1
BSN HESI 266 Med Surg Exam Nightingale College
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A patient with heart failure presents with dyspnea, orthopnea, and bilateral crackles. During
auscultation, the nurse hears an extra heart sound immediately following the S2 sound. This
sound is best described as:
A. Pericardial friction rub
B. S3 gallop
C. Murmur
D. S4 heart sound
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) is an early diastolic heart sound caused by rapid
ventricular filling creating a vibration in the ventricular wall. It is a classic sign of heart failure
(specifically HFrEF or volume overload) and is not heard in healthy adults. A pericardial rub (A)
is a grating sound heard in pericarditis. A murmur (C) is caused by turbulent blood flow. An S4
(D) occurs late in diastole (atrial gallop) and is associated with decreased ventricular compliance
(e.g., hypertension).
Q2: The nurse is providing discharge teaching to a patient with heart failure. Which statement by
the patient indicates an understanding of the self-management plan?
A. "I will weigh myself once a week and call the doctor if I gain 5 pounds."
B. "I can continue to use salt substitutes liberally to flavor my food."
C. "I will weigh myself every morning and report a weight gain of 2-3 pounds in a day or 5
pounds in a week."
D. "I will stop taking my diuretic if I feel dizzy."
,2
Correct Answer: C
Rationale: Daily weights are crucial for monitoring fluid retention in heart failure patients. A
gain of 2-3 lbs in a day or 5 lbs in a week indicates fluid accumulation and requires medical
intervention. Weighing once a week (A) is too infrequent to catch rapid fluid shifts. Salt
substitutes (B) are often high in potassium and can be dangerous for patients on ACE inhibitors
or those with renal issues. Stopping diuretics (D) without medical advice can lead to acute
decompensation.
Q3: A patient is admitted with an Acute Myocardial Infarction (STEMI). The nurse administers
aspirin 324 mg chewable. What is the primary mechanism of action of aspirin in this scenario?
A. Analgesia for chest pain
B. Antiplatelet effect to inhibit platelet aggregation
C. Anticoagulant effect to dissolve the clot
D. Vasodilation to improve coronary blood flow
Correct Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of
thromboxane A2, which is a potent mediator of platelet aggregation. This helps prevent further
growth of the coronary thrombus. While it may help with pain (A), that is not the primary goal in
MI. It does not dissolve clots (C)—fibrinolytics/PCI do that. It does not cause significant
vasodilation (D).
Q4: Which cardiac biomarker is the most specific for myocardial infarction and remains elevated
for 7 to 10 days?
A. Myoglobin
B. CK-MB
C. Troponin I or T
D. C-Reactive Protein
Correct Answer: C
,3
Rationale: Troponin I and T are regulatory proteins found in cardiac muscle that are highly
specific for myocardial injury. They rise within 3-4 hours of injury, peak at 12-24 hours, and
remain elevated for up to 7-10 days, allowing for late diagnosis. Myoglobin (A) rises early but is
not specific to the heart. CK-MB (B) is specific but returns to normal in 2-3 days. CRP (D) is a
marker of inflammation.
Q5: A patient diagnosed with unstable angina is prescribed nitroglycerin sublingual. The nurse
teaches the patient to take the medication at the first sign of chest pain. Which instruction is
essential?
A. "Take the pill with a full glass of water."
B. "If pain is not relieved after taking one pill, call 911 immediately."
C. "You may take up to 5 tablets 5 minutes apart."
D. "Store the tablets in the bathroom medicine cabinet."
Correct Answer: B
Rationale: Unstable angina is a medical emergency. The patient should take one dose; if pain is
not relieved after 5 minutes, they should call 911 immediately (as unstable angina indicates a
high risk of MI). They may take a total of 3 doses (5 minutes apart) while waiting for EMS, but
waiting for 5 tablets (C) is incorrect and dangerous. Water (A) is not needed for sublingual
absorption. Nitroglycerin should be stored in a cool, dry place, not the bathroom (D) due to
humidity/moisture degrading the tablets.
Q6: A patient with heart failure is started on Lisinopril, an ACE inhibitor. The nurse monitors the
patient for which common adverse effect of this medication?
