L AT E S T 2 0 2 0 2 7 E D I T I O N · G R A D E A · NVI GEHRTII NFGI AELDE
ANSWERS
BSN HESI 266
Med Surg Exam
A comprehensive 150-question Medical-Surgical nursing
examination aligned with the Nightingale College BSN
HESI 266 Course Syllabus, HESI RN Specialty Exam
Blueprint, and the NCLEX-RN Test Plan. Includes ten
clinical specialty sections with priority-setting,
pharmacology, and laboratory interpretation items, plus
integrated case studies, fully referenced rationales, and
verified Grade A answers.
Q UE STIONS SE CTIONS COGNITIVE MIX
150 Items 10 Clinical Areas R / A / AN
B S N H E S I 2 66 NIGHT INGAL E 20 26- 27
,BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
BSN HESI 266 MED SURG EXAM (LATEST 2026 /
2027) QUESTIONS AND VERIFIED ANSWERS | 100%
CORRECT | GRADE A - NIGHTINGALE
Aligned with the Nightingale College BSN HESI 266 Course Syllabus, HESI RN Specialty Exam Blueprint,
NCLEX-RN Test Plan, and Medical-Surgical Nursing Standards (2026/2027 Edition).
Examination Overview
This comprehensive specialty examination contains exactly 150 questions distributed across ten clinical specialty
areas: Cardiovascular (20), Respiratory (18), Neurological (18), Renal & Genitourinary (15), Endocrine (15),
Gastrointestinal & Hepatic (15), Hematological & Oncological (15), Musculoskeletal & Integumentary (12),
Perioperative & Emergency (12), and Pharmacology & Medication Management (10). Cognitive-level distribution
follows the HESI RN blueprint: approximately 20% recall, 50% application, and 30% analysis items, including
prioritization, clinical reasoning, and critical thinking. The bank contains 20 priority-setting items, 15
pharmacology items, 10 laboratory value interpretation items, and 5 integrated case studies with related questions.
Directions: Select the single best answer for each question. Mark the letter of the correct choice on your answer
sheet. Each question has only one correct response. Rationales follow each item and reference the Nightingale
College BSN HESI 266 curriculum, HESI RN Specialty Exam content standards, and the NCLEX-RN Test Plan.
Section 1: Cardiovascular Disorders
Acute Coronary Syndromes · Heart Failure · Dysrhythmias · Cardiac Surgery · Hemodynamic Monitoring · PVD · DVT
Q1: The charge nurse is assigning four clients on a cardiac telemetry unit. Which client should the RN
assess FIRST after receiving shift report?
A. A client 6 hours post-cardiac catheterization whose puncture site is dry and intact
B. A client with heart failure whose weight increased 1 kg overnight and has 2+ pitting edema
C. A client receiving IV heparin for an acute DVT whose aPTT is 95 seconds (control 35)
D. A client 24 hours post-MI reporting new chest pain that radiates to the jaw and is unrelieved by
nitroglycerin *[CORRECT]*
Correct Answer: D
Rationale: Recurrent or new chest pain after an MI suggests extension of infarction, re-occlusion, or
life-threatening complications such as extension into the myocardium or rupture — a medical emergency requiring
immediate assessment. The post-cath client (A) is stable per protocol, the heart failure client (B) requires ongoing
diuresis management, and the heparin client (C) with aPTT 95s (therapeutic range 1.5–2.5x control ≈ 52–88s) is
slightly high but not emergent. NCLEX-RN prioritization principle: airway/breathing/circulation threats first.
Q2: A 58-year-old male presents to the ED with crushing substernal chest pain, diaphoresis, and nausea.
The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which pathologic process does this
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 1
,BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
finding indicate?
