Nightingale College | BSN 266 HESI Medical-Surgical Comprehensive Examination
BSN 266 HESI Medical-Surgical
Comprehensive Examination 2026/2027 |
Verified Questions
Nightingale College | BSN 266 HESI Medical-Surgical Comprehensive Examination | University-Level Nursing
Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Nightingale College | BSN 266 HESI Medical-Surgical Comprehensive Examination
Comprehensive Proctored Examination Actual Exam | Academic Year 2026/2027
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This comprehensive examination contains exactly 100 original verified questions designed to reinforce the official
Nightingale College BSN 266 HESI Medical-Surgical Comprehensive Examination course objectives for actual exam
readiness and clinical proficiency in the 2026/2027 academic year. The questions span four core domains: Domain
1 Respiratory and Cardiovascular Disorders, Domain 2 Gastrointestinal and Renal Disorders, Domain 3
Neurological and Musculoskeletal Disorders, and Domain 4 Endocrine, Hematologic, and Oncologic Disorders.
Each question is crafted to test distinct sub-topics drawn from foundational medical-surgical nursing methodology,
enabling university-level nursing students to demonstrate clinical diagnostic mastery across major body systems.
ACTUAL QUESTIONS
Domain 1: Respiratory and Cardiovascular Disorders
Question 1. A client with community-acquired pneumonia is receiving oxygen via nasal cannula at 2
L/min. Which assessment finding requires the nurse’s immediate attention?
A. Respiratory rate of 22 breaths/min
B. Oxygen saturation of 88% on current oxygen settings
C. Temperature of 38.2°C (100.8°F)
D. Productive cough with yellow sputum
Correct Answer: D
Rationale: Oxygen saturation below 90% on supplemental oxygen indicates inadequate gas exchange and
requires prompt intervention to prevent hypoxemic respiratory failure.
Question 2. Which pathophysiologic change is the primary cause of the hypoxemia seen in a client
with pulmonary embolism?
A. Bronchoconstriction from inflammatory mediators
B. Alveolar hypoventilation due to pain
C. Ventilation-perfusion mismatch from obstructed pulmonary blood flow
D. Decreased diffusion capacity from interstitial edema
Correct Answer: B
Rationale: Pulmonary embolism produces areas of lung that are ventilated but not perfused (dead-space
ventilation), resulting in ventilation-perfusion mismatch and hypoxemia.
Question 3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4
L/min via nasal cannula. The nurse should monitor most closely for which complication?
A. Oxygen toxicity
B. Hypercapnic respiratory drive suppression
C. Pulmonary fibrosis
D. Methemoglobinemia
Correct Answer: C
Rationale: In clients with chronic hypercapnia, high-flow oxygen may remove the hypoxic respiratory drive,
leading to hypoventilation and worsening hypercapnia.
Question 4. Which electrocardiographic finding is most characteristic of an acute inferior-wall
myocardial infarction?
A. ST-segment elevation in leads V1–V4
B. ST-segment elevation in leads II, III, and aVF
C. ST-segment depression in leads I and aVL
D. Tall, peaked T waves in all precordial leads
Correct Answer: D
Rationale: Inferior-wall infarction typically produces ST-segment elevation in the inferior leads (II, III, aVF) and
is often associated with right coronary artery occlusion.
Question 5. A client with acute decompensated heart failure is receiving intravenous furosemide.
Which laboratory value should the nurse monitor most closely?
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
, A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: C
Rationale: Loop diuretics cause significant urinary potassium loss; hypokalemia can precipitate dysrhythmias
and must be monitored and replaced as needed.
Question 6. Which nursing action is the priority for a client experiencing acute pulmonary edema?
A. Administer a fluid bolus to support blood pressure
B. Place the client in high Fowler position and administer oxygen
C. Encourage the client to cough and deep-breathe
D. Obtain a 12-lead electrocardiogram before any other intervention
Correct Answer: D
Rationale: High Fowler positioning and supplemental oxygen reduce venous return and improve oxygenation,
which are immediate priorities in acute pulmonary edema.
