BSN 266 HESI MEDICAL-SURGICAL EXAM 2026/2027: COMPLETE
TEST BANK WITH 150+ NGN-STYLE QUESTIONS, VERIFIED
ANSWERS & DETAILED RATIONALES | CARDIOVASCULAR,
RENAL, GI, ENDOCRINE, NEUROLOGICAL & MORE | A+
GRADED MATERIAL
SECTION 1: CARDIOVASCULAR DISORDERS
1. A client with heart failure is receiving digoxin. Which assessment finding
indicates digoxin toxicity?
A. Heart rate of 72 beats/min
B. Serum potassium of 4.0 mEq/L
C. Anorexia, nausea, and visual disturbances
D. Blood pressure of 120/80 mm Hg
Answer: C. Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include anorexia, nausea, vomiting, and
visual disturbances (yellow-green halos). Heart rate of 72, potassium of 4.0, and
blood pressure of 120/80 are normal findings. Digoxin toxicity is more likely in
patients with hypokalemia, renal impairment, or elderly patients.
2. The nurse is assessing a client with left-sided heart failure. Which finding is
most consistent with this condition?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
,Answer: C. Crackles in the lung bases
Rationale: Left-sided heart failure causes pulmonary congestion, resulting in
crackles (rales) in the lung bases, dyspnea, and orthopnea. Jugular venous
distention, peripheral edema, and hepatomegaly are signs of right-sided heart
failure.
3. A client with angina pectoris is prescribed nitroglycerin sublingual. Which
instruction should the nurse include in the teaching?
A. "Take one tablet every 15 minutes for up to 3 doses."
B. "Swallow the tablet with a full glass of water."
C. "Take the tablet at the first sign of chest pain."
D. "Store the tablets in the refrigerator to maintain potency."
Answer: C. "Take the tablet at the first sign of chest pain."
Rationale: Nitroglycerin should be taken at the first sign of chest pain. The correct
protocol is one tablet every 5 minutes for up to 3 doses. Tablets should be
dissolved under the tongue, not swallowed. They should be stored in a cool, dark
place, not the refrigerator.
4. The nurse is monitoring a client receiving IV heparin for treatment of a
pulmonary embolism. Which laboratory value indicates the heparin is
therapeutic?
A. aPTT 60 seconds (normal 25-35 seconds)
B. INR 2.5
C. PT 12 seconds (normal 10-13 seconds)
D. Platelet count 150,000/mm³
Answer: A. aPTT 60 seconds (normal 25-35 seconds)
,Rationale: Heparin therapy is monitored by aPTT, which should be 1.5 to 2.5
times normal (approximately 60-80 seconds). INR and PT are used to monitor
warfarin therapy. Platelet count may decrease with heparin-induced
thrombocytopenia but does not indicate therapeutic effect.
5. A client with hypertension is prescribed lisinopril. Which adverse effect
should the nurse monitor for?
A. Dry cough
B. Bradycardia
C. Hyperkalemia
D. Both A and C
Answer: D. Both A and C
Rationale: Lisinopril (an ACE inhibitor) can cause a persistent dry cough (due to
increased bradykinin) and hyperkalemia (due to decreased aldosterone).
Bradycardia is not a typical adverse effect of ACE inhibitors.
6. The nurse is assessing a client with peripheral arterial disease (PAD).
Which finding is most characteristic?
A. Brownish discoloration of the lower legs
B. Intermittent claudication
C. Dependent edema
D. Stasis ulcers
Answer: B. Intermittent claudication
Rationale: Intermittent claudication (pain with exercise relieved by rest) is a
classic symptom of peripheral arterial disease. Brownish discoloration, dependent
edema, and stasis ulcers are characteristic of chronic venous insufficiency.
, 7. A client is admitted with acute myocardial infarction. Which laboratory
value is most specific for cardiac muscle damage?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Lactate dehydrogenase (LDH)
D. Aspartate aminotransferase (AST)
Answer: B. Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac marker for
myocardial infarction. It rises within 3-4 hours and remains elevated for 7-10 days.
CK-MB is less specific and rises later. LDH and AST are less specific and no
longer commonly used.
8. The nurse is caring for a client with a newly inserted pacemaker. Which
discharge instruction is most important?
A. "You may resume driving immediately."
B. "Avoid lifting heavy objects for 4-6 weeks."
C. "Microwave ovens should not be used."
D. "You can use your cell phone against the pacemaker site."
Answer: B. "Avoid lifting heavy objects for 4-6 weeks."
Rationale: Patients with a new pacemaker should avoid heavy lifting and
strenuous arm activity on the pacemaker side for 4-6 weeks to prevent
displacement of the leads. Driving should be avoided for several days to weeks.
Microwave ovens are generally safe, and cell phones should be kept at least 6
inches away from the pacemaker.
