BSN 266 HESI MED SURG PRACTICE EXAM V2 2026/2027 |
Questions & Verified Answers with Rationales | 100% Correct
| Grade A | Nightingale | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents to the clinic with a blood
pressure of 178/96 mmHg. He reports occasional headaches and dizziness but denies
chest pain or dyspnea. His current medications include lisinopril 10 mg daily. Which
nursing intervention is the priority for this patient at this time?
A. Initiate a 2 g sodium-restricted diet immediately
B. Assess for orthostatic hypotension before administering the morning dose of
lisinopril
C. Educate the patient on the importance of medication adherence and lifestyle
modifications [CORRECT]
D. Prepare the patient for immediate hospitalization due to hypertensive urgency
Correct Answer: C
Rationale: The patient has uncontrolled hypertension (Stage 2, BP ≥140/90) but is
asymptomatic for hypertensive emergency; priority nursing intervention focuses on
patient education regarding medication adherence, sodium restriction, weight
management, and follow-up, as nonadherence is the most common cause of
uncontrolled hypertension. Orthostatic assessment is important but not the priority in
clinic setting. Immediate hospitalization is unnecessary without target organ damage. A
2 g sodium diet requires provider order and gradual implementation.
Q2: A 72-year-old female with HFrEF (EF 35%) is admitted with acute decompensated
heart failure. She has 3+ pitting edema, JVD at 8 cm, and reports orthopnea. Her weight
has increased 4 kg in 3 days. Which assessment finding requires the most immediate
nursing intervention?
A. Bilateral crackles in the lung bases
,B. Oxygen saturation of 88% on room air [CORRECT]
C. Presence of an S3 heart sound
D. 2+ peripheral pulses
Correct Answer: B
Rationale: An SpO2 of 88% indicates severe hypoxemia requiring immediate
supplemental oxygen and possible escalation to high-flow or BiPAP to prevent
respiratory failure; this takes priority over other findings. Crackles, S3, and edema are
expected in decompensated HF but do not represent immediate threats to oxygenation.
The nurse must follow the ABC priority framework.
Q3: A 55-year-old male with NYHA Class III heart failure asks the nurse why he needs to
weigh himself daily. Which response by the nurse is most accurate?
A. "Daily weights help us monitor your kidney function."
B. "Weight changes help detect fluid retention before symptoms worsen." [CORRECT]
C. "We need to ensure you are losing weight for cardiac rehabilitation."
D. "Daily weights are required to calculate your exact fluid intake."
Correct Answer: B
Rationale: In heart failure, a weight gain of 2-3 pounds (1-1.5 kg) in 24 hours or 5
pounds (2.3 kg) in one week indicates fluid retention and impending decompensation,
allowing early intervention before hospitalization. It does not primarily monitor kidney
function, require weight loss, or calculate fluid intake precisely.
Q4: A 62-year-old male is admitted with unstable angina. His troponin I is 0.04 ng/mL
(slightly elevated) and he reports crushing chest pain radiating to the jaw. Which EKG
change is most characteristic of his condition?
A. ST-segment elevation in leads V1-V4
B. ST-segment depression and T-wave inversion [CORRECT]
C. Pathological Q waves in leads II, III, and aVF
D. Peaked T waves across all precordial leads
Correct Answer: B
,Rationale: Unstable angina/NSTEMI typically presents with ST-segment depression
and/or T-wave inversion indicating subendocardial ischemia without full-thickness
infarction. ST elevation indicates STEMI requiring emergent reperfusion. Pathological Q
waves indicate established infarction (age undetermined). Peaked T waves suggest
hyperkalemia.
Q5: A patient with acute inferior wall MI develops sudden onset of bradycardia,
hypotension, and syncope. Which rhythm should the nurse anticipate?
A. Third-degree AV block [CORRECT]
B. Atrial fibrillation with rapid ventricular response
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: A
Rationale: Inferior wall MI often involves the right coronary artery, which supplies the AV
node; this can cause various degrees of heart block, including third-degree AV block,
presenting with bradycardia, hypotension, and syncope due to inadequate cardiac
output. Atrial fibrillation with RVR and VT would present with tachycardia, not
bradycardia.
Q6: A 45-year-old female with newly diagnosed atrial fibrillation is started on dabigatran.
Which patient education point is essential?
