BSN 266 – HESI MEDICAL-SURGICAL EXAM NEWEST 2026/ 2027
ACTUAL EXAM| COMPLETE REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!) NIGHTINGALE COLLEGE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Question 1
A patient with heart failure is prescribed furosemide (Lasix). Which assessment
finding indicates the medication is having the desired therapeutic effect?
A) Weight gain of 2 kg in 24 hours
B) Decreased shortness of breath and clear lung sounds
C) Increased jugular venous distension
D) Blood pressure of 90/60 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. The desired effect is a reduction in pulmonary congestion, which
manifests as decreased dyspnea and clearer lung sounds on auscultation. Weight
gain (A) indicates fluid retention, the opposite of the desired effect. Increased JVD
(C) indicates worsening right-sided heart failure and fluid overload. While blood
pressure may drop, 90/60 (D) is hypotensive and could indicate excessive diuresis
or hypovolemia, which is an adverse effect, not the therapeutic goal.
Question 2
A patient with chronic stable angina is prescribed sublingual nitroglycerin. The
nurse instructs the patient to take the medication:
A) At the onset of chest pain, up to 3 tablets, 5 minutes apart, and call 911 if pain
is not relieved after the third dose
B) Every 30 minutes for up to 24 hours
C) With a full glass of milk to prevent gastric upset
D) Only when the pain is severe enough to interfere with sleep
1
,Correct Answer: A
Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet
at the onset of pain, wait 5 minutes, and if pain persists, take a second, wait
another 5 minutes, and take a third if needed. If pain is unrelieved after three
tablets, it indicates unstable angina or MI, and emergency services must be
activated. Taking it every 30 minutes (B) without reassessment is incorrect; it is
only taken for acute episodes. Milk (C) is not indicated; nitroglycerin is absorbed
sublingually and should not be swallowed. Waiting until pain is severe (D) defeats
the purpose of early intervention to reduce myocardial oxygen demand.
Question 3
The nurse is assessing a patient with left-sided heart failure. Which finding is most
characteristic of this condition?
A) Peripheral edema and jugular venous distension
B) Crackles in the lung bases and orthopnea
C) Hepatomegaly and ascites
D) Right upper quadrant pain and nausea
Correct Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion, which presents as crackles (fluid in
the alveoli) and orthopnea (difficulty breathing when lying flat). Peripheral edema
and JVD (A) are signs of right-sided heart failure, where blood backs up into the
systemic venous system. Hepatomegaly and ascites (C) are also signs of right-
sided failure due to liver congestion. Right upper quadrant pain and nausea (D)
are associated with liver congestion from right-sided failure, not left-sided.
Question 4
A patient is diagnosed with atrial fibrillation. Which priority medication would the
nurse expect to be prescribed for stroke prevention?
A) Digoxin (Lanoxin)
B) Warfarin (Coumadin) or a direct oral anticoagulant (DOAC)
C) Metoprolol (Lopressor)
2
,D) Amiodarone (Cordarone)
Correct Answer: B
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrial appendage, which can embolize to the brain and cause a stroke.
Anticoagulation with warfarin or a DOAC is the primary strategy to prevent this
complication. Digoxin (A) and metoprolol (C) are used for rate control but do not
prevent clot formation. Amiodarone (D) is used for rhythm control, but
anticoagulation is still prioritized because the patient remains at high
thromboembolic risk even if rhythm converts; rhythm control does not eliminate
the need for anticoagulation.
Question 5
The nurse is caring for a patient with an ST-segment elevation myocardial
infarction (STEMI). Which intervention is the highest priority within the first 30
minutes of arrival?
A) Administering morphine sulfate for pain
B) Performing a 12-lead ECG
C) Administering aspirin and preparing for percutaneous coronary intervention
(PCI) or thrombolytic therapy
D) Obtaining a complete blood count
Correct Answer: C
Rationale: The gold standard for STEMI is rapid reperfusion, either via PCI (balloon
angioplasty) or thrombolytic therapy, within 90 minutes of arrival (door-to-
balloon) or 30 minutes for thrombolytics. Aspirin is given immediately to inhibit
platelet aggregation. While a 12-lead ECG (B) is essential for diagnosis, it should
have been done immediately upon arrival, and the priority after confirming STEMI
is reperfusion. Morphine (A) for pain is important but secondary to reperfusion.
