BSN 266 HESI MED SURG PRACTICE EXAM V1 2026/2027 |
Questions & Verified Answers with Rationales | 100% Correct
| Grade A | Nightingale | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents with a blood pressure of
188/110 mmHg, headache, and blurred vision. He reports nonadherence to his
antihypertensive regimen for the past 2 weeks. Which nursing intervention is the
priority?
A. Administer a bolus of normal saline to increase perfusion
B. Initiate immediate IV antihypertensive therapy to lower MAP by 25% within the first
hour
C. Administer sublingual nitroglycerin and place the patient in supine position
D. Obtain a 12-lead EKG and cardiac enzymes before initiating any treatment
Correct Answer: B
Rationale: This patient is experiencing a hypertensive emergency (BP >180/120 with
target organ symptoms). The priority is controlled reduction of mean arterial pressure
by no more than 25% within the first hour using IV antihypertensives to prevent cerebral,
cardiac, and renal ischemia. Option A is contraindicated as fluid bolus would further
elevate BP. Option C is inappropriate for hypertensive emergency and supine positioning
is not indicated. Option D delays critical treatment; diagnostics should not precede
emergent intervention when end-organ damage is present.
Q2: A 72-year-old female with chronic heart failure (HFrEF, NYHA Class III) reports
increasing dyspnea on exertion, 3+ pitting edema in bilateral lower extremities, and a
5-pound weight gain over 3 days. Her current medications include lisinopril, metoprolol,
and furosemide. Which assessment finding requires immediate nursing intervention?
A. Blood pressure of 142/88 mmHg
B. Oxygen saturation of 89% on room air
C. Heart rate of 72 beats per minute
D. Potassium level of 3.8 mEq/L
,Correct Answer: B
Rationale: An SpO2 of 89% indicates severe hypoxemia and acute decompensated heart
failure requiring immediate supplemental oxygen to prevent tissue hypoxia and further
cardiac compromise. Option A is mildly elevated but not emergent. Option C is a normal
heart rate. Option D is within normal range (3.5-5.0 mEq/L) and does not require
immediate action.
Q3: A 58-year-old male is admitted with an ST-elevation myocardial infarction (STEMI) of
the anterior wall. He is scheduled for emergent PCI. Which medication should the nurse
administer immediately?
A. Oral aspirin 325 mg
B. Sublingual nitroglycerin 0.4 mg
C. Chewable aspirin 325 mg and IV heparin bolus
D. Clopidogrel 75 mg orally
Correct Answer: C
Rationale: For STEMI, immediate antiplatelet and anticoagulant therapy is essential;
chewable aspirin ensures rapid absorption, and IV heparin prevents thrombus
propagation during PCI preparation. Option A has slower absorption than chewable.
Option B is for angina relief but does not address thrombus. Option D has slower onset
and is not the immediate priority in STEMI.
Q4: A patient with atrial fibrillation is receiving warfarin therapy. The nurse notes an INR
of 4.2. Which action is most appropriate?
A. Hold the next dose and notify the provider
B. Administer vitamin K 10 mg IV immediately
C. Continue the current dose and recheck in 1 week
D. Administer fresh frozen plasma prophylactically
Correct Answer: A
Rationale: An INR of 4.2 is supratherapeutic (goal 2.0-3.0 for AFib); holding the next
dose and notifying the provider is the appropriate first step to prevent bleeding
complications. Option B is reserved for INR >10 or active bleeding. Option C is
dangerous and could cause hemorrhage. Option D is not indicated without active
bleeding.
,Q5: A patient post-mitral valve replacement develops a fever of 102.4°F, new-onset heart
murmur, and splinter hemorrhages on nail beds. Which condition is most likely?
A. Rheumatic fever
B. Infective endocarditis
C. Pericarditis
D. Cardiomyopathy
Correct Answer: B
Rationale: Fever, new murmur, and splinter hemorrhages (peripheral signs of emboli) are
classic manifestations of infective endocarditis, particularly in patients with prosthetic
valves. Option A typically follows streptococcal infection and presents with Jones
criteria. Option C presents with friction rub and chest pain. Option D presents with
progressive heart failure symptoms.
Q6: A 65-year-old male with peripheral arterial disease complains of severe leg pain at
rest and non-healing ulcers on his toes. His ABI is 0.45. Which nursing intervention is
the priority?
A. Apply heating pad to the affected extremity for 20 minutes
B. Encourage vigorous walking to improve collateral circulation
C. Position the legs in a dependent position and avoid pressure on heels
D. Perform aggressive range-of-motion exercises hourly
Correct Answer: C
Rationale: Dependent positioning improves arterial perfusion to ischemic tissues, and
heel offloading prevents further ulceration in PAD with critical limb ischemia. Option A is
contraindicated as heating can cause burns in insensate tissue. Option B is
inappropriate for rest pain and non-healing ulcers. Option D may further compromise
perfusion.
