BSN 266 HESI MED SURG PRACTICE EXAM VERSION 1
2026/2027 | Questions & Verified Answers with Rationales |
100% Correct | Grade A | Nightingale | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Disorders
12 questions covering heart failure, hypertension, CAD, MI, dysrhythmias, and vascular
disorders
Q1: A 68-year-old is admitted with acute decompensated heart failure. Vital signs: BP
162/94, HR 106, RR 28, SpO2 88% on room air. The nurse notes JVD at 6cm, bilateral
crackles, and 3+ pitting edema. Which action is the priority?
A. Administer IV furosemide 40mg immediately
B. Obtain a 12-lead ECG to rule out MI
C. Apply oxygen at 2L nasal cannula
D. Insert Foley catheter to monitor output
Correct Answer: A
Rationale: In acute decompensated heart failure with volume overload, the priority is
reducing preload with IV diuretics. While oxygen helps, and ECG is important, getting
that fluid off is what will stabilize this patient. For HESI practice, remember ABCs matter,
,but in flash pulmonary edema, the "B" problem is fixed by removing fluid, not just adding
oxygen.
Q2: A patient 24 hours post-MI reports sudden severe tearing chest pain radiating to the
back. BP is 168/92 in the right arm and 110/68 in the left arm. Which complication is
suspected?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Aortic dissection
D. Dressler's syndrome
Correct Answer: C
Rationale: Unequal blood pressures between arms plus tearing pain radiating to the
back is classic for aortic dissection. The post-MI patient may have underlying
atherosclerotic disease predisposing to this. Papillary muscle rupture (A) causes
sudden pulmonary edema and a new murmur. VSD (B) causes a harsh holosystolic
murmur. Dressler's (D) is pericarditis weeks later.
Q3: A patient with atrial fibrillation is on warfarin with INR 3.8. They develop melena and
dizziness. Which intervention is the priority?
A. Hold next warfarin dose and administer vitamin K
B. Continue warfarin and transfuse packed red blood cells
C. Switch to aspirin 325mg daily
,D. Administer protamine sulfate
Correct Answer: A
Rationale: With active bleeding and INR 3.8, we hold warfarin and give vitamin K to
reverse anticoagulation. Protamine (D) reverses heparin, not warfarin. Transfusion (B)
may be needed later for significant blood loss, but reversing the anticoagulant is the
immediate priority. Aspirin (C) would worsen bleeding.
Q4: A nurse is caring for four patients. Which patient should be assessed first?
A. Patient with stable angina requesting PRN nitroglycerin
B. Patient 2 hours post-cardiac catheterization with sheath still in place and oozing at
site
C. Patient with heart failure who received furosemide 2 hours ago and reports feeling
"much better"
D. Patient with new-onset atrial fibrillation, HR 142, BP 98/62, complaining of dizziness
Correct Answer: D
Rationale: This is your priority-setting question for HESI practice. The patient with new
rapid AFib, hypotension, and dizziness is unstable—cardiac output is compromised. The
post-cath patient (B) needs attention but oozing is expected; the sheath being in place
is planned. Stable angina (A) and improved CHF (C) can wait. Remember: unstable vital
signs beat stable every time.
Q5: A patient with hypertension is prescribed chlorthalidone. Which teaching is
essential?
, A. Take the medication at bedtime to avoid nocturia
B. Increase dietary potassium and report muscle weakness
C. Weigh daily and report gain of 2 pounds in one day
D. Check blood pressure only when feeling dizzy
Correct Answer: B
Rationale: Thiazide-like diuretics cause potassium wasting, so we teach patients to eat
potassium-rich foods and watch for hypokalemia symptoms—muscle weakness,
cramps, cardiac irregularities. Taking at bedtime (A) causes nighttime bathroom trips.
Daily weights (C) are for heart failure patients. BP checks (D) should be regular, not just
symptomatic.
Q6: A patient 48 hours post-MI becomes hypotensive, develops new holosystolic
murmur at left sternal border, and has crackles bilaterally. Which complication has
occurred?
