BSN 266 HESI Medical-Surgical (Med Surg)
Exam V4 2026/2027 Study Guide | Verified
Questions & Correct Answers with Detailed
Rationales | Nightingale College HESI Prep
DOCUMENT OVERVIEW:
• This study guide contains verified HESI Medical-Surgical Nursing practice
questions with detailed rationales designed for comprehensive exam preparation
and mastery of core clinical concepts.
• Study strategy: Work through questions systematically by topic, review rationales
for both correct and incorrect answers, and use this material to identify knowledge
gaps and reinforce critical nursing interventions.
QUESTION 1
A client with acute myocardial infarction is admitted to the coronary care
unit. Which assessment finding would indicate cardiogenic shock?
A) Increased urine output and warm, dry skin
B) Increased blood pressure and decreased heart rate
C) Decreased cardiac output with hypotension and cool, clammy skin
D) Tachycardia with flushed, warm skin
E) Normal vital signs with stable oxygen saturation
CORRECT ANSWER: C) Decreased cardiac output with hypotension and cool,
clammy skin
Rationale: Cardiogenic shock results from inadequate cardiac output, leading to
insufficient tissue perfusion. Classic signs include hypotension (systolic BP <90
mmHg), decreased urine output (<30 mL/hr), cool and clammy skin due to
peripheral vasoconstriction, and altered mental status. This represents a life-
threatening complication of MI with mortality rates of 50-60%. Options A and E
represent normal findings. Options B and D reflect compensatory responses seen
,in early shock, but cool, clammy skin with hypotension indicates severe shock
requiring immediate intervention including inotropic support and possible
mechanical assistance.
QUESTION 2
A 65-year-old client with heart failure is prescribed digoxin. The nurse should
monitor for which sign of digoxin toxicity?
A) Increased appetite and euphoria
B) Visual disturbances, arrhythmias, and nausea
C) Elevated blood pressure and tachycardia
D) Decreased potassium levels with hypertension
E) Increased urinary output with hypercalcemia
CORRECT ANSWER: B) Visual disturbances, arrhythmias, and nausea
Rationale: Digoxin toxicity manifests with a classic triad of gastrointestinal (nausea,
vomiting, anorexia), neurological (confusion, headache, visual disturbances like
yellow-green halos), and cardiac (various arrhythmias including heart blocks, PVCs,
and atrial fibrillation) symptoms. The narrow therapeutic index (0.5-2 ng/mL) means
toxicity can occur easily, especially with hypokalemia, hypomagnesemia, renal
impairment, or drug interactions. Early recognition is critical as toxicity can
precipitate life-threatening dysrhythmias. Regular serum level monitoring and
assessment of electrolytes are essential nursing interventions.
QUESTION 3
A client develops atrial fibrillation with a ventricular rate of 110 bpm. Which is
the priority nursing intervention?
A) Administer oxygen therapy and establish IV access
B) Place client in Trendelenburg position
,C) Prepare for cardioversion procedure immediately
D) Encourage coughing and deep breathing exercises
E) Administer aspirin 325 mg orally
CORRECT ANSWER: A) Administer oxygen therapy and establish IV access
Rationale: While cardioversion may be indicated, the immediate priority is
ensuring adequate oxygenation and hemodynamic stabilization. Atrial fibrillation
with rapid ventricular response (>100 bpm) decreases diastolic filling time, reducing
cardiac output and tissue perfusion. Oxygen therapy supports tissue oxygenation,
and IV access is essential for medication administration (rate-control agents like
beta-blockers or calcium channel blockers) and emergency medications if needed.
Cardioversion is considered when the client is hemodynamically unstable or if other
interventions fail. Trendelenburg position is contraindicated; client should be in
semi-Fowler's position for optimal cardiac output.
QUESTION 4
A client with chronic atrial fibrillation is prescribed warfarin. The nurse
should teach the client to report which symptom immediately?
