NGN RN Medical-Surgical HESI Exam 2025:
Ultimate Guide with Answer Explanations
and Test-Taking Strategies
Case Study 1: Acute Myocardial Infarction (6-Item Set)
Scenario: A 62-year-old male presents to the ED with crushing substernal chest pain
radiating to his left arm, diaphoresis, and nausea. His BP is 88/52, HR 110, SpO₂ 92% on RA,
and ECG shows ST-segment elevation in leads II, III, and aVF. He is diagnosed with an
inferior wall MI and receives aspirin, nitroglycerin, and IV morphine .
Question 1: What is the priority nursing action for this patient? A. Administer IV fluids for
hypotension. B. Prepare for emergent cardiac catheterization. C. Obtain a cardiac troponin level.
D. Assess for signs of heart failure.
Correct Answer: B Rationale: ST-segment elevation indicates an acute MI, and emergent
revascularization (via cardiac cath or thrombolytics) is the priority to restore coronary blood
flow. IV fluids (A) may worsen heart failure, troponin (C) confirms MI but is not urgent, and heart
failure assessment (D) is secondary.
NGN Clinical Judgment Step: Recognize Cues (ECG changes, hypotension, symptoms).
Question 2: The patient’s BP drops to 70/40 after nitroglycerin administration. What is the
most likely cause ? A. Hypovolemia B. Right ventricular infarction C. Anaphylaxis to morphine D.
Bradycardia from beta-blockers
Correct Answer: B Rationale: Right ventricular infarction (common with inferior MI) causes
preload dependency and hypotension with nitroglycerin (a venodilator). Hypovolemia (A) is
unlikely without fluid loss, anaphylaxis (C) would present with urticaria/bronchospasm, and
bradycardia (D) is not described.
NGN Clinical Judgment Step: Analyze Cues (BP drop post-nitro, inferior MI).
,Question 3: The patient is started on a heparin infusion. Which lab value should the nurse
monitor most closely? A. PT/INR B. aPTT C. Platelet count D. D-dimer
Correct Answer: B Rationale: aPTT monitors heparin therapy (target: 1.5–2.5× baseline).
PT/INR (A) monitors warfarin, platelet count (C) screens for HIT (but not primary monitoring),
and D-dimer (D) assesses clotting disorders.
NGN Clinical Judgment Step: Generate Solutions (heparin requires aPTT monitoring).
Question 4: The patient develops ventricular tachycardia on the monitor. What is the
first-line intervention? A. Administer IV amiodarone. B. Perform synchronized cardioversion.
C. Defibrillate immediately. D. Administer IV lidocaine.
Correct Answer: B Rationale: Synchronized cardioversion is first-line for stable VT with a
pulse . Amiodarone (A) and lidocaine (D) are second-line. Defibrillation (C) is for pulseless
VT/VF.
NGN Clinical Judgment Step: Take Action (VT with pulse → cardioversion).
Question 5: The patient is transferred to the CCU. Which complication should the nurse
anticipate within the first 24 hours? A. Cardiogenic shock B. Pulmonary embolism C.
Pericarditis D. Aortic dissection
Correct Answer: A Rationale: Cardiogenic shock (from pump failure) is a major
complication post-MI. Pulmonary embolism (B) is unrelated, pericarditis (C) occurs later
(Dressler’s syndrome), and aortic dissection (D) is not directly linked to MI.
NGN Clinical Judgment Step: Evaluate Outcomes (anticipate complications).
Question 6: The patient’s troponin level is elevated at 12 ng/mL. What does this indicate? A.
The MI is resolving. B. The MI is acute and ongoing. C. The patient has chronic stable angina. D.
The troponin assay is faulty.
,Correct Answer: B Rationale: Elevated troponin (peaks at 24–48 hours) confirms acute
myocardial injury. Resolving MI (A) would show declining levels, stable angina (C) does not
elevate troponin, and assay fault (D) is unlikely with consistent symptoms/ECG.
NGN Clinical Judgment Step: Recognize Cues (troponin trends).
Matrix Multiple Response
Question 7: A patient with COPD is admitted with acute respiratory failure . Which
assessments are priority? (Select all that apply.)
Assessment Priority (Yes/No)
Arterial blood gas (ABG) Yes
Sputum culture No
Oxygen saturation Yes
Chest X-ray Yes
Pulmonary function tests No
Correct Answers:
● ABG: Yes (assesses PaO₂, PaCO₂, pH for respiratory failure).
● Oxygen saturation: Yes (monitors hypoxemia).
