BSN 266 HESI Comprehensive Nursing Review (Latest 2026/2027 Update) | Complete Q&A with Verified Answers and Detailed Rationales | Medical-Surgical Nursing | A+ Graded | Nightingale College

INSTANT PDF DOWNLOAD – This comprehensive study guide is designed for the BSN 266 HESI Exam (Latest 2026/2027 Update) at Nightingale College, featuring verified practice questions with correct answers and detailed rationales . This resource covers all core content areas tested on the HESI 266 exam, including medical-surgical nursing (cardiovascular, respiratory, neurological, gastrointestinal, renal, endocrine, musculoskeletal, immunological, hematological, and integumentary disorders) , pharmacology (high-alert medications, drug calculations, side effect recognition), and clinical prioritization (ABCs, Maslow's Hierarchy) . Key topics include compartment syndrome management after leg casting (pale foot with sluggish capillary refill requiring immediate intervention), morphine sulfate patch overdose requiring narcotic antagonist administration , post-TURP discharge teaching (drink 3L of water daily) , and priority nursing interventions for chest tube continuous bubbling indicating an air leak requiring system assessment . Practice Questions from the Latest HESI 266 Exam: Q1: A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should the nurse implement? Answer: D. Give an antihypertensive medication. Rationale: Completed strokes usually produce neurologic deficits within an hour, and the client's current elevated blood pressure requires antihypertensive medication to prevent further damage. Most ischemic strokes occur during sleep when baseline blood pressure declines or blood viscosity increases due to minimal fluid intake . Q2: The nurse is caring for a client admitted with a tentative diagnosis of bacterial meningitis. Which diagnostic procedure should the nurse prepare the client for? Answer: A. Lumbar puncture. Rationale: A lumbar puncture is the definitive diagnostic procedure for bacterial meningitis, allowing cerebrospinal fluid (CSF) analysis to identify the causative organism. A lumbar puncture is the priority diagnostic test for suspected bacterial meningitis . Q3: A client with cirrhosis presents with 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema and ascites in a client with cirrhosis? Answer: B. Hypoalbuminemia that results in decreased colloidal oncotic pressure. Rationale: In cirrhosis, the liver's decreased synthesis of albumin leads to hypoalbuminemia. Albumin plays a crucial role in maintaining colloidal oncotic pressure; when decreased, fluid leaks out of blood vessels, resulting in edema and contributing to the development of ascites in the abdominal cavity . Q4: A client on a thiazide diuretic for the past six months has a serum potassium level of 3.0 mEq/L. The nurse anticipates which change in prescription for the client? Answer: C. A potassium supplement will be prescribed. Rationale: This client's potassium level is below the normal range (3.5-5.5 mEq/L). Thiazide diuretics often result in potassium loss, so a potassium supplement needs to be prescribed to restore a normal serum potassium level . Q5: Which action should the nurse implement first for a client with septic shock receiving norepinephrine who develops extravasation with blanching and swelling at the peripheral IV insertion site? Answer: B. Administer phentolamine 5-10 mg diluted in 10 mL normal saline as local subcutaneous infiltration. Rationale: Extravasation of vasopressors like norepinephrine can cause severe tissue ischemia and necrosis. The first-line treatment is local infiltration of phentolamine, an alpha-adrenergic blocker, to reverse vasoconstriction and prevent tissue damage. Warm compresses may worsen injury by increasing metabolic demand . Q6: A client with newly diagnosed Crohn's disease asks the nurse about dietary restrictions. How should the nurse respond? Answer: A. Describe the use of an elimination diet to find trigger foods. Rationale: Crohn's disease is a chronic inflammatory bowel disease where diet can trigger exacerbations. An elimination diet helps identify specific food triggers by systematically removing and reintroducing foods to pinpoint what aggravates symptoms. This client-centered, individualized approach is the most appropriate initial dietary guidance . Q7: A male client who had abdominal surgery 5 days ago and is hospitalized because of a surgical wound infection tells the nurse that he feels like his "insides just spilled out" when he coughed. What action should the nurse take first? Answer: A. Visualize the abdominal incision. Rationale: The client's description is consistent with wound dehiscence or evisceration. The nurse must first visualize the incision to confirm the finding before notifying the healthcare provider or preparing sterile supplies. Assessment is the priority nursing action . Q8: A client with multiple sclerosis (MS) is admitted to the medical unit and reports fatigue, muscle weakness, and diplopia. Which actions should the nurse implement to reduce the client's risk for falls? (Select All That Apply) Answer: A. Provide assistance to bedside commode; C. Schedule frequent rest periods; E. Teach to patch one eye while walking. Rationale: MS can cause muscle weakness, fatigue, and diplopia (double vision), increasing fall risk. Assisting with toileting prevents overexertion, frequent rest periods conserve energy, and patching one eye can reduce diplopia when ambulating. Warm baths (C) may exacerbate MS symptoms .