BSN 266 HESI Med Surg Exam (2025/2026 Edition) –
NGN-Style Case Scenarios & Clinical Judgment Questions |
Verified Questions and Answers
The BSN 266 HESI Medical-Surgical Exam (2025/2026) offers comprehensive,
NGN-style case scenarios designed to evaluate advanced clinical judgment and decision-making
skills essential for safe and effective nursing practice. Each question mirrors the Next
Generation NCLEX (NGN) format to strengthen students’ analytical reasoning and
patient-centered care strategies.
Key Focus Areas:
Complex medical-surgical conditions, patient safety, prioritization and delegation,
pharmacological interventions, diagnostic interpretations, and interprofessional collaboration in
acute care settings.
Answer Format
All correct responses are highlighted in bold and green with clear, concise rationales that
reinforce evidence-based nursing practices and support critical thinking development for the
BSN 266 HESI Med Surg Exam (2025/2026).
NGN-Style Case Scenarios (50 Questions)
Case Scenario 1: Acute Chest Pain (10 Questions)
1. A 58-year-old male patient presents to the ED with acute chest pain radiating to
the left arm, diaphoresis, and nausea. Vital signs: BP 160/90 mmHg, HR 92 bpm,
RR 20/min, SpO2 94% on room air. The nurse's priority action is to:
a) Administer aspirin 325 mg PO
b) Obtain a 12-lead ECG
c) Encourage the patient to rest quietly
d) Assess the patient's pain level
Answer: b) Obtain a 12-lead ECG
Rationale: Acute chest pain suggests acute coronary syndrome; a 12-lead ECG is the priority to
identify ST-elevation myocardial infarction (STEMI) or other cardiac abnormalities, guiding
immediate intervention.
2. The ECG shows ST elevation in leads II, III, and aVF. The nurse recognizes this
as an inferior wall myocardial infarction. The next priority intervention is:
a) Administer morphine 2 mg IV
b) Prepare for PCI or thrombolytic therapy
c) Administer oxygen at 6 L/min
d) Obtain a troponin level
, Answer: b) Prepare for PCI or thrombolytic therapy
Rationale: ST elevation in inferior leads indicates an inferior wall MI, a STEMI requiring urgent
reperfusion via PCI or thrombolytics within 90 minutes of arrival.
3. The patient is given aspirin 325 mg and heparin 60 units/kg IV bolus. The nurse
monitors for:
a) Hypoglycemia
b) Bleeding complications
c) Hyperkalemia
d) Hypothermia
Answer: b) Bleeding complications
Rationale: Aspirin and heparin inhibit platelet function and coagulation, increasing bleeding
risk, especially gastrointestinal or intracranial.
4. The patient's pain score is 8/10. The nurse administers nitroglycerin 0.4 mg SL.
The patient reports relief after 5 minutes. The nurse's next action is to:
a) Repeat nitroglycerin every 5 minutes up to 3 doses
b) Notify the provider for PCI
c) Encourage the patient to ambulate
d) Administer beta-blockers immediately
Answer: a) Repeat nitroglycerin every 5 minutes up to 3 doses
Rationale: Nitroglycerin relieves angina by vasodilation; repeat doses up to 3 are standard if
pain persists.
5. The patient's troponin I is 0.5 ng/mL (elevated). The nurse anticipates:
a) Discharge home
b) Transfer to the CCU for monitoring
c) Immediate surgery
d) Discharge with aspirin only
Answer: b) Transfer to the CCU for monitoring
Rationale: Elevated troponin confirms MI, requiring CCU monitoring for complications like
arrhythmias.
6. The patient develops ventricular ectopy. The nurse's priority action is to:
a) Administer lidocaine
b) Assess the rhythm and notify the provider
c) Ignore the ectopy
d) Restrict fluids
Answer: b) Assess the rhythm and notify the provider
Rationale: Ventricular ectopy in MI may precede ventricular tachycardia; assessment and
provider notification are essential.
