BSN HESI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 2026/2027 | Page 1 | Passing Score: 85%
BSN HESI 266 Med SurgNIGHTINGALE COLLEGE
Exam (Latest 2026/2027 Update) Questions and
Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027
MEDICAL-SURGICAL NURSING · Official Exam 2026/2027
100 85% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Cardiovascular & Hematologic Disorders Q1-Q20
Section 2 Respiratory & Thoracic Disorders Q21-Q39
Section 3 Gastrointestinal & Hepatic Disorders Q40-Q58
Section 4 Neurological & Musculoskeletal Disorders Q59-Q78
Section 5 Renal, Endocrine & Immune Disorders Q79-Q100
Instructions: Select the single best answer for each question. This exam is designed for BSN HESI 266 Medical-Surgical
Nursing exam preparation. Passing score: 85% (85 questions correct).
, SECTION 1 | Cardiovascular & Hematologic Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified
Answers|100% Correct| Already Graded A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of hypertension presents with sudden onset chest pain radiating to
the left arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in leads V1 through V4.
Which medication should the nurse anticipate administering first?
A. Metoprolol IV push
B. Nitroglycerin sublingual
C. Aspirin 325 mg chewable
D. Morphine sulfate IV
Correct Answer: C
Rationale:
Aspirin is the first-line medication for ST-elevation myocardial infarction (STEMI) because it inhibits platelet
aggregation and reduces mortality. While nitroglycerin is important, aspirin takes priority due to its proven
mortality benefit. Metoprolol is contraindicated initially if the patient is hemodynamically unstable.
Q2 Question 2 of 100
A 72-year-old female is admitted with acute decompensated heart failure and has crackles throughout
both lung fields, JVD, and 3+ pitting edema in bilateral lower extremities. Her BNP level is 1,840
pg/mL. Which assessment finding indicates the most immediate concern?
A. Oxygen saturation of 88% on room air
B. Bounding peripheral pulses
C. Weight gain of 4 pounds over 3 days
D. Heart rate of 110 bpm
Correct Answer: A
Rationale:
An oxygen saturation of 88% indicates significant hypoxemia due to pulmonary edema and requires immediate
intervention to improve oxygenation. While weight gain and tachycardia are concerning, hypoxemia poses the
most immediate threat to life. Bounding pulses are expected with increased preload.
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 2 of 43
, Q3 Question 3 of 100
A 55-year-old male with atrial fibrillation has been taking warfarin for 6 months. His INR today is 5.2
with no active bleeding. Which action should the nurse take first?
A. Hold the next dose of warfarin
B. Administer vitamin K orally
C. Administer fresh frozen plasma
D. Notify the provider for a stat CT scan
Correct Answer: A
Rationale:
When the INR is above the therapeutic range but the patient is not actively bleeding, the first action is to hold the
warfarin dose and monitor. Vitamin K is reserved for INR values above 10 or active bleeding. Fresh frozen
plasma is used for life-threatening hemorrhage. A CT scan is unnecessary without signs of bleeding.
Q4 Question 4 of 100
A 64-year-old female with a mechanical mitral valve replacement is transitioning from heparin to
warfarin therapy. Her INR is 2.0 and her aPTT is 68 seconds. Which statement by the patient
indicates a need for further teaching?
A. I can take ibuprofen for occasional headaches
B. I will use a soft-bristle toothbrush for oral care
C. I will notify my dentist before any dental procedures
D. I will eat consistent amounts of green leafy vegetables
Correct Answer: A
Rationale:
Ibuprofen is an NSAID that increases the risk of gastrointestinal bleeding when combined with warfarin, and it
can also potentiate the anticoagulant effect. Patients on warfarin should avoid NSAIDs and use acetaminophen
instead. The other statements reflect correct understanding of warfarin therapy.
Q5 Question 5 of 100
A 48-year-old male presents with unilateral leg swelling, warmth, and tenderness in the right calf
following a 12-hour flight. A Doppler ultrasound confirms a deep vein thrombosis. Which intervention
should the nurse implement immediately?
