BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct |
Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266 Med Surg Exam
(Latest 2026/2027) Questions and
Verified Answers | 100% Correct |
Grade A - Nightingale 2026/2027 -
2026/2027 Official Exam
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders
Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q1 Question 1 of 100
A 68-year-old male is admitted to the telemetry unit with crushing substernal chest pain radiating to
the left arm, diaphoresis, and dyspnea that began 45 minutes ago. The 12-lead ECG reveals
ST-segment elevation in leads II, III, and aVF. Which pathophysiological process is occurring in this
patient?
A. Ischemia of the inferior wall of the left ventricle due to right coronary artery occlusion
B. Ischemia of the anterior wall due to left anterior descending artery occlusion
C. Ischemia of the lateral wall due to circumflex artery occlusion
D. Pericardial inflammation causing diffuse ST elevation across all leads
Correct Answer: A
Rationale:
ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is most commonly
caused by occlusion of the right coronary artery. Choice B is incorrect because LAD occlusion would
produce ST elevation in V1-V4 (anterior), and choice C would show changes in I, aVL, V5-V6 (lateral).
Q2 Question 2 of 100
A 72-year-old female with a history of hypertension and atrial fibrillation is admitted with rightsided
weakness and aphasia that began 2 hours ago. The CT scan shows no hemorrhage. Which
medication should the nurse anticipate administering within the therapeutic window?
A. Intravenous metoprolol to control heart rate
B. Subcutaneous enoxaparin to prevent clot extension
C. Intravenous alteplase (tPA) to dissolve the thrombus
D. Oral clopidogrel to prevent future thrombotic events
Correct Answer: C
Rationale:
The patient is experiencing an acute ischemic stroke within the 3-4.5 hour window for IV thrombolytic
therapy with alteplase. Choice A treats rate control but not the stroke, choice C (enoxaparin) is
contraindicated acutely post-stroke, and choice D is for secondary prevention, not acute management.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q3 Question 3 of 100
A 58-year-old male with chronic heart failure (NYHA Class III) is admitted with a 5-pound weight gain
over 3 days, bilateral crackles in the lung bases, and 2+ pitting edema of the ankles. Which
pathophysiological change explains the weight gain and edema?
A. Decreased afterload causing increased cardiac output
B. Increased myocardial contractility causing sodium wasting
C. Increased pulmonary vascular resistance causing right-to-left shunting
D. Decreased renal perfusion activating the renin-angiotensin-aldosterone system
Correct Answer: D
Rationale:
In heart failure, decreased cardiac output reduces renal perfusion, activating the RAAS and causing sodium
and water retention that manifests as weight gain and edema. Choice A is incorrect because afterload
typically increases, not decreases, and choice D is the opposite of the actual pathophysiology.
Q4 Question 4 of 100
A 65-year-old male presents to the emergency department with sudden onset of tearing chest pain
that radiates to the back, blood pressure 180/110 in the right arm and 145/90 in the left arm, and a
widened mediastinum on chest X-ray. Which condition should the nurse suspect?
A. Acute myocardial infarction of the anterior wall
B. Pulmonary embolism with right ventricular strain
C. Acute aortic dissection
D. Tension pneumothorax
Correct Answer: C
Rationale:
Tearing chest pain radiating to the back, blood pressure discrepancy between arms, and a widened
mediastinum on chest X-ray are classic findings of acute aortic dissection. Choice A would show ECG
changes and not typically radiate to the back, and choice D would show tracheal deviation and absent
breath sounds.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q5 Question 5 of 100
A 60-year-old female is admitted with dyspnea, orthopnea, and pink frothy sputum. Assessment
reveals bilateral crackles, S3 heart sound, and respiratory rate 32. Which nursing intervention should
be implemented first?
A. Administer prescribed sublingual nitroglycerin
B. Place the patient in high Fowler's position and apply oxygen
C. Insert a large-bore IV for diuretic administration
D. Obtain a 12-lead ECG to rule out myocardial infarction
Correct Answer: B
Rationale:
The patient is in acute pulmonary edema; placing her in high Fowler's position reduces venous return and
immediately decreases pulmonary congestion while supplemental oxygen addresses hypoxemia. While
diuretics and ECG are needed, positioning and oxygenation are the priority first actions to stabilize the
patient.
Q6 Question 6 of 100
A 70-year-old male with a mechanical mitral valve replacement is admitted with signs of right-sided
heart failure and a new holosystolic murmur at the apex. Echocardiography reveals a perivalvular
leak. Which finding would the nurse expect to support this diagnosis?
A. Decreased BNP level
B. Hemoglobin of 16 g/dL
C. Elevated BNP and pulmonary congestion on chest X-ray
D. Decreased jugular venous distension
Correct Answer: C
Rationale:
A perivalvular leak causes volume overload of the left atrium and ventricle, increasing BNP due to
myocardial stretch and producing pulmonary congestion. Choice A is wrong because BNP rises with heart
failure, choice B is unrelated, and choice D is opposite because JVD typically increases with right-sided
failure.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266 Med Surg Exam
(Latest 2026/2027) Questions and
Verified Answers | 100% Correct |
Grade A - Nightingale 2026/2027 -
2026/2027 Official Exam
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular & Respiratory Disorders
Neurological & Musculoskeletal Disorders
Gastrointestinal & Renal Systems Complex Multisystem Management
Endocrine & Metabolic Conditions
COVER PAGE - 1
, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q1 Question 1 of 100
A 68-year-old male is admitted to the telemetry unit with crushing substernal chest pain radiating to
the left arm, diaphoresis, and dyspnea that began 45 minutes ago. The 12-lead ECG reveals
ST-segment elevation in leads II, III, and aVF. Which pathophysiological process is occurring in this
patient?
