BSN HESI 266 Med Surg Exam | 2025/2026 Edition |
Nightingale College | Real Exam 150 Q&A
This updated 2025/2026 resource includes fully verified questions and correct answers
from the BSN 266 Medical-Surgical HESI Exam used at Nightingale College. Aligned with
the latest HESI blueprint, it covers essential Med Surg topics such as respiratory and
cardiovascular disorders, perioperative care, pharmacology, fluid and electrolyte
balance, and patient safety. Designed to mirror the actual exam, this guide provides
reliable preparation for nursing students aiming to excel in their HESI assessments.
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should
the nurse implement?
A. Position the head of the bed (HOB) flat.
B. Withhold intravenous fluids.
C. Administer a bolus of IV fluids.
D. Give an antihypertensive medication. - correct answer -D. Give an antihypertensive medication.
Rationale
Most ischemic strokes occur during sleep when baseline blood pressure declines or blood viscosity
increases due to minimal fluid intake. Completed strokes usually produce neurologic deficits within an
hour, and the client's current elevated blood pressure requires antihypertensive medication.
The nurse is planning to initiate a socialization group for older residents of a long-term facility. Which
information would be most useful to the nurse when planning activities for the group?
A. The length of time each group member has resided at the nursing home.
B. A brief description of each resident's family life.
C. The age of each group member.
D. The usual activity patterns of each member of the group. - correct answer -D. The usual activity
patterns of each member of the group.
Rationale
An older person's level of activity is a determining factor in adjustment to aging as described by the
Activity Theory of Aging. The most useful information initially would be an assessment of each
individual's adjustment to the aging process.
,In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory
test results to indicate an increased serum level of which substance?
A. Sodium.
B. Antidiuretic hormone.
C. Potassium.
D. Glucose. - correct answer -A. Sodium.
Rationale
Clients with primary aldosteronism exhibit an increase in serum sodium levels (hypernatremia) and have
profound decline in the serum levels of potassium (hypokalemia)--hypertension is the most prominent
and universal sign. Antidiuretic hormone is decreased with diabetes insipidus. Glucose is not affected by
primary aldosteronism.
A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most
important for the nurse to teach this client?
A. Avoid high carbohydrate foods.
B. Decrease intake of fat soluble vitamins.
C. Decrease caloric intake.
D. Restrict salt and fluid intake. - correct answer -D. Restrict salt and fluid intake.
Rationale
Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as
manifested by edema and ascites.
Which finding should the nurse identify as most significant for a client diagnosed with polycystic
kidney disease (PKD)?
A. Hematuria.
B. 2 pounds weight gain.
C. 3+ bacteria in urine.
D. Steady, dull flank pain. - correct answer -C. 3+ bacteria in urine.
Rationale
,Urinary tract infections (UTI) for a client with PKD require prompt antibiotic therapy to prevent renal
damage and scarring which may cause further progression of the disease, so bacteria in the urine is the
most significant finding at this time.
The nurse is caring for a client with a stroke resulting in right-sided paresis and aphasia. The client
attempts to use the left hand for feeding and other self-care activities. The spouse becomes frustrated
and insists on doing everything for the client. Based on this data, which nursing diagnosis should the
nurse document for this client?
A. Situational low self-esteem related to functional impairment and change in role function.
B. Disabled family coping related to dissonant coping style of significant person.
C. Interrupted family processes related to shift in health status of family member.
D. Risk for ineffective therapeutic regimen management related to complexity of care. - correct answer
-B. Disabled family coping related to dissonant coping style of significant person.
Rationale
A stroke affects the whole family and in this case the spouse probably thinks that she is helping and
needs to feel that she is contributing to the client's care. Her help is noted as being incongruent with
attempts of self-care by the client thereby disabling family coping.
How should the nurse position the electrodes for modified chest lead one (MCL I) telemetry
monitoring?
A. Positive polarity right shoulder, negative polarity left shoulder, ground left chest nipple line.
B. Positive polarity left shoulder, negative polarity right chest nipple line, ground left chest nipple line.
C. Positive polarity right chest nipple line, negative polarity left chest nipple line, ground left shoulder.
D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line. -
correct answer -D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left
chest nipple line.
