BSN HESI 266 MED SURG EXAM LATEST 2026/2027 |
Questions & Verified Answers 100% Correct | Already
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Section 1: Cardiovascular Disorders (Questions 1-22)
Q1. A nurse is caring for a 68-year-old male with HFrEF (EF 30%). Which medication
combination represents guideline-directed medical therapy (GDMT) for this patient
according to 2026 ACC/AHA/HFSA heart failure guidelines?
A. Furosemide, lisinopril, metoprolol succinate, and spironolactone
B. Furosemide, losartan, carvedilol, and digoxin
C. Furosemide, sacubitril/valsartan, bisoprolol, and eplerenone
D. Furosemide, enalapril, metoprolol tartrate, and hydralazine/isosorbide dinitrate
C. Furosemide, sacubitril/valsartan, bisoprolol, and eplerenone [CORRECT]
Rationale: 2026 GDMT for HFrEF includes an ARNI (sacubitril/valsartan preferred over
ACEi/ARB), evidence-based beta-blocker (bisoprolol, metoprolol succinate, or
carvedilol), MRA (spironolactone or eplerenone), and SGLT2 inhibitor (not listed in
options but diuretic for congestion is appropriate). Option A lacks ARNI and includes
ACEi instead. Option B includes digoxin which is only for refractory symptoms, not
first-line GDMT. Option D includes metoprolol tartrate (not evidence-based for HF)
and hydralazine/isosorbide which is specifically for African Americans with persistent
symptoms on optimal therapy, not standard first-line for all HFrEF. This aligns with
HESI Med Surg competency in pharmacotherapy and NCLEX-RN priority of evidence-
based interventions.
Q2. A nurse is educating a patient with HFpEF about lifestyle modifications. Which
statement by the patient indicates understanding of sodium restriction guidelines?
,A. "I can have up to 3 grams of sodium per day as long as I take my diuretic."
B. "I should limit my sodium intake to less than 2,000 mg daily."
C. "Sodium restriction is only necessary when I have symptoms of fluid overload."
D. "I should avoid all salt and use salt substitutes containing potassium chloride."
B. "I should limit my sodium intake to less than 2,000 mg daily." [CORRECT]
Rationale: Current HF guidelines recommend sodium restriction <2,000 mg/day for
all HF patients to prevent fluid retention and exacerbations. Option A exceeds this
limit. Option C is incorrect because sodium restriction is a chronic management
strategy, not just during acute episodes. Option D is dangerous because potassium-
containing salt substitutes can cause hyperkalemia, especially in patients on
ACEi/ARB/ARNI or spironolactone. This demonstrates HESI Med Surg patient
education competency and NCLEX-RN safety priority.
Q3. A patient with chronic heart failure reports a 5-pound weight gain over 3 days
and increased dyspnea with minimal exertion. What is the nurse's FIRST priority
action?
A. Administer the scheduled dose of furosemide
B. Notify the provider immediately
C. Assess the patient's lung sounds and oxygen saturation
D. Instruct the patient to restrict fluids to 1 liter daily
C. Assess the patient's lung sounds and oxygen saturation [CORRECT]
Rationale: The FIRST priority follows the ABCs—assess breathing status before any
other intervention. While weight gain >2-3 lbs/24h or 5 lbs/week requires reporting,
the nurse must first determine if pulmonary edema is developing by auscultating for
crackles and checking SpO2. Option A may be appropriate but requires assessment
first. Option B is necessary but not before determining respiratory status. Option D is
an intervention that requires provider orders and assessment data first. This follows
NCLEX-RN prioritization (assess before act) and HESI unstable vs. stable patient
management.
,Q4. A nurse is reviewing medications for a patient with HFrEF. Which medication
requires the nurse to monitor for hyperkalemia and gynecomastia?
A. Carvedilol
B. Sacubitril/valsartan
C. Spironolactone
D. Empagliflozin
C. Spironolactone [CORRECT]
Rationale: Spironolactone is an aldosterone antagonist (MRA) that blocks
mineralocorticoid receptors, causing potassium retention (hyperkalemia risk) and has
anti-androgen effects causing gynecomastia in males. Option A (carvedilol) may
cause hypotension and bradycardia. Option B (sacubitril/valsartan) may cause
hypotension and angioedema. Option D (empagliflozin) may cause genitourinary
infections and volume depletion. This reflects HESI Med Surg pharmacology
knowledge and NCLEX-RN adverse effect monitoring.
Q5. A patient with hypertension has a BP of 158/96 mmHg on two separate
occasions. According to 2017 ACC/AHA and 2026 updates, what is the classification
and target BP for this patient?
