BSN HESI 266 Med Surg Exam Questions &
Correct Answers with Rationales Nightingale
Actual Exam 2026/2027 – Complete Exam-
Style Q&As | 100% Certified Verified – Pass
Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY DISORDERS (Questions 1–20)
Q1: James Henderson, a 72-year-old male, is admitted to the med-surg unit with crushing substernal
chest pain radiating to his left arm, diaphoresis, and nausea. His vital signs are BP 88/52, HR 110, RR 24,
SpO2 91% on room air. Which assessment finding is most consistent with an anterior wall myocardial
infarction?
A. Pain radiating to the right shoulder and jaw
B. ST-segment elevation in leads V1–V4, hypotension, and tachycardia indicating significant left
ventricular damage [CORRECT]
C. Bradycardia and hypertension with clear lung sounds
D. Isolated T-wave inversion in lead III without chest pain
Correct Answer: B
Rationale: The best answer is B. Anterior wall MIs show ST elevation in the precordial leads V1 through
V4 because those leads view the anterior wall of the left ventricle. The hypotension and tachycardia tell
you the heart isn't pumping effectively, which is common with anterior involvement since the left
ventricle does most of the pumping work. Right shoulder pain is more gallbladder, bradycardia and
hypertension don't fit the shock picture, and isolated T-wave inversion in one lead isn't the classic
presentation.
Q2: Mr. Henderson is taken to the cath lab where a drug-eluting stent is placed in the LAD artery. He
returns to the unit with a sheath in the right femoral artery. Two hours post-procedure, the nurse notes
,the groin site is swollen, and Mr. Henderson complains of increasing back pain. His BP has dropped to
78/48, and his heart rate is 118. The nurse's priority action is to:
A. Administer the ordered PRN acetaminophen for back pain
B. Apply manual pressure above the puncture site, activate the rapid response team, and prepare for
fluid resuscitation and possible surgical intervention [CORRECT]
C. Elevate the head of the bed to 45 degrees to improve breathing
D. Remove the arterial sheath immediately without assistance
Correct Answer: B
Rationale: The best answer is B. Swelling at the groin site plus hypotension and tachycardia after
femoral access screams retroperitoneal bleed or pseudoaneurysm until proven otherwise. This is a
vascular emergency. You need to hold pressure, get help, and prepare for aggressive fluid resuscitation
because he is actively bleeding into his retroperitoneal space. Acetaminophen isn't going to fix a
hemorrhage, elevating the head won't help hypotension, and removing the sheath yourself without
imaging or backup could make things catastrophically worse.
Q3: On day 3 of his hospitalization, Mr. Henderson develops sudden dyspnea, orthopnea, and fine
crackles bilaterally. His SpO2 is 86% on 2L nasal cannula. He is anxious and coughing up pink, frothy
sputum. The nurse recognizes these findings as consistent with:
A. A pulmonary embolism
B. Acute pulmonary edema secondary to left-sided heart failure [CORRECT]
C. A simple case of hospital-acquired pneumonia
D. An asthma exacerbation
Correct Answer: B
Rationale: The best answer is B. Pink, frothy sputum is the classic hallmark of acute pulmonary edema—
it's literally fluid from the lungs mixed with air. Add in the sudden dyspnea, orthopnea, crackles, and
hypoxemia after an MI, and you've got left-sided heart failure backing fluid up into the lungs. A PE would
show sudden dyspnea but not typically pink frothy sputum or bilateral crackles. Pneumonia usually has
colored sputum and fever, not frothy pink stuff. And asthma gives you wheezing, not crackles and frothy
sputum.
,Q4: Mr. Henderson is stabilized with diuretics and afterload reduction. On discharge day, the nurse is
teaching him about his new medications. Which statement by the patient indicates a correct
understanding of his heart failure regimen?
A. "I should take my furosemide at bedtime so it doesn't interfere with my day."
B. "If I gain more than 2 to 3 pounds in a day or 5 pounds in a week, I should call my cardiologist."
[CORRECT]
C. "I can stop taking my lisinopril once my blood pressure returns to normal."
D. "I should eat more salty foods to replace what the diuretics take out."
Correct Answer: B
Rationale: The best answer is B. Rapid weight gain is one of the earliest signs of fluid retention in heart
failure—2 to 3 pounds in a day or 5 in a week means fluid is accumulating and the patient needs to call
before it turns into another pulmonary edema episode. Furosemide should be taken in the morning so
you're not up all night peeing. ACE inhibitors like lisinopril are lifelong medications for heart failure, not
something you stop when your BP looks good. And salty foods are exactly what heart failure patients
need to avoid because sodium pulls water with it.
Q5: A nurse is caring for a patient with chronic heart failure who is prescribed digoxin 0.125 mg daily.
Before administering the dose, the nurse checks the patient's apical pulse and notes it is 58 beats per
minute. Which action should the nurse take?
A. Administer the digoxin as ordered since the dose is low
B. Hold the dose and notify the prescriber, as a heart rate below 60 bpm is a contraindication to digoxin
administration [CORRECT]
C. Give the dose and recheck the pulse in one hour
D. Administer the dose with a glass of orange juice to improve absorption
Correct Answer: B
Rationale: The best answer is B. Digoxin slows down the heart rate, and if the patient is already
bradycardic at 58, giving it could push them into dangerous bradycardia or heart block. The standard
rule is to hold digoxin if the apical pulse is below 60 and notify the provider. You don't give it anyway
because the dose is small—toxicity is about the patient's response, not the tablet size. Rechecking in an
hour doesn't change the fact that the pulse is too slow now. And orange juice has nothing to do with
digoxin absorption.
