A+ VERIFIED
NURSING · OBJECTIVE ASSESSMENT
BSN HESI 266 Med Surg Exam 2026/2027 -
Nightingale College 2026/2027 — Complete
Official Exam
A+ Verified Full Rationales Verified Answers
A+ 5 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Cardiovascular & Hematologic Disorders
02 Respiratory & Fluid-Electrolyte Balance
03 Neurological, Musculoskeletal & Sensory
04 Gastrointestinal, Renal & Endocrine
05 Perioperative, Integumentary & Immune
ABOUT THIS ASSESSMENT
Build mastery in medical-surgical nursing — from cardiovascular and respiratory
disorders to neurological, gastrointestinal, renal, endocrine, and perioperative care.
This original study bank targets application and analysis skills for BSN HESI 266
Med Surg, with full rationales for every answer. For review use only;
not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
80% Advanced (BSN Med-Surg) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Cardiovascular & Hematologic Disorders
Q1. A 72-year-old client with heart failure is admitted with acute dyspnea, bilateral crackles, and an S3 gallop. The nurse
prioritizes which intervention first?
A. Place the client flat to promote venous return.
B. Encourage ambulation to improve circulation.
C. Provide a high-sodium snack to stimulate appetite.
D. Administer prescribed intravenous loop diuretic and position upright.
Correct Answer: D
Rationale:
Intravenous diuretics rapidly reduce preload and pulmonary congestion. Upright positioning further decreases venous return. Ambulation
and sodium intake would worsen fluid overload.
Q2. A client recovering from myocardial infarction develops sudden severe chest pain radiating to the jaw and becomes
diaphoretic. ST elevation is noted on the monitor. The nurse's immediate action is to:
A. Administer an oral beta-blocker and reassess in 30 minutes.
B. Obtain a 12-lead ECG and activate the cardiac response team.
C. Document the findings and continue routine monitoring.
D. Encourage deep breathing and relaxation techniques.
Correct Answer: B
Rationale:
ST-elevation symptoms require immediate ECG confirmation and rapid reperfusion pathways. Delay increases myocardial necrosis.
Q3. A client on warfarin for atrial fibrillation has an INR of 5.2 and reports dark stools. The nurse anticipates which order?
A. Increase the warfarin dose to achieve a higher INR.
B. Hold warfarin, notify the provider, and prepare for possible vitamin K administration.
C. Continue the current dose and recheck INR in one week.
D. Administer a heparin bolus to reverse the effect.
Correct Answer: B
Rationale:
An elevated INR with evidence of possible bleeding requires holding the anticoagulant and provider notification for potential reversal.
Q4. After coronary artery bypass grafting, chest-tube output is 200 mL in the first hour and blood pressure falls to 86/52 mm Hg.
The priority nursing action is:
A. Milk the chest tubes vigorously every 15 minutes.
B. Increase the IV fluid rate and reassess in one hour.
C. Notify the surgeon of possible postoperative hemorrhage.
D. Place the client in Trendelenburg position only.
Correct Answer: C
Rationale:
Sudden high output with hypotension suggests bleeding or tamponade risk and requires immediate surgical consultation.
STUVIA ACTUAL EXAM · Page 2
, SECTION 1: Cardiovascular & Hematologic Disorders
Q5. A client with chronic stable angina is taught to take sublingual nitroglycerin at the onset of chest pain. Essential additional
teaching includes:
A. Swallow the tablet whole with a full glass of water.
B. If pain persists after three doses five minutes apart, seek emergency care.
C. Take the tablet only after pain has lasted 30 minutes.
D. Store tablets in a warm humid environment.
Correct Answer: B
Rationale:
Persistent pain after three doses signals possible acute coronary syndrome requiring emergency evaluation.
Q6. A client develops symptomatic bradycardia at 40 beats/min with dizziness. The nurse prepares to administer which
medication?
