BSN HESI 266 MED SURG EXAM
Latest - Verified Answers - Grade A
BSN HESI 266 MED SURG EXAM (LATEST
)
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A
Nightingale College · BSN HESI 266 Course Syllabus · 150 Questions
Aligned with HESI RN Specialty Exam Blueprint, NCLEX-RN Test Plan (2026/2027), and Medical-Surgical
Nursing Standards
Exam Overview: This comprehensive specialty examination contains 150 multiple-choice questions organized into 10 clinical
sections aligned with the Nightingale College BSN HESI 266 course syllabus, HESI RN Specialty Exam Blueprint, and the
2026/2027 NCLEX-RN Test Plan. Cognitive distribution approximates 20% recall, 50% application, and 30% analysis (priority
setting, clinical reasoning). Question style is 75% scenario-based and 25% direct knowledge. Special inclusions: 20
priority-setting questions, 15 pharmacology questions, 10 laboratory value interpretation questions, and 5 integrated case studies
with related questions. Each question provides the verified correct answer and a rationale grounded in the Nightingale College
BSN HESI 266 curriculum and HESI RN Specialty standards.
Section Topic # Qs
1 Cardiovascular Disorders 20
2 Respiratory Disorders 18
3 Neurological Disorders 18
4 Renal & Genitourinary Disorders 15
5 Endocrine Disorders 15
6 Gastrointestinal & Hepatic Disorders 15
7 Hematological & Oncological Disorders 15
8 Musculoskeletal & Integumentary Disorders 12
9 Perioperative & Emergency Nursing 12
10 Pharmacology & Medication Management 10
TOTAL 150
Section 1: Cardiovascular Disorders
Questions 1 - 20 | 20 questions
Nightingale College BSN HESI 266 Curriculum Page 1
,BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q1: The emergency department nurse receives four clients with chest pain. Which client should the nurse
assess FIRST? [Priority Setting | ACS/STEMI]
A. A 52-year-old with substernal chest pain rated 6/10 that started 30 minutes ago while resting
B. A 68-year-old with chest pain radiating to the jaw, diaphoresis, and ST elevation in leads II, III, and aVF
*[CORRECT]*
C. A 45-year-old with sharp, stabbing chest pain that increases with deep inspiration
D. A 60-year-old with chest pressure relieved by sublingual nitroglycerin taken at home
Correct Answer: B
Rationale: The client with ST elevation in II, III, and aVF is experiencing an acute inferior STEMI requiring immediate
reperfusion therapy (PCI within 90 minutes or thrombolytics within 30 minutes). Per the HESI RN Specialty Exam
Blueprint and ACS guidelines,clients with ST-elevation MI represent the highest acuity because ongoing ischemia
causes irreversible myocyte death every minute the artery remains occluded. The other clients have stable angina (D),
possible pericarditis (C), or intermediate-risk chest pain (A) that warrants evaluation but not before the STEMI client.
Q2: A client is admitted with an acute myocardial infarction. Four hours after admission, the client develops
coarse crackles in the lung bases, an S3 heart sound, and a productive cough with pink frothy sputum. Which
complication is MOST likely occurring? [MI Complication | Pulmonary Edema]
A. Cardiogenic shock
B. Acute pulmonary edema due to left ventricular failure *[CORRECT]*
C. Acute respiratory distress syndrome (ARDS)
D. Pulmonary embolism
Correct Answer: B
Rationale: The triad of crackles, S3 gallop, and pink frothy sputum is classic for acute pulmonary edema resulting from
left ventricular failure following MI. The S3 occurs when blood strikes a noncompliant left ventricle during rapid
filling, and pink frothy sputum reflects alveolar flooding. Cardiogenic shock (A) would also include hypotension (SBP
<90) and end-organ hypoperfusion; ARDS (C) typically follows a systemic insult 24-72 hours later; PE (D) presents
with sudden dyspnea and pleuritic pain without S3.
Q3: A client with stable angina reports chest pain rated 7/10. The nurse administers one sublingual
nitroglycerin tablet (0.4 mg). After 5 minutes, the pain is unchanged. Vital signs: BP 92/58, HR 110, RR 20.
