BSN 266 HESI EXAM
MED-SURG EXAM 5
2026/2027
150 QUESTIONS | VERIFIED QUESTIONS AND ANSWERS
NIGHTINGALE COLLEGE | 100% CORRECT ANSWERS | GRADED A+
Core Domains:
Cardiovascular Disorders | Respiratory Disorders
Endocrine & Metabolic Conditions | Gastrointestinal & Hepatic Disorders
Renal & Urinary Disorders | Neurologic Disorders
Hematologic & Immunologic Conditions | Fluid & Electrolyte Imbalances
Pain Management & Pharmacologic Interventions
Scenario-Based Clinical Decision-Making
Nightingale College – BSN 266 – Aligned Format
, BSN 266 HESI Med-Surg Exam 5
Introduction
This BSN 266 HESI Med-Surg Exam 5 for 2026/2027 reflects the standardized assessment used to
evaluate competency in med-surgical nursing. The exam measures understanding of pathophysiology,
assessment, intervention planning, pharmacology, and scenario-based clinical decision-making
essential for safe and effective nursing care.
Exam Structure
The BSN 266 HESI Med-Surg Exam 5 consists of 150 multiple-choice questions covering clinical
reasoning, patient safety, and evidence-based interventions. Questions include single-best-answer and
scenario-based nursing items designed to evaluate comprehensive understanding of med-surgical
nursing principles.
Instructions
Read each question carefully before selecting your answer. All questions are presented in bold.
Correct answers are indicated in bold and green. Rationales explaining disease processes,
interventions, pharmacologic reasoning, and patient care decision-making are provided in italic font.
1. Cardiovascular Disorders
1. A patient is admitted with acute myocardial infarction. Which finding requires
immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 110 beats per minute
C. Chest pain unrelieved by nitroglycerin
D. Respiratory rate of 18 breaths per minute
Rationale: Chest pain unrelieved by nitroglycerin indicates ongoing myocardial ischemia and
requires immediate intervention to prevent further heart muscle damage. This patient may
need additional medications or emergent cardiac catheterization.
2. A patient with heart failure is taking furosemide. Which symptom indicates
hypokalemia?
A. Muscle weakness and leg cramps
B. Peripheral edema
C. Increased blood pressure
D. Weight gain
Rationale: Hypokalemia causes muscle weakness, leg cramps, and cardiac dysrhythmias due
to the role of potassium in muscle and nerve function. Furosemide is a potassium-wasting
diuretic, requiring monitoring of potassium levels.
3. The nurse is caring for a patient with a new diagnosis of atrial fibrillation. What is the
priority nursing assessment?
A. Blood pressure
B. Apical-radial pulse deficit
C. Respiratory rate
D. Temperature
Page 2 of 33
, BSN 266 HESI Med-Surg Exam 5
Rationale: Atrial fibrillation causes an irregular ventricular response with a pulse deficit,
meaning the apical rate exceeds the radial rate. Assessment of the pulse deficit helps evaluate
the effectiveness of rate control therapy.
4. A patient receiving warfarin has an INR of 5.5. What action should the nurse take?
A. Administer the next dose as scheduled
B. Hold the warfarin and notify the provider
C. Give vitamin K immediately
D. Increase the dose
Rationale: An INR of 5.5 indicates a significantly elevated anticoagulation level with increased
bleeding risk. The nurse should hold the warfarin and notify the provider for further orders,
which may include vitamin K administration.
5. Which assessment finding indicates a patient may be developing cardiogenic shock?
A. Warm, dry skin
B. Blood pressure 90/60 mmHg with altered mental status
C. Heart rate 70 bpm
D. Urine output 50 mL/hour
Rationale: Cardiogenic shock presents with hypotension, altered mental status, cool
extremities, and decreased urine output due to inadequate cardiac output and tissue perfusion.
Immediate intervention is required.
6. A patient with hypertension is prescribed lisinopril. Which instruction should the
nurse provide?
A. Avoid potassium-rich foods
B. Change positions slowly to prevent dizziness
C. Take the medication at bedtime
D. Stop the medication if you develop a cough
Rationale: Lisinopril, an ACE inhibitor, can cause orthostatic hypotension. Patients should be
instructed to change positions slowly to prevent falls. A persistent cough is a common side
effect but should be reported, not an indication to stop abruptly.
7. The nurse is assessing a patient with peripheral arterial disease. Which finding is
expected?
A. Dependent rubor
B. Warm extremities
C. Bounding pulses
D. Edema
Rationale: Peripheral arterial disease causes decreased arterial blood flow, resulting in
dependent rubor (redness when legs are dependent), pallor when elevated, cool skin,
diminished pulses, and intermittent claudication.
