BSN HESI 266 MED SURG EXAM | 2026/2027| NIGHTINGALE COLLEGE
| REAL EXAM QUESTIONS & VERIFIED ANSWERS WITH
RATIONALES | 100% CORRECT | GRADED A+
Introduction
This resource contains the latest, fully verified questions and answers from the BSN 266
Medical-Surgical HESI Exam administered at Nightingale College for the 2026 cycle. The
material is designed to reflect the current exam blueprint, helping students succeed in mastering
Med Surg content with confidence and accuracy.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–35)
Question 1
A client with heart failure reports a 3-pound weight gain in 24 hours. What should
the nurse do first?
A. Administer furosemide as prescribed
B. Assess for peripheral edema
C. Restrict fluid intake
D. Notify the healthcare provider
Answer: Assess for peripheral edema
Rationale: Weight gain in heart failure suggests fluid retention; assessing edema
provides immediate clinical data to guide further action. The nurse must gather
assessment data before implementing interventions or notifying the provider.
Question 2
A client with a history of atrial fibrillation reports dizziness. What should the nurse
assess first?
A. Blood pressure
B. Heart rate
C. Oxygen saturation
D. Blood glucose
1
,Answer: Heart rate
Rationale: Dizziness in atrial fibrillation may indicate an irregular or rapid
ventricular rate, which directly affects cardiac output and cerebral perfusion.
Heart rate assessment is the priority.
Question 3
A client on warfarin for atrial fibrillation has an INR of 4.5. What is the priority
action?
A. Administer vitamin K
B. Hold the next dose and notify the healthcare provider
C. Increase the warfarin dose
D. Check platelet count
Answer: Hold the next dose and notify the healthcare provider
Rationale: An INR above 4.0 significantly increases bleeding risk. The nurse should
hold the dose and notify the provider for dose adjustment. Vitamin K is given only
for active bleeding or severe elevation per protocol.
Question 4
A client with acute myocardial infarction reports chest pain unrelieved by
nitroglycerin. What should the nurse do next?
A. Administer morphine IV
B. Apply oxygen at 2 L/min
C. Obtain a 12-lead ECG
D. Repeat nitroglycerin in 5 minutes
Answer: Administer morphine IV
Rationale: Morphine reduces pain, decreases preload and myocardial oxygen
demand, and is indicated when nitrates fail to relieve chest pain in acute MI.
2
,Question 5
A client with hypertension is prescribed lisinopril. Which adverse effect requires
immediate reporting?
A. Dry cough
B. Angioedema
C. Headache
D. Dizziness
Answer: Angioedema
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a life-
threatening allergic reaction to ACE inhibitors and requires immediate emergency
intervention.
Question 6
A client with left-sided heart failure exhibits which finding?
A. Jugular venous distension
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Answer: Crackles in the lungs
Rationale: Left-sided heart failure causes pulmonary congestion due to increased
pressure in the pulmonary circulation, resulting in crackles on auscultation.
Question 7
A client with pericarditis should be placed in which position to relieve pain?
A. Supine
B. Prone
C. High-Fowler's leaning forward
D. Left lateral
3
, Answer: High-Fowler's leaning forward
Rationale: Leaning forward reduces pericardial friction by moving the heart away
from the chest wall, which eases the pain associated with pericarditis.
Question 8
A client with an abdominal aortic aneurysm reports sudden severe back pain.
What is the priority?
A. Assess blood pressure
B. Palpate the abdomen
C. Prepare for emergency surgery
D. Administer pain medication
Answer: Prepare for emergency surgery
Rationale: Sudden severe back pain in a client with an AAA indicates impending or
actual rupture, which is a surgical emergency requiring immediate operative
intervention.
Question 9
A client with deep vein thrombosis is on heparin infusion. Which laboratory value
is used to monitor therapy?
A. aPTT
B. INR
C. Platelet count
D. PT
Answer: aPTT
Rationale: Activated partial thromboplastin time (aPTT) is the standard
monitoring test for unfractionated heparin therapy, with a therapeutic goal of 1.5
to 2.5 times the normal control value.
