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BSN 266 HESI Med Surg Exam Test Bank
Actual 2026/2027 – Complete Exam-Style
Questions | 100% Verified – Pass Guaranteed
– A+ Graded
EXAM OVERVIEW
The BSN 266 HESI Medical-Surgical Nursing Exam is a comprehensive assessment
designed for nursing students at Nightingale College and other nursing programs.
This examination evaluates students' clinical reasoning, prioritization skills, and
medical-surgical nursing knowledge essential for successful nursing practice. The
exam is specifically formatted to include Next Generation NCLEX (NGN)-style
questions with case scenarios that test clinical judgment and decision-making
capabilities
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-60)
Question 1: A client who underwent cardiac stent placement 4 days ago arrives to
the emergency department reporting sudden onset of chest pressure and shortness
of breath. Which action should the nurse take first?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead electrocardiogram (ECG) and begin continuous cardiac
monitoring
C) Give oxygen at 2 liters per minute via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure and shortness of breath after recent
cardiac stenting is at high risk for acute stent thrombosis or myocardial infarction
(MI) . Immediate acquisition of a 12-lead ECG is critical to assess for ischemic
changes and to prioritize timely reperfusion therapy if needed . Continuous cardiac
monitoring is essential to detect life-threatening arrhythmias. While oxygen and
nitroglycerin may be administered, assessment data guides further interventions.
Immediate preparation for catheterization is premature before diagnostic
confirmation .
,2|Page
Question 2: A client with a history of myocardial infarction reports chest pain. What
should the nurse do first?
A) Administer nitroglycerin sublingually
B) Obtain a 12-lead ECG
C) Assess the client's pain characteristics and vital signs
D) Notify the healthcare provider
Answer: C
Rationale: The priority nursing action is to assess the client's pain characteristics,
severity, location, and vital signs to determine if this is angina or a new MI. This
assessment guides appropriate interventions and determines urgency. While
nitroglycerin and ECG are important, they follow the initial comprehensive
assessment . Notification of the provider occurs after assessment.
Question 3: 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. Atrial fibrillation with rapid ventricular
response can cause decreased cardiac output, leading to dizziness, syncope, and
hypotension. The nurse should first assess the apical pulse for rate and regularity.
Blood pressure and oxygen saturation are also important but follow heart rate
assessment .
Question 4: 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
,3|Page
Answer: B
Rationale: Warfarin therapy requires monitoring of INR (International Normalized
Ratio) to maintain therapeutic levels (typically 2.0-3.0 for atrial fibrillation). INR
values outside the therapeutic range increase risk of bleeding (too high) or
thrombosis (too low) . aPTT is monitored for heparin therapy; platelet count and
hemoglobin are monitored for bleeding complications but are not the primary
monitoring parameter for warfarin.
Question 5: A client presents with chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which medication should the nurse anticipate being
prescribed after provider assessment?
A) Fentanyl
B) Hydromorphone
C) Oxycodone
D) Morphine
Answer: D
Rationale: Morphine is the opioid of choice for chest pain in suspected MI because
it reduces preload and afterload, decreases myocardial oxygen demand, and
alleviates pain and anxiety . Fentanyl may be used as an alternative in some
protocols, but morphine is the traditional first-line opioid. Hydromorphone and
oxycodone are not the preferred agents for acute MI pain management.
Question 6: A client with peripheral vascular disease (PVD) of the lower extremities
tells the nurse that walking is painful. The nurse should recommend which of the
following?
A) "Avoid walking to prevent leg pain."
B) "Walk until the pain begins, then rest until it resolves."
C) "Take pain medication before walking."
D) "Only walk in the evening when pain is less."
Answer: B
Rationale: For clients with PVD, supervised walking programs are recommended
where the client walks until pain begins, rests until it resolves, and then walks
again. This builds collateral circulation over time. Avoiding walking worsens the
condition; pain medication before walking does not address the underlying
ischemia.
, 4|Page
Question 7: A client has just returned from a cardiac catheterization via the femoral
artery. Which assessment finding requires immediate nursing action?
A) Dressing is dry and intact
B) Pedal pulses are palpable bilaterally
C) The client reports back pain
D) The groin site is slightly swollen
Answer: C
Rationale: Back pain after femoral artery catheterization may
indicate retroperitoneal bleeding , a serious complication requiring immediate
assessment. The other options are normal or expected findings. Dry dressing,
palpable pulses, and slight swelling are all acceptable post-procedure findings.
Question 8: A client is prescribed digoxin for heart failure. Which finding suggests
digoxin toxicity?
A) Heart rate of 68 bpm
B) Green-yellow halos around lights
C) Blood pressure of 120/80 mmHg
D) Weight gain of 2 pounds in 2 days
Answer: B
Rationale: Visual disturbances such as green-yellow halos around lights are classic
signs of digoxin toxicity . Other signs include nausea, vomiting, bradycardia, and
cardiac dysrhythmias. A heart rate of 68 bpm is within normal limits; blood
pressure of 120/80 is normal; weight gain may indicate worsening heart failure but
is not specific to digoxin toxicity.
Question 9: A client with heart failure is prescribed furosemide (Lasix). The nurse
should monitor for which electrolyte imbalance?
A) Hyperkalemia
B) Hyponatremia
C) Hypokalemia
D) Hypercalcemia
BSN 266 HESI Med Surg Exam Test Bank
Actual 2026/2027 – Complete Exam-Style
Questions | 100% Verified – Pass Guaranteed
– A+ Graded
EXAM OVERVIEW
The BSN 266 HESI Medical-Surgical Nursing Exam is a comprehensive assessment
designed for nursing students at Nightingale College and other nursing programs.
