BSN 266 HESI Medical-Surgical Practice Exam
V2 ACTUAL EXAM 2026/2027 | Nightingale
College Med-Surg | Verified Q&A | Pass
Guaranteed - A+ Graded
Cluster 1: Cardiovascular & Hematologic Disorders
Q1: A 58-year-old patient with newly diagnosed hypertension asks the nurse why lifestyle changes are
still needed even though he is taking lisinopril. Which response by the nurse best reflects current
evidence-based practice for managing primary hypertension?
A. "Medication alone is usually enough to keep your blood pressure under control, so diet changes are
optional."
B. "Lifestyle modifications like reducing sodium and increasing activity work alongside your medication
to lower cardiovascular risk." [CORRECT]
C. "Your doctor will probably stop the lisinopril once you lose about 10 pounds, so focus on weight loss
first."
D. "Blood pressure medications only work if you completely eliminate salt from your diet and exercise
daily."
Correct Answer: B
Rationale: The best nursing response here is that lifestyle modifications complement pharmacologic
therapy to reduce overall cardiovascular risk, which aligns with JNC-8 and current hypertension
management guidelines. Medication alone does not replace the need for dietary sodium reduction,
regular physical activity, and weight management.
Q2: During morning assessment, the nurse notes a patient with chronic heart failure has developed
bilateral crackles in the lung bases, an SpO2 of 88% on room air, and reports feeling "more tired than
usual." The patient is already on furosemide 40 mg daily. What is the nurse's priority action?
A. Encourage the patient to drink extra fluids to help thin secretions and improve oxygenation.
B. Place the patient in high-Fowler's position, apply supplemental oxygen, and notify the provider.
[CORRECT]
C. Hold the morning dose of furosemide because the patient is showing signs of dehydration.
,D. Administer a PRN dose of morphine to reduce the patient's anxiety about breathing difficulty.
Correct Answer: B
Rationale: The best nursing action here is to position the patient for optimal ventilation, provide
supplemental oxygen to address hypoxemia, and alert the provider because these findings indicate
acute pulmonary edema from heart failure exacerbation. High-Fowler's position decreases venous
return to the heart and eases the work of breathing.
Q3: A 67-year-old patient arrives in the emergency department complaining of crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. Vital signs show BP 92/58, HR 110, RR 24. Which
nursing intervention takes highest priority in the first few minutes?
A. Administer sublingual nitroglycerin every 5 minutes for up to three doses.
B. Obtain a 12-lead ECG within 10 minutes and establish IV access while preparing for aspirin
administration. [CORRECT]
C. Give the patient a glass of water and have them lie flat to reduce cardiac workload.
D. Call the family to come to the hospital before beginning any invasive procedures.
Correct Answer: B
Rationale: When caring for a patient with suspected acute coronary syndrome, the priority is to obtain a
12-lead ECG rapidly to identify STEMI versus NSTEMI, establish IV access, and administer chewable
aspirin as part of the initial protocol. Time is muscle in acute MI, and early identification drives
reperfusion decisions.
Q4: A patient with atrial fibrillation is started on warfarin 5 mg daily. The nurse is reviewing discharge
instructions and knows the patient must understand which critical safety point?
A. "You should take aspirin daily along with your warfarin to improve anticoagulation effects."
B. "You need to have your INR checked regularly and avoid large amounts of leafy green vegetables."
[CORRECT]
C. "If you miss a dose, double up the next day to keep your blood levels steady."
D. "Warfarin works immediately, so you will be fully protected from clots within 24 hours."
Correct Answer: B
Rationale: This choice is correct because warfarin therapy requires consistent INR monitoring and stable
vitamin K intake; sudden increases in leafy greens can decrease INR and reduce anticoagulant effect.
Patients also need education about bleeding precautions and when to seek emergency care.
, Q5: The nurse is caring for a patient with peripheral arterial disease who has a non-healing wound on
the right great toe. Which assessment finding would the nurse expect?
