BSN HESI 266
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266 Med Surg Exam
(2026/2027 Update) Questions &
Verified Answers, 100%
Guaranteed Pass || Complete A+
Guide - Nightingale
Medical-Surgical Nursing | Nightingale College
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Heart Failure & Cardiogenic Shock ManagementCOPD, Asthma & Mechanical Ventilation
Diabetes Mellitus, DKA & HHNS Stroke, Seizures & Increased Intracranial Pressure
Acute & Chronic Renal Failure / Dialysis GI Bleeding, Peptic Ulcer & Liver Disorders
COVER PAGE - 1
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, SECTION 1 | Cardiovascular & Hematologic | Q1-Q20 | BSN HESI 266 Med Surg Exam (2026/2027 Update) Questions
Q1 Question 1 of 100
A 68-year-old male is admitted with acute decompensated heart failure. He has
crackles in both lung bases, jugular venous distension at 8 cm, and 3+ pitting edema
in both lower extremities. His vital signs are BP 92/58 mmHg, HR 118 bpm, RR
28/min, SpO2 89% on room air. Which intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push.
B. Apply supplemental oxygen at 4 L/min via nasal cannula.
C. Insert an indwelling urinary catheter for strict intake and output monitoring.
D. Obtain a 12-lead ECG and notify the physician of the hypotension.
Correct Answer: B
Rationale:
The patient is hypoxemic with SpO2 89%, which is the most immediate life threat. Oxygenation takes
priority over diuresis, catheterization, or ECG acquisition per the ABC framework. Once oxygenation is
stabilized, the nurse can address fluid overload and hemodynamic status.
Q2 Question 2 of 100
A 54-year-old female with a history of atrial fibrillation is started on warfarin therapy.
Her INR is 2.8 on day 5 of therapy. She calls the clinic reporting dark, tarry stools and
mild epigastric discomfort. Which action should the nurse prioritize?
A. Instruct the patient to hold the next dose of warfarin and come to the clinic for an INR
recheck.
B. Reassure the patient that dark stools are an expected side effect of warfarin and no action is
needed.
C. Tell the patient to take an over-the-counter antacid and continue warfarin as prescribed.
D. Advise the patient to increase her vitamin K intake by eating more green leafy vegetables.
Correct Answer: A
Rationale:
Dark tarry stools (melena) in a patient on warfarin with a therapeutic-high INR suggest gastrointestinal
bleeding, a serious adverse effect. The nurse should instruct the patient to hold the next dose and seek
immediate evaluation. Increasing vitamin K or dismissing the symptom could worsen bleeding.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, Q3 Question 3 of 100
A 72-year-old male post-MI day 3 is receiving heparin infusion per protocol. His
platelet count was 180,000/mcL on admission and is now 85,000/mcL. He reports new
onset of calf pain and swelling. Which condition should the nurse suspect?
A. Disseminated intravascular coagulation (DIC).
B. Heparin-induced thrombocytopenia (HIT).
C. Thrombotic thrombocytopenic purpura (TTP).
D. Immune thrombocytopenic purpura (ITP).
Correct Answer: B
Rationale:
A 50% or greater drop in platelet count during heparin therapy, combined with new thrombosis (calf
pain/swelling), is classic for heparin-induced thrombocytopenia (HIT). The heparin must be stopped
immediately and an alternative anticoagulant initiated. DIC would show prolonged PT/PTT and fibrin
degradation products.
Q4 Question 4 of 100
A 45-year-old male with severe anemia (Hgb 6.8 g/dL) is receiving a unit of packed
red blood cells. Fifteen minutes after starting the transfusion, he develops chills,
fever of 101.2 F, and back pain. The nurse stops the transfusion immediately. Which
is the most likely cause?
A. Acute hemolytic transfusion reaction due to ABO incompatibility.
B. Febrile non-hemolytic transfusion reaction.
C. Transfusion-related acute lung injury (TRALI).
D. Bacterial contamination of the blood product.
Correct Answer: A
Rationale:
Chills, fever, and back pain occurring within minutes of transfusion onset are the hallmark triad of an acute
hemolytic transfusion reaction, most commonly caused by ABO incompatibility. The nurse must stop the
transfusion immediately, maintain IV access with normal saline, and notify the blood bank and physician.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, Q5 Question 5 of 100
A 62-year-old female is admitted with chest pain and is diagnosed with an acute
anterior wall ST-elevation myocardial infarction (STEMI). She is scheduled for
primary percutaneous coronary intervention (PCI). Which medication should the
nurse administer before transfer to the cardiac catheterization lab?