A) Mild joint pain and stiffness in the morning
B) Gum bleeding, hematuria, or unusual bruising
C) Dry mouth and mild fatigue
D) Constipation and decreased appetite
E) Headache and slight dizziness
CORRECT ANSWER: B) Gum bleeding, hematuria, or unusual bruising
Rationale: These signs indicate over-anticoagulation and increased bleeding risk,
requiring immediate evaluation. Warfarin inhibits vitamin K-dependent clotting
factors, requiring careful INR monitoring (therapeutic range 2-3 for atrial fibrillation
prevention). Signs of bleeding (hematuria, hemoptysis, epistaxis, gum bleeding,
unusual bruising, melena, or petechiae) suggest INR is supratherapeutic and
, warfarin dose reduction may be needed. The nurse must educate clients on
consistent vitamin K intake, drug interactions (antibiotics, NSAIDs, aspirin increase
effects), and regular INR monitoring. Minor symptoms like mild joint pain are
expected with warfarin therapy.
QUESTION 5
A 72-year-old client with hypertension is started on lisinopril, an ACE
inhibitor. What teaching should the nurse provide?
A) Take the medication with orange juice for better absorption
B) Expect a persistent dry cough; it will resolve in 2 weeks
C) Report persistent dry cough or angioedema immediately
D) Increase dietary sodium to maintain electrolyte balance
E) Take the medication with NSAIDs to enhance effectiveness
CORRECT ANSWER: C) Report persistent dry cough or angioedema
immediately
Rationale: ACE inhibitors cause a persistent dry cough in 10-15% of clients due to
reduced degradation of bradykinin in the lungs. While often benign, it warrants
reporting and may lead to medication change. More importantly, angioedema
(facial swelling, throat tightness, difficulty breathing) is a serious, potentially life-
threatening reaction requiring immediate medical attention and medication
discontinuation. ACE inhibitors work by blocking angiotensin II formation, reducing
peripheral vasoconstriction and aldosterone secretion, decreasing sodium and
water retention. They're contraindicated in pregnancy (teratogenic), require careful
monitoring with potassium-sparing diuretics, and baseline renal function
assessment is essential. NSAIDs reduce the antihypertensive effect.
QUESTION 6
Exam V4 2026/2027 Study Guide | Verified
Questions & Correct Answers with Detailed
Rationales | Nightingale College HESI Prep
DOCUMENT OVERVIEW:
• This study guide contains verified HESI Medical-Surgical Nursing practice
questions with detailed rationales designed for comprehensive exam preparation
and mastery of core clinical concepts.
• Study strategy: Work through questions systematically by topic, review rationales
for both correct and incorrect answers, and use this material to identify knowledge
gaps and reinforce critical nursing interventions.
QUESTION 1
A client with acute myocardial infarction is admitted to the coronary care
unit. Which assessment finding would indicate cardiogenic shock?
A) Increased urine output and warm, dry skin
B) Increased blood pressure and decreased heart rate
C) Decreased cardiac output with hypotension and cool, clammy skin
D) Tachycardia with flushed, warm skin
E) Normal vital signs with stable oxygen saturation
CORRECT ANSWER: C) Decreased cardiac output with hypotension and cool,
clammy skin
Rationale: Cardiogenic shock results from inadequate cardiac output, leading to
insufficient tissue perfusion. Classic signs include hypotension (systolic BP <90
mmHg), decreased urine output (<30 mL/hr), cool and clammy skin due to
peripheral vasoconstriction, and altered mental status. This represents a life-
threatening complication of MI with mortality rates of 50-60%. Options A and E
represent normal findings. Options B and D reflect compensatory responses seen
,in early shock, but cool, clammy skin with hypotension indicates severe shock
requiring immediate intervention including inotropic support and possible
mechanical assistance.
QUESTION 2
A 65-year-old client with heart failure is prescribed digoxin. The nurse should
monitor for which sign of digoxin toxicity?