A. Hyperkalemia and dry cough
B. Hypokalemia and tinnitus
C. Hypoglycemia and constipation
D. Thrombocytopenia and rash
Correct Answer: A
, 4
Rationale: ACE inhibitors inhibit the conversion of angiotensin I to II and prevent the breakdown
of bradykinin, leading to a dry cough in up to 20% of patients. They also reduce aldosterone
secretion, which can lead to potassium retention (hyperkalemia). Hypokalemia (B) is associated
with diuretics. Hypoglycemia (C) is not typical.
Q7: The nurse is caring for a patient receiving Digoxin (Lanoxin) for heart failure. Which
assessment finding would indicate toxicity?
A. Heart rate of 68 bpm
B. Blood pressure of 110/70 mmHg
C. Nausea, vomiting, and visual disturbances (yellow halos)
D. Urine output of 50 mL/hr
Correct Answer: C
Rationale: Early signs of digoxin toxicity include anorexia, nausea, vomiting, and fatigue. Visual
changes such as yellow/green halos are classic. Bradycardia and new arrhythmias are also critical
signs. A heart rate of 68 bpm (A) is acceptable (target is usually >60). BP and urine output (B, D)
are normal.
Q8: A patient with Stage 2 Hypertension (BP 150/96 mmHg) who is African American is
initiated on antihypertensive therapy. According to guidelines, which class of medication is often
effective as first-line therapy for this demographic?
A. ACE Inhibitor
B. Beta-blocker
C. Calcium Channel Blocker (CCB) or Thiazide Diuretic
D. ARB
Correct Answer: C
Rationale: Clinical guidelines (e.g., JNC 8/ACC/AHA) suggest that African American patients
respond better to Calcium Channel Blockers (like amlodipine) and Thiazide Diuretics (like
HCTZ) as first-line therapy compared to ACE inhibitors or ARBs, which are more effective in
white populations. Beta-blockers are not typically first-line for uncomplicated hypertension.
BSN HESI 266 Med Surg Exam Nightingale College
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A patient with heart failure presents with dyspnea, orthopnea, and bilateral crackles. During
auscultation, the nurse hears an extra heart sound immediately following the S2 sound. This
sound is best described as:
A. Pericardial friction rub
B. S3 gallop
C. Murmur
D. S4 heart sound
Correct Answer: B
Rationale: An S3 gallop (ventricular gallop) is an early diastolic heart sound caused by rapid
ventricular filling creating a vibration in the ventricular wall. It is a classic sign of heart failure
(specifically HFrEF or volume overload) and is not heard in healthy adults. A pericardial rub (A)
is a grating sound heard in pericarditis. A murmur (C) is caused by turbulent blood flow. An S4
(D) occurs late in diastole (atrial gallop) and is associated with decreased ventricular compliance
(e.g., hypertension).
Q2: The nurse is providing discharge teaching to a patient with heart failure. Which statement by
the patient indicates an understanding of the self-management plan?
A. "I will weigh myself once a week and call the doctor if I gain 5 pounds."
B. "I can continue to use salt substitutes liberally to flavor my food."
C. "I will weigh myself every morning and report a weight gain of 2-3 pounds in a day or 5
pounds in a week."
D. "I will stop taking my diuretic if I feel dizzy."
,2
Correct Answer: C
Rationale: Daily weights are crucial for monitoring fluid retention in heart failure patients. A
gain of 2-3 lbs in a day or 5 lbs in a week indicates fluid accumulation and requires medical
intervention. Weighing once a week (A) is too infrequent to catch rapid fluid shifts. Salt
substitutes (B) are often high in potassium and can be dangerous for patients on ACE inhibitors
or those with renal issues. Stopping diuretics (D) without medical advice can lead to acute
decompensation.
Q3: A patient is admitted with an Acute Myocardial Infarction (STEMI). The nurse administers
aspirin 324 mg chewable. What is the primary mechanism of action of aspirin in this scenario?
