Nightingale College BSN 266 Med-Surg HESI Exam 2026/2027 PDF – 200 High-Yield Practice Questions with Answers & Detailed Rationales | Instant Download

Nightingale College BSN 266 Med-Surg
HESI Exam 2026/2027
200 High-Yield Practice Questions with
Answers & Rationales

CARDIOVASCULAR SYSTEM (Questions 1-40)


QUESTION 1
A patient with chest pain has an ECG showing ST-segment elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Posterior descending artery
Answer: C) Right coronary artery
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, which is
supplied by the right coronary artery (RCA). Anterior wall MI (V1-V4) is supplied
by the left anterior descending artery (LAD). Lateral wall MI (I, aVL, V5-V6) is
supplied by the left circumflex artery .


QUESTION 2
A nurse is assessing a client with left-sided heart failure. Which finding is most
indicative of this condition?
A) Jugular vein distention
B) Peripheral edema
C) Bibasilar crackles
D) Hepatomegaly

,Answer: C) Bibasilar crackles
Rationale: Left-sided heart failure causes pulmonary congestion due to the left
ventricle's inability to pump blood forward. Blood backs up into the pulmonary
circulation, leading to pulmonary edema, which manifests as crackles on
auscultation .


QUESTION 3
A client with heart failure and a reduced ejection fraction (HFrEF) is prescribed an
ACE inhibitor. The nurse should monitor for which adverse effect?
A) Hyperkalemia
B) Hypokalemia
C) Hyperglycemia
D) Hypocalcemia
Answer: A) Hyperkalemia
Rationale: ACE inhibitors decrease aldosterone secretion, leading to potassium
retention. The nurse should monitor potassium levels and renal function, especially
in patients with pre-existing renal impairment .


QUESTION 4
A nurse is caring for a client 6 hours after a percutaneous coronary intervention
(PCI) via the femoral artery. The client reports severe pain in the groin. The nurse
observes a large, expanding hematoma. What is the priority action?
A) Apply manual pressure to the site
B) Administer morphine sulfate IV push
C) Measure the circumference of the thigh
D) Document the finding in the chart
Answer: A) Apply manual pressure to the site
Rationale: An expanding hematoma at the femoral access site indicates active
bleeding. The priority is to apply direct manual pressure to the site to achieve

,hemostasis while notifying the provider. Pain medication and measurement are
secondary to stopping the bleeding .


QUESTION 5
A client with atrial fibrillation is prescribed warfarin. The client's INR is 3.8. What
is the most appropriate nursing action?
A) Administer vitamin K as ordered
B) Hold the next dose of warfarin
C) Administer the warfarin as prescribed
D) Prepare for fresh frozen plasma transfusion
Answer: C) Administer the warfarin as prescribed
Rationale: For atrial fibrillation, the therapeutic INR goal is typically 2.0-3.0. An
INR of 3.8 is slightly above target but not critically high (critical is >4.5). The
standard protocol is to hold the dose only if INR >4.0 or if there is bleeding. Since
the question does not indicate bleeding, the nurse should administer the dose and
notify the provider for possible dose adjustment .


QUESTION 6
A client presents with tearing chest pain radiating to the back, blood pressure
160/90 in the right arm and 100/60 in the left arm. What condition does the nurse
suspect?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection is characterized by sudden, severe, tearing or ripping
chest pain that may radiate to the back. A key sign is a discrepancy in blood
pressure between arms due to the dissection affecting arterial flow to one
subclavian artery .

, QUESTION 7 k




A patient with chronic heart failure is on a fluid restriction of 1500 mL/day. Which
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statement indicates the patient needs further teaching?
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A) "I will limit my intake of soup and gelatin."
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B) "I can drink as much water as I want as long as I take my diuretic."
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C) "I will weigh myself daily and report weight gain."
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D) "I will spread my fluids throughout the day."
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Answer: B) "I can drink as much water as I want as long as I take my diuretic."
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Rationale: Patients with heart failure should adhere to prescribed fluid restrictions
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regardless of diuretic therapy. Diuretics help excrete excess fluid but do not
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eliminate the need for fluid restriction. Weight gain is a sign of fluid retention and should
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be reported .
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QUESTION 8 k




A patient prescribed Digoxin has a serum potassium level of 3.1 mEq/L. What is the
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priority nursing action?
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A) Administer the Digoxin as scheduled k k k k




B) Hold the Digoxin and notify the provider
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C) Administer potassium supplements k k




D) Increase the Digoxin dose k k k




Answer: B) Hold the Digoxin and notify the provider
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Rationale: Hypokalemia (normal 3.5-5.0 mEq/L) increases the risk of digoxin
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toxicity. Digoxin should be held in the presence of hypokalemia, and the provider
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should be notified. Low potassium levels cause digoxin to bind more strongly to
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myocardial cells, increasing toxicity risk .
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