A. Apply warm compresses to the affected leg
B. Elevate the affected leg above heart level
C. Encourage ambulation to promote circulation
D. Administer low-molecular-weight heparin
Correct Answer: D
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 3 of 43
, Rationale:
Anticoagulation with low-molecular-weight heparin is the priority intervention to prevent thrombus propagation
and pulmonary embolism. While elevation is appropriate, it is not the most immediate action. Ambulation is
contraindicated until anticoagulation therapy is initiated. Warm compresses may provide comfort but do not
address the clot.
Q6 Question 6 of 100
A 70-year-old male with a history of coronary artery disease reports experiencing chest discomfort
that occurs predictably with exertion and resolves with rest. His blood pressure is 148/92 mmHg. The
nurse understands this presentation is most consistent with which condition?
A. Unstable angina
B. Prinzmetal angina
C. Stable angina
D. Myocardial infarction
Correct Answer: C
Rationale:
Stable angina is characterized by chest discomfort that is predictable, occurs with exertion, and resolves with
rest or nitroglycerin. Unstable angina occurs at rest or with increasing frequency. Prinzmetal angina is caused by
coronary vasospasm. Myocardial infarction involves persistent pain and myocardial damage.
Q7 Question 7 of 100
A 58-year-old female is diagnosed with pernicious anemia. The nurse expects which set of laboratory
findings for this patient?
A. Macrocytic RBCs with low vitamin B12
B. Microcytic, hypochromic RBCs with low ferritin
C. Normocytic RBCs with elevated reticulocyte count
D. Microcytic RBCs with elevated TIBC
Correct Answer: A
Rationale:
Pernicious anemia results from inadequate vitamin B12 absorption due to lack of intrinsic factor, leading to
macrocytic (megaloblastic) anemia. Microcytic hypochromic RBCs with low ferritin indicate iron-deficiency
anemia. Elevated reticulocyte count suggests hemolytic anemia. Elevated TIBC is seen in iron deficiency.
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 4 of 43
BSN HESI 266 Med SurgNIGHTINGALE COLLEGE
Exam (Latest 2026/2027 Update) Questions and
Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027
MEDICAL-SURGICAL NURSING · Official Exam 2026/2027
100 85% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Cardiovascular & Hematologic Disorders Q1-Q20
Section 2 Respiratory & Thoracic Disorders Q21-Q39
Section 3 Gastrointestinal & Hepatic Disorders Q40-Q58
Section 4 Neurological & Musculoskeletal Disorders Q59-Q78
Section 5 Renal, Endocrine & Immune Disorders Q79-Q100
Instructions: Select the single best answer for each question. This exam is designed for BSN HESI 266 Medical-Surgical
Nursing exam preparation. Passing score: 85% (85 questions correct).
, SECTION 1 | Cardiovascular & Hematologic Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified
Answers|100% Correct| Already Graded A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of hypertension presents with sudden onset chest pain radiating to
the left arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in leads V1 through V4.
Which medication should the nurse anticipate administering first?
A. Metoprolol IV push
B. Nitroglycerin sublingual
C. Aspirin 325 mg chewable
D. Morphine sulfate IV
Correct Answer: C
Rationale:
Aspirin is the first-line medication for ST-elevation myocardial infarction (STEMI) because it inhibits platelet
aggregation and reduces mortality. While nitroglycerin is important, aspirin takes priority due to its proven
mortality benefit. Metoprolol is contraindicated initially if the patient is hemodynamically unstable.
Q2 Question 2 of 100
A 72-year-old female is admitted with acute decompensated heart failure and has crackles throughout
both lung fields, JVD, and 3+ pitting edema in bilateral lower extremities. Her BNP level is 1,840
pg/mL. Which assessment finding indicates the most immediate concern?
A. Oxygen saturation of 88% on room air
B. Bounding peripheral pulses
C. Weight gain of 4 pounds over 3 days
D. Heart rate of 110 bpm
Correct Answer: A
Rationale:
An oxygen saturation of 88% indicates significant hypoxemia due to pulmonary edema and requires immediate
intervention to improve oxygenation. While weight gain and tachycardia are concerning, hypoxemia poses the
most immediate threat to life. Bounding pulses are expected with increased preload.
