Med-Surg HESI PN Final Medical-Surgical Nursing EXAM 2026/2027 – Latest Version
Core Domains: Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders,
Endocrine Disorders, Renal & Genitourinary Disorders, Neurological Disorders, Musculoskeletal
Disorders, Hematological & Oncological Disorders, Immunological Disorders (including HIV/AIDS),
Integumentary Disorders, Perioperative Nursing, Fluid & Electrolyte Balance, Acid-Base Balance,
Pharmacology & Medication Administration, Pain Management, Wound Care, Complications of
Immobility, Gerontological Considerations, Cultural Competence, Prioritization/Clinical Judgment, and
Delegation to Unlicensed Assistive Personnel
Exam Structure: 100-question, multiple-choice and alternate-format (select-all-that-apply, ordered
response) examination designed to evaluate clinical judgment, prioritization skills, and application of
evidence-based medical-surgical nursing care across the adult health continuum for practical nursing
candidates.
[Domain 1: Cardiovascular Disorders]
1. A client with hypertension is prescribed hydrochlorothiazide (HCTZ). Which instruction
should the PN include in client teaching?
1. A) "Take this medication at bedtime to prevent daytime drowsiness."
2. B) "Take this medication in the morning to prevent nocturia."
3. C) "Double the dose if you miss a day."
4. D) "Stop taking the medication if you feel dizzy."
"Take this medication in the morning to prevent nocturia." HCTZ is a diuretic;
morning administration reduces nighttime urination (HESI PN, 2026; JNC 8
Hypertension Guidelines).
PN Note: Always assess for orthostatic hypotension when administering diuretics.
2. A client with heart failure reports a 3 lb (1.4 kg) weight gain in 2 days. Which action
should the PN take FIRST?
, 1. A) Administer the prescribed diuretic
2. B) Notify the RN or healthcare provider
3. C) Restrict fluids to 1000 mL/day
4. D) Document the finding and continue monitoring
Notify the RN or healthcare provider Sudden weight gain indicates fluid retention and
requires RN assessment for possible medication adjustment (HESI PN, 2026; HFSA
Heart Failure Guidelines).
PN Note: Weight gain >2 lbs/day is a red flag for fluid overload in heart failure.
3. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory
value should the PN monitor?
1. A) aPTT
2. B) PT
3. C) INR
4. D) Platelet count
INR is the standard for monitoring warfarin therapy; target range is 2-3 for most
indications (HESI PN, 2026; CHEST Antithrombotic Guidelines).
PN Note: Report INR >3 or <2 to the RN for further action.
4. A client with a history of myocardial infarction (MI) is prescribed aspirin 81 mg daily.
What is the purpose of this medication?
1. A) To reduce inflammation
2. B) To lower blood pressure
3. C) To prevent blood clots
4. D) To control cholesterol
, To prevent blood clots Aspirin's antiplatelet effect reduces the risk of thrombus
formation in coronary arteries (HESI PN, 2026; AHA Secondary Prevention
Guidelines).
PN Note: Teach client to report signs of bleeding (e.g., bruising, black stools).
5. A client with peripheral arterial disease (PAD) complains of leg pain during ambulation.
Which instruction should the PN provide?
1. A) "Avoid all physical activity to prevent pain."
2. B) "Walk until you feel mild pain, rest, then walk again."
3. C) "Take pain medication before walking."
4. D) "Use a wheelchair to avoid walking."
"Walk until you feel mild pain, rest, then walk again." Gradual exercise improves
circulation and reduces claudication symptoms (HESI PN, 2026; AHA PAD
Guidelines).
PN Note: Encourage smoking cessation and foot care education.
6. A client with deep vein thrombosis (DVT) is prescribed bed rest. Which intervention
should the PN implement?
1. A) Massage the affected leg every 4 hours
2. B) Elevate the affected leg above heart level
3. C) Apply warm compresses to the leg
4. D) Encourage ambulation three times daily
Elevate the affected leg above heart level Promotes venous return and reduces edema
and pain (HESI PN, 2026; CHEST Venous Thromboembolism Guidelines).
PN Note: Avoid massage to prevent dislodging the clot.
, 7. A client with a pacemaker reports dizziness. Which action should the PN take FIRST?
1. A) Administer PRN anti-nausea medication
2. B) Assess vital signs and notify the RN
3. C) Document the finding and continue monitoring
4. D) Encourage the client to lie down
Assess vital signs and notify the RN Dizziness may indicate pacemaker malfunction or
arrhythmia, requiring RN assessment (HESI PN, 2026; AHA Pacemaker Guidelines).
PN Note: Never adjust pacemaker settings; this is outside PN scope.
8. A client with hypertension is prescribed a low-sodium diet. Which food should the PN
instruct the client to avoid?
1. A) Fresh fruits
2. B) Steamed vegetables
3. C) Canned soups
4. D) Grilled chicken
Canned soups Typically high in sodium; fresh or homemade foods are preferred (HESI
PN, 2026; AHA Hypertension Guidelines).
PN Note: Teach client to read food labels for sodium content.
9. A client with heart failure is prescribed digoxin (Lanoxin). Which adverse effect should
the PN monitor for?
