BSN 266 HESI MED SURG ACTUAL EXAM 2026/2027 | Latest
Questions & Verified Answers | 100% Correct | Grade A |
Nightingale | Comprehensive Mastery | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents to the emergency
department with crushing chest pain radiating to the left arm, diaphoresis, and nausea.
Vital signs: BP 92/58 mmHg, HR 110 bpm, RR 24/min, SpO2 91% on room air. The
12-lead EKG reveals ST-segment elevation in leads V1-V4. Which nursing intervention is
the priority?
A. Administer sublingual nitroglycerin every 5 minutes for a total of 3 doses
B. Obtain a detailed pain history and complete medication reconciliation
C. Initiate IV access, administer oxygen, and prepare for emergent reperfusion therapy
D. Perform a comprehensive head-to-toe assessment before contacting the physician
C. Initiate IV access, administer oxygen, and prepare for emergent reperfusion therapy
[CORRECT]
Correct Answer: C
Rationale: This patient is presenting with an acute anterior ST-elevation myocardial
infarction (STEMI) with signs of cardiogenic shock (hypotension, tachycardia). The
priority is immediate stabilization and preparation for emergent reperfusion (PCI within
90 minutes or thrombolytics within 30 minutes). The MONA protocol (Morphine,
Oxygen, Nitrates, Aspirin) should be initiated, but nitroglycerin is contraindicated with
,hypotension (SBP <90 mmHg). A detailed history and comprehensive assessment
should not delay emergent treatment in a STEMI.
Q2: A 72-year-old female with chronic heart failure is admitted with worsening dyspnea,
3+ pitting edema in bilateral lower extremities, and a 10-pound weight gain over 3 days.
She is prescribed furosemide 80 mg IV twice daily. Which assessment finding indicates
the medication is achieving the desired therapeutic effect?
A. Decreased serum potassium level from 4.2 to 3.1 mEq/L
B. Increased urine output of 2,500 mL in 8 hours
C. Development of orthostatic hypotension with standing
D. Decreased serum sodium level from 138 to 132 mEq/L
B. Increased urine output of 2,500 mL in 8 hours [CORRECT]
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes diuresis by inhibiting sodium and
chloride reabsorption in the loop of Henle. The desired therapeutic effect in acute
decompensated heart failure is increased urine output, which reduces fluid overload,
decreases pulmonary congestion, and reduces peripheral edema. While hypokalemia
(Option A) and hyponatremia (Option D) are common adverse effects, they are not
therapeutic effects. Orthostatic hypotension (Option C) is an adverse effect requiring
monitoring.
Q3: A 55-year-old male with atrial fibrillation is prescribed warfarin 5 mg daily. His INR
today is 4.8 (therapeutic range 2.0-3.0). He has no active bleeding. Which nursing
intervention is most appropriate?
A. Administer the scheduled dose of warfarin and continue monitoring
B. Hold the next dose of warfarin and notify the healthcare provider
,C. Administer vitamin K 10 mg subcutaneously immediately
D. Increase the warfarin dose to achieve a higher therapeutic level
B. Hold the next dose of warfarin and notify the healthcare provider [CORRECT]
Correct Answer: B
Rationale: An INR of 4.8 is above the therapeutic range of 2.0-3.0 for atrial fibrillation but
does not typically require vitamin K administration unless there is active bleeding or the
INR is >10. The appropriate intervention is to hold the next dose and notify the provider
for dosage adjustment. Vitamin K (Option C) is reserved for serious bleeding or INR >10.
Continuing the dose (Option A) would worsen the supratherapeutic anticoagulation.
Q4: A 62-year-old male is post-operative day 2 following coronary artery bypass grafting
(CABG). His chest tube drainage suddenly increases from 50 mL/hr to 250 mL/hr of
bright red blood. Which is the priority nursing action?
A. Document the finding and continue hourly monitoring
B. Milk the chest tube to maintain patency
C. Notify the surgeon immediately and prepare for possible return to surgery
D. Administer protamine sulfate per protocol
C. Notify the surgeon immediately and prepare for possible return to surgery [CORRECT]
Correct Answer: C
Rationale: Sudden increase in chest tube drainage to >200 mL/hr of bright red blood
indicates active hemorrhage, possibly from a surgical site or graft disruption. This is a
surgical emergency requiring immediate notification of the surgeon. While milking the
chest tube (Option B) may be appropriate to maintain patency, it does not address the
, life-threatening hemorrhage. Protamine (Option D) reverses heparin but is not indicated
for surgical bleeding.
Q5: A 45-year-old female with a history of rheumatic fever is diagnosed with mitral
stenosis. During assessment, which finding is most consistent with this valvular
disorder?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic rumble at the apex with an opening snap
C. Systolic ejection murmur at the right upper sternal border
D. Pansystolic murmur at the left lower sternal border
B. Diastolic rumble at the apex with an opening snap [CORRECT]
Correct Answer: B
Rationale: Mitral stenosis produces a low-pitched diastolic rumble best heard at the
apex with an opening snap due to the stiffened valve leaflets snapping open during
diastole. A holosystolic murmur at the apex (Option A) indicates mitral regurgitation. A
systolic ejection murmur at the right upper sternal border (Option C) indicates aortic
stenosis. A pansystolic murmur at the left lower sternal border (Option D) indicates
tricuspid regurgitation.
Q6: A 58-year-old male with peripheral arterial disease (PAD) reports severe leg pain
when walking two blocks that resolves with rest. Which patient education instruction is
most appropriate?
