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. This resource contains exactly 60
questions — the confirmed number used in the actual HESI Med Surg Exam at Nightingale
College for BSN 266 in the 2025/2026 academic year.
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 (60 Questions – Actual Exam Format)
Case Scenario 1: Acute Coronary Syndrome (12 Questions)
1. A 60-year-old male presents with crushing chest pain, dyspnea, and diaphoresis.
Vital signs: BP 150/88 mmHg, HR 96 bpm, SpO2 93% RA. The nurse’s priority
action is:
a) Administer aspirin 325 mg
b) Obtain a 12-lead ECG
c) Start oxygen at 2 L/min
d) Assess pain scale
Answer: b) Obtain a 12-lead ECG
Rationale: ECG is the fastest diagnostic tool to identify STEMI and initiate reperfusion therapy
within 90 minutes.
2. ECG shows ST elevation in V2–V4. The nurse recognizes:
a) Inferior wall MI
b) Anterior wall MI
c) Lateral wall MI
d) Posterior wall MI
Answer: b) Anterior wall MI
Rationale: ST elevation in V2–V4 indicates anterior wall involvement (LAD occlusion).
, 3. The patient is within 3 hours of symptom onset. The priority intervention is:
a) Thrombolytics
b) Percutaneous coronary intervention (PCI)
c) CABG
d) Observation
Answer: b) Percutaneous coronary intervention (PCI)
Rationale: PCI is preferred over thrombolytics if available within 90 minutes (door-to-balloon
time).
4. Aspirin 325 mg is administered. The nurse monitors for:
a) Hypoglycemia
b) GI bleeding
c) Hyperkalemia
d) Seizures
Answer: b) GI bleeding
Rationale: Aspirin increases bleeding risk; monitor for melena, hematemesis, or drop in Hgb.
5. Nitroglycerin 0.4 mg SL is given. BP drops to 90/60 mmHg. The nurse’s priority
action is:
a) Repeat nitroglycerin
b) Elevate legs and notify provider
c) Administer morphine
d) Ignore the drop
Answer: b) Elevate legs and notify provider
Rationale: Hypotension contraindicates further nitroglycerin; treat with Trendelenburg and
fluid bolus.
6. Troponin I is 1.2 ng/mL. This confirms:
a) Unstable angina
b) Myocardial infarction
c) Pericarditis
d) Aortic dissection
Answer: b) Myocardial infarction
Rationale: Elevated troponin confirms myocardial necrosis.
7. Post-PCI, the patient develops ventricular tachycardia. The nurse’s first action
is:
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Check pulse
d) Give adenosine
Answer: c) Check pulse
Rationale: Determine if VT is with or without pulse; pulseless VT requires defibrillation.
8. The patient is prescribed metoprolol. The nurse monitors for:
a) Tachycardia
b) Bradycardia
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. This resource contains exactly 60
questions — the confirmed number used in the actual HESI Med Surg Exam at Nightingale
College for BSN 266 in the 2025/2026 academic year.
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 (60 Questions – Actual Exam Format)
Case Scenario 1: Acute Coronary Syndrome (12 Questions)
1. A 60-year-old male presents with crushing chest pain, dyspnea, and diaphoresis.
Vital signs: BP 150/88 mmHg, HR 96 bpm, SpO2 93% RA. The nurse’s priority
action is:
a) Administer aspirin 325 mg
b) Obtain a 12-lead ECG
c) Start oxygen at 2 L/min
d) Assess pain scale
Answer: b) Obtain a 12-lead ECG
Rationale: ECG is the fastest diagnostic tool to identify STEMI and initiate reperfusion therapy
within 90 minutes.
2. ECG shows ST elevation in V2–V4. The nurse recognizes:
a) Inferior wall MI
b) Anterior wall MI
c) Lateral wall MI
d) Posterior wall MI
Answer: b) Anterior wall MI
Rationale: ST elevation in V2–V4 indicates anterior wall involvement (LAD occlusion).
, 3. The patient is within 3 hours of symptom onset. The priority intervention is:
a) Thrombolytics
b) Percutaneous coronary intervention (PCI)
c) CABG
d) Observation
Answer: b) Percutaneous coronary intervention (PCI)
Rationale: PCI is preferred over thrombolytics if available within 90 minutes (door-to-balloon
time).
4. Aspirin 325 mg is administered. The nurse monitors for:
a) Hypoglycemia
b) GI bleeding
c) Hyperkalemia
d) Seizures
Answer: b) GI bleeding
Rationale: Aspirin increases bleeding risk; monitor for melena, hematemesis, or drop in Hgb.
5. Nitroglycerin 0.4 mg SL is given. BP drops to 90/60 mmHg. The nurse’s priority
action is:
a) Repeat nitroglycerin
b) Elevate legs and notify provider
c) Administer morphine
d) Ignore the drop
Answer: b) Elevate legs and notify provider
Rationale: Hypotension contraindicates further nitroglycerin; treat with Trendelenburg and
fluid bolus.
6. Troponin I is 1.2 ng/mL. This confirms:
a) Unstable angina
b) Myocardial infarction
c) Pericarditis
d) Aortic dissection
Answer: b) Myocardial infarction
Rationale: Elevated troponin confirms myocardial necrosis.
7. Post-PCI, the patient develops ventricular tachycardia. The nurse’s first action
is:
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Check pulse
d) Give adenosine
Answer: c) Check pulse
Rationale: Determine if VT is with or without pulse; pulseless VT requires defibrillation.
8. The patient is prescribed metoprolol. The nurse monitors for:
a) Tachycardia
b) Bradycardia
