Nightingale College BSN 266 Med-Surg HESI Exam 5 2026/2027 PDF – 200 Questions with Answers & Detailed Rationales | Instant Download

Nightingale College BSN 266 Med-Surg
HESI Exam 5 - 2026/2027
200 Questions with Answers and Rationales

SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-35)
1. A nurse is assessing a client admitted with a diagnosis of myocardial
infarction. Which laboratory value is most specific for confirming myocardial
damage?
A) Creatine kinase-MB (CK-MB)
B) Troponin I
C) Myoglobin
D) Lactate dehydrogenase (LDH)
Correct Answer: B) Troponin I
Rationale: Troponin I is a highly specific cardiac marker that rises within 3-4
hours of myocardial injury and remains elevated for up to 7-10 days. CK-MB and
myoglobin are less specific, and LDH is a general marker of tissue damage that
lacks cardiac specificity .


2. A client with heart failure is prescribed furosemide. Which assessment
finding is most important to report to the healthcare provider?
A) Blood pressure 130/80 mmHg
B) Weight loss of 1 kg in 24 hours
C) Heart rate 88 beats per minute and regular
D) Serum potassium 3.2 mEq/L
Correct Answer: D) Serum potassium 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Hypokalemia (normal range 3.5-5.0 mEq/L) can lead to cardiac dysrhythmias,

,especially in clients taking digoxin. A potassium level of 3.2 mEq/L requires
prompt notification and intervention .


3. A client with angina is prescribed sublingual nitroglycerin. Which
instruction should the nurse include in the teaching?
A) "Swallow the tablet with a full glass of water."
B) "Place the tablet under your tongue and allow it to dissolve."
C) "Chew the tablet for faster absorption."
D) "Take the tablet with food to prevent stomach upset."
Correct Answer: B) "Place the tablet under your tongue and allow it to dissolve."
Rationale: Sublingual nitroglycerin should be placed under the tongue and
allowed to dissolve for rapid absorption through the mucous membranes. It should
not be swallowed, chewed, or taken with food, as these routes would delay or
reduce absorption .


4. A client with peripheral artery disease reports leg pain that starts after
walking two blocks and stops with rest. The nurse should document this
finding as:
A) Rest pain
B) Neuropathic pain
C) Intermittent claudication
D) Venous insufficiency
Correct Answer: C) Intermittent claudication
Rationale: Intermittent claudication is ischemic muscle pain that occurs with
exercise and is relieved by rest. It is a classic symptom of peripheral artery disease.
Rest pain indicates severe ischemia, and venous insufficiency typically presents
with edema and skin changes .

,5. 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
Correct 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 .


6. 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
Correct Answer: C) Bibasilar crackles
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of
blood into the pulmonary circulation. Bibasilar crackles indicate fluid
accumulation in the lungs. Jugular vein distention, peripheral edema, and
hepatomegaly are signs of right-sided heart failure .


7. A client is receiving a continuous heparin infusion for deep vein thrombosis.
The aPTT result is 110 seconds (normal 30-40 seconds). Which action should
the nurse take first?
A) Increase the heparin infusion rate
B) Stop the heparin infusion

, C) Notify the healthcare provider k k k




D) Assess the client for bleeding k k k k




CorrectAnswer: B) Stop the heparin infusion
k k k k k k




Rationale: An aPTT of 110 seconds is significantly elevated and indicates a high
k k k k k k k k k k k k




risk of bleeding. The priority action is to stop the infusion and then assess the client for
k k k k k k k k k k k k k k k k




signs of bleeding before notifying the provider. Heparin is a high-alert
k k k k k k k k k k k




medication requiring close monitoring . k k k k




8. A client with hypertension is prescribed lisinopril. Which adverse effect should
k k k k k k k k k k k




the nurse teach the client to report immediately?
k k k k k k k k




A) Dry cough k




B) Headache
C) Swelling of the face, lips, or tongue k k k k k k




D) Dizziness
CorrectAnswer: C) Swelling of the face, lips, or tongue
k k k k k k k k k




Rationale: Angioedema (swelling of the face, lips, tongue, or airway) is a serious
k k k k k k k k k k k k




adverse effect ofACE inhibitors that can compromise the airway. Clients should be
k k k k k k k k k k k k k




instructed to seek emergency care immediately if this occurs. Dry cough is a
k k k k k k k k k k k k k




common but non-life-threatening side effect .
k k k k k




9. A client presents with tearing chest pain radiating to the back, blood
k k k k k k k k k k k k




pressure 160/90 in the right arm and 100/60 in the left arm. What condition does
k k k k k k k k k k k k k k




the nurse suspect?
k k k




A) Acute myocardial infarction k k




B) Pulmonary embolism k




C) Aortic dissection k




D) Pericarditis
CorrectAnswer: C) Aortic dissection
k k k k