1
BSN 266 HESI Med Surg Practice V2
(New 2025/2026 Update) Questions
and Verified Answers with Rationales |
100% Correct | Grade A – Nightingale
Cardiovascular System (Questions 1-20)
1. A client admitted with acute myocardial infarction reports sudden
onset of sharp chest pain radiating to the jaw. The nurse notes ST
elevation on ECG. What is the priority nursing action?
o A. Administer sublingual nitroglycerin
o B. Prepare for immediate percutaneous coronary
intervention
o C. Start oxygen at 2 L/min via nasal cannula
o D. Obtain a stat troponin level Rationale: In STEMI, timely
reperfusion via PCI is critical to restore blood flow and limit
myocardial damage; guidelines prioritize this over symptom
relief or diagnostics, as delays increase mortality risk.
2. A client with heart failure is prescribed furosemide 40 mg IV. The
nurse monitors for which potential adverse effect requiring
immediate intervention?
o A. Hypertension
o B. Hyperkalemia
o C. Hypokalemia
o D. Bradycardia Rationale: Loop diuretics like furosemide
promote potassium excretion, risking hypokalemia, which
can precipitate arrhythmias in heart failure clients; serial
electrolyte monitoring is essential.
3. During assessment of a client with hypertension, the nurse
auscultates a bruit over the renal artery. What does this finding
suggest?
o A. Atherosclerotic plaque rupture
, 2
o B. Renal artery stenosis
o C. Aortic aneurysm
o D. Peripheral embolism Rationale: A bruit indicates
turbulent blood flow due to narrowing, commonly from
stenosis in hypertensive clients, warranting further imaging
to prevent renal ischemia.
4. A postoperative CABG client develops atrial fibrillation with a
heart rate of 140 bpm. What is the initial pharmacological
intervention?
o A. Amiodarone IV bolus
o B. Beta-blocker such as metoprolol
o C. Heparin infusion
o D. Cardioversion Rationale: Rate control with beta-blockers
is first-line for new-onset AF in stable postoperative clients
to reduce myocardial oxygen demand; anticoagulation
follows if duration exceeds 48 hours.
5. The nurse is educating a client with peripheral artery disease on
lifestyle modifications. Which recommendation is most effective
for symptom management?
o A. Daily foot soaks in hot water
o B. Smoking cessation
o C. Supervised exercise program
o D. Low-sodium diet Rationale: Structured walking programs
improve collateral circulation and claudication tolerance in
PAD; smoking cessation is key but exercise directly
addresses functional limitations.
6. A client receiving warfarin therapy has an INR of 4.2. What is the
nurse's priority action?
o A. Administer vitamin K 10 mg PO
o B. Hold next dose and notify provider
o C. Increase green leafy vegetable intake
o D. Transfuse fresh frozen plasma Rationale: Elevated INR
indicates over-anticoagulation risk; holding the dose prevents
bleeding while awaiting provider guidance for reversal if
symptomatic.
, 3
7. In a client with endocarditis, the nurse identifies a new holosystolic
murmur. This change likely indicates:
o A. Pericardial effusion
o B. Valve vegetation progression
o C. Myocardial rupture
o D. Conduction block Rationale: Murmurs in endocarditis
reflect valvular damage from vegetations, signaling potential
embolization or heart failure; echocardiogram confirmation is
needed.
8. A client with cardiogenic shock post-MI is on dopamine infusion.
The nurse notes urine output of 15 mL/hr. What adjustment is
indicated?
o A. Decrease infusion rate
o B. Add dobutamine for inotropic support
o C. Fluid bolus of 500 mL
o D. Discontinue vasopressors Rationale: Persistent oliguria
despite vasopressors suggests inadequate cardiac output;
dobutamine enhances contractility without excessive
vasoconstriction.
9. The nurse assesses a client with aortic stenosis for exertional
dyspnea and syncope. What diagnostic test is priority?
o A. Stress ECG
o B. Echocardiogram
o C. Cardiac catheterization
o D. Holter monitor Rationale: Echocardiography quantifies
valve area and gradients, guiding surgical intervention in
symptomatic severe AS.
10. A client with venous thromboembolism is started on
enoxaparin. What laboratory monitoring is least necessary?
o A. Platelet count
o B. aPTT
o C. Activated partial thromboplastin time
o D. Hemoglobin Rationale: LMWH like enoxaparin has
predictable anticoagulation without routine aPTT monitoring;
anti-Xa levels are used only in special populations.