A. Metoprolol to further slow the rate.
B. Atropine as the first-line agent for symptomatic bradycardia.
C. Digoxin to increase contractility.
D. Adenosine to terminate a possible SVT.
Correct Answer: B
Rationale:
Atropine blocks vagal tone and is first-line for symptomatic bradycardia. The other agents would worsen the bradycardia.
Q7. A client with infective endocarditis develops a new murmur and sudden right-sided weakness. The nurse suspects:
A. Acute pericarditis with effusion.
B. Septic embolization to the cerebral circulation.
C. Myocardial rupture.
D. Deep-vein thrombosis with pulmonary embolism.
Correct Answer: B
Rationale:
Left-sided vegetations can embolize systemically; new neurologic deficit plus new murmur strongly suggests cerebral embolus.
Q8. A client receiving digoxin reports nausea, yellow-green visual halos, and has an irregular pulse. These findings most likely
indicate:
A. Therapeutic response to the medication.
B. Digoxin toxicity requiring immediate evaluation.
C. Need for an increased digoxin dose.
D. Expected gastrointestinal side effects only.
Correct Answer: B
Rationale:
Classic digoxin toxicity includes GI symptoms, visual changes, and arrhythmias. Serum level and electrolytes must be checked.
Q9. Assessment of a client with peripheral arterial disease reveals dependent rubor, intermittent claudication, and diminished
pedal pulses. Priority teaching includes:
A. Wear tight compression stockings continuously.
B. Elevate legs above heart level at all times.
C. Apply heating pads directly to the feet.
D. Keep legs dependent when sitting and avoid crossing the legs.
Correct Answer: D
Rationale:
Dependent positioning improves arterial flow. Elevation, heat, and tight compression can further compromise perfusion.
STUVIA ACTUAL EXAM · Page 3
, SECTION 1: Cardiovascular & Hematologic Disorders
Q10. Before elective cardioversion for persistent atrial fibrillation, the nurse confirms:
A. That the client may drink clear liquids until the procedure.
B. That the client has eaten a full meal.
C. That all cardiac medications have been held for 48 hours.
D. Adequate anticoagulation or a recent negative transesophageal echocardiogram.
Correct Answer: D
Rationale:
Cardioversion of AF lasting longer than 48 hours risks thromboembolism unless anticoagulation is adequate or thrombus is excluded.
Q11. A client with a permanent pacemaker reports lightheadedness; the heart rate is 46. The nurse first:
A. Encourages increased oral fluid intake.
B. Instructs the client to remain in bed and reassess later.
C. Administers a prescribed beta-blocker.
D. Notifies the provider of possible pacemaker malfunction.
Correct Answer: D
Rationale:
A rate below the programmed lower limit suggests failure to pace or capture and requires prompt evaluation.
Q12. A client in hypertensive emergency has BP 224/132 mm Hg with severe headache and blurred vision. Initial management
prioritizes:
A. An oral long-acting calcium-channel blocker.
B. Controlled reduction with a titratable intravenous antihypertensive.
C. Subcutaneous heparin.
D. Intramuscular opioid analgesia only.
Correct Answer: B
Rationale:
Hypertensive emergencies with end-organ involvement require carefully titrated IV agents, not slow-onset oral therapy.
Q13. After femoral cardiac catheterization, a client develops an expanding groin hematoma and reports severe back pain. The
nurse suspects:
A. Acute stent thrombosis.
B. Pulmonary embolism.
C. Retroperitoneal hemorrhage.
D. Contrast-induced nephropathy.
Correct Answer: C
Rationale:
Expanding hematoma with back or flank pain is classic for retroperitoneal bleeding after femoral access.
Q14. A client with dilated cardiomyopathy is started on carvedilol. Evidence of therapeutic benefit includes:
A. Increased resting heart rate.
B. Improved exercise tolerance and reduced dyspnea.
C. New peripheral edema.
D. Decreased ejection fraction.
Correct Answer: B
Rationale:
Beta-blockers improve remodeling and functional capacity in heart failure with reduced ejection fraction.
