BSN 266 HESI MEDICAL-SURGICAL
PRACTICE EXAM V2 2026 | NIGHTINGALE
COLLEGE | PRACTICE QUESTIONS, VERIFIED
ANSWERS & DETAILED RATIONALES
BSN 266 HESI MEDICAL-SURGICAL PRACTICE EXAM V2 2026
NIGHTINGALE COLLEGE | PRACTICE QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive practice exam contains evidence-based HESI questions
aligned with BSN 266 Medical-Surgical Nursing standards, designed to simulate the
actual licensing and certification exam format with clinically relevant scenarios and
prioritization focus.
• Study this material by working through questions systematically, reviewing each
rationale carefully, identifying knowledge gaps, and using incorrect answers as
learning opportunities to strengthen clinical reasoning and application of nursing
concepts across all body systems.
1. A 58-year-old client with a history of hypertension is admitted to the
medical unit with complaints of severe chest pain radiating to the left arm
and diaphoresis. Which nursing action is the PRIORITY?
A) Administer oxygen and establish IV access
B) Obtain a 12-lead electrocardiogram (ECG)
C) Provide reassurance and position client upright
D) Obtain a complete health history
E) Document vital signs in the chart
CORRECT ANSWER: B) Obtain a 12-lead electrocardiogram (ECG)
,Rationale: A 12-lead ECG must be obtained within 10 minutes of symptom onset in
a client presenting with chest pain suggestive of acute coronary syndrome (ACS).
The ECG is the most critical diagnostic tool to identify ST-segment elevation or
depression, T-wave changes, and dysrhythmias that guide immediate treatment
decisions. While oxygen and IV access are important supportive measures, the ECG
takes diagnostic priority to rule out or confirm myocardial infarction (MI). This is a
time-sensitive intervention that directly impacts treatment protocols and patient
outcomes.
2. A 72-year-old client is post-operative day 2 following abdominal surgery.
The client reports severe pain, nausea, abdominal distention, and absence of
bowel sounds. Which complication should the nurse suspect?
A) Paralytic ileus
B) Bowel obstruction
C) Anastomotic leak
D) Adhesion formation
E) Hemorrhage
CORRECT ANSWER: A) Paralytic ileus
Rationale: Paralytic ileus is a common post-operative complication occurring within
24-72 hours after abdominal surgery. Clinical manifestations include absence of
bowel sounds, abdominal distention, nausea, and pain resulting from temporary
loss of intestinal peristalsis. This occurs due to manipulation of abdominal organs,
anesthesia effects, and the inflammatory response to surgery. Management
includes NPO status, nasogastric (NG) tube placement, IV fluids, and early
mobilization. Bowel obstruction would typically present with hyperactive bowel
sounds initially, and anastomotic leak would present with signs of peritonitis.
3. A 45-year-old client with chronic obstructive pulmonary disease (COPD)
presents to the emergency department with increased respiratory distress.
,The arterial blood gas (ABG) shows: pH 7.32, PaCO2 58 mmHg, HCO3 28 mEq/L.
Which acid-base imbalance does this represent?
A) Respiratory acidosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Metabolic alkalosis with respiratory compensation
E) Mixed respiratory and metabolic acidosis
CORRECT ANSWER: A) Respiratory acidosis with metabolic compensation
Rationale: The pH is low (7.32, normal 7.35-7.45), indicating acidosis. The PaCO2 is
elevated (58 mmHg, normal 35-45 mmHg), indicating the primary problem is
respiratory in nature (CO2 retention). The HCO3 is elevated (28 mEq/L, normal 22-
26 mEq/L), indicating renal compensation as the kidneys attempt to retain
bicarbonate to buffer the excess acid. In COPD, impaired gas exchange leads to
CO2 retention causing respiratory acidosis. The kidneys compensate by retaining
HCO3, partially correcting the pH.
4. A client with end-stage renal disease (ESRD) is undergoing hemodialysis.
Which finding would indicate the client is experiencing dialysis disequilibrium
syndrome (DDS)?
