BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Page 1 | Passing Score: 85%
NIGHTINGALE COLLEGE
BSN 266 HESI Med Surg Exam Version 2 (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 Cardiovascular and Hematologic Disorders Q1-20
Section 2 Respiratory and Thoracic Disorders Q21-40
Section 3 Gastrointestinal and Hepatobiliary Disorders Q41-60
Section 4 Neurological and Musculoskeletal Disorders Q61-80
Section 5 Renal, Endocrine, and Immune Disorders Q81-100
Instructions: Select the single best answer for each question. This exam is designed for BSN 266 HESI Med Surg Exam Version 2
preparation. Passing score: 85% (85 questions correct).
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 1 of 51
, SECTION 1 | Cardiovascular and Hematologic Disorders | Q1-Q20 | BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update)
Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
A 68-year-old man presents to the emergency department with crushing substernal chest pain
radiating to his left arm, diaphoresis, and nausea that began 45 minutes ago. His ECG shows
ST-segment elevation in leads V2 through V4. Which intervention is the highest priority?
A. Initiate reperfusion therapy with percutaneous coronary intervention
B. Administer morphine sulfate for pain
C. Obtain a chest X-ray
D. Start a beta-blocker immediately
Correct Answer: A
Rationale:
ST-elevation myocardial infarction requires immediate reperfusion therapy, and PCI within 90 minutes is the gold
standard. While morphine and beta-blockers are part of the treatment protocol, restoring blood flow to the
ischemic myocardium takes priority. A chest X-ray does not change acute management.
Q2 Question 2 of 100
A 55-year-old woman with a history of atrial fibrillation is taking warfarin 5 mg daily. Her INR today
is 3.8 with a therapeutic goal of 2.0-3.0. She has no signs of bleeding. Which action is most
appropriate?
A. Hold the next dose of warfarin and recheck INR in 24-48 hours
B. Administer vitamin K immediately
C. Increase the warfarin dose
D. Discharge with no changes to medication
Correct Answer: A
Rationale:
An INR of 3.8 is above the therapeutic range but without bleeding. Holding the next dose and rechecking in 24-48
hours is the standard approach. Vitamin K is reserved for significantly elevated INR with active bleeding.
Increasing the dose would worsen the situation. No changes would be inappropriate given the supratherapeutic
level.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 2 of 51
, Q3 Question 3 of 100
A 72-year-old man is admitted with acute decompensated heart failure. He has crackles bilaterally,
JVD, and 3+ pitting edema in both lower extremities. His BNP level is 1,800 pg/mL. Which
medication should be administered first?
A. Furosemide IV push
B. Metoprolol succinate
C. Digoxin
D. Lisinopril
Correct Answer: A
Rationale:
Acute decompensated heart failure with pulmonary congestion and volume overload requires immediate diuresis
with IV furosemide as the first-line intervention. Beta-blockers like metoprolol are contraindicated in acute
decompensation. Digoxin is for rate control in atrial fibrillation or mild exacerbations. ACE inhibitors are initiated
after stabilization.
Q4 Question 4 of 100
A 60-year-old woman with a mechanical mitral valve replacement is found to have an INR of 1.5
with a goal of 2.5-3.5. She reports missing several doses of warfarin. Which intervention is most
appropriate?
A. Administer fresh frozen plasma
B. Increase the warfarin dose and recheck INR in one week
C. Resume warfarin at the prescribed dose and consider a bridge with low-molecular-weight heparin
D. No intervention needed as INR is close to goal
Correct Answer: C
Rationale:
A subtherapeutic INR with a mechanical valve carries a high risk of thromboembolism. Resuming warfarin at the
prescribed dose with LMWH bridging is the appropriate approach to rapidly restore anticoagulation. FFP is for
reversing anticoagulation, not for subtherapeutic levels. Simply increasing the dose without bridging leaves the
patient unprotected for days. No intervention is dangerous with a mechanical valve.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 3 of 51
, Q5 Question 5 of 100
A 45-year-old man with hypertension presents with a blood pressure of 182/110 mmHg, severe
headache, and blurred vision. Which term best describes his condition and what is the priority
treatment?
A. Hypertensive emergency; lower BP by no more than 25% in the first hour with IV antihypertensives
B. Hypertensive urgency; lower BP gradually over 24-48 hours with oral medications
C. Primary hypertension; start lifestyle modifications
D. White coat hypertension; reassess in one week
Correct Answer: A
Rationale:
Severe hypertension with end-organ damage (blurred vision suggests retinal changes, severe headache suggests
cerebral involvement) constitutes a hypertensive emergency requiring IV antihypertensives with controlled BP
reduction. Hypertensive urgency lacks acute end-organ damage. Lifestyle modifications are insufficient. Delayed
reassessment is dangerous.
Q6 Question 6 of 100
A 58-year-old man undergoes cardiac catheterization showing 90% occlusion of the left anterior
descending artery. He is scheduled for PCI with stent placement. Which medication must be
administered before the procedure to prevent stent thrombosis?
A. Dual antiplatelet therapy with aspirin and clopidogrel
B. Warfarin
C. Heparin alone
D. Alteplase
Correct Answer: A
Rationale:
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel) is mandatory before and after stent
placement to prevent stent thrombosis. Warfarin is not used for stent prophylaxis. Heparin alone is insufficient for
long-term prevention. Alteplase is a thrombolytic for acute MI, not for stent prophylaxis.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 4 of 51
2026/2027 | Page 1 | Passing Score: 85%
NIGHTINGALE COLLEGE
BSN 266 HESI Med Surg Exam Version 2 (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 Cardiovascular and Hematologic Disorders Q1-20
Section 2 Respiratory and Thoracic Disorders Q21-40
Section 3 Gastrointestinal and Hepatobiliary Disorders Q41-60
Section 4 Neurological and Musculoskeletal Disorders Q61-80
Section 5 Renal, Endocrine, and Immune Disorders Q81-100
Instructions: Select the single best answer for each question. This exam is designed for BSN 266 HESI Med Surg Exam Version 2
preparation. Passing score: 85% (85 questions correct).