A. Aspirin 325 mg chewable.
B. Clopidogrel 75 mg orally.
C. Atorvastatin 80 mg orally.
D. Metoprolol 25 mg orally.
Correct Answer: A
Rationale:
Aspirin is the cornerstone of antiplatelet therapy in acute STEMI and should be given as soon as possible,
ideally before PCI, unless the patient has a true aspirin allergy. A loading dose of 325 mg chewable is
preferred for rapid absorption. While other agents are important, aspirin is the priority pre-PCI medication.
Q6 Question 6 of 100
A 58-year-old male with heart failure is prescribed digoxin 0.25 mg daily. His most
recent laboratory results show serum potassium 3.1 mEq/L and serum digoxin level
1.8 ng/mL. He reports nausea and reports seeing yellow-green halos around lights.
Which nursing action is most appropriate?
A. Hold the next dose of digoxin and notify the physician of the hypokalemia and visual
changes.
B. Administer the digoxin as prescribed since the serum level is within therapeutic range.
C. Give the patient a potassium supplement and administer the digoxin as scheduled.
D. Reassure the patient that visual disturbances are a normal side effect of digoxin therapy.
Correct Answer: A
Rationale:
Hypokalemia potentiates digoxin toxicity even when serum digoxin levels appear therapeutic. Visual
disturbances (yellow-green halos) are a classic sign of digoxin toxicity. The nurse must hold the dose and
notify the physician immediately. Simply giving potassium without physician orders is outside the nurse's
scope.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
OBJECTIVE ASSESSMENT - EXAM
BSN HESI 266 Med Surg Exam
(2026/2027 Update) Questions &
Verified Answers, 100%
Guaranteed Pass || Complete A+
Guide - Nightingale
Medical-Surgical Nursing | Nightingale College
100 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Heart Failure & Cardiogenic Shock ManagementCOPD, Asthma & Mechanical Ventilation
Diabetes Mellitus, DKA & HHNS Stroke, Seizures & Increased Intracranial Pressure
Acute & Chronic Renal Failure / Dialysis GI Bleeding, Peptic Ulcer & Liver Disorders
COVER PAGE - 1
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, SECTION 1 | Cardiovascular & Hematologic | Q1-Q20 | BSN HESI 266 Med Surg Exam (2026/2027 Update) Questions
Q1 Question 1 of 100
A 68-year-old male is admitted with acute decompensated heart failure. He has
crackles in both lung bases, jugular venous distension at 8 cm, and 3+ pitting edema
in both lower extremities. His vital signs are BP 92/58 mmHg, HR 118 bpm, RR
28/min, SpO2 89% on room air. Which intervention should the nurse implement first?
A. Administer furosemide 40 mg IV push.
B. Apply supplemental oxygen at 4 L/min via nasal cannula.
C. Insert an indwelling urinary catheter for strict intake and output monitoring.
D. Obtain a 12-lead ECG and notify the physician of the hypotension.
Correct Answer: B
Rationale:
The patient is hypoxemic with SpO2 89%, which is the most immediate life threat. Oxygenation takes
priority over diuresis, catheterization, or ECG acquisition per the ABC framework. Once oxygenation is
stabilized, the nurse can address fluid overload and hemodynamic status.
Q2 Question 2 of 100
A 54-year-old female with a history of atrial fibrillation is started on warfarin therapy.
Her INR is 2.8 on day 5 of therapy. She calls the clinic reporting dark, tarry stools and
mild epigastric discomfort. Which action should the nurse prioritize?
A. Instruct the patient to hold the next dose of warfarin and come to the clinic for an INR
recheck.
B. Reassure the patient that dark stools are an expected side effect of warfarin and no action is
needed.
