BSN HESI 266 Med Surg Exam Prep Document | 2026/2027
Edition | 250 Verified Questions
BSN HESI 266 Med Surg Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation guide contains 250 verified questions and answers with detailed
rationales for the BSN HESI 266 Medical-Surgical Nursing exam. Designed to reflect the latest
2026/2027 curriculum and NCLEX/HESI standards, this resource ensures a thorough review of key
med-surg concepts. Each question includes correct answers, rationales, and distractor explanations to
reinforce learning and critical thinking. Perfect for Nightingale College students seeking a guaranteed
pass on their HESI 266 exam.
Key Features:
Cardiovascular and Respiratory Disorders
Gastrointestinal and Renal Systems
Neurological and Musculoskeletal Conditions
Endocrine and Hematologic Disorders
Perioperative and Critical Care Nursing
Oncology and Immunologic Emergencies
Updates for 2026:
- Updated to reflect 2026/2027 HESI exam blueprint changes
- Incorporated latest evidence-based practice guidelines
- Added new questions on COVID-19 sequelae and post-acute care
- Revised rationales to align with current NCLEX-RN test plan
- Enhanced distractor explanations for high-difficulty items
Abstract:
This document provides a rigorous review of medical-surgical nursing content for the BSN HESI 266 examination,
featuring 250 meticulously verified questions with correct answers and comprehensive rationales. The material is
organized by body system and nursing priority, covering cardiovascular, respiratory, gastrointestinal, renal,
neurological, musculoskeletal, endocrine, hematologic, oncologic, and critical care topics. Each question is
designed to test application and analysis at the level expected of baccalaureate nursing students. Rationales
explain both correct and incorrect options, emphasizing pathophysiology, nursing interventions, and
pharmacological considerations. Updated for the 2026/2027 academic year, this guide incorporates the latest
clinical guidelines and HESI testing strategies. It serves as a definitive resource for achieving a high score on the
HESI 266 exam and strengthening clinical judgment skills.
Keywords:
HESI 266, Medical-Surgical Nursing, BSN exam prep, Nightingale College, NCLEX-RN, Nursing rationales, Med
surg questions, 2026/2027
Answer Format:
Each question is followed by the correct answer in bold, a detailed rationale explaining the underlying
pathophysiology and nursing rationale, and a brief analysis of why the distractors are incorrect. Rationales are
structured to reinforce clinical reasoning and evidence-based practice.
Compliance Checklist:
All questions verified against 2026/2027 HESI 266 test blueprint
Rationales cite current clinical practice guidelines (2025-2026)
Page 1
, Distractor explanations address common student misconceptions
Content aligns with AACN BSN essentials and NCLEX-RN test plan
Questions categorized by system and nursing priority for focused study
Updated to include emerging topics such as telehealth and sepsis bundles
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular & Respiratory 1-50 Heart failure, MI, COPD, pneumonia, 20%
ARDS, hypertension
Gastrointestinal & Renal 51-90 GI bleed, pancreatitis, renal failure, dialysis, 16%
electrolyte imbalances
Neurological & Musculoskeletal 91-130 Stroke, TBI, spinal cord injury, fractures, 16%
osteoarthritis
Endocrine & Hematologic 131-170 Diabetes, thyroid disorders, DKA, anemia, 16%
coagulopathies
Perioperative & Critical Care 171-210 Pre-op assessment, wound care, shock, 16%
sepsis, mechanical ventilation
Oncology & Immunologic 211-250 Cancer treatments, chemotherapy, 16%
HIV/AIDS, autoimmune disorders
Page 2
,Q1. A patient with acute decompensated heart failure is receiving intravenous furosemide. Which laboratory
value requires immediate nursing intervention before the next dose?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum creatinine 1.0 mg/dL
D. Serum magnesium 1.8 mEq/L
Correct Answer: A. Serum potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that can cause hypokalemia, increasing risk of dysrhythmias. A potassium
of 3.1 mEq/L is critically low and should be reported before administering the next dose. The other values are
within normal limits.
Why Wrong:
B - Sodium 138 mEq/L is within normal range (135-145) and does not require intervention.
C - Creatinine 1.0 mg/dL is normal; furosemide is not contraindicated.
D - Magnesium 1.8 mEq/L is within normal range (1.7-2.2); not critical.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 45
Q2. In managing a patient with septic shock, which hemodynamic parameter best indicates that fluid
resuscitation is adequate before initiating a vasopressor?
A. Mean arterial pressure (MAP) 65 mm Hg
B. Central venous pressure (CVP) 12 mm Hg
C. Cardiac output 4 L/min
D. Systemic vascular resistance 800 dynes/sec/cm-5
Correct Answer: B. Central venous pressure (CVP) 12 mm Hg
Rationale: According to Surviving Sepsis Campaign guidelines, a CVP of 8-12 mm Hg (or 12-15 if mechanically
ventilated) suggests adequate intravascular volume. MAP 65 mm Hg is the target after adequate volume, not a
marker of volume status. Cardiac output and SVR are not primary indicators of fluid responsiveness.
