BSN HESI 266 MED SURG EXAM 2026/2027 | Latest Update
Questions & Verified Answers | 100% Correct | Already
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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 currently takes lisinopril 10 mg daily and reports
occasional dizziness. His serum creatinine is 1.4 mg/dL and potassium is 5.1 mEq/L.
Which nursing intervention is the priority before initiating any medication changes?
A. Increase lisinopril to 20 mg daily to achieve goal BP
B. Administer a thiazide diuretic to enhance antihypertensive effect
C. Notify the provider about the elevated potassium and creatinine before adjusting ACE
inhibitor therapy [CORRECT]
D. Recommend the patient stop lisinopril immediately due to dizziness
Correct Answer: C
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia and worsen renal
function, especially in older adults. The patient's potassium of 5.1 mEq/L is at the upper
limit of normal, and creatinine of 1.4 mg/dL suggests reduced renal function. The nurse
must notify the provider before making any changes, as dose escalation could
precipitate acute kidney injury or life-threatening hyperkalemia. Option A risks
worsening renal function and hyperkalemia. Option B could further alter electrolytes.
Option D is inappropriate without provider orders.
Q2: A 72-year-old female with HFrEF (EF 35%) is admitted with acute decompensated
heart failure. She has 3+ pitting edema, crackles bilaterally, and an S3 gallop. Vital signs:
BP 98/62, HR 112, RR 26, SpO2 88% on room air. Which medication should the nurse
anticipate administering first?
A. Digoxin 0.25 mg IV push
B. Furosemide 40 mg IV push [CORRECT]
,C. Metoprolol 25 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: In acute decompensated heart failure with volume overload (evidenced by S3
gallop, crackles, and edema), IV loop diuretics are first-line to reduce preload and
improve symptoms. Furosemide promotes rapid diuresis, reducing pulmonary
congestion. Digoxin is not first-line for acute decompensation. Metoprolol, a
beta-blocker, could worsen acute heart failure and hypotension. Enalapril may be held in
hypotensive patients until hemodynamic stabilization.
Q3: A 55-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 148/92, HR 96, RR 22. The 12-lead EKG
shows ST-segment elevation in leads V1-V4. Which is the priority nursing action?
A. Administer aspirin 325 mg chewable and establish IV access [CORRECT]
B. Prepare the patient for immediate stress testing
C. Administer sublingual nitroglycerin every 5 minutes × 3 without other interventions
D. Obtain a chest X-ray before giving any medications
Correct Answer: A
Rationale: This patient is experiencing an ST-elevation myocardial infarction (STEMI).
The priority is immediate aspirin administration (if not allergic) to inhibit platelet
aggregation and prevent further thrombus formation, along with IV access for
anticipated reperfusion therapy. Stress testing is contraindicated in acute MI.
Nitroglycerin alone without aspirin and without ruling out right ventricular infarction
could cause hypotension. Chest X-ray is not a priority over immediate cardiac
intervention.
Q4: A patient with atrial fibrillation is started on warfarin therapy. The nurse is educating
the patient about dietary considerations. Which statement by the patient indicates
understanding of the teaching?
A. "I should completely avoid all green leafy vegetables"
B. "I need to keep my vitamin K intake consistent from day to day" [CORRECT]
C. "I can double my vegetable intake on weekends"
,D. "Cranberry juice will enhance my warfarin effect safely"
Correct Answer: B
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors. The key dietary
teaching is maintaining consistent vitamin K intake rather than avoiding it entirely, as
fluctuations destabilize INR. Complete avoidance (Option A) is unnecessary and
nutritionally deficient. Variable intake (Option C) causes unpredictable INR fluctuations.
Cranberry juice can potentiate warfarin and increase bleeding risk, making Option D
dangerous.
Q5: A patient post-cardiac catheterization via the right femoral artery has been on
bedrest for 4 hours. The nurse assesses the site and finds a 5 cm hematoma, the pedal
pulse is diminished compared to the pre-procedure assessment, and the foot is cool
and pale. What is the priority nursing action?
A. Apply a pressure dressing and notify the provider immediately [CORRECT]
B. Elevate the leg above heart level to reduce swelling
C. Remove the existing dressing to assess the hematoma size
D. Document the findings and reassess in 30 minutes
Correct Answer: A
Rationale: Diminished pedal pulse, cool/pale extremity, and expanding hematoma
indicate possible arterial compromise or pseudoaneurysm formation
post-catheterization. This is a vascular emergency requiring immediate pressure
application and provider notification to prevent limb ischemia. Elevating the leg (Option
B) could further compromise arterial flow. Removing the dressing (Option C) may
worsen bleeding. Delaying intervention (Option D) risks permanent vascular damage.
