1
BSN HESI 266 Med Surg Exam 2026/2027 Actual
Exam - Complete Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A client admitted with acute decompensated heart failure has bilateral crackles, dyspnea at
rest, and 3+ pitting edema in the lower extremities. Which intervention should the nurse
implement first?
A. Administer intravenous furosemide as prescribed.
B. Obtain a 12-lead electrocardiogram (ECG).
C. Elevate the lower extremities on pillows.
D. Assess the client's oxygen saturation.
Correct Answer: D
Rationale: The ABC (Airway, Breathing, Circulation) framework prioritizes assessing
oxygenation and respiratory status in a client with acute dyspnea and pulmonary edema before
implementing interventions or diagnostic tests. While furosemide (A), elevating legs (C), and an
ECG (B) are important, they follow the immediate need to evaluate the severity of hypoxemia.
Q2: A client is being discharged following a myocardial infarction (MI). Which statement by the
client indicates a need for further teaching regarding lifestyle modifications?
A. "I will take my prescribed nitroglycerin sublingually if I experience chest pain."
B. "I will walk for 15 minutes a day initially and gradually increase my exercise."
C. "I can continue to smoke as long as I reduce it to only five cigarettes a day."
D. "I will eat a diet low in saturated fats and high in fiber."
Correct Answer: C
Rationale: Smoking is a major modifiable risk factor for coronary artery disease and must be
stopped completely to prevent reinfarction; reducing the amount does not eliminate the risk.
Options A, B, and D demonstrate correct understanding of angina management, cardiac
rehabilitation, and dietary modifications post-MI.
,2
Q3: A client with hypertension is prescribed lisinopril, an ACE inhibitor. Which instruction
should the nurse include in the discharge teaching?
A. Avoid potassium-rich foods and salt substitutes.
B. Expect a persistent dry cough and do not report it unless it causes vomiting.
C. Rise slowly from a sitting or lying position.
D. Take the medication at bedtime to prevent daytime dizziness.
Correct Answer: C
Rationale: ACE inhibitors commonly cause orthostatic hypotension, so clients should be
instructed to change positions slowly to prevent dizziness and falls. ACE inhibitors actually
cause potassium retention, making salt substitutes (which contain potassium) dangerous (A); a
dry cough is a side effect that should be reported as it may require a medication change (B); and
taking it at bedtime is not specifically required and may complicate managing nocturnal
hypotension (D).
Q4: A client with atrial fibrillation is prescribed warfarin. The nurse reviews the client's medical
record and notes a new prescription for amiodarone. Which action is most appropriate for the
nurse to take?
A. Administer the medications as prescribed and monitor for bleeding.
B. Contact the provider to discuss the increased risk of bleeding.
C. Hold the warfarin and administer the amiodarone only.
D. Instruct the client to increase their intake of green leafy vegetables.
Correct Answer: B
Rationale: Amiodarone inhibits the cytochrome P450 enzymes responsible for warfarin
metabolism, significantly increasing warfarin levels and the risk of severe bleeding. The nurse
must contact the provider to anticipate a necessary reduction in the warfarin dose and closer INR
monitoring. Administering as prescribed without questioning (A) is unsafe, holding warfarin
entirely (C) increases clot risk, and increasing vitamin K intake (D) further disrupts INR
management.
Q5: A client with mitral stenosis presents with new symptoms of atrial fibrillation. The nurse
understands that the primary pathophysiological reason for this dysrhythmia in this client is:
,3
A. Increased preload stretching the right atrium.
B. Left atrial dilation and hypertrophy due to chronic pressure overload.
C. Right ventricular failure causing backup pressure into the atrium.
D. Decreased cardiac output stimulating the sympathetic nervous system.
Correct Answer: B
Rationale: Mitral stenosis impedes blood flow from the left atrium to the left ventricle, causing
pressure to build up in the left atrium. This chronic pressure overload leads to left atrial dilation
and hypertrophy, which irritates the cardiac conduction system and frequently triggers atrial
fibrillation. Right-sided issues (A, C) are not the primary drivers in isolated mitral stenosis, and
while sympathetic stimulation (D) can occur, it is not the structural cause of the atrial fibrillation.
Q6: The nurse is assessing a client with chronic heart failure. Which finding is an early sign of
fluid volume excess that the nurse should report?
A. 3+ pitting edema in the lower extremities.
B. Weight gain of 2 kg (4.4 lbs) over two days.
C. Paroxysmal nocturnal dyspnea.
D. Bilateral crackles in the lung bases.
Correct Answer: B
Rationale: Daily weight measurement is the most sensitive, early indicator of fluid retention in
heart failure; a weight gain of more than 1 to 2 kg in a short period indicates fluid retention
before visible edema or pulmonary symptoms manifest. Edema (A), PND (C), and crackles (D)
are later signs of significant fluid overload.