Q7: A patient with a history of DVT is receiving enoxaparin 40 mg subcutaneously daily.
The nurse notes a platelet count of 85,000/mm³. Which action is priority?
A. Continue enoxaparin and monitor platelets daily
B. Discontinue enoxaparin immediately and notify the provider
C. Switch to warfarin therapy immediately
D. Administer a platelet transfusion
Correct Answer: B
, Rationale: A platelet count of 85,000/mm³ with heparin exposure suggests
heparin-induced thrombocytopenia (HIT); discontinuing all heparin immediately is
critical to prevent thrombotic complications. Option A could worsen thrombosis. Option
C is contraindicated as warfarin alone can cause skin necrosis in HIT. Option D is not
indicated unless active bleeding occurs.
Q8: A 70-year-old male with an abdominal aortic aneurysm (AAA) measuring 5.8 cm
reports sudden severe back pain and hypotension (82/50 mmHg). Which nursing action
is the priority?
A. Prepare the patient for emergent surgical repair
B. Administer IV morphine for pain control
C. Obtain a CT angiography to confirm rupture
D. Insert a Foley catheter to monitor output
Correct Answer: A
Rationale: Sudden back pain with hypotension in a patient with AAA indicates rupture, a
surgical emergency requiring immediate operative intervention; all other actions delay
critical care. Option B is secondary to hemodynamic stabilization. Option C delays
surgery and may not be feasible with hemodynamic instability. Option D is not the
priority in hemorrhagic shock.
Q9: A patient with dilated cardiomyopathy presents with dyspnea, fatigue, and an S3
gallop. Which hemodynamic monitoring finding is most consistent with this condition?
A. Elevated cardiac output and decreased preload
B. Decreased cardiac output and elevated preload
C. Normal cardiac output and decreased afterload
D. Increased afterload and decreased preload
Correct Answer: B
Rationale: Dilated cardiomyopathy causes systolic dysfunction with impaired
contractility, resulting in decreased cardiac output and blood pooling in the ventricles
(elevated preload), producing an S3 gallop. Option A is incorrect as output is decreased.
Option C is incorrect as afterload is typically elevated. Option D is physiologically
inconsistent with this pathology.
Questions & Verified Answers with Rationales | 100% Correct
| Grade A | Nightingale | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents with a blood pressure of
188/110 mmHg, headache, and blurred vision. He reports nonadherence to his
antihypertensive regimen for the past 2 weeks. Which nursing intervention is the
priority?
A. Administer a bolus of normal saline to increase perfusion
B. Initiate immediate IV antihypertensive therapy to lower MAP by 25% within the first
hour
C. Administer sublingual nitroglycerin and place the patient in supine position
D. Obtain a 12-lead EKG and cardiac enzymes before initiating any treatment
Correct Answer: B
Rationale: This patient is experiencing a hypertensive emergency (BP >180/120 with
target organ symptoms). The priority is controlled reduction of mean arterial pressure
by no more than 25% within the first hour using IV antihypertensives to prevent cerebral,
cardiac, and renal ischemia. Option A is contraindicated as fluid bolus would further
elevate BP. Option C is inappropriate for hypertensive emergency and supine positioning
is not indicated. Option D delays critical treatment; diagnostics should not precede
emergent intervention when end-organ damage is present.
Q2: A 72-year-old female with chronic heart failure (HFrEF, NYHA Class III) reports
increasing dyspnea on exertion, 3+ pitting edema in bilateral lower extremities, and a
5-pound weight gain over 3 days. Her current medications include lisinopril, metoprolol,
and furosemide. Which assessment finding requires immediate nursing intervention?
A. Blood pressure of 142/88 mmHg
B. Oxygen saturation of 89% on room air
C. Heart rate of 72 beats per minute
D. Potassium level of 3.8 mEq/L
,Correct Answer: B
Rationale: An SpO2 of 89% indicates severe hypoxemia and acute decompensated heart
failure requiring immediate supplemental oxygen to prevent tissue hypoxia and further
cardiac compromise. Option A is mildly elevated but not emergent. Option C is a normal
heart rate. Option D is within normal range (3.5-5.0 mEq/L) and does not require
immediate action.
Q3: A 58-year-old male is admitted with an ST-elevation myocardial infarction (STEMI) of
the anterior wall. He is scheduled for emergent PCI. Which medication should the nurse
administer immediately?