A. Warm, edematous foot with brownish discoloration around the ankle.
B. Cool, pale foot with diminished pedal pulses and minimal hair growth. [CORRECT]
C. Pitting edema of both lower extremities with weeping serous drainage.
D. Erythema and warmth extending up the calf with positive Homan's sign.
Correct Answer: B
Rationale: In peripheral arterial disease, reduced blood flow leads to cool, pale extremities, diminished
or absent pulses, thin shiny skin, and decreased hair growth due to chronic ischemia. Venous
insufficiency presents differently with edema and brown discoloration, so recognizing these distinctions
guides appropriate wound care.
Q6: A 34-year-old patient with iron deficiency anemia reports fatigue, pallor, and craving ice. The nurse
is planning dietary teaching. Which food choice should the nurse recommend as the best source of
highly absorbable iron?
A. Spinach salad with sliced almonds and balsamic vinaigrette.
B. Grilled chicken breast with steamed broccoli and brown rice.
C. Beef liver with a small glass of orange juice. [CORRECT]
D. Baked cod with a side of mashed potatoes and green beans.
Correct Answer: C
Rationale: Heme iron found in organ meats and red meat is the most readily absorbed form of dietary
iron, and vitamin C from orange juice enhances non-heme iron absorption as well. While plant sources
contain iron, they are not absorbed as efficiently without vitamin C pairing.
Q7: A patient on warfarin for a mechanical heart valve presents for a routine clinic visit. The nurse
reviews the latest lab results: INR 4.8, PT 42 seconds. The patient's usual therapeutic range is 2.5–3.5.
Based on these values, what is the nurse's best interpretation?
A. The patient is within therapeutic range and can continue the current warfarin dose.
B. The patient is subtherapeutic and at increased risk for thromboembolism.
C. The patient is supratherapeutic and at increased risk for bleeding complications. [CORRECT]
D. The patient needs an immediate vitamin K injection and fresh frozen plasma.
V2 ACTUAL EXAM 2026/2027 | Nightingale
College Med-Surg | Verified Q&A | Pass
Guaranteed - A+ Graded
Cluster 1: Cardiovascular & Hematologic Disorders
Q1: A 58-year-old patient with newly diagnosed hypertension asks the nurse why lifestyle changes are
still needed even though he is taking lisinopril. Which response by the nurse best reflects current
evidence-based practice for managing primary hypertension?
A. "Medication alone is usually enough to keep your blood pressure under control, so diet changes are
optional."
B. "Lifestyle modifications like reducing sodium and increasing activity work alongside your medication
to lower cardiovascular risk." [CORRECT]
C. "Your doctor will probably stop the lisinopril once you lose about 10 pounds, so focus on weight loss
first."
D. "Blood pressure medications only work if you completely eliminate salt from your diet and exercise
daily."
Correct Answer: B
Rationale: The best nursing response here is that lifestyle modifications complement pharmacologic
therapy to reduce overall cardiovascular risk, which aligns with JNC-8 and current hypertension
management guidelines. Medication alone does not replace the need for dietary sodium reduction,
regular physical activity, and weight management.
Q2: During morning assessment, the nurse notes a patient with chronic heart failure has developed
bilateral crackles in the lung bases, an SpO2 of 88% on room air, and reports feeling "more tired than
usual." The patient is already on furosemide 40 mg daily. What is the nurse's priority action?
A. Encourage the patient to drink extra fluids to help thin secretions and improve oxygenation.
B. Place the patient in high-Fowler's position, apply supplemental oxygen, and notify the provider.
[CORRECT]
C. Hold the morning dose of furosemide because the patient is showing signs of dehydration.
,D. Administer a PRN dose of morphine to reduce the patient's anxiety about breathing difficulty.
Correct Answer: B
Rationale: The best nursing action here is to position the patient for optimal ventilation, provide
supplemental oxygen to address hypoxemia, and alert the provider because these findings indicate
acute pulmonary edema from heart failure exacerbation. High-Fowler's position decreases venous
return to the heart and eases the work of breathing.
