
with legs elevated supports circulation unless respiratory distress requires semi-Fowler's (C);
documentation occurs after stabilization (D). All actions align with the Take Action step of the Clinical
Judgment Measurement Model. The LPN must act rapidly while working within scope and notifying the
RN/provider.
3. A client with heart failure reports increased shortness of breath and the LPN notes
crackles in the bilateral lung bases. Which step of the Clinical Judgment Measurement
Model does recognizing these crackles represent?
A. Generate Solutions
B. Recognize Cues
C. Take Action
D. Evaluate Outcomes
Correct Answer: B
Rationale: Recognizing crackles on auscultation represents the Recognize Cues step of the CJMM, where
the nurse identifies relevant clinical data that may indicate a change in the client's condition. Generate
Solutions (A) involves developing interventions, which comes after analyzing cues. Take Action (C)
involves implementing interventions. Evaluate Outcomes (D) involves assessing the effectiveness of
implemented interventions. The CJMM provides a structured framework for clinical decision-making
that aligns with NCLEX-PN testing.
4. The LPN receives four clients at change of shift. Which client should the LPN assess
first?
A. A client with diabetes requesting a snack
B. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 88%
C. A client who is post-op day 2 requesting pain medication
D. A client with a Foley catheter whose urine output has decreased from 60 mL/hr to 40 mL/hr
Correct Answer: B
Rationale: Using ABC (Airway, Breathing, Circulation) prioritization, the COPD client with SpO2 of
88% is the most urgent because this indicates significant hypoxemia requiring immediate intervention.
The diabetic client's snack request (A) is a comfort need. Post-op pain (C) is important but not
immediately life-threatening. Decreased urine output (D) is concerning but less urgent than hypoxemia.
The LPN must apply prioritization frameworks consistently when managing multiple clients.
5. A client with pneumonia has the following vital signs: T 101.8°F, HR 110, RR 28, BP
100/60. Which finding is most concerning and should be reported immediately?
A. Temperature of 101.8°F
B. Respiratory rate of 28 breaths per minute
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, HESI PN Med-Surg Test Bank 2026/2027
C. Heart rate of 110 beats per minute
D. Blood pressure of 100/60 mmHg
Correct Answer: B
Rationale: A respiratory rate of 28 breaths per minute indicates tachypnea and potential respiratory
distress, which is the most concerning finding in a pneumonia client and aligns with the Breathing
priority in ABC framework. While fever (A), tachycardia (B), and borderline BP (D) are all significant,
respiratory compromise poses the greatest immediate threat. The LPN must analyze cues to identify
which findings represent the most urgent threat to the client's safety and prioritize accordingly.
6. During evaluation of a care plan, the LPN notes that a client's wound has not improved
after 5 days of treatment. Which action reflects the Evaluate Outcomes step of the CJMM?
A. Changing the wound dressing more frequently
B. Comparing current wound assessment findings to expected outcomes
C. Requesting a wound culture from the provider
D. Applying a different type of wound dressing
Correct Answer: B
Rationale: Comparing current wound assessment findings to expected outcomes is the Evaluate
Outcomes step, where the nurse determines whether the interventions achieved the desired results.
Changing dressing frequency (A), requesting a culture (C), and applying a different dressing (D) are all
interventions that belong to the Generate Solutions or Take Action steps. Evaluation is essential for
determining whether the plan of care is effective or needs modification, and this step completes the
CJMM cycle.
7. Select All That Apply: Select All That Apply: Which findings should the LPN recognize as
cues indicating potential fluid volume excess in a client with heart failure?
A. Jugular venous distension
B. Crackles in the lung fields
C. Urine specific gravity of 1.035
D. Weight gain of 3 pounds over 2 days
Correct Answer: A,B,D
Rationale: Jugular venous distension (A), crackles (B), and weight gain (D) are classic indicators of
fluid volume excess. JVD reflects increased venous pressure; crackles indicate pulmonary congestion
from fluid overload; rapid weight gain is a sensitive indicator of fluid retention. Urine specific gravity
of 1.035 (C) is elevated, indicating concentrated urine, which is associated with fluid volume deficit
rather than excess. Recognizing these cues is essential for early identification of heart failure
exacerbation.
8. A client reports sudden onset chest pain rated 8/10. Which nursing action is the
priority?
