BSN 266 HESI MED SURG PRACTICE EXAM VERSION 2
2026/2027 | Questions & Verified Answers with Rationales |
100% Correct | Grade A | Nightingale | Pass Guaranteed - A+
Graded
[Section 1: Cardiovascular Disorders (Q1-20)]
Q1. A client with heart failure has a BNP level of 850 pg/mL. Which assessment finding
would the nurse expect to correlate with this laboratory value?
A. Bounding peripheral pulses and widened pulse pressure
B. Respiratory crackles, jugular venous distention, and peripheral edema [CORRECT]
C. Bradycardia and hypotension with clear lung sounds
D. Systolic ejection murmur and syncope with exertion
Rationale: BNP is released from ventricular myocardium in response to stretch from
volume overload; levels >400 pg/mL indicate significant heart failure. The correct
answer reflects left-sided failure (crackles from pulmonary edema) and right-sided
failure (JVD, peripheral edema) consistent with decompensation. Option A describes
aortic regurgitation; Option C is inconsistent with HF (tachycardia, not bradycardia, is
typical); Option D describes aortic stenosis. HESI Med Surg competency: Laboratory
correlation with clinical presentation. NCLEX-RN principle: Analyze diagnostic findings
to determine client needs.
Correct Answer: B
,Q2. The nurse is administering furosemide 40 mg IV to a client with acute
decompensated heart failure. Which electrolyte requires the most frequent monitoring
during therapy?
A. Sodium
B. Potassium [CORRECT]
C. Calcium
D. Magnesium
Rationale: Furosemide is a loop diuretic that inhibits Na-K-2Cl cotransport in the thick
ascending loop of Henle, causing profound kaliuresis and risk for hypokalemia, which
can precipitate life-threatening cardiac dysrhythmias. While sodium, calcium, and
magnesium may be affected, potassium is the priority due to immediate cardiac
consequences. HESI Med Surg competency: Pharmacological management and
adverse effect monitoring. NCLEX-RN principle: Safety and risk reduction.
Correct Answer: B
Q3. A client with HFrEF (EF 30%) is prescribed sacubitril/valsartan (Entresto). Which
mechanism of action does the nurse include in patient education?
A. Pure vasodilation reducing afterload through nitric oxide potentiation
B. Inhibition of neprilysin to increase natriuretic peptides and RAAS blockade
[CORRECT]
C. Direct stimulation of cardiac beta-1 receptors to improve contractility
D. Aldosterone receptor antagonism to reduce myocardial fibrosis
Rationale: Sacubitril/valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor);
sacubitril inhibits neprilysin (increasing beneficial natriuretic peptides), while valsartan
blocks AT1 receptors. This dual mechanism reduces vasoconstriction, sodium
retention, and sympathetic tone. Option A describes hydralazine/isosorbide; Option C
describes digoxin/dobutamine; Option D describes spironolactone/eplerenone. HESI
,Med Surg competency: Mechanism-based pharmacology education. NCLEX-RN
principle: Health promotion and maintenance through accurate information.
Correct Answer: B
Q4. The nurse is caring for a client with acute pulmonary edema. Which intervention
should be implemented FIRST?
A. Administer morphine sulfate 2 mg IV push
B. Apply non-rebreather mask at 15 L/min
C. Administer furosemide 80 mg IV push [CORRECT]
D. Initiate CPAP at 10 cmH2O
Rationale: While all options may be appropriate, the FIRST priority in acute cardiogenic
pulmonary edema is reducing preload through rapid diuresis with IV loop diuretics.
Furosemide promotes venodilation within minutes and diuresis within 20-30 minutes.
Morphine is no longer first-line due to respiratory depression risks; oxygen/CPAP are
important but do not address the fluid overload etiology. HESI Med Surg competency:
Prioritization in acute cardiovascular emergencies. NCLEX-RN principle: ABCs with
attention to underlying pathophysiology.
Correct Answer: C
Q5. A client with severe aortic stenosis reports syncope with exertion. Which
pathophysiological explanation is most accurate?
A. Decreased preload causes inadequate ventricular filling during diastole
B. Fixed outflow obstruction prevents compensatory increased cardiac output, causing
cerebral hypoperfusion [CORRECT]
C. Coronary artery compression from dilated aortic root reduces myocardial oxygen
supply
D. Diastolic runoff into the left ventricle reduces systemic vascular resistance
, Rationale: In aortic stenosis, the fixed valvular obstruction prevents the normal
exercise-induced increase in cardiac output; when peripheral muscle vasodilation
occurs during exertion without compensatory output increase, cerebral perfusion drops
causing syncope. Option A describes mitral stenosis; Option C is not characteristic;
Option D describes aortic regurgitation. HESI Med Surg competency: Pathophysiology
application to symptom analysis. NCLEX-RN principle: Physiological adaptation.
Correct Answer: B
Q6. The nurse auscultates a high-pitched, blowing, decrescendo diastolic murmur at the
left sternal border in a client with bounding peripheral pulses. Which valve disorder is
suspected?
A. Mitral stenosis
B. Aortic regurgitation [CORRECT]
C. Mitral regurgitation
D. Aortic stenosis
Rationale: Aortic regurgitation produces a diastolic decrescendo murmur (immediately
after S2) due to diastolic flow back into the LV; the widened pulse pressure and
bounding pulses (Corrigan's pulse, water-hammer pulse) result from increased stroke
volume and rapid diastolic runoff. Option A produces a diastolic rumble with opening
snap; Option C produces a holosystolic murmur; Option D produces a systolic
crescendo-decrescendo murmur. HESI Med Surg competency: Cardiovascular
assessment and murmur identification. NCLEX-RN principle: Reduction of risk potential
through accurate assessment.