9. Which ECG change is most indicative of myocardial ischemia?
TEST BANK WITH 150+ NGN-STYLE QUESTIONS, VERIFIED
ANSWERS & DETAILED RATIONALES | CARDIOVASCULAR,
RENAL, GI, ENDOCRINE, NEUROLOGICAL & MORE | A+
GRADED MATERIAL
SECTION 1: CARDIOVASCULAR DISORDERS
1. A client with heart failure is receiving digoxin. Which assessment finding
indicates digoxin toxicity?
A. Heart rate of 72 beats/min
B. Serum potassium of 4.0 mEq/L
C. Anorexia, nausea, and visual disturbances
D. Blood pressure of 120/80 mm Hg
Answer: C. Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include anorexia, nausea, vomiting, and
visual disturbances (yellow-green halos). Heart rate of 72, potassium of 4.0, and
blood pressure of 120/80 are normal findings. Digoxin toxicity is more likely in
patients with hypokalemia, renal impairment, or elderly patients.
2. The nurse is assessing a client with left-sided heart failure. Which finding is
most consistent with this condition?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
,Answer: C. Crackles in the lung bases
Rationale: Left-sided heart failure causes pulmonary congestion, resulting in
crackles (rales) in the lung bases, dyspnea, and orthopnea. Jugular venous
distention, peripheral edema, and hepatomegaly are signs of right-sided heart
failure.
3. A client with angina pectoris is prescribed nitroglycerin sublingual. Which
instruction should the nurse include in the teaching?
A. "Take one tablet every 15 minutes for up to 3 doses."
B. "Swallow the tablet with a full glass of water."
C. "Take the tablet at the first sign of chest pain."
D. "Store the tablets in the refrigerator to maintain potency."
Answer: C. "Take the tablet at the first sign of chest pain."
Rationale: Nitroglycerin should be taken at the first sign of chest pain. The correct
protocol is one tablet every 5 minutes for up to 3 doses. Tablets should be
dissolved under the tongue, not swallowed. They should be stored in a cool, dark
place, not the refrigerator.
4. The nurse is monitoring a client receiving IV heparin for treatment of a
pulmonary embolism. Which laboratory value indicates the heparin is
therapeutic?
A. aPTT 60 seconds (normal 25-35 seconds)
B. INR 2.5
C. PT 12 seconds (normal 10-13 seconds)
D. Platelet count 150,000/mm³
Answer: A. aPTT 60 seconds (normal 25-35 seconds)
,Rationale: Heparin therapy is monitored by aPTT, which should be 1.5 to 2.5
times normal (approximately 60-80 seconds). INR and PT are used to monitor
warfarin therapy. Platelet count may decrease with heparin-induced
thrombocytopenia but does not indicate therapeutic effect.
5. A client with hypertension is prescribed lisinopril. Which adverse effect
should the nurse monitor for?
A. Dry cough
B. Bradycardia
C. Hyperkalemia
D. Both A and C
Answer: D. Both A and C
Rationale: Lisinopril (an ACE inhibitor) can cause a persistent dry cough (due to
increased bradykinin) and hyperkalemia (due to decreased aldosterone).
Bradycardia is not a typical adverse effect of ACE inhibitors.
6. The nurse is assessing a client with peripheral arterial disease (PAD).
Which finding is most characteristic?
A. Brownish discoloration of the lower legs
B. Intermittent claudication
C. Dependent edema
D. Stasis ulcers
Answer: B. Intermittent claudication
Rationale: Intermittent claudication (pain with exercise relieved by rest) is a
classic symptom of peripheral arterial disease. Brownish discoloration, dependent
edema, and stasis ulcers are characteristic of chronic venous insufficiency.
, 7. A client is admitted with acute myocardial infarction. Which laboratory
value is most specific for cardiac muscle damage?
A. Creatine kinase-MB (CK-MB)
B. Troponin I
C. Lactate dehydrogenase (LDH)
D. Aspartate aminotransferase (AST)
Answer: B. Troponin I
Rationale: Troponin I is the most specific and sensitive cardiac marker for
myocardial infarction. It rises within 3-4 hours and remains elevated for 7-10 days.
CK-MB is less specific and rises later. LDH and AST are less specific and no
longer commonly used.
8. The nurse is caring for a client with a newly inserted pacemaker. Which
discharge instruction is most important?
A. "You may resume driving immediately."
B. "Avoid lifting heavy objects for 4-6 weeks."
C. "Microwave ovens should not be used."
D. "You can use your cell phone against the pacemaker site."
Answer: B. "Avoid lifting heavy objects for 4-6 weeks."
Rationale: Patients with a new pacemaker should avoid heavy lifting and
strenuous arm activity on the pacemaker side for 4-6 weeks to prevent
displacement of the leads. Driving should be avoided for several days to weeks.
Microwave ovens are generally safe, and cell phones should be kept at least 6
inches away from the pacemaker.
9. Which ECG change is most indicative of myocardial ischemia?