Q6: A 60-year-old with severe aortic stenosis becomes dizzy and hypotensive (BP
82/50) after receiving sublingual nitroglycerin for chest pain. Which pathophysiological
concept explains this reaction?
A. Nitroglycerin reduces afterload, which is essential in aortic stenosis
B. Nitroglycerin causes venodilation and reduced preload, which the stenotic valve
cannot compensate for [CORRECT]
C. Nitroglycerin increases myocardial oxygen demand in aortic stenosis
, D. Nitroglycerin causes coronary vasospasm in valvular disease
Correct Answer: B
Rationale: In severe aortic stenosis, the fixed outflow obstruction prevents
compensatory increases in cardiac output. Nitroglycerin causes venodilation, reducing
preload and ventricular filling. The stenotic valve cannot accommodate the reduced
volume, leading to profound hypotension and syncope. Nitroglycerin does not increase
oxygen demand (Option C) or cause vasospasm (Option D). Afterload reduction (Option
A) is not the primary issue; preload dependence is.
Q7: A patient with a newly placed permanent pacemaker asks when they can resume
driving. Which response by the nurse is most appropriate?
A. "You can drive as soon as you feel comfortable"
B. "You should not drive until you receive clearance from your cardiologist, typically after
the first device check" [CORRECT]
C. "You can resume driving in 1 week if you have no complications"
D. "Driving restrictions apply only to commercial vehicles"
Correct Answer: B
Rationale: Post-pacemaker implantation driving restrictions vary by institutional policy
and patient condition, but generally require cardiology clearance after the first device
interrogation (typically 2-6 weeks) to ensure proper lead placement and function. Option
A is unsafe as it lacks medical oversight. Option C provides an arbitrary timeline without
individual assessment. Option D is incorrect as private vehicle operation may also be
restricted initially.
Q8: A nurse is caring for a patient with hypertrophic cardiomyopathy (HCM). Which
activity recommendation is most appropriate?
A. Encourage vigorous aerobic exercise to improve cardiac output
B. Recommend participation in competitive sports to build cardiovascular endurance
C. Advise moderate activity while avoiding strenuous exercise and dehydration
[CORRECT]
D. Prescribe bedrest to prevent all physical exertion
Questions & Verified Answers | 100% Correct | Already
Graded 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 clinic with a blood
pressure of 178/96 mmHg. He currently takes lisinopril 10 mg daily and reports
occasional dizziness. His serum creatinine is 1.4 mg/dL and potassium is 5.1 mEq/L.
Which nursing intervention is the priority before initiating any medication changes?
A. Increase lisinopril to 20 mg daily to achieve goal BP
B. Administer a thiazide diuretic to enhance antihypertensive effect
C. Notify the provider about the elevated potassium and creatinine before adjusting ACE
inhibitor therapy [CORRECT]
D. Recommend the patient stop lisinopril immediately due to dizziness
Correct Answer: C
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia and worsen renal
function, especially in older adults. The patient's potassium of 5.1 mEq/L is at the upper
limit of normal, and creatinine of 1.4 mg/dL suggests reduced renal function. The nurse
must notify the provider before making any changes, as dose escalation could
precipitate acute kidney injury or life-threatening hyperkalemia. Option A risks
worsening renal function and hyperkalemia. Option B could further alter electrolytes.
Option D is inappropriate without provider orders.
Q2: A 72-year-old female with HFrEF (EF 35%) is admitted with acute decompensated
heart failure. She has 3+ pitting edema, crackles bilaterally, and an S3 gallop. Vital signs:
BP 98/62, HR 112, RR 26, SpO2 88% on room air. Which medication should the nurse
anticipate administering first?
A. Digoxin 0.25 mg IV push
B. Furosemide 40 mg IV push [CORRECT]
,C. Metoprolol 25 mg PO
D. Enalapril 5 mg PO
Correct Answer: B
Rationale: In acute decompensated heart failure with volume overload (evidenced by S3
gallop, crackles, and edema), IV loop diuretics are first-line to reduce preload and
improve symptoms. Furosemide promotes rapid diuresis, reducing pulmonary
congestion. Digoxin is not first-line for acute decompensation. Metoprolol, a
beta-blocker, could worsen acute heart failure and hypotension. Enalapril may be held in
hypotensive patients until hemodynamic stabilization.
Q3: A 55-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. Vital signs: BP 148/92, HR 96, RR 22. The 12-lead EKG
shows ST-segment elevation in leads V1-V4. Which is the priority nursing action?
