BSN 266 HESI Med Surg Proctored Exam
ACTUAL EXAM 2026/2027 | Medical
Surgical Nursing | Verified Q&A | Pass
Guaranteed - A+ Graded
Category 1: Cardiovascular Disorders (15 questions)
Q1: A patient with acute decompensated heart failure has crackles in all lung fields, S3 gallop, JVD, and
SpO2 88% on room air. What is the FIRST intervention?
A. Administer IV furosemide
B. Place patient in high Fowler's position [CORRECT]
C. Apply non-rebreather mask at 15 L/min
D. Start dopamine infusion
Rationale: High Fowler's position reduces preload and improves ventilation immediately. Oxygen (C)
important but positioning first maximizes ventilation. Furosemide (A) not before positioning. Dopamine
(D) for cardiogenic shock with hypotension—no hypotension mentioned.
Q2: A patient with MI presents with chest pain 8/10, BP 100/60, HR 92. What is the priority medication
administration order?
A. Morphine, oxygen, nitroglycerin, aspirin (MONA)
B. Aspirin 325 mg chewable first (unless allergic), then nitroglycerin sublingual (if SBP >90),
morphine if pain persists, oxygen if SpO2 <90% [CORRECT]
C. Nitroglycerin first regardless of BP
D. Oxygen at 10 L/min nasal cannula for all MI patients
Rationale: AHA guidelines: aspirin first (unless contraindicated), then nitroglycerin if hemodynamically
stable (SBP >90), morphine for refractory pain, oxygen only if hypoxemic. Not all need oxygen (D).
Nitroglycerin (C) can cause hypotension if SBP <90.
Q3: A patient with atrial fibrillation has CHA₂DS₂-VASc score 4. What is indicated?
, A. No anticoagulation needed
B. Anticoagulation indicated (warfarin with INR 2-3, or DOAC: apixaban, rivaroxaban, dabigatran)
– score ≥2 in men or ≥3 in women indicates anticoagulation [CORRECT]
C. Aspirin 81 mg only
D. Cardioversion immediately
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) = anticoagulation indicated for stroke prevention.
Score 4 is high risk. Aspirin insufficient (C). Cardioversion (D) if indicated for rhythm control, not based
on score alone.
Q4: A patient post-MI is started on metoprolol. What is the therapeutic effect?
A. Increases heart rate
B. Beta-blocker: reduces myocardial oxygen demand, prevents remodeling, reduces mortality
post-MI, target HR 50-60 bpm [CORRECT]
C. Causes vasodilation primarily
D. Increases contractility
Rationale: Beta-blockers post-MI: reduce oxygen demand, prevent adverse remodeling, mortality
benefit. Reduce HR (A incorrect). Some vasodilation but primarily beta-1 blockade (C). Negative
inotrope, not increased contractility (D).
Q5: A patient with heart failure has BNP 1200 pg/mL. What does this indicate?
A. Normal cardiac function
B. Elevated BNP indicates ventricular wall stress and heart failure severity; >400 strongly
suggests heart failure, guides treatment and prognosis [CORRECT]
C. Myocardial infarction
D. Pulmonary embolism
Rationale: BNP released from ventricles with stretch/wall stress. Elevated in HF. Normal <100, gray zone
100-400, >400 suggests HF. Not specific for MI (C) or PE (D).
Q6: A patient with left-sided heart failure exhibits which symptoms?
A. JVD, peripheral edema, ascites, weight gain (right-sided failure)
B. Pulmonary congestion, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, frothy
sputum (left-sided failure – backup into lungs) [CORRECT]
, C. Hepatomegaly alone
D. Bounding pulses
Rationale: Left-sided failure: pulmonary symptoms (backup into pulmonary circulation). Right-sided (A):
systemic congestion (JVD, edema, ascites). Not just hepatomegaly (C). Not bounding pulses (D—weak
pulses more likely).
Q7: A patient with hypertension (160/95) is prescribed lisinopril. What education is essential?
A. Take medication only when BP is high
B. Take daily even if asymptomatic, monitor for cough (ACE inhibitor side effect), hyperkalemia,
angioedema; avoid NSAIDs and salt substitutes with potassium [CORRECT]
C. Stop if feeling dizzy immediately
D. Double dose if BP remains high
Rationale: ACE inhibitors require daily adherence, monitoring for characteristic side effects (cough,
hyperkalemia, rare angioedema). PRN use (A) ineffective. Don't stop without consulting (C). Don't
double dose (D).
Q8: A patient with PAD (peripheral arterial disease) has pain in calves when walking 100 yards that
resolves with rest. What is this called?
A. Rest pain
B. Intermittent claudication – reproducible ischemic muscle pain with exercise, relieved by rest,
hallmark of PAD [CORRECT]
C. Critical limb ischemia
D. Deep vein thrombosis
Rationale: Intermittent claudication: exertional pain relieved by rest. Rest pain (A) occurs at rest (severe
ischemia). Critical limb ischemia (C): rest pain + tissue loss. Not DVT (D—different etiology).