Q3: A 67-year-old patient arrives in the emergency department complaining of crushing substernal chest
pain radiating to the left arm, diaphoresis, and nausea. Vital signs show BP 92/58, HR 110, RR 24. Which
nursing intervention takes highest priority in the first few minutes?
A. Administer sublingual nitroglycerin every 5 minutes for up to three doses.
B. Obtain a 12-lead ECG within 10 minutes and establish IV access while preparing for aspirin
administration. [CORRECT]
C. Give the patient a glass of water and have them lie flat to reduce cardiac workload.
D. Call the family to come to the hospital before beginning any invasive procedures.
Correct Answer: B
Rationale: When caring for a patient with suspected acute coronary syndrome, the priority is to obtain a
12-lead ECG rapidly to identify STEMI versus NSTEMI, establish IV access, and administer chewable
aspirin as part of the initial protocol. Time is muscle in acute MI, and early identification drives
reperfusion decisions.
Q4: A patient with atrial fibrillation is started on warfarin 5 mg daily. The nurse is reviewing discharge
instructions and knows the patient must understand which critical safety point?
A. "You should take aspirin daily along with your warfarin to improve anticoagulation effects."
B. "You need to have your INR checked regularly and avoid large amounts of leafy green vegetables."
[CORRECT]
C. "If you miss a dose, double up the next day to keep your blood levels steady."
D. "Warfarin works immediately, so you will be fully protected from clots within 24 hours."
Correct Answer: B
Rationale: This choice is correct because warfarin therapy requires consistent INR monitoring and stable
vitamin K intake; sudden increases in leafy greens can decrease INR and reduce anticoagulant effect.
Patients also need education about bleeding precautions and when to seek emergency care.
, Q5: The nurse is caring for a patient with peripheral arterial disease who has a non-healing wound on
the right great toe. Which assessment finding would the nurse expect?
A. Warm, edematous foot with brownish discoloration around the ankle.
B. Cool, pale foot with diminished pedal pulses and minimal hair growth. [CORRECT]
C. Pitting edema of both lower extremities with weeping serous drainage.
D. Erythema and warmth extending up the calf with positive Homan's sign.
Correct Answer: B
Rationale: In peripheral arterial disease, reduced blood flow leads to cool, pale extremities, diminished
or absent pulses, thin shiny skin, and decreased hair growth due to chronic ischemia. Venous
insufficiency presents differently with edema and brown discoloration, so recognizing these distinctions
guides appropriate wound care.
Q6: A 34-year-old patient with iron deficiency anemia reports fatigue, pallor, and craving ice. The nurse
is planning dietary teaching. Which food choice should the nurse recommend as the best source of
highly absorbable iron?
A. Spinach salad with sliced almonds and balsamic vinaigrette.
B. Grilled chicken breast with steamed broccoli and brown rice.
C. Beef liver with a small glass of orange juice. [CORRECT]
D. Baked cod with a side of mashed potatoes and green beans.
Correct Answer: C
Rationale: Heme iron found in organ meats and red meat is the most readily absorbed form of dietary
iron, and vitamin C from orange juice enhances non-heme iron absorption as well. While plant sources
contain iron, they are not absorbed as efficiently without vitamin C pairing.
Q7: A patient on warfarin for a mechanical heart valve presents for a routine clinic visit. The nurse
reviews the latest lab results: INR 4.8, PT 42 seconds. The patient's usual therapeutic range is 2.5–3.5.
Based on these values, what is the nurse's best interpretation?
A. The patient is within therapeutic range and can continue the current warfarin dose.
B. The patient is subtherapeutic and at increased risk for thromboembolism.
C. The patient is supratherapeutic and at increased risk for bleeding complications. [CORRECT]
D. The patient needs an immediate vitamin K injection and fresh frozen plasma.
