BSN 266 - HESI MEDICAL-SURGICAL PRACTICE EXAM V2
(NIGHTINGALE COLLEGE, 2025/2026) - VERIFIED QUESTIONS,
ANSWERS, AND RATIONALES (GRADE A, 100% CORRECT)
190 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze complex medical-surgical conditions to formulate prioritized nursing interventions
2 Evaluate the appropriateness of pharmacological and non-pharmacological treatments based on current
evidence
3 Synthesize assessment data to identify complications and implement timely, safe care
4 Apply ethical, legal, and interprofessional principles in acute care settings
5 BSN 266
6 HESI Medical
7 Surgical Practice Exam V2
8 Nightingale College
9 2025
10 2026
11 Verified Questions
12 Answers
13 and Rationales
14 Grade A
15 100% Correct
16 Foundations of Medical-Surgical Nursing
17 Applied Medical-Surgical Nursing
18 Advanced Medical-Surgical Nursing
19 Medical-Surgical Nursing Review
Page 1
,Q1 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
In a patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation, plateau pressure rises to 32 cm H2O and static compliance falls. Which
ventilator adjustment best addresses the underlying pathophysiology while
minimizing further lung injury?
A. Increase PEEP to 15 cm H2O and reduce tidal volume to 4-6 mL/kg ideal body weight
CORRECT
B. Increase respiratory rate to maintain minute ventilation without changing tidal volume
C. Switch to pressure-controlled ventilation with peak pressure limited to 35 cm H2O
D. Decrease FiO2 to 50% and accept permissive hypercapnia
RATIONALE: In ARDS, low tidal volume (4-6 mL/kg) and higher PEEP are lung-protective,
reducing volutrauma and improving compliance. Increasing rate alone doesn't address high
plateau pressure. Pressure-controlled ventilation doesn't guarantee safe tidal volumes.
Permissive hypercapnia is used but not the primary adjustment for high plateau pressure.
Q2 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
A patient with chronic kidney disease (stage 4) is started on lisinopril. Which
laboratory trend indicates an adverse effect requiring prompt discontinuation?
A. Serum potassium rising from 4.2 to 5.6 mEq/L CORRECT
B. Serum creatinine increasing by 0.2 mg/dL from baseline
C. Blood urea nitrogen (BUN) decreasing from 40 to 28 mg/dL
D. Hemoglobin increasing from 9.5 to 10.5 g/dL
RATIONALE: ACE inhibitors can cause hyperkalemia due to reduced aldosterone; a rise to 5.6
mEq/L is concerning and may warrant discontinuation. A 0.2 mg/dL creatinine rise is acceptable.
Decreasing BUN and increasing hemoglobin are not adverse effects.
Page 2
,Q3 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
For a patient with severe sepsis and lactic acidosis, which fluid resuscitation
strategy is most consistent with the Surviving Sepsis Campaign guidelines?
A. Administer 30 mL/kg crystalloid within the first 3 hours, reassess perfusion CORRECT
B. Use hydroxyethyl starch to reduce volume required
C. Restrict fluids to avoid pulmonary edema
D. Give 500 mL boluses every 30 minutes until central venous pressure >12 mmHg
RATIONALE: Guidelines recommend 30 mL/kg crystalloid for sepsis-induced hypoperfusion, with
dynamic assessment. Starch is harmful. Restriction is inappropriate. CVP targeting is no longer
emphasized; dynamic measures are preferred.
Q4 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
In a patient with acute pancreatitis, which finding best distinguishes severe
disease requiring intensive care from mild disease?
A. Serum amylase level of 1200 U/L
B. Hematocrit rising from 44% to 50% at 24 hours CORRECT
C. Presence of epigastric pain radiating to the back
D. White blood cell count of 12,000/mm³
RATIONALE: Persistent hemoconcentration indicates significant third-spacing and is a poor
prognostic sign. Amylase does not correlate with severity. Pain and mild leukocytosis are typical
but not indicative of severity.
Page 3
, Q5 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 60
mm Hg and intracranial pressure (ICP) of 25 mm Hg. Which intervention should be
implemented first?
A. Administer mannitol 0.5 g/kg IV
B. Elevate the head of the bed to 30 degrees
C. Increase IV norepinephrine to raise MAP above 65 mm Hg CORRECT
D. Hyperventilate to a PaCO2 of 30 mm Hg
RATIONALE: Cerebral perfusion pressure (CPP) = MAP - ICP. Here CPP is 35 mm Hg, critically
low. The priority is to raise MAP to maintain CPP >60 mm Hg. Mannitol and head elevation are
adjuncts. Hyperventilation is reserved for herniation.
Q6 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
Which medication order requires the nurse to question for a patient with diabetic
gastroparesis?
A. Metoclopramide 10 mg IV before meals
B. Erythromycin 250 mg IV every 6 hours
C. Dulaglutide 1.5 mg subcutaneously weekly CORRECT
D. Omeprazole 20 mg orally daily
RATIONALE: Dulaglutide, a GLP-1 agonist, delays gastric emptying and can worsen
gastroparesis. Metoclopramide and erythromycin are prokinetics used to treat it. Omeprazole is
for GERD, not contraindicated.
