BSN HESI 266 Med Surg Exam (
Update) Questions & Verified Answers with
Rationales | Complete A+ Guide Nightingale
College Edition 300 Questions with Correct
Answers & Detailed Rationales
About This Exam Guide
This comprehensive practice examination is specifically designed
for Nightingale College nursing students preparing for the BSN 266 Medical-
Surgical HESI Exam. Updated for the 2026/2027 academic year, this resource
contains expertly verified practice questions and detailed rationales aligned
with the latest HESI blueprint .
The exam is organized into 8 major content domains with 300 questions,
each including the correct answer and a detailed rationale to reinforce
understanding of key medical-surgical nursing concepts.
Domain 1: Cardiovascular Disorders (Questions 1-40)
1. A 77-year-old female client is admitted to the hospital. She is confused, has
no appetite, is nauseated and vomiting, and is complaining of a headache.
Her pulse rate is 43 beats per minute. Which question is a priority for the
nurse to ask this client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Answer: D. "Does the client take digitalis?"
,Rationale: Symptoms such as confusion, nausea, vomiting, headache, and
bradycardia are classic signs of digitalis toxicity, especially in elderly clients.
Older persons are particularly susceptible to the buildup of cardiac
glycosides to toxic levels. Prompt assessment of medication history is
critical .
2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a
rapid ventricular response. Based on this finding, the nurse anticipates
assisting the physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Answer: B. Perform synchronized cardioversion
Rationale: With uncontrolled atrial fibrillation and rapid ventricular
response, the treatment of choice is synchronized cardioversion to convert
the cardiac rhythm back to normal sinus rhythm. Lidocaine is used for
ventricular arrhythmias. Defibrillation is for pulseless rhythms. Atropine is
for symptomatic bradycardia .
3. The nurse is caring for a client who is one day post-acute myocardial
infarction. The client is receiving oxygen at 2 L/min via nasal cannula and
has a peripheral saline lock. The nurse notes that the client is having eight
premature ventricular contractions (PVCs) per minute. Which action should
the nurse take first?
A. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
,Rationale: The first action should be to increase oxygen to maximize
myocardial oxygenation, which may reduce PVCs. PVCs after an MI can
indicate irritation of the myocardium. Increasing oxygen is a non-invasive
intervention that can be implemented immediately .
4. An elderly male client comes to the geriatric screening clinic complaining
of pain in his left calf. The nurse notices a reddened area on the calf of his
right leg which is warm to the touch. Which type of pain would further
confirm thrombophlebitis?
A. Pain in the calf awakening him from a sound sleep
B. Calf pain on exertion which stops when standing in one place
C. Pain in the calf upon exertion which is relieved by rest and elevating the
extremity
D. Pain upon arising in the morning which is relieved after some stretching
and exercise
Answer: C. Pain in the calf upon exertion which is relieved by rest and
elevating the extremity
Rationale: Thrombophlebitis pain is relieved by rest and elevation of the
extremity. It typically occurs with exercise at the site of the thrombus and is
aggravated by placing the extremity in a dependent position, such as
standing in one place .
5. The nurse would be correct in withholding a dose of digoxin in a client
with congestive heart failure without specific instruction from the healthcare
provider if the client's:
A. Serum digoxin level is 1.5 ng/mL
B. Blood pressure is 104/68 mmHg
C. Serum potassium level is 3.0 mEq/L
D. Apical pulse is 68 beats/min
Answer: C. Serum potassium level is 3.0 mEq/L
, *Rationale: Hypokalemia (normal potassium 3.5-5.0 mEq/L) can precipitate
digitalis toxicity in persons receiving digoxin, which will increase the chance
of dangerous dysrhythmias. A digoxin level of 1.5 is within therapeutic range
(0.8-2.0). The apical pulse of 68 is above the usual hold parameter of 60
bpm .*
6. A client with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading
to hypokalemia. Hypokalemia can precipitate cardiac arrhythmias, especially
in clients taking digoxin. The nurse should monitor potassium levels closely
and assess for signs of hypokalemia .
7. A client with deep vein thrombosis (DVT) is receiving heparin therapy.
Which laboratory value indicates the therapy is therapeutic?
A. INR 2.0-3.0
B. aPTT 1.5-2.5 times control
C. Platelet count 150,000-400,000/mm³
D. PT 12-15 seconds
Answer: B. aPTT 1.5-2.5 times control
*Rationale: Heparin therapy is monitored by aPTT (activated partial
thromboplastin time), with a therapeutic goal of 1.5-2.5 times the control
value. INR and PT monitor warfarin therapy. Platelet count monitors for
heparin-induced thrombocytopenia .*
Update) Questions & Verified Answers with
Rationales | Complete A+ Guide Nightingale
College Edition 300 Questions with Correct
Answers & Detailed Rationales
About This Exam Guide
This comprehensive practice examination is specifically designed
for Nightingale College nursing students preparing for the BSN 266 Medical-
Surgical HESI Exam. Updated for the 2026/2027 academic year, this resource
contains expertly verified practice questions and detailed rationales aligned
with the latest HESI blueprint .
