BSN 266 HESI Med-Surg Practice Exam V2 Nightingale College –
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Total Questions: 50
Time Allowed: 90 Minutes
Passing Score: 850+
Instructions: Select the BEST answer for each question based on medical-surgical
nursing principles, pathophysiology, and evidence-based practice. For SATA questions,
select all that apply. Pay attention to priority words (FIRST, BEST, INITIAL, MOST
IMPORTANT).
SECTION 1: CARDIOVASCULAR DISORDERS
Questions 1–10
Question 1
A 68-year-old male is admitted with exacerbation of congestive heart failure.
Assessment reveals bilateral crackles, jugular venous distension, 3+ pitting edema of
the lower extremities, and hepatomegaly. Which type of heart failure is this patient
MOST likely experiencing?
A. Left-sided heart failure only
,B. Right-sided heart failure only
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: C
Rationale: The patient exhibits signs of both left-sided failure (crackles from pulmonary
congestion) and right-sided failure (JVD, peripheral edema, hepatomegaly from
systemic venous congestion). This indicates biventricular failure. Left-sided failure
alone would not cause JVD or hepatomegaly. Right-sided failure alone would not cause
pulmonary crackles. High-output failure presents with warm extremities and bounding
pulses, not these findings.
Question 2
A nurse is caring for a patient with heart failure who has gained 3 pounds in 24 hours.
Which nursing intervention is the MOST appropriate INITIAL action?
A. Increase oral fluid intake to dilute excess sodium
B. Notify the healthcare provider and assess for signs of fluid overload
C. Administer a stat dose of antihypertensive medication
D. Encourage ambulation to promote diuresis
Correct Answer: B
Rationale: A weight gain of 2–3 pounds in 24 hours indicates fluid retention, a hallmark
of worsening heart failure. The nurse must notify the provider and assess for signs of
fluid overload (JVD, crackles, edema, decreased urine output). Increasing fluids worsens
,overload. Antihypertensives do not address acute fluid retention. Ambulation is
appropriate but not the initial priority when acute decompensation is suspected.
Question 3
A 55-year-old male is admitted with chest pain. Troponin I is elevated at 2.8 ng/mL, and
ST-segment elevation is noted in leads V1–V4. Which nursing intervention has the
HIGHEST priority?
A. Administer aspirin 325 mg chewable
B. Prepare the patient for emergent cardiac catheterization
C. Obtain a 12-lead ECG
D. Insert a Foley catheter
Correct Answer: B
Rationale: ST-elevation in V1–V4 indicates an anterior ST-elevation myocardial infarction
(STEMI). The priority intervention is emergent reperfusion therapy, ideally percutaneous
coronary intervention (PCI) within 90 minutes of first medical contact. While aspirin and
ECG are important initial steps, they should already be completed if troponin is elevated
and STEMI is confirmed. The nurse's highest priority is facilitating rapid transfer to the
cardiac catheterization lab. Foley catheterization is not an immediate priority.
Question 4
A patient with atrial fibrillation is receiving heparin infusion. The nurse notes the aPTT is
95 seconds (therapeutic range 60–80 seconds). Which action should the nurse take
FIRST?
, A. Continue the infusion at the current rate
B. Stop the infusion immediately and notify the provider
C. Reduce the infusion rate per protocol and recheck aPTT in 4 hours
D. Administer protamine sulfate
Correct Answer: C
Rationale: An aPTT of 95 seconds is mildly supratherapeutic. The appropriate first
action is to reduce the heparin infusion rate per institutional protocol and recheck the
aPTT. Stopping the infusion is unnecessary for a mild elevation. Protamine sulfate is
reserved for significant bleeding or severe overdose. Continuing the current rate
increases bleeding risk.
Question 5
A patient with hypertension is prescribed lisinopril. Which patient education statement
indicates understanding of the medication?
A. "I should take this medication on an empty stomach to improve absorption."
B. "I need to monitor my blood pressure daily and report dizziness or persistent cough."
C. "I can stop taking this medication once my blood pressure returns to normal."
D. "This medication will cure my high blood pressure permanently."
Correct Answer: B
Rationale: ACE inhibitors like lisinopril require daily home blood pressure monitoring.
