N 266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 2026/2027 | Page 1 | Passing Score: 8
NIGHTINGALE COLLEGE
BSN 266 HESI Med Surg Exam Version 1 (2026/2027 Update)
Questions and Verified Answers with Rationales|100% Correct|
Grade A- Nightingale 2026/2027
MEDICAL-SURGICAL NURSING · Official Exam 2026/2027
100 85% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Perioperative Nursing Care Q1-20
Section 2 Cardiovascular Disorders Q21-40
Section 3 Respiratory and Hematological Disorders Q41-60
Section 4 Neurological and Musculoskeletal Disorders Q61-80
Section 5 Endocrine, Immune, and Oncological Disorders Q81-100
Instructions: Select the single best answer for each question. This exam is designed for BSN 266 HESI Med Surg Exam
Version 1 preparation. Passing score: 85% (85 questions correct).
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, SECTION 1 | Perioperative Nursing Care | Q1-Q20 | BSN 266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and
Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
Q1. A 54-year-old male is scheduled for a total knee arthroplasty under general anesthesia. During the
preoperative assessment, the nurse discovers the patient has been taking aspirin 325 mg daily for cardiac
prophylaxis. Which action should the nurse take first?
A. Instruct the patient to stop taking aspirin immediately postoperatively
B. Administer the prescribed preoperative antibiotic on schedule
C. Notify the surgeon and anesthesia provider about the aspirin use
D. Document the finding and proceed with routine preoperative care
Correct Answer: A
Rationale:
Aspirin inhibits platelet aggregation and increases surgical bleeding risk. The nurse must notify the surgeon and
anesthesia provider immediately so they can decide whether to postpone surgery or take measures to mitigate
bleeding. Simply documenting or proceeding without notification could endanger the patient.
Q2 Question 2 of 100
Q2. A 67-year-old female undergoes an open cholecystectomy. In the postanesthesia care unit, her oxygen
saturation drops to 88% on room air and she has diminished breath sounds on the left side. Which intervention
should the nurse implement first?
A. Increase the intravenous fluid rate to improve perfusion
B. Administer supplemental oxygen via nasal cannula at 4 L/min
C. Reposition the patient to a high Fowler position and encourage deep breathing
D. Prepare for immediate chest tube insertion on the left side
Correct Answer: A
Rationale:
Atelectasis is the most common cause of hypoxemia in the immediate postoperative period. Repositioning to high
Fowler and encouraging deep breathing promotes lung expansion. Supplemental oxygen treats the symptom but
does not address the root cause of atelectasis, while chest tube insertion is premature without confirmation of
pneumothorax.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, Q3 Question 3 of 100
Q3. A 45-year-old man is receiving patient-controlled analgesia (PCA) with morphine after abdominal surgery.
The nurse assesses a respiratory rate of 8 breaths per minute and the patient is difficult to arouse. Which
medication should the nurse prepare to administer?
A. Flumazenil 0.2 mg intravenous push
B. Naloxone 0.4 mg intravenous push
C. Naloxone 0.04 mg intravenous push
D. Physostigmine 1 mg intravenous push
Correct Answer: C
Rationale:
Naloxone is the opioid antagonist for morphine-induced respiratory depression. A low initial dose (0.04 mg IV) is
recommended to reverse respiratory depression without causing acute withdrawal or severe pain. Flumazenil
reverses benzodiazepines, not opioids. The 0.4 mg dose is too high initially and risks precipitating withdrawal.
Q4 Question 4 of 100
Q4. A 72-year-old woman is transferred from the PACU after hip replacement surgery. The nurse notices the
surgical dressing is saturated with bright red blood and the drainage has increased by 50 mL in the last hour.
Vital signs show BP 102/64 and HR 104. What is the nurse's priority action?
A. Administer a 500 mL normal saline fluid bolus and reassess
B. Reinforce the dressing and continue to monitor vital signs every 15 minutes
C. Apply direct pressure to the surgical site and notify the surgeon immediately
D. Remove the dressing to inspect the wound and clean the area
Correct Answer: A
Rationale:
Bright red blood with hemodynamic instability (hypotension and tachycardia) indicates active hemorrhage. Applying
direct pressure controls bleeding while the surgeon is notified for possible surgical intervention. Reinforcing the
dressing does not address the source, and removing the dressing may disrupt the surgical site.
Q5 Question 5 of 100
Q5. A 58-year-old patient is preparing for colorectal surgery and the surgeon has ordered a mechanical bowel
preparation with polyethylene glycol. The patient asks the nurse why this is necessary. Which response by the
nurse is most accurate?
A. It reduces the bacterial load in the colon to decrease the risk of postoperative infection
B. It prevents postoperative constipation by clearing stool from the intestines
C. It helps the surgeon visualize the surgical field during the laparoscopic procedure
D. It eliminates the need for prophylactic antibiotics before surgery
Correct Answer: A
Rationale:
Mechanical bowel preparation reduces fecal volume and bacterial counts in the colon, which lowers the risk of
anastomotic leak and surgical site infection. While it does clear stool, infection prevention is the primary surgical
rationale. It does not replace prophylactic antibiotics.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, Q6 Question 6 of 100
Q6. A 63-year-old man is in the holding area before coronary artery bypass graft surgery. He tells the nurse he is
very anxious and his hands are trembling. His blood pressure is 168/96 mm Hg. Which intervention should the
nurse implement first?
