BSN 266 HESI MED SURG ACTUAL EXAM 2026/2027 |
Questions & Verified Answers 100% Correct | Grade A |
Nightingale | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
The heart and vascular system are central to medical-surgical nursing. This section covers
everything from pump failure to clot formation—conditions you'll see daily on the floor.
Q1: A nurse is caring for a patient admitted with acute decompensated heart failure.
The patient has crackles bilaterally, JVD at 6 cm, and 3+ pitting edema in the lower
extremities. Which medication should the nurse expect to administer first?
A. Oral metoprolol 25 mg daily
B. IV furosemide 40 mg push [CORRECT]
C. Oral lisinopril 5 mg daily
D. Subcutaneous heparin 5000 units
Correct Answer: B
Rationale: On the HESI, remember that acute decompensated heart failure with volume
overload is a "wet and warm" situation—you need to get that fluid off immediately. IV
loop diuretics like furosemide act quickly to reduce preload and relieve pulmonary
congestion. Beta-blockers (A) and ACE inhibitors (C) are important for chronic
,management but not first-line in acute decompensation. Heparin (D) is for DVT
prophylaxis, not the immediate priority.
Q2: A patient with a history of hypertension presents with blood pressure 198/112
mmHg, headache, and blurred vision. The nurse notes papilledema on assessment.
Which condition is this patient most likely experiencing?
A. Primary hypertension with target organ damage
B. Hypertensive emergency [CORRECT]
C. Hypertensive urgency without target organ damage
D. Secondary hypertension from renal disease
Correct Answer: B
Rationale: That's correct because in Med-Surg nursing, we distinguish urgency from
emergency based on target organ damage. This patient has papilledema (optic nerve
involvement) and neuro symptoms—this is hypertensive emergency requiring
immediate IV therapy and ICU monitoring. Urgency (C) would be high BP without these
acute changes.
Q3: A nurse is reviewing morning labs for a patient who had an MI 3 days ago. Which
troponin trend indicates the patient is healing appropriately?
A. Troponin I rising from 0.8 to 12.5 ng/mL over 24 hours
B. Troponin I peaked at 18 ng/mL and now decreasing to 8 ng/mL [CORRECT]
C. Troponin I remaining steady at 15 ng/mL for 72 hours
,D. Troponin I not detectable 48 hours post-MI
Correct Answer: B
Rationale: The priority action is understanding that troponins peak around 12–24 hours
after MI onset and then gradually decline over 7–10 days. A decreasing trend (B) shows
the infarction has completed and healing is underway. Rising levels (A) suggest ongoing
necrosis or reinfarction, steady levels (C) are unusual and concerning, and undetectable
levels (D) at 48 hours would be unexpected after a true MI.
Q4: A patient with atrial fibrillation is receiving warfarin 5 mg daily. The INR this morning
is 3.8 (therapeutic range 2.0–3.0). Which action by the nurse is most appropriate?
A. Hold today's dose and notify the provider [CORRECT]
B. Administer the usual 5 mg dose
C. Administer vitamin K 10 mg IV immediately
D. Increase the dose to 7.5 mg to stabilize the INR
Correct Answer: A
Rationale: On the HESI, remember that INR above therapeutic range increases bleeding
risk significantly. Holding one dose and notifying the provider is standard practice for
INR 3.8—it's elevated but not dangerously so requiring vitamin K. Vitamin K (C) is
reserved for INR >4.0 or active bleeding. Never increase the dose (D) when already
supratherapeutic.
Q5: A patient with a mechanical mitral valve replacement is being discharged. Which
statement by the patient indicates understanding of lifelong anticoagulation needs?
, A. "I can stop my warfarin once my valve is fully healed in 6 months."
B. "I'll need to have my INR checked regularly and avoid high-vitamin K foods."
[CORRECT]
C. "Aspirin alone will be enough to prevent clots on my valve."
D. "I only need to take warfarin when I feel my heart skipping beats."
Correct Answer: B
Rationale: This aligns with HESI testing strategies where patient teaching evaluation is
key. Mechanical valves require lifelong warfarin because they are thrombogenic—the
metal surface activates clotting. INR monitoring and dietary consistency (not avoidance,
but consistency) with vitamin K foods are essential. Bioprosthetic valves might need
only 3–6 months of anticoagulation, but mechanical is forever.
Q6: A nurse is caring for a patient with a suspected abdominal aortic aneurysm. The
patient suddenly reports severe tearing back pain and becomes hypotensive. Which
action is the priority?
A. Prepare the patient for immediate surgical intervention [CORRECT]
B. Administer IV morphine for pain control
C. Obtain a stat CT scan with contrast
D. Insert a nasogastric tube for decompression
Correct Answer: A
Rationale: The priority action is recognizing that sudden severe back pain with
hypotension in an AAA patient means rupture—this is a surgical emergency with
Questions & Verified Answers 100% Correct | Grade A |
Nightingale | Pass Guaranteed - A+ Graded
Section 1: Cardiovascular Disorders
The heart and vascular system are central to medical-surgical nursing. This section covers
everything from pump failure to clot formation—conditions you'll see daily on the floor.