A) Hypotension, bradycardia, and muscle twitching
B) Headache, nausea, confusion, and restlessness
C) Hypertension, tachycardia, and pulmonary edema
D) Hypothermia, shivering, and pallor
E) Hyperkalemia, peaked T-waves, and cardiac arrhythmias
CORRECT ANSWER: B) Headache, nausea, confusion, and restlessness
Rationale: Dialysis disequilibrium syndrome occurs when electrolytes and urea are
removed too rapidly from the blood during hemodialysis, creating an osmotic
, gradient between blood and cerebrospinal fluid (CSF). This causes fluid to shift into
the brain tissue, leading to cerebral edema. Clinical manifestations include
headache, nausea, vomiting, confusion, restlessness, muscle twitching, and in
severe cases, seizures. This complication is prevented by using shorter dialysis
times initially, lower blood flow rates, and gradual ultrafiltration in new dialysis
patients.
5. A 62-year-old client with a myocardial infarction (MI) is receiving
thrombolytic therapy. Which adverse effect requires immediate reporting to
the healthcare provider?
A) Mild bleeding from IV sites
B) Transient chest discomfort
C) Internal bleeding or signs of stroke
D) Temporary hypotension
E) Mild fever
CORRECT ANSWER: C) Internal bleeding or signs of stroke
Rationale: Thrombolytic agents (alteplase, tenecteplase, reteplase) work by
dissolving clots and carry a significant risk of hemorrhage, including internal
bleeding (GI, intracranial, urinary) and intracerebral hemorrhage (stroke). Signs of
serious bleeding include altered mental status, severe headache, focal neurological
deficits, hemoptysis, hematuria, severe abdominal pain, and hypotension
unresponsive to fluids. These are emergencies requiring immediate intervention.
Mild bleeding from IV sites is common and expected, and mild transient symptoms
like brief chest discomfort or low-grade fever may occur but are not emergencies.
6. A 70-year-old client with newly diagnosed atrial fibrillation is prescribed
warfarin. Which information should the nurse include in the client's discharge
teaching?
A) Increase vitamin K intake to improve clotting factors
PRACTICE EXAM V2 2026 | NIGHTINGALE
COLLEGE | PRACTICE QUESTIONS, VERIFIED
ANSWERS & DETAILED RATIONALES
BSN 266 HESI MEDICAL-SURGICAL PRACTICE EXAM V2 2026
NIGHTINGALE COLLEGE | PRACTICE QUESTIONS, VERIFIED ANSWERS &
DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive practice exam contains evidence-based HESI questions
aligned with BSN 266 Medical-Surgical Nursing standards, designed to simulate the
actual licensing and certification exam format with clinically relevant scenarios and
prioritization focus.
• Study this material by working through questions systematically, reviewing each
rationale carefully, identifying knowledge gaps, and using incorrect answers as
learning opportunities to strengthen clinical reasoning and application of nursing
concepts across all body systems.
1. A 58-year-old client with a history of hypertension is admitted to the
medical unit with complaints of severe chest pain radiating to the left arm
and diaphoresis. Which nursing action is the PRIORITY?
A) Administer oxygen and establish IV access
B) Obtain a 12-lead electrocardiogram (ECG)
C) Provide reassurance and position client upright
D) Obtain a complete health history
E) Document vital signs in the chart
CORRECT ANSWER: B) Obtain a 12-lead electrocardiogram (ECG)
,Rationale: A 12-lead ECG must be obtained within 10 minutes of symptom onset in
a client presenting with chest pain suggestive of acute coronary syndrome (ACS).
The ECG is the most critical diagnostic tool to identify ST-segment elevation or
depression, T-wave changes, and dysrhythmias that guide immediate treatment
decisions. While oxygen and IV access are important supportive measures, the ECG
takes diagnostic priority to rule out or confirm myocardial infarction (MI). This is a
time-sensitive intervention that directly impacts treatment protocols and patient
outcomes.
2. A 72-year-old client is post-operative day 2 following abdominal surgery.
The client reports severe pain, nausea, abdominal distention, and absence of
bowel sounds. Which complication should the nurse suspect?