A. Administer prescribed nitroglycerin
B. Assess vital signs and perform a focused assessment
C. Notify the RN and provider immediately
D. Obtain a 12-lead ECG
Correct Answer: C
Rationale: Sudden onset severe chest pain requires immediate notification of the RN and provider
because it may indicate myocardial infarction, a life-threatening emergency requiring rapid
intervention beyond LPN scope. While vital signs (B) and ECG (D) are important, the LPN must escalate
immediately. Nitroglycerin (A) may be administered per protocol but only after proper assessment and
notification. The LPN must recognize when a client's condition requires RN/provider-level intervention
and escalate promptly.
9. The LPN is using the nursing process to care for a client with a new colostomy. Which
activity represents the Implementation step?
4
HESI PN MEDICAL-SURGICAL
TEST BANK
2026/2027 Academic Year
──────────────────────────────────────────────────
Comprehensive NGN-Style Competency Assessment
for Practical/Vocational Nursing
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Total Questions: 100 Multiple-Choice Questions (MCQ)
Testing Time: 120 Minutes (Computer-Based, Proctored)
Passing Score: 850 HESI Score or 75–80% Required
Item Types: Standard MCQ, SATA, NGN Bow-Tie, Trend Recognition, Matrix, Prioritization Scenarios
Format: Single-Best-Answer Unless Marked SATA
1
, HESI PN Med-Surg Test Bank 2026/2027
Examination Overview
Domain Questions Key Topics Weight
Clinical Judgment & 15 Recognize Cues, 15%
Nursing Process Analyze Cues, Prioritize
Hypotheses, Generate
Solutions, Take Action,
Evaluate Outcomes
Safety & Infection 14 Standard Precautions, 14%
Control Isolation, Fall
Prevention, Error
Prevention, Emergency
Response
Basic Care & Comfort 16 ADLs, Pain 16%
Management,
Nutrition, Elimination,
Mobility, Rest/Sleep,
Comfort Measures
Pharmacological & 18 Medication 18%
Parenteral Therapies Administration, Side
Effects, Interactions, IV
Therapy, Dosage
Calculations, High-
Alert Medications
Reduction of Risk 15 Diagnostic Tests, Vital 15%
Potential Signs, Complication
Prevention,
Therapeutic
Procedures, Pre/Post-
Op Care
Physiological 14 Acute/Chronic 14%
Adaptation Conditions,
Fluid/Electrolytes,
Pathophysiology,
Emergency Care,
Chronic Disease
Management
Care Coordination & 8 Delegation, 8%
NGN Case Studies Interprofessional
Collaboration,
Discharge Planning,
NGN Bow-
Tie/Trend/Matrix
Items
Domain: Clinical Judgment & Nursing Process
──────────────────────────────────────────────────────────────────
──────────────
1. The LPN is caring for a client who had abdominal surgery 24 hours ago. Which
assessment finding requires immediate notification of the RN?
A. Temperature of 99.2°F (37.3°C)
B. Absent bowel sounds in all four quadrants
C. Urine output of 25 mL in the past hour
D. Pain rating of 6/10 at the incision site
2
, HESI PN Med-Surg Test Bank 2026/2027
Correct Answer: C
Rationale: Urine output less than 30 mL/hour in an adult indicates potential acute kidney injury or
hypovolemia and requires immediate notification. A temperature of 99.2°F (A) is within expected
postoperative range. Absent bowel sounds (B) are common at 24 hours post-op due to ileus and not an
emergency. Pain of 6/10 (D) requires intervention but is not immediately life-threatening. The LPN
must recognize cues indicating deterioration and escalate appropriately per the CJMM framework.
2. Select All That Apply: Select All That Apply: Which actions should the LPN take when
recognizing a client is experiencing anaphylaxis after medication administration?
A. Administer epinephrine per standing order or protocol
B. Maintain airway and administer high-flow oxygen
C. Position the client supine with legs elevated unless contraindicated
D. Document the reaction after the client is stabilized
Correct Answer: A,B,C,D
Rationale: Anaphylaxis is a life-threatening emergency requiring immediate action: epinephrine is
first-line treatment (A); airway management and oxygen support breathing (B); positioning supine
with legs elevated supports circulation unless respiratory distress requires semi-Fowler's (C);
documentation occurs after stabilization (D). All actions align with the Take Action step of the Clinical
Judgment Measurement Model. The LPN must act rapidly while working within scope and notifying the
RN/provider.
3. A client with heart failure reports increased shortness of breath and the LPN notes
crackles in the bilateral lung bases. Which step of the Clinical Judgment Measurement
Model does recognizing these crackles represent?
