H E S I R N S P E C I A LT Y E X A M I N AT I O N · 2 0 2 0 2 7
U P D AT E
BSN HESI 266
Med Surg Exam
A comprehensive specialty examination with verified
answers and detailed rationales, aligned with the
Nightingale College BSN HESI 266 course syllabus, the
HESI RN Specialty exam blueprint, and the NCLEX-RN
test plan.
Nightingale College — BSN Program
150 Questions · Verified Answers · Already Graded A
L ATEST 2 0 2 0 2 7 EDI TI O N · 1 0 0 % CO RRECT · V ERI FI ED
,BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
Section 1: Cardiovascular Disorders
Questions 1-20 | 20 items
Q1: The nurse is assessing a client reporting chest discomfort. Which assessment finding best
differentiates an acute myocardial infarction from stable angina?
A. Pain that occurs after climbing two flights of stairs
B. Pain relieved within 5 minutes of rest and one nitroglycerin tablet
C. Pain described as burning that follows a large meal
D. Pain lasting more than 20 minutes, unrelieved by rest or nitroglycerin, accompanied by
diaphoresis *[CORRECT]*
Correct Answer: D
Rationale: Myocardial infarction pain is classically prolonged (longer than 20 minutes), unrelieved by rest
or nitrates, and accompanied by autonomic features such as diaphoresis, nausea, and dyspnea; this
distinction is a core content point in the Nightingale College BSN HESI 266 curriculum. Options A and B
describe classic stable angina, which is predictable with exertion and relieved within minutes. Option C
suggests reflux or noncardiac chest pain rather than infarction.
Q2: Which assessment findings should the nurse expect when caring for a client with early left-sided
heart failure?
A. Bilateral peripheral edema, jugular venous distention, and hepatomegaly
B. Dyspnea, orthopnea, and fine crackles in the bilateral lung bases *[CORRECT]*
C. Right upper quadrant pain and ascites
D. Weight gain, anorexia, and dependent sacral edema
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary venous congestion, producing dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, and bibasilar crackles, which the Nightingale College BSN HESI 266
curriculum identifies as hallmark findings. Options A, C, and D describe right-sided heart failure, in which
systemic venous congestion causes peripheral edema, jugular distention, hepatomegaly, and ascites.
Distinguishing ventricular involvement guides assessment priorities on the HESI RN Specialty examination.
Nightingale College - BSN Program 1
,BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
CASE STUDY 1
Mr. H., a 62-year-old male with hypertension and a 40-pack-year smoking history, arrives at the
emergency department with crushing substernal chest pressure radiating to the left arm and jaw,
diaphoresis, and nausea that began 45 minutes ago. The ECG shows ST-segment elevation in leads
V1-V4. He is taken to the catheterization laboratory, where a drug-eluting stent is placed in the left
anterior descending artery.
Q3: (Continuation of Case Study 1) Which laboratory result should the nurse expect to be elevated and
most specific to confirm myocardial injury in Mr. H.?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. C-reactive protein
D. Cardiac troponin I *[CORRECT]*
Correct Answer: D
Rationale: Cardiac troponin I is the most specific and sensitive biomarker of myocardial cell injury, rising
within 3 to 4 hours and remaining elevated for up to 10 days, a point emphasized in the Nightingale College
BSN HESI 266 curriculum. CK-MB (option A) is cardiac-specific but less sensitive than troponin, and
myoglobin (option B) rises earliest but is found in skeletal muscle, making it nonspecific. C-reactive protein
(option C) is an inflammatory marker and does not confirm infarction.
Nightingale College - BSN Program 2
, BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
CASE STUDY 1
Mr. H., a 62-year-old male with hypertension and a 40-pack-year smoking history, arrives at the
emergency department with crushing substernal chest pressure radiating to the left arm and jaw,
diaphoresis, and nausea that began 45 minutes ago. The ECG shows ST-segment elevation in leads
V1-V4. He is taken to the catheterization laboratory, where a drug-eluting stent is placed in the left
anterior descending artery.
Q4: (Continuation of Case Study 1) Twenty-four hours after stent placement, Mr. H. suddenly develops
a loud holosystolic murmur at the apex, crackles throughout all lung fields, and worsening dyspnea.
Which complication should the nurse suspect?
A. Reocclusion of the coronary stent
B. Papillary muscle rupture with acute mitral regurgitation *[CORRECT]*
C. Pericarditis
D. Ventricular septal rupture
Correct Answer: B
Rationale: A new holosystolic apical murmur with acute pulmonary edema 24 hours after infarction is the
classic presentation of papillary muscle rupture causing acute mitral regurgitation, a mechanical
complication highlighted in the Nightingale College BSN HESI 266 curriculum. Stent reocclusion (option
A) produces recurrent chest pain and new ST elevation, not a new murmur. Pericarditis (option C) produces
a friction rub and pleuritic pain, while ventricular septal rupture (option D) produces a harsh murmur at the
left sternal border with rising right-sided saturations.