A) Paralytic ileus
B) Bowel obstruction
C) Anastomotic leak
D) Adhesion formation
E) Hemorrhage
CORRECT ANSWER: A) Paralytic ileus
Rationale: Paralytic ileus is a common post-operative complication occurring within
24-72 hours after abdominal surgery. Clinical manifestations include absence of
bowel sounds, abdominal distention, nausea, and pain resulting from temporary
loss of intestinal peristalsis. This occurs due to manipulation of abdominal organs,
anesthesia effects, and the inflammatory response to surgery. Management
includes NPO status, nasogastric (NG) tube placement, IV fluids, and early
mobilization. Bowel obstruction would typically present with hyperactive bowel
sounds initially, and anastomotic leak would present with signs of peritonitis.
3. A 45-year-old client with chronic obstructive pulmonary disease (COPD)
presents to the emergency department with increased respiratory distress.
,The arterial blood gas (ABG) shows: pH 7.32, PaCO2 58 mmHg, HCO3 28 mEq/L.
Which acid-base imbalance does this represent?
A) Respiratory acidosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Metabolic alkalosis with respiratory compensation
E) Mixed respiratory and metabolic acidosis
CORRECT ANSWER: A) Respiratory acidosis with metabolic compensation
Rationale: The pH is low (7.32, normal 7.35-7.45), indicating acidosis. The PaCO2 is
elevated (58 mmHg, normal 35-45 mmHg), indicating the primary problem is
respiratory in nature (CO2 retention). The HCO3 is elevated (28 mEq/L, normal 22-
26 mEq/L), indicating renal compensation as the kidneys attempt to retain
bicarbonate to buffer the excess acid. In COPD, impaired gas exchange leads to
CO2 retention causing respiratory acidosis. The kidneys compensate by retaining
HCO3, partially correcting the pH.
4. A client with end-stage renal disease (ESRD) is undergoing hemodialysis.
Which finding would indicate the client is experiencing dialysis disequilibrium
syndrome (DDS)?
A) Hypotension, bradycardia, and muscle twitching
B) Headache, nausea, confusion, and restlessness
C) Hypertension, tachycardia, and pulmonary edema
D) Hypothermia, shivering, and pallor
E) Hyperkalemia, peaked T-waves, and cardiac arrhythmias
CORRECT ANSWER: B) Headache, nausea, confusion, and restlessness
Rationale: Dialysis disequilibrium syndrome occurs when electrolytes and urea are
removed too rapidly from the blood during hemodialysis, creating an osmotic
, gradient between blood and cerebrospinal fluid (CSF). This causes fluid to shift into
the brain tissue, leading to cerebral edema. Clinical manifestations include
headache, nausea, vomiting, confusion, restlessness, muscle twitching, and in
severe cases, seizures. This complication is prevented by using shorter dialysis
times initially, lower blood flow rates, and gradual ultrafiltration in new dialysis
patients.
5. A 62-year-old client with a myocardial infarction (MI) is receiving
thrombolytic therapy. Which adverse effect requires immediate reporting to
the healthcare provider?
A) Mild bleeding from IV sites
B) Transient chest discomfort
C) Internal bleeding or signs of stroke
D) Temporary hypotension
E) Mild fever
CORRECT ANSWER: C) Internal bleeding or signs of stroke
Rationale: Thrombolytic agents (alteplase, tenecteplase, reteplase) work by
dissolving clots and carry a significant risk of hemorrhage, including internal
bleeding (GI, intracranial, urinary) and intracerebral hemorrhage (stroke). Signs of
serious bleeding include altered mental status, severe headache, focal neurological
deficits, hemoptysis, hematuria, severe abdominal pain, and hypotension
unresponsive to fluids. These are emergencies requiring immediate intervention.
Mild bleeding from IV sites is common and expected, and mild transient symptoms
like brief chest discomfort or low-grade fever may occur but are not emergencies.
6. A 70-year-old client with newly diagnosed atrial fibrillation is prescribed
warfarin. Which information should the nurse include in the client's discharge
teaching?
A) Increase vitamin K intake to improve clotting factors
