BSN 266 HESI Med-Surg Practice Exam | NGN Case Scenarios & Rationales 2026/2027
Medical-Surgical Nursing Practice & Clinical Judgment | Key Domains: Acute & Chronic Condition
Management, Postoperative Complications, Fluid & Electrolyte Imbalances, Pain Management,
Patient Education for Self-Care, and Coordination of Discharge Planning | Expert-Aligned Structure |
NGN Practice Exam Format
Introduction
This structured BSN 266 HESI Medical-Surgical Practice Exam for 2026/2027 provides a realistic
set of Next Generation NCLEX-style case scenarios with correct answers and rationales. It focuses on
applying medical-surgical knowledge to manage common patient conditions and prevent
complications, emphasizing the "Evaluate Outcomes" and "Generate Solutions" steps of the clinical
judgment model within a simulated exam environment.
Exam Structure:
• NGN Practice Exam: (55 UNFOLDING SCENARIOS)
Answer Format
All correct nursing actions and evaluation findings must appear in bold and cyan blue,
accompanied by concise rationales explaining whether an intervention was effective (e.g., "Evaluate
Outcomes" of oxygen therapy for hypoxia), the generation of an alternative solution for an
unresolved problem (e.g., a new medication for uncontrolled pain), the appropriate teaching for a
patient being discharged with a new diagnosis (e.g., heart failure), and why alternative actions
would not achieve the desired patient outcome.
1 A 68-year-old male is 24 hours post-op from a right total hip arthroplasty. He reports
increasing pain in his right calf with swelling and redness. Vital signs: T 38.1°C (100.6°F), HR
102 bpm, RR 22, BP 138/84 mmHg, SpO₂ 94% on room air. Which action should the nurse
take first?
A. Elevate the leg and apply warm compresses.
, B. Administer PRN acetaminophen for pain.
C. Notify the provider immediately due to signs of possible deep vein thrombosis (DVT).
D. Encourage ambulation to improve circulation.
Rationale: The patient exhibits classic signs of DVT (unilateral calf swelling, warmth, redness, pain,
and low-grade fever). Notifying the provider immediately is critical to initiate diagnostic testing
(e.g., Doppler ultrasound) and anticoagulation therapy to prevent pulmonary embolism. Elevation and
warm compresses (A) are inappropriate and may dislodge a clot. Acetaminophen (B) does not address
the underlying cause. Ambulation (D) is contraindicated until DVT is ruled out due to embolism risk.
2 A patient with heart failure is being discharged with a new prescription for furosemide 40
mg PO daily. Which statement by the patient indicates effective teaching?
A. “I will take this medication at bedtime to avoid frequent urination during the day.”
B. “I should avoid eating bananas and oranges while on this medication.”
C. “I need to monitor my weight daily and report a gain of 2 pounds or more in one day.”
D. “If I feel dizzy, I will stop taking the medication until I feel better.”
Rationale: Daily weight monitoring is essential in heart failure management. A weight gain of 2 or
more pounds in a day suggests fluid retention, requiring prompt intervention. Furosemide should
be taken in the morning (A) to prevent nocturia. The patient should consume potassium-rich foods (B)
unless otherwise directed, as furosemide causes potassium loss. Discontinuing medication without
provider input (D) can worsen heart failure.
3 A postoperative patient has a serum potassium level of 3.1 mEq/L. Which assessment
finding should the nurse prioritize?
A. Muscle stiffness
B. Muscle weakness and palpitations
C. Hypertension
, D. Hyperreflexia
Rationale: Hypokalemia (normal K⁺: 3.5–5.0 mEq/L) causes muscle weakness and cardiac
dysrhythmias (palpitations) due to impaired cellular repolarization. Hypertension (C) and
hyperreflexia (D) are associated with hyperkalemia. Muscle stiffness (A) is not typical; flaccidity is
more common in hypokalemia.
4 A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which action is
most important for the nurse to take prior to the procedure?
A. Assess for shellfish allergy.
B. Hold metformin for 24 to 48 hours before the procedure.
C. Administer a bowel prep.
D. Check capillary blood glucose.
Rationale: Metformin can cause lactic acidosis when combined with iodinated contrast due to
potential contrast-induced nephropathy. Holding metformin 24–48 hours before and after the
procedure is standard protocol. Shellfish allergy (A) is a myth; contrast allergy is unrelated. Bowel
prep (C) is not required for abdominal CT with contrast unless specified. Glucose (D) is important but
secondary to renal/metformin risk.
5 A patient 2 days post-op from abdominal surgery has absent bowel sounds, abdominal
distension, and has not passed flatus. The nurse suspects paralytic ileus. Which intervention
is most appropriate?
