BSN 266 HESI Med Surg Practice Exam V1 – Newest
Questions with Answers & Detailed Explanations for
Nightingale College (2026/2027)
BSN 266 HESI Med-Surg Practice Questions
1. A client who had a cardiac stent placed 4 days ago arrives at the ED reporting
sudden chest pressure and shortness of breath. What is the nurse's priority
action?
• A) Administer prescribed nitroglycerin sublingually.
• B) Obtain a 12-lead 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) Obtain a 12-lead ECG and begin continuous cardiac monitoring.
Rationale: This client is at high risk for acute stent thrombosis, a life-threatening
complication. The priority is to rapidly assess for myocardial ischemia with an ECG
and initiate continuous cardiac monitoring to detect lethal dysrhythmias. This
data guides subsequent reperfusion therapy .
2. A client with hypothyroidism is admitted with lethargy and confusion. Which
finding warrants the most immediate action by the nurse?
• A) Further decline in level of consciousness.
• B) Hematocrit of 30%.
• C) Cold and dry skin.
• D) Facial puffiness and periorbital edema.
Answer: A) Further decline in level of consciousness.
Rationale: A declining LOC in a client with hypothyroidism is a critical sign of
myxedema coma, a life-threatening emergency. This indicates severe,
decompensated hypothyroidism requiring immediate intervention .
,3. An older client who is agitated, dyspneic, and using accessory muscles to
breathe is admitted. An hour after IV furosemide, which assessments best
determine the client's response? (Select all that apply)
• A) Urinary output.
• B) Oxygen saturation.
• C) Pain scale.
• D) Lung sounds.
• E) Skin elasticity.
Answer: A) Urinary output, B) Oxygen saturation, D) Lung sounds.
Rationale: These assessments evaluate the effectiveness of the diuretic in
reducing fluid overload and improving gas exchange. Urinary output measures
kidney response, oxygen saturation monitors hypoxemia, and lung sounds
indicate resolution of pulmonary edema .
4. A client is diagnosed with chronic kidney disease and needs to begin dialysis.
Which condition on the client's medical record is a contraindication for
peritoneal dialysis?
• A) Diabetes mellitus.
• B) Crohn's disease with colectomy.
• C) Peripheral vascular disease.
• D) Congestive heart failure.
Answer: B) Crohn's disease with colectomy.
Rationale: Clients with extensive intra-abdominal surgical history (like a
colectomy) are not candidates for peritoneal dialysis, as they may have decreased
peritoneal membrane surface area and scar tissue formation, making dialysis
insufficient .
,5. A client presents to the ED reporting chest pain radiating to the left arm,
shortness of breath, and diaphoresis. Which medication should the nurse
anticipate?
• A) Fentanyl.
• B) Oxycodone.
• C) Morphine.
• D) Hydromorphone.
Answer: C) Morphine.
Rationale: Morphine is a key intervention for acute chest pain unrelieved by
nitroglycerin. It reduces pain, anxiety, and myocardial oxygen demand, which are
crucial in managing an acute myocardial infarction .
6. A client with a history of hypothyroidism was admitted with lethargy and
confusion. Which finding warrants the most immediate action?
• A) Further decline in level of consciousness.
• B) Hematocrit of 30%.
• C) Cold and dry skin.
• D) Facial puffiness and periorbital edema.
Answer: A) Further decline in level of consciousness.
Rationale: A declining level of consciousness in a client with hypothyroidism is a
critical sign of myxedema coma, a life-threatening emergency. This indicates
severe, decompensated hypothyroidism requiring immediate intervention .
7. The nurse is evaluating a client's understanding of the DASH eating plan.
Which behavior indicates adherence?
• A) Uses only lactose-free dairy products.
• B) Carefully cleans and peels all fresh fruit and vegetables.
, • C) No longer includes grains in the daily diet.
• D) Enjoys fat-free yogurt as an occasional snack food.
Answer: D) Enjoys fat-free yogurt as an occasional snack food.
Rationale: The DASH eating plan emphasizes low-fat or fat-free dairy products,
fruits, vegetables, and whole grains. Fat-free yogurt is an appropriate choice that
aligns with the plan's recommendations .
8. A nurse assesses a client with petechiae and ecchymosis scattered across the
arms and legs. Which laboratory result should the nurse review?
• A) Red blood cell count.
• B) Hemoglobin levels.
• C) White blood cell count.
• D) Platelet count.
Answer: D) Platelet count.
Rationale: Petechiae and ecchymosis are signs of bleeding and bruising, which are
associated with thrombocytopenia (low platelet count). The nurse should review
the platelet count to assess for this potential cause .
9. The nurse is providing discharge teaching to a client with Type 2 diabetes and
peripheral neuropathy. Which information should the nurse provide?
• A) Family members can help with regular foot exams.
• B) Heating pads are useful if on the lowest setting.
• C) Shoes should be worn outside the house, but barefoot is fine inside.
• D) Aching feet may be soaked in lukewarm water for one hour or more.
Answer: A) Family members can help with regular foot exams.