A. Anterior wall ischemia from left anterior descending artery occlusion
B. Inferior wall injury from right coronary artery occlusion *[CORRECT]*
C. Lateral wall ischemia from circumflex artery occlusion
D. Subendocardial ischemia from non-ST-elevation MI
Correct Answer: B
Rationale: Leads II, III, and aVF view the inferior wall of the left ventricle, which is perfused by the right coronary
artery (RCA). ST elevation in these leads is diagnostic of an inferior-wall STEMI and indicates acute injury — a
candidate for emergent reperfusion (PCI within 90 minutes or fibrinolytics within 30 minutes of first medical
contact). Anterior (A) = V1–V4/LAD; lateral (C) = I, aVL, V5–V6/circumflex; subendocardial (D) shows ST
depression or T-wave inversion without elevation.
Q3: A client is admitted with acute STEMI and the provider orders MONA therapy (morphine, oxygen,
nitroglycerin, aspirin). Which action by the nurse is MOST appropriate regarding oxygen administration?
A. Apply 4 L/min oxygen via nasal cannula to all clients suspected of ACS
B. Administer 100% oxygen via nonrebreather mask to maintain SpO2 above 94%
C. Administer oxygen only if SpO2 is less than 90% on room air or if respiratory distress is present
*[CORRECT]*
D. Withhold oxygen because it causes coronary vasoconstriction
Correct Answer: C
Rationale: Current AHA/ACC guidelines recommend supplemental oxygen ONLY for clients with SpO2 < 90%
(or < 92–94% in select populations) or signs of respiratory distress. Routine oxygen in normoxic clients is
associated with increased infarct size due to coronary vasoconstriction and free-radical formation. The legacy "give
oxygen to everyone with chest pain" practice is outdated per 2026/2027 ACS guidelines and the HESI RN Specialty
cardiovascular module.
Q4: A client with systolic heart failure (HFrEF, EF 28%) is receiving furosemide 40 mg IV twice daily.
Which laboratory finding requires the MOST immediate nursing action?
A. Sodium 134 mEq/L
B. Magnesium 1.6 mg/dL
C. Potassium 3.0 mEq/L *[CORRECT]*
D. BUN 32 mg/dL
Correct Answer: C
Rationale: A potassium of 3.0 mEq/L is severe hypokalemia (normal 3.5–5.0) and significantly increases the risk
of life-threatening dysrhythmias, especially in a client with already-compromised cardiac function (EF 28%). IV
furosemide causes renal potassium wasting, so the nurse should hold the next dose, notify the provider for IV
potassium replacement, and initiate continuous cardiac monitoring. The other findings (mild hyponatremia,
hypomagnesemia, mild azotemia) require attention but are not immediately life-threatening.
Q5: A client with heart failure is being discharged with a new prescription for carvedilol 3.125 mg PO twice
daily. Which statement by the client indicates the teaching was EFFECTIVE?
A. I will take this medication on an empty stomach to improve absorption
B. I should weigh myself at the same time every morning before breakfast *[CORRECT]*
C. I can stop taking this medication if I feel tired or short of breath
D. I should expect my heart rate to increase as my body adjusts to the drug
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 2
, BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
Correct Answer: B
Rationale: Daily weight at the same time each morning, after voiding and before eating, using the same scale and
similar clothing is the single most sensitive indicator of fluid status in heart failure — a weight gain of 1 kg in 24
hours or 2 kg in 3 days signals fluid retention requiring provider notification. Carvedilol should be taken with food
(A) to slow absorption and reduce orthostatic hypotension; beta-blockers must NEVER be abruptly stopped (C) due
to rebound tachycardia and ischemia; beta-blockers LOWER heart rate (D).
Q6: A client 12 hours post-MI becomes hypotensive (BP 78/42), tachycardic (HR 122), tachypneic (RR 32),
with cool clammy skin and oliguria (15 mL/hr). Pulmonary artery pressures show PCWP 26 mmHg and
cardiac index 1.6 L/min/m². Which condition is the client experiencing?
A. Hypovolemic shock from hemorrhage
B. Distributive shock from sepsis
C. Cardiogenic shock from pump failure *[CORRECT]*
D. Obstructive shock from pulmonary embolism
Correct Answer: C
Rationale: Cardiogenic shock after MI is characterized by hypotension, signs of hypoperfusion (cool/clammy skin,
oliguria, altered mental status), and hemodynamic evidence of pump failure: elevated PCWP (>18 mmHg,
indicating left ventricular failure and pulmonary congestion) with reduced cardiac index (<2.2 L/min/m²).
