BSN 266 HESI V2 Exam | Complete Practice
Questions with Verified Answers and Detailed
Rationales | Latest Updated Edition 2026/2027 -
Already Graded A+
Question 1
A client admitted with acute myocardial infarction reports sudden onset of sharp
chest pain radiating to the jaw. The nurse notes ST elevation on ECG. What is the
priority nursing action?
A. Administer sublingual nitroglycerin
B. Start oxygen at 2 L/min via nasal cannula
C. Prepare for immediate percutaneous coronary intervention
D. Obtain a stat troponin level
Answer: C
Rationale: ST elevation on ECG indicates an acute STEMI. The priority is to
prepare for immediate percutaneous coronary intervention (PCI) to restore
coronary blood flow. While nitroglycerin (A), oxygen (B), and troponin (D) are
important, PCI is the definitive treatment for STEMI.
Question 2
A client with heart failure is prescribed furosemide 40 mg IV. The nurse monitors
for which potential adverse effect requiring immediate intervention?
A. Bradycardia
B. Hypokalemia
C. Hyperkalemia
D. Hypertension
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading
to hypokalemia. Hypokalemia can cause cardiac arrhythmias and requires
immediate intervention. Bradycardia (A) is not an adverse effect. Hyperkalemia
(C) is not caused by loop diuretics. Hypertension (D) is not an adverse effect—
furosemide lowers blood pressure.
pg. 1
,Question 3
During assessment of a client with hypertension, the nurse auscultates a bruit over
the renal artery. What does this finding suggest?
A. Renal artery stenosis
B. Atherosclerotic plaque rupture
C. Aortic aneurysm
D. Peripheral embolism
Answer: A
Rationale: A bruit over the renal artery suggests renal artery stenosis, which can
cause secondary hypertension due to reduced renal blood flow and activation of the
renin-angiotensin system. Atherosclerotic plaque rupture (B) would cause acute
symptoms. Aortic aneurysm (C) would present with a pulsatile mass. Peripheral
embolism (D) would cause acute ischemic symptoms.
Question 4
A postoperative CABG client develops atrial fibrillation with a heart rate of 140
bpm. What is the initial pharmacological intervention?
A. Heparin infusion
B. Amiodarone IV bolus
C. Cardiorespiratory
D. Beta-blocker such as metoprolol
Answer: D
Rationale: Beta-blockers (metoprolol) are the first-line treatment for rate control
in postoperative atrial fibrillation. Heparin (A) is for anticoagulation, not rate
control. Amiodarone (B) may be used if beta-blockers are ineffective.
Question 5
The nurse is educating a client with peripheral artery disease on lifestyle
modifications. Which recommendation is most effective for symptom
management?
A. Smoking cessation
B. Supervised exercise program
C. Daily foot soaks in hot water
D. Low-sodium diet
Answer: B
pg. 2
,Rationale: A supervised exercise program is the most effective non-
pharmacological intervention for improving symptoms of peripheral artery disease
by promoting collateral circulation. Smoking cessation (A) is also important but
exercise directly improves symptoms. Hot water soaks (C) can damage ischemic
skin. Low-sodium diet (D) is for hypertension.
Question 6
A client receiving warfarin therapy has an INR of 4.2. What is the nurse's priority
action?
A. Administer vitamin K 10 mg PO
B. Transfuse fresh frozen plasma
C. Hold next dose and notify provider
D. Increase green leafy vegetable intake
Answer: C
Rationale: An INR of 4.2 is elevated above the therapeutic range (2.0-3.0 for most
indications). The nurse should hold the next dose and notify the provider. Vitamin
K (A) may be administered if there is bleeding. Fresh frozen plasma (B) is for
severe bleeding. Green leafy vegetables (D) would lower INR but are not the
immediate action.