● Chest X-ray: Yes (rules out pneumonia/pneumothorax).
● Sputum culture: No (not urgent in acute failure).
● PFTs: No (contraindicated in acute distress).
Rationale: ABG, SpO₂, and CXR are critical for diagnosing and managing
hypoxemic/respiratory failure . Sputum culture and PFTs are non-urgent in acute settings.
NGN Clinical Judgment Step: Prioritize Hypotheses (acute vs. chronic data).
Cloze/Drop-Down
, Question 8: A patient with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL
and serum potassium of 3.2 mEq/L. The nurse should anticipate administering _____ first. A.
Regular insulin IV B. Potassium chloride IV C. Sodium bicarbonate IV D. 0.9% normal saline IV
Correct Answer: D Rationale: Fluid resuscitation (0.9% NS) is the first priority in DKA to
correct dehydration and hyperosmolarity. Insulin (A) is given after fluids, potassium (B) is
replaced after insulin lowers K+, and bicarbonate (C) is rarely used (only for severe acidosis, pH
< 7.0).
NGN Clinical Judgment Step: Generate Solutions (DKA management priorities).
Bow-Tie Item
Question 9: Link the following clinical manifestations to the most likely diagnosis:
1. Dyspnea, frothy sputum, +S3 gallop → A. Acute pulmonary edema
2. Sudden chest pain, +D-dimer, tachycardia → B. Pulmonary embolism
3. Fever, productive cough, +infiltrates on CXR → C. Pneumonia
4. Hypotension, oliguria, +troponin → D. Cardiogenic shock
Correct Answers: 1 → A, 2 → B, 3 → C, 4 → D
Rationale:
● Pulmonary edema (A): Left-sided heart failure → crackles, S3, frothy sputum.
● Pulmonary embolism (B): Sudden dyspnea, tachycardia, +D-dimer.
● Pneumonia (C): Infectious process → fever, productive cough, CXR infiltrates.
● Cardiogenic shock (D): Pump failure → hypotension, oliguria, +troponin.
NGN Clinical Judgment Step: Recognize Patterns (matching symptoms to diagnoses).
Trend Item
Question 10: A patient’s ABG results over 4 hours are shown below. What is the trend
indicating?
Time pH PaCO₂ PaO₂ HCO₃⁻
Ultimate Guide with Answer Explanations
and Test-Taking Strategies
Case Study 1: Acute Myocardial Infarction (6-Item Set)
Scenario: A 62-year-old male presents to the ED with crushing substernal chest pain
radiating to his left arm, diaphoresis, and nausea. His BP is 88/52, HR 110, SpO₂ 92% on RA,
and ECG shows ST-segment elevation in leads II, III, and aVF. He is diagnosed with an
inferior wall MI and receives aspirin, nitroglycerin, and IV morphine .
Question 1: What is the priority nursing action for this patient? A. Administer IV fluids for
hypotension. B. Prepare for emergent cardiac catheterization. C. Obtain a cardiac troponin level.
D. Assess for signs of heart failure.
Correct Answer: B Rationale: ST-segment elevation indicates an acute MI, and emergent
revascularization (via cardiac cath or thrombolytics) is the priority to restore coronary blood
flow. IV fluids (A) may worsen heart failure, troponin (C) confirms MI but is not urgent, and heart
failure assessment (D) is secondary.
NGN Clinical Judgment Step: Recognize Cues (ECG changes, hypotension, symptoms).
Question 2: The patient’s BP drops to 70/40 after nitroglycerin administration. What is the
most likely cause ? A. Hypovolemia B. Right ventricular infarction C. Anaphylaxis to morphine D.
Bradycardia from beta-blockers
Correct Answer: B Rationale: Right ventricular infarction (common with inferior MI) causes
preload dependency and hypotension with nitroglycerin (a venodilator). Hypovolemia (A) is
unlikely without fluid loss, anaphylaxis (C) would present with urticaria/bronchospasm, and
bradycardia (D) is not described.
NGN Clinical Judgment Step: Analyze Cues (BP drop post-nitro, inferior MI).
,Question 3: The patient is started on a heparin infusion. Which lab value should the nurse
monitor most closely? A. PT/INR B. aPTT C. Platelet count D. D-dimer
Correct Answer: B Rationale: aPTT monitors heparin therapy (target: 1.5–2.5× baseline).
PT/INR (A) monitors warfarin, platelet count (C) screens for HIT (but not primary monitoring),
and D-dimer (D) assesses clotting disorders.