A. Administer the prescribed preoperative benzodiazepine medication
B. Notify the anesthesiologist of the elevated blood pressure reading
C. Guide the patient through a deep breathing and relaxation exercise
D. Document the findings and reassess blood pressure in 15 minutes
Correct Answer: C
Rationale:
Anxiety is likely causing the elevated blood pressure through sympathetic stimulation. Nonpharmacological
interventions such as guided deep breathing and relaxation should be attempted first before administering
medications or notifying the provider. If nonpharmacological measures fail, then medication or provider notification
would be appropriate.
Q7 Question 7 of 100
Q7. A 49-year-old woman is recovering from a thyroidectomy. She reports numbness and tingling in her fingers
and around her mouth 6 hours postoperatively. Which laboratory value should the nurse monitor most closely?
A. Serum sodium level
B. Serum potassium level
C. Serum calcium level
D. Serum magnesium level
Correct Answer: A
Rationale:
Numbness and tingling in the fingers and perioral area are classic signs of hypocalcemia, a potential complication
after thyroidectomy due to inadvertent removal or damage to the parathyroid glands. Serum calcium must be
monitored closely. Potassium, magnesium, and sodium imbalances do not present with these specific
manifestations.
Q8 Question 8 of 100
Q8. A 70-year-old man with benign prostatic hyperplasia is scheduled for a transurethral resection of the prostate
under spinal anesthesia. Which assessment finding requires immediate intervention by the nurse during the
procedure?
A. Complaint of nausea and a feeling of fullness in the abdomen
B. Heart rate increase from 72 to 88 beats per minute
C. Urine output of 30 mL over the first 30 minutes of the procedure
D. Blood pressure decrease from 140/86 to 110/70 mm Hg
Correct Answer: C
Rationale:
During transurethral resection of the prostate, continuous bladder irrigation with irrigation fluid can lead to fluid
absorption causing TURP syndrome. Nausea and abdominal fullness are early signs of fluid overload and possible
hyponatremia. A mild blood pressure decrease is expected with spinal anesthesia, and the other findings are within
acceptable ranges.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
NIGHTINGALE COLLEGE
BSN 266 HESI Med Surg Exam Version 1 (2026/2027 Update)
Questions and Verified Answers with Rationales|100% Correct|
Grade A- Nightingale 2026/2027
MEDICAL-SURGICAL NURSING · Official Exam 2026/2027
100 85% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Perioperative Nursing Care Q1-20
Section 2 Cardiovascular Disorders Q21-40
Section 3 Respiratory and Hematological Disorders Q41-60
Section 4 Neurological and Musculoskeletal Disorders Q61-80
Section 5 Endocrine, Immune, and Oncological Disorders Q81-100
Instructions: Select the single best answer for each question. This exam is designed for BSN 266 HESI Med Surg Exam
Version 1 preparation. Passing score: 85% (85 questions correct).
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, SECTION 1 | Perioperative Nursing Care | Q1-Q20 | BSN 266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and
Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
Q1. A 54-year-old male is scheduled for a total knee arthroplasty under general anesthesia. During the
preoperative assessment, the nurse discovers the patient has been taking aspirin 325 mg daily for cardiac
prophylaxis. Which action should the nurse take first?
A. Instruct the patient to stop taking aspirin immediately postoperatively
B. Administer the prescribed preoperative antibiotic on schedule
C. Notify the surgeon and anesthesia provider about the aspirin use
D. Document the finding and proceed with routine preoperative care
Correct Answer: A
Rationale:
Aspirin inhibits platelet aggregation and increases surgical bleeding risk. The nurse must notify the surgeon and
anesthesia provider immediately so they can decide whether to postpone surgery or take measures to mitigate
bleeding. Simply documenting or proceeding without notification could endanger the patient.
Q2 Question 2 of 100
Q2. A 67-year-old female undergoes an open cholecystectomy. In the postanesthesia care unit, her oxygen
saturation drops to 88% on room air and she has diminished breath sounds on the left side. Which intervention
should the nurse implement first?
A. Increase the intravenous fluid rate to improve perfusion
B. Administer supplemental oxygen via nasal cannula at 4 L/min
C. Reposition the patient to a high Fowler position and encourage deep breathing
D. Prepare for immediate chest tube insertion on the left side
Correct Answer: A
Rationale:
Atelectasis is the most common cause of hypoxemia in the immediate postoperative period. Repositioning to high
Fowler and encouraging deep breathing promotes lung expansion. Supplemental oxygen treats the symptom but
does not address the root cause of atelectasis, while chest tube insertion is premature without confirmation of
pneumothorax.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, Q3 Question 3 of 100
Q3. A 45-year-old man is receiving patient-controlled analgesia (PCA) with morphine after abdominal surgery.