A. "You should take an aspirin daily in addition to dabigatran for better protection."
B. "You need to have your INR checked monthly while on this medication."
C. "Report any signs of bleeding, including dark tarry stools or severe headache,
immediately." [CORRECT]
D. "This medication will convert your atrial fibrillation back to normal rhythm."
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (anticoagulant) used for stroke
prevention in AFib; bleeding is the major adverse effect, and patients must report signs
of GI or intracranial bleeding immediately. It does not require INR monitoring (that is
, warfarin). Aspirin should not be combined without provider order due to bleeding risk.
Dabigatran does not convert rhythm.
Q7: A patient with severe aortic stenosis becomes dizzy and hypotensive during a
bedside commode transfer. Which action should the nurse take first?
A. Administer a fluid bolus of 500 mL normal saline
B. Return the patient to bed in a supine position [CORRECT]
C. Prepare for immediate cardioversion
D. Increase the dose of antihypertensive medications
Correct Answer: B
Rationale: In aortic stenosis, dizziness and hypotension during exertion indicate
reduced cerebral perfusion due to fixed outflow obstruction; the immediate action is to
reduce metabolic demand by returning the patient to a supine position to increase
venous return and cardiac output. Fluid boluses may help but positioning is faster and
safer. Cardioversion is for tachyarrhythmias. Antihypertensives would worsen
hypotension.
Q8: A 58-year-old male post-hip replacement surgery develops sudden dyspnea,
tachycardia, and pleuritic chest pain. His SpO2 drops from 96% to 84%. Which nursing
action is the priority?
A. Administer heparin per protocol
B. Apply supplemental oxygen at 15 L/min via non-rebreather mask [CORRECT]
C. Obtain a 12-lead EKG
D. Insert a urinary catheter to monitor output
Correct Answer: B
Rationale: This patient presents with classic signs of pulmonary embolism (sudden
dyspnea, pleuritic chest pain, hypoxemia, tachycardia) following orthopedic surgery; the
priority intervention is oxygenation support per the ABC framework. While heparin and
EKG are important, oxygenation takes precedence. Urinary catheterization is not a
priority.
Questions & Verified Answers with Rationales | 100% Correct
| Grade A | Nightingale | Pass Guaranteed
SECTION 1: CARDIOVASCULAR DISORDERS (35 Questions)
Q1: A 68-year-old male with a history of hypertension presents to the clinic with a blood
pressure of 178/96 mmHg. He reports occasional headaches and dizziness but denies
chest pain or dyspnea. His current medications include lisinopril 10 mg daily. Which
nursing intervention is the priority for this patient at this time?
A. Initiate a 2 g sodium-restricted diet immediately
B. Assess for orthostatic hypotension before administering the morning dose of
lisinopril
C. Educate the patient on the importance of medication adherence and lifestyle
modifications [CORRECT]
D. Prepare the patient for immediate hospitalization due to hypertensive urgency
Correct Answer: C
Rationale: The patient has uncontrolled hypertension (Stage 2, BP ≥140/90) but is
asymptomatic for hypertensive emergency; priority nursing intervention focuses on
patient education regarding medication adherence, sodium restriction, weight
management, and follow-up, as nonadherence is the most common cause of
uncontrolled hypertension. Orthostatic assessment is important but not the priority in
clinic setting. Immediate hospitalization is unnecessary without target organ damage. A
2 g sodium diet requires provider order and gradual implementation.
Q2: A 72-year-old female with HFrEF (EF 35%) is admitted with acute decompensated
heart failure. She has 3+ pitting edema, JVD at 8 cm, and reports orthopnea. Her weight
has increased 4 kg in 3 days. Which assessment finding requires the most immediate
nursing intervention?
A. Bilateral crackles in the lung bases
,B. Oxygen saturation of 88% on room air [CORRECT]
C. Presence of an S3 heart sound
D. 2+ peripheral pulses
Correct Answer: B
Rationale: An SpO2 of 88% indicates severe hypoxemia requiring immediate
supplemental oxygen and possible escalation to high-flow or BiPAP to prevent
respiratory failure; this takes priority over other findings. Crackles, S3, and edema are
expected in decompensated HF but do not represent immediate threats to oxygenation.
The nurse must follow the ABC priority framework.
Q3: A 55-year-old male with NYHA Class III heart failure asks the nurse why he needs to
weigh himself daily. Which response by the nurse is most accurate?
