Page 1 of 57
BSN HESI 266 MED SURG EXAM 1 –
COMPREHENSIVE 2026 COMPLETE (125)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
MED SURG
Prepare for the BSN HESI 266 Med Surg Exam 1 with focused review
materials covering foundational medical-surgical nursing concepts,
including cardiovascular, respiratory, endocrine, gastrointestinal, renal,
neurological, and musculoskeletal disorders, along with patient
assessment, pathophysiology, pharmacology, diagnostic testing, fluid
and electrolyte balance, nursing interventions, patient education, and
prioritization of care. Designed to build confidence in recognizing clinical
changes, interpreting assessment findings, prioritizing interventions, and
delivering safe, patient-centered care. Suitable for BSN nursing students
preparing for the HESI 266 Medical-Surgical Nursing Exam 1.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A client with heart failure reports a 3-pound weight gain in 24 hours,
increased shortness of breath, and ankle edema. What is the
nurse's priority action?
A. Encourage the client to rest with legs elevated
B. Restrict oral fluid intake to 1,000 mL/day
C. Assess lung sounds and administer diuretics as prescribed
, Page 2 of 57
D. Notify the healthcare provider immediately
Correct answer: C. Assess lung sounds and administer
diuretics as prescribed
Rationale: A 3-pound weight gain in 24 hours indicates fluid
retention, a sign of worsening heart failure. The nurse should
assess for pulmonary congestion (crackles) and administer
diuretics as ordered. Elevating legs and fluid restriction are
appropriate but not the priority action; notifying the provider
may be necessary after assessment.
2. A client who underwent cardiac stent placement 4 days ago arrives
to the emergency department with severe chest pain. Which
laboratory value is most indicative of acute myocardial injury?
A. Elevated creatine kinase-MB (CK-MB)
B. Elevated troponin I
C. Elevated B-type natriuretic peptide (BNP)
D. Elevated myoglobin
Correct answer: B. Elevated troponin I
Rationale: Troponin I is a cardiac-specific biomarker that rises
3–4 hours after myocardial injury and remains elevated for 7–10
days. It is the most specific and sensitive marker for myocardial
necrosis. CK-MB rises and falls more quickly, while BNP is
elevated in heart failure.
3. A client with atrial fibrillation is prescribed warfarin. The nurse
should monitor which laboratory value to evaluate the
effectiveness of this medication?
A. Serum potassium
B. International normalized ratio (INR)
C. Platelet count
D. Partial thromboplastin time (PTT)
, Page 3 of 57
Correct answer: B. International normalized ratio (INR)
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-
dependent clotting factors. The therapeutic INR for atrial
fibrillation is typically 2.0–3.0. PTT monitors heparin therapy,
and platelet count monitors for thrombocytopenia.
4. A client with chronic heart failure is receiving furosemide (Lasix).
Which adverse effect should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Correct answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium
and chloride reabsorption in the loop of Henle, leading to
increased excretion of sodium, chloride, potassium, and water.
It can cause hypokalemia, which can precipitate cardiac
arrhythmias, especially in clients taking digoxin.
5. The nurse is caring for a client with right-sided heart failure. Which
finding is most characteristic?
A. Crackles in the lung bases
B. Jugular venous distension (JVD)
C. Pulmonary edema
D. Orthopnea
Correct answer: B. Jugular venous distension (JVD)
Rationale: Right-sided heart failure leads to systemic venous
congestion, resulting in JVD, peripheral edema, hepatomegaly,
and ascites. Pulmonary congestion (crackles, pulmonary
edema, orthopnea) is characteristic of left-sided heart failure.
, Page 4 of 57
6. A client with hypertension is prescribed lisinopril. The nurse
understands that the mechanism of action of ACE inhibitors in
hypertension is to:
A. Increase heart rate
B. Decrease preload and afterload
C. Increase cardiac contractility
D. Decrease urine output
Correct answer: B. Decrease preload and afterload
Rationale: ACE inhibitors block the conversion of angiotensin I
to angiotensin II, reducing vasoconstriction and aldosterone
secretion. This decreases both preload (by reducing venous
tone) and afterload (by reducing arteriolar tone), lowering blood
pressure and improving cardiac output.
7. A client is 2 days post-myocardial infarction. The nurse should
monitor for which complication in the first 72 hours?
A. Cardiac tamponade
B. Ventricular arrhythmias
C. Heart failure
D. All of the above
Correct answer: D. All of the above
Rationale: Complications following MI include ventricular
arrhythmias (especially in the first 24–48 hours), heart failure
(from decreased contractility), and cardiac tamponade (from
rupture, though less common). Close monitoring is essential
during the acute phase.
8. A client with peripheral arterial disease (PAD) complains of leg pain
that occurs with walking and is relieved by rest. This pain is known
as:
A. Rest pain
BSN HESI 266 MED SURG EXAM 1 –
COMPREHENSIVE 2026 COMPLETE (125)
CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES.