Question 7
In a client with endocarditis, the nurse identifies a new holosystolic murmur. This
change likely indicates:
A. Conduction block
B. Myocardial rupture
C. Valve vegetation progression
D. Pericardial effusion
Answer: C
Rationale: A new holosystolic murmur in a client with endocarditis indicates
valve vegetation progression causing valve regurgitation. Conduction block (A)
causes bradyarrhythmias. Myocardial rupture (B) is a complication of MI.
Pericardial effusion (D) causes muffled heart sounds.
Question 8
A client with cardiogenic shock post-MI is on dopamine infusion. The nurse notes
pg. 3
, urine output of 15 mL/hr. What adjustment is indicated?
A. Fluid bolus of 500 mL
B. Add dobutamine for inotropic support
C. Decrease infusion rate
D. Discontinue vasopressors
Answer: B
Rationale: Urine output of 15 mL/hr indicates inadequate renal perfusion. Adding
dobutamine for inotropic support improves cardiac output and renal perfusion.
Fluid bolus (A) may worsen pulmonary edema. Decreasing infusion (C) would
worsen perfusion. Discontinuing vasopressors (D) would cause hemodynamic
collapse.
Question 9
The nurse assesses a client with aortic stenosis for exertional dyspnea and syncope.
What diagnostic test is priority?
A. Holter monitor
B. Stress ECG
C. Cardiac catheterization
D. Echocardiogram
Answer: D
Rationale: Echocardiogram is the priority diagnostic test to assess valve structure,
severity of stenosis, and left ventricular function. Holter monitor (A) assesses
arrhythmias. Stress ECG (B) may be contraindicated. Cardiac catheterization (C) is
invasive and used if surgery is planned.
Question 10
A client with venous thromboembolism is started on enoxaparin. What laboratory
monitoring is least necessary?
A. Platelet count
B. Hemoglobin
C. aPTT
D. Activated partial thromboplastin time
Answer: D
Rationale: Enoxaparin is a low-molecular-weight heparin that does not require
aPTT monitoring. Platelet count (A) is monitored for heparin-induced
pg. 4
Questions with Verified Answers and Detailed
Rationales | Latest Updated Edition 2026/2027 -
Already Graded A+
Question 1
A client admitted with acute myocardial infarction reports sudden onset of sharp
chest pain radiating to the jaw. The nurse notes ST elevation on ECG. What is the
priority nursing action?
A. Administer sublingual nitroglycerin
B. Start oxygen at 2 L/min via nasal cannula
C. Prepare for immediate percutaneous coronary intervention
D. Obtain a stat troponin level
Answer: C
Rationale: ST elevation on ECG indicates an acute STEMI. The priority is to
prepare for immediate percutaneous coronary intervention (PCI) to restore
coronary blood flow. While nitroglycerin (A), oxygen (B), and troponin (D) are
important, PCI is the definitive treatment for STEMI.
Question 2
A client with heart failure is prescribed furosemide 40 mg IV. The nurse monitors
for which potential adverse effect requiring immediate intervention?
A. Bradycardia
B. Hypokalemia
C. Hyperkalemia
D. Hypertension
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading
to hypokalemia. Hypokalemia can cause cardiac arrhythmias and requires
immediate intervention. Bradycardia (A) is not an adverse effect. Hyperkalemia
(C) is not caused by loop diuretics. Hypertension (D) is not an adverse effect—
furosemide lowers blood pressure.
pg. 1
,Question 3
During assessment of a client with hypertension, the nurse auscultates a bruit over
the renal artery. What does this finding suggest?
A. Renal artery stenosis
B. Atherosclerotic plaque rupture
C. Aortic aneurysm
D. Peripheral embolism
Answer: A
Rationale: A bruit over the renal artery suggests renal artery stenosis, which can
cause secondary hypertension due to reduced renal blood flow and activation of the
renin-angiotensin system. Atherosclerotic plaque rupture (B) would cause acute
symptoms. Aortic aneurysm (C) would present with a pulsatile mass. Peripheral
embolism (D) would cause acute ischemic symptoms.