NGN Clinical Judgment Step: Generate Solutions (heparin requires aPTT monitoring).
Question 4: The patient develops ventricular tachycardia on the monitor. What is the
first-line intervention? A. Administer IV amiodarone. B. Perform synchronized cardioversion.
C. Defibrillate immediately. D. Administer IV lidocaine.
Correct Answer: B Rationale: Synchronized cardioversion is first-line for stable VT with a
pulse . Amiodarone (A) and lidocaine (D) are second-line. Defibrillation (C) is for pulseless
VT/VF.
NGN Clinical Judgment Step: Take Action (VT with pulse → cardioversion).
Question 5: The patient is transferred to the CCU. Which complication should the nurse
anticipate within the first 24 hours? A. Cardiogenic shock B. Pulmonary embolism C.
Pericarditis D. Aortic dissection
Correct Answer: A Rationale: Cardiogenic shock (from pump failure) is a major
complication post-MI. Pulmonary embolism (B) is unrelated, pericarditis (C) occurs later
(Dressler’s syndrome), and aortic dissection (D) is not directly linked to MI.
NGN Clinical Judgment Step: Evaluate Outcomes (anticipate complications).
Question 6: The patient’s troponin level is elevated at 12 ng/mL. What does this indicate? A.
The MI is resolving. B. The MI is acute and ongoing. C. The patient has chronic stable angina. D.
The troponin assay is faulty.
,Correct Answer: B Rationale: Elevated troponin (peaks at 24–48 hours) confirms acute
myocardial injury. Resolving MI (A) would show declining levels, stable angina (C) does not
elevate troponin, and assay fault (D) is unlikely with consistent symptoms/ECG.
NGN Clinical Judgment Step: Recognize Cues (troponin trends).
Matrix Multiple Response
Question 7: A patient with COPD is admitted with acute respiratory failure . Which
assessments are priority? (Select all that apply.)
Assessment Priority (Yes/No)
Arterial blood gas (ABG) Yes
Sputum culture No
Oxygen saturation Yes
Chest X-ray Yes
Pulmonary function tests No
Correct Answers:
● ABG: Yes (assesses PaO₂, PaCO₂, pH for respiratory failure).
● Oxygen saturation: Yes (monitors hypoxemia).
● Chest X-ray: Yes (rules out pneumonia/pneumothorax).
● Sputum culture: No (not urgent in acute failure).
● PFTs: No (contraindicated in acute distress).
Rationale: ABG, SpO₂, and CXR are critical for diagnosing and managing
hypoxemic/respiratory failure . Sputum culture and PFTs are non-urgent in acute settings.
NGN Clinical Judgment Step: Prioritize Hypotheses (acute vs. chronic data).
Cloze/Drop-Down
, Question 8: A patient with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL
and serum potassium of 3.2 mEq/L. The nurse should anticipate administering _____ first. A.
Regular insulin IV B. Potassium chloride IV C. Sodium bicarbonate IV D. 0.9% normal saline IV
Correct Answer: D Rationale: Fluid resuscitation (0.9% NS) is the first priority in DKA to
correct dehydration and hyperosmolarity. Insulin (A) is given after fluids, potassium (B) is
replaced after insulin lowers K+, and bicarbonate (C) is rarely used (only for severe acidosis, pH
< 7.0).
NGN Clinical Judgment Step: Generate Solutions (DKA management priorities).
Bow-Tie Item
Question 9: Link the following clinical manifestations to the most likely diagnosis:
1. Dyspnea, frothy sputum, +S3 gallop → A. Acute pulmonary edema
2. Sudden chest pain, +D-dimer, tachycardia → B. Pulmonary embolism
3. Fever, productive cough, +infiltrates on CXR → C. Pneumonia
4. Hypotension, oliguria, +troponin → D. Cardiogenic shock
Correct Answers: 1 → A, 2 → B, 3 → C, 4 → D
Rationale:
● Pulmonary edema (A): Left-sided heart failure → crackles, S3, frothy sputum.
● Pulmonary embolism (B): Sudden dyspnea, tachycardia, +D-dimer.
● Pneumonia (C): Infectious process → fever, productive cough, CXR infiltrates.
● Cardiogenic shock (D): Pump failure → hypotension, oliguria, +troponin.
NGN Clinical Judgment Step: Recognize Patterns (matching symptoms to diagnoses).
Trend Item
Question 10: A patient’s ABG results over 4 hours are shown below. What is the trend
indicating?
Time pH PaCO₂ PaO₂ HCO₃⁻