1. A) Hypernatremia
2. B) Bradycardia
3. C) Hyperglycemia
4. D) Diarrhea
Core Domains: Cardiovascular Disorders, Respiratory Disorders, Gastrointestinal Disorders,
Endocrine Disorders, Renal & Genitourinary Disorders, Neurological Disorders, Musculoskeletal
Disorders, Hematological & Oncological Disorders, Immunological Disorders (including HIV/AIDS),
Integumentary Disorders, Perioperative Nursing, Fluid & Electrolyte Balance, Acid-Base Balance,
Pharmacology & Medication Administration, Pain Management, Wound Care, Complications of
Immobility, Gerontological Considerations, Cultural Competence, Prioritization/Clinical Judgment, and
Delegation to Unlicensed Assistive Personnel
Exam Structure: 100-question, multiple-choice and alternate-format (select-all-that-apply, ordered
response) examination designed to evaluate clinical judgment, prioritization skills, and application of
evidence-based medical-surgical nursing care across the adult health continuum for practical nursing
candidates.
[Domain 1: Cardiovascular Disorders]
1. A client with hypertension is prescribed hydrochlorothiazide (HCTZ). Which instruction
should the PN include in client teaching?
1. A) "Take this medication at bedtime to prevent daytime drowsiness."
2. B) "Take this medication in the morning to prevent nocturia."
3. C) "Double the dose if you miss a day."
4. D) "Stop taking the medication if you feel dizzy."
"Take this medication in the morning to prevent nocturia." HCTZ is a diuretic;
morning administration reduces nighttime urination (HESI PN, 2026; JNC 8
Hypertension Guidelines).
PN Note: Always assess for orthostatic hypotension when administering diuretics.
2. A client with heart failure reports a 3 lb (1.4 kg) weight gain in 2 days. Which action
should the PN take FIRST?
, 1. A) Administer the prescribed diuretic
2. B) Notify the RN or healthcare provider
3. C) Restrict fluids to 1000 mL/day
4. D) Document the finding and continue monitoring
Notify the RN or healthcare provider Sudden weight gain indicates fluid retention and
requires RN assessment for possible medication adjustment (HESI PN, 2026; HFSA
Heart Failure Guidelines).
PN Note: Weight gain >2 lbs/day is a red flag for fluid overload in heart failure.
3. A client with atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory
value should the PN monitor?
1. A) aPTT
2. B) PT
3. C) INR
4. D) Platelet count
INR is the standard for monitoring warfarin therapy; target range is 2-3 for most
indications (HESI PN, 2026; CHEST Antithrombotic Guidelines).
PN Note: Report INR >3 or <2 to the RN for further action.
4. A client with a history of myocardial infarction (MI) is prescribed aspirin 81 mg daily.
What is the purpose of this medication?
1. A) To reduce inflammation
2. B) To lower blood pressure
3. C) To prevent blood clots
4. D) To control cholesterol
, To prevent blood clots Aspirin's antiplatelet effect reduces the risk of thrombus
formation in coronary arteries (HESI PN, 2026; AHA Secondary Prevention
Guidelines).
PN Note: Teach client to report signs of bleeding (e.g., bruising, black stools).
5. A client with peripheral arterial disease (PAD) complains of leg pain during ambulation.
Which instruction should the PN provide?
1. A) "Avoid all physical activity to prevent pain."
2. B) "Walk until you feel mild pain, rest, then walk again."
3. C) "Take pain medication before walking."
4. D) "Use a wheelchair to avoid walking."
"Walk until you feel mild pain, rest, then walk again." Gradual exercise improves
circulation and reduces claudication symptoms (HESI PN, 2026; AHA PAD
Guidelines).
PN Note: Encourage smoking cessation and foot care education.
6. A client with deep vein thrombosis (DVT) is prescribed bed rest. Which intervention
should the PN implement?
1. A) Massage the affected leg every 4 hours
2. B) Elevate the affected leg above heart level
3. C) Apply warm compresses to the leg
4. D) Encourage ambulation three times daily
Elevate the affected leg above heart level Promotes venous return and reduces edema
and pain (HESI PN, 2026; CHEST Venous Thromboembolism Guidelines).
PN Note: Avoid massage to prevent dislodging the clot.
, 7. A client with a pacemaker reports dizziness. Which action should the PN take FIRST?
1. A) Administer PRN anti-nausea medication
2. B) Assess vital signs and notify the RN
3. C) Document the finding and continue monitoring
4. D) Encourage the client to lie down
Assess vital signs and notify the RN Dizziness may indicate pacemaker malfunction or
arrhythmia, requiring RN assessment (HESI PN, 2026; AHA Pacemaker Guidelines).
PN Note: Never adjust pacemaker settings; this is outside PN scope.
8. A client with hypertension is prescribed a low-sodium diet. Which food should the PN
instruct the client to avoid?
1. A) Fresh fruits
2. B) Steamed vegetables
3. C) Canned soups
4. D) Grilled chicken
Canned soups Typically high in sodium; fresh or homemade foods are preferred (HESI
PN, 2026; AHA Hypertension Guidelines).
PN Note: Teach client to read food labels for sodium content.
9. A client with heart failure is prescribed digoxin (Lanoxin). Which adverse effect should
the PN monitor for?
1. A) Hypernatremia
2. B) Bradycardia
3. C) Hyperglycemia
4. D) Diarrhea