A. Stage 1 hypertension; target <140/90 mmHg
B. Stage 2 hypertension; target <130/80 mmHg
C. Stage 1 hypertension; target <130/80 mmHg
D. Stage 2 hypertension; target <140/90 mmHg
B. Stage 2 hypertension; target <130/80 mmHg [CORRECT]
Rationale: ACC/AHA 2017 guidelines classify BP 140/90 or higher as Stage 2
hypertension (Stage 1 is 130-139/80-89). The target for most adults including those
with diabetes or CKD is <130/80 mmHg. Option A and C misclassify the BP. Option D
has the wrong target. This demonstrates HESI Med Surg knowledge of current
hypertension classification and NCLEX-RN evidence-based practice standards.
, Q6. A nurse is caring for a patient admitted with unstable angina. Which finding
differentiates unstable angina from NSTEMI?
A. ST-segment elevation on 12-lead EKG
B. Elevated cardiac troponin levels
C. Chest pain relieved by sublingual nitroglycerin
D. Presence of pathological Q waves
B. Elevated cardiac troponin levels [CORRECT]
Rationale: Unstable angina is defined as myocardial ischemia without myocardial
necrosis—therefore NO troponin elevation. NSTEMI involves myocardial necrosis
with elevated troponins. Option A describes STEMI. Option C describes stable angina.
Option D indicates prior MI (old infarction). This is fundamental HESI Med Surg ACS
pathophysiology and critical for NCLEX-RN clinical differentiation.
Q7. A patient with chest pain is receiving MONA therapy. The nurse notes the
patient's blood pressure is 82/50 mmHg and heart rate is 52 bpm. Which medication
should the nurse withhold and notify the provider?
A. Morphine
B. Oxygen
C. Nitroglycerin
D. Aspirin
C. Nitroglycerin [CORRECT]
Rationale: Nitroglycerin is contraindicated with SBP <90 mmHg and bradycardia <60
bpm due to risk of profound hypotension and cardiovascular collapse. Morphine may
be given for persistent pain after NTG (with caution in hypotension). Oxygen is
indicated if SpO2 <90%. Aspirin should be given unless contraindicated. This reflects
HESI Med Surg medication contraindications and NCLEX-RN safety priority.
Questions & Verified Answers 100% Correct | Already
Graded A | Nightingale College | Pass Guaranteed - A+
Graded
Section 1: Cardiovascular Disorders (Questions 1-22)
Q1. A nurse is caring for a 68-year-old male with HFrEF (EF 30%). Which medication
combination represents guideline-directed medical therapy (GDMT) for this patient
according to 2026 ACC/AHA/HFSA heart failure guidelines?
A. Furosemide, lisinopril, metoprolol succinate, and spironolactone
B. Furosemide, losartan, carvedilol, and digoxin
C. Furosemide, sacubitril/valsartan, bisoprolol, and eplerenone
D. Furosemide, enalapril, metoprolol tartrate, and hydralazine/isosorbide dinitrate
C. Furosemide, sacubitril/valsartan, bisoprolol, and eplerenone [CORRECT]
Rationale: 2026 GDMT for HFrEF includes an ARNI (sacubitril/valsartan preferred over
ACEi/ARB), evidence-based beta-blocker (bisoprolol, metoprolol succinate, or
carvedilol), MRA (spironolactone or eplerenone), and SGLT2 inhibitor (not listed in
options but diuretic for congestion is appropriate). Option A lacks ARNI and includes
ACEi instead. Option B includes digoxin which is only for refractory symptoms, not
first-line GDMT. Option D includes metoprolol tartrate (not evidence-based for HF)
and hydralazine/isosorbide which is specifically for African Americans with persistent
symptoms on optimal therapy, not standard first-line for all HFrEF. This aligns with
HESI Med Surg competency in pharmacotherapy and NCLEX-RN priority of evidence-
based interventions.
Q2. A nurse is educating a patient with HFpEF about lifestyle modifications. Which
statement by the patient indicates understanding of sodium restriction guidelines?
,A. "I can have up to 3 grams of sodium per day as long as I take my diuretic."
B. "I should limit my sodium intake to less than 2,000 mg daily."
C. "Sodium restriction is only necessary when I have symptoms of fluid overload."
D. "I should avoid all salt and use salt substitutes containing potassium chloride."
B. "I should limit my sodium intake to less than 2,000 mg daily." [CORRECT]
Rationale: Current HF guidelines recommend sodium restriction <2,000 mg/day for
all HF patients to prevent fluid retention and exacerbations. Option A exceeds this
limit. Option C is incorrect because sodium restriction is a chronic management
strategy, not just during acute episodes. Option D is dangerous because potassium-
containing salt substitutes can cause hyperkalemia, especially in patients on
ACEi/ARB/ARNI or spironolactone. This demonstrates HESI Med Surg patient
education competency and NCLEX-RN safety priority.
