BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
Cardiovascular System (Questions 1–18)
1. A client with acute decompensated heart failure has jugular venous distention, crackles in all lung fields,
and an oxygen saturation of 88% on room air. Which intervention should the nurse implement first?
a) Administer furosemide IV push
b) Place the client in high-Fowler’s position
c) Start dopamine drip per protocol
d) Obtain a stat chest x-ray
2. A nurse is monitoring a client 2 hours after a percutaneous coronary intervention (PCI) via the femoral
artery. Which finding requires immediate action?
a) Blood pressure 118/72 mm Hg
b) Pulse oximetry 94% on room air
c) Expanding hematoma in the groin
d) Urine output 40 mL/hour
3. Select all that apply: A client with unstable angina is started on nitroglycerin IV. Which findings indicate a
therapeutic response?
Chest pain decreased from 7/10 to 2/10
Blood pressure 85/50 mm Hg
ST-segment elevation resolves on telemetry
Headache reported
Heart rate 110 bpm
4. A client with chronic hypertension presents with a blood pressure of 210/120 mm Hg, severe headache, and
blurred vision. The nurse suspects hypertensive emergency. Which medication is most appropriate initially?
a) Metoprolol PO
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
b) Nitroprusside IV
c) Lisinopril PO
d) Hydrochlorothiazide PO
5. A client with peripheral artery disease (PAD) reports calf pain when walking that resolves with rest. Which
teaching is most important?
a) Elevate legs above heart when resting
b) Apply heat to legs for 20 minutes three times daily
c) Walk to the point of pain, rest, then resume walking
d) Wear compression stockings during the day
6. A client’s telemetry shows a regular rhythm with a heart rate of 42 bpm, no visible P waves, and wide QRS
complexes. Which intervention should the nurse anticipate?
a) Atropine 0.5 mg IV push
b) Transcutaneous pacing
c) Amiodarone 150 mg IV over 10 minutes
d) Adenosine 6 mg rapid IV push
7. Ordered response: The nurse is caring for a client with an acute myocardial infarction being transferred for
primary PCI. Place the following actions in the correct priority order (1=first, 4=last):
1 – Administer chewable aspirin 324 mg
2 – Obtain 12-lead ECG
3 – Start IV access
4 – Give morphine 2 mg IV for chest pain unrelieved by nitroglycerin
8. A client with heart failure has a brain natriuretic peptide (BNP) level of 1200 pg/mL. The nurse correlates
this with which finding?
a) Dehydration
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
b) Fluid volume overload
c) Acute kidney injury
d) Severe anemia
9. SATA: Which clients are at highest risk for developing infective endocarditis?
Client with mitral valve prolapse without regurgitation
Client with a mechanical aortic valve
Client with a history of IV drug use
Client with hypertrophic cardiomyopathy
Client with recent dental extraction without prophylaxis
10. A client after cardiac catheterization has a right groin hematoma. The nurse auscultates a bruit over the
site. What is the priority action?
a) Apply sandbag to groin for 4 hours
b) Notify the provider of possible pseudoaneurysm
c) Encourage bed rest for another 2 hours
d) Apply cold compress to site
11. The nurse is administering IV furosemide to a client with acute heart failure. Which assessment finding
warrants holding the dose?
a) Urine output 140 mL in last 2 hours
b) Potassium 3.8 mEq/L
c) Blood pressure 82/46 mm Hg
d) Mild headache
12. A client with atrial fibrillation on warfarin has an INR of 4.8. No bleeding is present. The nurse anticipates
which order?
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
a) Hold warfarin and give vitamin K 2.5 mg PO
b) Administer fresh frozen plasma
c) Increase warfarin dose
d) Give protamine sulfate IV
13. SATA: A client with left ventricular assist device (LVAD) is being discharged. Which teaching points are
essential?
Avoid checking blood pressure by manual cuff
Do not sleep on the side with the driveline exit site
Notify provider if low-flow alarms occur
Pumping sensation in chest indicates malfunction
Keep extra controller and batteries at bedside
14. A client’s telemetry shows torsades de pointes. The client is unresponsive with no pulse. After
defibrillation, the nurse should prepare to give:
a) Amiodarone 300 mg IV push
b) Magnesium sulfate 2 g IV push
c) Epinephrine 1 mg IV push
d) Lidocaine 100 mg IV push
15. A client with severe aortic stenosis is scheduled for valve replacement. Preoperatively, the nurse avoids
administering which medication?
a) Fentanyl for pain
b) Metoprolol for rate control
c) Nitroglycerin for chest pain
d) Cefazolin antibiotic prophylaxis
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
Cardiovascular System (Questions 1–18)
1. A client with acute decompensated heart failure has jugular venous distention, crackles in all lung fields,
and an oxygen saturation of 88% on room air. Which intervention should the nurse implement first?
a) Administer furosemide IV push
b) Place the client in high-Fowler’s position
c) Start dopamine drip per protocol
d) Obtain a stat chest x-ray
2. A nurse is monitoring a client 2 hours after a percutaneous coronary intervention (PCI) via the femoral
artery. Which finding requires immediate action?
a) Blood pressure 118/72 mm Hg
b) Pulse oximetry 94% on room air
c) Expanding hematoma in the groin
d) Urine output 40 mL/hour
3. Select all that apply: A client with unstable angina is started on nitroglycerin IV. Which findings indicate a
therapeutic response?