Q7: A client is admitted with a suspected aortic dissection. Which assessment finding is most
critical for the nurse to report immediately to the healthcare provider?
A. Intercostal space retraction.
B. Unequal radial pulses and blood pressure between arms.
C. A harsh systolic murmur at the left sternal border.
D. Jugular venous distention (JVD).
Correct Answer: B
, 4
Rationale: Unequal pulses or blood pressure between arms is a classic, highly critical sign of an
aortic dissection, indicating that the dissection is occluding or compromising the subclavian
artery. This requires immediate surgical intervention. Intercostal retractions (A) suggest
respiratory distress, a murmur (C) could indicate valvular issues, and JVD (D) suggests right-
sided heart failure, but none are as specifically diagnostic or time-critical for aortic dissection as
unequal pulses.
Q8: A client with peripheral arterial disease (PAD) complains of leg pain when walking, which is
relieved by resting. How should the nurse document this finding?
A. Lymphedema.
B. Chronic venous insufficiency.
C. Intermittent claudication.
D. Deep vein thrombosis.
Correct Answer: C
Rationale: Intermittent claudication is the classic hallmark of PAD, characterized by ischemic
muscle pain in the extremities that occurs during activity (due to increased oxygen demand) and
is relieved by rest. Lymphedema (A) is swelling, venous insufficiency (B) causes aching that is
relieved by elevation, and DVT (D) causes acute pain and swelling unrelated to walking.
Q9: A client with heart failure is receiving intravenous heparin. The nurse notes that the client's
activated partial thromboplastin time (aPTT) is 90 seconds (control 30 seconds). What is the
nurse's priority action?
A. Administer protamine sulfate intravenously.
B. Stop the heparin infusion immediately.
C. Reduce the heparin infusion rate by half.
D. Document the finding and reassess in 4 hours.
Correct Answer: B
Rationale: The therapeutic aPTT for heparin therapy is typically 1.5 to 2.5 times the control
value (45-75 seconds). An aPTT of 90 seconds indicates the client is severely anticoagulated and
at high risk for spontaneous bleeding. The first priority is to stop the infusion to prevent further
risk; protamine sulfate (A) may be needed if there is active bleeding, but stopping the infusion is
the immediate first step. Reducing the rate (C) or waiting 4 hours (D) are unsafe.
BSN HESI 266 Med Surg Exam 2026/2027 Actual
Exam - Complete Questions with Detailed
Rationales | 100% Verified Graded A+ Pass
Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A client admitted with acute decompensated heart failure has bilateral crackles, dyspnea at
rest, and 3+ pitting edema in the lower extremities. Which intervention should the nurse
implement first?
A. Administer intravenous furosemide as prescribed.
B. Obtain a 12-lead electrocardiogram (ECG).
C. Elevate the lower extremities on pillows.
D. Assess the client's oxygen saturation.
Correct Answer: D
Rationale: The ABC (Airway, Breathing, Circulation) framework prioritizes assessing
oxygenation and respiratory status in a client with acute dyspnea and pulmonary edema before
implementing interventions or diagnostic tests. While furosemide (A), elevating legs (C), and an
ECG (B) are important, they follow the immediate need to evaluate the severity of hypoxemia.
Q2: A client is being discharged following a myocardial infarction (MI). Which statement by the
client indicates a need for further teaching regarding lifestyle modifications?
A. "I will take my prescribed nitroglycerin sublingually if I experience chest pain."
B. "I will walk for 15 minutes a day initially and gradually increase my exercise."
C. "I can continue to smoke as long as I reduce it to only five cigarettes a day."
D. "I will eat a diet low in saturated fats and high in fiber."
Correct Answer: C
Rationale: Smoking is a major modifiable risk factor for coronary artery disease and must be
stopped completely to prevent reinfarction; reducing the amount does not eliminate the risk.
Options A, B, and D demonstrate correct understanding of angina management, cardiac
rehabilitation, and dietary modifications post-MI.
,2
Q3: A client with hypertension is prescribed lisinopril, an ACE inhibitor. Which instruction
should the nurse include in the discharge teaching?
A. Avoid potassium-rich foods and salt substitutes.
B. Expect a persistent dry cough and do not report it unless it causes vomiting.
C. Rise slowly from a sitting or lying position.
D. Take the medication at bedtime to prevent daytime dizziness.
Correct Answer: C
Rationale: ACE inhibitors commonly cause orthostatic hypotension, so clients should be
instructed to change positions slowly to prevent dizziness and falls. ACE inhibitors actually
cause potassium retention, making salt substitutes (which contain potassium) dangerous (A); a
dry cough is a side effect that should be reported as it may require a medication change (B); and
taking it at bedtime is not specifically required and may complicate managing nocturnal
hypotension (D).
