BSN HESI 266 Med Surg Exam Actual Exam 2026/2027:
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal & Hepatic Disorders | Q21 – Q30
Section 4 | Endocrine, Renal & Genitourinary Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man with a history of heart failure with reduced ejection fraction calls the
cardiac clinic to report he has gained 3 pounds over the past two days and feels more
short of breath when walking to the mailbox. His ankles look puffy.
A. Increase his daily salt intake to improve his appetite and energy levels.
B. Advise him to weigh himself daily and call if he gains more than 2 to 3 pounds in a
day or 5 pounds in a week. ✓ CORRECT
C. Tell him to skip his furosemide for two days so his kidneys can rest.
D. Recommend he drink at least 3 liters of fluid daily to flush out the extra sodium.
Correct Answer: B
Rationale: Rapid weight gain in heart failure indicates fluid retention, and daily weights
with specific thresholds are the standard self-monitoring strategy that triggers early
intervention. Choice A is incorrect because sodium restriction is foundational in heart
failure management, and increasing salt would worsen fluid overload. Teaching patients
,these specific weight parameters helps prevent acute decompensation and reduces
hospital readmissions.
Question 2 of 50
A 72-year-old woman is admitted following an ST-elevation myocardial infarction treated
with primary PCI. On post-op day two, her blood pressure is 88/52 mmHg, heart rate is
48 beats per minute, and she feels dizzy when standing. She is due for her scheduled
metoprolol.
A. Administer the metoprolol as ordered because beta-blockers are essential after MI.
B. Give half the dose to maintain some cardiac protection while avoiding hypotension.
C. Hold the dose and notify the provider after the next vital sign check in four hours.
D. Hold the metoprolol and notify the provider immediately because symptomatic
bradycardia and hypotension are contraindications. ✓ CORRECT
Correct Answer: D
Rationale: Beta-blockers should be held when a patient develops symptomatic
bradycardia or hypotension because continuing the medication could precipitate
cardiogenic shock or further reduce coronary perfusion. Choice A is a common error
because while beta-blockers improve long-term outcomes post-MI, they are not safe in
the setting of active hemodynamic compromise. Nurses must always prioritize the
patient's current stability over routine medication administration.
Question 3 of 50
A 45-year-old man is hospitalized for a deep vein thrombosis in his left calf and is
receiving a continuous heparin infusion. His baseline aPTT was 35 seconds. Four hours
after the last titration, his aPTT returns at 95 seconds, and he reports brushing his teeth
caused his gums to bleed slightly.
,A. Stop the heparin infusion for one hour, redraw the aPTT, and notify the provider per
protocol. ✓ CORRECT
B. Increase the infusion rate by 2 units per kilogram per hour to reach therapeutic range
faster.
C. Administer protamine sulfate immediately without waiting for provider orders.
D. Continue the current rate because aPTT values naturally fluctuate throughout the day.
Correct Answer: A
Rationale: An aPTT of 95 seconds is supratherapeutic and associated with bleeding
risk, requiring the infusion to be stopped temporarily and the provider notified for dose
adjustment per institutional protocol. Choice B is incorrect because increasing the rate
would further elevate the aPTT and increase hemorrhage risk. Heparin protocols are
designed precisely for these situations so nurses can act quickly while maintaining
patient safety.
Question 4 of 50
A 58-year-old woman with iron deficiency anemia is discharged with a prescription for
ferrous sulfate. During discharge teaching, she asks whether she can take the pill with
her morning coffee and yogurt.
A. Yes, dairy products and caffeine improve iron absorption when taken together.
B. Take the iron with an antacid to prevent stomach upset and improve absorption.
C. Take the iron with orange juice or another source of vitamin C, and avoid dairy or
antacids for two hours. ✓ CORRECT
D. Crush the tablet and mix it with milk to mask the metallic taste and prevent nausea.
Correct Answer: C
Rationale: Vitamin C enhances the absorption of non-heme iron, while calcium in dairy
and the alkaline environment created by antacids both inhibit iron absorption
significantly. Choice A is incorrect because coffee contains polyphenols and dairy
contains calcium, both of which bind iron and reduce its bioavailability. Patients often
, need specific instructions about timing because they assume any food is acceptable
with oral medications.
Question 5 of 50
A 76-year-old man with atrial fibrillation is taking warfarin 5 mg daily. His INR today is
4.2, up from his therapeutic baseline of 2.5. He has no active bleeding but reports he
started eating large salads daily because he is trying to lose weight.
A. Administer vitamin K 10 mg intravenously immediately to reverse the anticoagulation.
B. Hold the next warfarin dose, contact the provider, and review his dietary vitamin K
intake. ✓ CORRECT
C. Continue the warfarin as scheduled because INR fluctuations are expected in elderly
patients.
D. Increase the warfarin dose to 7.5 mg to overcome the extra vitamin K from the
vegetables.
Correct Answer: B
Rationale: An INR of 4.2 in a patient without bleeding typically warrants holding the next
dose and notifying the provider for dose adjustment, along with dietary counseling
about consistent vitamin K intake. Choice A is incorrect because vitamin K is reserved
for serious bleeding or dangerously elevated INR, not for moderate elevations without
hemorrhage. Teaching patients about consistent leafy green consumption prevents
these fluctuations better than asking them to avoid vegetables entirely.
Question 6 of 50
A 52-year-old man with a history of poorly controlled hypertension presents to the
emergency department with a blood pressure of 220/130 mmHg. He reports a mild
headache but denies chest pain, dyspnea, or neuro deficits. His ECG and troponins are
normal.