8. A patient post-cardiac catheterization via femoral approach develops a hematoma.
What is the priority nursing action?
A. Apply a warm compress
B. Apply manual pressure and notify the provider
C. Elevate the affected leg
D. Administer pain medication
Page 3 of 33
, BSN 266 HESI Med-Surg Exam 5
Rationale: A hematoma at the catheterization site indicates bleeding and requires immediate
manual pressure to stop bleeding, followed by provider notification. The patient may need
additional interventions to prevent hemorrhage.
9. Which ECG finding is characteristic of a myocardial infarction?
A. ST segment depression
B. ST segment elevation in leads facing the injured area
C. Tall, peaked T waves
D. Shortened PR interval
Rationale: ST segment elevation in contiguous leads indicates acute myocardial injury from a
myocardial infarction. This finding helps identify the location of the infarction and guides
emergent treatment decisions.
10. A patient with deep vein thrombosis is started on heparin infusion. Which
laboratory value should the nurse monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count only
Rationale: Heparin therapy is monitored using the aPTT, with the therapeutic range typically
1.5-2.5 times the control value. PT/INR is used to monitor warfarin therapy, not heparin.
11. The nurse is teaching a patient about nitroglycerin sublingual tablets. Which
statement indicates understanding?
A. I should swallow the tablet with water
B. I can take up to three tablets 5 minutes apart for chest pain
C. I should store the tablets in the refrigerator
D. I should take the tablet before meals only
Rationale: Patients should place nitroglycerin under the tongue and can take up to three
tablets at 5-minute intervals for chest pain. If pain persists after three tablets, emergency
services should be called. Tablets should be stored in a cool, dry place, not refrigerated.
12. A patient with heart failure reports increasing shortness of breath and has gained 3
pounds in 2 days. What does this indicate?
A. Medication effectiveness
B. Fluid retention and worsening heart failure
C. Improved nutritional status
D. Normal daily variation
Rationale: Weight gain of 2-3 pounds in 1-2 days indicates fluid retention, a sign of worsening
heart failure. Patients should monitor daily weights and report gains of more than 2 pounds in
one day or 5 pounds in one week.
13. Which patient is at highest risk for developing a venous thromboembolism?
A. A 25-year-old ambulatory patient
B. A 65-year-old patient on bed rest after surgery
C. A 40-year-old patient on a regular diet
D. A 30-year-old patient with a cough
Page 4 of 33
MED-SURG EXAM 5
2026/2027
150 QUESTIONS | VERIFIED QUESTIONS AND ANSWERS
NIGHTINGALE COLLEGE | 100% CORRECT ANSWERS | GRADED A+
Core Domains:
Cardiovascular Disorders | Respiratory Disorders
Endocrine & Metabolic Conditions | Gastrointestinal & Hepatic Disorders
Renal & Urinary Disorders | Neurologic Disorders
Hematologic & Immunologic Conditions | Fluid & Electrolyte Imbalances
Pain Management & Pharmacologic Interventions
Scenario-Based Clinical Decision-Making
Nightingale College – BSN 266 – Aligned Format
, BSN 266 HESI Med-Surg Exam 5
Introduction
This BSN 266 HESI Med-Surg Exam 5 for 2026/2027 reflects the standardized assessment used to
evaluate competency in med-surgical nursing. The exam measures understanding of pathophysiology,
assessment, intervention planning, pharmacology, and scenario-based clinical decision-making
essential for safe and effective nursing care.
Exam Structure
The BSN 266 HESI Med-Surg Exam 5 consists of 150 multiple-choice questions covering clinical
reasoning, patient safety, and evidence-based interventions. Questions include single-best-answer and
scenario-based nursing items designed to evaluate comprehensive understanding of med-surgical
nursing principles.
Instructions
Read each question carefully before selecting your answer. All questions are presented in bold.
Correct answers are indicated in bold and green. Rationales explaining disease processes,
interventions, pharmacologic reasoning, and patient care decision-making are provided in italic font.
1. Cardiovascular Disorders
1. A patient is admitted with acute myocardial infarction. Which finding requires
immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Heart rate of 110 beats per minute
C. Chest pain unrelieved by nitroglycerin
D. Respiratory rate of 18 breaths per minute
Rationale: Chest pain unrelieved by nitroglycerin indicates ongoing myocardial ischemia and
requires immediate intervention to prevent further heart muscle damage. This patient may
need additional medications or emergent cardiac catheterization.
2. A patient with heart failure is taking furosemide. Which symptom indicates
hypokalemia?
A. Muscle weakness and leg cramps
B. Peripheral edema
C. Increased blood pressure
D. Weight gain
Rationale: Hypokalemia causes muscle weakness, leg cramps, and cardiac dysrhythmias due
to the role of potassium in muscle and nerve function. Furosemide is a potassium-wasting
diuretic, requiring monitoring of potassium levels.