BSN 266 HESI Med Surg Practice V2
(New 2025/2026 Update) Questions
and Verified Answers with Rationales |
100% Correct | Grade A – Nightingale
Cardiovascular System (Questions 1-20)
1. A client admitted with acute myocardial infarction reports sudden
onset of sharp chest pain radiating to the jaw. The nurse notes ST
elevation on ECG. What is the priority nursing action?
o A. Administer sublingual nitroglycerin
o B. Prepare for immediate percutaneous coronary
intervention
o C. Start oxygen at 2 L/min via nasal cannula
o D. Obtain a stat troponin level Rationale: In STEMI, timely
reperfusion via PCI is critical to restore blood flow and limit
myocardial damage; guidelines prioritize this over symptom
relief or diagnostics, as delays increase mortality risk.
2. A client with heart failure is prescribed furosemide 40 mg IV. The
nurse monitors for which potential adverse effect requiring
immediate intervention?
o A. Hypertension
o B. Hyperkalemia
o C. Hypokalemia
o D. Bradycardia Rationale: Loop diuretics like furosemide
promote potassium excretion, risking hypokalemia, which
can precipitate arrhythmias in heart failure clients; serial
electrolyte monitoring is essential.
3. During assessment of a client with hypertension, the nurse
auscultates a bruit over the renal artery. What does this finding
suggest?
o A. Atherosclerotic plaque rupture
, 2
o B. Renal artery stenosis
o C. Aortic aneurysm
o D. Peripheral embolism Rationale: A bruit indicates
turbulent blood flow due to narrowing, commonly from
stenosis in hypertensive clients, warranting further imaging
to prevent renal ischemia.
4. A postoperative CABG client develops atrial fibrillation with a
heart rate of 140 bpm. What is the initial pharmacological
intervention?
o A. Amiodarone IV bolus
o B. Beta-blocker such as metoprolol
o C. Heparin infusion
o D. Cardioversion Rationale: Rate control with beta-blockers
is first-line for new-onset AF in stable postoperative clients
to reduce myocardial oxygen demand; anticoagulation
follows if duration exceeds 48 hours.
5. The nurse is educating a client with peripheral artery disease on
lifestyle modifications. Which recommendation is most effective
for symptom management?
o A. Daily foot soaks in hot water
o B. Smoking cessation
o C. Supervised exercise program
o D. Low-sodium diet Rationale: Structured walking programs
improve collateral circulation and claudication tolerance in
PAD; smoking cessation is key but exercise directly
addresses functional limitations.
6. A client receiving warfarin therapy has an INR of 4.2. What is the
nurse's priority action?
o A. Administer vitamin K 10 mg PO
o B. Hold next dose and notify provider
o C. Increase green leafy vegetable intake
o D. Transfuse fresh frozen plasma Rationale: Elevated INR
indicates over-anticoagulation risk; holding the dose prevents
bleeding while awaiting provider guidance for reversal if
symptomatic.
, 3
7. In a client with endocarditis, the nurse identifies a new holosystolic
murmur. This change likely indicates:
o A. Pericardial effusion
o B. Valve vegetation progression
o C. Myocardial rupture
o D. Conduction block Rationale: Murmurs in endocarditis
reflect valvular damage from vegetations, signaling potential
embolization or heart failure; echocardiogram confirmation is
needed.
8. A client with cardiogenic shock post-MI is on dopamine infusion.
The nurse notes urine output of 15 mL/hr. What adjustment is
indicated?
o A. Decrease infusion rate
o B. Add dobutamine for inotropic support
o C. Fluid bolus of 500 mL
o D. Discontinue vasopressors Rationale: Persistent oliguria
despite vasopressors suggests inadequate cardiac output;
dobutamine enhances contractility without excessive
vasoconstriction.
9. The nurse assesses a client with aortic stenosis for exertional
dyspnea and syncope. What diagnostic test is priority?
o A. Stress ECG
o B. Echocardiogram
o C. Cardiac catheterization
o D. Holter monitor Rationale: Echocardiography quantifies
valve area and gradients, guiding surgical intervention in
symptomatic severe AS.
10. A client with venous thromboembolism is started on
enoxaparin. What laboratory monitoring is least necessary?
o A. Platelet count
o B. aPTT
o C. Activated partial thromboplastin time
o D. Hemoglobin Rationale: LMWH like enoxaparin has
predictable anticoagulation without routine aPTT monitoring;
anti-Xa levels are used only in special populations.