7. The patient is started on a beta-blocker. The nurse monitors for:
a) Bradycardia and hypotension
b) Tachycardia
c) Hyperglycemia
d) Hyperthermia
NGN-Style Case Scenarios & Clinical Judgment Questions |
Verified Questions and Answers
The BSN 266 HESI Medical-Surgical Exam (2025/2026) offers comprehensive,
NGN-style case scenarios designed to evaluate advanced clinical judgment and decision-making
skills essential for safe and effective nursing practice. Each question mirrors the Next
Generation NCLEX (NGN) format to strengthen students’ analytical reasoning and
patient-centered care strategies.
Key Focus Areas:
Complex medical-surgical conditions, patient safety, prioritization and delegation,
pharmacological interventions, diagnostic interpretations, and interprofessional collaboration in
acute care settings.
Answer Format
All correct responses are highlighted in bold and green with clear, concise rationales that
reinforce evidence-based nursing practices and support critical thinking development for the
BSN 266 HESI Med Surg Exam (2025/2026).
NGN-Style Case Scenarios (50 Questions)
Case Scenario 1: Acute Chest Pain (10 Questions)
1. A 58-year-old male patient presents to the ED with acute chest pain radiating to
the left arm, diaphoresis, and nausea. Vital signs: BP 160/90 mmHg, HR 92 bpm,
RR 20/min, SpO2 94% on room air. The nurse's priority action is to:
a) Administer aspirin 325 mg PO
b) Obtain a 12-lead ECG
c) Encourage the patient to rest quietly
d) Assess the patient's pain level
Answer: b) Obtain a 12-lead ECG
Rationale: Acute chest pain suggests acute coronary syndrome; a 12-lead ECG is the priority to
identify ST-elevation myocardial infarction (STEMI) or other cardiac abnormalities, guiding
immediate intervention.
2. The ECG shows ST elevation in leads II, III, and aVF. The nurse recognizes this
as an inferior wall myocardial infarction. The next priority intervention is:
a) Administer morphine 2 mg IV
b) Prepare for PCI or thrombolytic therapy
c) Administer oxygen at 6 L/min
d) Obtain a troponin level
, Answer: b) Prepare for PCI or thrombolytic therapy
Rationale: ST elevation in inferior leads indicates an inferior wall MI, a STEMI requiring urgent
reperfusion via PCI or thrombolytics within 90 minutes of arrival.
3. The patient is given aspirin 325 mg and heparin 60 units/kg IV bolus. The nurse
monitors for:
a) Hypoglycemia
b) Bleeding complications
c) Hyperkalemia
d) Hypothermia
Answer: b) Bleeding complications
Rationale: Aspirin and heparin inhibit platelet function and coagulation, increasing bleeding
risk, especially gastrointestinal or intracranial.
4. The patient's pain score is 8/10. The nurse administers nitroglycerin 0.4 mg SL.
The patient reports relief after 5 minutes. The nurse's next action is to:
a) Repeat nitroglycerin every 5 minutes up to 3 doses
b) Notify the provider for PCI
c) Encourage the patient to ambulate
d) Administer beta-blockers immediately
Answer: a) Repeat nitroglycerin every 5 minutes up to 3 doses
Rationale: Nitroglycerin relieves angina by vasodilation; repeat doses up to 3 are standard if
pain persists.
5. The patient's troponin I is 0.5 ng/mL (elevated). The nurse anticipates:
a) Discharge home
b) Transfer to the CCU for monitoring
c) Immediate surgery
d) Discharge with aspirin only
Answer: b) Transfer to the CCU for monitoring
Rationale: Elevated troponin confirms MI, requiring CCU monitoring for complications like
arrhythmias.
6. The patient develops ventricular ectopy. The nurse's priority action is to:
a) Administer lidocaine
b) Assess the rhythm and notify the provider
c) Ignore the ectopy
d) Restrict fluids
Answer: b) Assess the rhythm and notify the provider
Rationale: Ventricular ectopy in MI may precede ventricular tachycardia; assessment and
provider notification are essential.
7. The patient is started on a beta-blocker. The nurse monitors for:
a) Bradycardia and hypotension
b) Tachycardia
c) Hyperglycemia
d) Hyperthermia