The exam is organized into 8 major content domains with 300 questions,
each including the correct answer and a detailed rationale to reinforce
understanding of key medical-surgical nursing concepts.
Domain 1: Cardiovascular Disorders (Questions 1-40)
1. A 77-year-old female client is admitted to the hospital. She is confused, has
no appetite, is nauseated and vomiting, and is complaining of a headache.
Her pulse rate is 43 beats per minute. Which question is a priority for the
nurse to ask this client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Answer: D. "Does the client take digitalis?"
,Rationale: Symptoms such as confusion, nausea, vomiting, headache, and
bradycardia are classic signs of digitalis toxicity, especially in elderly clients.
Older persons are particularly susceptible to the buildup of cardiac
glycosides to toxic levels. Prompt assessment of medication history is
critical .
2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a
rapid ventricular response. Based on this finding, the nurse anticipates
assisting the physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Answer: B. Perform synchronized cardioversion
Rationale: With uncontrolled atrial fibrillation and rapid ventricular
response, the treatment of choice is synchronized cardioversion to convert
the cardiac rhythm back to normal sinus rhythm. Lidocaine is used for
ventricular arrhythmias. Defibrillation is for pulseless rhythms. Atropine is
for symptomatic bradycardia .
3. The nurse is caring for a client who is one day post-acute myocardial
infarction. The client is receiving oxygen at 2 L/min via nasal cannula and
has a peripheral saline lock. The nurse notes that the client is having eight
premature ventricular contractions (PVCs) per minute. Which action should
the nurse take first?
A. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
,Rationale: The first action should be to increase oxygen to maximize
myocardial oxygenation, which may reduce PVCs. PVCs after an MI can
indicate irritation of the myocardium. Increasing oxygen is a non-invasive
intervention that can be implemented immediately .
4. An elderly male client comes to the geriatric screening clinic complaining
of pain in his left calf. The nurse notices a reddened area on the calf of his
right leg which is warm to the touch. Which type of pain would further
confirm thrombophlebitis?
A. Pain in the calf awakening him from a sound sleep
B. Calf pain on exertion which stops when standing in one place
C. Pain in the calf upon exertion which is relieved by rest and elevating the
extremity
D. Pain upon arising in the morning which is relieved after some stretching
and exercise
Answer: C. Pain in the calf upon exertion which is relieved by rest and
elevating the extremity
Rationale: Thrombophlebitis pain is relieved by rest and elevation of the
extremity. It typically occurs with exercise at the site of the thrombus and is
aggravated by placing the extremity in a dependent position, such as
standing in one place .
5. The nurse would be correct in withholding a dose of digoxin in a client
with congestive heart failure without specific instruction from the healthcare
provider if the client's:
A. Serum digoxin level is 1.5 ng/mL
B. Blood pressure is 104/68 mmHg
C. Serum potassium level is 3.0 mEq/L
D. Apical pulse is 68 beats/min
Answer: C. Serum potassium level is 3.0 mEq/L
, *Rationale: Hypokalemia (normal potassium 3.5-5.0 mEq/L) can precipitate
digitalis toxicity in persons receiving digoxin, which will increase the chance
of dangerous dysrhythmias. A digoxin level of 1.5 is within therapeutic range
(0.8-2.0). The apical pulse of 68 is above the usual hold parameter of 60
bpm .*
6. A client with heart failure is prescribed furosemide (Lasix). Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading
to hypokalemia. Hypokalemia can precipitate cardiac arrhythmias, especially
in clients taking digoxin. The nurse should monitor potassium levels closely
and assess for signs of hypokalemia .
7. A client with deep vein thrombosis (DVT) is receiving heparin therapy.
Which laboratory value indicates the therapy is therapeutic?
A. INR 2.0-3.0
B. aPTT 1.5-2.5 times control
C. Platelet count 150,000-400,000/mm³
D. PT 12-15 seconds
Answer: B. aPTT 1.5-2.5 times control
*Rationale: Heparin therapy is monitored by aPTT (activated partial
thromboplastin time), with a therapeutic goal of 1.5-2.5 times the control
value. INR and PT monitor warfarin therapy. Platelet count monitors for
heparin-induced thrombocytopenia .*
