BSN 266 HESI EXAM PACKAGE | LATEST UPDATE 2026 | 200
PRACTICE QUESTIONS WITH VERIFIED ANSWERS & DETAILED
RATIONALES | 100% CORRECT | COMPLETE NURSING STUDY
RESOURCE
SECTION 1: MEDICAL‑SURGICAL NURSING — CARDIOVASCULAR SYSTEM (Questions 1–30)
Question 1
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which assessment finding
is most important for the nurse to report to the healthcare provider before administering the
medication?
A) Weight gain of 2 pounds in 24 hours
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 110/70 mm Hg
D) Urine output of 200 mL in the last 8 hours
Answer: B) Serum potassium level of 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium level of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and increases the risk of cardiac dysrhythmias, particularly
with digitalis therapy. The nurse should report this critical laboratory value before administering
furosemide to prevent further potassium loss. While weight gain and decreased urine output are
important, they are expected findings in heart failure and do not pose the same immediate safety risk.
Question 2
A client with acute myocardial infarction is receiving thrombolytic therapy with alteplase (tPA). Which
assessment finding requires immediate intervention?
A) Presence of petechiae on the chest
B) Blood pressure of 130/80 mm Hg
,C) Complaint of chest pain 3 on a 0–10 scale
D) Heart rate of 88 beats per minute
Answer: A) Presence of petechiae on the chest
Rationale: Petechiae indicate bleeding tendencies, a significant adverse effect of thrombolytic therapy.
Alteplase lyses clots and increases the risk of hemorrhage. New petechiae suggest thrombocytopenia or
active bleeding, requiring immediate discontinuation of tPA and notification of the healthcare provider.
The chest pain may indicate incomplete reperfusion but does not require immediate intervention
compared to potential hemorrhage.
Question 3
A client with hypertension is prescribed lisinopril (Prinivil, Zestril). The nurse should teach the client to
report which common adverse effect of this medication?
A) Dry, persistent cough
B) Constipation
C) Weight gain
D) Photosensitivity
Answer: A) Dry, persistent cough
Rationale: Lisinopril is an ACE inhibitor. A dry, nonproductive cough is a common adverse effect
occurring in 5–20% of clients due to accumulation of bradykinin. If the cough becomes bothersome, the
healthcare provider may switch the client to an angiotensin II receptor blocker (ARB). Weight gain,
constipation, and photosensitivity are not typical adverse effects of ACE inhibitors.
Question 4
,A client is admitted with infective endocarditis. Which assessment finding is characteristic of this
condition?
A) Splinter hemorrhages under the fingernails
B) Clubbing of the fingers
C) Peripheral edema
D) Jugular vein distention
Answer: A) Splinter hemorrhages under the fingernails
Rationale: Splinter hemorrhages are linear, red‑brown streaks under the nails caused by small emboli
from vegetation on heart valves. They are classic peripheral stigmata of infective endocarditis. Clubbing
is associated with chronic hypoxia, peripheral edema with heart failure, and jugular vein distention with
right‑sided heart failure—none are pathognomonic for endocarditis.
Question 5
A client with unstable angina is prescribed nitroglycerin sublingual. The nurse instructs the client to take
the medication:
A) Every 5 minutes for up to three doses for chest pain not relieved by rest
B) Every 10 minutes for up to six doses
C) Only when the pain becomes severe
D) Every 15 minutes as needed until pain subsides
Answer: A) Every 5 minutes for up to three doses for chest pain not relieved by rest
Rationale: The standard protocol for sublingual nitroglycerin is one tablet every 5 minutes for up to
three doses. If chest pain persists after three tablets, the client should activate emergency medical
services (call 911). This regimen is based on the medication's short duration of action and the need to
differentiate unstable angina from acute myocardial infarction.
, Question 6
A client with peripheral artery disease (PAD) reports intermittent claudication. Which nursing
intervention is most appropriate?
A) Encourage a structured walking program to improve collateral circulation
B) Instruct the client to elevate the legs above heart level when resting
C) Apply heat to the lower extremities to relieve pain
D) Limit fluid intake to prevent edema
Answer: A) Encourage a structured walking program to improve collateral circulation
Rationale: In PAD, a supervised walking program (walk until pain, rest until pain subsides, then resume
walking) stimulates development of collateral blood vessels, increases pain‑free walking distance, and
improves overall circulation. Elevating legs worsens symptoms because it decreases arterial flow. Heat
can increase oxygen demand and cause burns due to decreased sensation. Fluids should not be
restricted.
Question 7
A client with deep vein thrombosis (DVT) is receiving heparin infusion. Which laboratory value indicates
therapeutic anticoagulation?
A) aPTT of 60 seconds (control 30 seconds)
B) INR of 2.5
C) Platelet count of 150,000/mm³
D) PT of 12 seconds
Answer: A) aPTT of 60 seconds (control 30 seconds)
Rationale: For heparin therapy, the therapeutic goal is an aPTT 1.5–2.5 times the normal control value.
