BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nighti
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266
Medical-Surgical Nursing
Exam | 2026/2027 Edition
QUESTIONS VERIFIED ANSWERS PASSING SCORE EDITION
75 100% 80% 2026/2027
TOPICS COVERED
• Cardiovascular & Hematologic Disorders • Heart Failure & Arrhythmias
• Respiratory & Renal Disorders • COPD, ARDS & Dialysis
• Gastrointestinal & Endocrine Disorders • Diabetes, DKA & Liver Disease
• Musculoskeletal & Integumentary • Burns, Fractures & Sensory Loss
• Multisystem, Oncology & Perioperative • Chemotherapy, Sepsis & Surgery
COVER PAGE - 1
, Section 1: Cardiovascular and Hematologic Disorders
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A -
Q1.
A 68-year-old client is admitted with acute coronary syndrome and reports crushing substernal chest pain
radiating to the left jaw. The nurse notes diaphoresis, nausea, and a blood pressure of 88/52 mmHg. Which
action should the nurse prioritize before administering the prescribed morphine sulfate?
A. Obtain a 12-lead ECG to confirm ST-elevation before giving any analgesics.
B. Assess the client's respiratory rate and oxygen saturation to establish a baseline.
C. Administer aspirin 325 mg orally to inhibit platelet aggregation immediately.
D. Insert a Foley catheter to monitor hourly urine output during the acute phase.
Correct Answer: B
Rationale: Morphine can cause respiratory depression; establishing baseline respiratory status is essential before
administration. Option A is important but morphine should not be delayed for ECG confirmation in suspected ACS.
Q2.
A 54-year-old client with heart failure has been taking furosemide 80 mg daily at home. On admission, the client
reports severe muscle cramps and weakness. Laboratory results reveal a potassium level of 2.8 mEq/L. Which
cardiac rhythm should the nurse anticipate monitoring for closely?
A. Atrial fibrillation with rapid ventricular response
B. Ventricular tachycardia and premature ventricular contractions
C. Third-degree atrioventricular block with junctional escape rhythm
D. Sinus bradycardia with first-degree AV block
Correct Answer: B
Rationale: Hypokalemia increases myocardial irritability and predisposes to ventricular dysrhythmias including PVCs and
VT. Option A is more associated with structural heart changes, not electrolyte imbalance.
Q3.
During a routine postoperative assessment, a nurse auscultates a loud machinery-like murmur at the left sternal
border in a 42-year-old client who had a myocardial infarction three days ago. The client is tachycardic and
hypotensive. Which complication should the nurse suspect?
A. Papillary muscle rupture causing acute mitral regurgitation
B. Ventricular septal defect from necrotic septal wall rupture
C. Cardiac tamponade from Dressler syndrome inflammation
D. Left ventricular free wall rupture with impending cardiac arrest
Correct Answer: B
Rationale: A machinery-like murmur at the left sternal border with hemodynamic compromise post-MI is classic for
ventricular septal defect rupture. Option A produces a holosystolic murmur at the apex.
Q4.
, A 71-year-old client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the client's
and notes consistent intake of spinach, kale, and broccoli. Which laboratory value should the nurse priori
monitoring to evaluate anticoagulation efficacy?
A. Activated partial thromboplastin time maintained at 1.5-2.5 times control
B. International normalized ratio maintained between 2.0 and 3.0
C. Platelet count maintained above 150,000 per microliter
D. Prothrombin time maintained between 12 and 15 seconds
Correct Answer: B
Rationale: Warfarin therapy is monitored using INR with a therapeutic range of 2.0-3.0 for atrial fibrillation. Vitamin K-rich
foods affect warfarin metabolism, making INR monitoring critical. Option A monitors heparin therapy.
Q5.
A 39-year-old client with sickle cell disease presents with severe abdominal pain, a temperature of 39.2°C, and
a hemoglobin of 5.8 g/dL. The client reports recent travel to a high-altitude location. Which pathophysiological
process is primarily responsible for the current vaso-occlusive crisis?
A. Autoimmune hemolysis of erythrocytes by immunoglobulin G antibodies
B. Deoxygenation-induced polymerization of hemoglobin S causing cell sickling
C. Bone marrow suppression from viral infection leading to aplastic crisis
D. Splenic sequestration of circulating red blood cells and platelets
Correct Answer: B
Rationale: High altitude reduces oxygen tension, promoting deoxygenation and HbS polymerization that causes red blood
cell sickling and vaso-occlusion. Option A describes autoimmune hemolytic anemia.
Q6.
A 62-year-old client with peripheral arterial disease reports intermittent claudication after walking two blocks.
The nurse notes absent posterior tibial pulses and cool, pale skin on the bilateral lower extremities. Which
nursing intervention should be included in the plan of care?
A. Apply heating pads to the lower extremities to improve circulation and comfort.
B. Elevate the legs above heart level to promote venous return and reduce edema.
C. Encourage daily walking to the point of pain to stimulate collateral circulation.
D. Massage the lower extremities vigorously to increase arterial blood flow.
Correct Answer: C
Rationale: Supervised exercise to the point of claudication pain stimulates collateral vessel development and improves
walking distance. Heating pads (Option A) can cause burns in insensate tissue.
Q7.
A 45-year-old client is admitted with hypertensive emergency presenting with a blood pressure of 220/140
mmHg, headache, and blurred vision. The prescriber orders nicardipine IV infusion. Which parameter should
the nurse monitor most frequently during the first hour of infusion?