Rationale
In MCL I monitoring, the positive electrode is placed on the client's mid-chest to the right of the
sternum, and the negative electrode is placed on the upper left part of the chest. The ground may be
placed anywhere, but is usually placed on the lower left portion of the chest.
The nurse is planning care to prevent complication for a client with multiple myeloma. Which
intervention is most important for the nurse to include?
, A. Safety precautions during activity.
B. Assess for changes in size of lymph nodes.
C. Maintain a fluid intake of 3 to 4 L per day.
D. Administer narcotic analgesic around the clock. - correct answer -C. Maintain a fluid intake of 3 to 4
L per day.
Rationale
Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and
hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to
promote excretion of serum calcium. Although the client is at risk for pathologic fractures due to diffuse
osteoporosis, mobilization and weight bearing should be encouraged to promote bone reabsorption of
circulating calcium, which can cause renal complications.
The nurse is teaching a female client who uses a contraceptive diaphragm about reducing the risk for
toxic shock syndrome (TSS). Which information should the nurse include? (Select all that apply.)
A. Remove the diaphragm immediately after intercourse.
B. Wash the diaphragm with an alcohol solution.
C. Use the diaphragm to prevent conception during the menstrual cycle.
D. Do not leave the diaphragm in place longer than 8 hours after intercourse.
E. Replace the old diaphragm every 3 months. - correct answer -D and E
Rationale
The diaphragm needs to remain against the cervix for 6 to 8 hours to prevent pregnancy but should not
remain for longer than 8 hours to avoid the risk of TSS. The diaphragm should be replaced every 3
months to maintain integrity.
Which intervention should the nurse implement for a female client diagnosed with pelvic relaxation
disorder?
A. Describe proper administration of vaginal suppositories and cream.
B. Encourage the client to perform Kegel exercises 10 times daily.
C. Explain the importance of using condoms when having sexual intercourse.
D. Discuss the importance of keeping a diary of daily temperature and menstrual cycle events. - correct
answer -B. Encourage the client to perform Kegel exercises 10 times daily.
Rationale
Nightingale College | Real Exam 150 Q&A
This updated 2025/2026 resource includes fully verified questions and correct answers
from the BSN 266 Medical-Surgical HESI Exam used at Nightingale College. Aligned with
the latest HESI blueprint, it covers essential Med Surg topics such as respiratory and
cardiovascular disorders, perioperative care, pharmacology, fluid and electrolyte
balance, and patient safety. Designed to mirror the actual exam, this guide provides
reliable preparation for nursing students aiming to excel in their HESI assessments.
A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should
the nurse implement?
A. Position the head of the bed (HOB) flat.
B. Withhold intravenous fluids.
C. Administer a bolus of IV fluids.
D. Give an antihypertensive medication. - correct answer -D. Give an antihypertensive medication.
Rationale
Most ischemic strokes occur during sleep when baseline blood pressure declines or blood viscosity
increases due to minimal fluid intake. Completed strokes usually produce neurologic deficits within an
hour, and the client's current elevated blood pressure requires antihypertensive medication.
The nurse is planning to initiate a socialization group for older residents of a long-term facility. Which
information would be most useful to the nurse when planning activities for the group?
A. The length of time each group member has resided at the nursing home.
B. A brief description of each resident's family life.
C. The age of each group member.
D. The usual activity patterns of each member of the group. - correct answer -D. The usual activity
patterns of each member of the group.
Rationale
An older person's level of activity is a determining factor in adjustment to aging as described by the
Activity Theory of Aging. The most useful information initially would be an assessment of each
individual's adjustment to the aging process.
,In assessing a client diagnosed with primary hyperaldosteronism, the nurse expects the laboratory
test results to indicate an increased serum level of which substance?
A. Sodium.
B. Antidiuretic hormone.
C. Potassium.
D. Glucose. - correct answer -A. Sodium.
Rationale
Clients with primary aldosteronism exhibit an increase in serum sodium levels (hypernatremia) and have
profound decline in the serum levels of potassium (hypokalemia)--hypertension is the most prominent
and universal sign. Antidiuretic hormone is decreased with diabetes insipidus. Glucose is not affected by
primary aldosteronism.
A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most
important for the nurse to teach this client?
