BSN 266 – HESI MEDICAL-SURGICAL PRACTICE
EXAM V2 (NIGHTINGALE COLLEGE, 2026/2027) –
VERIFIED QUESTIONS, ANSWERS, AND
RATIONALES (GRADE A, 100% CORRECT)
Core Domains
• Cardiovascular System
• Respiratory System
• Gastrointestinal System
• Endocrine System
• Renal and Genitourinary System
• Neurological System
• Musculoskeletal System
• Hematological and Immune System
• Integumentary System
• Perioperative and Emergency Nursing Care
Introduction
This comprehensive BSN 266 HESI Medical-Surgical Practice Exam V2 is
specifically designed for Nightingale College nursing students preparing for the
2025/2026 HESI Medical-Surgical examination. The exam contains 100 multiple-
choice questions that align with the Elsevier HESI Specialty Exit Exam format and
covers all major medical-surgical nursing content areas. Each question includes a
detailed rationale to reinforce clinical reasoning and evidence-based practice. The
questions are designed to test critical thinking, prioritization, delegation, and clinical
,judgment skills essential for success on the HESI exam and in professional nursing
practice. This resource is verified for accuracy and reflects current medical-surgical
nursing standards.
SECTION ONE: QUESTIONS 1 – 100
Question 1
A client with a chest tube has continuous bubbling in the water seal chamber. What
is the priority nursing action?
A. Clamp the chest tube immediately
B. Assess for an air leak
C. Strip the tubing to clear clots
D. Notify the healthcare provider immediately
B
RATIONALE: Continuous bubbling in the water seal chamber indicates an air
leak, which requires assessment to identify the source. Tidaling (fluctuation with
respirations) is expected; continuous bubbling is not. Clamping can cause tension
pneumothorax. Stripping the tubing and notifying the provider are not the priority
actions.
Question 2
A client with COPD has an oxygen saturation of 88%. Which oxygen delivery
method should the nurse use?
A. Nasal cannula at 2 L/min
B. Non-rebreather mask at 10 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 24% FiO₂
, D
RATIONALE: COPD clients rely on a hypoxic drive; high oxygen can cause
respiratory depression. A Venturi mask delivers precise oxygen concentration; low
flow (24–28%) is preferred initially. Nasal cannula, non-rebreather mask, and
simple face mask deliver less precise oxygen concentrations that may cause
hypoventilation.
Question 3
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates the medication is having the desired effect?
A. Blood pressure 100/60 mm Hg
B. Weight decrease of 2 kg in 24 hours
C. Urine output of 50 mL/hour
D. Clear breath sounds
D
RATIONALE: Furosemide reduces preload by promoting diuresis. The desired
effect in heart failure is relief of pulmonary congestion, evidenced by clear breath
sounds. Weight decrease and urine output are indicators of diuresis but do not
directly confirm resolution of pulmonary congestion.
Question 4
A client with chest pain receives sublingual nitroglycerin. Which side effect should
the nurse anticipate?
A. Headache
B. Bradycardia
C. Hypertension
D. Dizziness
, A
RATIONALE: Nitroglycerin causes vasodilation, which can lead to headache
due to cerebral vessel dilation. Bradycardia and hypertension are not expected side
effects; hypotension may occur.
Question 5
A client with atrial fibrillation is prescribed warfarin (Coumadin). Which lab value
indicates therapeutic anticoagulation?
A. aPTT 1.5–2.5 times control
B. INR 2.0–3.0
C. Platelets 150,000/mm³
D. PT 1.5–2.5 times control
B
RATIONALE: Warfarin therapy is monitored by INR; for atrial fibrillation, the
target INR is 2.0–3.0. aPTT is used to monitor heparin therapy. Platelet count does
not indicate warfarin effectiveness.
Question 6
A client is 2 hours post-cardiac catheterization via the femoral artery. The nurse
notes the groin site is swollen and the pedal pulse is weak. What should the nurse
do first?
