BSN HESI 266 Med Surg Exam (Latest 2026
/ 2027) Questions & Correct Answers With
Rationales, 100% Guaranteed Pass ||
Complete A+ Guide - Nightingale
Section 1: Cardiovascular System (Questions 1-40)
A patient with chest pain has an ECG showing ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Leads II, III, and aVF represent the inferior wall of
the heart, which is supplied by the right coronary artery
(RCA). Anterior wall MI (V1-V4) is supplied by the left anterior
descending artery (LAD).
A patient with heart failure and reduced ejection fraction (HFrEF)
is prescribed carvedilol. What is the primary benefit of beta-
blockers in heart failure?
A. Increased heart rate
,B. Decreased myocardial oxygen demand and reduced cardiac
remodeling
C. Bronchodilation
D. Increased contractility
Answer: B. Decreased myocardial oxygen demand and
reduced cardiac remodeling
Rationale: Beta-blockers decrease heart rate, contractility,
and blood pressure, reducing myocardial oxygen demand and
preventing adverse cardiac remodeling. They have
demonstrated mortality benefit in HFrEF.
A patient taking warfarin has an INR of 4.5 with no signs of
bleeding. What is the appropriate management?
A. Administer vitamin K
B. Hold the next dose and monitor INR
C. Increase the warfarin dose
D. Administer fresh frozen plasma
Answer: B. Hold the next dose and monitor INR
Rationale: For INR 4.5 without bleeding, the warfarin dose
should be held and INR monitored. Vitamin K is indicated for
INR >10 or with signs of bleeding. Fresh frozen plasma is
reserved for life-threatening bleeding.
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4.
What is the recommended anticoagulation?
A. Aspirin 81 mg daily
,B. Aspirin 325 mg daily
C. Direct oral anticoagulant (apixaban, rivaroxaban, edoxaban, or
dabigatran)
D. No anticoagulation
Answer: C. Direct oral anticoagulant (apixaban, rivaroxaban,
edoxaban, or dabigatran)
Rationale: DOACs are preferred over warfarin for stroke
prevention in non-valvular AF with CHA₂DS₂-VASc ≥2 in men
or ≥3 in women.
A patient with acute pericarditis would most likely have which
ECG finding?
A. ST-segment depression in all leads
B. Diffuse ST-segment elevation (concave upward) in most leads
C. Pathologic Q waves
D. Tall peaked T waves
Answer: B. Diffuse ST-segment elevation (concave upward) in
most leads
Rationale: Acute pericarditis causes subepicardial
inflammation, resulting in diffuse ST elevation with
reciprocal changes in aVR and V1. PR-segment depression
may also be seen.
Beck's triad (hypotension, JVD, muffled heart sounds) is classic for:
A. Tension pneumothorax
, B. Cardiac tamponade
C. Pulmonary embolism
D. Myocardial infarction
Answer: B. Cardiac tamponade
Rationale: Beck's triad is the classic presentation of cardiac
tamponade, requiring immediate pericardiocentesis. Pulsus
paradoxus is also characteristic.
A patient with aortic stenosis would most likely have which
murmur?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the right second
intercostal space
C. Early diastolic decrescendo murmur at the left sternal border
D. Mid-diastolic rumble at the apex
Answer: B. Crescendo-decrescendo systolic murmur at the
right second intercostal space
Rationale: Aortic stenosis produces a harsh systolic ejection
murmur best heard at the aortic area (right second
intercostal space) with radiation to the carotids.
A patient with peripheral arterial disease (PAD) reports calf pain
with walking that resolves with rest. This is called:
A. Rest pain
B. Intermittent claudication
/ 2027) Questions & Correct Answers With
Rationales, 100% Guaranteed Pass ||
Complete A+ Guide - Nightingale
Section 1: Cardiovascular System (Questions 1-40)
A patient with chest pain has an ECG showing ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale: Leads II, III, and aVF represent the inferior wall of
the heart, which is supplied by the right coronary artery
(RCA). Anterior wall MI (V1-V4) is supplied by the left anterior
descending artery (LAD).
A patient with heart failure and reduced ejection fraction (HFrEF)
is prescribed carvedilol. What is the primary benefit of beta-
blockers in heart failure?
A. Increased heart rate
,B. Decreased myocardial oxygen demand and reduced cardiac
remodeling
C. Bronchodilation
D. Increased contractility
Answer: B. Decreased myocardial oxygen demand and
reduced cardiac remodeling
Rationale: Beta-blockers decrease heart rate, contractility,
and blood pressure, reducing myocardial oxygen demand and
preventing adverse cardiac remodeling. They have
demonstrated mortality benefit in HFrEF.
A patient taking warfarin has an INR of 4.5 with no signs of
bleeding. What is the appropriate management?
A. Administer vitamin K
B. Hold the next dose and monitor INR
C. Increase the warfarin dose
D. Administer fresh frozen plasma
Answer: B. Hold the next dose and monitor INR
Rationale: For INR 4.5 without bleeding, the warfarin dose
should be held and INR monitored. Vitamin K is indicated for
INR >10 or with signs of bleeding. Fresh frozen plasma is
reserved for life-threatening bleeding.
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4.
What is the recommended anticoagulation?
A. Aspirin 81 mg daily
,B. Aspirin 325 mg daily
C. Direct oral anticoagulant (apixaban, rivaroxaban, edoxaban, or
dabigatran)
D. No anticoagulation
Answer: C. Direct oral anticoagulant (apixaban, rivaroxaban,
edoxaban, or dabigatran)
Rationale: DOACs are preferred over warfarin for stroke
prevention in non-valvular AF with CHA₂DS₂-VASc ≥2 in men
or ≥3 in women.
A patient with acute pericarditis would most likely have which
ECG finding?
A. ST-segment depression in all leads
B. Diffuse ST-segment elevation (concave upward) in most leads
C. Pathologic Q waves
D. Tall peaked T waves
Answer: B. Diffuse ST-segment elevation (concave upward) in
most leads
Rationale: Acute pericarditis causes subepicardial
inflammation, resulting in diffuse ST elevation with
reciprocal changes in aVR and V1. PR-segment depression
may also be seen.
Beck's triad (hypotension, JVD, muffled heart sounds) is classic for:
A. Tension pneumothorax
, B. Cardiac tamponade
C. Pulmonary embolism
D. Myocardial infarction
Answer: B. Cardiac tamponade
Rationale: Beck's triad is the classic presentation of cardiac
tamponade, requiring immediate pericardiocentesis. Pulsus
paradoxus is also characteristic.
A patient with aortic stenosis would most likely have which
murmur?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the right second
intercostal space
C. Early diastolic decrescendo murmur at the left sternal border
D. Mid-diastolic rumble at the apex
Answer: B. Crescendo-decrescendo systolic murmur at the
right second intercostal space
Rationale: Aortic stenosis produces a harsh systolic ejection
murmur best heard at the aortic area (right second
intercostal space) with radiation to the carotids.
A patient with peripheral arterial disease (PAD) reports calf pain
with walking that resolves with rest. This is called:
A. Rest pain
B. Intermittent claudication
