BSN HESI 266 MED SURG ACTUAL EXAM 2026/2027 |
Questions & Verified Answers 100% Correct | Already Graded
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Section 1: Cardiovascular Disorders
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient should
the nurse assess first?
A. Patient with stable angina requesting nitroglycerin for chest pain rated 3/10
B. Patient with heart failure who gained 0.5 kg overnight and has mild ankle edema
C. Patient with acute MI who suddenly developed ventricular tachycardia with pulse 160
[CORRECT]
D. Patient with hypertension whose BP is 148/92 and reports mild headache
Correct Answer: C
Rationale: On the HESI, remember that life-threatening dysrhythmias take absolute
priority. Ventricular tachycardia in a post-MI patient can rapidly degenerate into
ventricular fibrillation and cardiac arrest. The priority action is immediate assessment
and preparation for ACLS interventions. While the other patients need attention, none
are in immediate life-threatening situations like a pulseless or unstable rhythm.
Q2: A patient with chronic heart failure is receiving furosemide 40 mg IV daily. Which
finding indicates the medication is effective?
A. Weight gain of 2 kg over 3 days
B. Decreased JVD and clear lung sounds [CORRECT]
C. Increased peripheral edema in lower extremities
,D. Elevated BUN and creatinine levels
Correct Answer: B
Rationale: That's correct because in Med-Surg nursing, we evaluate diuretic
effectiveness by assessing fluid overload reduction—decreased jugular venous
distension and clearing lung sounds indicate reduced pulmonary congestion. Weight
gain, increased edema, or rising creatinine would suggest worsening fluid retention or
renal impairment, not therapeutic response.
Q3: A patient with right-sided heart failure presents with which classic symptom
cluster?
A. Pulmonary crackles, orthopnea, and frothy sputum
B. Jugular venous distension, hepatomegaly, and peripheral edema [CORRECT]
C. Substernal chest pain radiating to left arm
D. Hypertension and bounding peripheral pulses
Correct Answer: B
Rationale: The key is understanding backward failure—right heart failure backs up into
the systemic venous system, producing JVD, liver congestion, and dependent edema.
Left-sided failure (A) produces pulmonary congestion. Chest pain (C) suggests coronary
disease, and hypertension with bounding pulses (D) doesn't match right HF, which
typically shows normal or low BP.
Q4: A patient with hypertension reports dizziness after taking their first dose of
prazosin. The nurse explains this occurs because:
A. The medication causes rebound hypertension
B. Alpha-1 blockade causes vasodilation and first-dose hypotension [CORRECT]
C. The drug increases cardiac contractility excessively
,D. ACE inhibition reduces aldosterone secretion
Correct Answer: B
Rationale: Prazosin is an alpha-1 adrenergic antagonist that blocks vasoconstriction,
causing significant vasodilation and first-dose hypotension—often with syncope. That's
why we teach patients to take the first dose at bedtime and rise slowly. Rebound
hypertension (A) occurs with clonidine withdrawal, not prazosin initiation.
Q5: A patient with acute MI receives tissue plasminogen activator (tPA). Which finding
requires immediate intervention?
A. Resolution of chest pain after 45 minutes
B. Bleeding from the IV site with hematoma formation [CORRECT]
C. Sinus rhythm at 88 beats per minute
D. Mild nausea that responds to antiemetics
Correct Answer: B
Rationale: The priority concern with thrombolytics is bleeding—tPA converts
plasminogen to plasmin, which lyses clots systemically, not just in the coronary artery.
IV site bleeding with hematoma suggests significant coagulopathy and requires
immediate pressure, possible reversal agents, and close monitoring for intracranial or
other serious bleeding.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates therapeutic anticoagulation?
A. PT 12 seconds, INR 1.0
B. PT 18 seconds, INR 2.5 [CORRECT]
C. aPTT 45 seconds
D. Platelet count 150,000/mm³
, Correct Answer: B
Rationale: For atrial fibrillation, the target INR is typically 2.0-3.0, with warfarin
monitored by PT/INR. An INR of 2.5 with prolonged PT indicates therapeutic
anticoagulation. Normal INR (A) is subtherapeutic, aPTT (C) monitors heparin not
warfarin, and platelet count (D) assesses thrombocytopenia, not anticoagulation effect.
Q7: A patient with peripheral arterial disease complains of leg pain when walking that
resolves with rest. The nurse explains this intermittent claudication results from:
A. Venous insufficiency causing blood pooling
B. Inadequate oxygen supply to muscles during exertion [CORRECT]
C. Nerve compression from lumbar spinal stenosis
D. Deep vein thrombosis causing venous congestion
Correct Answer: B
Rationale: Intermittent claudication is classic PAD—atherosclerotic narrowing limits
blood flow, and when muscles demand more oxygen during walking, supply is
insufficient, causing ischemic pain that resolves when demand decreases with rest. It's
not venous (A, D) or neurogenic claudication (C), which has different characteristics.
Q8: A patient with a DVT is started on enoxaparin and warfarin. The nurse understands
that enoxaparin is continued until:
A. The patient is discharged home
B. The INR reaches therapeutic range for 2 consecutive days [CORRECT]
C. Warfarin has been given for 24 hours
D. The D-dimer level normalizes
Correct Answer: B
Questions & Verified Answers 100% Correct | Already Graded
A | Nightingale | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient should
the nurse assess first?