Question 7. A client with atrial fibrillation is prescribed warfarin. Which laboratory result indicates
that the anticoagulant effect is within the therapeutic range?
A. aPTT 1.5–2.5 times control
B. INR 2.0–3.0
C. Platelet count 150,000–400,000/mm³
D. Bleeding time 2–7 minutes
Correct Answer: A
Rationale: Therapeutic anticoagulation with warfarin for atrial fibrillation is reflected by an INR of 2.0–3.0.
Question 8. Which clinical manifestation is most indicative of right-sided heart failure?
A. Pulmonary crackles and orthopnea
B. Peripheral edema and jugular venous distention
C. Productive cough with pink frothy sputum
D. Decreased peripheral pulses and cool extremities
Correct Answer: C
Rationale: Right-sided heart failure produces systemic venous congestion manifested by jugular venous
distention, peripheral edema, and hepatomegaly.
Question 9. A client is receiving continuous positive airway pressure (CPAP) for obstructive sleep
apnea. Which assessment finding indicates that the therapy is effective?
A. Decreased daytime sleepiness and improved oxygen saturation during sleep
B. Increased respiratory rate and accessory muscle use
C. Elevated PaCO₂ on arterial blood gas analysis
D. Development of central apnea episodes
Correct Answer: D
Rationale: Effective CPAP therapy reduces apneic episodes, improves nocturnal oxygenation, and decreases
daytime somnolence.
Question 10. Which intervention is the priority when a client develops sudden dyspnea, chest pain,
and a feeling of impending doom after a long-bone fracture?
A. Administer analgesics for the chest pain
B. Prepare for immediate intubation
C. Position the client on the left side and administer high-flow oxygen
D. Encourage deep breathing and coughing
Correct Answer: C
Rationale: These signs suggest fat embolism; left-side positioning and high-flow oxygen are initial supportive
measures while preparing for definitive care.
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
BSN 266 HESI Medical-Surgical
Comprehensive Examination 2026/2027 |
Verified Questions
Nightingale College | BSN 266 HESI Medical-Surgical Comprehensive Examination | University-Level Nursing
Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Nightingale College | BSN 266 HESI Medical-Surgical Comprehensive Examination
Comprehensive Proctored Examination Actual Exam | Academic Year 2026/2027
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This comprehensive examination contains exactly 100 original verified questions designed to reinforce the official
Nightingale College BSN 266 HESI Medical-Surgical Comprehensive Examination course objectives for actual exam
readiness and clinical proficiency in the 2026/2027 academic year. The questions span four core domains: Domain
1 Respiratory and Cardiovascular Disorders, Domain 2 Gastrointestinal and Renal Disorders, Domain 3
Neurological and Musculoskeletal Disorders, and Domain 4 Endocrine, Hematologic, and Oncologic Disorders.
Each question is crafted to test distinct sub-topics drawn from foundational medical-surgical nursing methodology,
enabling university-level nursing students to demonstrate clinical diagnostic mastery across major body systems.
ACTUAL QUESTIONS
Domain 1: Respiratory and Cardiovascular Disorders
Question 1. A client with community-acquired pneumonia is receiving oxygen via nasal cannula at 2
L/min. Which assessment finding requires the nurse’s immediate attention?
A. Respiratory rate of 22 breaths/min
B. Oxygen saturation of 88% on current oxygen settings
C. Temperature of 38.2°C (100.8°F)
D. Productive cough with yellow sputum
Correct Answer: D
Rationale: Oxygen saturation below 90% on supplemental oxygen indicates inadequate gas exchange and
requires prompt intervention to prevent hypoxemic respiratory failure.
Question 2. Which pathophysiologic change is the primary cause of the hypoxemia seen in a client
with pulmonary embolism?
