Page 1 of 78
BSN 266 – HESI MEDICAL-SURGICAL V2 NIGHTINGALE
COLLEGE ACTUAL EXAM LATEST VERSION QUESTIONS AND
ANSWERS 2026 EDITION
BSN 266 – HESI MEDICAL-SURGICAL PRACTICE EXAM V2
NIGHTINGALE COLLEGE
250 Multiple Choice Questions with Rationales
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-50)
1. A client scheduled for a cardiac stress test is taking metoprolol. Which action
should the nurse take regarding this medication?
• A) Administer as scheduled
• B) Hold the medication prior to the test
• C) Give a double dose
• D) Switch to an alternative medication
Rationale: Beta-blockers like metoprolol blunt the heart rate response to exercise,
potentially masking ischemia during a stress test. They are typically held before the test
to allow an accurate assessment of cardiac function. Other medications like metformin
are held before contrast studies.
2. A client with heart failure has a new prescription for metoprolol. Which finding
would cause the nurse to question the order?
• A) Heart rate 52 beats per minute
• B) Blood pressure 130/80 mm Hg
• C) Respiratory rate 18 breaths/min
• D) Oxygen saturation 94%
, Page 2 of 78
Rationale: Beta-blockers such as metoprolol should generally be held if the heart rate
is below 60 beats per minute to prevent symptomatic bradycardia. The medication
lowers heart rate and contractility; administering it with existing bradycardia could lead
to further hemodynamic compromise.
3. A client with an acute myocardial infarction is receiving morphine. Which
adverse effect should the nurse monitor most closely?
• A) Hypotension
• B) Tachycardia
• C) Respiratory depression
• D) Constipation
Rationale: Morphine is an opioid that can cause respiratory depression, especially in
older adults or those with COPD. Respiratory rate and depth should be monitored
closely. While hypotension and constipation are also concerns, respiratory depression
is the priority adverse effect requiring immediate intervention.
4. A client with chronic heart failure reports a persistent dry cough. Which
medication is most likely the cause?
• A) Furosemide
• B) Lisinopril
• C) Metoprolol
• D) Digoxin
Rationale: ACE inhibitors like lisinopril cause a persistent dry, nonproductive cough in
10-20% of patients due to increased bradykinin levels. This side effect often leads to
switching from an ACE inhibitor to an ARB (angiotensin receptor blocker) such as
losartan.
5. A client with atrial fibrillation has a new prescription for dabigatran (Pradaxa).
Which instruction should the nurse include?
• A) "Take this medication with a full glass of water."
• B) "You will need monthly INR monitoring."
• C) "Avoid eating green leafy vegetables."
, Page 3 of 78
• D) "This medication can be crushed if difficult to swallow."
Rationale: Dabigatran capsules should be taken with a full glass of water to ensure
proper absorption and reduce the risk of esophageal irritation. INR monitoring is
required for warfarin, not dabigatran. Vitamin K-rich foods are relevant to warfarin
therapy. Capsules should not be crushed as this affects absorption.
6. A client with peripheral venous insufficiency should be taught to:
• A) Elevate the legs when sitting
• B) Walk with legs dangling
• C) Apply heat to the legs
• D) Cross legs at the knees
Rationale: Elevation of the legs when sitting promotes venous return and reduces
edema in clients with venous insufficiency. Legs dangling or crossing at the knees
impedes circulation. Heat application may cause burns due to impaired sensation.
7. A client is prescribed verapamil for hypertension. Which side effect should the
nurse include in client teaching?
• A) Diarrhea
• B) Constipation
• C) Tachycardia
• D) Hypoglycemia
Rationale: Constipation is a common adverse effect of verapamil, a calcium channel
blocker. Patients should be advised to increase fluid and fiber intake to manage this
side effect.
8. A client with a completed ischemic stroke has a blood pressure of 180/90 mm
Hg. Which action should the nurse implement?
• A) Position the head of bed flat
• B) Withhold intravenous fluids
• C) Administer a bolus of IV fluids
• D) Give an antihypertensive medication
, Page 4 of 78
Rationale: Elevated blood pressure in a client with a completed stroke requires
antihypertensive medication to reduce the risk of further cerebrovascular damage. Most
ischemic strokes occur during sleep when blood pressure declines or viscosity
increases. Antihypertensive therapy is a priority.
9. A client who underwent cardiac stent placement four days ago arrives at the
emergency department reporting sudden chest pressure and shortness of breath.
Which action should the nurse take first?
• A) Administer oxygen at 2 L/min via nasal cannula
• B) Obtain a 12-lead ECG
• C) Assess vital signs
• D) Prepare for thrombolytic therapy
Rationale: The ABCs are the priority—vital signs should be assessed first to detect
instability (e.g., hypotension) in a client with potential stent thrombosis. ECG and
oxygen administration follow; thrombolytics are not indicated for stent thrombosis.
10. The nurse is teaching a client with heart failure about fluid restriction. Which
statement indicates the client understands the teaching?
• A) "I can drink as much as I want as long as I take my diuretics."
• B) "I should limit my fluid intake to the amount prescribed by my doctor."
• C) "I can have extra fluids if I exercise more."
• D) "Fluid restriction is only necessary if I have edema."
Rationale: Clients with heart failure must adhere to prescribed fluid restrictions to
prevent fluid overload, which can exacerbate symptoms and lead to pulmonary edema.
Diuretics help remove excess fluid but do not eliminate the need for restriction.
11. A client with heart failure has crackles in the lung bases, jugular venous
distention, and peripheral edema. Which nursing intervention has the highest
priority?