CBC (D) is a routine lab that does not dictate the immediate life-saving
intervention.
Question 6
3
, A patient with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
should monitor for which common side effect?
A) Dry, persistent cough
B) Peripheral neuropathy
C) Tachycardia
D) Hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin, which
accumulates and stimulates the cough reflex, leading to a characteristic dry,
hacking cough that can be so bothersome that patients often discontinue the
drug. This cough is not responsive to antitussives and is the most common reason
for switching to an ARB. Peripheral neuropathy (B) is not associated with ACE
inhibitors; it is more common with certain chemotherapeutic agents or diabetes.
Tachycardia (C) is not typical; ACE inhibitors can cause hypotension, which may
reflexively increase heart rate, but bradycardia is more common. Hyperglycemia
(D) is not a direct effect; ACE inhibitors actually have a neutral or beneficial effect
on glucose metabolism.
Question 7
The nurse is assessing a patient with peripheral arterial disease (PAD). Which
finding is consistent with this diagnosis?
A) Bilateral lower extremity edema with pitting
B) Cool, pale extremities with diminished or absent pulses and dependent rubor
C) Warm, erythematous skin with palpable pulses
D) Brownish discoloration around the ankles with stasis dermatitis
Correct Answer: B
Rationale: PAD results from atherosclerosis causing narrowing of the arteries,
leading to reduced blood flow. Classic signs include coolness, pallor (due to lack of
blood flow), diminished/absent pulses, and dependent rubor (a reddish-blue
discoloration when the leg is lowered due to reactive hyperemia). Bilateral edema
(A) and brownish discoloration (D) are signs of chronic venous insufficiency, not
4
ACTUAL EXAM| COMPLETE REAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!) NIGHTINGALE COLLEGE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Question 1
A patient with heart failure is prescribed furosemide (Lasix). Which assessment
finding indicates the medication is having the desired therapeutic effect?
A) Weight gain of 2 kg in 24 hours
B) Decreased shortness of breath and clear lung sounds
C) Increased jugular venous distension
D) Blood pressure of 90/60 mmHg
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid overload in heart
failure. The desired effect is a reduction in pulmonary congestion, which
manifests as decreased dyspnea and clearer lung sounds on auscultation. Weight
gain (A) indicates fluid retention, the opposite of the desired effect. Increased JVD
(C) indicates worsening right-sided heart failure and fluid overload. While blood
pressure may drop, 90/60 (D) is hypotensive and could indicate excessive diuresis
or hypovolemia, which is an adverse effect, not the therapeutic goal.
Question 2
A patient with chronic stable angina is prescribed sublingual nitroglycerin. The
nurse instructs the patient to take the medication:
A) At the onset of chest pain, up to 3 tablets, 5 minutes apart, and call 911 if pain
is not relieved after the third dose
B) Every 30 minutes for up to 24 hours
C) With a full glass of milk to prevent gastric upset
D) Only when the pain is severe enough to interfere with sleep
1
,Correct Answer: A
Rationale: The standard protocol for sublingual nitroglycerin is to take one tablet
at the onset of pain, wait 5 minutes, and if pain persists, take a second, wait
another 5 minutes, and take a third if needed. If pain is unrelieved after three
tablets, it indicates unstable angina or MI, and emergency services must be
activated. Taking it every 30 minutes (B) without reassessment is incorrect; it is
only taken for acute episodes. Milk (C) is not indicated; nitroglycerin is absorbed
sublingually and should not be swallowed. Waiting until pain is severe (D) defeats
the purpose of early intervention to reduce myocardial oxygen demand.
Question 3
The nurse is assessing a patient with left-sided heart failure. Which finding is most
characteristic of this condition?