Q1: A nurse is caring for a patient admitted with acute decompensated heart failure.
The patient has crackles bilaterally, JVD at 6 cm, and 3+ pitting edema in the lower
extremities. Which medication should the nurse expect to administer first?
A. Oral metoprolol 25 mg daily
B. IV furosemide 40 mg push [CORRECT]
C. Oral lisinopril 5 mg daily
D. Subcutaneous heparin 5000 units
Correct Answer: B
Rationale: On the HESI, remember that acute decompensated heart failure with volume
overload is a "wet and warm" situation—you need to get that fluid off immediately. IV
loop diuretics like furosemide act quickly to reduce preload and relieve pulmonary
congestion. Beta-blockers (A) and ACE inhibitors (C) are important for chronic
,management but not first-line in acute decompensation. Heparin (D) is for DVT
prophylaxis, not the immediate priority.
Q2: A patient with a history of hypertension presents with blood pressure 198/112
mmHg, headache, and blurred vision. The nurse notes papilledema on assessment.
Which condition is this patient most likely experiencing?
A. Primary hypertension with target organ damage
B. Hypertensive emergency [CORRECT]
C. Hypertensive urgency without target organ damage
D. Secondary hypertension from renal disease
Correct Answer: B
Rationale: That's correct because in Med-Surg nursing, we distinguish urgency from
emergency based on target organ damage. This patient has papilledema (optic nerve
involvement) and neuro symptoms—this is hypertensive emergency requiring
immediate IV therapy and ICU monitoring. Urgency (C) would be high BP without these
acute changes.
Q3: A nurse is reviewing morning labs for a patient who had an MI 3 days ago. Which
troponin trend indicates the patient is healing appropriately?
A. Troponin I rising from 0.8 to 12.5 ng/mL over 24 hours
B. Troponin I peaked at 18 ng/mL and now decreasing to 8 ng/mL [CORRECT]
C. Troponin I remaining steady at 15 ng/mL for 72 hours
,D. Troponin I not detectable 48 hours post-MI
Correct Answer: B
Rationale: The priority action is understanding that troponins peak around 12–24 hours
after MI onset and then gradually decline over 7–10 days. A decreasing trend (B) shows
the infarction has completed and healing is underway. Rising levels (A) suggest ongoing
necrosis or reinfarction, steady levels (C) are unusual and concerning, and undetectable
levels (D) at 48 hours would be unexpected after a true MI.
Q4: A patient with atrial fibrillation is receiving warfarin 5 mg daily. The INR this morning
is 3.8 (therapeutic range 2.0–3.0). Which action by the nurse is most appropriate?
A. Hold today's dose and notify the provider [CORRECT]
B. Administer the usual 5 mg dose
C. Administer vitamin K 10 mg IV immediately
D. Increase the dose to 7.5 mg to stabilize the INR
Correct Answer: A
Rationale: On the HESI, remember that INR above therapeutic range increases bleeding
risk significantly. Holding one dose and notifying the provider is standard practice for
INR 3.8—it's elevated but not dangerously so requiring vitamin K. Vitamin K (C) is
reserved for INR >4.0 or active bleeding. Never increase the dose (D) when already
supratherapeutic.
Q5: A patient with a mechanical mitral valve replacement is being discharged. Which
statement by the patient indicates understanding of lifelong anticoagulation needs?
, A. "I can stop my warfarin once my valve is fully healed in 6 months."
B. "I'll need to have my INR checked regularly and avoid high-vitamin K foods."
[CORRECT]
C. "Aspirin alone will be enough to prevent clots on my valve."
D. "I only need to take warfarin when I feel my heart skipping beats."
Correct Answer: B
Rationale: This aligns with HESI testing strategies where patient teaching evaluation is
key. Mechanical valves require lifelong warfarin because they are thrombogenic—the
metal surface activates clotting. INR monitoring and dietary consistency (not avoidance,
but consistency) with vitamin K foods are essential. Bioprosthetic valves might need
only 3–6 months of anticoagulation, but mechanical is forever.
Q6: A nurse is caring for a patient with a suspected abdominal aortic aneurysm. The
patient suddenly reports severe tearing back pain and becomes hypotensive. Which
action is the priority?
A. Prepare the patient for immediate surgical intervention [CORRECT]
B. Administer IV morphine for pain control
C. Obtain a stat CT scan with contrast
D. Insert a nasogastric tube for decompression
Correct Answer: A
Rationale: The priority action is recognizing that sudden severe back pain with
hypotension in an AAA patient means rupture—this is a surgical emergency with