STUVIA ACTUAL EXAM · Page 4
NURSING · OBJECTIVE ASSESSMENT
BSN HESI 266 Med Surg Exam 2026/2027 -
Nightingale College 2026/2027 — Complete
Official Exam
A+ Verified Full Rationales Verified Answers
A+ 5 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Cardiovascular & Hematologic Disorders
02 Respiratory & Fluid-Electrolyte Balance
03 Neurological, Musculoskeletal & Sensory
04 Gastrointestinal, Renal & Endocrine
05 Perioperative, Integumentary & Immune
ABOUT THIS ASSESSMENT
Build mastery in medical-surgical nursing — from cardiovascular and respiratory
disorders to neurological, gastrointestinal, renal, endocrine, and perioperative care.
This original study bank targets application and analysis skills for BSN HESI 266
Med Surg, with full rationales for every answer. For review use only;
not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
80% Advanced (BSN Med-Surg) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Cardiovascular & Hematologic Disorders
Q1. A 72-year-old client with heart failure is admitted with acute dyspnea, bilateral crackles, and an S3 gallop. The nurse
prioritizes which intervention first?
A. Place the client flat to promote venous return.
B. Encourage ambulation to improve circulation.
C. Provide a high-sodium snack to stimulate appetite.
D. Administer prescribed intravenous loop diuretic and position upright.
Correct Answer: D
Rationale:
Intravenous diuretics rapidly reduce preload and pulmonary congestion. Upright positioning further decreases venous return. Ambulation
and sodium intake would worsen fluid overload.
Q2. A client recovering from myocardial infarction develops sudden severe chest pain radiating to the jaw and becomes
diaphoretic. ST elevation is noted on the monitor. The nurse's immediate action is to:
A. Administer an oral beta-blocker and reassess in 30 minutes.
B. Obtain a 12-lead ECG and activate the cardiac response team.
C. Document the findings and continue routine monitoring.
D. Encourage deep breathing and relaxation techniques.
Correct Answer: B
Rationale:
ST-elevation symptoms require immediate ECG confirmation and rapid reperfusion pathways. Delay increases myocardial necrosis.
Q3. A client on warfarin for atrial fibrillation has an INR of 5.2 and reports dark stools. The nurse anticipates which order?
A. Increase the warfarin dose to achieve a higher INR.
B. Hold warfarin, notify the provider, and prepare for possible vitamin K administration.
C. Continue the current dose and recheck INR in one week.
D. Administer a heparin bolus to reverse the effect.
Correct Answer: B
Rationale:
An elevated INR with evidence of possible bleeding requires holding the anticoagulant and provider notification for potential reversal.
Q4. After coronary artery bypass grafting, chest-tube output is 200 mL in the first hour and blood pressure falls to 86/52 mm Hg.
The priority nursing action is:
A. Milk the chest tubes vigorously every 15 minutes.
B. Increase the IV fluid rate and reassess in one hour.
C. Notify the surgeon of possible postoperative hemorrhage.
D. Place the client in Trendelenburg position only.
Correct Answer: C
Rationale:
Sudden high output with hypotension suggests bleeding or tamponade risk and requires immediate surgical consultation.
STUVIA ACTUAL EXAM · Page 2
, SECTION 1: Cardiovascular & Hematologic Disorders
Q5. A client with chronic stable angina is taught to take sublingual nitroglycerin at the onset of chest pain. Essential additional
teaching includes:
A. Swallow the tablet whole with a full glass of water.
B. If pain persists after three doses five minutes apart, seek emergency care.
C. Take the tablet only after pain has lasted 30 minutes.
D. Store tablets in a warm humid environment.
Correct Answer: B
Rationale:
Persistent pain after three doses signals possible acute coronary syndrome requiring emergency evaluation.
Q6. A client develops symptomatic bradycardia at 40 beats/min with dizziness. The nurse prepares to administer which
medication?