A. Patient with stable angina requesting nitroglycerin for chest pain rated 3/10
B. Patient with heart failure who gained 0.5 kg overnight and has mild ankle edema
C. Patient with acute MI who suddenly developed ventricular tachycardia with pulse 160
[CORRECT]
D. Patient with hypertension whose BP is 148/92 and reports mild headache
Correct Answer: C
Rationale: On the HESI, remember that life-threatening dysrhythmias take absolute
priority. Ventricular tachycardia in a post-MI patient can rapidly degenerate into
ventricular fibrillation and cardiac arrest. The priority action is immediate assessment
and preparation for ACLS interventions. While the other patients need attention, none
are in immediate life-threatening situations like a pulseless or unstable rhythm.
Q2: A patient with chronic heart failure is receiving furosemide 40 mg IV daily. Which
finding indicates the medication is effective?
A. Weight gain of 2 kg over 3 days
B. Decreased JVD and clear lung sounds [CORRECT]
C. Increased peripheral edema in lower extremities
,D. Elevated BUN and creatinine levels
Correct Answer: B
Rationale: That's correct because in Med-Surg nursing, we evaluate diuretic
effectiveness by assessing fluid overload reduction—decreased jugular venous
distension and clearing lung sounds indicate reduced pulmonary congestion. Weight
gain, increased edema, or rising creatinine would suggest worsening fluid retention or
renal impairment, not therapeutic response.
Q3: A patient with right-sided heart failure presents with which classic symptom
cluster?
A. Pulmonary crackles, orthopnea, and frothy sputum
B. Jugular venous distension, hepatomegaly, and peripheral edema [CORRECT]
C. Substernal chest pain radiating to left arm
D. Hypertension and bounding peripheral pulses
Correct Answer: B
Rationale: The key is understanding backward failure—right heart failure backs up into
the systemic venous system, producing JVD, liver congestion, and dependent edema.
Left-sided failure (A) produces pulmonary congestion. Chest pain (C) suggests coronary
disease, and hypertension with bounding pulses (D) doesn't match right HF, which
typically shows normal or low BP.
Q4: A patient with hypertension reports dizziness after taking their first dose of
prazosin. The nurse explains this occurs because:
A. The medication causes rebound hypertension
B. Alpha-1 blockade causes vasodilation and first-dose hypotension [CORRECT]
C. The drug increases cardiac contractility excessively
,D. ACE inhibition reduces aldosterone secretion
Correct Answer: B
Rationale: Prazosin is an alpha-1 adrenergic antagonist that blocks vasoconstriction,
causing significant vasodilation and first-dose hypotension—often with syncope. That's
why we teach patients to take the first dose at bedtime and rise slowly. Rebound
hypertension (A) occurs with clonidine withdrawal, not prazosin initiation.
Q5: A patient with acute MI receives tissue plasminogen activator (tPA). Which finding
requires immediate intervention?
A. Resolution of chest pain after 45 minutes
B. Bleeding from the IV site with hematoma formation [CORRECT]
C. Sinus rhythm at 88 beats per minute
D. Mild nausea that responds to antiemetics
Correct Answer: B
Rationale: The priority concern with thrombolytics is bleeding—tPA converts
plasminogen to plasmin, which lyses clots systemically, not just in the coronary artery.
IV site bleeding with hematoma suggests significant coagulopathy and requires
immediate pressure, possible reversal agents, and close monitoring for intracranial or
other serious bleeding.
Q6: A patient with atrial fibrillation is prescribed warfarin. Which laboratory value
indicates therapeutic anticoagulation?
A. PT 12 seconds, INR 1.0
B. PT 18 seconds, INR 2.5 [CORRECT]
C. aPTT 45 seconds
D. Platelet count 150,000/mm³
, Correct Answer: B
Rationale: For atrial fibrillation, the target INR is typically 2.0-3.0, with warfarin
monitored by PT/INR. An INR of 2.5 with prolonged PT indicates therapeutic
anticoagulation. Normal INR (A) is subtherapeutic, aPTT (C) monitors heparin not
warfarin, and platelet count (D) assesses thrombocytopenia, not anticoagulation effect.
Q7: A patient with peripheral arterial disease complains of leg pain when walking that
resolves with rest. The nurse explains this intermittent claudication results from:
A. Venous insufficiency causing blood pooling
B. Inadequate oxygen supply to muscles during exertion [CORRECT]
C. Nerve compression from lumbar spinal stenosis
D. Deep vein thrombosis causing venous congestion
Correct Answer: B
Rationale: Intermittent claudication is classic PAD—atherosclerotic narrowing limits
blood flow, and when muscles demand more oxygen during walking, supply is
insufficient, causing ischemic pain that resolves when demand decreases with rest. It's
not venous (A, D) or neurogenic claudication (C), which has different characteristics.
Q8: A patient with a DVT is started on enoxaparin and warfarin. The nurse understands
that enoxaparin is continued until:
A. The patient is discharged home
B. The INR reaches therapeutic range for 2 consecutive days [CORRECT]
C. Warfarin has been given for 24 hours
D. The D-dimer level normalizes
Correct Answer: B