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 1 of 51
, SECTION 1 | Cardiovascular and Hematologic Disorders | Q1-Q20 | BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update)
Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027 2026/2027
Q1 Question 1 of 100
A 68-year-old man presents to the emergency department with crushing substernal chest pain
radiating to his left arm, diaphoresis, and nausea that began 45 minutes ago. His ECG shows
ST-segment elevation in leads V2 through V4. Which intervention is the highest priority?
A. Initiate reperfusion therapy with percutaneous coronary intervention
B. Administer morphine sulfate for pain
C. Obtain a chest X-ray
D. Start a beta-blocker immediately
Correct Answer: A
Rationale:
ST-elevation myocardial infarction requires immediate reperfusion therapy, and PCI within 90 minutes is the gold
standard. While morphine and beta-blockers are part of the treatment protocol, restoring blood flow to the
ischemic myocardium takes priority. A chest X-ray does not change acute management.
Q2 Question 2 of 100
A 55-year-old woman with a history of atrial fibrillation is taking warfarin 5 mg daily. Her INR today
is 3.8 with a therapeutic goal of 2.0-3.0. She has no signs of bleeding. Which action is most
appropriate?
A. Hold the next dose of warfarin and recheck INR in 24-48 hours
B. Administer vitamin K immediately
C. Increase the warfarin dose
D. Discharge with no changes to medication
Correct Answer: A
Rationale:
An INR of 3.8 is above the therapeutic range but without bleeding. Holding the next dose and rechecking in 24-48
hours is the standard approach. Vitamin K is reserved for significantly elevated INR with active bleeding.
Increasing the dose would worsen the situation. No changes would be inappropriate given the supratherapeutic
level.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 2 of 51
, Q3 Question 3 of 100
A 72-year-old man is admitted with acute decompensated heart failure. He has crackles bilaterally,
JVD, and 3+ pitting edema in both lower extremities. His BNP level is 1,800 pg/mL. Which
medication should be administered first?
A. Furosemide IV push
B. Metoprolol succinate
C. Digoxin
D. Lisinopril
Correct Answer: A
Rationale:
Acute decompensated heart failure with pulmonary congestion and volume overload requires immediate diuresis
with IV furosemide as the first-line intervention. Beta-blockers like metoprolol are contraindicated in acute
decompensation. Digoxin is for rate control in atrial fibrillation or mild exacerbations. ACE inhibitors are initiated
after stabilization.
Q4 Question 4 of 100
A 60-year-old woman with a mechanical mitral valve replacement is found to have an INR of 1.5
with a goal of 2.5-3.5. She reports missing several doses of warfarin. Which intervention is most
appropriate?
A. Administer fresh frozen plasma
B. Increase the warfarin dose and recheck INR in one week
C. Resume warfarin at the prescribed dose and consider a bridge with low-molecular-weight heparin
D. No intervention needed as INR is close to goal
Correct Answer: C
Rationale:
A subtherapeutic INR with a mechanical valve carries a high risk of thromboembolism. Resuming warfarin at the
prescribed dose with LMWH bridging is the appropriate approach to rapidly restore anticoagulation. FFP is for
reversing anticoagulation, not for subtherapeutic levels. Simply increasing the dose without bridging leaves the
patient unprotected for days. No intervention is dangerous with a mechanical valve.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 3 of 51
, Q5 Question 5 of 100
A 45-year-old man with hypertension presents with a blood pressure of 182/110 mmHg, severe
headache, and blurred vision. Which term best describes his condition and what is the priority
treatment?
A. Hypertensive emergency; lower BP by no more than 25% in the first hour with IV antihypertensives
B. Hypertensive urgency; lower BP gradually over 24-48 hours with oral medications
C. Primary hypertension; start lifestyle modifications
D. White coat hypertension; reassess in one week
Correct Answer: A
Rationale:
Severe hypertension with end-organ damage (blurred vision suggests retinal changes, severe headache suggests
cerebral involvement) constitutes a hypertensive emergency requiring IV antihypertensives with controlled BP
reduction. Hypertensive urgency lacks acute end-organ damage. Lifestyle modifications are insufficient. Delayed
reassessment is dangerous.
Q6 Question 6 of 100
A 58-year-old man undergoes cardiac catheterization showing 90% occlusion of the left anterior
descending artery. He is scheduled for PCI with stent placement. Which medication must be
administered before the procedure to prevent stent thrombosis?
A. Dual antiplatelet therapy with aspirin and clopidogrel
B. Warfarin
C. Heparin alone
D. Alteplase
Correct Answer: A
Rationale:
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel) is mandatory before and after stent
placement to prevent stent thrombosis. Warfarin is not used for stent prophylaxis. Heparin alone is insufficient for
long-term prevention. Alteplase is a thrombolytic for acute MI, not for stent prophylaxis.
BSN 266 HESI Med Surg Exam Version 2 (2026/2027 Update) Questions and Verified Answers with Rationales|100% Correct| Grade A- Nightingale 2026/2027
2026/2027 | Passing Score: 85% | Page 4 of 51