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular & Hematologic Disorders | Q1 – Q10
Section 2 | Respiratory & Acid-Base Disorders | Q11 – Q20
Section 3 | Gastrointestinal & Hepatic Disorders | Q21 – Q30
Section 4 | Endocrine, Renal & Genitourinary Disorders | Q31 – Q40
Section 5 | Neurologic, Musculoskeletal & Integumentary Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & HEMATOLOGIC DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man with a history of heart failure with reduced ejection fraction calls the
cardiac clinic to report he has gained 3 pounds over the past two days and feels more
short of breath when walking to the mailbox. His ankles look puffy.
A. Increase his daily salt intake to improve his appetite and energy levels.
B. Advise him to weigh himself daily and call if he gains more than 2 to 3 pounds in a
day or 5 pounds in a week. ✓ CORRECT
C. Tell him to skip his furosemide for two days so his kidneys can rest.
D. Recommend he drink at least 3 liters of fluid daily to flush out the extra sodium.
Correct Answer: B
Rationale: Rapid weight gain in heart failure indicates fluid retention, and daily weights
with specific thresholds are the standard self-monitoring strategy that triggers early
intervention. Choice A is incorrect because sodium restriction is foundational in heart
failure management, and increasing salt would worsen fluid overload. Teaching patients
,these specific weight parameters helps prevent acute decompensation and reduces
hospital readmissions.
Question 2 of 50
A 72-year-old woman is admitted following an ST-elevation myocardial infarction treated
with primary PCI. On post-op day two, her blood pressure is 88/52 mmHg, heart rate is
48 beats per minute, and she feels dizzy when standing. She is due for her scheduled
metoprolol.
A. Administer the metoprolol as ordered because beta-blockers are essential after MI.
B. Give half the dose to maintain some cardiac protection while avoiding hypotension.
C. Hold the dose and notify the provider after the next vital sign check in four hours.
D. Hold the metoprolol and notify the provider immediately because symptomatic
bradycardia and hypotension are contraindications. ✓ CORRECT
Correct Answer: D
Rationale: Beta-blockers should be held when a patient develops symptomatic
bradycardia or hypotension because continuing the medication could precipitate
cardiogenic shock or further reduce coronary perfusion. Choice A is a common error
because while beta-blockers improve long-term outcomes post-MI, they are not safe in
the setting of active hemodynamic compromise. Nurses must always prioritize the
patient's current stability over routine medication administration.
Question 3 of 50
A 45-year-old man is hospitalized for a deep vein thrombosis in his left calf and is
receiving a continuous heparin infusion. His baseline aPTT was 35 seconds. Four hours
after the last titration, his aPTT returns at 95 seconds, and he reports brushing his teeth
caused his gums to bleed slightly.
,A. Stop the heparin infusion for one hour, redraw the aPTT, and notify the provider per
protocol. ✓ CORRECT
B. Increase the infusion rate by 2 units per kilogram per hour to reach therapeutic range
faster.
C. Administer protamine sulfate immediately without waiting for provider orders.
D. Continue the current rate because aPTT values naturally fluctuate throughout the day.
Correct Answer: A
Rationale: An aPTT of 95 seconds is supratherapeutic and associated with bleeding
risk, requiring the infusion to be stopped temporarily and the provider notified for dose
adjustment per institutional protocol. Choice B is incorrect because increasing the rate
would further elevate the aPTT and increase hemorrhage risk. Heparin protocols are
designed precisely for these situations so nurses can act quickly while maintaining
patient safety.
Question 4 of 50
A 58-year-old woman with iron deficiency anemia is discharged with a prescription for
ferrous sulfate. During discharge teaching, she asks whether she can take the pill with
her morning coffee and yogurt.
A. Yes, dairy products and caffeine improve iron absorption when taken together.
B. Take the iron with an antacid to prevent stomach upset and improve absorption.
C. Take the iron with orange juice or another source of vitamin C, and avoid dairy or
antacids for two hours. ✓ CORRECT
D. Crush the tablet and mix it with milk to mask the metallic taste and prevent nausea.
Correct Answer: C
Rationale: Vitamin C enhances the absorption of non-heme iron, while calcium in dairy
and the alkaline environment created by antacids both inhibit iron absorption
significantly. Choice A is incorrect because coffee contains polyphenols and dairy
contains calcium, both of which bind iron and reduce its bioavailability. Patients often
, need specific instructions about timing because they assume any food is acceptable
with oral medications.
Question 5 of 50
A 76-year-old man with atrial fibrillation is taking warfarin 5 mg daily. His INR today is
4.2, up from his therapeutic baseline of 2.5. He has no active bleeding but reports he
started eating large salads daily because he is trying to lose weight.
A. Administer vitamin K 10 mg intravenously immediately to reverse the anticoagulation.
B. Hold the next warfarin dose, contact the provider, and review his dietary vitamin K
intake. ✓ CORRECT
C. Continue the warfarin as scheduled because INR fluctuations are expected in elderly
patients.
D. Increase the warfarin dose to 7.5 mg to overcome the extra vitamin K from the
vegetables.
Correct Answer: B
Rationale: An INR of 4.2 in a patient without bleeding typically warrants holding the next
dose and notifying the provider for dose adjustment, along with dietary counseling
about consistent vitamin K intake. Choice A is incorrect because vitamin K is reserved
for serious bleeding or dangerously elevated INR, not for moderate elevations without
hemorrhage. Teaching patients about consistent leafy green consumption prevents
these fluctuations better than asking them to avoid vegetables entirely.
Question 6 of 50
A 52-year-old man with a history of poorly controlled hypertension presents to the
emergency department with a blood pressure of 220/130 mmHg. He reports a mild
headache but denies chest pain, dyspnea, or neuro deficits. His ECG and troponins are
normal.