Page 4
(NIGHTINGALE COLLEGE, 2025/2026) - VERIFIED QUESTIONS,
ANSWERS, AND RATIONALES (GRADE A, 100% CORRECT)
190 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze complex medical-surgical conditions to formulate prioritized nursing interventions
2 Evaluate the appropriateness of pharmacological and non-pharmacological treatments based on current
evidence
3 Synthesize assessment data to identify complications and implement timely, safe care
4 Apply ethical, legal, and interprofessional principles in acute care settings
5 BSN 266
6 HESI Medical
7 Surgical Practice Exam V2
8 Nightingale College
9 2025
10 2026
11 Verified Questions
12 Answers
13 and Rationales
14 Grade A
15 100% Correct
16 Foundations of Medical-Surgical Nursing
17 Applied Medical-Surgical Nursing
18 Advanced Medical-Surgical Nursing
19 Medical-Surgical Nursing Review
Page 1
,Q1 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
In a patient with acute respiratory distress syndrome (ARDS) on volume-controlled
ventilation, plateau pressure rises to 32 cm H2O and static compliance falls. Which
ventilator adjustment best addresses the underlying pathophysiology while
minimizing further lung injury?
A. Increase PEEP to 15 cm H2O and reduce tidal volume to 4-6 mL/kg ideal body weight
CORRECT
B. Increase respiratory rate to maintain minute ventilation without changing tidal volume
C. Switch to pressure-controlled ventilation with peak pressure limited to 35 cm H2O
D. Decrease FiO2 to 50% and accept permissive hypercapnia
RATIONALE: In ARDS, low tidal volume (4-6 mL/kg) and higher PEEP are lung-protective,
reducing volutrauma and improving compliance. Increasing rate alone doesn't address high
plateau pressure. Pressure-controlled ventilation doesn't guarantee safe tidal volumes.
Permissive hypercapnia is used but not the primary adjustment for high plateau pressure.
Q2 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
A patient with chronic kidney disease (stage 4) is started on lisinopril. Which
laboratory trend indicates an adverse effect requiring prompt discontinuation?
A. Serum potassium rising from 4.2 to 5.6 mEq/L CORRECT
B. Serum creatinine increasing by 0.2 mg/dL from baseline
C. Blood urea nitrogen (BUN) decreasing from 40 to 28 mg/dL
D. Hemoglobin increasing from 9.5 to 10.5 g/dL
RATIONALE: ACE inhibitors can cause hyperkalemia due to reduced aldosterone; a rise to 5.6
mEq/L is concerning and may warrant discontinuation. A 0.2 mg/dL creatinine rise is acceptable.
Decreasing BUN and increasing hemoglobin are not adverse effects.
Page 2
,Q3 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
For a patient with severe sepsis and lactic acidosis, which fluid resuscitation
strategy is most consistent with the Surviving Sepsis Campaign guidelines?
A. Administer 30 mL/kg crystalloid within the first 3 hours, reassess perfusion CORRECT
B. Use hydroxyethyl starch to reduce volume required
C. Restrict fluids to avoid pulmonary edema
D. Give 500 mL boluses every 30 minutes until central venous pressure >12 mmHg
RATIONALE: Guidelines recommend 30 mL/kg crystalloid for sepsis-induced hypoperfusion, with
dynamic assessment. Starch is harmful. Restriction is inappropriate. CVP targeting is no longer
emphasized; dynamic measures are preferred.
Q4 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
In a patient with acute pancreatitis, which finding best distinguishes severe
disease requiring intensive care from mild disease?
A. Serum amylase level of 1200 U/L
B. Hematocrit rising from 44% to 50% at 24 hours CORRECT
C. Presence of epigastric pain radiating to the back
D. White blood cell count of 12,000/mm³
RATIONALE: Persistent hemoconcentration indicates significant third-spacing and is a poor
prognostic sign. Amylase does not correlate with severity. Pain and mild leukocytosis are typical
but not indicative of severity.
Page 3
, Q5 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
A patient with a traumatic brain injury has a mean arterial pressure (MAP) of 60
mm Hg and intracranial pressure (ICP) of 25 mm Hg. Which intervention should be
implemented first?
A. Administer mannitol 0.5 g/kg IV
B. Elevate the head of the bed to 30 degrees
C. Increase IV norepinephrine to raise MAP above 65 mm Hg CORRECT
D. Hyperventilate to a PaCO2 of 30 mm Hg
RATIONALE: Cerebral perfusion pressure (CPP) = MAP - ICP. Here CPP is 35 mm Hg, critically
low. The priority is to raise MAP to maintain CPP >60 mm Hg. Mannitol and head elevation are
adjuncts. Hyperventilation is reserved for herniation.
Q6 ANALYZE COMPLEX MEDICAL-SURGICAL CONDITIONS TO FORMULATE PRIORITIZED
NURSING INTERVENTIONS
Which medication order requires the nurse to question for a patient with diabetic
gastroparesis?
A. Metoclopramide 10 mg IV before meals
B. Erythromycin 250 mg IV every 6 hours
C. Dulaglutide 1.5 mg subcutaneously weekly CORRECT
D. Omeprazole 20 mg orally daily
RATIONALE: Dulaglutide, a GLP-1 agonist, delays gastric emptying and can worsen
gastroparesis. Metoclopramide and erythromycin are prokinetics used to treat it. Omeprazole is
for GERD, not contraindicated.
Page 4
