Nightingale College BSN HESI 266 Med Surg Exam
Comprehensive Practice Test Bank | 2 Exam Versions
2026/2027 Academic Year | 200 Questions with
Answers & Detailed Rationales
Instructions: This comprehensive examination consists of 200 multiple-choice
questions designed to assess your knowledge and readiness for the Nightingale
College BSN HESI 266 Med Surg examination. Select the best answer for each
question. All questions are weighted equally.
Time Allowed: 4 Hours (2 versions of 100 questions each)
Passing Score: Varies by institution (typically 850+ on HESI scale)
VERSION 1: MEDICAL-SURGICAL NURSING
(100 Questions)
SECTION 1: CARDIAC & HEMODYNAMICS
(25 Questions)
1. A client with heart failure reports a 3-pound weight gain in 24 hours. What
should the nurse do first?
• A) Administer furosemide as prescribed
• B) Assess for peripheral edema
• C) Restrict fluid intake
• D) Notify the healthcare provider
Answer: B
Rationale: Weight gain in heart failure suggests fluid retention; assessing edema
,provides immediate clinical data to guide further action. The nurse must gather
assessment data before implementing interventions or notifying the provider.
2. A client with a history of atrial fibrillation reports dizziness. What should
the nurse assess first?
• A) Blood pressure
• B) Heart rate
• C) Oxygen saturation
• D) Blood glucose
Answer: B
Rationale: Dizziness in atrial fibrillation may indicate an irregular or rapid heart
rate, requiring immediate assessment. The ventricular rate directly affects cardiac
output and cerebral perfusion.
3. A client with a history of atrial fibrillation is receiving warfarin. Which
laboratory value should the nurse monitor?
• A) Platelet count
• B) INR
• C) aPTT
• D) Hemoglobin
Answer: B
Rationale: INR (International Normalized Ratio) is the standard monitoring test
for warfarin therapy. The therapeutic range for atrial fibrillation is typically 2.0-
3.0.
4. A client with heart failure is prescribed furosemide. Which instruction
should the nurse reinforce?
• A) Take the medication at bedtime
• B) Take the medication first thing in the morning
, • C) Take with a high-potassium meal
• D) Take on an empty stomach
Answer: B
Rationale: Furosemide should be taken in the morning to avoid nocturia and sleep
disturbance. The diuretic effect peaks within 1-2 hours.
5. A client experiencing uncontrolled atrial fibrillation is admitted to the
telemetry unit. What initial medication should the nurse anticipate
administering?
• A) Lidocaine
• B) Procainamide
• C) Phenytoin
• D) Digoxin
Answer: D
Rationale: Digoxin is administered for uncontrolled, symptomatic atrial
fibrillation to slow ventricular rate by prolonging the refractory period of the AV
node.
6. Based on the analysis of a client's atrial fibrillation, the nurse should
prepare the client for which treatment protocol?
• A) Diuretic therapy
• B) Pacemaker implantation
• C) Anticoagulation therapy
• D) Cardiac catheterization
Answer: C
Rationale: Anticoagulation therapy is essential in atrial fibrillation to prevent
thrombus formation and reduce the risk of stroke. Warfarin or direct oral
anticoagulants are commonly used.
, 7. A client with heart failure is prescribed an ACE inhibitor. The nurse should
monitor for which adverse effect?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hyperglycemia
• D) Angioedema
Answer: D
Rationale: Angioedema is a potentially life-threatening adverse effect of ACE
inhibitors. Other adverse effects include hyperkalemia, cough, and hypotension.
8. A client is diagnosed with left-sided heart failure. Which assessment finding
is most consistent with this condition?
• A) Peripheral edema
• B) Jugular venous distension
• C) Crackles in the lungs
• D) Ascites
Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
crackles in the lungs, dyspnea, and orthopnea. Peripheral edema and JVD are
signs of right-sided heart failure.
9. A client with a myocardial infarction is prescribed morphine. The nurse
should monitor for which adverse effect?