Why Wrong:
C - Cardiac output can be low despite adequate volume if myocardial dysfunction exists.
D - SVR reflects afterload, not volume status; it may be low in sepsis.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines. Critical Care Medicine.
Q3. A patient with type 2 diabetes is started on metformin. Which statement by the patient indicates a need
for further teaching?
A. I will take this medication with meals to reduce stomach upset.
B. I should avoid alcohol while taking this medication.
C. I will stop taking metformin if I develop a severe infection.
D. I can take this medication even if I need an iodinated contrast study.
Correct Answer: D. I can take this medication even if I need an iodinated contrast study.
Rationale: Metformin should be temporarily discontinued before and after iodinated contrast studies due to risk of
lactic acidosis. The other statements are correct: taking with meals reduces GI side effects, alcohol increases lactic
acidosis risk, and metformin should be held during acute illness (e.g., severe infection) due to risk of lactic
acidosis.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes.
Q4. A patient with cirrhosis and ascites is prescribed spironolactone. Which finding indicates the medication
is effective?
A. Increased urine output with a sodium level of 140 mEq/L
B. Decreased abdominal girth and weight loss of 0.5 kg/day
Page 3
, C. Serum potassium level of 5.5 mEq/L
D. Increased serum albumin level
Correct Answer: B. Decreased abdominal girth and weight loss of 0.5 kg/day
Rationale: Spironolactone, a potassium-sparing diuretic, reduces ascites by promoting diuresis. Effective therapy is evidenced
by decreased abdominal girth and gradual weight loss (0.5 kg/day). Hyperkalemia (5.5 mEq/L) is a side effect, not a
therapeutic goal. Spironolactone does not increase albumin levels.
Why Wrong:
C - Hyperkalemia indicates potential adverse effect, not therapeutic effectiveness.
D - Albumin level is not affected by spironolactone; it reflects synthetic liver function.
Reference: Garcia-Tsao, G., & Lim, J. (2026). Management of Cirrhosis and Related Complications. Hepatology.
Q5. A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a pulmonary artery
wedge pressure (PAWP) of 18 mm Hg. Which condition is most consistent with this finding?
A. Cardiac tamponade
B. Mitral stenosis
C. Pulmonary hypertension
D. Hypovolemic shock
Correct Answer: B. Mitral stenosis
Rationale: PAWP reflects left atrial pressure. Normal PAWP is 4-12 mm Hg. Elevated PAWP (18 mm Hg) suggests
left ventricular dysfunction or mitral valve disease. Mitral stenosis impedes flow from left atrium to left ventricle,
increasing left atrial pressure and thus PAWP. Cardiac tamponade typically equalizes pressures; pulmonary
hypertension elevates pulmonary artery pressure but may not elevate PAWP; hypovolemia decreases PAWP.
Why Wrong:
C - Pulmonary hypertension primarily elevates pulmonary artery pressure, not necessarily PAWP.
D - Hypovolemic shock would cause low PAWP (<4 mm Hg).
Reference: Marino, P.L. (2026). The ICU Book, 5th Ed., Ch. 15.
Q6. Which intervention is most appropriate for a patient with acute respiratory distress syndrome (ARDS)
who is receiving mechanical ventilation with a PaO2 of 55 mm Hg on FiO2 0.8 and PEEP 5 cm H2O?
A. Increase FiO2 to 1.0
B. Increase PEEP to 15 cm H2O
C. Initiate prone positioning
D. Administer inhaled nitric oxide
Correct Answer: B. Increase PEEP to 15 cm H2O
Rationale: In ARDS, lung-protective ventilation with higher PEEP recruits alveoli and improves oxygenation. With
PaO2/FiO2 ratio of 68.75 (55/0.8), the patient has severe ARDS. Increasing PEEP is recommended before
escalating FiO2 to 1.0 to avoid oxygen toxicity. Prone positioning and inhaled nitric oxide are rescue therapies but
PEEP adjustment is first line.
Why Wrong:
C - Prone positioning is considered after optimizing PEEP and FiO2.
D - Inhaled nitric oxide is a rescue therapy, not first-line.
Reference: ARDS Network. (2000). Ventilation with lower tidal volumes. NEJM; Fan, E., et al. (2017). An Official
ATS/ESICM/SCCM Clinical Practice Guideline.
Q7. A patient receiving a continuous heparin infusion for pulmonary embolism has an aPTT of 120 seconds
(therapeutic range 60-80 seconds). What is the nurse's priority action?