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 2 of 43
, Q3 Question 3 of 100
A 55-year-old male with atrial fibrillation has been taking warfarin for 6 months. His INR today is 5.2
with no active bleeding. Which action should the nurse take first?
A. Hold the next dose of warfarin
B. Administer vitamin K orally
C. Administer fresh frozen plasma
D. Notify the provider for a stat CT scan
Correct Answer: A
Rationale:
When the INR is above the therapeutic range but the patient is not actively bleeding, the first action is to hold the
warfarin dose and monitor. Vitamin K is reserved for INR values above 10 or active bleeding. Fresh frozen
plasma is used for life-threatening hemorrhage. A CT scan is unnecessary without signs of bleeding.
Q4 Question 4 of 100
A 64-year-old female with a mechanical mitral valve replacement is transitioning from heparin to
warfarin therapy. Her INR is 2.0 and her aPTT is 68 seconds. Which statement by the patient
indicates a need for further teaching?
A. I can take ibuprofen for occasional headaches
B. I will use a soft-bristle toothbrush for oral care
C. I will notify my dentist before any dental procedures
D. I will eat consistent amounts of green leafy vegetables
Correct Answer: A
Rationale:
Ibuprofen is an NSAID that increases the risk of gastrointestinal bleeding when combined with warfarin, and it
can also potentiate the anticoagulant effect. Patients on warfarin should avoid NSAIDs and use acetaminophen
instead. The other statements reflect correct understanding of warfarin therapy.
Q5 Question 5 of 100
A 48-year-old male presents with unilateral leg swelling, warmth, and tenderness in the right calf
following a 12-hour flight. A Doppler ultrasound confirms a deep vein thrombosis. Which intervention
should the nurse implement immediately?
A. Apply warm compresses to the affected leg
B. Elevate the affected leg above heart level
C. Encourage ambulation to promote circulation
D. Administer low-molecular-weight heparin
Correct Answer: D
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 3 of 43
, Rationale:
Anticoagulation with low-molecular-weight heparin is the priority intervention to prevent thrombus propagation
and pulmonary embolism. While elevation is appropriate, it is not the most immediate action. Ambulation is
contraindicated until anticoagulation therapy is initiated. Warm compresses may provide comfort but do not
address the clot.
Q6 Question 6 of 100
A 70-year-old male with a history of coronary artery disease reports experiencing chest discomfort
that occurs predictably with exertion and resolves with rest. His blood pressure is 148/92 mmHg. The
nurse understands this presentation is most consistent with which condition?
A. Unstable angina
B. Prinzmetal angina
C. Stable angina
D. Myocardial infarction
Correct Answer: C
Rationale:
Stable angina is characterized by chest discomfort that is predictable, occurs with exertion, and resolves with
rest or nitroglycerin. Unstable angina occurs at rest or with increasing frequency. Prinzmetal angina is caused by
coronary vasospasm. Myocardial infarction involves persistent pain and myocardial damage.
Q7 Question 7 of 100
A 58-year-old female is diagnosed with pernicious anemia. The nurse expects which set of laboratory
findings for this patient?
A. Macrocytic RBCs with low vitamin B12
B. Microcytic, hypochromic RBCs with low ferritin
C. Normocytic RBCs with elevated reticulocyte count
D. Microcytic RBCs with elevated TIBC
Correct Answer: A
Rationale:
Pernicious anemia results from inadequate vitamin B12 absorption due to lack of intrinsic factor, leading to
macrocytic (megaloblastic) anemia. Microcytic hypochromic RBCs with low ferritin indicate iron-deficiency
anemia. Elevated reticulocyte count suggests hemolytic anemia. Elevated TIBC is seen in iron deficiency.
SI 266 Med Surg Exam (Latest 2026/2027 Update) Questions and Verified Answers|100% Correct| Already Graded A- Nightingale 2026/2027 - 2026/2027 | Passing Score: 85% | Page 4 of 43
