1
BSN HESI 266 MED SURG EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Rationales Grade A 100%
Correct Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.8 mEq/L [CORRECT]
• C. Creatinine 1.0 mg/dL
• D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting through the
kidneys. A potassium level of 2.8 mEq/L represents severe hypokalemia that can precipitate life-
threatening ventricular dysrhythmias, muscle weakness, and respiratory failure. The nurse should
immediately notify the provider and anticipate potassium replacement therapy while continuous
cardiac monitoring is initiated.
Q2: A patient with a history of atrial fibrillation is prescribed warfarin 5 mg daily. Which
laboratory result indicates the therapeutic goal has been achieved?
• A. aPTT 1.5 times control
• B. INR 2.5 [CORRECT]
• C. PT 8 seconds
• D. Platelet count 150,000/mm³
Correct Answer: B
,2
Rationale: For patients with atrial fibrillation, the target INR (International Normalized Ratio) is
typically 2.0-3.0 to prevent thromboembolic events while minimizing bleeding risk. An INR of
2.5 falls within this therapeutic range. aPTT monitors heparin therapy, not warfarin. PT alone is
not standardized like INR, and platelet counts assess clotting function but not warfarin efficacy.
Q3: A nurse is assessing a patient with acute coronary syndrome. Which finding requires
immediate notification of the healthcare provider?
• A. Blood pressure 138/88 mmHg
• B. Chest pain unrelieved by nitroglycerin [CORRECT]
• C. Heart rate 78 beats/minute
• D. Respiratory rate 16 breaths/minute
Correct Answer: B
Rationale: Chest pain unrelieved by nitroglycerin indicates ongoing myocardial ischemia or
infarction, representing a medical emergency requiring immediate intervention. This may
indicate STEMI requiring rapid reperfusion therapy (PCI within 90 minutes or fibrinolysis within
30 minutes). The other vital signs are within normal limits and do not indicate acute
deterioration.
Q4: A patient with heart failure is receiving digoxin 0.25 mg daily. Which assessment finding
indicates possible digoxin toxicity?
• A. Apical pulse 68 beats/minute
• B. Visual disturbances including yellow-green halos [CORRECT]
• C. Blood pressure 130/80 mmHg
• D. Urine output 50 mL/hour
Correct Answer: B
Rationale: Visual disturbances, particularly the perception of yellow-green halos around objects,
are classic early signs of digoxin toxicity. Other manifestations include nausea, vomiting,
anorexia, confusion, and cardiac dysrhythmias (especially ventricular ectopy and heart blocks).
The therapeutic range for digoxin is narrow (0.5-0.9 ng/mL), and toxicity risk increases with
hypokalemia, hypomagnesemia, renal impairment, and advanced age.
,3
Q5: A nurse is caring for a patient immediately post-cardiac catheterization via the femoral
artery. Which intervention is the priority?
• A. Encourage ambulation to prevent DVT
• B. Maintain bed rest with affected leg straight for 4-6 hours [CORRECT]
• C. Administer aspirin 325 mg orally
• D. Begin cardiac rehabilitation exercises
Correct Answer: B
Rationale: Following femoral artery catheterization, maintaining bed rest with the affected leg
straight prevents bleeding and hematoma formation at the insertion site by allowing adequate
platelet plug formation and vessel sealing. The head of bed may be elevated up to 30 degrees.
Ambulation too soon risks hemorrhage, pseudoaneurysm, or arteriovenous fistula formation.
Manual or mechanical compression devices are often used.
Q6: A patient with hypertension is prescribed lisinopril 10 mg daily. Which instruction should
the nurse include in the teaching plan?
• A. Take the medication with food to enhance absorption
• B. Rise slowly from sitting or lying positions to prevent dizziness [CORRECT]
• C. Monitor heart rate daily and hold medication if below 60 bpm
• D. Expect increased swelling in the legs as a normal side effect
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, can cause first-dose hypotension and orthostatic
hypotension, particularly in patients with heart failure or those taking diuretics. Teaching patients
to rise slowly minimizes fall risk from dizziness. ACE inhibitors do not require food for
absorption, do not typically cause bradycardia requiring monitoring, and actually reduce edema
rather than cause it.