A. Left ventricular free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture with acute mitral regurgitation
D. Right ventricular infarction
Correct Answer: B
Rationale: The harsh holosystolic murmur at the left sternal border with biventricular
failure (left-sided crackles, right-sided impending shock) is classic for ventricular septal
defect. This usually happens days 3-5 post-MI. Free wall rupture (A) causes tamponade
2026/2027 | Questions & Verified Answers with Rationales |
100% Correct | Grade A | Nightingale | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Disorders
12 questions covering heart failure, hypertension, CAD, MI, dysrhythmias, and vascular
disorders
Q1: A 68-year-old is admitted with acute decompensated heart failure. Vital signs: BP
162/94, HR 106, RR 28, SpO2 88% on room air. The nurse notes JVD at 6cm, bilateral
crackles, and 3+ pitting edema. Which action is the priority?
A. Administer IV furosemide 40mg immediately
B. Obtain a 12-lead ECG to rule out MI
C. Apply oxygen at 2L nasal cannula
D. Insert Foley catheter to monitor output
Correct Answer: A
Rationale: In acute decompensated heart failure with volume overload, the priority is
reducing preload with IV diuretics. While oxygen helps, and ECG is important, getting
that fluid off is what will stabilize this patient. For HESI practice, remember ABCs matter,
,but in flash pulmonary edema, the "B" problem is fixed by removing fluid, not just adding
oxygen.
Q2: A patient 24 hours post-MI reports sudden severe tearing chest pain radiating to the
back. BP is 168/92 in the right arm and 110/68 in the left arm. Which complication is
suspected?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Aortic dissection
D. Dressler's syndrome
Correct Answer: C
Rationale: Unequal blood pressures between arms plus tearing pain radiating to the
back is classic for aortic dissection. The post-MI patient may have underlying
atherosclerotic disease predisposing to this. Papillary muscle rupture (A) causes
sudden pulmonary edema and a new murmur. VSD (B) causes a harsh holosystolic
murmur. Dressler's (D) is pericarditis weeks later.
Q3: A patient with atrial fibrillation is on warfarin with INR 3.8. They develop melena and
dizziness. Which intervention is the priority?
A. Hold next warfarin dose and administer vitamin K
B. Continue warfarin and transfuse packed red blood cells
C. Switch to aspirin 325mg daily
,D. Administer protamine sulfate
Correct Answer: A
Rationale: With active bleeding and INR 3.8, we hold warfarin and give vitamin K to
reverse anticoagulation. Protamine (D) reverses heparin, not warfarin. Transfusion (B)
may be needed later for significant blood loss, but reversing the anticoagulant is the
immediate priority. Aspirin (C) would worsen bleeding.
Q4: A nurse is caring for four patients. Which patient should be assessed first?
A. Patient with stable angina requesting PRN nitroglycerin
B. Patient 2 hours post-cardiac catheterization with sheath still in place and oozing at
site
C. Patient with heart failure who received furosemide 2 hours ago and reports feeling
"much better"
D. Patient with new-onset atrial fibrillation, HR 142, BP 98/62, complaining of dizziness
Correct Answer: D
Rationale: This is your priority-setting question for HESI practice. The patient with new
rapid AFib, hypotension, and dizziness is unstable—cardiac output is compromised. The
post-cath patient (B) needs attention but oozing is expected; the sheath being in place
is planned. Stable angina (A) and improved CHF (C) can wait. Remember: unstable vital
signs beat stable every time.
Q5: A patient with hypertension is prescribed chlorthalidone. Which teaching is
essential?
, A. Take the medication at bedtime to avoid nocturia
B. Increase dietary potassium and report muscle weakness
C. Weigh daily and report gain of 2 pounds in one day
D. Check blood pressure only when feeling dizzy
Correct Answer: B
Rationale: Thiazide-like diuretics cause potassium wasting, so we teach patients to eat
potassium-rich foods and watch for hypokalemia symptoms—muscle weakness,
cramps, cardiac irregularities. Taking at bedtime (A) causes nighttime bathroom trips.
Daily weights (C) are for heart failure patients. BP checks (D) should be regular, not just
symptomatic.
Q6: A patient 48 hours post-MI becomes hypotensive, develops new holosystolic
murmur at left sternal border, and has crackles bilaterally. Which complication has
occurred?
A. Left ventricular free wall rupture
B. Ventricular septal rupture
C. Papillary muscle rupture with acute mitral regurgitation
D. Right ventricular infarction
Correct Answer: B
Rationale: The harsh holosystolic murmur at the left sternal border with biventricular
failure (left-sided crackles, right-sided impending shock) is classic for ventricular septal
defect. This usually happens days 3-5 post-MI. Free wall rupture (A) causes tamponade