Nightingale College - BSN Program 3
U P D AT E
BSN HESI 266
Med Surg Exam
A comprehensive specialty examination with verified
answers and detailed rationales, aligned with the
Nightingale College BSN HESI 266 course syllabus, the
HESI RN Specialty exam blueprint, and the NCLEX-RN
test plan.
Nightingale College — BSN Program
150 Questions · Verified Answers · Already Graded A
L ATEST 2 0 2 0 2 7 EDI TI O N · 1 0 0 % CO RRECT · V ERI FI ED
,BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
Section 1: Cardiovascular Disorders
Questions 1-20 | 20 items
Q1: The nurse is assessing a client reporting chest discomfort. Which assessment finding best
differentiates an acute myocardial infarction from stable angina?
A. Pain that occurs after climbing two flights of stairs
B. Pain relieved within 5 minutes of rest and one nitroglycerin tablet
C. Pain described as burning that follows a large meal
D. Pain lasting more than 20 minutes, unrelieved by rest or nitroglycerin, accompanied by
diaphoresis *[CORRECT]*
Correct Answer: D
Rationale: Myocardial infarction pain is classically prolonged (longer than 20 minutes), unrelieved by rest
or nitrates, and accompanied by autonomic features such as diaphoresis, nausea, and dyspnea; this
distinction is a core content point in the Nightingale College BSN HESI 266 curriculum. Options A and B
describe classic stable angina, which is predictable with exertion and relieved within minutes. Option C
suggests reflux or noncardiac chest pain rather than infarction.
Q2: Which assessment findings should the nurse expect when caring for a client with early left-sided
heart failure?
A. Bilateral peripheral edema, jugular venous distention, and hepatomegaly
B. Dyspnea, orthopnea, and fine crackles in the bilateral lung bases *[CORRECT]*
C. Right upper quadrant pain and ascites
D. Weight gain, anorexia, and dependent sacral edema
Correct Answer: B
Rationale: Left-sided heart failure causes pulmonary venous congestion, producing dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, and bibasilar crackles, which the Nightingale College BSN HESI 266
curriculum identifies as hallmark findings. Options A, C, and D describe right-sided heart failure, in which
systemic venous congestion causes peripheral edema, jugular distention, hepatomegaly, and ascites.
Distinguishing ventricular involvement guides assessment priorities on the HESI RN Specialty examination.
Nightingale College - BSN Program 1
,BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
CASE STUDY 1
Mr. H., a 62-year-old male with hypertension and a 40-pack-year smoking history, arrives at the
emergency department with crushing substernal chest pressure radiating to the left arm and jaw,
diaphoresis, and nausea that began 45 minutes ago. The ECG shows ST-segment elevation in leads
V1-V4. He is taken to the catheterization laboratory, where a drug-eluting stent is placed in the left
anterior descending artery.
Q3: (Continuation of Case Study 1) Which laboratory result should the nurse expect to be elevated and
most specific to confirm myocardial injury in Mr. H.?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. C-reactive protein
D. Cardiac troponin I *[CORRECT]*
Correct Answer: D
Rationale: Cardiac troponin I is the most specific and sensitive biomarker of myocardial cell injury, rising
within 3 to 4 hours and remaining elevated for up to 10 days, a point emphasized in the Nightingale College
BSN HESI 266 curriculum. CK-MB (option A) is cardiac-specific but less sensitive than troponin, and
myoglobin (option B) rises earliest but is found in skeletal muscle, making it nonspecific. C-reactive protein
(option C) is an inflammatory marker and does not confirm infarction.
Nightingale College - BSN Program 2
, BSN HESI 266 MED SURG EXAM (LATEST 2026/2027 UPDATE) | QUESTIONS AND VERIFIED ANSWERS
CASE STUDY 1
Mr. H., a 62-year-old male with hypertension and a 40-pack-year smoking history, arrives at the
emergency department with crushing substernal chest pressure radiating to the left arm and jaw,
diaphoresis, and nausea that began 45 minutes ago. The ECG shows ST-segment elevation in leads
V1-V4. He is taken to the catheterization laboratory, where a drug-eluting stent is placed in the left
anterior descending artery.
Q4: (Continuation of Case Study 1) Twenty-four hours after stent placement, Mr. H. suddenly develops
a loud holosystolic murmur at the apex, crackles throughout all lung fields, and worsening dyspnea.
Which complication should the nurse suspect?
A. Reocclusion of the coronary stent
B. Papillary muscle rupture with acute mitral regurgitation *[CORRECT]*
C. Pericarditis
D. Ventricular septal rupture
Correct Answer: B
Rationale: A new holosystolic apical murmur with acute pulmonary edema 24 hours after infarction is the
classic presentation of papillary muscle rupture causing acute mitral regurgitation, a mechanical
complication highlighted in the Nightingale College BSN HESI 266 curriculum. Stent reocclusion (option
A) produces recurrent chest pain and new ST elevation, not a new murmur. Pericarditis (option C) produces
a friction rub and pleuritic pain, while ventricular septal rupture (option D) produces a harsh murmur at the
left sternal border with rising right-sided saturations.
Nightingale College - BSN Program 3