A. Avoid high carbohydrate foods.
B. Decrease intake of fat soluble vitamins.
C. Decrease caloric intake.
D. Restrict salt and fluid intake. - correct answer -D. Restrict salt and fluid intake.
Rationale
Salt and fluid restrictions are the first dietary modifications for a client who is retaining fluid as
manifested by edema and ascites.
Which finding should the nurse identify as most significant for a client diagnosed with polycystic
kidney disease (PKD)?
A. Hematuria.
B. 2 pounds weight gain.
C. 3+ bacteria in urine.
D. Steady, dull flank pain. - correct answer -C. 3+ bacteria in urine.
Rationale
,Urinary tract infections (UTI) for a client with PKD require prompt antibiotic therapy to prevent renal
damage and scarring which may cause further progression of the disease, so bacteria in the urine is the
most significant finding at this time.
The nurse is caring for a client with a stroke resulting in right-sided paresis and aphasia. The client
attempts to use the left hand for feeding and other self-care activities. The spouse becomes frustrated
and insists on doing everything for the client. Based on this data, which nursing diagnosis should the
nurse document for this client?
A. Situational low self-esteem related to functional impairment and change in role function.
B. Disabled family coping related to dissonant coping style of significant person.
C. Interrupted family processes related to shift in health status of family member.
D. Risk for ineffective therapeutic regimen management related to complexity of care. - correct answer
-B. Disabled family coping related to dissonant coping style of significant person.
Rationale
A stroke affects the whole family and in this case the spouse probably thinks that she is helping and
needs to feel that she is contributing to the client's care. Her help is noted as being incongruent with
attempts of self-care by the client thereby disabling family coping.
How should the nurse position the electrodes for modified chest lead one (MCL I) telemetry
monitoring?
A. Positive polarity right shoulder, negative polarity left shoulder, ground left chest nipple line.
B. Positive polarity left shoulder, negative polarity right chest nipple line, ground left chest nipple line.
C. Positive polarity right chest nipple line, negative polarity left chest nipple line, ground left shoulder.
D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line. -
correct answer -D. Negative polarity left shoulder, positive polarity right chest nipple line, ground left
chest nipple line.
Rationale
In MCL I monitoring, the positive electrode is placed on the client's mid-chest to the right of the
sternum, and the negative electrode is placed on the upper left part of the chest. The ground may be
placed anywhere, but is usually placed on the lower left portion of the chest.
The nurse is planning care to prevent complication for a client with multiple myeloma. Which
intervention is most important for the nurse to include?
, A. Safety precautions during activity.
B. Assess for changes in size of lymph nodes.
C. Maintain a fluid intake of 3 to 4 L per day.
D. Administer narcotic analgesic around the clock. - correct answer -C. Maintain a fluid intake of 3 to 4
L per day.
Rationale
Multiple myeloma is a malignancy of plasma cells that infiltrate bone causing demineralization and
hypercalcemia, so maintaining a urinary output of 1.5 to 2 L per day requires an intake of 3 to 4 L (C) to
promote excretion of serum calcium. Although the client is at risk for pathologic fractures due to diffuse
osteoporosis, mobilization and weight bearing should be encouraged to promote bone reabsorption of
circulating calcium, which can cause renal complications.
The nurse is teaching a female client who uses a contraceptive diaphragm about reducing the risk for
toxic shock syndrome (TSS). Which information should the nurse include? (Select all that apply.)
A. Remove the diaphragm immediately after intercourse.
B. Wash the diaphragm with an alcohol solution.
C. Use the diaphragm to prevent conception during the menstrual cycle.
D. Do not leave the diaphragm in place longer than 8 hours after intercourse.
E. Replace the old diaphragm every 3 months. - correct answer -D and E
Rationale
The diaphragm needs to remain against the cervix for 6 to 8 hours to prevent pregnancy but should not
remain for longer than 8 hours to avoid the risk of TSS. The diaphragm should be replaced every 3
months to maintain integrity.
Which intervention should the nurse implement for a female client diagnosed with pelvic relaxation
disorder?
A. Describe proper administration of vaginal suppositories and cream.
B. Encourage the client to perform Kegel exercises 10 times daily.
C. Explain the importance of using condoms when having sexual intercourse.
D. Discuss the importance of keeping a diary of daily temperature and menstrual cycle events. - correct
answer -B. Encourage the client to perform Kegel exercises 10 times daily.
Rationale