A. Bronchoconstriction from inflammatory mediators
B. Alveolar hypoventilation due to pain
C. Ventilation-perfusion mismatch from obstructed pulmonary blood flow
D. Decreased diffusion capacity from interstitial edema
Correct Answer: B
Rationale: Pulmonary embolism produces areas of lung that are ventilated but not perfused (dead-space
ventilation), resulting in ventilation-perfusion mismatch and hypoxemia.
Question 3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4
L/min via nasal cannula. The nurse should monitor most closely for which complication?
A. Oxygen toxicity
B. Hypercapnic respiratory drive suppression
C. Pulmonary fibrosis
D. Methemoglobinemia
Correct Answer: C
Rationale: In clients with chronic hypercapnia, high-flow oxygen may remove the hypoxic respiratory drive,
leading to hypoventilation and worsening hypercapnia.
Question 4. Which electrocardiographic finding is most characteristic of an acute inferior-wall
myocardial infarction?
A. ST-segment elevation in leads V1–V4
B. ST-segment elevation in leads II, III, and aVF
C. ST-segment depression in leads I and aVL
D. Tall, peaked T waves in all precordial leads
Correct Answer: D
Rationale: Inferior-wall infarction typically produces ST-segment elevation in the inferior leads (II, III, aVF) and
is often associated with right coronary artery occlusion.
Question 5. A client with acute decompensated heart failure is receiving intravenous furosemide.
Which laboratory value should the nurse monitor most closely?
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
, A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: C
Rationale: Loop diuretics cause significant urinary potassium loss; hypokalemia can precipitate dysrhythmias
and must be monitored and replaced as needed.
Question 6. Which nursing action is the priority for a client experiencing acute pulmonary edema?
A. Administer a fluid bolus to support blood pressure
B. Place the client in high Fowler position and administer oxygen
C. Encourage the client to cough and deep-breathe
D. Obtain a 12-lead electrocardiogram before any other intervention
Correct Answer: D
Rationale: High Fowler positioning and supplemental oxygen reduce venous return and improve oxygenation,
which are immediate priorities in acute pulmonary edema.
Question 7. A client with atrial fibrillation is prescribed warfarin. Which laboratory result indicates
that the anticoagulant effect is within the therapeutic range?
A. aPTT 1.5–2.5 times control
B. INR 2.0–3.0
C. Platelet count 150,000–400,000/mm³
D. Bleeding time 2–7 minutes
Correct Answer: A
Rationale: Therapeutic anticoagulation with warfarin for atrial fibrillation is reflected by an INR of 2.0–3.0.
Question 8. Which clinical manifestation is most indicative of right-sided heart failure?
A. Pulmonary crackles and orthopnea
B. Peripheral edema and jugular venous distention
C. Productive cough with pink frothy sputum
D. Decreased peripheral pulses and cool extremities
Correct Answer: C
Rationale: Right-sided heart failure produces systemic venous congestion manifested by jugular venous
distention, peripheral edema, and hepatomegaly.
Question 9. A client is receiving continuous positive airway pressure (CPAP) for obstructive sleep
apnea. Which assessment finding indicates that the therapy is effective?
A. Decreased daytime sleepiness and improved oxygen saturation during sleep
B. Increased respiratory rate and accessory muscle use
C. Elevated PaCO₂ on arterial blood gas analysis
D. Development of central apnea episodes
Correct Answer: D
Rationale: Effective CPAP therapy reduces apneic episodes, improves nocturnal oxygenation, and decreases
daytime somnolence.
Question 10. Which intervention is the priority when a client develops sudden dyspnea, chest pain,
and a feeling of impending doom after a long-bone fracture?
A. Administer analgesics for the chest pain
B. Prepare for immediate intubation
C. Position the client on the left side and administer high-flow oxygen
D. Encourage deep breathing and coughing
Correct Answer: C
Rationale: These signs suggest fat embolism; left-side positioning and high-flow oxygen are initial supportive
measures while preparing for definitive care.
BSN 266 HESI Medical-Surgical Comprehensive Examination 2026/2027 | Verified Questions