3. The nurse is caring for a patient with a new diagnosis of atrial fibrillation. What is the
priority nursing assessment?
A. Blood pressure
B. Apical-radial pulse deficit
C. Respiratory rate
D. Temperature
Page 2 of 33
, BSN 266 HESI Med-Surg Exam 5
Rationale: Atrial fibrillation causes an irregular ventricular response with a pulse deficit,
meaning the apical rate exceeds the radial rate. Assessment of the pulse deficit helps evaluate
the effectiveness of rate control therapy.
4. A patient receiving warfarin has an INR of 5.5. What action should the nurse take?
A. Administer the next dose as scheduled
B. Hold the warfarin and notify the provider
C. Give vitamin K immediately
D. Increase the dose
Rationale: An INR of 5.5 indicates a significantly elevated anticoagulation level with increased
bleeding risk. The nurse should hold the warfarin and notify the provider for further orders,
which may include vitamin K administration.
5. Which assessment finding indicates a patient may be developing cardiogenic shock?
A. Warm, dry skin
B. Blood pressure 90/60 mmHg with altered mental status
C. Heart rate 70 bpm
D. Urine output 50 mL/hour
Rationale: Cardiogenic shock presents with hypotension, altered mental status, cool
extremities, and decreased urine output due to inadequate cardiac output and tissue perfusion.
Immediate intervention is required.
6. A patient with hypertension is prescribed lisinopril. Which instruction should the
nurse provide?
A. Avoid potassium-rich foods
B. Change positions slowly to prevent dizziness
C. Take the medication at bedtime
D. Stop the medication if you develop a cough
Rationale: Lisinopril, an ACE inhibitor, can cause orthostatic hypotension. Patients should be
instructed to change positions slowly to prevent falls. A persistent cough is a common side
effect but should be reported, not an indication to stop abruptly.
7. The nurse is assessing a patient with peripheral arterial disease. Which finding is
expected?
A. Dependent rubor
B. Warm extremities
C. Bounding pulses
D. Edema
Rationale: Peripheral arterial disease causes decreased arterial blood flow, resulting in
dependent rubor (redness when legs are dependent), pallor when elevated, cool skin,
diminished pulses, and intermittent claudication.
8. A patient post-cardiac catheterization via femoral approach develops a hematoma.
What is the priority nursing action?
A. Apply a warm compress
B. Apply manual pressure and notify the provider
C. Elevate the affected leg
D. Administer pain medication
Page 3 of 33
, BSN 266 HESI Med-Surg Exam 5
Rationale: A hematoma at the catheterization site indicates bleeding and requires immediate
manual pressure to stop bleeding, followed by provider notification. The patient may need
additional interventions to prevent hemorrhage.
9. Which ECG finding is characteristic of a myocardial infarction?
A. ST segment depression
B. ST segment elevation in leads facing the injured area
C. Tall, peaked T waves
D. Shortened PR interval
Rationale: ST segment elevation in contiguous leads indicates acute myocardial injury from a
myocardial infarction. This finding helps identify the location of the infarction and guides
emergent treatment decisions.
10. A patient with deep vein thrombosis is started on heparin infusion. Which
laboratory value should the nurse monitor?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count only
Rationale: Heparin therapy is monitored using the aPTT, with the therapeutic range typically
1.5-2.5 times the control value. PT/INR is used to monitor warfarin therapy, not heparin.
11. The nurse is teaching a patient about nitroglycerin sublingual tablets. Which
statement indicates understanding?
A. I should swallow the tablet with water
B. I can take up to three tablets 5 minutes apart for chest pain
C. I should store the tablets in the refrigerator
D. I should take the tablet before meals only
Rationale: Patients should place nitroglycerin under the tongue and can take up to three
tablets at 5-minute intervals for chest pain. If pain persists after three tablets, emergency
services should be called. Tablets should be stored in a cool, dry place, not refrigerated.
12. A patient with heart failure reports increasing shortness of breath and has gained 3
pounds in 2 days. What does this indicate?
A. Medication effectiveness
B. Fluid retention and worsening heart failure
C. Improved nutritional status
D. Normal daily variation
Rationale: Weight gain of 2-3 pounds in 1-2 days indicates fluid retention, a sign of worsening
heart failure. Patients should monitor daily weights and report gains of more than 2 pounds in
one day or 5 pounds in one week.
13. Which patient is at highest risk for developing a venous thromboembolism?
A. A 25-year-old ambulatory patient
B. A 65-year-old patient on bed rest after surgery
C. A 40-year-old patient on a regular diet
D. A 30-year-old patient with a cough
Page 4 of 33
