BSN HESI 266 MED SURG EXAM (LATEST ) QUESTIONS &
CORRECT ANSWERS WITH RATIONALES, 100% GUARANTEED PASS ||
COMPLETE A+ GUIDE - NIGHTINGALE
BSN HESI 266 Med Surg Exam (2026/2027)
Course Code and Name: BSN 266: Medical-Surgical Nursing
Institution Name: Chamberlain University
Author/Creator: Prepared by Edu nurse pro
Table of Contents
1. Cardiovascular System (Questions 1–18)
2. Respiratory System (Questions 19–35)
3. Gastrointestinal & Hepatic Systems (Questions 36–52)
4. Renal & Urinary Systems (Questions 53–68)
5. Neurological System (Questions 69–84)
6. Endocrine & Musculoskeletal Systems (Questions 85–100)
1. Cardiovascular System
Question 1
A client with chronic heart failure is prescribed digoxin 0.25 mg PO daily and furosemide 40 mg
PO daily. Which serum laboratory value requires immediate action by the nurse?
• A. Sodium 138 mEq/L
• B. Potassium 3.1 mEq/L
• C. Digoxin level 1.2 ng/mL
• D. BUN 18 mg/dL
Correct Answer: B. Potassium 3.1 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) sensitizes the myocardium to digoxin, greatly
increasing the risk of digoxin toxicity and life-threatening dysrhythmias. Furosemide is a loop
diuretic that wastes potassium. The sodium, digoxin, and BUN levels are within normal limits.
,Question 2
A nurse is caring for a client experiencing acute chest pain. The electrocardiogram (ECG) reveals
ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
• A. Left anterior descending (LAD)
• B. Circumflex artery
• C. Right coronary artery (RCA)
• D. Left main coronary artery
Correct Answer: C. Right coronary artery (RCA)
Rationale: Leads II, III, and aVF look at the inferior wall of the left ventricle, which is supplied
primarily by the Right Coronary Artery (RCA). LAD occlusion typically causes anterior wall MI
(V1–V4), and circumflex occlusion causes lateral wall MI (I, aVL, V5–V6).
Question 3
A client arrives in the emergency department with atrial fibrillation and a ventricular rate of 150
bpm. The client is confused, pale, and blood pressure is 82/46 mmHg. What is the priority
nursing intervention?
• A. Administer oral diltiazem
• B. Prepare for immediate synchronized cardioversion
• C. Administer IV metoprolol
• D. Perform carotid sinus massage
Correct Answer: B. Prepare for immediate synchronized cardioversion
Rationale: Unstable tachydysrhythmias accompanied by signs of hemodynamically
compromised perfusion (hypotension, altered mental status, chest pain) require immediate
synchronized electrical cardioversion. Pharmacological control is indicated when the client is
stable.
Question 4
Which clinical manifestation should the nurse expect to find in a client diagnosed with right-
sided heart failure?
• A. Pulmonary crackles and dyspnea
• B. Jugular vein distension (JVD) and peripheral edema
, • C. Paroxysmal nocturnal dyspnea
• D. Hemoptysis and orthopnea
Correct Answer: B. Jugular vein distension (JVD) and peripheral edema
Rationale: Right-sided heart failure leads to systemic venous congestion, manifesting as JVD,
peripheral edema, hepatomegaly, and ascites. Left-sided heart failure leads to pulmonary
congestion (crackles, dyspnea, orthopnea, PND).
Question 5
A client with infective endocarditis develops sudden severe left flank pain accompanied by
hematuria. Which complication should the nurse suspect?
• A. Splenic infarction
• B. Renal embolization
• C. Pulmonary embolism
• D. Heart block
Correct Answer: B. Renal embolization
Rationale: Vegetations on the heart valves in infective endocarditis can break off and travel as
arterial emboli. Embolization to the kidneys manifests as flank pain, hematuria, and oliguria.
Splenic embolization causes left upper quadrant pain.
Question 6
Which teaching point is essential for a client prescribed warfarin following a mechanical heart
valve replacement?