Q9: A patient with CVI (chronic venous insufficiency) should be educated about:
A. Elevating legs above heart level, compression stockings, skin care, walking to promote calf
muscle pump; avoid prolonged standing/sitting [CORRECT]
B. Keeping legs dependent at all times
C. Applying heat to legs
D. Complete bed rest
, Rationale: CVI management: leg elevation, compression, activity, skin care. Dependent position (B)
worsens edema. Heat (C) increases blood flow and edema. Bed rest (D) worsens venous stasis.
Q10: A patient has ventricular tachycardia with pulse, BP 90/60. What is the treatment?
A. Immediate defibrillation
B. Synchronized cardioversion if unstable (altered mental status, hypotension, chest pain, heart
failure) or antiarrhythmic (amiodarone 150 mg IV over 10 minutes) if stable [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Observation only
Rationale: VT with pulse: cardioversion if unstable, antiarrhythmic if stable. Defibrillation (A) for
pulseless VT. Adenosine (C) for SVT, not VT. Observation (D) dangerous.
Q11: A patient has ST-elevation MI (STEMI) and door-to-balloon time is 120 minutes. What is the goal?
A. Within 90 minutes per AHA guidelines for primary PCI; if >90 minutes or not available,
consider thrombolytics if within 12 hours of onset [CORRECT]
B. Within 3 hours acceptable
C. No time limit
D. 24 hours acceptable
Rationale: Door-to-balloon goal ≤90 minutes for PCI. Door-to-needle (thrombolytics) ≤30 minutes if PCI
unavailable. Time is myocardium—longer delays (B, C, D) increase mortality.
Q12: A patient is on warfarin with INR 4.5 (therapeutic 2-3). What is the action?
A. Continue current dose
B. Hold next dose(s), monitor INR, vitamin K if bleeding or INR >10, assess for bleeding signs; INR
4.5 supratherapeutic [CORRECT]
C. Increase dose to achieve higher INR
D. No action needed
Rationale: INR 4.5 supratherapeutic (goal 2-3 for most indications). Hold doses, monitor, vitamin K if
bleeding or very high. Continue (A) or increase (C) dangerous. Action needed (D incorrect).
Q13: A patient with cardiogenic shock has BP 70/40, cool clammy skin, altered mental status, urine
output 15 mL/hr. What is the priority?
A. Diuretics to reduce preload
ACTUAL EXAM 2026/2027 | Medical
Surgical Nursing | Verified Q&A | Pass
Guaranteed - A+ Graded
Category 1: Cardiovascular Disorders (15 questions)
Q1: A patient with acute decompensated heart failure has crackles in all lung fields, S3 gallop, JVD, and
SpO2 88% on room air. What is the FIRST intervention?
A. Administer IV furosemide
B. Place patient in high Fowler's position [CORRECT]
C. Apply non-rebreather mask at 15 L/min
D. Start dopamine infusion
Rationale: High Fowler's position reduces preload and improves ventilation immediately. Oxygen (C)
important but positioning first maximizes ventilation. Furosemide (A) not before positioning. Dopamine
(D) for cardiogenic shock with hypotension—no hypotension mentioned.
Q2: A patient with MI presents with chest pain 8/10, BP 100/60, HR 92. What is the priority medication
administration order?
A. Morphine, oxygen, nitroglycerin, aspirin (MONA)
B. Aspirin 325 mg chewable first (unless allergic), then nitroglycerin sublingual (if SBP >90),
morphine if pain persists, oxygen if SpO2 <90% [CORRECT]
C. Nitroglycerin first regardless of BP
D. Oxygen at 10 L/min nasal cannula for all MI patients
Rationale: AHA guidelines: aspirin first (unless contraindicated), then nitroglycerin if hemodynamically
stable (SBP >90), morphine for refractory pain, oxygen only if hypoxemic. Not all need oxygen (D).
Nitroglycerin (C) can cause hypotension if SBP <90.
Q3: A patient with atrial fibrillation has CHA₂DS₂-VASc score 4. What is indicated?
, A. No anticoagulation needed
B. Anticoagulation indicated (warfarin with INR 2-3, or DOAC: apixaban, rivaroxaban, dabigatran)
– score ≥2 in men or ≥3 in women indicates anticoagulation [CORRECT]
C. Aspirin 81 mg only
D. Cardioversion immediately
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) = anticoagulation indicated for stroke prevention.
Score 4 is high risk. Aspirin insufficient (C). Cardioversion (D) if indicated for rhythm control, not based
on score alone.
Q4: A patient post-MI is started on metoprolol. What is the therapeutic effect?
