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