A) Increased appetite and euphoria
B) Visual disturbances, arrhythmias, and nausea
C) Elevated blood pressure and tachycardia
D) Decreased potassium levels with hypertension
E) Increased urinary output with hypercalcemia
CORRECT ANSWER: B) Visual disturbances, arrhythmias, and nausea
Rationale: Digoxin toxicity manifests with a classic triad of gastrointestinal (nausea,
vomiting, anorexia), neurological (confusion, headache, visual disturbances like
yellow-green halos), and cardiac (various arrhythmias including heart blocks, PVCs,
and atrial fibrillation) symptoms. The narrow therapeutic index (0.5-2 ng/mL) means
toxicity can occur easily, especially with hypokalemia, hypomagnesemia, renal
impairment, or drug interactions. Early recognition is critical as toxicity can
precipitate life-threatening dysrhythmias. Regular serum level monitoring and
assessment of electrolytes are essential nursing interventions.
QUESTION 3
A client develops atrial fibrillation with a ventricular rate of 110 bpm. Which is
the priority nursing intervention?
A) Administer oxygen therapy and establish IV access
B) Place client in Trendelenburg position
,C) Prepare for cardioversion procedure immediately
D) Encourage coughing and deep breathing exercises
E) Administer aspirin 325 mg orally
CORRECT ANSWER: A) Administer oxygen therapy and establish IV access
Rationale: While cardioversion may be indicated, the immediate priority is
ensuring adequate oxygenation and hemodynamic stabilization. Atrial fibrillation
with rapid ventricular response (>100 bpm) decreases diastolic filling time, reducing
cardiac output and tissue perfusion. Oxygen therapy supports tissue oxygenation,
and IV access is essential for medication administration (rate-control agents like
beta-blockers or calcium channel blockers) and emergency medications if needed.
Cardioversion is considered when the client is hemodynamically unstable or if other
interventions fail. Trendelenburg position is contraindicated; client should be in
semi-Fowler's position for optimal cardiac output.
QUESTION 4
A client with chronic atrial fibrillation is prescribed warfarin. The nurse
should teach the client to report which symptom immediately?
A) Mild joint pain and stiffness in the morning
B) Gum bleeding, hematuria, or unusual bruising
C) Dry mouth and mild fatigue
D) Constipation and decreased appetite
E) Headache and slight dizziness
CORRECT ANSWER: B) Gum bleeding, hematuria, or unusual bruising
Rationale: These signs indicate over-anticoagulation and increased bleeding risk,
requiring immediate evaluation. Warfarin inhibits vitamin K-dependent clotting
factors, requiring careful INR monitoring (therapeutic range 2-3 for atrial fibrillation
prevention). Signs of bleeding (hematuria, hemoptysis, epistaxis, gum bleeding,
unusual bruising, melena, or petechiae) suggest INR is supratherapeutic and
, warfarin dose reduction may be needed. The nurse must educate clients on
consistent vitamin K intake, drug interactions (antibiotics, NSAIDs, aspirin increase
effects), and regular INR monitoring. Minor symptoms like mild joint pain are
expected with warfarin therapy.
QUESTION 5
A 72-year-old client with hypertension is started on lisinopril, an ACE
inhibitor. What teaching should the nurse provide?
A) Take the medication with orange juice for better absorption
B) Expect a persistent dry cough; it will resolve in 2 weeks
C) Report persistent dry cough or angioedema immediately
D) Increase dietary sodium to maintain electrolyte balance
E) Take the medication with NSAIDs to enhance effectiveness
CORRECT ANSWER: C) Report persistent dry cough or angioedema
immediately
Rationale: ACE inhibitors cause a persistent dry cough in 10-15% of clients due to
reduced degradation of bradykinin in the lungs. While often benign, it warrants
reporting and may lead to medication change. More importantly, angioedema
(facial swelling, throat tightness, difficulty breathing) is a serious, potentially life-
threatening reaction requiring immediate medical attention and medication
discontinuation. ACE inhibitors work by blocking angiotensin II formation, reducing
peripheral vasoconstriction and aldosterone secretion, decreasing sodium and
water retention. They're contraindicated in pregnancy (teratogenic), require careful
monitoring with potassium-sparing diuretics, and baseline renal function
assessment is essential. NSAIDs reduce the antihypertensive effect.
QUESTION 6