Hypovolemic shock would show LOW PCWP; septic shock shows WARM skin initially with low SVR; PE presents
with elevated PAP but normal/low PCWP. Treatment includes inotropes (dobutamine, milrinone), vasopressors,
and emergent mechanical support (IABP or Impella).
Q7: A client with new-onset atrial fibrillation with rapid ventricular response (HR 152, BP 96/58) reports
palpitations and mild dyspnea. Which order should the nurse implement FIRST?
A. Administer adenosine 6 mg IV push
B. Administer diltiazem 20 mg IV push over 2 minutes *[CORRECT]*
C. Synchronized cardioversion at 120 joules
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: B
Rationale: The client is hemodynamically stable (BP 96/58, no signs of shock) but symptomatic — IV diltiazem (a
calcium channel blocker) or IV metoprolol is the first-line agent to control ventricular rate. Synchronized
cardioversion (C) is reserved for unstable clients (hypotension with end-organ dysfunction, chest pain, or altered
mental status). Adenosine (A) is for SVT, not AFib. Amiodarone (D) may be used for rhythm control or in heart
failure clients where CCBs are contraindicated, but is not first-line for rate control in stable AFib with RVR per
AHA ACLS guidelines.
Q8: A client with cardiogenic shock has a pulmonary artery catheter in place. The nurse notes these values:
CVP 14 mmHg, PAP 42/22 mmHg, PCWP 28 mmHg, CO 3.2 L/min, SVR 1900 dynes/sec/cm⁵. Which
interpretation is correct?
A. Hypovolemia; give 500 mL fluid bolus
B. Left ventricular failure with increased afterload; prepare for inotrope and vasodilator
*[CORRECT]*
C. Distributive shock from sepsis; give antibiotics and fluids
D. Right ventricular infarction; give IV nitroglycerin
Correct Answer: B
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 3
ANSWERS
BSN HESI 266
Med Surg Exam
A comprehensive 150-question Medical-Surgical nursing
examination aligned with the Nightingale College BSN
HESI 266 Course Syllabus, HESI RN Specialty Exam
Blueprint, and the NCLEX-RN Test Plan. Includes ten
clinical specialty sections with priority-setting,
pharmacology, and laboratory interpretation items, plus
integrated case studies, fully referenced rationales, and
verified Grade A answers.
Q UE STIONS SE CTIONS COGNITIVE MIX
150 Items 10 Clinical Areas R / A / AN
B S N H E S I 2 66 NIGHT INGAL E 20 26- 27
,BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
BSN HESI 266 MED SURG EXAM (LATEST 2026 /
2027) QUESTIONS AND VERIFIED ANSWERS | 100%
CORRECT | GRADE A - NIGHTINGALE
Aligned with the Nightingale College BSN HESI 266 Course Syllabus, HESI RN Specialty Exam Blueprint,
NCLEX-RN Test Plan, and Medical-Surgical Nursing Standards (2026/2027 Edition).
Examination Overview
This comprehensive specialty examination contains exactly 150 questions distributed across ten clinical specialty
areas: Cardiovascular (20), Respiratory (18), Neurological (18), Renal & Genitourinary (15), Endocrine (15),
Gastrointestinal & Hepatic (15), Hematological & Oncological (15), Musculoskeletal & Integumentary (12),
Perioperative & Emergency (12), and Pharmacology & Medication Management (10). Cognitive-level distribution
follows the HESI RN blueprint: approximately 20% recall, 50% application, and 30% analysis items, including
prioritization, clinical reasoning, and critical thinking. The bank contains 20 priority-setting items, 15
pharmacology items, 10 laboratory value interpretation items, and 5 integrated case studies with related questions.
Directions: Select the single best answer for each question. Mark the letter of the correct choice on your answer
sheet. Each question has only one correct response. Rationales follow each item and reference the Nightingale
College BSN HESI 266 curriculum, HESI RN Specialty Exam content standards, and the NCLEX-RN Test Plan.
