BSN 266 HESI Med Surg Exam Version 2
Actual Exam 2026/2027 – Complete
Exam-Style Questions | Detailed
Rationales – Pass Guaranteed – A+
Graded
Q1. A male client with heart failure (HF) calls the clinic and reports
that he cannot put his shoes on because they are too tight. Which
additional information should the nurse obtain?
• A) What time did he take his last medications?
• B) Has his weight changed in the last several days?
• C) Is he still able to tighten his belt buckle?
• D) How many hours did he sleep last night?
Correct ,,,answer,,,,: B) Has his weight changed in the last several
days?
Rationale: Difficulty putting on shoes due to tightness indicates
peripheral edema, a sign of fluid volume overload in heart failure.
Daily weight monitoring is the most reliable indicator of fluid
retention. Weight gain of 2-3 pounds in a day or 5 pounds in a week
warrants provider notification.
,Q2. A client is admitted to the medical intensive care unit with a
diagnosis of myocardial infarction. The client's history indicates the
infarction occurred ten hours ago. Which laboratory test result
would the nurse expect this client to exhibit?
• A) Elevated LDH
• B) Elevated serum amylase
• C) Elevated CK-MB
• D) Elevated hematocrit
Correct ,,,answer,,,,: C) Elevated CK-MB
Rationale: Troponin elevates within 2-3 hours, peaking at 12-24
hours. CK-MB elevates within 6-9 hours, peaking at 12-20 hours
after MI. At 10 hours post-MI, both troponin and CK-MB would be
elevated. LDH rises later and is less specific.
Q3. A client who underwent cardiac stent placement four days ago
arrives to the emergency department reporting a sudden onset of
chest pressure and shortness of breath. Which action should the
nurse take next?
• A) Administer prescribed nitroglycerin sublingually
• B) Obtain a 12-lead ECG
• C) Give oxygen at 2 L/min via nasal cannula
• D) Prepare the client for immediate cardiac catheterization
Correct ,,,answer,,,,: B) Obtain a 12-lead ECG
Rationale: A client with sudden chest pressure and shortness of
breath after recent stenting is at high risk for acute stent thrombosis
,or myocardial infarction. Immediate acquisition of a 12-lead ECG is
critical to assess for ischemic changes and to prioritize timely
reperfusion therapy.
Q4. A client is receiving warfarin for atrial fibrillation. The client's
INR is 3.8. What is the most appropriate nursing action?
• A) Administer vitamin K as ordered
• B) Hold the next dose of warfarin
• C) Administer the warfarin as prescribed
• D) Prepare for fresh frozen plasma transfusion
Correct ,,,answer,,,,: C) Administer the warfarin as prescribed
Rationale: For atrial fibrillation, the therapeutic INR goal is typically
2.0-3.0. An INR of 3.8 is slightly above target but not critically high
(critical is >4.5). The standard protocol is to hold the dose only if
INR >4.0 or if there is bleeding.
Q5. A client with chronic kidney disease has a potassium level of 6.2
mEq/L. Which ECG change is most concerning?
• A) Peaked T waves
• B) Widened QRS complex
• C) Prolonged PR interval
• D) Prominent U waves
Correct ,,,answer,,,,: B) Widened QRS complex
, Rationale: Hyperkalemia causes peaked T waves (early), then
widened QRS, prolonged PR, and eventually sine wave. Widened
QRS indicates imminent cardiac arrest risk and requires immediate
intervention including calcium gluconate.
Q6. A client presents with tearing chest pain radiating to the back,
blood pressure 160/90 in the right arm and 100/60 in the left arm.
What condition does the nurse suspect?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Correct ,,,answer,,,,: C) Aortic dissection
Rationale: Aortic dissection is characterized by sudden, severe,
tearing or ripping chest pain that may radiate to the back. A key sign
is a discrepancy in blood pressure between arms due to the
dissection affecting arterial flow to one subclavian artery.
Q7. A client with peripheral artery disease (PAD) reports leg pain
that starts after walking for 10 minutes and stops with rest. The
nurse documents this finding as:
• A) Rest pain
• B) Neuropathic pain
• C) Intermittent claudication
Actual Exam 2026/2027 – Complete
Exam-Style Questions | Detailed
Rationales – Pass Guaranteed – A+
Graded
Q1. A male client with heart failure (HF) calls the clinic and reports
that he cannot put his shoes on because they are too tight. Which
additional information should the nurse obtain?