• A. Increase intake of green leafy vegetables to avoid anemia
• B. Take aspirin 325 mg daily for pain relief
• C. Have regular International Normalized Ratio (INR) blood tests monitored
• D. Stop taking warfarin 2 days before dental procedures without consulting a physician
Correct Answer: C. Have regular International Normalized Ratio (INR) blood tests monitored
Rationale: Warfarin requires frequent INR monitoring to ensure therapeutic dosing (target INR
is typically 2.5–3.5 for mechanical valves). Green leafy vegetables contain Vitamin K and alter
INR; aspirin increases bleeding risk; anticoagulants should never be stopped abruptly without
medical supervision.
, Question 7
What is the target therapeutic INR level for a client with a mechanical prosthetic mitral valve
receiving warfarin therapy?
• A. 1.0–2.0
• B. 2.0–3.0
• C. 2.5–3.5
• D. 3.5–4.5
Correct Answer: C. 2.5–3.5
Rationale: Mechanical heart valves are highly thrombogenic. The target INR range for
mechanical mitral valves is 2.5–3.5 to prevent clot formation while minimizing major
hemorrhage risk.
Question 8
A client on telemetry suddenly exhibits a chaotic, wavy baseline with no identifiable P waves,
QRS complexes, or T waves. The client is unresponsive and pulseless. Which rhythm is present,
and what action should be taken first?
• A. Ventricular tachycardia; administer IV amiodarone
• B. Ventricular fibrillation; initiate CPR and prepare for immediate defibrillation
• C. Asystole; administer IV epinephrine
• D. Atrial flutter; perform synchronized cardioversion
Correct Answer: B. Ventricular fibrillation; initiate CPR and prepare for immediate defibrillation
Rationale: Ventricular fibrillation (VF) is characterized by chaotic electrical activity without
recognizable waves or mechanical contraction. Immediate high-quality CPR and early
defibrillation are the primary lifesaving interventions for VF.
Question 9
A nurse is caring for a client following a cardiac catheterization via the right femoral artery.
Which assessment finding requires immediate nursing action?
• A. Right pedal pulse 2+ and equal to left
• B. Capillary refill < 2 seconds bilaterally
CORRECT ANSWERS WITH RATIONALES, 100% GUARANTEED PASS ||
COMPLETE A+ GUIDE - NIGHTINGALE
BSN HESI 266 Med Surg Exam (2026/2027)
Course Code and Name: BSN 266: Medical-Surgical Nursing
Institution Name: Chamberlain University
Author/Creator: Prepared by Edu nurse pro
Table of Contents
1. Cardiovascular System (Questions 1–18)
2. Respiratory System (Questions 19–35)
3. Gastrointestinal & Hepatic Systems (Questions 36–52)
4. Renal & Urinary Systems (Questions 53–68)
5. Neurological System (Questions 69–84)
6. Endocrine & Musculoskeletal Systems (Questions 85–100)
1. Cardiovascular System
Question 1
A client with chronic heart failure is prescribed digoxin 0.25 mg PO daily and furosemide 40 mg
PO daily. Which serum laboratory value requires immediate action by the nurse?
• A. Sodium 138 mEq/L
• B. Potassium 3.1 mEq/L
• C. Digoxin level 1.2 ng/mL
• D. BUN 18 mg/dL
Correct Answer: B. Potassium 3.1 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) sensitizes the myocardium to digoxin, greatly
increasing the risk of digoxin toxicity and life-threatening dysrhythmias. Furosemide is a loop
diuretic that wastes potassium. The sodium, digoxin, and BUN levels are within normal limits.
,Question 2
A nurse is caring for a client experiencing acute chest pain. The electrocardiogram (ECG) reveals
ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
• A. Left anterior descending (LAD)
• B. Circumflex artery
• C. Right coronary artery (RCA)
• D. Left main coronary artery
Correct Answer: C. Right coronary artery (RCA)
Rationale: Leads II, III, and aVF look at the inferior wall of the left ventricle, which is supplied
primarily by the Right Coronary Artery (RCA). LAD occlusion typically causes anterior wall MI
(V1–V4), and circumflex occlusion causes lateral wall MI (I, aVL, V5–V6).
