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BSN 266 HESI Med-Surg Practice Exam: 100 Questions with Answers
Section 1: Cardiovascular Disorders (Questions 1–20)
Q1. A patient with acute decompensated heart failure is receiving intravenous furosemide.
Which assessment finding most urgently requires the nurse to notify the provider?
A) Urine output of 50 mL/hr
B) Serum potassium of 3.1 mEq/L
C) Blood pressure of 108/68 mmHg
D) Weight loss of 1 kg in 24 hours
Answer: B
Rationale: Loop diuretics like furosemide can cause hypokalemia, which predisposes to
lethal dysrhythmias; a potassium of 3.1 mEq/L is critically low and requires immediate
intervention. The other findings are expected therapeutic effects or within acceptable ranges
.
Q2. A patient with heart failure presents with dyspnea on exertion, jugular vein distention,
and bilateral pedal edema. Which medication is most appropriate first-line to reduce
preload?
A) Digoxin
B) Metoprolol
C) Furosemide (Lasix)
D) Spironolactone
Answer: C
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting sodium
and water excretion, relieving congestion. Digoxin increases contractility but does not
reduce preload. Metoprolol is for chronic HF management. Spironolactone is used in chronic
HF .
Q3. A patient with hypertension has a blood pressure of 180/120 mmHg and reports
headache and blurred vision. Which condition should the nurse suspect?
A) Hypertensive emergency
B) Mild hypertension
C) Hypertensive urgency without target organ damage
D) White coat syndrome
Answer: A
Rationale: BP ≥180/120 with target organ damage (headache, blurred vision, dyspnea, chest
pain, neurologic deficits) defines hypertensive emergency requiring immediate IV
antihypertensive therapy .
, 2
Q4. A patient with atrial fibrillation is prescribed warfarin. The INR is 1.2. What is the
appropriate nursing action?
A) Hold the warfarin because INR is too high
B) Administer vitamin K
C) Expect to administer additional warfarin as ordered
D) Document as normal
Answer: C
Rationale: For AF, target INR is 2.0–3.0. INR 1.2 is subtherapeutic; the patient is at risk for
stroke. The provider will likely increase the warfarin dose. Vitamin K is given for elevated INR
with bleeding .
Q5. A patient with heart failure is started on carvedilol. The nurse should monitor for which
adverse effects?
A) Hyperglycemia and hyperkalemia
B) Bradycardia and hypotension
C) Tachycardia and hypertension
D) Hypernatremia and hypokalemia
Answer: B
Rationale: Carvedilol is a non-selective beta-blocker with alpha-blocking activity. It causes
bradycardia and hypotension, especially during initiation. Monitor heart rate and blood
pressure closely .
Q6. A patient with unstable angina is admitted. Which laboratory finding is most indicative
of myocardial necrosis?
A) CK-MB within normal range
B) Myoglobin normal
C) Troponin I >0.04 ng/mL
D) BNP elevated
Answer: C
Rationale: Troponin I and T are cardiac-specific markers of myocardial necrosis. Elevation
indicates non-ST elevation MI (NSTEMI) rather than unstable angina. CK-MB is less specific.
Myoglobin is early but non-specific. BNP indicates heart failure .
Q7. A patient with peripheral artery disease (PAD) has a non-healing ulcer on the great toe.
Which finding is consistent with PAD?
A) Bounding pedal pulses
B) Warm, erythematous skin
C) Diminished dorsalis pedis pulse and cool, pale skin
D) Dependent rubor that resolves with elevation
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Answer: C
Rationale: PAD causes decreased arterial blood flow, leading to diminished pulses, cool/pale
skin, delayed capillary refill, and ulceration. Dependent rubor occurs with severe PAD .
Q8. A patient with deep vein thrombosis is prescribed enoxaparin. Which teaching should
the nurse include?
A) Take with aspirin to increase efficacy
B) Stop the medication if pain improves
C) Report any signs of bleeding such as hematuria or black tarry stools
D) Apply heat to the affected extremity
Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin. Patients should report signs of
bleeding. Aspirin increases bleeding risk. The medication should not be stopped without
provider guidance. Heat is contraindicated in acute DVT .
Q9. A client with a completed ischemic stroke has a blood pressure of 180/90 mmHg. Which
action should the nurse implement?
A) Position the head of the bed flat
B) Withhold intravenous fluids
C) Administer a bolus of IV fluids
D) Give an antihypertensive medication
Answer: D
Rationale: Completed strokes usually produce neurologic deficits within an hour, and the
client's current elevated blood pressure requires antihypertensive medication to prevent
further damage .
Q10. A client who underwent cardiac stent placement 4 days ago arrives reporting sudden
onset chest pressure and shortness of breath. Which action should the nurse take next?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead ECG and begin continuous cardiac monitoring
C) Give oxygen at 2 liters per minute via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure after recent stenting is at high risk for acute
stent thrombosis or MI. Immediate acquisition of a 12-lead ECG is critical to assess for
ischemic changes. Continuous cardiac monitoring is essential to detect arrhythmias .
Q11. A patient receiving a blood transfusion develops fever, chills, and low back pain within
15 minutes. What is the nurse's priority action?
