1
BSN 266 HESI Med Surg Test Bank Medical-
Surgical Nursing Nightingale College Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular System | Q1 – Q10
Section 2 | Respiratory System | Q11 – Q20
Section 3 | Gastrointestinal, Renal & Endocrine Systems | Q21 – Q30
Section 4 | Neurological, Musculoskeletal & Immunologic Systems | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Comprehensive Case Analysis | Q41 –
Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR SYSTEM Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old male presents to the emergency department with crushing substernal
chest pain unrelieved by nitroglycerin. The nurse prepares to administer morphine
intravenously per protocol. What is the primary physiological rationale for
administering morphine in this scenario?
,2
A. It increases systemic vascular resistance.
B. It promotes rapid platelet aggregation.
C. It reduces preload and afterload. ✓ CORRECT
D. It enhances myocardial oxygen supply.
Correct Answer: C
Rationale: Morphine is the opioid of choice for chest pain in suspected myocardial
infarction because it reduces preload and afterload, decreasing myocardial oxygen
demand. Hydromorphone does not provide the same hemodynamic benefits and is
not the standard of care for acute cardiac ischemia. Always pair analgesia with
continuous cardiac monitoring to track ischemic changes.
Question 2 of 50
A 72-year-old female with a history of heart failure presents with worsening
dyspnea, bilateral crackles, and 3+ pitting edema. The provider orders intravenous
furosemide. What is the expected therapeutic effect of this medication?
A. Decreased intravascular fluid volume. ✓ CORRECT
B. Increased systemic blood pressure.
C. Enhanced renal perfusion pressure.
D. Decreased cardiac afterload immediately.
Correct Answer: A
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle to
promote rapid sodium and water excretion, decreasing intravascular fluid volume.
Administering a normal saline bolus would be detrimental by expanding
,3
intravascular volume and worsening pulmonary edema. Monitor serum potassium
closely as furosemide causes significant potassium wasting.
Question 3 of 50
A 65-year-old male with new-onset atrial fibrillation is started on warfarin. The
nurse provides discharge teaching regarding dietary considerations. What
instruction is most appropriate for this patient?
A. Eat large amounts of spinach daily.
B. Avoid all citrus fruit juices entirely.
C. Restrict fluid intake to 1 liter.
D. Maintain a consistent intake of vitamin K. ✓ CORRECT
Correct Answer: D
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors, so
maintaining a consistent daily intake of vitamin K-rich foods prevents erratic
fluctuations in the INR. Sudden increases in dietary vitamin K can dangerously
lower the INR and promote thrombosis. Patients do not need to eliminate vitamin
K foods, just keep their intake stable.
Question 4 of 50
A 50-year-old male is prescribed lisinopril for newly diagnosed hypertension. The
nurse reviews the medication profile and notes the patient also takes
spironolactone. What laboratory value requires close monitoring due to this
combination?
, 4
A. Serum sodium levels.
B. Serum potassium levels. ✓ CORRECT
C. Serum calcium levels.
D. Serum magnesium levels.
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that reduces aldosterone production,
while spironolactone is a potassium-sparing diuretic, creating a high risk of
hyperkalemia when used together. Monitoring for hypoglycemia is irrelevant as
neither medication affects blood glucose metabolism. Check potassium levels
routinely to prevent life-threatening cardiac dysrhythmias.
Question 5 of 50
A 60-year-old female with peripheral vascular disease reports severe calf pain after
walking two blocks that resolves with rest. What teaching should the nurse provide
regarding exercise?