MED SURG
Prepare for the BSN HESI 266 Med Surg Exam 1 with focused review
materials covering foundational medical-surgical nursing concepts,
including cardiovascular, respiratory, endocrine, gastrointestinal, renal,
neurological, and musculoskeletal disorders, along with patient
assessment, pathophysiology, pharmacology, diagnostic testing, fluid
and electrolyte balance, nursing interventions, patient education, and
prioritization of care. Designed to build confidence in recognizing clinical
changes, interpreting assessment findings, prioritizing interventions, and
delivering safe, patient-centered care. Suitable for BSN nursing students
preparing for the HESI 266 Medical-Surgical Nursing Exam 1.
MULTIPLE CHOICE.
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A client with heart failure reports a 3-pound weight gain in 24 hours,
increased shortness of breath, and ankle edema. What is the
nurse's priority action?
A. Encourage the client to rest with legs elevated
B. Restrict oral fluid intake to 1,000 mL/day
C. Assess lung sounds and administer diuretics as prescribed
, Page 2 of 57
D. Notify the healthcare provider immediately
Correct answer: C. Assess lung sounds and administer
diuretics as prescribed
Rationale: A 3-pound weight gain in 24 hours indicates fluid
retention, a sign of worsening heart failure. The nurse should
assess for pulmonary congestion (crackles) and administer
diuretics as ordered. Elevating legs and fluid restriction are
appropriate but not the priority action; notifying the provider
may be necessary after assessment.
2. A client who underwent cardiac stent placement 4 days ago arrives
to the emergency department with severe chest pain. Which
laboratory value is most indicative of acute myocardial injury?
A. Elevated creatine kinase-MB (CK-MB)
B. Elevated troponin I
C. Elevated B-type natriuretic peptide (BNP)
D. Elevated myoglobin
Correct answer: B. Elevated troponin I
Rationale: Troponin I is a cardiac-specific biomarker that rises
3–4 hours after myocardial injury and remains elevated for 7–10
days. It is the most specific and sensitive marker for myocardial
necrosis. CK-MB rises and falls more quickly, while BNP is
elevated in heart failure.
3. A client with atrial fibrillation is prescribed warfarin. The nurse
should monitor which laboratory value to evaluate the
effectiveness of this medication?
A. Serum potassium
B. International normalized ratio (INR)
C. Platelet count
D. Partial thromboplastin time (PTT)
, Page 3 of 57
Correct answer: B. International normalized ratio (INR)
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-
dependent clotting factors. The therapeutic INR for atrial
fibrillation is typically 2.0–3.0. PTT monitors heparin therapy,
and platelet count monitors for thrombocytopenia.
4. A client with chronic heart failure is receiving furosemide (Lasix).
Which adverse effect should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Correct answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium
and chloride reabsorption in the loop of Henle, leading to
increased excretion of sodium, chloride, potassium, and water.
It can cause hypokalemia, which can precipitate cardiac
arrhythmias, especially in clients taking digoxin.
5. The nurse is caring for a client with right-sided heart failure. Which
finding is most characteristic?
A. Crackles in the lung bases
B. Jugular venous distension (JVD)
C. Pulmonary edema
D. Orthopnea
Correct answer: B. Jugular venous distension (JVD)
Rationale: Right-sided heart failure leads to systemic venous
congestion, resulting in JVD, peripheral edema, hepatomegaly,
and ascites. Pulmonary congestion (crackles, pulmonary
edema, orthopnea) is characteristic of left-sided heart failure.
, Page 4 of 57
6. A client with hypertension is prescribed lisinopril. The nurse
understands that the mechanism of action of ACE inhibitors in
hypertension is to:
A. Increase heart rate
B. Decrease preload and afterload
C. Increase cardiac contractility
D. Decrease urine output
Correct answer: B. Decrease preload and afterload
Rationale: ACE inhibitors block the conversion of angiotensin I
to angiotensin II, reducing vasoconstriction and aldosterone
secretion. This decreases both preload (by reducing venous
tone) and afterload (by reducing arteriolar tone), lowering blood
pressure and improving cardiac output.
7. A client is 2 days post-myocardial infarction. The nurse should
monitor for which complication in the first 72 hours?
A. Cardiac tamponade
B. Ventricular arrhythmias
C. Heart failure
D. All of the above
Correct answer: D. All of the above
Rationale: Complications following MI include ventricular
arrhythmias (especially in the first 24–48 hours), heart failure
(from decreased contractility), and cardiac tamponade (from
rupture, though less common). Close monitoring is essential
during the acute phase.
8. A client with peripheral arterial disease (PAD) complains of leg pain
that occurs with walking and is relieved by rest. This pain is known
as:
A. Rest pain