Chest pain decreased from 7/10 to 2/10
Blood pressure 85/50 mm Hg
ST-segment elevation resolves on telemetry
Headache reported
Heart rate 110 bpm
4. A client with chronic hypertension presents with a blood pressure of 210/120 mm Hg, severe headache, and
blurred vision. The nurse suspects hypertensive emergency. Which medication is most appropriate initially?
a) Metoprolol PO
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
b) Nitroprusside IV
c) Lisinopril PO
d) Hydrochlorothiazide PO
5. A client with peripheral artery disease (PAD) reports calf pain when walking that resolves with rest. Which
teaching is most important?
a) Elevate legs above heart when resting
b) Apply heat to legs for 20 minutes three times daily
c) Walk to the point of pain, rest, then resume walking
d) Wear compression stockings during the day
6. A client’s telemetry shows a regular rhythm with a heart rate of 42 bpm, no visible P waves, and wide QRS
complexes. Which intervention should the nurse anticipate?
a) Atropine 0.5 mg IV push
b) Transcutaneous pacing
c) Amiodarone 150 mg IV over 10 minutes
d) Adenosine 6 mg rapid IV push
7. Ordered response: The nurse is caring for a client with an acute myocardial infarction being transferred for
primary PCI. Place the following actions in the correct priority order (1=first, 4=last):
1 – Administer chewable aspirin 324 mg
2 – Obtain 12-lead ECG
3 – Start IV access
4 – Give morphine 2 mg IV for chest pain unrelieved by nitroglycerin
8. A client with heart failure has a brain natriuretic peptide (BNP) level of 1200 pg/mL. The nurse correlates
this with which finding?
a) Dehydration
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
b) Fluid volume overload
c) Acute kidney injury
d) Severe anemia
9. SATA: Which clients are at highest risk for developing infective endocarditis?
Client with mitral valve prolapse without regurgitation
Client with a mechanical aortic valve
Client with a history of IV drug use
Client with hypertrophic cardiomyopathy
Client with recent dental extraction without prophylaxis
10. A client after cardiac catheterization has a right groin hematoma. The nurse auscultates a bruit over the
site. What is the priority action?
a) Apply sandbag to groin for 4 hours
b) Notify the provider of possible pseudoaneurysm
c) Encourage bed rest for another 2 hours
d) Apply cold compress to site
11. The nurse is administering IV furosemide to a client with acute heart failure. Which assessment finding
warrants holding the dose?
a) Urine output 140 mL in last 2 hours
b) Potassium 3.8 mEq/L
c) Blood pressure 82/46 mm Hg
d) Mild headache
12. A client with atrial fibrillation on warfarin has an INR of 4.8. No bleeding is present. The nurse anticipates
which order?
, BSN HESI 266 MED-SURG V2 EXAM ACTUAL EXAM 2026/2027 | MOST
TESTED | NIGHTINGALE COLLEGE CURRICULUM | REAL EXAM
SIMULATION | 120 REAL QUESTIONS | PASS GUARANTEED - GRADED A+
a) Hold warfarin and give vitamin K 2.5 mg PO
b) Administer fresh frozen plasma
c) Increase warfarin dose
d) Give protamine sulfate IV
13. SATA: A client with left ventricular assist device (LVAD) is being discharged. Which teaching points are
essential?
Avoid checking blood pressure by manual cuff
Do not sleep on the side with the driveline exit site
Notify provider if low-flow alarms occur
Pumping sensation in chest indicates malfunction
Keep extra controller and batteries at bedside
14. A client’s telemetry shows torsades de pointes. The client is unresponsive with no pulse. After
defibrillation, the nurse should prepare to give:
a) Amiodarone 300 mg IV push
b) Magnesium sulfate 2 g IV push
c) Epinephrine 1 mg IV push
d) Lidocaine 100 mg IV push
15. A client with severe aortic stenosis is scheduled for valve replacement. Preoperatively, the nurse avoids
administering which medication?
a) Fentanyl for pain
b) Metoprolol for rate control
c) Nitroglycerin for chest pain
d) Cefazolin antibiotic prophylaxis