Question 4
A postoperative CABG client develops atrial fibrillation with a heart rate of 140
bpm. What is the initial pharmacological intervention?
A. Heparin infusion
B. Amiodarone IV bolus
C. Cardiorespiratory
D. Beta-blocker such as metoprolol
Answer: D
Rationale: Beta-blockers (metoprolol) are the first-line treatment for rate control
in postoperative atrial fibrillation. Heparin (A) is for anticoagulation, not rate
control. Amiodarone (B) may be used if beta-blockers are ineffective.
Question 5
The nurse is educating a client with peripheral artery disease on lifestyle
modifications. Which recommendation is most effective for symptom
management?
A. Smoking cessation
B. Supervised exercise program
C. Daily foot soaks in hot water
D. Low-sodium diet
Answer: B
pg. 2
,Rationale: A supervised exercise program is the most effective non-
pharmacological intervention for improving symptoms of peripheral artery disease
by promoting collateral circulation. Smoking cessation (A) is also important but
exercise directly improves symptoms. Hot water soaks (C) can damage ischemic
skin. Low-sodium diet (D) is for hypertension.
Question 6
A client receiving warfarin therapy has an INR of 4.2. What is the nurse's priority
action?
A. Administer vitamin K 10 mg PO
B. Transfuse fresh frozen plasma
C. Hold next dose and notify provider
D. Increase green leafy vegetable intake
Answer: C
Rationale: An INR of 4.2 is elevated above the therapeutic range (2.0-3.0 for most
indications). The nurse should hold the next dose and notify the provider. Vitamin
K (A) may be administered if there is bleeding. Fresh frozen plasma (B) is for
severe bleeding. Green leafy vegetables (D) would lower INR but are not the
immediate action.
Question 7
In a client with endocarditis, the nurse identifies a new holosystolic murmur. This
change likely indicates:
A. Conduction block
B. Myocardial rupture
C. Valve vegetation progression
D. Pericardial effusion
Answer: C
Rationale: A new holosystolic murmur in a client with endocarditis indicates
valve vegetation progression causing valve regurgitation. Conduction block (A)
causes bradyarrhythmias. Myocardial rupture (B) is a complication of MI.
Pericardial effusion (D) causes muffled heart sounds.
Question 8
A client with cardiogenic shock post-MI is on dopamine infusion. The nurse notes
pg. 3
, urine output of 15 mL/hr. What adjustment is indicated?
A. Fluid bolus of 500 mL
B. Add dobutamine for inotropic support
C. Decrease infusion rate
D. Discontinue vasopressors
Answer: B
Rationale: Urine output of 15 mL/hr indicates inadequate renal perfusion. Adding
dobutamine for inotropic support improves cardiac output and renal perfusion.
Fluid bolus (A) may worsen pulmonary edema. Decreasing infusion (C) would
worsen perfusion. Discontinuing vasopressors (D) would cause hemodynamic
collapse.
Question 9
The nurse assesses a client with aortic stenosis for exertional dyspnea and syncope.
What diagnostic test is priority?
A. Holter monitor
B. Stress ECG
C. Cardiac catheterization
D. Echocardiogram
Answer: D
Rationale: Echocardiogram is the priority diagnostic test to assess valve structure,
severity of stenosis, and left ventricular function. Holter monitor (A) assesses
arrhythmias. Stress ECG (B) may be contraindicated. Cardiac catheterization (C) is
invasive and used if surgery is planned.
Question 10
A client with venous thromboembolism is started on enoxaparin. What laboratory
monitoring is least necessary?
A. Platelet count
B. Hemoglobin
C. aPTT
D. Activated partial thromboplastin time
Answer: D
Rationale: Enoxaparin is a low-molecular-weight heparin that does not require
aPTT monitoring. Platelet count (A) is monitored for heparin-induced
pg. 4