• A) Hypertension
• B) Respiratory depression
• C) Tachycardia
• D) Hyperthermia
Comprehensive Practice Test Bank | 2 Exam Versions
2026/2027 Academic Year | 200 Questions with
Answers & Detailed Rationales
Instructions: This comprehensive examination consists of 200 multiple-choice
questions designed to assess your knowledge and readiness for the Nightingale
College BSN HESI 266 Med Surg examination. Select the best answer for each
question. All questions are weighted equally.
Time Allowed: 4 Hours (2 versions of 100 questions each)
Passing Score: Varies by institution (typically 850+ on HESI scale)
VERSION 1: MEDICAL-SURGICAL NURSING
(100 Questions)
SECTION 1: CARDIAC & HEMODYNAMICS
(25 Questions)
1. A client with heart failure reports a 3-pound weight gain in 24 hours. What
should the nurse do first?
• A) Administer furosemide as prescribed
• B) Assess for peripheral edema
• C) Restrict fluid intake
• D) Notify the healthcare provider
Answer: B
Rationale: Weight gain in heart failure suggests fluid retention; assessing edema
,provides immediate clinical data to guide further action. The nurse must gather
assessment data before implementing interventions or notifying the provider.
2. A client with a history of atrial fibrillation reports dizziness. What should
the nurse assess first?
• A) Blood pressure
• B) Heart rate
• C) Oxygen saturation
• D) Blood glucose
Answer: B
Rationale: Dizziness in atrial fibrillation may indicate an irregular or rapid heart
rate, requiring immediate assessment. The ventricular rate directly affects cardiac
output and cerebral perfusion.
3. A client with a history of atrial fibrillation is receiving warfarin. Which
laboratory value should the nurse monitor?
• A) Platelet count
• B) INR
• C) aPTT
• D) Hemoglobin
Answer: B
Rationale: INR (International Normalized Ratio) is the standard monitoring test
for warfarin therapy. The therapeutic range for atrial fibrillation is typically 2.0-
3.0.
4. A client with heart failure is prescribed furosemide. Which instruction
should the nurse reinforce?
• A) Take the medication at bedtime
• B) Take the medication first thing in the morning
, • C) Take with a high-potassium meal
• D) Take on an empty stomach
Answer: B
Rationale: Furosemide should be taken in the morning to avoid nocturia and sleep
disturbance. The diuretic effect peaks within 1-2 hours.
5. A client experiencing uncontrolled atrial fibrillation is admitted to the
telemetry unit. What initial medication should the nurse anticipate
administering?
• A) Lidocaine
• B) Procainamide
• C) Phenytoin
• D) Digoxin
Answer: D
Rationale: Digoxin is administered for uncontrolled, symptomatic atrial
fibrillation to slow ventricular rate by prolonging the refractory period of the AV
node.
6. Based on the analysis of a client's atrial fibrillation, the nurse should
prepare the client for which treatment protocol?
• A) Diuretic therapy
• B) Pacemaker implantation
• C) Anticoagulation therapy
• D) Cardiac catheterization
Answer: C
Rationale: Anticoagulation therapy is essential in atrial fibrillation to prevent
thrombus formation and reduce the risk of stroke. Warfarin or direct oral
anticoagulants are commonly used.
, 7. A client with heart failure is prescribed an ACE inhibitor. The nurse should
monitor for which adverse effect?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hyperglycemia
• D) Angioedema
Answer: D
Rationale: Angioedema is a potentially life-threatening adverse effect of ACE
inhibitors. Other adverse effects include hyperkalemia, cough, and hypotension.
8. A client is diagnosed with left-sided heart failure. Which assessment finding
is most consistent with this condition?
• A) Peripheral edema
• B) Jugular venous distension
• C) Crackles in the lungs
• D) Ascites
Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, leading to
crackles in the lungs, dyspnea, and orthopnea. Peripheral edema and JVD are
signs of right-sided heart failure.
9. A client with a myocardial infarction is prescribed morphine. The nurse
should monitor for which adverse effect?
• A) Hypertension
• B) Respiratory depression
• C) Tachycardia
• D) Hyperthermia
