BSN 266 HESI EXAM
MED-SURG EXAM 4
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 4
Introduction
This BSN 266 HESI Med-Surg Exam 4 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 4 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 with angina is prescribed nitroglycerin sublingual tablets. What is the
correct administration?
A. Swallow the tablet with water
B. Place under the tongue and let dissolve
C. Chew the tablet
D. Crush and mix with food
Rationale: Sublingual nitroglycerin must be placed under the tongue to allow rapid absorption
through the oral mucosa into the bloodstream, bypassing first-pass hepatic metabolism.
Swallowing would delay and reduce effectiveness.
2. Which laboratory value is most important to monitor for a patient on digoxin?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Rationale: Hypokalemia increases the risk of digoxin toxicity because potassium competes
with digoxin for binding sites. Patients on digoxin should maintain normal potassium levels,
and concurrent diuretic use requires close monitoring.
3. A patient with heart failure is prescribed an ACE inhibitor. Which side effect should
the nurse teach about?
A. Persistent dry cough
B. Weight gain
C. Bradycardia
D. Constipation
Page 2 of 34
, BSN 266 HESI Med-Surg Exam 4
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin accumulation in
the lungs. This occurs in up to 20% of patients and may require switching to an ARB if the
cough is intolerable.
4. What is the priority assessment for a patient receiving a thrombolytic agent?
A. Monitoring for signs of bleeding
B. Checking temperature
C. Assessing respiratory rate only
D. Monitoring blood glucose
Rationale: Thrombolytics dissolve clots but significantly increase bleeding risk. Monitor for
overt and covert bleeding, including intracranial hemorrhage. Any signs of bleeding require
immediate intervention and discontinuation of the drug.
5. A patient has a new prescription for atorvastatin. Which instruction is most
important?
A. Take with grapefruit juice
B. Report unexplained muscle pain
C. Take on an empty stomach
D. Avoid all exercise
Rationale: Statins can cause myopathy and rhabdomyolysis. Patients should report
unexplained muscle pain, tenderness, or weakness. Grapefruit juice should be avoided as it
increases statin levels and risk of toxicity.
6. The nurse is caring for a patient with a new pacemaker. Which finding requires
immediate notification of the provider?
A. Heart rate of 72 bpm
B. Hiccups that won't stop
C. Mild bruising at insertion site
D. Temperature of 99.0°F
Rationale: Persistent hiccups may indicate pacemaker lead perforation of the right ventricle
with diaphragmatic stimulation. This is a serious complication requiring immediate evaluation
and possible lead repositioning.
7. A patient with peripheral vascular disease reports leg pain that worsens with
elevation and improves with dangling. What type of pain is this?
A. Intermittent claudication
B. Rest pain from arterial insufficiency
C. Venous stasis pain
D. Neuropathic pain
Rationale: Rest pain from arterial insufficiency worsens with elevation (gravity reduces blood
flow) and improves with dangling (gravity increases blood flow). This indicates severe arterial
disease requiring vascular evaluation.
8. Which intervention is most appropriate for a patient experiencing a hypertensive
crisis?
A. Rapidly lower blood pressure to normal
B. Gradually lower blood pressure with IV antihypertensives
C. Administer oral antihypertensives only
D. No treatment is needed
Page 3 of 34
, BSN 266 HESI Med-Surg Exam 4
Rationale: In hypertensive crisis, blood pressure should be lowered gradually (by 25% in the
first hour) to prevent cerebral hypoperfusion and stroke. Rapid normalization can cause
ischemic damage. IV medications allow controlled reduction.
9. A patient with an abdominal aortic aneurysm reports sudden severe back pain. What
should the nurse suspect?
A. Routine discomfort
B. Aneurysm rupture
C. Muscle strain
D. Kidney stone
Rationale: Sudden severe back or abdominal pain in a patient with AAA may indicate
aneurysm rupture, a life-threatening emergency. The nurse should immediately assess vital
signs, notify the provider, and prepare for emergency surgery.
10. What is the most accurate method to measure central venous pressure?
A. Peripheral IV site
B. Central venous catheter at the phlebostatic axis
C. Arterial line
D. Blood pressure cuff
Rationale: Central venous pressure is measured using a central venous catheter positioned at
the phlebostatic axis (fourth intercostal space, mid-axillary line). This reflects right atrial
pressure and right ventricular preload.
11. A patient post-MI is prescribed a beta-blocker. What is the therapeutic effect?
A. Increased heart rate
B. Reduced myocardial oxygen demand
C. Increased contractility
D. Vasodilation
Rationale: Beta-blockers reduce heart rate, blood pressure, and contractility, thereby
decreasing myocardial oxygen demand. They improve survival post-MI by reducing
arrhythmias and preventing cardiac remodeling.
12. Which finding suggests cardiac tamponade?
A. Hypertension
B. Muffled heart sounds, hypotension, and JVD (Beck's triad)
C. Tachycardia only
D. Peripheral edema
Rationale: Cardiac tamponade causes Beck's triad: muffled heart sounds, hypotension, and
jugular venous distension due to fluid accumulation in the pericardial sac compressing the
heart. Pulsus paradoxus is also present.