Q3. A patient with chronic heart failure reports a 5-pound weight gain over 3 days
and increased dyspnea with minimal exertion. What is the nurse's FIRST priority
action?
A. Administer the scheduled dose of furosemide
B. Notify the provider immediately
C. Assess the patient's lung sounds and oxygen saturation
D. Instruct the patient to restrict fluids to 1 liter daily
C. Assess the patient's lung sounds and oxygen saturation [CORRECT]
Rationale: The FIRST priority follows the ABCs—assess breathing status before any
other intervention. While weight gain >2-3 lbs/24h or 5 lbs/week requires reporting,
the nurse must first determine if pulmonary edema is developing by auscultating for
crackles and checking SpO2. Option A may be appropriate but requires assessment
first. Option B is necessary but not before determining respiratory status. Option D is
an intervention that requires provider orders and assessment data first. This follows
NCLEX-RN prioritization (assess before act) and HESI unstable vs. stable patient
management.
,Q4. A nurse is reviewing medications for a patient with HFrEF. Which medication
requires the nurse to monitor for hyperkalemia and gynecomastia?
A. Carvedilol
B. Sacubitril/valsartan
C. Spironolactone
D. Empagliflozin
C. Spironolactone [CORRECT]
Rationale: Spironolactone is an aldosterone antagonist (MRA) that blocks
mineralocorticoid receptors, causing potassium retention (hyperkalemia risk) and has
anti-androgen effects causing gynecomastia in males. Option A (carvedilol) may
cause hypotension and bradycardia. Option B (sacubitril/valsartan) may cause
hypotension and angioedema. Option D (empagliflozin) may cause genitourinary
infections and volume depletion. This reflects HESI Med Surg pharmacology
knowledge and NCLEX-RN adverse effect monitoring.
Q5. A patient with hypertension has a BP of 158/96 mmHg on two separate
occasions. According to 2017 ACC/AHA and 2026 updates, what is the classification
and target BP for this patient?
A. Stage 1 hypertension; target <140/90 mmHg
B. Stage 2 hypertension; target <130/80 mmHg
C. Stage 1 hypertension; target <130/80 mmHg
D. Stage 2 hypertension; target <140/90 mmHg
B. Stage 2 hypertension; target <130/80 mmHg [CORRECT]
Rationale: ACC/AHA 2017 guidelines classify BP 140/90 or higher as Stage 2
hypertension (Stage 1 is 130-139/80-89). The target for most adults including those
with diabetes or CKD is <130/80 mmHg. Option A and C misclassify the BP. Option D
has the wrong target. This demonstrates HESI Med Surg knowledge of current
hypertension classification and NCLEX-RN evidence-based practice standards.
, Q6. A nurse is caring for a patient admitted with unstable angina. Which finding
differentiates unstable angina from NSTEMI?
A. ST-segment elevation on 12-lead EKG
B. Elevated cardiac troponin levels
C. Chest pain relieved by sublingual nitroglycerin
D. Presence of pathological Q waves
B. Elevated cardiac troponin levels [CORRECT]
Rationale: Unstable angina is defined as myocardial ischemia without myocardial
necrosis—therefore NO troponin elevation. NSTEMI involves myocardial necrosis
with elevated troponins. Option A describes STEMI. Option C describes stable angina.
Option D indicates prior MI (old infarction). This is fundamental HESI Med Surg ACS
pathophysiology and critical for NCLEX-RN clinical differentiation.
Q7. A patient with chest pain is receiving MONA therapy. The nurse notes the
patient's blood pressure is 82/50 mmHg and heart rate is 52 bpm. Which medication
should the nurse withhold and notify the provider?
A. Morphine
B. Oxygen
C. Nitroglycerin
D. Aspirin
C. Nitroglycerin [CORRECT]
Rationale: Nitroglycerin is contraindicated with SBP <90 mmHg and bradycardia <60
bpm due to risk of profound hypotension and cardiovascular collapse. Morphine may
be given for persistent pain after NTG (with caution in hypotension). Oxygen is
indicated if SpO2 <90%. Aspirin should be given unless contraindicated. This reflects
HESI Med Surg medication contraindications and NCLEX-RN safety priority.