A. "Apply warm heating pads to both legs for 30 minutes daily"
B. "Walk until the pain begins, rest until it resolves, then resume walking"
C. "Elevate your legs above heart level when sitting"
Questions & Verified Answers | 100% Correct | Grade A |
Nightingale | Comprehensive Mastery | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents to the emergency
department with crushing chest pain radiating to the left arm, diaphoresis, and nausea.
Vital signs: BP 92/58 mmHg, HR 110 bpm, RR 24/min, SpO2 91% on room air. The
12-lead EKG reveals ST-segment elevation in leads V1-V4. Which nursing intervention is
the priority?
A. Administer sublingual nitroglycerin every 5 minutes for a total of 3 doses
B. Obtain a detailed pain history and complete medication reconciliation
C. Initiate IV access, administer oxygen, and prepare for emergent reperfusion therapy
D. Perform a comprehensive head-to-toe assessment before contacting the physician
C. Initiate IV access, administer oxygen, and prepare for emergent reperfusion therapy
[CORRECT]
Correct Answer: C
Rationale: This patient is presenting with an acute anterior ST-elevation myocardial
infarction (STEMI) with signs of cardiogenic shock (hypotension, tachycardia). The
priority is immediate stabilization and preparation for emergent reperfusion (PCI within
90 minutes or thrombolytics within 30 minutes). The MONA protocol (Morphine,
Oxygen, Nitrates, Aspirin) should be initiated, but nitroglycerin is contraindicated with
,hypotension (SBP <90 mmHg). A detailed history and comprehensive assessment
should not delay emergent treatment in a STEMI.
Q2: A 72-year-old female with chronic heart failure is admitted with worsening dyspnea,
3+ pitting edema in bilateral lower extremities, and a 10-pound weight gain over 3 days.
She is prescribed furosemide 80 mg IV twice daily. Which assessment finding indicates
the medication is achieving the desired therapeutic effect?
A. Decreased serum potassium level from 4.2 to 3.1 mEq/L
B. Increased urine output of 2,500 mL in 8 hours
C. Development of orthostatic hypotension with standing
D. Decreased serum sodium level from 138 to 132 mEq/L
B. Increased urine output of 2,500 mL in 8 hours [CORRECT]
Correct Answer: B
Rationale: Furosemide is a loop diuretic that promotes diuresis by inhibiting sodium and
chloride reabsorption in the loop of Henle. The desired therapeutic effect in acute
decompensated heart failure is increased urine output, which reduces fluid overload,
decreases pulmonary congestion, and reduces peripheral edema. While hypokalemia
(Option A) and hyponatremia (Option D) are common adverse effects, they are not
therapeutic effects. Orthostatic hypotension (Option C) is an adverse effect requiring
monitoring.
Q3: A 55-year-old male with atrial fibrillation is prescribed warfarin 5 mg daily. His INR
today is 4.8 (therapeutic range 2.0-3.0). He has no active bleeding. Which nursing
intervention is most appropriate?
A. Administer the scheduled dose of warfarin and continue monitoring
B. Hold the next dose of warfarin and notify the healthcare provider
,C. Administer vitamin K 10 mg subcutaneously immediately
D. Increase the warfarin dose to achieve a higher therapeutic level
B. Hold the next dose of warfarin and notify the healthcare provider [CORRECT]
Correct Answer: B
Rationale: An INR of 4.8 is above the therapeutic range of 2.0-3.0 for atrial fibrillation but
does not typically require vitamin K administration unless there is active bleeding or the
INR is >10. The appropriate intervention is to hold the next dose and notify the provider
for dosage adjustment. Vitamin K (Option C) is reserved for serious bleeding or INR >10.
Continuing the dose (Option A) would worsen the supratherapeutic anticoagulation.
Q4: A 62-year-old male is post-operative day 2 following coronary artery bypass grafting
(CABG). His chest tube drainage suddenly increases from 50 mL/hr to 250 mL/hr of
bright red blood. Which is the priority nursing action?
A. Document the finding and continue hourly monitoring
B. Milk the chest tube to maintain patency
C. Notify the surgeon immediately and prepare for possible return to surgery
D. Administer protamine sulfate per protocol
C. Notify the surgeon immediately and prepare for possible return to surgery [CORRECT]
Correct Answer: C
Rationale: Sudden increase in chest tube drainage to >200 mL/hr of bright red blood
indicates active hemorrhage, possibly from a surgical site or graft disruption. This is a
surgical emergency requiring immediate notification of the surgeon. While milking the
chest tube (Option B) may be appropriate to maintain patency, it does not address the
, life-threatening hemorrhage. Protamine (Option D) reverses heparin but is not indicated
for surgical bleeding.
Q5: A 45-year-old female with a history of rheumatic fever is diagnosed with mitral
stenosis. During assessment, which finding is most consistent with this valvular
disorder?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic rumble at the apex with an opening snap
C. Systolic ejection murmur at the right upper sternal border
D. Pansystolic murmur at the left lower sternal border
B. Diastolic rumble at the apex with an opening snap [CORRECT]
Correct Answer: B
Rationale: Mitral stenosis produces a low-pitched diastolic rumble best heard at the
apex with an opening snap due to the stiffened valve leaflets snapping open during
diastole. A holosystolic murmur at the apex (Option A) indicates mitral regurgitation. A
systolic ejection murmur at the right upper sternal border (Option C) indicates aortic
stenosis. A pansystolic murmur at the left lower sternal border (Option D) indicates
tricuspid regurgitation.
Q6: A 58-year-old male with peripheral arterial disease (PAD) reports severe leg pain
when walking two blocks that resolves with rest. Which patient education instruction is
most appropriate?
A. "Apply warm heating pads to both legs for 30 minutes daily"
B. "Walk until the pain begins, rest until it resolves, then resume walking"
C. "Elevate your legs above heart level when sitting"