Q7: A patient with acute myocardial infarction is receiving heparin infusion. Which laboratory
value requires immediate intervention?
• A. aPTT 60 seconds [CORRECT]
• B. Hemoglobin 13.5 g/dL
• C. Platelet count 250,000/mm³
, 4
• D. INR 1.0
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5-2.5 times the control value
(usually 46-70 seconds depending on laboratory standards). An aPTT of 60 seconds likely
represents supratherapeutic heparin levels with increased bleeding risk, requiring immediate dose
adjustment per protocol. Hemoglobin and platelet counts are normal. INR is not used to monitor
heparin but is normal.
Q8: A nurse is caring for a patient with left-sided heart failure. Which assessment finding is
consistent with this condition?
• A. Jugular venous distension
• B. Hepatomegaly
• C. Pulmonary crackles [CORRECT]
• D. Peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the
pulmonary circulation, resulting in crackles (rales), dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. Jugular venous distension, hepatomegaly, and peripheral edema are signs of
right-sided heart failure caused by systemic venous congestion. Understanding this distinction is
crucial for appropriate nursing interventions.
Q9: A patient is being discharged home on warfarin therapy. Which dietary instruction is most
important?
• A. Avoid all green leafy vegetables
• B. Maintain consistent vitamin K intake [CORRECT]
• C. Increase intake of vitamin K-rich foods
• D. Take with high-fat meals for absorption
Correct Answer: B
Rationale: Patients on warfarin should maintain consistent daily intake of vitamin K
(approximately 90-120 mcg for adults) rather than avoiding it completely. Sudden increases or
BSN HESI 266 MED SURG EXAM Actual Exam
2026/2027 Complete Questions and Verified
Answers with Detailed Rationales Grade A 100%
Correct Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-25)
Q1: A nurse is caring for a patient with heart failure who has been receiving furosemide 40 mg
IV daily. Which laboratory value requires immediate intervention?
• A. Sodium 135 mEq/L
• B. Potassium 2.8 mEq/L [CORRECT]
• C. Creatinine 1.0 mg/dL
• D. Hemoglobin 12.5 g/dL
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting through the
kidneys. A potassium level of 2.8 mEq/L represents severe hypokalemia that can precipitate life-
threatening ventricular dysrhythmias, muscle weakness, and respiratory failure. The nurse should
immediately notify the provider and anticipate potassium replacement therapy while continuous
cardiac monitoring is initiated.
Q2: A patient with a history of atrial fibrillation is prescribed warfarin 5 mg daily. Which
laboratory result indicates the therapeutic goal has been achieved?
• A. aPTT 1.5 times control
• B. INR 2.5 [CORRECT]
• C. PT 8 seconds
• D. Platelet count 150,000/mm³
Correct Answer: B
,2
Rationale: For patients with atrial fibrillation, the target INR (International Normalized Ratio) is
typically 2.0-3.0 to prevent thromboembolic events while minimizing bleeding risk. An INR of
2.5 falls within this therapeutic range. aPTT monitors heparin therapy, not warfarin. PT alone is
not standardized like INR, and platelet counts assess clotting function but not warfarin efficacy.
Q3: A nurse is assessing a patient with acute coronary syndrome. Which finding requires
immediate notification of the healthcare provider?
• A. Blood pressure 138/88 mmHg
• B. Chest pain unrelieved by nitroglycerin [CORRECT]
• C. Heart rate 78 beats/minute
• D. Respiratory rate 16 breaths/minute
Correct Answer: B
Rationale: Chest pain unrelieved by nitroglycerin indicates ongoing myocardial ischemia or
infarction, representing a medical emergency requiring immediate intervention. This may
indicate STEMI requiring rapid reperfusion therapy (PCI within 90 minutes or fibrinolysis within
30 minutes). The other vital signs are within normal limits and do not indicate acute
deterioration.
