BSN HESI 266 MED SURG ACTUAL EXAM 2026/2027 | Latest
Questions & Verified Answers | 100% Correct | Grade A |
Nightingale | Comprehensive Mastery | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male presents to the emergency department with crushing substernal
chest pain radiating to the left arm, diaphoresis, and nausea. Vital signs: BP 92/58
mmHg, HR 112 bpm, RR 24/min, SpO₂ 91% on room air. The 12-lead EKG shows
ST-segment elevation in leads V1-V4. Which nursing intervention is the priority?
A. Administer sublingual nitroglycerin every 5 minutes
B. Obtain a stat chest X-ray
C. Prepare the patient for emergent percutaneous coronary intervention [CORRECT]
D. Start a heparin drip at 18 units/kg/hr
Correct Answer: C
Rationale: This patient presents with an anterior ST-elevation myocardial infarction
(STEMI) with hemodynamic instability. The priority is immediate reperfusion therapy;
door-to-balloon time should be under 90 minutes. While nitroglycerin and heparin are
important adjuncts, they do not restore coronary blood flow. A chest X-ray is not
emergent and delays definitive treatment.
Q2: A 72-year-old female with chronic heart failure (HFrEF, EF 35%) reports increased
dyspnea on exertion, 3+ pitting edema bilaterally, and a 5-pound weight gain over 3
days. Current medications include lisinopril, metoprolol, and furosemide. Which
assessment finding requires the most immediate nursing intervention?
A. Serum potassium of 3.2 mEq/L
B. Blood pressure of 148/92 mmHg
,C. Crackles auscultated in bilateral lung bases [CORRECT]
D. Heart rate of 88 bpm
Correct Answer: C
Rationale: Bilateral crackles indicate acute pulmonary edema from fluid overload,
representing impending respiratory failure. This requires immediate intervention
including oxygen, diuretics, and positioning. While hypokalemia from furosemide is
concerning, it is not immediately life-threatening. Blood pressure and heart rate are
expected findings in decompensated heart failure.
Q3: A 58-year-old male with atrial fibrillation on warfarin (INR 2.5) presents with a
sudden severe headache, slurred speech, and right-sided weakness. CT scan reveals an
intracranial hemorrhage. Which medication should the nurse prepare to administer
immediately?
A. Protamine sulfate
B. Vitamin K and four-factor prothrombin complex concentrate [CORRECT]
C. Alteplase (tPA)
D. Aspirin 325 mg
Correct Answer: B
Rationale: Warfarin-induced intracranial hemorrhage requires rapid reversal with vitamin
K and PCC to restore coagulation and prevent hematoma expansion. Protamine
reverses heparin, not warfarin. Alteplase is absolutely contraindicated in hemorrhagic
stroke. Aspirin would worsen bleeding.
Q4: A 45-year-old female with newly diagnosed hypertension (BP 168/104 mmHg) is
prescribed hydrochlorothiazide. Which patient education statement indicates correct
understanding?
A. "I should take this medication at bedtime to prevent nocturia."
B. "I need to increase my intake of bananas and oranges." [CORRECT]
C. "I can stop the medication once my blood pressure normalizes."
,D. "I should avoid all salt in my diet."
Correct Answer: B
Rationale: Thiazide diuretics cause potassium wasting; increasing potassium-rich foods
helps prevent hypokalemia. The medication should be taken in the morning to prevent
nocturia. Antihypertensives require lifelong adherence; abrupt cessation causes
rebound hypertension. Sodium restriction is advised, not complete elimination.
Q5: A 65-year-old male post-CABG day 2 has a chest tube draining 150 mL of bright red
blood in the past hour. His BP drops from 124/78 to 94/62 mmHg, and HR increases
from 76 to 108 bpm. What is the nurse's priority action?
A. Increase the suction on the chest tube to -30 cm H₂O
B. Notify the surgeon immediately and prepare for emergency return to OR [CORRECT]
C. Administer a 500 mL bolus of normal saline
D. Document the finding and continue hourly monitoring
Correct Answer: B
Rationale: Hemorrhage exceeding 100-150 mL/hr with hemodynamic instability
indicates active postoperative bleeding requiring surgical intervention. While fluid
resuscitation may be needed, the definitive priority is notifying the surgeon. Increasing
suction is not appropriate and may cause tissue trauma.