Section 1: Cardiovascular Disorders
Acute Coronary Syndromes · Heart Failure · Dysrhythmias · Cardiac Surgery · Hemodynamic Monitoring · PVD · DVT
Q1: The charge nurse is assigning four clients on a cardiac telemetry unit. Which client should the RN
assess FIRST after receiving shift report?
A. A client 6 hours post-cardiac catheterization whose puncture site is dry and intact
B. A client with heart failure whose weight increased 1 kg overnight and has 2+ pitting edema
C. A client receiving IV heparin for an acute DVT whose aPTT is 95 seconds (control 35)
D. A client 24 hours post-MI reporting new chest pain that radiates to the jaw and is unrelieved by
nitroglycerin *[CORRECT]*
Correct Answer: D
Rationale: Recurrent or new chest pain after an MI suggests extension of infarction, re-occlusion, or
life-threatening complications such as extension into the myocardium or rupture — a medical emergency requiring
immediate assessment. The post-cath client (A) is stable per protocol, the heart failure client (B) requires ongoing
diuresis management, and the heparin client (C) with aPTT 95s (therapeutic range 1.5–2.5x control ≈ 52–88s) is
slightly high but not emergent. NCLEX-RN prioritization principle: airway/breathing/circulation threats first.
Q2: A 58-year-old male presents to the ED with crushing substernal chest pain, diaphoresis, and nausea.
The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which pathologic process does this
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 1
,BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
finding indicate?
A. Anterior wall ischemia from left anterior descending artery occlusion
B. Inferior wall injury from right coronary artery occlusion *[CORRECT]*
C. Lateral wall ischemia from circumflex artery occlusion
D. Subendocardial ischemia from non-ST-elevation MI
Correct Answer: B
Rationale: Leads II, III, and aVF view the inferior wall of the left ventricle, which is perfused by the right coronary
artery (RCA). ST elevation in these leads is diagnostic of an inferior-wall STEMI and indicates acute injury — a
candidate for emergent reperfusion (PCI within 90 minutes or fibrinolytics within 30 minutes of first medical
contact). Anterior (A) = V1–V4/LAD; lateral (C) = I, aVL, V5–V6/circumflex; subendocardial (D) shows ST
depression or T-wave inversion without elevation.
Q3: A client is admitted with acute STEMI and the provider orders MONA therapy (morphine, oxygen,
nitroglycerin, aspirin). Which action by the nurse is MOST appropriate regarding oxygen administration?
A. Apply 4 L/min oxygen via nasal cannula to all clients suspected of ACS
B. Administer 100% oxygen via nonrebreather mask to maintain SpO2 above 94%
C. Administer oxygen only if SpO2 is less than 90% on room air or if respiratory distress is present
*[CORRECT]*
D. Withhold oxygen because it causes coronary vasoconstriction
Correct Answer: C
Rationale: Current AHA/ACC guidelines recommend supplemental oxygen ONLY for clients with SpO2 < 90%
(or < 92–94% in select populations) or signs of respiratory distress. Routine oxygen in normoxic clients is
associated with increased infarct size due to coronary vasoconstriction and free-radical formation. The legacy "give
oxygen to everyone with chest pain" practice is outdated per 2026/2027 ACS guidelines and the HESI RN Specialty
cardiovascular module.
Q4: A client with systolic heart failure (HFrEF, EF 28%) is receiving furosemide 40 mg IV twice daily.
Which laboratory finding requires the MOST immediate nursing action?
A. Sodium 134 mEq/L
B. Magnesium 1.6 mg/dL
C. Potassium 3.0 mEq/L *[CORRECT]*
D. BUN 32 mg/dL
Correct Answer: C
Rationale: A potassium of 3.0 mEq/L is severe hypokalemia (normal 3.5–5.0) and significantly increases the risk
of life-threatening dysrhythmias, especially in a client with already-compromised cardiac function (EF 28%). IV
furosemide causes renal potassium wasting, so the nurse should hold the next dose, notify the provider for IV
potassium replacement, and initiate continuous cardiac monitoring. The other findings (mild hyponatremia,
hypomagnesemia, mild azotemia) require attention but are not immediately life-threatening.