• A) Place the client in high-Fowler's position
• B) Restrict oral fluids to 1,000 mL/day
• C) Administer diuretics as ordered
BSN 266 – HESI MEDICAL-SURGICAL V2 NIGHTINGALE
COLLEGE ACTUAL EXAM LATEST VERSION QUESTIONS AND
ANSWERS 2026 EDITION
BSN 266 – HESI MEDICAL-SURGICAL PRACTICE EXAM V2
NIGHTINGALE COLLEGE
250 Multiple Choice Questions with Rationales
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-50)
1. A client scheduled for a cardiac stress test is taking metoprolol. Which action
should the nurse take regarding this medication?
• A) Administer as scheduled
• B) Hold the medication prior to the test
• C) Give a double dose
• D) Switch to an alternative medication
Rationale: Beta-blockers like metoprolol blunt the heart rate response to exercise,
potentially masking ischemia during a stress test. They are typically held before the test
to allow an accurate assessment of cardiac function. Other medications like metformin
are held before contrast studies.
2. A client with heart failure has a new prescription for metoprolol. Which finding
would cause the nurse to question the order?
• A) Heart rate 52 beats per minute
• B) Blood pressure 130/80 mm Hg
• C) Respiratory rate 18 breaths/min
• D) Oxygen saturation 94%
, Page 2 of 78
Rationale: Beta-blockers such as metoprolol should generally be held if the heart rate
is below 60 beats per minute to prevent symptomatic bradycardia. The medication
lowers heart rate and contractility; administering it with existing bradycardia could lead
to further hemodynamic compromise.
3. A client with an acute myocardial infarction is receiving morphine. Which
adverse effect should the nurse monitor most closely?
• A) Hypotension
• B) Tachycardia
• C) Respiratory depression
• D) Constipation
Rationale: Morphine is an opioid that can cause respiratory depression, especially in
older adults or those with COPD. Respiratory rate and depth should be monitored
closely. While hypotension and constipation are also concerns, respiratory depression
is the priority adverse effect requiring immediate intervention.
4. A client with chronic heart failure reports a persistent dry cough. Which
medication is most likely the cause?
• A) Furosemide
• B) Lisinopril
• C) Metoprolol
• D) Digoxin
Rationale: ACE inhibitors like lisinopril cause a persistent dry, nonproductive cough in
10-20% of patients due to increased bradykinin levels. This side effect often leads to
switching from an ACE inhibitor to an ARB (angiotensin receptor blocker) such as
losartan.
5. A client with atrial fibrillation has a new prescription for dabigatran (Pradaxa).
Which instruction should the nurse include?
• A) "Take this medication with a full glass of water."
• B) "You will need monthly INR monitoring."
• C) "Avoid eating green leafy vegetables."
, Page 3 of 78
• D) "This medication can be crushed if difficult to swallow."
Rationale: Dabigatran capsules should be taken with a full glass of water to ensure
proper absorption and reduce the risk of esophageal irritation. INR monitoring is
required for warfarin, not dabigatran. Vitamin K-rich foods are relevant to warfarin
therapy. Capsules should not be crushed as this affects absorption.
6. A client with peripheral venous insufficiency should be taught to:
• A) Elevate the legs when sitting
• B) Walk with legs dangling
• C) Apply heat to the legs
• D) Cross legs at the knees
Rationale: Elevation of the legs when sitting promotes venous return and reduces
edema in clients with venous insufficiency. Legs dangling or crossing at the knees
impedes circulation. Heat application may cause burns due to impaired sensation.
7. A client is prescribed verapamil for hypertension. Which side effect should the
nurse include in client teaching?
• A) Diarrhea
• B) Constipation
• C) Tachycardia
• D) Hypoglycemia
Rationale: Constipation is a common adverse effect of verapamil, a calcium channel
blocker. Patients should be advised to increase fluid and fiber intake to manage this
side effect.
8. A client with a completed ischemic stroke has a blood pressure of 180/90 mm
Hg. Which action should the nurse implement?
• A) Position the head of bed flat
• B) Withhold intravenous fluids
• C) Administer a bolus of IV fluids
• D) Give an antihypertensive medication
, Page 4 of 78
Rationale: Elevated blood pressure in a client with a completed stroke requires
antihypertensive medication to reduce the risk of further cerebrovascular damage. Most
ischemic strokes occur during sleep when blood pressure declines or viscosity
increases. Antihypertensive therapy is a priority.
9. A client who underwent cardiac stent placement four days ago arrives at the
emergency department reporting sudden chest pressure and shortness of breath.
Which action should the nurse take first?
• A) Administer oxygen at 2 L/min via nasal cannula
• B) Obtain a 12-lead ECG
• C) Assess vital signs
• D) Prepare for thrombolytic therapy
Rationale: The ABCs are the priority—vital signs should be assessed first to detect
instability (e.g., hypotension) in a client with potential stent thrombosis. ECG and
oxygen administration follow; thrombolytics are not indicated for stent thrombosis.
10. The nurse is teaching a client with heart failure about fluid restriction. Which
statement indicates the client understands the teaching?
• A) "I can drink as much as I want as long as I take my diuretics."
• B) "I should limit my fluid intake to the amount prescribed by my doctor."
• C) "I can have extra fluids if I exercise more."
• D) "Fluid restriction is only necessary if I have edema."
Rationale: Clients with heart failure must adhere to prescribed fluid restrictions to
prevent fluid overload, which can exacerbate symptoms and lead to pulmonary edema.
Diuretics help remove excess fluid but do not eliminate the need for restriction.
11. A client with heart failure has crackles in the lung bases, jugular venous
distention, and peripheral edema. Which nursing intervention has the highest
priority?
• A) Place the client in high-Fowler's position
• B) Restrict oral fluids to 1,000 mL/day
• C) Administer diuretics as ordered