BSN 266 HESI Med-Surg Practice Exam: 100 Questions with Answers
Section 1: Cardiovascular Disorders (Questions 1–20)
Q1. A patient with acute decompensated heart failure is receiving intravenous furosemide.
Which assessment finding most urgently requires the nurse to notify the provider?
A) Urine output of 50 mL/hr
B) Serum potassium of 3.1 mEq/L
C) Blood pressure of 108/68 mmHg
D) Weight loss of 1 kg in 24 hours
Answer: B
Rationale: Loop diuretics like furosemide can cause hypokalemia, which predisposes to
lethal dysrhythmias; a potassium of 3.1 mEq/L is critically low and requires immediate
intervention. The other findings are expected therapeutic effects or within acceptable ranges
.
Q2. A patient with heart failure presents with dyspnea on exertion, jugular vein distention,
and bilateral pedal edema. Which medication is most appropriate first-line to reduce
preload?
A) Digoxin
B) Metoprolol
C) Furosemide (Lasix)
D) Spironolactone
Answer: C
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting sodium
and water excretion, relieving congestion. Digoxin increases contractility but does not
reduce preload. Metoprolol is for chronic HF management. Spironolactone is used in chronic
HF .
Q3. A patient with hypertension has a blood pressure of 180/120 mmHg and reports
headache and blurred vision. Which condition should the nurse suspect?
A) Hypertensive emergency
B) Mild hypertension
C) Hypertensive urgency without target organ damage
D) White coat syndrome
Answer: A
Rationale: BP ≥180/120 with target organ damage (headache, blurred vision, dyspnea, chest
pain, neurologic deficits) defines hypertensive emergency requiring immediate IV
antihypertensive therapy .
, 2
Q4. A patient with atrial fibrillation is prescribed warfarin. The INR is 1.2. What is the
appropriate nursing action?
A) Hold the warfarin because INR is too high
B) Administer vitamin K
C) Expect to administer additional warfarin as ordered
D) Document as normal
Answer: C
Rationale: For AF, target INR is 2.0–3.0. INR 1.2 is subtherapeutic; the patient is at risk for
stroke. The provider will likely increase the warfarin dose. Vitamin K is given for elevated INR
with bleeding .
Q5. A patient with heart failure is started on carvedilol. The nurse should monitor for which
adverse effects?
A) Hyperglycemia and hyperkalemia
B) Bradycardia and hypotension
C) Tachycardia and hypertension
D) Hypernatremia and hypokalemia
Answer: B
Rationale: Carvedilol is a non-selective beta-blocker with alpha-blocking activity. It causes
bradycardia and hypotension, especially during initiation. Monitor heart rate and blood
pressure closely .
Q6. A patient with unstable angina is admitted. Which laboratory finding is most indicative
of myocardial necrosis?
A) CK-MB within normal range
B) Myoglobin normal
C) Troponin I >0.04 ng/mL
D) BNP elevated
Answer: C
Rationale: Troponin I and T are cardiac-specific markers of myocardial necrosis. Elevation
indicates non-ST elevation MI (NSTEMI) rather than unstable angina. CK-MB is less specific.
Myoglobin is early but non-specific. BNP indicates heart failure .
Q7. A patient with peripheral artery disease (PAD) has a non-healing ulcer on the great toe.
Which finding is consistent with PAD?
A) Bounding pedal pulses
B) Warm, erythematous skin
C) Diminished dorsalis pedis pulse and cool, pale skin
D) Dependent rubor that resolves with elevation
, 3
Answer: C
Rationale: PAD causes decreased arterial blood flow, leading to diminished pulses, cool/pale
skin, delayed capillary refill, and ulceration. Dependent rubor occurs with severe PAD .
Q8. A patient with deep vein thrombosis is prescribed enoxaparin. Which teaching should
the nurse include?
A) Take with aspirin to increase efficacy
B) Stop the medication if pain improves
C) Report any signs of bleeding such as hematuria or black tarry stools
D) Apply heat to the affected extremity
Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin. Patients should report signs of
bleeding. Aspirin increases bleeding risk. The medication should not be stopped without
provider guidance. Heat is contraindicated in acute DVT .
Q9. A client with a completed ischemic stroke has a blood pressure of 180/90 mmHg. Which
action should the nurse implement?
A) Position the head of the bed flat
B) Withhold intravenous fluids
C) Administer a bolus of IV fluids
D) Give an antihypertensive medication
Answer: D
Rationale: Completed strokes usually produce neurologic deficits within an hour, and the
client's current elevated blood pressure requires antihypertensive medication to prevent
further damage .
Q10. A client who underwent cardiac stent placement 4 days ago arrives reporting sudden
onset chest pressure and shortness of breath. Which action should the nurse take next?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead ECG and begin continuous cardiac monitoring
C) Give oxygen at 2 liters per minute via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure after recent stenting is at high risk for acute
stent thrombosis or MI. Immediate acquisition of a 12-lead ECG is critical to assess for
ischemic changes. Continuous cardiac monitoring is essential to detect arrhythmias .
Q11. A patient receiving a blood transfusion develops fever, chills, and low back pain within
15 minutes. What is the nurse's priority action?