Rationale: Clients with peripheral neuropathy have decreased sensation in their
feet and are at high risk for injury and infection. Family members can assist with
Questions with Answers & Detailed Explanations for
Nightingale College (2026/2027)
BSN 266 HESI Med-Surg Practice Questions
1. A client who had a cardiac stent placed 4 days ago arrives at the ED reporting
sudden chest pressure and shortness of breath. What is the nurse's priority
action?
• A) Administer prescribed nitroglycerin sublingually.
• B) Obtain a 12-lead 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) Obtain a 12-lead ECG and begin continuous cardiac monitoring.
Rationale: This client is at high risk for acute stent thrombosis, a life-threatening
complication. The priority is to rapidly assess for myocardial ischemia with an ECG
and initiate continuous cardiac monitoring to detect lethal dysrhythmias. This
data guides subsequent reperfusion therapy .
2. A client with hypothyroidism is admitted with lethargy and confusion. Which
finding warrants the most immediate action by the nurse?
• A) Further decline in level of consciousness.
• B) Hematocrit of 30%.
• C) Cold and dry skin.
• D) Facial puffiness and periorbital edema.
Answer: A) Further decline in level of consciousness.
Rationale: A declining LOC in a client with hypothyroidism is a critical sign of
myxedema coma, a life-threatening emergency. This indicates severe,
decompensated hypothyroidism requiring immediate intervention .
,3. An older client who is agitated, dyspneic, and using accessory muscles to
breathe is admitted. An hour after IV furosemide, which assessments best
determine the client's response? (Select all that apply)
• A) Urinary output.
• B) Oxygen saturation.
• C) Pain scale.
• D) Lung sounds.
• E) Skin elasticity.
Answer: A) Urinary output, B) Oxygen saturation, D) Lung sounds.
Rationale: These assessments evaluate the effectiveness of the diuretic in
reducing fluid overload and improving gas exchange. Urinary output measures
kidney response, oxygen saturation monitors hypoxemia, and lung sounds
indicate resolution of pulmonary edema .
4. A client is diagnosed with chronic kidney disease and needs to begin dialysis.
Which condition on the client's medical record is a contraindication for
peritoneal dialysis?
• A) Diabetes mellitus.
• B) Crohn's disease with colectomy.
• C) Peripheral vascular disease.
• D) Congestive heart failure.
Answer: B) Crohn's disease with colectomy.
Rationale: Clients with extensive intra-abdominal surgical history (like a
colectomy) are not candidates for peritoneal dialysis, as they may have decreased
peritoneal membrane surface area and scar tissue formation, making dialysis
insufficient .
,5. A client presents to the ED reporting chest pain radiating to the left arm,
shortness of breath, and diaphoresis. Which medication should the nurse
anticipate?
• A) Fentanyl.
• B) Oxycodone.
• C) Morphine.
• D) Hydromorphone.
Answer: C) Morphine.
Rationale: Morphine is a key intervention for acute chest pain unrelieved by
nitroglycerin. It reduces pain, anxiety, and myocardial oxygen demand, which are
crucial in managing an acute myocardial infarction .
6. A client with a history of hypothyroidism was admitted with lethargy and
confusion. Which finding warrants the most immediate action?
• A) Further decline in level of consciousness.
• B) Hematocrit of 30%.
• C) Cold and dry skin.
• D) Facial puffiness and periorbital edema.
Answer: A) Further decline in level of consciousness.
Rationale: A declining level of consciousness in a client with hypothyroidism is a
critical sign of myxedema coma, a life-threatening emergency. This indicates
severe, decompensated hypothyroidism requiring immediate intervention .
7. The nurse is evaluating a client's understanding of the DASH eating plan.
Which behavior indicates adherence?
• A) Uses only lactose-free dairy products.
• B) Carefully cleans and peels all fresh fruit and vegetables.
, • C) No longer includes grains in the daily diet.
• D) Enjoys fat-free yogurt as an occasional snack food.
Answer: D) Enjoys fat-free yogurt as an occasional snack food.
Rationale: The DASH eating plan emphasizes low-fat or fat-free dairy products,
fruits, vegetables, and whole grains. Fat-free yogurt is an appropriate choice that
aligns with the plan's recommendations .
8. A nurse assesses a client with petechiae and ecchymosis scattered across the
arms and legs. Which laboratory result should the nurse review?
• A) Red blood cell count.
• B) Hemoglobin levels.
• C) White blood cell count.
• D) Platelet count.
Answer: D) Platelet count.
Rationale: Petechiae and ecchymosis are signs of bleeding and bruising, which are
associated with thrombocytopenia (low platelet count). The nurse should review
the platelet count to assess for this potential cause .
9. The nurse is providing discharge teaching to a client with Type 2 diabetes and
peripheral neuropathy. Which information should the nurse provide?
• A) Family members can help with regular foot exams.
• B) Heating pads are useful if on the lowest setting.
• C) Shoes should be worn outside the house, but barefoot is fine inside.
• D) Aching feet may be soaked in lukewarm water for one hour or more.
Answer: A) Family members can help with regular foot exams.
Rationale: Clients with peripheral neuropathy have decreased sensation in their
feet and are at high risk for injury and infection. Family members can assist with