A. Walk until pain occurs, then rest. ✓ CORRECT
B. Apply a heating pad to the calves.
C. Soak feet in hot water daily.
D. Perform vigorous weightlifting routines.
Correct Answer: A
Rationale: Intermittent claudication is managed by a walking program that pushes
the patient to the point of pain, followed by rest, to encourage collateral circulation
development. Applying direct heat is contraindicated because decreased sensation
BSN 266 HESI Med Surg Test Bank Medical-
Surgical Nursing Nightingale College Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular System | Q1 – Q10
Section 2 | Respiratory System | Q11 – Q20
Section 3 | Gastrointestinal, Renal & Endocrine Systems | Q21 – Q30
Section 4 | Neurological, Musculoskeletal & Immunologic Systems | Q31 – Q40
Section 5 | NGN-Style Clinical Judgment & Comprehensive Case Analysis | Q41 –
Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR SYSTEM Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old male presents to the emergency department with crushing substernal
chest pain unrelieved by nitroglycerin. The nurse prepares to administer morphine
intravenously per protocol. What is the primary physiological rationale for
administering morphine in this scenario?
,2
A. It increases systemic vascular resistance.
B. It promotes rapid platelet aggregation.
C. It reduces preload and afterload. ✓ CORRECT
D. It enhances myocardial oxygen supply.
Correct Answer: C
Rationale: Morphine is the opioid of choice for chest pain in suspected myocardial
infarction because it reduces preload and afterload, decreasing myocardial oxygen
demand. Hydromorphone does not provide the same hemodynamic benefits and is
not the standard of care for acute cardiac ischemia. Always pair analgesia with
continuous cardiac monitoring to track ischemic changes.
Question 2 of 50
A 72-year-old female with a history of heart failure presents with worsening
dyspnea, bilateral crackles, and 3+ pitting edema. The provider orders intravenous
furosemide. What is the expected therapeutic effect of this medication?
A. Decreased intravascular fluid volume. ✓ CORRECT
B. Increased systemic blood pressure.
C. Enhanced renal perfusion pressure.
D. Decreased cardiac afterload immediately.
Correct Answer: A
Rationale: Furosemide is a loop diuretic that acts on the ascending loop of Henle to
promote rapid sodium and water excretion, decreasing intravascular fluid volume.
Administering a normal saline bolus would be detrimental by expanding
,3
intravascular volume and worsening pulmonary edema. Monitor serum potassium
closely as furosemide causes significant potassium wasting.
Question 3 of 50
A 65-year-old male with new-onset atrial fibrillation is started on warfarin. The
nurse provides discharge teaching regarding dietary considerations. What
instruction is most appropriate for this patient?
A. Eat large amounts of spinach daily.
B. Avoid all citrus fruit juices entirely.
C. Restrict fluid intake to 1 liter.
D. Maintain a consistent intake of vitamin K. ✓ CORRECT
Correct Answer: D
Rationale: Warfarin antagonizes vitamin K-dependent clotting factors, so
maintaining a consistent daily intake of vitamin K-rich foods prevents erratic
fluctuations in the INR. Sudden increases in dietary vitamin K can dangerously
lower the INR and promote thrombosis. Patients do not need to eliminate vitamin
K foods, just keep their intake stable.
Question 4 of 50
A 50-year-old male is prescribed lisinopril for newly diagnosed hypertension. The
nurse reviews the medication profile and notes the patient also takes
spironolactone. What laboratory value requires close monitoring due to this
combination?
, 4
A. Serum sodium levels.
B. Serum potassium levels. ✓ CORRECT
C. Serum calcium levels.
D. Serum magnesium levels.
Correct Answer: B
Rationale: Lisinopril is an ACE inhibitor that reduces aldosterone production,
while spironolactone is a potassium-sparing diuretic, creating a high risk of
hyperkalemia when used together. Monitoring for hypoglycemia is irrelevant as
neither medication affects blood glucose metabolism. Check potassium levels
routinely to prevent life-threatening cardiac dysrhythmias.
Question 5 of 50
A 60-year-old female with peripheral vascular disease reports severe calf pain after
walking two blocks that resolves with rest. What teaching should the nurse provide
regarding exercise?
A. Walk until pain occurs, then rest. ✓ CORRECT
B. Apply a heating pad to the calves.
C. Soak feet in hot water daily.
D. Perform vigorous weightlifting routines.
Correct Answer: A
Rationale: Intermittent claudication is managed by a walking program that pushes
the patient to the point of pain, followed by rest, to encourage collateral circulation
development. Applying direct heat is contraindicated because decreased sensation