A. Ischemia of the inferior wall of the left ventricle due to right coronary artery occlusion
B. Ischemia of the anterior wall due to left anterior descending artery occlusion
C. Ischemia of the lateral wall due to circumflex artery occlusion
D. Pericardial inflammation causing diffuse ST elevation across all leads
Correct Answer: A
Rationale:
ST elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction, which is most commonly
caused by occlusion of the right coronary artery. Choice B is incorrect because LAD occlusion would
produce ST elevation in V1-V4 (anterior), and choice C would show changes in I, aVL, V5-V6 (lateral).
Q2 Question 2 of 100
A 72-year-old female with a history of hypertension and atrial fibrillation is admitted with rightsided
weakness and aphasia that began 2 hours ago. The CT scan shows no hemorrhage. Which
medication should the nurse anticipate administering within the therapeutic window?
A. Intravenous metoprolol to control heart rate
B. Subcutaneous enoxaparin to prevent clot extension
C. Intravenous alteplase (tPA) to dissolve the thrombus
D. Oral clopidogrel to prevent future thrombotic events
Correct Answer: C
Rationale:
The patient is experiencing an acute ischemic stroke within the 3-4.5 hour window for IV thrombolytic
therapy with alteplase. Choice A treats rate control but not the stroke, choice C (enoxaparin) is
contraindicated acutely post-stroke, and choice D is for secondary prevention, not acute management.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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Score: Exam
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, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q3 Question 3 of 100
A 58-year-old male with chronic heart failure (NYHA Class III) is admitted with a 5-pound weight gain
over 3 days, bilateral crackles in the lung bases, and 2+ pitting edema of the ankles. Which
pathophysiological change explains the weight gain and edema?
A. Decreased afterload causing increased cardiac output
B. Increased myocardial contractility causing sodium wasting
C. Increased pulmonary vascular resistance causing right-to-left shunting
D. Decreased renal perfusion activating the renin-angiotensin-aldosterone system
Correct Answer: D
Rationale:
In heart failure, decreased cardiac output reduces renal perfusion, activating the RAAS and causing sodium
and water retention that manifests as weight gain and edema. Choice A is incorrect because afterload
typically increases, not decreases, and choice D is the opposite of the actual pathophysiology.
Q4 Question 4 of 100
A 65-year-old male presents to the emergency department with sudden onset of tearing chest pain
that radiates to the back, blood pressure 180/110 in the right arm and 145/90 in the left arm, and a
widened mediastinum on chest X-ray. Which condition should the nurse suspect?
A. Acute myocardial infarction of the anterior wall
B. Pulmonary embolism with right ventricular strain
C. Acute aortic dissection
D. Tension pneumothorax
Correct Answer: C
Rationale:
Tearing chest pain radiating to the back, blood pressure discrepancy between arms, and a widened
mediastinum on chest X-ray are classic findings of acute aortic dissection. Choice A would show ECG
changes and not typically radiate to the back, and choice D would show tracheal deviation and absent
breath sounds.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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, SECTION 1 | Cardiovascular & Respiratory Disorders | Q1-Q20 | BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified
Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027 Official Exam 2026/2027
Q5 Question 5 of 100
A 60-year-old female is admitted with dyspnea, orthopnea, and pink frothy sputum. Assessment
reveals bilateral crackles, S3 heart sound, and respiratory rate 32. Which nursing intervention should
be implemented first?
A. Administer prescribed sublingual nitroglycerin
B. Place the patient in high Fowler's position and apply oxygen
C. Insert a large-bore IV for diuretic administration
D. Obtain a 12-lead ECG to rule out myocardial infarction
Correct Answer: B
Rationale:
The patient is in acute pulmonary edema; placing her in high Fowler's position reduces venous return and
immediately decreases pulmonary congestion while supplemental oxygen addresses hypoxemia. While
diuretics and ECG are needed, positioning and oxygenation are the priority first actions to stabilize the
patient.
Q6 Question 6 of 100
A 70-year-old male with a mechanical mitral valve replacement is admitted with signs of right-sided
heart failure and a new holosystolic murmur at the apex. Echocardiography reveals a perivalvular
leak. Which finding would the nurse expect to support this diagnosis?
A. Decreased BNP level
B. Hemoglobin of 16 g/dL
C. Elevated BNP and pulmonary congestion on chest X-ray
D. Decreased jugular venous distension
Correct Answer: C
Rationale:
A perivalvular leak causes volume overload of the left atrium and ventricle, increasing BNP due to
myocardial stretch and producing pulmonary congestion. Choice A is wrong because BNP rises with heart
failure, choice B is unrelated, and choice D is opposite because JVD typically increases with right-sided
failure.
BSN HESI 266 Med Surg Exam (Latest 2026/2027) Questions and Verified Answers | 100% Correct | Grade A - Nightingale 2026/2027 - 2026/2027
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