A. Administer bisacodyl suppository.
B. Encourage high-fiber foods.
C. Maintain NPO status and monitor for return of bowel function.
D. Increase IV fluids to 150 mL/hr.
Medical-Surgical Nursing Practice & Clinical Judgment | Key Domains: Acute & Chronic Condition
Management, Postoperative Complications, Fluid & Electrolyte Imbalances, Pain Management,
Patient Education for Self-Care, and Coordination of Discharge Planning | Expert-Aligned Structure |
NGN Practice Exam Format
Introduction
This structured BSN 266 HESI Medical-Surgical Practice Exam for 2026/2027 provides a realistic
set of Next Generation NCLEX-style case scenarios with correct answers and rationales. It focuses on
applying medical-surgical knowledge to manage common patient conditions and prevent
complications, emphasizing the "Evaluate Outcomes" and "Generate Solutions" steps of the clinical
judgment model within a simulated exam environment.
Exam Structure:
• NGN Practice Exam: (55 UNFOLDING SCENARIOS)
Answer Format
All correct nursing actions and evaluation findings must appear in bold and cyan blue,
accompanied by concise rationales explaining whether an intervention was effective (e.g., "Evaluate
Outcomes" of oxygen therapy for hypoxia), the generation of an alternative solution for an
unresolved problem (e.g., a new medication for uncontrolled pain), the appropriate teaching for a
patient being discharged with a new diagnosis (e.g., heart failure), and why alternative actions
would not achieve the desired patient outcome.
1 A 68-year-old male is 24 hours post-op from a right total hip arthroplasty. He reports
increasing pain in his right calf with swelling and redness. Vital signs: T 38.1°C (100.6°F), HR
102 bpm, RR 22, BP 138/84 mmHg, SpO₂ 94% on room air. Which action should the nurse
take first?
A. Elevate the leg and apply warm compresses.
, B. Administer PRN acetaminophen for pain.
C. Notify the provider immediately due to signs of possible deep vein thrombosis (DVT).
D. Encourage ambulation to improve circulation.
Rationale: The patient exhibits classic signs of DVT (unilateral calf swelling, warmth, redness, pain,
and low-grade fever). Notifying the provider immediately is critical to initiate diagnostic testing
(e.g., Doppler ultrasound) and anticoagulation therapy to prevent pulmonary embolism. Elevation and
warm compresses (A) are inappropriate and may dislodge a clot. Acetaminophen (B) does not address
the underlying cause. Ambulation (D) is contraindicated until DVT is ruled out due to embolism risk.
2 A patient with heart failure is being discharged with a new prescription for furosemide 40
mg PO daily. Which statement by the patient indicates effective teaching?
A. “I will take this medication at bedtime to avoid frequent urination during the day.”
B. “I should avoid eating bananas and oranges while on this medication.”
C. “I need to monitor my weight daily and report a gain of 2 pounds or more in one day.”
D. “If I feel dizzy, I will stop taking the medication until I feel better.”
Rationale: Daily weight monitoring is essential in heart failure management. A weight gain of 2 or
more pounds in a day suggests fluid retention, requiring prompt intervention. Furosemide should
be taken in the morning (A) to prevent nocturia. The patient should consume potassium-rich foods (B)
unless otherwise directed, as furosemide causes potassium loss. Discontinuing medication without
provider input (D) can worsen heart failure.
3 A postoperative patient has a serum potassium level of 3.1 mEq/L. Which assessment
finding should the nurse prioritize?
A. Muscle stiffness
B. Muscle weakness and palpitations
C. Hypertension
, D. Hyperreflexia
Rationale: Hypokalemia (normal K⁺: 3.5–5.0 mEq/L) causes muscle weakness and cardiac
dysrhythmias (palpitations) due to impaired cellular repolarization. Hypertension (C) and
hyperreflexia (D) are associated with hyperkalemia. Muscle stiffness (A) is not typical; flaccidity is
more common in hypokalemia.
4 A patient with type 2 diabetes is scheduled for a CT scan with contrast. Which action is
most important for the nurse to take prior to the procedure?
A. Assess for shellfish allergy.
B. Hold metformin for 24 to 48 hours before the procedure.
C. Administer a bowel prep.
D. Check capillary blood glucose.
Rationale: Metformin can cause lactic acidosis when combined with iodinated contrast due to
potential contrast-induced nephropathy. Holding metformin 24–48 hours before and after the
procedure is standard protocol. Shellfish allergy (A) is a myth; contrast allergy is unrelated. Bowel
prep (C) is not required for abdominal CT with contrast unless specified. Glucose (D) is important but
secondary to renal/metformin risk.
5 A patient 2 days post-op from abdominal surgery has absent bowel sounds, abdominal
distension, and has not passed flatus. The nurse suspects paralytic ileus. Which intervention
is most appropriate?
A. Administer bisacodyl suppository.
B. Encourage high-fiber foods.
C. Maintain NPO status and monitor for return of bowel function.
D. Increase IV fluids to 150 mL/hr.