A. Oral aspirin 325 mg
B. Sublingual nitroglycerin 0.4 mg
C. Chewable aspirin 325 mg and IV heparin bolus
D. Clopidogrel 75 mg orally
Correct Answer: C
Rationale: For STEMI, immediate antiplatelet and anticoagulant therapy is essential;
chewable aspirin ensures rapid absorption, and IV heparin prevents thrombus
propagation during PCI preparation. Option A has slower absorption than chewable.
Option B is for angina relief but does not address thrombus. Option D has slower onset
and is not the immediate priority in STEMI.
Q4: A patient with atrial fibrillation is receiving warfarin therapy. The nurse notes an INR
of 4.2. Which action is most appropriate?
A. Hold the next dose and notify the provider
B. Administer vitamin K 10 mg IV immediately
C. Continue the current dose and recheck in 1 week
D. Administer fresh frozen plasma prophylactically
Correct Answer: A
Rationale: An INR of 4.2 is supratherapeutic (goal 2.0-3.0 for AFib); holding the next
dose and notifying the provider is the appropriate first step to prevent bleeding
complications. Option B is reserved for INR >10 or active bleeding. Option C is
dangerous and could cause hemorrhage. Option D is not indicated without active
bleeding.
,Q5: A patient post-mitral valve replacement develops a fever of 102.4°F, new-onset heart
murmur, and splinter hemorrhages on nail beds. Which condition is most likely?
A. Rheumatic fever
B. Infective endocarditis
C. Pericarditis
D. Cardiomyopathy
Correct Answer: B
Rationale: Fever, new murmur, and splinter hemorrhages (peripheral signs of emboli) are
classic manifestations of infective endocarditis, particularly in patients with prosthetic
valves. Option A typically follows streptococcal infection and presents with Jones
criteria. Option C presents with friction rub and chest pain. Option D presents with
progressive heart failure symptoms.
Q6: A 65-year-old male with peripheral arterial disease complains of severe leg pain at
rest and non-healing ulcers on his toes. His ABI is 0.45. Which nursing intervention is
the priority?
A. Apply heating pad to the affected extremity for 20 minutes
B. Encourage vigorous walking to improve collateral circulation
C. Position the legs in a dependent position and avoid pressure on heels
D. Perform aggressive range-of-motion exercises hourly
Correct Answer: C
Rationale: Dependent positioning improves arterial perfusion to ischemic tissues, and
heel offloading prevents further ulceration in PAD with critical limb ischemia. Option A is
contraindicated as heating can cause burns in insensate tissue. Option B is
inappropriate for rest pain and non-healing ulcers. Option D may further compromise
perfusion.
Q7: A patient with a history of DVT is receiving enoxaparin 40 mg subcutaneously daily.
The nurse notes a platelet count of 85,000/mm³. Which action is priority?
A. Continue enoxaparin and monitor platelets daily
B. Discontinue enoxaparin immediately and notify the provider
C. Switch to warfarin therapy immediately
D. Administer a platelet transfusion
Correct Answer: B
, Rationale: A platelet count of 85,000/mm³ with heparin exposure suggests
heparin-induced thrombocytopenia (HIT); discontinuing all heparin immediately is
critical to prevent thrombotic complications. Option A could worsen thrombosis. Option
C is contraindicated as warfarin alone can cause skin necrosis in HIT. Option D is not
indicated unless active bleeding occurs.
Q8: A 70-year-old male with an abdominal aortic aneurysm (AAA) measuring 5.8 cm
reports sudden severe back pain and hypotension (82/50 mmHg). Which nursing action
is the priority?
A. Prepare the patient for emergent surgical repair
B. Administer IV morphine for pain control
C. Obtain a CT angiography to confirm rupture
D. Insert a Foley catheter to monitor output
Correct Answer: A
Rationale: Sudden back pain with hypotension in a patient with AAA indicates rupture, a
surgical emergency requiring immediate operative intervention; all other actions delay
critical care. Option B is secondary to hemodynamic stabilization. Option C delays
surgery and may not be feasible with hemodynamic instability. Option D is not the
priority in hemorrhagic shock.
Q9: A patient with dilated cardiomyopathy presents with dyspnea, fatigue, and an S3
gallop. Which hemodynamic monitoring finding is most consistent with this condition?
A. Elevated cardiac output and decreased preload
B. Decreased cardiac output and elevated preload
C. Normal cardiac output and decreased afterload
D. Increased afterload and decreased preload
Correct Answer: B
Rationale: Dilated cardiomyopathy causes systolic dysfunction with impaired
contractility, resulting in decreased cardiac output and blood pooling in the ventricles
(elevated preload), producing an S3 gallop. Option A is incorrect as output is decreased.
Option C is incorrect as afterload is typically elevated. Option D is physiologically
inconsistent with this pathology.