A. "Daily weights help us monitor your kidney function."
B. "Weight changes help detect fluid retention before symptoms worsen." [CORRECT]
C. "We need to ensure you are losing weight for cardiac rehabilitation."
D. "Daily weights are required to calculate your exact fluid intake."
Correct Answer: B
Rationale: In heart failure, a weight gain of 2-3 pounds (1-1.5 kg) in 24 hours or 5
pounds (2.3 kg) in one week indicates fluid retention and impending decompensation,
allowing early intervention before hospitalization. It does not primarily monitor kidney
function, require weight loss, or calculate fluid intake precisely.
Q4: A 62-year-old male is admitted with unstable angina. His troponin I is 0.04 ng/mL
(slightly elevated) and he reports crushing chest pain radiating to the jaw. Which EKG
change is most characteristic of his condition?
A. ST-segment elevation in leads V1-V4
B. ST-segment depression and T-wave inversion [CORRECT]
C. Pathological Q waves in leads II, III, and aVF
D. Peaked T waves across all precordial leads
Correct Answer: B
,Rationale: Unstable angina/NSTEMI typically presents with ST-segment depression
and/or T-wave inversion indicating subendocardial ischemia without full-thickness
infarction. ST elevation indicates STEMI requiring emergent reperfusion. Pathological Q
waves indicate established infarction (age undetermined). Peaked T waves suggest
hyperkalemia.
Q5: A patient with acute inferior wall MI develops sudden onset of bradycardia,
hypotension, and syncope. Which rhythm should the nurse anticipate?
A. Third-degree AV block [CORRECT]
B. Atrial fibrillation with rapid ventricular response
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: A
Rationale: Inferior wall MI often involves the right coronary artery, which supplies the AV
node; this can cause various degrees of heart block, including third-degree AV block,
presenting with bradycardia, hypotension, and syncope due to inadequate cardiac
output. Atrial fibrillation with RVR and VT would present with tachycardia, not
bradycardia.
Q6: A 45-year-old female with newly diagnosed atrial fibrillation is started on dabigatran.
Which patient education point is essential?
A. "You should take an aspirin daily in addition to dabigatran for better protection."
B. "You need to have your INR checked monthly while on this medication."
C. "Report any signs of bleeding, including dark tarry stools or severe headache,
immediately." [CORRECT]
D. "This medication will convert your atrial fibrillation back to normal rhythm."
Correct Answer: C
Rationale: Dabigatran is a direct thrombin inhibitor (anticoagulant) used for stroke
prevention in AFib; bleeding is the major adverse effect, and patients must report signs
of GI or intracranial bleeding immediately. It does not require INR monitoring (that is
, warfarin). Aspirin should not be combined without provider order due to bleeding risk.
Dabigatran does not convert rhythm.
Q7: A patient with severe aortic stenosis becomes dizzy and hypotensive during a
bedside commode transfer. Which action should the nurse take first?
A. Administer a fluid bolus of 500 mL normal saline
B. Return the patient to bed in a supine position [CORRECT]
C. Prepare for immediate cardioversion
D. Increase the dose of antihypertensive medications
Correct Answer: B
Rationale: In aortic stenosis, dizziness and hypotension during exertion indicate
reduced cerebral perfusion due to fixed outflow obstruction; the immediate action is to
reduce metabolic demand by returning the patient to a supine position to increase
venous return and cardiac output. Fluid boluses may help but positioning is faster and
safer. Cardioversion is for tachyarrhythmias. Antihypertensives would worsen
hypotension.
Q8: A 58-year-old male post-hip replacement surgery develops sudden dyspnea,
tachycardia, and pleuritic chest pain. His SpO2 drops from 96% to 84%. Which nursing
action is the priority?
A. Administer heparin per protocol
B. Apply supplemental oxygen at 15 L/min via non-rebreather mask [CORRECT]
C. Obtain a 12-lead EKG
D. Insert a urinary catheter to monitor output
Correct Answer: B
Rationale: This patient presents with classic signs of pulmonary embolism (sudden
dyspnea, pleuritic chest pain, hypoxemia, tachycardia) following orthopedic surgery; the
priority intervention is oxygenation support per the ABC framework. While heparin and
EKG are important, oxygenation takes precedence. Urinary catheterization is not a
priority.