• A) What time did he take his last medications?
• B) Has his weight changed in the last several days?
• C) Is he still able to tighten his belt buckle?
• D) How many hours did he sleep last night?
Correct ,,,answer,,,,: B) Has his weight changed in the last several
days?
Rationale: Difficulty putting on shoes due to tightness indicates
peripheral edema, a sign of fluid volume overload in heart failure.
Daily weight monitoring is the most reliable indicator of fluid
retention. Weight gain of 2-3 pounds in a day or 5 pounds in a week
warrants provider notification.
,Q2. A client is admitted to the medical intensive care unit with a
diagnosis of myocardial infarction. The client's history indicates the
infarction occurred ten hours ago. Which laboratory test result
would the nurse expect this client to exhibit?
• A) Elevated LDH
• B) Elevated serum amylase
• C) Elevated CK-MB
• D) Elevated hematocrit
Correct ,,,answer,,,,: C) Elevated CK-MB
Rationale: Troponin elevates within 2-3 hours, peaking at 12-24
hours. CK-MB elevates within 6-9 hours, peaking at 12-20 hours
after MI. At 10 hours post-MI, both troponin and CK-MB would be
elevated. LDH rises later and is less specific.
Q3. A client who underwent cardiac stent placement four days ago
arrives to the emergency department reporting a sudden onset of
chest pressure and shortness of breath. Which action should the
nurse take next?
• A) Administer prescribed nitroglycerin sublingually
• B) Obtain a 12-lead ECG
• C) Give oxygen at 2 L/min via nasal cannula
• D) Prepare the client for immediate cardiac catheterization
Correct ,,,answer,,,,: B) Obtain a 12-lead ECG
Rationale: A client with sudden chest pressure and shortness of
breath after recent stenting is at high risk for acute stent thrombosis
,or myocardial infarction. Immediate acquisition of a 12-lead ECG is
critical to assess for ischemic changes and to prioritize timely
reperfusion therapy.
Q4. A client is receiving warfarin for atrial fibrillation. The client's
INR is 3.8. What is the most appropriate nursing action?
• A) Administer vitamin K as ordered
• B) Hold the next dose of warfarin
• C) Administer the warfarin as prescribed
• D) Prepare for fresh frozen plasma transfusion
Correct ,,,answer,,,,: C) Administer the warfarin as prescribed
Rationale: For atrial fibrillation, the therapeutic INR goal is typically
2.0-3.0. An INR of 3.8 is slightly above target but not critically high
(critical is >4.5). The standard protocol is to hold the dose only if
INR >4.0 or if there is bleeding.
Q5. A client with chronic kidney disease has a potassium level of 6.2
mEq/L. Which ECG change is most concerning?
• A) Peaked T waves
• B) Widened QRS complex
• C) Prolonged PR interval
• D) Prominent U waves
Correct ,,,answer,,,,: B) Widened QRS complex
, Rationale: Hyperkalemia causes peaked T waves (early), then
widened QRS, prolonged PR, and eventually sine wave. Widened
QRS indicates imminent cardiac arrest risk and requires immediate
intervention including calcium gluconate.
Q6. A client presents with tearing chest pain radiating to the back,
blood pressure 160/90 in the right arm and 100/60 in the left arm.
What condition does the nurse suspect?
• A) Acute myocardial infarction
• B) Pulmonary embolism
• C) Aortic dissection
• D) Pericarditis
Correct ,,,answer,,,,: C) Aortic dissection
Rationale: Aortic dissection is characterized by sudden, severe,
tearing or ripping chest pain that may radiate to the back. A key sign
is a discrepancy in blood pressure between arms due to the
dissection affecting arterial flow to one subclavian artery.
Q7. A client with peripheral artery disease (PAD) reports leg pain
that starts after walking for 10 minutes and stops with rest. The
nurse documents this finding as:
• A) Rest pain
• B) Neuropathic pain
• C) Intermittent claudication
