BSN 266 HESI Med Surg Test Bank | 400+ Questions &
Answers | NGN-Style Case Scenarios
Medical-Surgical Nursing (HESI & NGN Focus) | Key Domains: Complex Multisystem Disorders,
Advanced Cardiac & Respiratory Care, Neurological & Sensory Emergencies, Renal & Endocrine
Management, Oncology & Immunologic Disorders, Perioperative & Trauma Care, and Gerontological
Considerations | Expert-Aligned Structure | Comprehensive NGN Test Bank Format
Introduction
This structured BSN 266 HESI Medical-Surgical Test Bank for 2026/2027 provides an extensive
collection of 400+ questions, including Next Generation NCLEX-style case scenarios, with correct
answers and rationales. It is designed to prepare students for the complexity of the HESI Med Surg
exit exam and the NGN by emphasizing clinical judgment, prioritization in multi-patient scenarios,
and management of intricate, unfolding patient cases.
Test Bank Structure:
• Comprehensive Test Bank: (400+ QUESTIONS & SCENARIOS)
Answer Format
All correct answers and selected actions within NGN scenarios must appear in bold and cyan blue,
accompanied by concise rationales explaining the clinical judgment process (e.g., "Recognize Cues"
of sepsis in an elderly post-op patient), the pathophysiological link between disorders, the priority
intervention for a deteriorating patient, and why alternative options or unselected actions represent
flawed reasoning or unsafe practice in a medical-surgical context.
1. (Unfolding Case – Part 1) A 78-year-old male is 2 days post-op from hip replacement. Vital
signs: T 101.8°F, HR 118 bpm, RR 24/min, BP 88/50 mm Hg, SpO₂ 90% on room air. What is
the nurse’s priority action? (Select one.)
A. Administer acetaminophen for fever
B. Apply oxygen via nasal cannula
C. Notify the provider immediately
D. Increase IV fluid rate
,C. Notify the provider immediately
This client shows signs of sepsis (fever, tachycardia, tachypnea, hypotension, hypoxia) — a
life-threatening emergency. According to the Surviving Sepsis Campaign, the priority is rapid provider
notification for blood cultures, antibiotics, and fluid resuscitation within the "golden hour." Oxygen (B)
and fluids (D) are important but follow immediate escalation.
1. (Unfolding Case – Part 2) The client’s lactate is 4.5 mmol/L and WBC is 18,000/µL. The
provider orders blood cultures, broad-spectrum antibiotics, and 30 mL/kg IV fluids. Which
action should the nurse take first? (Select one.)
A. Draw blood cultures
B. Administer antibiotics
C. Start IV fluid bolus
D. Reassess vital signs
A. Draw blood cultures
Blood cultures must be obtained before antibiotics to ensure accurate identification of the pathogen.
Fluid resuscitation (C) is simultaneous but cultures are time-critical. Antibiotics (B) follow cultures.
Reassessment (D) is ongoing but not first.
1. (Unfolding Case – Part 3) After 2 hours of treatment, the client’s BP is 92/58 mm Hg, HR
100 bpm, and urine output is 10 mL/hr. What is the priority concern? (Select one.)
A. Persistent hypotension
B. Inadequate urine output
C. Tachycardia
D. Continued fever
B. Inadequate urine output
,Urine output <30 mL/hr in an adult indicates acute kidney injury (AKI) and ongoing hypoperfusion —
a sign that sepsis resuscitation is incomplete. While hypotension (A) and tachycardia (C) are
improving, oliguria requires immediate intervention (e.g., more fluids, vasopressors).
2. (Bowtie Item) A client with heart failure has crackles in lung bases, +3 pitting edema, and
dyspnea at rest. What is the priority action? (Select one best intervention.)
Left: Assessment findings → Right: Priority intervention
A. Administer furosemide IV
B. Elevate the head of the bed to High Fowler’s
C. Apply oxygen via nasal cannula
D. Notify the provider
B. Elevate the head of the bed to High Fowler’s
This action immediately improves oxygenation by reducing venous return and easing breathing —
addressing the ABCs (Airway/Breathing) in acute pulmonary edema. Oxygen (C) and diuretics (A)
follow. Notification (D) is important but not the first action.
3. (Matrix/Grid Item) A nurse is assessing four clients. Which findings require immediate
intervention? (Check all that apply.)
A. Client post-stroke: right-sided facial droop
B. Client with brain tumor: new-onset seizure
C. Client post-craniotomy: PERRLA
D. Client with meningitis: nuchal rigidity and photophobia
E. Client with migraine: visual aura
B, D
, B: New seizure in a brain tumor patient may indicate increased intracranial pressure or tumor
progression — requires urgent evaluation.
D: Nuchal rigidity and photophobia are signs of meningeal irritation — meningitis is a medical
emergency.
Facial droop (A) is an expected stroke deficit. PERRLA (C) is normal post-op. Aura (E) is a common
migraine prodrome.
4. (Extended Multiple Response) A client receiving cisplatin reports fatigue, nausea, and
decreased urine output. Which actions are priority? (Select all that apply.)
A. Monitor serum creatinine and BUN
B. Administer antiemetics as prescribed
C. Encourage high-protein diet
D. Assess for hearing loss
E. Restrict oral fluids
A, B, D
A: Cisplatin is nephrotoxic — monitor renal function.
B: Cisplatin causes severe nausea — antiemetics are essential.
D: Cisplatin is ototoxic — assess hearing.
Protein (C) is not a priority; fluids (E) should be encouraged to reduce nephrotoxicity.
5. (Prioritization Item) The nurse receives report on four trauma clients. Which should be
assessed first? (Select one.)