C. Tell the patient to take an over-the-counter antacid and continue warfarin as prescribed.
D. Advise the patient to increase her vitamin K intake by eating more green leafy vegetables.
Correct Answer: A
Rationale:
Dark tarry stools (melena) in a patient on warfarin with a therapeutic-high INR suggest gastrointestinal
bleeding, a serious adverse effect. The nurse should instruct the patient to hold the next dose and seek
immediate evaluation. Increasing vitamin K or dismissing the symptom could worsen bleeding.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, Q3 Question 3 of 100
A 72-year-old male post-MI day 3 is receiving heparin infusion per protocol. His
platelet count was 180,000/mcL on admission and is now 85,000/mcL. He reports new
onset of calf pain and swelling. Which condition should the nurse suspect?
A. Disseminated intravascular coagulation (DIC).
B. Heparin-induced thrombocytopenia (HIT).
C. Thrombotic thrombocytopenic purpura (TTP).
D. Immune thrombocytopenic purpura (ITP).
Correct Answer: B
Rationale:
A 50% or greater drop in platelet count during heparin therapy, combined with new thrombosis (calf
pain/swelling), is classic for heparin-induced thrombocytopenia (HIT). The heparin must be stopped
immediately and an alternative anticoagulant initiated. DIC would show prolonged PT/PTT and fibrin
degradation products.
Q4 Question 4 of 100
A 45-year-old male with severe anemia (Hgb 6.8 g/dL) is receiving a unit of packed
red blood cells. Fifteen minutes after starting the transfusion, he develops chills,
fever of 101.2 F, and back pain. The nurse stops the transfusion immediately. Which
is the most likely cause?
A. Acute hemolytic transfusion reaction due to ABO incompatibility.
B. Febrile non-hemolytic transfusion reaction.
C. Transfusion-related acute lung injury (TRALI).
D. Bacterial contamination of the blood product.
Correct Answer: A
Rationale:
Chills, fever, and back pain occurring within minutes of transfusion onset are the hallmark triad of an acute
hemolytic transfusion reaction, most commonly caused by ABO incompatibility. The nurse must stop the
transfusion immediately, maintain IV access with normal saline, and notify the blood bank and physician.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
, Q5 Question 5 of 100
A 62-year-old female is admitted with chest pain and is diagnosed with an acute
anterior wall ST-elevation myocardial infarction (STEMI). She is scheduled for
primary percutaneous coronary intervention (PCI). Which medication should the
nurse administer before transfer to the cardiac catheterization lab?
A. Aspirin 325 mg chewable.
B. Clopidogrel 75 mg orally.
C. Atorvastatin 80 mg orally.
D. Metoprolol 25 mg orally.
Correct Answer: A
Rationale:
Aspirin is the cornerstone of antiplatelet therapy in acute STEMI and should be given as soon as possible,
ideally before PCI, unless the patient has a true aspirin allergy. A loading dose of 325 mg chewable is
preferred for rapid absorption. While other agents are important, aspirin is the priority pre-PCI medication.
Q6 Question 6 of 100
A 58-year-old male with heart failure is prescribed digoxin 0.25 mg daily. His most
recent laboratory results show serum potassium 3.1 mEq/L and serum digoxin level
1.8 ng/mL. He reports nausea and reports seeing yellow-green halos around lights.
Which nursing action is most appropriate?
A. Hold the next dose of digoxin and notify the physician of the hypokalemia and visual
changes.
B. Administer the digoxin as prescribed since the serum level is within therapeutic range.
C. Give the patient a potassium supplement and administer the digoxin as scheduled.
D. Reassure the patient that visual disturbances are a normal side effect of digoxin therapy.
Correct Answer: A
Rationale:
Hypokalemia potentiates digoxin toxicity even when serum digoxin levels appear therapeutic. Visual
disturbances (yellow-green halos) are a classic sign of digoxin toxicity. The nurse must hold the dose and
notify the physician immediately. Simply giving potassium without physician orders is outside the nurse's
scope.
266 Med Surg Exam (2026/2027 Update) Questions & Verified Answers, 100% Guaranteed Pass || Complete A+ Guide - Nightingale - 2026/2027 | Passing Score: 80% | Pag