Correct Answer: B
2026/2027 | Questions & Verified Answers with Rationales |
100% Correct | Grade A | Nightingale | Pass Guaranteed - A+
Graded
[Section 1: Cardiovascular Disorders (Q1-20)]
Q1. A client with heart failure has a BNP level of 850 pg/mL. Which assessment finding
would the nurse expect to correlate with this laboratory value?
A. Bounding peripheral pulses and widened pulse pressure
B. Respiratory crackles, jugular venous distention, and peripheral edema [CORRECT]
C. Bradycardia and hypotension with clear lung sounds
D. Systolic ejection murmur and syncope with exertion
Rationale: BNP is released from ventricular myocardium in response to stretch from
volume overload; levels >400 pg/mL indicate significant heart failure. The correct
answer reflects left-sided failure (crackles from pulmonary edema) and right-sided
failure (JVD, peripheral edema) consistent with decompensation. Option A describes
aortic regurgitation; Option C is inconsistent with HF (tachycardia, not bradycardia, is
typical); Option D describes aortic stenosis. HESI Med Surg competency: Laboratory
correlation with clinical presentation. NCLEX-RN principle: Analyze diagnostic findings
to determine client needs.
Correct Answer: B
,Q2. The nurse is administering furosemide 40 mg IV to a client with acute
decompensated heart failure. Which electrolyte requires the most frequent monitoring
during therapy?
A. Sodium
B. Potassium [CORRECT]
C. Calcium
D. Magnesium
Rationale: Furosemide is a loop diuretic that inhibits Na-K-2Cl cotransport in the thick
ascending loop of Henle, causing profound kaliuresis and risk for hypokalemia, which
can precipitate life-threatening cardiac dysrhythmias. While sodium, calcium, and
magnesium may be affected, potassium is the priority due to immediate cardiac
consequences. HESI Med Surg competency: Pharmacological management and
adverse effect monitoring. NCLEX-RN principle: Safety and risk reduction.
Correct Answer: B
Q3. A client with HFrEF (EF 30%) is prescribed sacubitril/valsartan (Entresto). Which
mechanism of action does the nurse include in patient education?
A. Pure vasodilation reducing afterload through nitric oxide potentiation
B. Inhibition of neprilysin to increase natriuretic peptides and RAAS blockade
[CORRECT]
C. Direct stimulation of cardiac beta-1 receptors to improve contractility
D. Aldosterone receptor antagonism to reduce myocardial fibrosis
Rationale: Sacubitril/valsartan is an ARNI (angiotensin receptor-neprilysin inhibitor);
sacubitril inhibits neprilysin (increasing beneficial natriuretic peptides), while valsartan
blocks AT1 receptors. This dual mechanism reduces vasoconstriction, sodium
retention, and sympathetic tone. Option A describes hydralazine/isosorbide; Option C
describes digoxin/dobutamine; Option D describes spironolactone/eplerenone. HESI
,Med Surg competency: Mechanism-based pharmacology education. NCLEX-RN
principle: Health promotion and maintenance through accurate information.
Correct Answer: B
Q4. The nurse is caring for a client with acute pulmonary edema. Which intervention
should be implemented FIRST?
A. Administer morphine sulfate 2 mg IV push
B. Apply non-rebreather mask at 15 L/min
C. Administer furosemide 80 mg IV push [CORRECT]
D. Initiate CPAP at 10 cmH2O
Rationale: While all options may be appropriate, the FIRST priority in acute cardiogenic
pulmonary edema is reducing preload through rapid diuresis with IV loop diuretics.
Furosemide promotes venodilation within minutes and diuresis within 20-30 minutes.
Morphine is no longer first-line due to respiratory depression risks; oxygen/CPAP are
important but do not address the fluid overload etiology. HESI Med Surg competency:
Prioritization in acute cardiovascular emergencies. NCLEX-RN principle: ABCs with
attention to underlying pathophysiology.
Correct Answer: C
Q5. A client with severe aortic stenosis reports syncope with exertion. Which
pathophysiological explanation is most accurate?
A. Decreased preload causes inadequate ventricular filling during diastole
B. Fixed outflow obstruction prevents compensatory increased cardiac output, causing
cerebral hypoperfusion [CORRECT]
C. Coronary artery compression from dilated aortic root reduces myocardial oxygen
supply
D. Diastolic runoff into the left ventricle reduces systemic vascular resistance
, Rationale: In aortic stenosis, the fixed valvular obstruction prevents the normal
exercise-induced increase in cardiac output; when peripheral muscle vasodilation
occurs during exertion without compensatory output increase, cerebral perfusion drops
causing syncope. Option A describes mitral stenosis; Option C is not characteristic;
Option D describes aortic regurgitation. HESI Med Surg competency: Pathophysiology
application to symptom analysis. NCLEX-RN principle: Physiological adaptation.
Correct Answer: B
Q6. The nurse auscultates a high-pitched, blowing, decrescendo diastolic murmur at the
left sternal border in a client with bounding peripheral pulses. Which valve disorder is
suspected?
A. Mitral stenosis
B. Aortic regurgitation [CORRECT]
C. Mitral regurgitation
D. Aortic stenosis
Rationale: Aortic regurgitation produces a diastolic decrescendo murmur (immediately
after S2) due to diastolic flow back into the LV; the widened pulse pressure and
bounding pulses (Corrigan's pulse, water-hammer pulse) result from increased stroke
volume and rapid diastolic runoff. Option A produces a diastolic rumble with opening
snap; Option C produces a holosystolic murmur; Option D produces a systolic
crescendo-decrescendo murmur. HESI Med Surg competency: Cardiovascular
assessment and murmur identification. NCLEX-RN principle: Reduction of risk potential
through accurate assessment.
Correct Answer: B