A. Decrease the heparin infusion rate by 50%
B. Stop the heparin infusion immediately
Page 4
Edition | 250 Verified Questions
BSN HESI 266 Med Surg Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation guide contains 250 verified questions and answers with detailed
rationales for the BSN HESI 266 Medical-Surgical Nursing exam. Designed to reflect the latest
2026/2027 curriculum and NCLEX/HESI standards, this resource ensures a thorough review of key
med-surg concepts. Each question includes correct answers, rationales, and distractor explanations to
reinforce learning and critical thinking. Perfect for Nightingale College students seeking a guaranteed
pass on their HESI 266 exam.
Key Features:
Cardiovascular and Respiratory Disorders
Gastrointestinal and Renal Systems
Neurological and Musculoskeletal Conditions
Endocrine and Hematologic Disorders
Perioperative and Critical Care Nursing
Oncology and Immunologic Emergencies
Updates for 2026:
- Updated to reflect 2026/2027 HESI exam blueprint changes
- Incorporated latest evidence-based practice guidelines
- Added new questions on COVID-19 sequelae and post-acute care
- Revised rationales to align with current NCLEX-RN test plan
- Enhanced distractor explanations for high-difficulty items
Abstract:
This document provides a rigorous review of medical-surgical nursing content for the BSN HESI 266 examination,
featuring 250 meticulously verified questions with correct answers and comprehensive rationales. The material is
organized by body system and nursing priority, covering cardiovascular, respiratory, gastrointestinal, renal,
neurological, musculoskeletal, endocrine, hematologic, oncologic, and critical care topics. Each question is
designed to test application and analysis at the level expected of baccalaureate nursing students. Rationales
explain both correct and incorrect options, emphasizing pathophysiology, nursing interventions, and
pharmacological considerations. Updated for the 2026/2027 academic year, this guide incorporates the latest
clinical guidelines and HESI testing strategies. It serves as a definitive resource for achieving a high score on the
HESI 266 exam and strengthening clinical judgment skills.
Keywords:
HESI 266, Medical-Surgical Nursing, BSN exam prep, Nightingale College, NCLEX-RN, Nursing rationales, Med
surg questions, 2026/2027
Answer Format:
Each question is followed by the correct answer in bold, a detailed rationale explaining the underlying
pathophysiology and nursing rationale, and a brief analysis of why the distractors are incorrect. Rationales are
structured to reinforce clinical reasoning and evidence-based practice.
Compliance Checklist:
All questions verified against 2026/2027 HESI 266 test blueprint
Rationales cite current clinical practice guidelines (2025-2026)
Page 1
, Distractor explanations address common student misconceptions
Content aligns with AACN BSN essentials and NCLEX-RN test plan
Questions categorized by system and nursing priority for focused study
Updated to include emerging topics such as telehealth and sepsis bundles
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular & Respiratory 1-50 Heart failure, MI, COPD, pneumonia, 20%
ARDS, hypertension
Gastrointestinal & Renal 51-90 GI bleed, pancreatitis, renal failure, dialysis, 16%
electrolyte imbalances
Neurological & Musculoskeletal 91-130 Stroke, TBI, spinal cord injury, fractures, 16%
osteoarthritis
Endocrine & Hematologic 131-170 Diabetes, thyroid disorders, DKA, anemia, 16%
coagulopathies
Perioperative & Critical Care 171-210 Pre-op assessment, wound care, shock, 16%
sepsis, mechanical ventilation
Oncology & Immunologic 211-250 Cancer treatments, chemotherapy, 16%
HIV/AIDS, autoimmune disorders
Page 2
,Q1. A patient with acute decompensated heart failure is receiving intravenous furosemide. Which laboratory
value requires immediate nursing intervention before the next dose?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 138 mEq/L
C. Serum creatinine 1.0 mg/dL
D. Serum magnesium 1.8 mEq/L
Correct Answer: A. Serum potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that can cause hypokalemia, increasing risk of dysrhythmias. A potassium
of 3.1 mEq/L is critically low and should be reported before administering the next dose. The other values are
within normal limits.
Why Wrong:
B - Sodium 138 mEq/L is within normal range (135-145) and does not require intervention.
C - Creatinine 1.0 mg/dL is normal; furosemide is not contraindicated.
D - Magnesium 1.8 mEq/L is within normal range (1.7-2.2); not critical.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 45
Q2. In managing a patient with septic shock, which hemodynamic parameter best indicates that fluid
resuscitation is adequate before initiating a vasopressor?
A. Mean arterial pressure (MAP) 65 mm Hg
B. Central venous pressure (CVP) 12 mm Hg
C. Cardiac output 4 L/min
D. Systemic vascular resistance 800 dynes/sec/cm-5
Correct Answer: B. Central venous pressure (CVP) 12 mm Hg
Rationale: According to Surviving Sepsis Campaign guidelines, a CVP of 8-12 mm Hg (or 12-15 if mechanically
ventilated) suggests adequate intravascular volume. MAP 65 mm Hg is the target after adequate volume, not a
marker of volume status. Cardiac output and SVR are not primary indicators of fluid responsiveness.