13. A patient with Buerger's disease should be taught to:
A. Continue smoking in moderation
B. Stop smoking completely
C. Avoid all physical activity
D. Keep extremities warm with heating pads
Page 4 of 34
MED-SURG EXAM 4
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 4
Introduction
This BSN 266 HESI Med-Surg Exam 4 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 4 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 with angina is prescribed nitroglycerin sublingual tablets. What is the
correct administration?
A. Swallow the tablet with water
B. Place under the tongue and let dissolve
C. Chew the tablet
D. Crush and mix with food
Rationale: Sublingual nitroglycerin must be placed under the tongue to allow rapid absorption
through the oral mucosa into the bloodstream, bypassing first-pass hepatic metabolism.
Swallowing would delay and reduce effectiveness.
2. Which laboratory value is most important to monitor for a patient on digoxin?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
Rationale: Hypokalemia increases the risk of digoxin toxicity because potassium competes
with digoxin for binding sites. Patients on digoxin should maintain normal potassium levels,
and concurrent diuretic use requires close monitoring.
3. A patient with heart failure is prescribed an ACE inhibitor. Which side effect should
the nurse teach about?
A. Persistent dry cough
B. Weight gain
C. Bradycardia
D. Constipation
Page 2 of 34
, BSN 266 HESI Med-Surg Exam 4
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin accumulation in
the lungs. This occurs in up to 20% of patients and may require switching to an ARB if the
cough is intolerable.
4. What is the priority assessment for a patient receiving a thrombolytic agent?
A. Monitoring for signs of bleeding
B. Checking temperature
C. Assessing respiratory rate only
D. Monitoring blood glucose
Rationale: Thrombolytics dissolve clots but significantly increase bleeding risk. Monitor for
overt and covert bleeding, including intracranial hemorrhage. Any signs of bleeding require
immediate intervention and discontinuation of the drug.
5. A patient has a new prescription for atorvastatin. Which instruction is most
important?
A. Take with grapefruit juice
B. Report unexplained muscle pain
C. Take on an empty stomach
D. Avoid all exercise
Rationale: Statins can cause myopathy and rhabdomyolysis. Patients should report
unexplained muscle pain, tenderness, or weakness. Grapefruit juice should be avoided as it
increases statin levels and risk of toxicity.
6. The nurse is caring for a patient with a new pacemaker. Which finding requires
immediate notification of the provider?
A. Heart rate of 72 bpm
B. Hiccups that won't stop
C. Mild bruising at insertion site
D. Temperature of 99.0°F
Rationale: Persistent hiccups may indicate pacemaker lead perforation of the right ventricle
with diaphragmatic stimulation. This is a serious complication requiring immediate evaluation
and possible lead repositioning.
7. A patient with peripheral vascular disease reports leg pain that worsens with
elevation and improves with dangling. What type of pain is this?
A. Intermittent claudication
B. Rest pain from arterial insufficiency
C. Venous stasis pain
D. Neuropathic pain
Rationale: Rest pain from arterial insufficiency worsens with elevation (gravity reduces blood
flow) and improves with dangling (gravity increases blood flow). This indicates severe arterial
disease requiring vascular evaluation.
8. Which intervention is most appropriate for a patient experiencing a hypertensive
crisis?
A. Rapidly lower blood pressure to normal
B. Gradually lower blood pressure with IV antihypertensives
C. Administer oral antihypertensives only
D. No treatment is needed
Page 3 of 34
, BSN 266 HESI Med-Surg Exam 4
Rationale: In hypertensive crisis, blood pressure should be lowered gradually (by 25% in the
first hour) to prevent cerebral hypoperfusion and stroke. Rapid normalization can cause
ischemic damage. IV medications allow controlled reduction.
9. A patient with an abdominal aortic aneurysm reports sudden severe back pain. What
should the nurse suspect?
A. Routine discomfort
B. Aneurysm rupture
C. Muscle strain
D. Kidney stone
Rationale: Sudden severe back or abdominal pain in a patient with AAA may indicate
aneurysm rupture, a life-threatening emergency. The nurse should immediately assess vital
signs, notify the provider, and prepare for emergency surgery.
10. What is the most accurate method to measure central venous pressure?
A. Peripheral IV site
B. Central venous catheter at the phlebostatic axis
C. Arterial line
D. Blood pressure cuff
Rationale: Central venous pressure is measured using a central venous catheter positioned at
the phlebostatic axis (fourth intercostal space, mid-axillary line). This reflects right atrial
pressure and right ventricular preload.
11. A patient post-MI is prescribed a beta-blocker. What is the therapeutic effect?
A. Increased heart rate
B. Reduced myocardial oxygen demand
C. Increased contractility
D. Vasodilation
Rationale: Beta-blockers reduce heart rate, blood pressure, and contractility, thereby
decreasing myocardial oxygen demand. They improve survival post-MI by reducing
arrhythmias and preventing cardiac remodeling.
12. Which finding suggests cardiac tamponade?
A. Hypertension
B. Muffled heart sounds, hypotension, and JVD (Beck's triad)
C. Tachycardia only
D. Peripheral edema
Rationale: Cardiac tamponade causes Beck's triad: muffled heart sounds, hypotension, and
jugular venous distension due to fluid accumulation in the pericardial sac compressing the
heart. Pulsus paradoxus is also present.
13. A patient with Buerger's disease should be taught to:
A. Continue smoking in moderation
B. Stop smoking completely
C. Avoid all physical activity
D. Keep extremities warm with heating pads
Page 4 of 34