Q4: A client with atrial fibrillation is prescribed warfarin. The nurse reviews the client's medical
record and notes a new prescription for amiodarone. Which action is most appropriate for the
nurse to take?
A. Administer the medications as prescribed and monitor for bleeding.
B. Contact the provider to discuss the increased risk of bleeding.
C. Hold the warfarin and administer the amiodarone only.
D. Instruct the client to increase their intake of green leafy vegetables.
Correct Answer: B
Rationale: Amiodarone inhibits the cytochrome P450 enzymes responsible for warfarin
metabolism, significantly increasing warfarin levels and the risk of severe bleeding. The nurse
must contact the provider to anticipate a necessary reduction in the warfarin dose and closer INR
monitoring. Administering as prescribed without questioning (A) is unsafe, holding warfarin
entirely (C) increases clot risk, and increasing vitamin K intake (D) further disrupts INR
management.
Q5: A client with mitral stenosis presents with new symptoms of atrial fibrillation. The nurse
understands that the primary pathophysiological reason for this dysrhythmia in this client is:
,3
A. Increased preload stretching the right atrium.
B. Left atrial dilation and hypertrophy due to chronic pressure overload.
C. Right ventricular failure causing backup pressure into the atrium.
D. Decreased cardiac output stimulating the sympathetic nervous system.
Correct Answer: B
Rationale: Mitral stenosis impedes blood flow from the left atrium to the left ventricle, causing
pressure to build up in the left atrium. This chronic pressure overload leads to left atrial dilation
and hypertrophy, which irritates the cardiac conduction system and frequently triggers atrial
fibrillation. Right-sided issues (A, C) are not the primary drivers in isolated mitral stenosis, and
while sympathetic stimulation (D) can occur, it is not the structural cause of the atrial fibrillation.
Q6: The nurse is assessing a client with chronic heart failure. Which finding is an early sign of
fluid volume excess that the nurse should report?
A. 3+ pitting edema in the lower extremities.
B. Weight gain of 2 kg (4.4 lbs) over two days.
C. Paroxysmal nocturnal dyspnea.
D. Bilateral crackles in the lung bases.
Correct Answer: B
Rationale: Daily weight measurement is the most sensitive, early indicator of fluid retention in
heart failure; a weight gain of more than 1 to 2 kg in a short period indicates fluid retention
before visible edema or pulmonary symptoms manifest. Edema (A), PND (C), and crackles (D)
are later signs of significant fluid overload.
Q7: A client is admitted with a suspected aortic dissection. Which assessment finding is most
critical for the nurse to report immediately to the healthcare provider?
A. Intercostal space retraction.
B. Unequal radial pulses and blood pressure between arms.
C. A harsh systolic murmur at the left sternal border.
D. Jugular venous distention (JVD).
Correct Answer: B
, 4
Rationale: Unequal pulses or blood pressure between arms is a classic, highly critical sign of an
aortic dissection, indicating that the dissection is occluding or compromising the subclavian
artery. This requires immediate surgical intervention. Intercostal retractions (A) suggest
respiratory distress, a murmur (C) could indicate valvular issues, and JVD (D) suggests right-
sided heart failure, but none are as specifically diagnostic or time-critical for aortic dissection as
unequal pulses.
Q8: A client with peripheral arterial disease (PAD) complains of leg pain when walking, which is
relieved by resting. How should the nurse document this finding?
A. Lymphedema.
B. Chronic venous insufficiency.
C. Intermittent claudication.
D. Deep vein thrombosis.
Correct Answer: C
Rationale: Intermittent claudication is the classic hallmark of PAD, characterized by ischemic
muscle pain in the extremities that occurs during activity (due to increased oxygen demand) and
is relieved by rest. Lymphedema (A) is swelling, venous insufficiency (B) causes aching that is
relieved by elevation, and DVT (D) causes acute pain and swelling unrelated to walking.
Q9: A client with heart failure is receiving intravenous heparin. The nurse notes that the client's
activated partial thromboplastin time (aPTT) is 90 seconds (control 30 seconds). What is the
nurse's priority action?
A. Administer protamine sulfate intravenously.
B. Stop the heparin infusion immediately.
C. Reduce the heparin infusion rate by half.
D. Document the finding and reassess in 4 hours.
Correct Answer: B
Rationale: The therapeutic aPTT for heparin therapy is typically 1.5 to 2.5 times the control
value (45-75 seconds). An aPTT of 90 seconds indicates the client is severely anticoagulated and
at high risk for spontaneous bleeding. The first priority is to stop the infusion to prevent further
risk; protamine sulfate (A) may be needed if there is active bleeding, but stopping the infusion is
the immediate first step. Reducing the rate (C) or waiting 4 hours (D) are unsafe.