Q6: A 55-year-old male with peripheral arterial disease reports severe leg pain at rest,
non-healing ulcers on the toes, and dependent rubor. Which nursing intervention is most
appropriate?
A. Apply warm compresses to the affected limb
B. Elevate the legs above heart level to reduce edema
C. Keep the legs in a dependent position and avoid pressure on heels [CORRECT]
D. Massage the calves to improve circulation
Correct Answer: C
, Rationale: In PAD, elevating limbs worsens ischemia; dependent positioning utilizes
gravity to improve perfusion. Warm compresses can cause thermal injury to ischemic
tissue. Massage may dislodge thrombi and cause embolization.
Q7: A 38-year-old female with a history of rheumatic fever is diagnosed with mitral
stenosis. Which assessment finding is most consistent with this valvular disorder?
A. Widened pulse pressure and bounding pulses
B. Diastolic rumbling murmur at the apex with an opening snap [CORRECT]
C. Holosystolic murmur at the left sternal border
D. Pulsus paradoxus and distant heart sounds
Correct Answer: B
Rationale: Mitral stenosis produces a characteristic low-pitched diastolic rumbling
murmur best heard at the apex with an opening snap due to stiff valve leaflets. Widened
pulse pressure suggests aortic regurgitation. A holosystolic murmur indicates mitral
regurgitation. Pulsus paradoxus suggests cardiac tamponade.
Q8: A 70-year-old male with a history of atrial fibrillation presents with acute onset of
left leg pain, pallor, pulselessness, paresthesia, and paralysis. The leg is cool to touch.
Which intervention is the priority?
A. Apply compression stockings to the affected limb
B. Elevate the leg above heart level
C. Notify the physician immediately; prepare for emergent revascularization [CORRECT]
D. Perform passive range-of-motion exercises
Correct Answer: C
Rationale: The 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia)
indicate acute arterial occlusion requiring emergent revascularization within 6 hours to
prevent limb loss. Compression stockings and elevation are contraindicated. Exercise
increases metabolic demand on ischemic tissue.
Questions & Verified Answers | 100% Correct | Grade A |
Nightingale | Comprehensive Mastery | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male presents to the emergency department with crushing substernal
chest pain radiating to the left arm, diaphoresis, and nausea. Vital signs: BP 92/58
mmHg, HR 112 bpm, RR 24/min, SpO₂ 91% on room air. The 12-lead EKG shows
ST-segment elevation in leads V1-V4. Which nursing intervention is the priority?
A. Administer sublingual nitroglycerin every 5 minutes
B. Obtain a stat chest X-ray
C. Prepare the patient for emergent percutaneous coronary intervention [CORRECT]
D. Start a heparin drip at 18 units/kg/hr
Correct Answer: C
Rationale: This patient presents with an anterior ST-elevation myocardial infarction
(STEMI) with hemodynamic instability. The priority is immediate reperfusion therapy;
door-to-balloon time should be under 90 minutes. While nitroglycerin and heparin are
important adjuncts, they do not restore coronary blood flow. A chest X-ray is not
emergent and delays definitive treatment.
Q2: A 72-year-old female with chronic heart failure (HFrEF, EF 35%) reports increased
dyspnea on exertion, 3+ pitting edema bilaterally, and a 5-pound weight gain over 3
days. Current medications include lisinopril, metoprolol, and furosemide. Which
assessment finding requires the most immediate nursing intervention?
A. Serum potassium of 3.2 mEq/L
B. Blood pressure of 148/92 mmHg
,C. Crackles auscultated in bilateral lung bases [CORRECT]
D. Heart rate of 88 bpm
Correct Answer: C
Rationale: Bilateral crackles indicate acute pulmonary edema from fluid overload,
representing impending respiratory failure. This requires immediate intervention
including oxygen, diuretics, and positioning. While hypokalemia from furosemide is
concerning, it is not immediately life-threatening. Blood pressure and heart rate are
expected findings in decompensated heart failure.
Q3: A 58-year-old male with atrial fibrillation on warfarin (INR 2.5) presents with a
sudden severe headache, slurred speech, and right-sided weakness. CT scan reveals an
intracranial hemorrhage. Which medication should the nurse prepare to administer
immediately?