Question 3
A client arrives in the emergency department with atrial fibrillation and a ventricular rate of 150
bpm. The client is confused, pale, and blood pressure is 82/46 mmHg. What is the priority
nursing intervention?
• A. Administer oral diltiazem
• B. Prepare for immediate synchronized cardioversion
• C. Administer IV metoprolol
• D. Perform carotid sinus massage
Correct Answer: B. Prepare for immediate synchronized cardioversion
Rationale: Unstable tachydysrhythmias accompanied by signs of hemodynamically
compromised perfusion (hypotension, altered mental status, chest pain) require immediate
synchronized electrical cardioversion. Pharmacological control is indicated when the client is
stable.
Question 4
Which clinical manifestation should the nurse expect to find in a client diagnosed with right-
sided heart failure?
• A. Pulmonary crackles and dyspnea
• B. Jugular vein distension (JVD) and peripheral edema
, • C. Paroxysmal nocturnal dyspnea
• D. Hemoptysis and orthopnea
Correct Answer: B. Jugular vein distension (JVD) and peripheral edema
Rationale: Right-sided heart failure leads to systemic venous congestion, manifesting as JVD,
peripheral edema, hepatomegaly, and ascites. Left-sided heart failure leads to pulmonary
congestion (crackles, dyspnea, orthopnea, PND).
Question 5
A client with infective endocarditis develops sudden severe left flank pain accompanied by
hematuria. Which complication should the nurse suspect?
• A. Splenic infarction
• B. Renal embolization
• C. Pulmonary embolism
• D. Heart block
Correct Answer: B. Renal embolization
Rationale: Vegetations on the heart valves in infective endocarditis can break off and travel as
arterial emboli. Embolization to the kidneys manifests as flank pain, hematuria, and oliguria.
Splenic embolization causes left upper quadrant pain.
Question 6
Which teaching point is essential for a client prescribed warfarin following a mechanical heart
valve replacement?
• A. Increase intake of green leafy vegetables to avoid anemia
• B. Take aspirin 325 mg daily for pain relief
• C. Have regular International Normalized Ratio (INR) blood tests monitored
• D. Stop taking warfarin 2 days before dental procedures without consulting a physician
Correct Answer: C. Have regular International Normalized Ratio (INR) blood tests monitored
Rationale: Warfarin requires frequent INR monitoring to ensure therapeutic dosing (target INR
is typically 2.5–3.5 for mechanical valves). Green leafy vegetables contain Vitamin K and alter
INR; aspirin increases bleeding risk; anticoagulants should never be stopped abruptly without
medical supervision.
, Question 7
What is the target therapeutic INR level for a client with a mechanical prosthetic mitral valve
receiving warfarin therapy?
• A. 1.0–2.0
• B. 2.0–3.0
• C. 2.5–3.5
• D. 3.5–4.5
Correct Answer: C. 2.5–3.5
Rationale: Mechanical heart valves are highly thrombogenic. The target INR range for
mechanical mitral valves is 2.5–3.5 to prevent clot formation while minimizing major
hemorrhage risk.
Question 8
A client on telemetry suddenly exhibits a chaotic, wavy baseline with no identifiable P waves,
QRS complexes, or T waves. The client is unresponsive and pulseless. Which rhythm is present,
and what action should be taken first?
• A. Ventricular tachycardia; administer IV amiodarone
• B. Ventricular fibrillation; initiate CPR and prepare for immediate defibrillation
• C. Asystole; administer IV epinephrine
• D. Atrial flutter; perform synchronized cardioversion
Correct Answer: B. Ventricular fibrillation; initiate CPR and prepare for immediate defibrillation
Rationale: Ventricular fibrillation (VF) is characterized by chaotic electrical activity without
recognizable waves or mechanical contraction. Immediate high-quality CPR and early
defibrillation are the primary lifesaving interventions for VF.
Question 9
A nurse is caring for a client following a cardiac catheterization via the right femoral artery.
Which assessment finding requires immediate nursing action?
• A. Right pedal pulse 2+ and equal to left
• B. Capillary refill < 2 seconds bilaterally