The nurse assesses a respiratory rate of 8 breaths per minute and the patient is difficult to arouse. Which
medication should the nurse prepare to administer?
A. Flumazenil 0.2 mg intravenous push
B. Naloxone 0.4 mg intravenous push
C. Naloxone 0.04 mg intravenous push
D. Physostigmine 1 mg intravenous push
Correct Answer: C
Rationale:
Naloxone is the opioid antagonist for morphine-induced respiratory depression. A low initial dose (0.04 mg IV) is
recommended to reverse respiratory depression without causing acute withdrawal or severe pain. Flumazenil
reverses benzodiazepines, not opioids. The 0.4 mg dose is too high initially and risks precipitating withdrawal.
Q4 Question 4 of 100
Q4. A 72-year-old woman is transferred from the PACU after hip replacement surgery. The nurse notices the
surgical dressing is saturated with bright red blood and the drainage has increased by 50 mL in the last hour.
Vital signs show BP 102/64 and HR 104. What is the nurse's priority action?
A. Administer a 500 mL normal saline fluid bolus and reassess
B. Reinforce the dressing and continue to monitor vital signs every 15 minutes
C. Apply direct pressure to the surgical site and notify the surgeon immediately
D. Remove the dressing to inspect the wound and clean the area
Correct Answer: A
Rationale:
Bright red blood with hemodynamic instability (hypotension and tachycardia) indicates active hemorrhage. Applying
direct pressure controls bleeding while the surgeon is notified for possible surgical intervention. Reinforcing the
dressing does not address the source, and removing the dressing may disrupt the surgical site.
Q5 Question 5 of 100
Q5. A 58-year-old patient is preparing for colorectal surgery and the surgeon has ordered a mechanical bowel
preparation with polyethylene glycol. The patient asks the nurse why this is necessary. Which response by the
nurse is most accurate?
A. It reduces the bacterial load in the colon to decrease the risk of postoperative infection
B. It prevents postoperative constipation by clearing stool from the intestines
C. It helps the surgeon visualize the surgical field during the laparoscopic procedure
D. It eliminates the need for prophylactic antibiotics before surgery
Correct Answer: A
Rationale:
Mechanical bowel preparation reduces fecal volume and bacterial counts in the colon, which lowers the risk of
anastomotic leak and surgical site infection. While it does clear stool, infection prevention is the primary surgical
rationale. It does not replace prophylactic antibiotics.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
, Q6 Question 6 of 100
Q6. A 63-year-old man is in the holding area before coronary artery bypass graft surgery. He tells the nurse he is
very anxious and his hands are trembling. His blood pressure is 168/96 mm Hg. Which intervention should the
nurse implement first?
A. Administer the prescribed preoperative benzodiazepine medication
B. Notify the anesthesiologist of the elevated blood pressure reading
C. Guide the patient through a deep breathing and relaxation exercise
D. Document the findings and reassess blood pressure in 15 minutes
Correct Answer: C
Rationale:
Anxiety is likely causing the elevated blood pressure through sympathetic stimulation. Nonpharmacological
interventions such as guided deep breathing and relaxation should be attempted first before administering
medications or notifying the provider. If nonpharmacological measures fail, then medication or provider notification
would be appropriate.
Q7 Question 7 of 100
Q7. A 49-year-old woman is recovering from a thyroidectomy. She reports numbness and tingling in her fingers
and around her mouth 6 hours postoperatively. Which laboratory value should the nurse monitor most closely?
A. Serum sodium level
B. Serum potassium level
C. Serum calcium level
D. Serum magnesium level
Correct Answer: A
Rationale:
Numbness and tingling in the fingers and perioral area are classic signs of hypocalcemia, a potential complication
after thyroidectomy due to inadvertent removal or damage to the parathyroid glands. Serum calcium must be
monitored closely. Potassium, magnesium, and sodium imbalances do not present with these specific
manifestations.
Q8 Question 8 of 100
Q8. A 70-year-old man with benign prostatic hyperplasia is scheduled for a transurethral resection of the prostate
under spinal anesthesia. Which assessment finding requires immediate intervention by the nurse during the
procedure?
A. Complaint of nausea and a feeling of fullness in the abdomen
B. Heart rate increase from 72 to 88 beats per minute
C. Urine output of 30 mL over the first 30 minutes of the procedure
D. Blood pressure decrease from 140/86 to 110/70 mm Hg
Correct Answer: C
Rationale:
During transurethral resection of the prostate, continuous bladder irrigation with irrigation fluid can lead to fluid
absorption causing TURP syndrome. Nausea and abdominal fullness are early signs of fluid overload and possible
hyponatremia. A mild blood pressure decrease is expected with spinal anesthesia, and the other findings are within
acceptable ranges.
266 HESI Med Surg Exam Version 1 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 — 2026/2027 | Passing Score: 85% | Pa