A. Apply firm pressure 1 inch above the insertion site
B. Elevate the leg
C. Remove the pressure dressing
D. Notify the healthcare provider
A
EXAM V2 (NIGHTINGALE COLLEGE, 2026/2027) –
VERIFIED QUESTIONS, ANSWERS, AND
RATIONALES (GRADE A, 100% CORRECT)
Core Domains
• Cardiovascular System
• Respiratory System
• Gastrointestinal System
• Endocrine System
• Renal and Genitourinary System
• Neurological System
• Musculoskeletal System
• Hematological and Immune System
• Integumentary System
• Perioperative and Emergency Nursing Care
Introduction
This comprehensive BSN 266 HESI Medical-Surgical Practice Exam V2 is
specifically designed for Nightingale College nursing students preparing for the
2025/2026 HESI Medical-Surgical examination. The exam contains 100 multiple-
choice questions that align with the Elsevier HESI Specialty Exit Exam format and
covers all major medical-surgical nursing content areas. Each question includes a
detailed rationale to reinforce clinical reasoning and evidence-based practice. The
questions are designed to test critical thinking, prioritization, delegation, and clinical
,judgment skills essential for success on the HESI exam and in professional nursing
practice. This resource is verified for accuracy and reflects current medical-surgical
nursing standards.
SECTION ONE: QUESTIONS 1 – 100
Question 1
A client with a chest tube has continuous bubbling in the water seal chamber. What
is the priority nursing action?
A. Clamp the chest tube immediately
B. Assess for an air leak
C. Strip the tubing to clear clots
D. Notify the healthcare provider immediately
B
RATIONALE: Continuous bubbling in the water seal chamber indicates an air
leak, which requires assessment to identify the source. Tidaling (fluctuation with
respirations) is expected; continuous bubbling is not. Clamping can cause tension
pneumothorax. Stripping the tubing and notifying the provider are not the priority
actions.
Question 2
A client with COPD has an oxygen saturation of 88%. Which oxygen delivery
method should the nurse use?
A. Nasal cannula at 2 L/min
B. Non-rebreather mask at 10 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 24% FiO₂
, D
RATIONALE: COPD clients rely on a hypoxic drive; high oxygen can cause
respiratory depression. A Venturi mask delivers precise oxygen concentration; low
flow (24–28%) is preferred initially. Nasal cannula, non-rebreather mask, and
simple face mask deliver less precise oxygen concentrations that may cause
hypoventilation.
Question 3
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates the medication is having the desired effect?
A. Blood pressure 100/60 mm Hg
B. Weight decrease of 2 kg in 24 hours
C. Urine output of 50 mL/hour
D. Clear breath sounds
D
RATIONALE: Furosemide reduces preload by promoting diuresis. The desired
effect in heart failure is relief of pulmonary congestion, evidenced by clear breath
sounds. Weight decrease and urine output are indicators of diuresis but do not
directly confirm resolution of pulmonary congestion.
Question 4
A client with chest pain receives sublingual nitroglycerin. Which side effect should
the nurse anticipate?
A. Headache
B. Bradycardia
C. Hypertension
D. Dizziness
, A
RATIONALE: Nitroglycerin causes vasodilation, which can lead to headache
due to cerebral vessel dilation. Bradycardia and hypertension are not expected side
effects; hypotension may occur.
Question 5
A client with atrial fibrillation is prescribed warfarin (Coumadin). Which lab value
indicates therapeutic anticoagulation?
A. aPTT 1.5–2.5 times control
B. INR 2.0–3.0
C. Platelets 150,000/mm³
D. PT 1.5–2.5 times control
B
RATIONALE: Warfarin therapy is monitored by INR; for atrial fibrillation, the
target INR is 2.0–3.0. aPTT is used to monitor heparin therapy. Platelet count does
not indicate warfarin effectiveness.
Question 6
A client is 2 hours post-cardiac catheterization via the femoral artery. The nurse
notes the groin site is swollen and the pedal pulse is weak. What should the nurse
do first?
A. Apply firm pressure 1 inch above the insertion site
B. Elevate the leg
C. Remove the pressure dressing
D. Notify the healthcare provider
A