A. Metoprolol to further slow the rate.
B. Atropine as the first-line agent for symptomatic bradycardia.
C. Digoxin to increase contractility.
D. Adenosine to terminate a possible SVT.
Correct Answer: B
Rationale:
Atropine blocks vagal tone and is first-line for symptomatic bradycardia. The other agents would worsen the bradycardia.
Q7. A client with infective endocarditis develops a new murmur and sudden right-sided weakness. The nurse suspects:
A. Acute pericarditis with effusion.
B. Septic embolization to the cerebral circulation.
C. Myocardial rupture.
D. Deep-vein thrombosis with pulmonary embolism.
Correct Answer: B
Rationale:
Left-sided vegetations can embolize systemically; new neurologic deficit plus new murmur strongly suggests cerebral embolus.
Q8. A client receiving digoxin reports nausea, yellow-green visual halos, and has an irregular pulse. These findings most likely
indicate:
A. Therapeutic response to the medication.
B. Digoxin toxicity requiring immediate evaluation.
C. Need for an increased digoxin dose.
D. Expected gastrointestinal side effects only.
Correct Answer: B
Rationale:
Classic digoxin toxicity includes GI symptoms, visual changes, and arrhythmias. Serum level and electrolytes must be checked.
Q9. Assessment of a client with peripheral arterial disease reveals dependent rubor, intermittent claudication, and diminished
pedal pulses. Priority teaching includes:
A. Wear tight compression stockings continuously.
B. Elevate legs above heart level at all times.
C. Apply heating pads directly to the feet.
D. Keep legs dependent when sitting and avoid crossing the legs.
Correct Answer: D
Rationale:
Dependent positioning improves arterial flow. Elevation, heat, and tight compression can further compromise perfusion.
STUVIA ACTUAL EXAM · Page 3
, SECTION 1: Cardiovascular & Hematologic Disorders
Q10. Before elective cardioversion for persistent atrial fibrillation, the nurse confirms:
A. That the client may drink clear liquids until the procedure.
B. That the client has eaten a full meal.
C. That all cardiac medications have been held for 48 hours.
D. Adequate anticoagulation or a recent negative transesophageal echocardiogram.
Correct Answer: D
Rationale:
Cardioversion of AF lasting longer than 48 hours risks thromboembolism unless anticoagulation is adequate or thrombus is excluded.
Q11. A client with a permanent pacemaker reports lightheadedness; the heart rate is 46. The nurse first:
A. Encourages increased oral fluid intake.
B. Instructs the client to remain in bed and reassess later.
C. Administers a prescribed beta-blocker.
D. Notifies the provider of possible pacemaker malfunction.
Correct Answer: D
Rationale:
A rate below the programmed lower limit suggests failure to pace or capture and requires prompt evaluation.
Q12. A client in hypertensive emergency has BP 224/132 mm Hg with severe headache and blurred vision. Initial management
prioritizes:
A. An oral long-acting calcium-channel blocker.
B. Controlled reduction with a titratable intravenous antihypertensive.
C. Subcutaneous heparin.
D. Intramuscular opioid analgesia only.
Correct Answer: B
Rationale:
Hypertensive emergencies with end-organ involvement require carefully titrated IV agents, not slow-onset oral therapy.
Q13. After femoral cardiac catheterization, a client develops an expanding groin hematoma and reports severe back pain. The
nurse suspects:
A. Acute stent thrombosis.
B. Pulmonary embolism.
C. Retroperitoneal hemorrhage.
D. Contrast-induced nephropathy.
Correct Answer: C
Rationale:
Expanding hematoma with back or flank pain is classic for retroperitoneal bleeding after femoral access.
Q14. A client with dilated cardiomyopathy is started on carvedilol. Evidence of therapeutic benefit includes:
A. Increased resting heart rate.
B. Improved exercise tolerance and reduced dyspnea.
C. New peripheral edema.
D. Decreased ejection fraction.
Correct Answer: B
Rationale:
Beta-blockers improve remodeling and functional capacity in heart failure with reduced ejection fraction.
STUVIA ACTUAL EXAM · Page 4