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266
Medical-Surgical Nursing
Exam | 2026/2027 Edition
QUESTIONS VERIFIED ANSWERS PASSING SCORE EDITION
75 100% 80% 2026/2027
TOPICS COVERED
• Cardiovascular & Hematologic Disorders • Heart Failure & Arrhythmias
• Respiratory & Renal Disorders • COPD, ARDS & Dialysis
• Gastrointestinal & Endocrine Disorders • Diabetes, DKA & Liver Disease
• Musculoskeletal & Integumentary • Burns, Fractures & Sensory Loss
• Multisystem, Oncology & Perioperative • Chemotherapy, Sepsis & Surgery
COVER PAGE - 1
, Section 1: Cardiovascular and Hematologic Disorders
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A -
Q1.
A 68-year-old client is admitted with acute coronary syndrome and reports crushing substernal chest pain
radiating to the left jaw. The nurse notes diaphoresis, nausea, and a blood pressure of 88/52 mmHg. Which
action should the nurse prioritize before administering the prescribed morphine sulfate?
A. Obtain a 12-lead ECG to confirm ST-elevation before giving any analgesics.
B. Assess the client's respiratory rate and oxygen saturation to establish a baseline.
C. Administer aspirin 325 mg orally to inhibit platelet aggregation immediately.
D. Insert a Foley catheter to monitor hourly urine output during the acute phase.
Correct Answer: B
Rationale: Morphine can cause respiratory depression; establishing baseline respiratory status is essential before
administration. Option A is important but morphine should not be delayed for ECG confirmation in suspected ACS.
Q2.
A 54-year-old client with heart failure has been taking furosemide 80 mg daily at home. On admission, the client
reports severe muscle cramps and weakness. Laboratory results reveal a potassium level of 2.8 mEq/L. Which
cardiac rhythm should the nurse anticipate monitoring for closely?
A. Atrial fibrillation with rapid ventricular response
B. Ventricular tachycardia and premature ventricular contractions
C. Third-degree atrioventricular block with junctional escape rhythm
D. Sinus bradycardia with first-degree AV block
Correct Answer: B
Rationale: Hypokalemia increases myocardial irritability and predisposes to ventricular dysrhythmias including PVCs and
VT. Option A is more associated with structural heart changes, not electrolyte imbalance.
Q3.
During a routine postoperative assessment, a nurse auscultates a loud machinery-like murmur at the left sternal
border in a 42-year-old client who had a myocardial infarction three days ago. The client is tachycardic and
hypotensive. Which complication should the nurse suspect?
A. Papillary muscle rupture causing acute mitral regurgitation
B. Ventricular septal defect from necrotic septal wall rupture
C. Cardiac tamponade from Dressler syndrome inflammation
D. Left ventricular free wall rupture with impending cardiac arrest
Correct Answer: B
Rationale: A machinery-like murmur at the left sternal border with hemodynamic compromise post-MI is classic for
ventricular septal defect rupture. Option A produces a holosystolic murmur at the apex.
Q4.
, A 71-year-old client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the client's
and notes consistent intake of spinach, kale, and broccoli. Which laboratory value should the nurse priori
monitoring to evaluate anticoagulation efficacy?
A. Activated partial thromboplastin time maintained at 1.5-2.5 times control
B. International normalized ratio maintained between 2.0 and 3.0
C. Platelet count maintained above 150,000 per microliter
D. Prothrombin time maintained between 12 and 15 seconds
Correct Answer: B
Rationale: Warfarin therapy is monitored using INR with a therapeutic range of 2.0-3.0 for atrial fibrillation. Vitamin K-rich
foods affect warfarin metabolism, making INR monitoring critical. Option A monitors heparin therapy.
Q5.
A 39-year-old client with sickle cell disease presents with severe abdominal pain, a temperature of 39.2°C, and
a hemoglobin of 5.8 g/dL. The client reports recent travel to a high-altitude location. Which pathophysiological
process is primarily responsible for the current vaso-occlusive crisis?
A. Autoimmune hemolysis of erythrocytes by immunoglobulin G antibodies
B. Deoxygenation-induced polymerization of hemoglobin S causing cell sickling
C. Bone marrow suppression from viral infection leading to aplastic crisis
D. Splenic sequestration of circulating red blood cells and platelets
Correct Answer: B
Rationale: High altitude reduces oxygen tension, promoting deoxygenation and HbS polymerization that causes red blood
cell sickling and vaso-occlusion. Option A describes autoimmune hemolytic anemia.
Q6.
A 62-year-old client with peripheral arterial disease reports intermittent claudication after walking two blocks.
The nurse notes absent posterior tibial pulses and cool, pale skin on the bilateral lower extremities. Which
nursing intervention should be included in the plan of care?
A. Apply heating pads to the lower extremities to improve circulation and comfort.
B. Elevate the legs above heart level to promote venous return and reduce edema.
C. Encourage daily walking to the point of pain to stimulate collateral circulation.
D. Massage the lower extremities vigorously to increase arterial blood flow.
Correct Answer: C
Rationale: Supervised exercise to the point of claudication pain stimulates collateral vessel development and improves
walking distance. Heating pads (Option A) can cause burns in insensate tissue.
Q7.
A 45-year-old client is admitted with hypertensive emergency presenting with a blood pressure of 220/140
mmHg, headache, and blurred vision. The prescriber orders nicardipine IV infusion. Which parameter should
the nurse monitor most frequently during the first hour of infusion?