A) Peripheral edema and jugular venous distension
B) Crackles in the lung bases and orthopnea
C) Hepatomegaly and ascites
D) Right upper quadrant pain and nausea
Correct Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion, which presents as crackles (fluid in
the alveoli) and orthopnea (difficulty breathing when lying flat). Peripheral edema
and JVD (A) are signs of right-sided heart failure, where blood backs up into the
systemic venous system. Hepatomegaly and ascites (C) are also signs of right-
sided failure due to liver congestion. Right upper quadrant pain and nausea (D)
are associated with liver congestion from right-sided failure, not left-sided.
Question 4
A patient is diagnosed with atrial fibrillation. Which priority medication would the
nurse expect to be prescribed for stroke prevention?
A) Digoxin (Lanoxin)
B) Warfarin (Coumadin) or a direct oral anticoagulant (DOAC)
C) Metoprolol (Lopressor)
2
,D) Amiodarone (Cordarone)
Correct Answer: B
Rationale: Atrial fibrillation predisposes patients to thrombus formation in the left
atrial appendage, which can embolize to the brain and cause a stroke.
Anticoagulation with warfarin or a DOAC is the primary strategy to prevent this
complication. Digoxin (A) and metoprolol (C) are used for rate control but do not
prevent clot formation. Amiodarone (D) is used for rhythm control, but
anticoagulation is still prioritized because the patient remains at high
thromboembolic risk even if rhythm converts; rhythm control does not eliminate
the need for anticoagulation.
Question 5
The nurse is caring for a patient with an ST-segment elevation myocardial
infarction (STEMI). Which intervention is the highest priority within the first 30
minutes of arrival?
A) Administering morphine sulfate for pain
B) Performing a 12-lead ECG
C) Administering aspirin and preparing for percutaneous coronary intervention
(PCI) or thrombolytic therapy
D) Obtaining a complete blood count
Correct Answer: C
Rationale: The gold standard for STEMI is rapid reperfusion, either via PCI (balloon
angioplasty) or thrombolytic therapy, within 90 minutes of arrival (door-to-
balloon) or 30 minutes for thrombolytics. Aspirin is given immediately to inhibit
platelet aggregation. While a 12-lead ECG (B) is essential for diagnosis, it should
have been done immediately upon arrival, and the priority after confirming STEMI
is reperfusion. Morphine (A) for pain is important but secondary to reperfusion.
CBC (D) is a routine lab that does not dictate the immediate life-saving
intervention.
Question 6
3
, A patient with hypertension is prescribed lisinopril, an ACE inhibitor. The nurse
should monitor for which common side effect?
A) Dry, persistent cough
B) Peripheral neuropathy
C) Tachycardia
D) Hyperglycemia
Correct Answer: A
Rationale: ACE inhibitors prevent the breakdown of bradykinin, which
accumulates and stimulates the cough reflex, leading to a characteristic dry,
hacking cough that can be so bothersome that patients often discontinue the
drug. This cough is not responsive to antitussives and is the most common reason
for switching to an ARB. Peripheral neuropathy (B) is not associated with ACE
inhibitors; it is more common with certain chemotherapeutic agents or diabetes.
Tachycardia (C) is not typical; ACE inhibitors can cause hypotension, which may
reflexively increase heart rate, but bradycardia is more common. Hyperglycemia
(D) is not a direct effect; ACE inhibitors actually have a neutral or beneficial effect
on glucose metabolism.
Question 7
The nurse is assessing a patient with peripheral arterial disease (PAD). Which
finding is consistent with this diagnosis?
A) Bilateral lower extremity edema with pitting
B) Cool, pale extremities with diminished or absent pulses and dependent rubor
C) Warm, erythematous skin with palpable pulses
D) Brownish discoloration around the ankles with stasis dermatitis
Correct Answer: B
Rationale: PAD results from atherosclerosis causing narrowing of the arteries,
leading to reduced blood flow. Classic signs include coolness, pallor (due to lack of
blood flow), diminished/absent pulses, and dependent rubor (a reddish-blue
discoloration when the leg is lowered due to reactive hyperemia). Bilateral edema
(A) and brownish discoloration (D) are signs of chronic venous insufficiency, not
4
