BSN 266 – HESI Medical-Surgical Exam
(Nightingale College, 2025/2026) –
Verified Questions & Answers (Grade A,
100% Correct)
CARDIOVASCULAR (1–8)
1. A client with acute decompensated heart failure (ADHF) has pulmonary edema.
The priority medication is: Furosemide IV
Rationale: Rapid diuresis reduces preload and relieves pulmonary congestion. Monitor
electrolytes and BP.
2. The nurse identifies a narrow-complex tachycardia at 160 bpm with stable BP.
First action: Administer adenosine 6 mg IV push
Rationale: Likely SVT. Adenosine blocks AV node → terminates reentry. Follow with 20
mL saline flush.
3. A client on digoxin has nausea and yellow vision. The nurse checks: Serum
digoxin level
Rationale: Toxicity signs (GI, visual). Therapeutic range 0.5–2.0 ng/mL. Hold dose if
>2.0.
4. The nurse teaches a client with hypertension to limit: Sodium to <2,300 mg/day
Rationale: DASH diet → ↓ BP. Avoid processed foods.
, 5. A client post-MI develops ventricular fibrillation. Immediate action: Defibrillate at
200 J biphasic
Rationale: Unstable pulseless VT/VF → unsynchronized shock. CPR until defibrillator
ready.
6. The nurse monitors a client on dobutamine for: Tachycardia
Rationale: Inotrope → ↑ HR and contractility. Titrate to MAP >65 mm Hg.
7. A client with aortic stenosis reports syncope. This is due to: Fixed cardiac output
Rationale: Narrow valve → ↓ CO with exertion. Avoid vasodilators.
8. The nurse identifies jugular venous distension (JVD) in right heart failure due to:
Increased central venous pressure
Rationale: Backward failure → fluid backup into veins.
RESPIRATORY (9–14)
9. A client with ARDS is on low tidal volume ventilation. The goal is: 6 mL/kg ideal
body weight
Rationale: ARDSNet protocol → lung-protective strategy to prevent volutrauma.
10. The nurse hears stridor post-extubation. First action: Administer racemic
epinephrine
Rationale: Laryngeal edema → nebulized epi + corticosteroids.
(Nightingale College, 2025/2026) –
Verified Questions & Answers (Grade A,
100% Correct)
CARDIOVASCULAR (1–8)
1. A client with acute decompensated heart failure (ADHF) has pulmonary edema.
The priority medication is: Furosemide IV
Rationale: Rapid diuresis reduces preload and relieves pulmonary congestion. Monitor
electrolytes and BP.
2. The nurse identifies a narrow-complex tachycardia at 160 bpm with stable BP.
First action: Administer adenosine 6 mg IV push
Rationale: Likely SVT. Adenosine blocks AV node → terminates reentry. Follow with 20
mL saline flush.
3. A client on digoxin has nausea and yellow vision. The nurse checks: Serum
digoxin level
Rationale: Toxicity signs (GI, visual). Therapeutic range 0.5–2.0 ng/mL. Hold dose if
>2.0.
4. The nurse teaches a client with hypertension to limit: Sodium to <2,300 mg/day
Rationale: DASH diet → ↓ BP. Avoid processed foods.
, 5. A client post-MI develops ventricular fibrillation. Immediate action: Defibrillate at
200 J biphasic
Rationale: Unstable pulseless VT/VF → unsynchronized shock. CPR until defibrillator
ready.
6. The nurse monitors a client on dobutamine for: Tachycardia
Rationale: Inotrope → ↑ HR and contractility. Titrate to MAP >65 mm Hg.
7. A client with aortic stenosis reports syncope. This is due to: Fixed cardiac output
Rationale: Narrow valve → ↓ CO with exertion. Avoid vasodilators.
8. The nurse identifies jugular venous distension (JVD) in right heart failure due to:
Increased central venous pressure
Rationale: Backward failure → fluid backup into veins.
RESPIRATORY (9–14)
9. A client with ARDS is on low tidal volume ventilation. The goal is: 6 mL/kg ideal
body weight
Rationale: ARDSNet protocol → lung-protective strategy to prevent volutrauma.
10. The nurse hears stridor post-extubation. First action: Administer racemic
epinephrine
Rationale: Laryngeal edema → nebulized epi + corticosteroids.