A. Generate Solutions
B. Recognize Cues
C. Take Action
D. Evaluate Outcomes
Correct Answer: B
Rationale: Recognizing crackles on auscultation represents the Recognize Cues step of the CJMM, where
the nurse identifies relevant clinical data that may indicate a change in the client's condition. Generate
Solutions (A) involves developing interventions, which comes after analyzing cues. Take Action (C)
involves implementing interventions. Evaluate Outcomes (D) involves assessing the effectiveness of
implemented interventions. The CJMM provides a structured framework for clinical decision-making
that aligns with NCLEX-PN testing.
4. The LPN receives four clients at change of shift. Which client should the LPN assess
first?
A. A client with diabetes requesting a snack
B. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation of 88%
C. A client who is post-op day 2 requesting pain medication
D. A client with a Foley catheter whose urine output has decreased from 60 mL/hr to 40 mL/hr
Correct Answer: B
Rationale: Using ABC (Airway, Breathing, Circulation) prioritization, the COPD client with SpO2 of
88% is the most urgent because this indicates significant hypoxemia requiring immediate intervention.
The diabetic client's snack request (A) is a comfort need. Post-op pain (C) is important but not
immediately life-threatening. Decreased urine output (D) is concerning but less urgent than hypoxemia.
The LPN must apply prioritization frameworks consistently when managing multiple clients.
5. A client with pneumonia has the following vital signs: T 101.8°F, HR 110, RR 28, BP
100/60. Which finding is most concerning and should be reported immediately?
A. Temperature of 101.8°F
B. Respiratory rate of 28 breaths per minute
3
, HESI PN Med-Surg Test Bank 2026/2027
C. Heart rate of 110 beats per minute
D. Blood pressure of 100/60 mmHg
Correct Answer: B
Rationale: A respiratory rate of 28 breaths per minute indicates tachypnea and potential respiratory
distress, which is the most concerning finding in a pneumonia client and aligns with the Breathing
priority in ABC framework. While fever (A), tachycardia (B), and borderline BP (D) are all significant,
respiratory compromise poses the greatest immediate threat. The LPN must analyze cues to identify
which findings represent the most urgent threat to the client's safety and prioritize accordingly.
6. During evaluation of a care plan, the LPN notes that a client's wound has not improved
after 5 days of treatment. Which action reflects the Evaluate Outcomes step of the CJMM?
A. Changing the wound dressing more frequently
B. Comparing current wound assessment findings to expected outcomes
C. Requesting a wound culture from the provider
D. Applying a different type of wound dressing
Correct Answer: B
Rationale: Comparing current wound assessment findings to expected outcomes is the Evaluate
Outcomes step, where the nurse determines whether the interventions achieved the desired results.
Changing dressing frequency (A), requesting a culture (C), and applying a different dressing (D) are all
interventions that belong to the Generate Solutions or Take Action steps. Evaluation is essential for
determining whether the plan of care is effective or needs modification, and this step completes the
CJMM cycle.
7. Select All That Apply: Select All That Apply: Which findings should the LPN recognize as
cues indicating potential fluid volume excess in a client with heart failure?
A. Jugular venous distension
B. Crackles in the lung fields
C. Urine specific gravity of 1.035
D. Weight gain of 3 pounds over 2 days
Correct Answer: A,B,D
Rationale: Jugular venous distension (A), crackles (B), and weight gain (D) are classic indicators of
fluid volume excess. JVD reflects increased venous pressure; crackles indicate pulmonary congestion
from fluid overload; rapid weight gain is a sensitive indicator of fluid retention. Urine specific gravity
of 1.035 (C) is elevated, indicating concentrated urine, which is associated with fluid volume deficit
rather than excess. Recognizing these cues is essential for early identification of heart failure
exacerbation.
8. A client reports sudden onset chest pain rated 8/10. Which nursing action is the
priority?
A. Administer prescribed nitroglycerin
B. Assess vital signs and perform a focused assessment
C. Notify the RN and provider immediately
D. Obtain a 12-lead ECG
Correct Answer: C
Rationale: Sudden onset severe chest pain requires immediate notification of the RN and provider
because it may indicate myocardial infarction, a life-threatening emergency requiring rapid
intervention beyond LPN scope. While vital signs (B) and ECG (D) are important, the LPN must escalate
immediately. Nitroglycerin (A) may be administered per protocol but only after proper assessment and
notification. The LPN must recognize when a client's condition requires RN/provider-level intervention
and escalate promptly.
9. The LPN is using the nursing process to care for a client with a new colostomy. Which
activity represents the Implementation step?
4