With a normal control of 30 seconds, an aPTT of 60 seconds is 2 times the control, indicating therapeutic
anticoagulation. INR is used to monitor warfarin (Coumadin), not heparin. Platelet count monitors for
PRACTICE QUESTIONS WITH VERIFIED ANSWERS & DETAILED
RATIONALES | 100% CORRECT | COMPLETE NURSING STUDY
RESOURCE
SECTION 1: MEDICAL‑SURGICAL NURSING — CARDIOVASCULAR SYSTEM (Questions 1–30)
Question 1
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which assessment finding
is most important for the nurse to report to the healthcare provider before administering the
medication?
A) Weight gain of 2 pounds in 24 hours
B) Serum potassium level of 3.2 mEq/L
C) Blood pressure of 110/70 mm Hg
D) Urine output of 200 mL in the last 8 hours
Answer: B) Serum potassium level of 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting. A potassium level of 3.2 mEq/L
is below the normal range (3.5–5.0 mEq/L) and increases the risk of cardiac dysrhythmias, particularly
with digitalis therapy. The nurse should report this critical laboratory value before administering
furosemide to prevent further potassium loss. While weight gain and decreased urine output are
important, they are expected findings in heart failure and do not pose the same immediate safety risk.
Question 2
A client with acute myocardial infarction is receiving thrombolytic therapy with alteplase (tPA). Which
assessment finding requires immediate intervention?
A) Presence of petechiae on the chest
B) Blood pressure of 130/80 mm Hg
,C) Complaint of chest pain 3 on a 0–10 scale
D) Heart rate of 88 beats per minute
Answer: A) Presence of petechiae on the chest
Rationale: Petechiae indicate bleeding tendencies, a significant adverse effect of thrombolytic therapy.
Alteplase lyses clots and increases the risk of hemorrhage. New petechiae suggest thrombocytopenia or
active bleeding, requiring immediate discontinuation of tPA and notification of the healthcare provider.
The chest pain may indicate incomplete reperfusion but does not require immediate intervention
compared to potential hemorrhage.
Question 3
A client with hypertension is prescribed lisinopril (Prinivil, Zestril). The nurse should teach the client to
report which common adverse effect of this medication?
A) Dry, persistent cough
B) Constipation
C) Weight gain
D) Photosensitivity
Answer: A) Dry, persistent cough
Rationale: Lisinopril is an ACE inhibitor. A dry, nonproductive cough is a common adverse effect
occurring in 5–20% of clients due to accumulation of bradykinin. If the cough becomes bothersome, the
healthcare provider may switch the client to an angiotensin II receptor blocker (ARB). Weight gain,
constipation, and photosensitivity are not typical adverse effects of ACE inhibitors.
Question 4
,A client is admitted with infective endocarditis. Which assessment finding is characteristic of this
condition?
A) Splinter hemorrhages under the fingernails
B) Clubbing of the fingers
C) Peripheral edema
D) Jugular vein distention
Answer: A) Splinter hemorrhages under the fingernails
Rationale: Splinter hemorrhages are linear, red‑brown streaks under the nails caused by small emboli
from vegetation on heart valves. They are classic peripheral stigmata of infective endocarditis. Clubbing
is associated with chronic hypoxia, peripheral edema with heart failure, and jugular vein distention with
right‑sided heart failure—none are pathognomonic for endocarditis.
Question 5
A client with unstable angina is prescribed nitroglycerin sublingual. The nurse instructs the client to take
the medication:
A) Every 5 minutes for up to three doses for chest pain not relieved by rest
B) Every 10 minutes for up to six doses
C) Only when the pain becomes severe
D) Every 15 minutes as needed until pain subsides
Answer: A) Every 5 minutes for up to three doses for chest pain not relieved by rest
Rationale: The standard protocol for sublingual nitroglycerin is one tablet every 5 minutes for up to
three doses. If chest pain persists after three tablets, the client should activate emergency medical
services (call 911). This regimen is based on the medication's short duration of action and the need to
differentiate unstable angina from acute myocardial infarction.
, Question 6
A client with peripheral artery disease (PAD) reports intermittent claudication. Which nursing
intervention is most appropriate?
A) Encourage a structured walking program to improve collateral circulation
B) Instruct the client to elevate the legs above heart level when resting
C) Apply heat to the lower extremities to relieve pain
D) Limit fluid intake to prevent edema
Answer: A) Encourage a structured walking program to improve collateral circulation
Rationale: In PAD, a supervised walking program (walk until pain, rest until pain subsides, then resume
walking) stimulates development of collateral blood vessels, increases pain‑free walking distance, and
improves overall circulation. Elevating legs worsens symptoms because it decreases arterial flow. Heat
can increase oxygen demand and cause burns due to decreased sensation. Fluids should not be
restricted.
Question 7
A client with deep vein thrombosis (DVT) is receiving heparin infusion. Which laboratory value indicates
therapeutic anticoagulation?
A) aPTT of 60 seconds (control 30 seconds)
B) INR of 2.5
C) Platelet count of 150,000/mm³
D) PT of 12 seconds
Answer: A) aPTT of 60 seconds (control 30 seconds)
Rationale: For heparin therapy, the therapeutic goal is an aPTT 1.5–2.5 times the normal control value.
With a normal control of 30 seconds, an aPTT of 60 seconds is 2 times the control, indicating therapeutic
anticoagulation. INR is used to monitor warfarin (Coumadin), not heparin. Platelet count monitors for
