BSN 266 HESI Med Surg Proctored
Exam 2025/2026 – 100% Verified Full
Exam with A+ Answers | Actual Test Bank
| Nightingale College
CARDIOVASCULAR (Q1–10)
Q1. What is the priority nursing action for a client with chest pain and ST elevation in leads II,
III, aVF? Administer oxygen and notify the provider for immediate PCI. Rationale: Inferior
wall MI; right coronary artery occlusion requires urgent reperfusion within 90 minutes.
Q2. What is the most common complication 48 hours after an anterior wall MI? Ventricular
septal rupture. Rationale: Day 3–5 post-MI; new holosystolic murmur, cardiogenic shock.
Q3. What medication should the nurse question in a client with acute decompensated heart
failure and potassium 5.8 mEq/L? Spironolactone. Rationale: Potassium-sparing diuretic; risk
of life-threatening hyperkalemia.
Q4. What is the expected outcome of nitroglycerin sublingual in angina? Relief of chest pain
within 3–5 minutes. Rationale: Venous vasodilation reduces preload and myocardial O2
demand.
Q5. What finding requires immediate intervention in a client on heparin infusion? aPTT greater
than 100 seconds. Rationale: Therapeutic range 60–80 seconds; high bleeding risk.
Q6. What is the first action for sudden dyspnea and hypotension 24 hours post-CABG? Return
to OR for mediastinal exploration. Rationale: Cardiac tamponade from bleeding; Beck’s triad.
, Q7. What diet is prescribed for heart failure on furosemide? Low-sodium diet 2 g/day.
Rationale: Reduces fluid retention; potassium-rich foods replace diuretic losses.
Q8. What is the antidote for dabigatran? Idaruciumab (Praxbind). Rationale: Specific reversal
for life-threatening bleeding.
Q9. What INR indicates therapeutic warfarin response? INR 2.0–3.0. Rationale: Prevents
thrombosis without excessive bleeding.
Q10. What is the priority nursing diagnosis for pulmonary edema? Impaired gas exchange.
Rationale: Life-threatening; requires high Fowler’s, oxygen, diuretics.
RESPIRATORY (Q11–20)
Q11. What is the priority intervention for pneumothorax after central line placement? Apply
occlusive dressing and prepare chest tube. Rationale: Tension pneumothorax risk; tracheal
deviation, absent breath sounds.
Q12. What ABG shows acute respiratory failure in COPD exacerbation? pH 7.30, PaCO2 70
mmHg, PaO2 55 mmHg, HCO3 32 mEq/L. Rationale: Acute-on-chronic respiratory acidosis.
Q13. What position should a client with massive hemoptysis assume? Affected lung down.
Rationale: Prevents blood spilling into good lung.
Q14. What is the first sign of fat embolism after long bone fracture? Petechial rash on chest
and neck. Rationale: Classic triad: respiratory distress, neurologic changes, petechiae.
Q15. What medication is contraindicated in asthma with peanut allergy? Ipratropium
inhalation solution (some brands contain soy lecithin). Rationale: Cross-reactivity risk; use
albuterol alone.
Exam 2025/2026 – 100% Verified Full
Exam with A+ Answers | Actual Test Bank
| Nightingale College
CARDIOVASCULAR (Q1–10)
Q1. What is the priority nursing action for a client with chest pain and ST elevation in leads II,
III, aVF? Administer oxygen and notify the provider for immediate PCI. Rationale: Inferior
wall MI; right coronary artery occlusion requires urgent reperfusion within 90 minutes.
Q2. What is the most common complication 48 hours after an anterior wall MI? Ventricular
septal rupture. Rationale: Day 3–5 post-MI; new holosystolic murmur, cardiogenic shock.
Q3. What medication should the nurse question in a client with acute decompensated heart
failure and potassium 5.8 mEq/L? Spironolactone. Rationale: Potassium-sparing diuretic; risk
of life-threatening hyperkalemia.
Q4. What is the expected outcome of nitroglycerin sublingual in angina? Relief of chest pain
within 3–5 minutes. Rationale: Venous vasodilation reduces preload and myocardial O2
demand.
Q5. What finding requires immediate intervention in a client on heparin infusion? aPTT greater
than 100 seconds. Rationale: Therapeutic range 60–80 seconds; high bleeding risk.
Q6. What is the first action for sudden dyspnea and hypotension 24 hours post-CABG? Return
to OR for mediastinal exploration. Rationale: Cardiac tamponade from bleeding; Beck’s triad.
, Q7. What diet is prescribed for heart failure on furosemide? Low-sodium diet 2 g/day.
Rationale: Reduces fluid retention; potassium-rich foods replace diuretic losses.
Q8. What is the antidote for dabigatran? Idaruciumab (Praxbind). Rationale: Specific reversal
for life-threatening bleeding.
Q9. What INR indicates therapeutic warfarin response? INR 2.0–3.0. Rationale: Prevents
thrombosis without excessive bleeding.
Q10. What is the priority nursing diagnosis for pulmonary edema? Impaired gas exchange.
Rationale: Life-threatening; requires high Fowler’s, oxygen, diuretics.
RESPIRATORY (Q11–20)
Q11. What is the priority intervention for pneumothorax after central line placement? Apply
occlusive dressing and prepare chest tube. Rationale: Tension pneumothorax risk; tracheal
deviation, absent breath sounds.
Q12. What ABG shows acute respiratory failure in COPD exacerbation? pH 7.30, PaCO2 70
mmHg, PaO2 55 mmHg, HCO3 32 mEq/L. Rationale: Acute-on-chronic respiratory acidosis.
Q13. What position should a client with massive hemoptysis assume? Affected lung down.
Rationale: Prevents blood spilling into good lung.
Q14. What is the first sign of fat embolism after long bone fracture? Petechial rash on chest
and neck. Rationale: Classic triad: respiratory distress, neurologic changes, petechiae.
Q15. What medication is contraindicated in asthma with peanut allergy? Ipratropium
inhalation solution (some brands contain soy lecithin). Rationale: Cross-reactivity risk; use
albuterol alone.