A. Increases heart rate
B. Beta-blocker: reduces myocardial oxygen demand, prevents remodeling, reduces mortality
post-MI, target HR 50-60 bpm [CORRECT]
C. Causes vasodilation primarily
D. Increases contractility
Rationale: Beta-blockers post-MI: reduce oxygen demand, prevent adverse remodeling, mortality
benefit. Reduce HR (A incorrect). Some vasodilation but primarily beta-1 blockade (C). Negative
inotrope, not increased contractility (D).
Q5: A patient with heart failure has BNP 1200 pg/mL. What does this indicate?
A. Normal cardiac function
B. Elevated BNP indicates ventricular wall stress and heart failure severity; >400 strongly
suggests heart failure, guides treatment and prognosis [CORRECT]
C. Myocardial infarction
D. Pulmonary embolism
Rationale: BNP released from ventricles with stretch/wall stress. Elevated in HF. Normal <100, gray zone
100-400, >400 suggests HF. Not specific for MI (C) or PE (D).
Q6: A patient with left-sided heart failure exhibits which symptoms?
A. JVD, peripheral edema, ascites, weight gain (right-sided failure)
B. Pulmonary congestion, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, frothy
sputum (left-sided failure – backup into lungs) [CORRECT]
, C. Hepatomegaly alone
D. Bounding pulses
Rationale: Left-sided failure: pulmonary symptoms (backup into pulmonary circulation). Right-sided (A):
systemic congestion (JVD, edema, ascites). Not just hepatomegaly (C). Not bounding pulses (D—weak
pulses more likely).
Q7: A patient with hypertension (160/95) is prescribed lisinopril. What education is essential?
A. Take medication only when BP is high
B. Take daily even if asymptomatic, monitor for cough (ACE inhibitor side effect), hyperkalemia,
angioedema; avoid NSAIDs and salt substitutes with potassium [CORRECT]
C. Stop if feeling dizzy immediately
D. Double dose if BP remains high
Rationale: ACE inhibitors require daily adherence, monitoring for characteristic side effects (cough,
hyperkalemia, rare angioedema). PRN use (A) ineffective. Don't stop without consulting (C). Don't
double dose (D).
Q8: A patient with PAD (peripheral arterial disease) has pain in calves when walking 100 yards that
resolves with rest. What is this called?
A. Rest pain
B. Intermittent claudication – reproducible ischemic muscle pain with exercise, relieved by rest,
hallmark of PAD [CORRECT]
C. Critical limb ischemia
D. Deep vein thrombosis
Rationale: Intermittent claudication: exertional pain relieved by rest. Rest pain (A) occurs at rest (severe
ischemia). Critical limb ischemia (C): rest pain + tissue loss. Not DVT (D—different etiology).
Q9: A patient with CVI (chronic venous insufficiency) should be educated about:
A. Elevating legs above heart level, compression stockings, skin care, walking to promote calf
muscle pump; avoid prolonged standing/sitting [CORRECT]
B. Keeping legs dependent at all times
C. Applying heat to legs
D. Complete bed rest
, Rationale: CVI management: leg elevation, compression, activity, skin care. Dependent position (B)
worsens edema. Heat (C) increases blood flow and edema. Bed rest (D) worsens venous stasis.
Q10: A patient has ventricular tachycardia with pulse, BP 90/60. What is the treatment?
A. Immediate defibrillation
B. Synchronized cardioversion if unstable (altered mental status, hypotension, chest pain, heart
failure) or antiarrhythmic (amiodarone 150 mg IV over 10 minutes) if stable [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Observation only
Rationale: VT with pulse: cardioversion if unstable, antiarrhythmic if stable. Defibrillation (A) for
pulseless VT. Adenosine (C) for SVT, not VT. Observation (D) dangerous.
Q11: A patient has ST-elevation MI (STEMI) and door-to-balloon time is 120 minutes. What is the goal?
A. Within 90 minutes per AHA guidelines for primary PCI; if >90 minutes or not available,
consider thrombolytics if within 12 hours of onset [CORRECT]
B. Within 3 hours acceptable
C. No time limit
D. 24 hours acceptable
Rationale: Door-to-balloon goal ≤90 minutes for PCI. Door-to-needle (thrombolytics) ≤30 minutes if PCI
unavailable. Time is myocardium—longer delays (B, C, D) increase mortality.
Q12: A patient is on warfarin with INR 4.5 (therapeutic 2-3). What is the action?
A. Continue current dose
B. Hold next dose(s), monitor INR, vitamin K if bleeding or INR >10, assess for bleeding signs; INR
4.5 supratherapeutic [CORRECT]
C. Increase dose to achieve higher INR
D. No action needed
Rationale: INR 4.5 supratherapeutic (goal 2-3 for most indications). Hold doses, monitor, vitamin K if
bleeding or very high. Continue (A) or increase (C) dangerous. Action needed (D incorrect).
Q13: A patient with cardiogenic shock has BP 70/40, cool clammy skin, altered mental status, urine
output 15 mL/hr. What is the priority?
A. Diuretics to reduce preload