Dizziness indicates hypotension, and a persistent dry cough is a common side effect
Complete Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
Total Questions: 50
Time Allowed: 90 Minutes
Passing Score: 850+
Instructions: Select the BEST answer for each question based on medical-surgical
nursing principles, pathophysiology, and evidence-based practice. For SATA questions,
select all that apply. Pay attention to priority words (FIRST, BEST, INITIAL, MOST
IMPORTANT).
SECTION 1: CARDIOVASCULAR DISORDERS
Questions 1–10
Question 1
A 68-year-old male is admitted with exacerbation of congestive heart failure.
Assessment reveals bilateral crackles, jugular venous distension, 3+ pitting edema of
the lower extremities, and hepatomegaly. Which type of heart failure is this patient
MOST likely experiencing?
A. Left-sided heart failure only
,B. Right-sided heart failure only
C. Biventricular heart failure
D. High-output heart failure
Correct Answer: C
Rationale: The patient exhibits signs of both left-sided failure (crackles from pulmonary
congestion) and right-sided failure (JVD, peripheral edema, hepatomegaly from
systemic venous congestion). This indicates biventricular failure. Left-sided failure
alone would not cause JVD or hepatomegaly. Right-sided failure alone would not cause
pulmonary crackles. High-output failure presents with warm extremities and bounding
pulses, not these findings.
Question 2
A nurse is caring for a patient with heart failure who has gained 3 pounds in 24 hours.
Which nursing intervention is the MOST appropriate INITIAL action?
A. Increase oral fluid intake to dilute excess sodium
B. Notify the healthcare provider and assess for signs of fluid overload
C. Administer a stat dose of antihypertensive medication
D. Encourage ambulation to promote diuresis
Correct Answer: B
Rationale: A weight gain of 2–3 pounds in 24 hours indicates fluid retention, a hallmark
of worsening heart failure. The nurse must notify the provider and assess for signs of
fluid overload (JVD, crackles, edema, decreased urine output). Increasing fluids worsens
,overload. Antihypertensives do not address acute fluid retention. Ambulation is
appropriate but not the initial priority when acute decompensation is suspected.
Question 3
A 55-year-old male is admitted with chest pain. Troponin I is elevated at 2.8 ng/mL, and
ST-segment elevation is noted in leads V1–V4. Which nursing intervention has the
HIGHEST priority?
A. Administer aspirin 325 mg chewable
B. Prepare the patient for emergent cardiac catheterization
C. Obtain a 12-lead ECG
D. Insert a Foley catheter
Correct Answer: B
Rationale: ST-elevation in V1–V4 indicates an anterior ST-elevation myocardial infarction
(STEMI). The priority intervention is emergent reperfusion therapy, ideally percutaneous
coronary intervention (PCI) within 90 minutes of first medical contact. While aspirin and
ECG are important initial steps, they should already be completed if troponin is elevated
and STEMI is confirmed. The nurse's highest priority is facilitating rapid transfer to the
cardiac catheterization lab. Foley catheterization is not an immediate priority.
Question 4
A patient with atrial fibrillation is receiving heparin infusion. The nurse notes the aPTT is
95 seconds (therapeutic range 60–80 seconds). Which action should the nurse take
FIRST?
, A. Continue the infusion at the current rate
B. Stop the infusion immediately and notify the provider
C. Reduce the infusion rate per protocol and recheck aPTT in 4 hours
D. Administer protamine sulfate
Correct Answer: C
Rationale: An aPTT of 95 seconds is mildly supratherapeutic. The appropriate first
action is to reduce the heparin infusion rate per institutional protocol and recheck the
aPTT. Stopping the infusion is unnecessary for a mild elevation. Protamine sulfate is
reserved for significant bleeding or severe overdose. Continuing the current rate
increases bleeding risk.
Question 5
A patient with hypertension is prescribed lisinopril. Which patient education statement
indicates understanding of the medication?
A. "I should take this medication on an empty stomach to improve absorption."
B. "I need to monitor my blood pressure daily and report dizziness or persistent cough."
C. "I can stop taking this medication once my blood pressure returns to normal."
D. "This medication will cure my high blood pressure permanently."
Correct Answer: B
Rationale: ACE inhibitors like lisinopril require daily home blood pressure monitoring.
Dizziness indicates hypotension, and a persistent dry cough is a common side effect