A. Client with fractured femur, stable vitals
B. Client with head injury, GCS 13, vomiting
C. Client with abdominal trauma, BP 90/60 mm Hg
Answers | NGN-Style Case Scenarios
Medical-Surgical Nursing (HESI & NGN Focus) | Key Domains: Complex Multisystem Disorders,
Advanced Cardiac & Respiratory Care, Neurological & Sensory Emergencies, Renal & Endocrine
Management, Oncology & Immunologic Disorders, Perioperative & Trauma Care, and Gerontological
Considerations | Expert-Aligned Structure | Comprehensive NGN Test Bank Format
Introduction
This structured BSN 266 HESI Medical-Surgical Test Bank for 2026/2027 provides an extensive
collection of 400+ questions, including Next Generation NCLEX-style case scenarios, with correct
answers and rationales. It is designed to prepare students for the complexity of the HESI Med Surg
exit exam and the NGN by emphasizing clinical judgment, prioritization in multi-patient scenarios,
and management of intricate, unfolding patient cases.
Test Bank Structure:
• Comprehensive Test Bank: (400+ QUESTIONS & SCENARIOS)
Answer Format
All correct answers and selected actions within NGN scenarios must appear in bold and cyan blue,
accompanied by concise rationales explaining the clinical judgment process (e.g., "Recognize Cues"
of sepsis in an elderly post-op patient), the pathophysiological link between disorders, the priority
intervention for a deteriorating patient, and why alternative options or unselected actions represent
flawed reasoning or unsafe practice in a medical-surgical context.
1. (Unfolding Case – Part 1) A 78-year-old male is 2 days post-op from hip replacement. Vital
signs: T 101.8°F, HR 118 bpm, RR 24/min, BP 88/50 mm Hg, SpO₂ 90% on room air. What is
the nurse’s priority action? (Select one.)
A. Administer acetaminophen for fever
B. Apply oxygen via nasal cannula
C. Notify the provider immediately
D. Increase IV fluid rate
,C. Notify the provider immediately
This client shows signs of sepsis (fever, tachycardia, tachypnea, hypotension, hypoxia) — a
life-threatening emergency. According to the Surviving Sepsis Campaign, the priority is rapid provider
notification for blood cultures, antibiotics, and fluid resuscitation within the "golden hour." Oxygen (B)
and fluids (D) are important but follow immediate escalation.
1. (Unfolding Case – Part 2) The client’s lactate is 4.5 mmol/L and WBC is 18,000/µL. The
provider orders blood cultures, broad-spectrum antibiotics, and 30 mL/kg IV fluids. Which
action should the nurse take first? (Select one.)
A. Draw blood cultures
B. Administer antibiotics
C. Start IV fluid bolus
D. Reassess vital signs
A. Draw blood cultures
Blood cultures must be obtained before antibiotics to ensure accurate identification of the pathogen.
Fluid resuscitation (C) is simultaneous but cultures are time-critical. Antibiotics (B) follow cultures.
Reassessment (D) is ongoing but not first.
1. (Unfolding Case – Part 3) After 2 hours of treatment, the client’s BP is 92/58 mm Hg, HR
100 bpm, and urine output is 10 mL/hr. What is the priority concern? (Select one.)
A. Persistent hypotension
B. Inadequate urine output
C. Tachycardia
D. Continued fever
B. Inadequate urine output
,Urine output <30 mL/hr in an adult indicates acute kidney injury (AKI) and ongoing hypoperfusion —
a sign that sepsis resuscitation is incomplete. While hypotension (A) and tachycardia (C) are
improving, oliguria requires immediate intervention (e.g., more fluids, vasopressors).
2. (Bowtie Item) A client with heart failure has crackles in lung bases, +3 pitting edema, and
dyspnea at rest. What is the priority action? (Select one best intervention.)
Left: Assessment findings → Right: Priority intervention
A. Administer furosemide IV
B. Elevate the head of the bed to High Fowler’s
C. Apply oxygen via nasal cannula
D. Notify the provider
B. Elevate the head of the bed to High Fowler’s
This action immediately improves oxygenation by reducing venous return and easing breathing —
addressing the ABCs (Airway/Breathing) in acute pulmonary edema. Oxygen (C) and diuretics (A)
follow. Notification (D) is important but not the first action.
3. (Matrix/Grid Item) A nurse is assessing four clients. Which findings require immediate
intervention? (Check all that apply.)
A. Client post-stroke: right-sided facial droop
B. Client with brain tumor: new-onset seizure
C. Client post-craniotomy: PERRLA
D. Client with meningitis: nuchal rigidity and photophobia
E. Client with migraine: visual aura
B, D
, B: New seizure in a brain tumor patient may indicate increased intracranial pressure or tumor
progression — requires urgent evaluation.
D: Nuchal rigidity and photophobia are signs of meningeal irritation — meningitis is a medical
emergency.
Facial droop (A) is an expected stroke deficit. PERRLA (C) is normal post-op. Aura (E) is a common
migraine prodrome.
4. (Extended Multiple Response) A client receiving cisplatin reports fatigue, nausea, and
decreased urine output. Which actions are priority? (Select all that apply.)
A. Monitor serum creatinine and BUN
B. Administer antiemetics as prescribed
C. Encourage high-protein diet
D. Assess for hearing loss
E. Restrict oral fluids
A, B, D
A: Cisplatin is nephrotoxic — monitor renal function.
B: Cisplatin causes severe nausea — antiemetics are essential.
D: Cisplatin is ototoxic — assess hearing.
Protein (C) is not a priority; fluids (E) should be encouraged to reduce nephrotoxicity.
5. (Prioritization Item) The nurse receives report on four trauma clients. Which should be
assessed first? (Select one.)
A. Client with fractured femur, stable vitals
B. Client with head injury, GCS 13, vomiting
C. Client with abdominal trauma, BP 90/60 mm Hg