A. Protamine sulfate
B. Vitamin K and four-factor prothrombin complex concentrate [CORRECT]
C. Alteplase (tPA)
D. Aspirin 325 mg
Correct Answer: B
Rationale: Warfarin-induced intracranial hemorrhage requires rapid reversal with vitamin
K and PCC to restore coagulation and prevent hematoma expansion. Protamine
reverses heparin, not warfarin. Alteplase is absolutely contraindicated in hemorrhagic
stroke. Aspirin would worsen bleeding.
Q4: A 45-year-old female with newly diagnosed hypertension (BP 168/104 mmHg) is
prescribed hydrochlorothiazide. Which patient education statement indicates correct
understanding?
A. "I should take this medication at bedtime to prevent nocturia."
B. "I need to increase my intake of bananas and oranges." [CORRECT]
C. "I can stop the medication once my blood pressure normalizes."
,D. "I should avoid all salt in my diet."
Correct Answer: B
Rationale: Thiazide diuretics cause potassium wasting; increasing potassium-rich foods
helps prevent hypokalemia. The medication should be taken in the morning to prevent
nocturia. Antihypertensives require lifelong adherence; abrupt cessation causes
rebound hypertension. Sodium restriction is advised, not complete elimination.
Q5: A 65-year-old male post-CABG day 2 has a chest tube draining 150 mL of bright red
blood in the past hour. His BP drops from 124/78 to 94/62 mmHg, and HR increases
from 76 to 108 bpm. What is the nurse's priority action?
A. Increase the suction on the chest tube to -30 cm H₂O
B. Notify the surgeon immediately and prepare for emergency return to OR [CORRECT]
C. Administer a 500 mL bolus of normal saline
D. Document the finding and continue hourly monitoring
Correct Answer: B
Rationale: Hemorrhage exceeding 100-150 mL/hr with hemodynamic instability
indicates active postoperative bleeding requiring surgical intervention. While fluid
resuscitation may be needed, the definitive priority is notifying the surgeon. Increasing
suction is not appropriate and may cause tissue trauma.
Q6: A 55-year-old male with peripheral arterial disease reports severe leg pain at rest,
non-healing ulcers on the toes, and dependent rubor. Which nursing intervention is most
appropriate?
A. Apply warm compresses to the affected limb
B. Elevate the legs above heart level to reduce edema
C. Keep the legs in a dependent position and avoid pressure on heels [CORRECT]
D. Massage the calves to improve circulation
Correct Answer: C
, Rationale: In PAD, elevating limbs worsens ischemia; dependent positioning utilizes
gravity to improve perfusion. Warm compresses can cause thermal injury to ischemic
tissue. Massage may dislodge thrombi and cause embolization.
Q7: A 38-year-old female with a history of rheumatic fever is diagnosed with mitral
stenosis. Which assessment finding is most consistent with this valvular disorder?
A. Widened pulse pressure and bounding pulses
B. Diastolic rumbling murmur at the apex with an opening snap [CORRECT]
C. Holosystolic murmur at the left sternal border
D. Pulsus paradoxus and distant heart sounds
Correct Answer: B
Rationale: Mitral stenosis produces a characteristic low-pitched diastolic rumbling
murmur best heard at the apex with an opening snap due to stiff valve leaflets. Widened
pulse pressure suggests aortic regurgitation. A holosystolic murmur indicates mitral
regurgitation. Pulsus paradoxus suggests cardiac tamponade.
Q8: A 70-year-old male with a history of atrial fibrillation presents with acute onset of
left leg pain, pallor, pulselessness, paresthesia, and paralysis. The leg is cool to touch.
Which intervention is the priority?
A. Apply compression stockings to the affected limb
B. Elevate the leg above heart level
C. Notify the physician immediately; prepare for emergent revascularization [CORRECT]
D. Perform passive range-of-motion exercises
Correct Answer: C
Rationale: The 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia)
indicate acute arterial occlusion requiring emergent revascularization within 6 hours to
prevent limb loss. Compression stockings and elevation are contraindicated. Exercise
increases metabolic demand on ischemic tissue.