What is the nurse's BEST action? [Pharmacology | Nitroglycerin]
A. Administer a second nitroglycerin tablet sublingually
B. Administer oral morphine 4 mg for pain relief
C. Withhold nitroglycerin and notify the provider; place the client supine with legs elevated *[CORRECT]*
D. Apply oxygen at 2 L/min via nasal cannula and reassess in 10 minutes
Correct Answer: C
Rationale: Nitroglycerin is contraindicated when systolic BP is below 90 mmHg because it is a potent venous (and
arterial) vasodilator that will worsen hypotension and may precipitate cardiovascular collapse. The nurse should
withhold the next dose, place the client supine with legs elevated to maximize venous return, and notify the provider.
Per the NCLEX-RN Test Plan and Nightingale pharmacology curriculum, ongoing chest pain with hypotension after
nitroglycerin suggests evolving MI and warrants escalation of care.
Nightingale College BSN HESI 266 Curriculum Page 2
,BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q4: A client with heart failure is being discharged with prescriptions for furosemide 40 mg daily, lisinopril 10
mg daily, and carvedilol 12.5 mg twice daily. Which discharge statement by the client indicates teaching has
been EFFECTIVE? [Heart Failure | Discharge Teaching]
A. 'I will weigh myself once a week at the same time of day.'
B. 'I should stop taking the carvedilol if I feel tired or dizzy.'
C. 'I will call my provider if I gain more than 2 pounds in a day or 5 pounds in a week.' *[CORRECT]*
D. 'I should eat plenty of bananas and salt substitutes to balance my electrolytes.'
Correct Answer: C
Rationale: Daily weights are the most sensitive indicator of fluid retention in heart failure; a gain of more than 2 lb in
24 hours or 5 lb in a week signals decompensation requiring provider notification. Clients should weigh themselves
DAILY, not weekly (A). Beta-blockers like carvedilol should never be abruptly stopped (B) due to rebound tachycardia
and ischemia. Salt substitutes contain potassium (D), which combined with an ACE inhibitor and potassium-sparing
effects of HF therapy can cause life-threatening hyperkalemia.
Q5: A client presents to the ED with dyspnea and bilateral lower lobe crackles. Lab results: BNP 1,850 pg/mL
(normal <100), troponin I 0.06 ng/mL (normal <0.04), creatinine 1.8 mg/dL, potassium 3.1 mEq/L. Which
interpretation is MOST accurate? [Lab Interpretation | BNP | Heart Failure]
A. The client is having an acute myocardial infarction and needs immediate PCI
B. The client is in acute heart failure with possible mild myocardial injury and hypokalemia requiring careful
diuresis and electrolyte replacement *[CORRECT]*
C. The BNP is falsely elevated due to renal failure and should be ignored
D. The troponin is normal and the symptoms are likely respiratory, not cardiac
Correct Answer: B
Rationale: A BNP of 1,850 pg/mL is markedly elevated and correlates with severe heart failure, while a troponin of
0.06 ng/mL is only mildly elevated, suggesting myocardial strain rather than massive necrosis. The combination of
crackles, BNP elevation, and mild troponin rise supports acute decompensated heart failure possibly with type 2 MI.
BNP can be elevated in renal failure but remains clinically meaningful. Hypokalemia (3.1) must be corrected before
aggressive diuresis to avoid life-threatening dysrhythmias, per Nightingale fluid and electrolyte curriculum.
Nightingale College BSN HESI 266 Curriculum Page 3
, BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q6: A client with acute decompensated heart failure has BP 88/52, HR 118, RR 28, SpO2 90% on room air,
and is producing pink frothy sputum. The provider orders interventions. Which order should the nurse
QUESTION? [Pharmacology | Priority | Heart Failure]
A. IV furosemide 80 mg IV push now
B. IV nitroglycerin infusion starting at 10 mcg/min, titrate to BP
C. IV metoprolol 5 mg push now to control heart rate *[CORRECT]*
D. Non-rebreather mask oxygen at 15 L/min
Correct Answer: C
Rationale: IV metoprolol is contraindicated in acute decompensated HF with hypotension (SBP <90) because
beta-blockade reduces inotropy and can precipitate cardiogenic shock. Beta-blockers are initiated only after the client
is stabilized and euvolemic. IV furosemide (A), IV nitroglycerin with careful titration (B), and high-flow oxygen (D) are
all appropriate interventions to reduce preload, afterload, and hypoxia. This reflects the HESI emphasis on safe
medication administration in hemodynamically unstable clients.