This examination evaluates students' clinical reasoning, prioritization skills, and
medical-surgical nursing knowledge essential for successful nursing practice. The
exam is specifically formatted to include Next Generation NCLEX (NGN)-style
questions with case scenarios that test clinical judgment and decision-making
capabilities
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-60)
Question 1: A client who underwent cardiac stent placement 4 days ago arrives to
the emergency department reporting sudden onset of chest pressure and shortness
of breath. Which action should the nurse take first?
A) Administer prescribed nitroglycerin sublingually
B) Obtain a 12-lead electrocardiogram (ECG) and begin continuous cardiac
monitoring
C) Give oxygen at 2 liters per minute via nasal cannula
D) Prepare the client for immediate cardiac catheterization
Answer: B
Rationale: A client with sudden chest pressure and shortness of breath after recent
cardiac stenting is at high risk for acute stent thrombosis or myocardial infarction
(MI) . Immediate acquisition of a 12-lead ECG is critical to assess for ischemic
changes and to prioritize timely reperfusion therapy if needed . Continuous cardiac
monitoring is essential to detect life-threatening arrhythmias. While oxygen and
nitroglycerin may be administered, assessment data guides further interventions.
Immediate preparation for catheterization is premature before diagnostic
confirmation .
,2|Page
Question 2: A client with a history of myocardial infarction reports chest pain. What
should the nurse do first?
A) Administer nitroglycerin sublingually
B) Obtain a 12-lead ECG
C) Assess the client's pain characteristics and vital signs
D) Notify the healthcare provider
Answer: C
Rationale: The priority nursing action is to assess the client's pain characteristics,
severity, location, and vital signs to determine if this is angina or a new MI. This
assessment guides appropriate interventions and determines urgency. While
nitroglycerin and ECG are important, they follow the initial comprehensive
assessment . Notification of the provider occurs after assessment.
Question 3: 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. Atrial fibrillation with rapid ventricular
response can cause decreased cardiac output, leading to dizziness, syncope, and
hypotension. The nurse should first assess the apical pulse for rate and regularity.
Blood pressure and oxygen saturation are also important but follow heart rate
assessment .
Question 4: 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
,3|Page
Answer: B
Rationale: Warfarin therapy requires monitoring of INR (International Normalized
Ratio) to maintain therapeutic levels (typically 2.0-3.0 for atrial fibrillation). INR
values outside the therapeutic range increase risk of bleeding (too high) or
thrombosis (too low) . aPTT is monitored for heparin therapy; platelet count and
hemoglobin are monitored for bleeding complications but are not the primary
monitoring parameter for warfarin.
Question 5: A client presents with chest pain radiating to the left arm, shortness of
breath, and diaphoresis. Which medication should the nurse anticipate being
prescribed after provider assessment?
A) Fentanyl
B) Hydromorphone
C) Oxycodone
D) Morphine
Answer: D
Rationale: Morphine is the opioid of choice for chest pain in suspected MI because
it reduces preload and afterload, decreases myocardial oxygen demand, and
alleviates pain and anxiety . Fentanyl may be used as an alternative in some
protocols, but morphine is the traditional first-line opioid. Hydromorphone and
oxycodone are not the preferred agents for acute MI pain management.
Question 6: A client with peripheral vascular disease (PVD) of the lower extremities
tells the nurse that walking is painful. The nurse should recommend which of the
following?
A) "Avoid walking to prevent leg pain."
B) "Walk until the pain begins, then rest until it resolves."
C) "Take pain medication before walking."
D) "Only walk in the evening when pain is less."
Answer: B
Rationale: For clients with PVD, supervised walking programs are recommended
where the client walks until pain begins, rests until it resolves, and then walks
again. This builds collateral circulation over time. Avoiding walking worsens the
condition; pain medication before walking does not address the underlying
ischemia.
, 4|Page
Question 7: A client has just returned from a cardiac catheterization via the femoral
artery. Which assessment finding requires immediate nursing action?
A) Dressing is dry and intact
B) Pedal pulses are palpable bilaterally
C) The client reports back pain
D) The groin site is slightly swollen
Answer: C
Rationale: Back pain after femoral artery catheterization may
indicate retroperitoneal bleeding , a serious complication requiring immediate
assessment. The other options are normal or expected findings. Dry dressing,
palpable pulses, and slight swelling are all acceptable post-procedure findings.
Question 8: A client is prescribed digoxin for heart failure. Which finding suggests
digoxin toxicity?
A) Heart rate of 68 bpm
B) Green-yellow halos around lights
C) Blood pressure of 120/80 mmHg
D) Weight gain of 2 pounds in 2 days
Answer: B
Rationale: Visual disturbances such as green-yellow halos around lights are classic
signs of digoxin toxicity . Other signs include nausea, vomiting, bradycardia, and
cardiac dysrhythmias. A heart rate of 68 bpm is within normal limits; blood
pressure of 120/80 is normal; weight gain may indicate worsening heart failure but
is not specific to digoxin toxicity.
Question 9: A client with heart failure is prescribed furosemide (Lasix). The nurse
should monitor for which electrolyte imbalance?
A) Hyperkalemia
B) Hyponatremia
C) Hypokalemia
D) Hypercalcemia