A. Administer aspirin 325 mg chewable and establish IV access [CORRECT]
B. Prepare the patient for immediate stress testing
C. Administer sublingual nitroglycerin every 5 minutes × 3 without other interventions
D. Obtain a chest X-ray before giving any medications
Correct Answer: A
Rationale: This patient is experiencing an ST-elevation myocardial infarction (STEMI).
The priority is immediate aspirin administration (if not allergic) to inhibit platelet
aggregation and prevent further thrombus formation, along with IV access for
anticipated reperfusion therapy. Stress testing is contraindicated in acute MI.
Nitroglycerin alone without aspirin and without ruling out right ventricular infarction
could cause hypotension. Chest X-ray is not a priority over immediate cardiac
intervention.
Q4: A patient with atrial fibrillation is started on warfarin therapy. The nurse is educating
the patient about dietary considerations. Which statement by the patient indicates
understanding of the teaching?
A. "I should completely avoid all green leafy vegetables"
B. "I need to keep my vitamin K intake consistent from day to day" [CORRECT]
C. "I can double my vegetable intake on weekends"
,D. "Cranberry juice will enhance my warfarin effect safely"
Correct Answer: B
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors. The key dietary
teaching is maintaining consistent vitamin K intake rather than avoiding it entirely, as
fluctuations destabilize INR. Complete avoidance (Option A) is unnecessary and
nutritionally deficient. Variable intake (Option C) causes unpredictable INR fluctuations.
Cranberry juice can potentiate warfarin and increase bleeding risk, making Option D
dangerous.
Q5: A patient post-cardiac catheterization via the right femoral artery has been on
bedrest for 4 hours. The nurse assesses the site and finds a 5 cm hematoma, the pedal
pulse is diminished compared to the pre-procedure assessment, and the foot is cool
and pale. What is the priority nursing action?
A. Apply a pressure dressing and notify the provider immediately [CORRECT]
B. Elevate the leg above heart level to reduce swelling
C. Remove the existing dressing to assess the hematoma size
D. Document the findings and reassess in 30 minutes
Correct Answer: A
Rationale: Diminished pedal pulse, cool/pale extremity, and expanding hematoma
indicate possible arterial compromise or pseudoaneurysm formation
post-catheterization. This is a vascular emergency requiring immediate pressure
application and provider notification to prevent limb ischemia. Elevating the leg (Option
B) could further compromise arterial flow. Removing the dressing (Option C) may
worsen bleeding. Delaying intervention (Option D) risks permanent vascular damage.
Q6: A 60-year-old with severe aortic stenosis becomes dizzy and hypotensive (BP
82/50) after receiving sublingual nitroglycerin for chest pain. Which pathophysiological
concept explains this reaction?
A. Nitroglycerin reduces afterload, which is essential in aortic stenosis
B. Nitroglycerin causes venodilation and reduced preload, which the stenotic valve
cannot compensate for [CORRECT]
C. Nitroglycerin increases myocardial oxygen demand in aortic stenosis
, D. Nitroglycerin causes coronary vasospasm in valvular disease
Correct Answer: B
Rationale: In severe aortic stenosis, the fixed outflow obstruction prevents
compensatory increases in cardiac output. Nitroglycerin causes venodilation, reducing
preload and ventricular filling. The stenotic valve cannot accommodate the reduced
volume, leading to profound hypotension and syncope. Nitroglycerin does not increase
oxygen demand (Option C) or cause vasospasm (Option D). Afterload reduction (Option
A) is not the primary issue; preload dependence is.
Q7: A patient with a newly placed permanent pacemaker asks when they can resume
driving. Which response by the nurse is most appropriate?
A. "You can drive as soon as you feel comfortable"
B. "You should not drive until you receive clearance from your cardiologist, typically after
the first device check" [CORRECT]
C. "You can resume driving in 1 week if you have no complications"
D. "Driving restrictions apply only to commercial vehicles"
Correct Answer: B
Rationale: Post-pacemaker implantation driving restrictions vary by institutional policy
and patient condition, but generally require cardiology clearance after the first device
interrogation (typically 2-6 weeks) to ensure proper lead placement and function. Option
A is unsafe as it lacks medical oversight. Option C provides an arbitrary timeline without
individual assessment. Option D is incorrect as private vehicle operation may also be
restricted initially.
Q8: A nurse is caring for a patient with hypertrophic cardiomyopathy (HCM). Which
activity recommendation is most appropriate?
A. Encourage vigorous aerobic exercise to improve cardiac output
B. Recommend participation in competitive sports to build cardiovascular endurance
C. Advise moderate activity while avoiding strenuous exercise and dehydration
[CORRECT]
D. Prescribe bedrest to prevent all physical exertion