Q7: A client with new-onset atrial fibrillation has an irregularly irregular radial pulse of 92 and an apical rate
of 124. The nurse prepares to administer IV diltiazem. Which assessment finding requires IMMEDIATE
notification of the provider before administration? [Dysrhythmia | Pharmacology]
A. BP 104/68
B. ST elevation noted on the cardiac monitor *[CORRECT]*
C. Respiratory rate of 22 with bilateral basilar crackles
D. The client reports mild lightheadedness when standing
Correct Answer: B
Rationale: ST elevation on the monitor indicates an acute STEMI, which takes priority over rate control and requires
immediate provider notification for activation of the cardiac catheterization lab. The provider may still want rate
control, but STEMI changes the clinical pathway entirely. Diltiazem is a calcium channel blocker that can worsen
hypotension (A, D) but is acceptable when SBP is above 90. Crackles (C) suggest mild congestion but do not
contraindicate diltiazem. Per NCLEX, ST elevation is always an emergency.
Q8: A client on telemetry suddenly becomes unresponsive. The monitor shows ventricular fibrillation. There
is no IV access. What is the nurse's FIRST action? [ACLS | V-Fib | Priority]
A. Begin chest compressions at a rate of 100-120 per minute
B. Deliver an unsynchronized electrical shock of 200 joules (biphasic) *[CORRECT]*
C. Establish intraosseous access for amiodarone administration
D. Administer 1 mg of epinephrine IV push
Correct Answer: B
Rationale: Per the 2020 AHA ACLS algorithm, the first action for witnessed ventricular fibrillation is immediate
unsynchronized defibrillation. Early defibrillation is the single most important determinant of survival. Chest
compressions (A) should begin immediately if a defibrillator is not instantly available, but the shock takes priority
when the defibrillator is at the bedside. Drugs (C, D) are administered after the second shock, not before defibrillation.
Nightingale College BSN HESI 266 Curriculum Page 4
Latest - Verified Answers - Grade A
BSN HESI 266 MED SURG EXAM (LATEST
)
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A
Nightingale College · BSN HESI 266 Course Syllabus · 150 Questions
Aligned with HESI RN Specialty Exam Blueprint, NCLEX-RN Test Plan (2026/2027), and Medical-Surgical
Nursing Standards
Exam Overview: This comprehensive specialty examination contains 150 multiple-choice questions organized into 10 clinical
sections aligned with the Nightingale College BSN HESI 266 course syllabus, HESI RN Specialty Exam Blueprint, and the
2026/2027 NCLEX-RN Test Plan. Cognitive distribution approximates 20% recall, 50% application, and 30% analysis (priority
setting, clinical reasoning). Question style is 75% scenario-based and 25% direct knowledge. Special inclusions: 20
priority-setting questions, 15 pharmacology questions, 10 laboratory value interpretation questions, and 5 integrated case studies
with related questions. Each question provides the verified correct answer and a rationale grounded in the Nightingale College
BSN HESI 266 curriculum and HESI RN Specialty standards.
Section Topic # Qs
1 Cardiovascular Disorders 20
2 Respiratory Disorders 18
3 Neurological Disorders 18
4 Renal & Genitourinary Disorders 15
5 Endocrine Disorders 15
6 Gastrointestinal & Hepatic Disorders 15
7 Hematological & Oncological Disorders 15
8 Musculoskeletal & Integumentary Disorders 12
9 Perioperative & Emergency Nursing 12
10 Pharmacology & Medication Management 10
TOTAL 150
Section 1: Cardiovascular Disorders
Questions 1 - 20 | 20 questions
Nightingale College BSN HESI 266 Curriculum Page 1
,BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q1: The emergency department nurse receives four clients with chest pain. Which client should the nurse
assess FIRST? [Priority Setting | ACS/STEMI]
A. A 52-year-old with substernal chest pain rated 6/10 that started 30 minutes ago while resting
B. A 68-year-old with chest pain radiating to the jaw, diaphoresis, and ST elevation in leads II, III, and aVF
*[CORRECT]*
C. A 45-year-old with sharp, stabbing chest pain that increases with deep inspiration
D. A 60-year-old with chest pressure relieved by sublingual nitroglycerin taken at home
Correct Answer: B
Rationale: The client with ST elevation in II, III, and aVF is experiencing an acute inferior STEMI requiring immediate
reperfusion therapy (PCI within 90 minutes or thrombolytics within 30 minutes). Per the HESI RN Specialty Exam
Blueprint and ACS guidelines,clients with ST-elevation MI represent the highest acuity because ongoing ischemia
causes irreversible myocyte death every minute the artery remains occluded. The other clients have stable angina (D),
possible pericarditis (C), or intermediate-risk chest pain (A) that warrants evaluation but not before the STEMI client.