A. Analgesia for chest pain
B. Antiplatelet effect to inhibit platelet aggregation
C. Anticoagulant effect to dissolve the clot
D. Vasodilation to improve coronary blood flow
Correct Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), preventing the formation of
thromboxane A2, which is a potent mediator of platelet aggregation. This helps prevent further
growth of the coronary thrombus. While it may help with pain (A), that is not the primary goal in
MI. It does not dissolve clots (C)—fibrinolytics/PCI do that. It does not cause significant
vasodilation (D).
Q4: Which cardiac biomarker is the most specific for myocardial infarction and remains elevated
for 7 to 10 days?
A. Myoglobin
B. CK-MB
C. Troponin I or T
D. C-Reactive Protein
Correct Answer: C
,3
Rationale: Troponin I and T are regulatory proteins found in cardiac muscle that are highly
specific for myocardial injury. They rise within 3-4 hours of injury, peak at 12-24 hours, and
remain elevated for up to 7-10 days, allowing for late diagnosis. Myoglobin (A) rises early but is
not specific to the heart. CK-MB (B) is specific but returns to normal in 2-3 days. CRP (D) is a
marker of inflammation.
Q5: A patient diagnosed with unstable angina is prescribed nitroglycerin sublingual. The nurse
teaches the patient to take the medication at the first sign of chest pain. Which instruction is
essential?
A. "Take the pill with a full glass of water."
B. "If pain is not relieved after taking one pill, call 911 immediately."
C. "You may take up to 5 tablets 5 minutes apart."
D. "Store the tablets in the bathroom medicine cabinet."
Correct Answer: B
Rationale: Unstable angina is a medical emergency. The patient should take one dose; if pain is
not relieved after 5 minutes, they should call 911 immediately (as unstable angina indicates a
high risk of MI). They may take a total of 3 doses (5 minutes apart) while waiting for EMS, but
waiting for 5 tablets (C) is incorrect and dangerous. Water (A) is not needed for sublingual
absorption. Nitroglycerin should be stored in a cool, dry place, not the bathroom (D) due to
humidity/moisture degrading the tablets.
Q6: A patient with heart failure is started on Lisinopril, an ACE inhibitor. The nurse monitors the
patient for which common adverse effect of this medication?
A. Hyperkalemia and dry cough
B. Hypokalemia and tinnitus
C. Hypoglycemia and constipation
D. Thrombocytopenia and rash
Correct Answer: A
, 4
Rationale: ACE inhibitors inhibit the conversion of angiotensin I to II and prevent the breakdown
of bradykinin, leading to a dry cough in up to 20% of patients. They also reduce aldosterone
secretion, which can lead to potassium retention (hyperkalemia). Hypokalemia (B) is associated
with diuretics. Hypoglycemia (C) is not typical.
Q7: The nurse is caring for a patient receiving Digoxin (Lanoxin) for heart failure. Which
assessment finding would indicate toxicity?
A. Heart rate of 68 bpm
B. Blood pressure of 110/70 mmHg
C. Nausea, vomiting, and visual disturbances (yellow halos)
D. Urine output of 50 mL/hr
Correct Answer: C
Rationale: Early signs of digoxin toxicity include anorexia, nausea, vomiting, and fatigue. Visual
changes such as yellow/green halos are classic. Bradycardia and new arrhythmias are also critical
signs. A heart rate of 68 bpm (A) is acceptable (target is usually >60). BP and urine output (B, D)
are normal.
Q8: A patient with Stage 2 Hypertension (BP 150/96 mmHg) who is African American is
initiated on antihypertensive therapy. According to guidelines, which class of medication is often
effective as first-line therapy for this demographic?
A. ACE Inhibitor
B. Beta-blocker
C. Calcium Channel Blocker (CCB) or Thiazide Diuretic
D. ARB
Correct Answer: C
Rationale: Clinical guidelines (e.g., JNC 8/ACC/AHA) suggest that African American patients
respond better to Calcium Channel Blockers (like amlodipine) and Thiazide Diuretics (like
HCTZ) as first-line therapy compared to ACE inhibitors or ARBs, which are more effective in
white populations. Beta-blockers are not typically first-line for uncomplicated hypertension.