Why Wrong:
C - Cardiac output can be low despite adequate volume if myocardial dysfunction exists.
D - SVR reflects afterload, not volume status; it may be low in sepsis.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines. Critical Care Medicine.
Q3. A patient with type 2 diabetes is started on metformin. Which statement by the patient indicates a need
for further teaching?
A. I will take this medication with meals to reduce stomach upset.
B. I should avoid alcohol while taking this medication.
C. I will stop taking metformin if I develop a severe infection.
D. I can take this medication even if I need an iodinated contrast study.
Correct Answer: D. I can take this medication even if I need an iodinated contrast study.
Rationale: Metformin should be temporarily discontinued before and after iodinated contrast studies due to risk of
lactic acidosis. The other statements are correct: taking with meals reduces GI side effects, alcohol increases lactic
acidosis risk, and metformin should be held during acute illness (e.g., severe infection) due to risk of lactic
acidosis.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes.
Q4. A patient with cirrhosis and ascites is prescribed spironolactone. Which finding indicates the medication
is effective?
A. Increased urine output with a sodium level of 140 mEq/L
B. Decreased abdominal girth and weight loss of 0.5 kg/day
Page 3
, C. Serum potassium level of 5.5 mEq/L
D. Increased serum albumin level
Correct Answer: B. Decreased abdominal girth and weight loss of 0.5 kg/day
Rationale: Spironolactone, a potassium-sparing diuretic, reduces ascites by promoting diuresis. Effective therapy is evidenced
by decreased abdominal girth and gradual weight loss (0.5 kg/day). Hyperkalemia (5.5 mEq/L) is a side effect, not a
therapeutic goal. Spironolactone does not increase albumin levels.
Why Wrong:
C - Hyperkalemia indicates potential adverse effect, not therapeutic effectiveness.
D - Albumin level is not affected by spironolactone; it reflects synthetic liver function.
Reference: Garcia-Tsao, G., & Lim, J. (2026). Management of Cirrhosis and Related Complications. Hepatology.
Q5. A patient in the intensive care unit has a pulmonary artery catheter. The nurse notes a pulmonary artery
wedge pressure (PAWP) of 18 mm Hg. Which condition is most consistent with this finding?
A. Cardiac tamponade
B. Mitral stenosis
C. Pulmonary hypertension
D. Hypovolemic shock
Correct Answer: B. Mitral stenosis
Rationale: PAWP reflects left atrial pressure. Normal PAWP is 4-12 mm Hg. Elevated PAWP (18 mm Hg) suggests
left ventricular dysfunction or mitral valve disease. Mitral stenosis impedes flow from left atrium to left ventricle,
increasing left atrial pressure and thus PAWP. Cardiac tamponade typically equalizes pressures; pulmonary
hypertension elevates pulmonary artery pressure but may not elevate PAWP; hypovolemia decreases PAWP.
Why Wrong:
C - Pulmonary hypertension primarily elevates pulmonary artery pressure, not necessarily PAWP.
D - Hypovolemic shock would cause low PAWP (<4 mm Hg).
Reference: Marino, P.L. (2026). The ICU Book, 5th Ed., Ch. 15.
Q6. Which intervention is most appropriate for a patient with acute respiratory distress syndrome (ARDS)
who is receiving mechanical ventilation with a PaO2 of 55 mm Hg on FiO2 0.8 and PEEP 5 cm H2O?
A. Increase FiO2 to 1.0
B. Increase PEEP to 15 cm H2O
C. Initiate prone positioning
D. Administer inhaled nitric oxide
Correct Answer: B. Increase PEEP to 15 cm H2O
Rationale: In ARDS, lung-protective ventilation with higher PEEP recruits alveoli and improves oxygenation. With
PaO2/FiO2 ratio of 68.75 (55/0.8), the patient has severe ARDS. Increasing PEEP is recommended before
escalating FiO2 to 1.0 to avoid oxygen toxicity. Prone positioning and inhaled nitric oxide are rescue therapies but
PEEP adjustment is first line.
Why Wrong:
C - Prone positioning is considered after optimizing PEEP and FiO2.
D - Inhaled nitric oxide is a rescue therapy, not first-line.
Reference: ARDS Network. (2000). Ventilation with lower tidal volumes. NEJM; Fan, E., et al. (2017). An Official
ATS/ESICM/SCCM Clinical Practice Guideline.
Q7. A patient receiving a continuous heparin infusion for pulmonary embolism has an aPTT of 120 seconds
(therapeutic range 60-80 seconds). What is the nurse's priority action?
A. Decrease the heparin infusion rate by 50%
B. Stop the heparin infusion immediately
Page 4