Q5: A client with heart failure is being discharged with a new prescription for carvedilol 3.125 mg PO twice
daily. Which statement by the client indicates the teaching was EFFECTIVE?
A. I will take this medication on an empty stomach to improve absorption
B. I should weigh myself at the same time every morning before breakfast *[CORRECT]*
C. I can stop taking this medication if I feel tired or short of breath
D. I should expect my heart rate to increase as my body adjusts to the drug
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 2
, BSN HESI 266 MED SURG EXAM (2026/2027) — GRADE A — NIGHTINGALE Verified Answers · 150 Questions
Correct Answer: B
Rationale: Daily weight at the same time each morning, after voiding and before eating, using the same scale and
similar clothing is the single most sensitive indicator of fluid status in heart failure — a weight gain of 1 kg in 24
hours or 2 kg in 3 days signals fluid retention requiring provider notification. Carvedilol should be taken with food
(A) to slow absorption and reduce orthostatic hypotension; beta-blockers must NEVER be abruptly stopped (C) due
to rebound tachycardia and ischemia; beta-blockers LOWER heart rate (D).
Q6: A client 12 hours post-MI becomes hypotensive (BP 78/42), tachycardic (HR 122), tachypneic (RR 32),
with cool clammy skin and oliguria (15 mL/hr). Pulmonary artery pressures show PCWP 26 mmHg and
cardiac index 1.6 L/min/m². Which condition is the client experiencing?
A. Hypovolemic shock from hemorrhage
B. Distributive shock from sepsis
C. Cardiogenic shock from pump failure *[CORRECT]*
D. Obstructive shock from pulmonary embolism
Correct Answer: C
Rationale: Cardiogenic shock after MI is characterized by hypotension, signs of hypoperfusion (cool/clammy skin,
oliguria, altered mental status), and hemodynamic evidence of pump failure: elevated PCWP (>18 mmHg,
indicating left ventricular failure and pulmonary congestion) with reduced cardiac index (<2.2 L/min/m²).
Hypovolemic shock would show LOW PCWP; septic shock shows WARM skin initially with low SVR; PE presents
with elevated PAP but normal/low PCWP. Treatment includes inotropes (dobutamine, milrinone), vasopressors,
and emergent mechanical support (IABP or Impella).
Q7: A client with new-onset atrial fibrillation with rapid ventricular response (HR 152, BP 96/58) reports
palpitations and mild dyspnea. Which order should the nurse implement FIRST?
A. Administer adenosine 6 mg IV push
B. Administer diltiazem 20 mg IV push over 2 minutes *[CORRECT]*
C. Synchronized cardioversion at 120 joules
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: B
Rationale: The client is hemodynamically stable (BP 96/58, no signs of shock) but symptomatic — IV diltiazem (a
calcium channel blocker) or IV metoprolol is the first-line agent to control ventricular rate. Synchronized
cardioversion (C) is reserved for unstable clients (hypotension with end-organ dysfunction, chest pain, or altered
mental status). Adenosine (A) is for SVT, not AFib. Amiodarone (D) may be used for rhythm control or in heart
failure clients where CCBs are contraindicated, but is not first-line for rate control in stable AFib with RVR per
AHA ACLS guidelines.
Q8: A client with cardiogenic shock has a pulmonary artery catheter in place. The nurse notes these values:
CVP 14 mmHg, PAP 42/22 mmHg, PCWP 28 mmHg, CO 3.2 L/min, SVR 1900 dynes/sec/cm⁵. Which
interpretation is correct?
A. Hypovolemia; give 500 mL fluid bolus
B. Left ventricular failure with increased afterload; prepare for inotrope and vasodilator
*[CORRECT]*
C. Distributive shock from sepsis; give antibiotics and fluids
D. Right ventricular infarction; give IV nitroglycerin
Correct Answer: B
Nightingale College BSN · HESI RN Specialty · NCLEX-RN Aligned Page 3