4
| REAL EXAM QUESTIONS & VERIFIED ANSWERS WITH
RATIONALES | 100% CORRECT | GRADED A+
Introduction
This resource contains the latest, fully verified questions and answers from the BSN 266
Medical-Surgical HESI Exam administered at Nightingale College for the 2026 cycle. The
material is designed to reflect the current exam blueprint, helping students succeed in mastering
Med Surg content with confidence and accuracy.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–35)
Question 1
A client with heart failure reports a 3-pound weight gain in 24 hours. What should
the nurse do first?
A. Administer furosemide as prescribed
B. Assess for peripheral edema
C. Restrict fluid intake
D. Notify the healthcare provider
Answer: Assess for peripheral edema
Rationale: Weight gain in heart failure suggests fluid retention; assessing edema
provides immediate clinical data to guide further action. The nurse must gather
assessment data before implementing interventions or notifying the provider.
Question 2
A client with a history of atrial fibrillation reports dizziness. What should the nurse
assess first?
A. Blood pressure
B. Heart rate
C. Oxygen saturation
D. Blood glucose
1
,Answer: Heart rate
Rationale: Dizziness in atrial fibrillation may indicate an irregular or rapid
ventricular rate, which directly affects cardiac output and cerebral perfusion.
Heart rate assessment is the priority.
Question 3
A client on warfarin for atrial fibrillation has an INR of 4.5. What is the priority
action?
A. Administer vitamin K
B. Hold the next dose and notify the healthcare provider
C. Increase the warfarin dose
D. Check platelet count
Answer: Hold the next dose and notify the healthcare provider
Rationale: An INR above 4.0 significantly increases bleeding risk. The nurse should
hold the dose and notify the provider for dose adjustment. Vitamin K is given only
for active bleeding or severe elevation per protocol.
Question 4
A client with acute myocardial infarction reports chest pain unrelieved by
nitroglycerin. What should the nurse do next?
A. Administer morphine IV
B. Apply oxygen at 2 L/min
C. Obtain a 12-lead ECG
D. Repeat nitroglycerin in 5 minutes
Answer: Administer morphine IV
Rationale: Morphine reduces pain, decreases preload and myocardial oxygen
demand, and is indicated when nitrates fail to relieve chest pain in acute MI.
2
,Question 5
A client with hypertension is prescribed lisinopril. Which adverse effect requires
immediate reporting?
A. Dry cough
B. Angioedema
C. Headache
D. Dizziness
Answer: Angioedema
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a life-
threatening allergic reaction to ACE inhibitors and requires immediate emergency
intervention.
Question 6
A client with left-sided heart failure exhibits which finding?
A. Jugular venous distension
B. Peripheral edema
C. Crackles in the lungs
D. Hepatomegaly
Answer: Crackles in the lungs
Rationale: Left-sided heart failure causes pulmonary congestion due to increased
pressure in the pulmonary circulation, resulting in crackles on auscultation.
Question 7
A client with pericarditis should be placed in which position to relieve pain?
A. Supine
B. Prone
C. High-Fowler's leaning forward
D. Left lateral
3
, Answer: High-Fowler's leaning forward
Rationale: Leaning forward reduces pericardial friction by moving the heart away
from the chest wall, which eases the pain associated with pericarditis.
Question 8
A client with an abdominal aortic aneurysm reports sudden severe back pain.
What is the priority?
A. Assess blood pressure
B. Palpate the abdomen
C. Prepare for emergency surgery
D. Administer pain medication
Answer: Prepare for emergency surgery
Rationale: Sudden severe back pain in a client with an AAA indicates impending or
actual rupture, which is a surgical emergency requiring immediate operative
intervention.
Question 9
A client with deep vein thrombosis is on heparin infusion. Which laboratory value
is used to monitor therapy?
A. aPTT
B. INR
C. Platelet count
D. PT
Answer: aPTT
Rationale: Activated partial thromboplastin time (aPTT) is the standard
monitoring test for unfractionated heparin therapy, with a therapeutic goal of 1.5
to 2.5 times the normal control value.
4