Q2: A client is admitted with an acute myocardial infarction. Four hours after admission, the client develops
coarse crackles in the lung bases, an S3 heart sound, and a productive cough with pink frothy sputum. Which
complication is MOST likely occurring? [MI Complication | Pulmonary Edema]
A. Cardiogenic shock
B. Acute pulmonary edema due to left ventricular failure *[CORRECT]*
C. Acute respiratory distress syndrome (ARDS)
D. Pulmonary embolism
Correct Answer: B
Rationale: The triad of crackles, S3 gallop, and pink frothy sputum is classic for acute pulmonary edema resulting from
left ventricular failure following MI. The S3 occurs when blood strikes a noncompliant left ventricle during rapid
filling, and pink frothy sputum reflects alveolar flooding. Cardiogenic shock (A) would also include hypotension (SBP
<90) and end-organ hypoperfusion; ARDS (C) typically follows a systemic insult 24-72 hours later; PE (D) presents
with sudden dyspnea and pleuritic pain without S3.
Q3: A client with stable angina reports chest pain rated 7/10. The nurse administers one sublingual
nitroglycerin tablet (0.4 mg). After 5 minutes, the pain is unchanged. Vital signs: BP 92/58, HR 110, RR 20.
What is the nurse's BEST action? [Pharmacology | Nitroglycerin]
A. Administer a second nitroglycerin tablet sublingually
B. Administer oral morphine 4 mg for pain relief
C. Withhold nitroglycerin and notify the provider; place the client supine with legs elevated *[CORRECT]*
D. Apply oxygen at 2 L/min via nasal cannula and reassess in 10 minutes
Correct Answer: C
Rationale: Nitroglycerin is contraindicated when systolic BP is below 90 mmHg because it is a potent venous (and
arterial) vasodilator that will worsen hypotension and may precipitate cardiovascular collapse. The nurse should
withhold the next dose, place the client supine with legs elevated to maximize venous return, and notify the provider.
Per the NCLEX-RN Test Plan and Nightingale pharmacology curriculum, ongoing chest pain with hypotension after
nitroglycerin suggests evolving MI and warrants escalation of care.
Nightingale College BSN HESI 266 Curriculum Page 2
,BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q4: A client with heart failure is being discharged with prescriptions for furosemide 40 mg daily, lisinopril 10
mg daily, and carvedilol 12.5 mg twice daily. Which discharge statement by the client indicates teaching has
been EFFECTIVE? [Heart Failure | Discharge Teaching]
A. 'I will weigh myself once a week at the same time of day.'
B. 'I should stop taking the carvedilol if I feel tired or dizzy.'
C. 'I will call my provider if I gain more than 2 pounds in a day or 5 pounds in a week.' *[CORRECT]*
D. 'I should eat plenty of bananas and salt substitutes to balance my electrolytes.'
Correct Answer: C
Rationale: Daily weights are the most sensitive indicator of fluid retention in heart failure; a gain of more than 2 lb in
24 hours or 5 lb in a week signals decompensation requiring provider notification. Clients should weigh themselves
DAILY, not weekly (A). Beta-blockers like carvedilol should never be abruptly stopped (B) due to rebound tachycardia
and ischemia. Salt substitutes contain potassium (D), which combined with an ACE inhibitor and potassium-sparing
effects of HF therapy can cause life-threatening hyperkalemia.