Q4: A patient with heart failure is receiving digoxin 0.25 mg daily. Which assessment finding
indicates possible digoxin toxicity?
• A. Apical pulse 68 beats/minute
• B. Visual disturbances including yellow-green halos [CORRECT]
• C. Blood pressure 130/80 mmHg
• D. Urine output 50 mL/hour
Correct Answer: B
Rationale: Visual disturbances, particularly the perception of yellow-green halos around objects,
are classic early signs of digoxin toxicity. Other manifestations include nausea, vomiting,
anorexia, confusion, and cardiac dysrhythmias (especially ventricular ectopy and heart blocks).
The therapeutic range for digoxin is narrow (0.5-0.9 ng/mL), and toxicity risk increases with
hypokalemia, hypomagnesemia, renal impairment, and advanced age.
,3
Q5: A nurse is caring for a patient immediately post-cardiac catheterization via the femoral
artery. Which intervention is the priority?
• A. Encourage ambulation to prevent DVT
• B. Maintain bed rest with affected leg straight for 4-6 hours [CORRECT]
• C. Administer aspirin 325 mg orally
• D. Begin cardiac rehabilitation exercises
Correct Answer: B
Rationale: Following femoral artery catheterization, maintaining bed rest with the affected leg
straight prevents bleeding and hematoma formation at the insertion site by allowing adequate
platelet plug formation and vessel sealing. The head of bed may be elevated up to 30 degrees.
Ambulation too soon risks hemorrhage, pseudoaneurysm, or arteriovenous fistula formation.
Manual or mechanical compression devices are often used.
Q6: A patient with hypertension is prescribed lisinopril 10 mg daily. Which instruction should
the nurse include in the teaching plan?
• A. Take the medication with food to enhance absorption
• B. Rise slowly from sitting or lying positions to prevent dizziness [CORRECT]
• C. Monitor heart rate daily and hold medication if below 60 bpm
• D. Expect increased swelling in the legs as a normal side effect
Correct Answer: B
Rationale: Lisinopril, an ACE inhibitor, can cause first-dose hypotension and orthostatic
hypotension, particularly in patients with heart failure or those taking diuretics. Teaching patients
to rise slowly minimizes fall risk from dizziness. ACE inhibitors do not require food for
absorption, do not typically cause bradycardia requiring monitoring, and actually reduce edema
rather than cause it.
Q7: A patient with acute myocardial infarction is receiving heparin infusion. Which laboratory
value requires immediate intervention?
• A. aPTT 60 seconds [CORRECT]
• B. Hemoglobin 13.5 g/dL
• C. Platelet count 250,000/mm³
, 4
• D. INR 1.0
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5-2.5 times the control value
(usually 46-70 seconds depending on laboratory standards). An aPTT of 60 seconds likely
represents supratherapeutic heparin levels with increased bleeding risk, requiring immediate dose
adjustment per protocol. Hemoglobin and platelet counts are normal. INR is not used to monitor
heparin but is normal.
Q8: A nurse is caring for a patient with left-sided heart failure. Which assessment finding is
consistent with this condition?
• A. Jugular venous distension
• B. Hepatomegaly
• C. Pulmonary crackles [CORRECT]
• D. Peripheral edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the
pulmonary circulation, resulting in crackles (rales), dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. Jugular venous distension, hepatomegaly, and peripheral edema are signs of
right-sided heart failure caused by systemic venous congestion. Understanding this distinction is
crucial for appropriate nursing interventions.
Q9: A patient is being discharged home on warfarin therapy. Which dietary instruction is most
important?
• A. Avoid all green leafy vegetables
• B. Maintain consistent vitamin K intake [CORRECT]
• C. Increase intake of vitamin K-rich foods
• D. Take with high-fat meals for absorption
Correct Answer: B
Rationale: Patients on warfarin should maintain consistent daily intake of vitamin K
(approximately 90-120 mcg for adults) rather than avoiding it completely. Sudden increases or