Q5: A client presents to the ED with dyspnea and bilateral lower lobe crackles. Lab results: BNP 1,850 pg/mL
(normal <100), troponin I 0.06 ng/mL (normal <0.04), creatinine 1.8 mg/dL, potassium 3.1 mEq/L. Which
interpretation is MOST accurate? [Lab Interpretation | BNP | Heart Failure]
A. The client is having an acute myocardial infarction and needs immediate PCI
B. The client is in acute heart failure with possible mild myocardial injury and hypokalemia requiring careful
diuresis and electrolyte replacement *[CORRECT]*
C. The BNP is falsely elevated due to renal failure and should be ignored
D. The troponin is normal and the symptoms are likely respiratory, not cardiac
Correct Answer: B
Rationale: A BNP of 1,850 pg/mL is markedly elevated and correlates with severe heart failure, while a troponin of
0.06 ng/mL is only mildly elevated, suggesting myocardial strain rather than massive necrosis. The combination of
crackles, BNP elevation, and mild troponin rise supports acute decompensated heart failure possibly with type 2 MI.
BNP can be elevated in renal failure but remains clinically meaningful. Hypokalemia (3.1) must be corrected before
aggressive diuresis to avoid life-threatening dysrhythmias, per Nightingale fluid and electrolyte curriculum.
Nightingale College BSN HESI 266 Curriculum Page 3
, BSN HESI 266 Med Surg Exam (Latest 2026/2027) - Grade A - Nightingale 150 Verified Questions
Q6: A client with acute decompensated heart failure has BP 88/52, HR 118, RR 28, SpO2 90% on room air,
and is producing pink frothy sputum. The provider orders interventions. Which order should the nurse
QUESTION? [Pharmacology | Priority | Heart Failure]
A. IV furosemide 80 mg IV push now
B. IV nitroglycerin infusion starting at 10 mcg/min, titrate to BP
C. IV metoprolol 5 mg push now to control heart rate *[CORRECT]*
D. Non-rebreather mask oxygen at 15 L/min
Correct Answer: C
Rationale: IV metoprolol is contraindicated in acute decompensated HF with hypotension (SBP <90) because
beta-blockade reduces inotropy and can precipitate cardiogenic shock. Beta-blockers are initiated only after the client
is stabilized and euvolemic. IV furosemide (A), IV nitroglycerin with careful titration (B), and high-flow oxygen (D) are
all appropriate interventions to reduce preload, afterload, and hypoxia. This reflects the HESI emphasis on safe
medication administration in hemodynamically unstable clients.
Q7: A client with new-onset atrial fibrillation has an irregularly irregular radial pulse of 92 and an apical rate
of 124. The nurse prepares to administer IV diltiazem. Which assessment finding requires IMMEDIATE
notification of the provider before administration? [Dysrhythmia | Pharmacology]
A. BP 104/68
B. ST elevation noted on the cardiac monitor *[CORRECT]*
C. Respiratory rate of 22 with bilateral basilar crackles
D. The client reports mild lightheadedness when standing
Correct Answer: B
Rationale: ST elevation on the monitor indicates an acute STEMI, which takes priority over rate control and requires
immediate provider notification for activation of the cardiac catheterization lab. The provider may still want rate
control, but STEMI changes the clinical pathway entirely. Diltiazem is a calcium channel blocker that can worsen
hypotension (A, D) but is acceptable when SBP is above 90. Crackles (C) suggest mild congestion but do not
contraindicate diltiazem. Per NCLEX, ST elevation is always an emergency.
Q8: A client on telemetry suddenly becomes unresponsive. The monitor shows ventricular fibrillation. There
is no IV access. What is the nurse's FIRST action? [ACLS | V-Fib | Priority]
A. Begin chest compressions at a rate of 100-120 per minute
B. Deliver an unsynchronized electrical shock of 200 joules (biphasic) *[CORRECT]*
C. Establish intraosseous access for amiodarone administration
D. Administer 1 mg of epinephrine IV push
Correct Answer: B
Rationale: Per the 2020 AHA ACLS algorithm, the first action for witnessed ventricular fibrillation is immediate
unsynchronized defibrillation. Early defibrillation is the single most important determinant of survival. Chest
compressions (A) should begin immediately if a defibrillator is not instantly available, but the shock takes priority
when the defibrillator is at the bedside. Drugs (C, D) are administered after the second shock, not before defibrillation.
Nightingale College BSN HESI 266 Curriculum Page 4