, Q6: A patient with a history of atrial fibrillation is prescribed warfarin. The nurse is reviewing dietary
teaching. Which statement by the patient demonstrates an understanding of warfarin therapy?
A. "I should eat large amounts of leafy green vegetables every day for my health."
B. "I need to keep my vitamin K intake consistent so my INR stays stable, and I'll have regular blood work
to monitor my levels." [CORRECT]
C. "I can take aspirin and ibuprofen whenever I have a headache since they are over-the-counter."
D. "If I miss a dose, I should double up the next day to make up for it."
Correct Answer: B
Rationale: The best answer is B. Warfarin works by antagonizing vitamin K, so the key is consistency—
not avoiding greens entirely, but keeping your vitamin K intake steady so your INR doesn't swing.
Regular INR monitoring is essential because warfarin has a narrow therapeutic window. Large amounts
of leafy greens would mess with your INR. Aspirin and ibuprofen increase bleeding risk and shouldn't be
taken casually on warfarin. And doubling up after a missed dose is a great way to cause bleeding.
Q7: A patient with COPD is admitted with an exacerbation. The nurse notes the patient is using
accessory muscles to breathe, has a respiratory rate of 28, and is sitting in a tripod position. The
patient's ABG results show pH 7.32, PaCO2 58, PaO2 62, HCO3 30. The nurse interprets these results as:
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Metabolic acidosis with respiratory compensation
D. Normal ABG values for a patient with COPD
Correct Answer: B
Rationale: The best answer is B. The pH is low at 7.32, so we're in acidosis. The PaCO2 is high at 58,
which points to respiratory acidosis because CO2 is the respiratory component. The HCO3 is elevated at
30, which shows the kidneys have kicked in to compensate by holding onto bicarbonate. This is classic
compensated respiratory acidosis, which is exactly what you see in a COPD exacerbation when the
patient can't blow off CO2 effectively. The pH isn't normal, so it's not just "normal for COPD."
Q8: A nurse is caring for a patient with a pulmonary embolism who is receiving a heparin infusion. The
patient's baseline aPTT is 35 seconds. Four hours after starting the infusion, the aPTT is 92 seconds.
Which action should the nurse take?
Correct Answers with Rationales Nightingale
Actual Exam 2026/2027 – Complete Exam-
Style Q&As | 100% Certified Verified – Pass
Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY DISORDERS (Questions 1–20)
Q1: James Henderson, a 72-year-old male, is admitted to the med-surg unit with crushing substernal
chest pain radiating to his left arm, diaphoresis, and nausea. His vital signs are BP 88/52, HR 110, RR 24,
SpO2 91% on room air. Which assessment finding is most consistent with an anterior wall myocardial
infarction?
A. Pain radiating to the right shoulder and jaw
B. ST-segment elevation in leads V1–V4, hypotension, and tachycardia indicating significant left
ventricular damage [CORRECT]
C. Bradycardia and hypertension with clear lung sounds
D. Isolated T-wave inversion in lead III without chest pain
Correct Answer: B
Rationale: The best answer is B. Anterior wall MIs show ST elevation in the precordial leads V1 through
V4 because those leads view the anterior wall of the left ventricle. The hypotension and tachycardia tell
you the heart isn't pumping effectively, which is common with anterior involvement since the left
ventricle does most of the pumping work. Right shoulder pain is more gallbladder, bradycardia and
hypertension don't fit the shock picture, and isolated T-wave inversion in one lead isn't the classic
presentation.
Q2: Mr. Henderson is taken to the cath lab where a drug-eluting stent is placed in the LAD artery. He
returns to the unit with a sheath in the right femoral artery. Two hours post-procedure, the nurse notes
,the groin site is swollen, and Mr. Henderson complains of increasing back pain. His BP has dropped to
78/48, and his heart rate is 118. The nurse's priority action is to:
A. Administer the ordered PRN acetaminophen for back pain
B. Apply manual pressure above the puncture site, activate the rapid response team, and prepare for
fluid resuscitation and possible surgical intervention [CORRECT]
C. Elevate the head of the bed to 45 degrees to improve breathing
D. Remove the arterial sheath immediately without assistance
Correct Answer: B
Rationale: The best answer is B. Swelling at the groin site plus hypotension and tachycardia after
femoral access screams retroperitoneal bleed or pseudoaneurysm until proven otherwise. This is a
vascular emergency. You need to hold pressure, get help, and prepare for aggressive fluid resuscitation
because he is actively bleeding into his retroperitoneal space. Acetaminophen isn't going to fix a
hemorrhage, elevating the head won't help hypotension, and removing the sheath yourself without
imaging or backup could make things catastrophically worse.
Q3: On day 3 of his hospitalization, Mr. Henderson develops sudden dyspnea, orthopnea, and fine
crackles bilaterally. His SpO2 is 86% on 2L nasal cannula. He is anxious and coughing up pink, frothy
sputum. The nurse recognizes these findings as consistent with:
A. A pulmonary embolism
B. Acute pulmonary edema secondary to left-sided heart failure [CORRECT]
C. A simple case of hospital-acquired pneumonia
D. An asthma exacerbation
Correct Answer: B
Rationale: The best answer is B. Pink, frothy sputum is the classic hallmark of acute pulmonary edema—
it's literally fluid from the lungs mixed with air. Add in the sudden dyspnea, orthopnea, crackles, and
hypoxemia after an MI, and you've got left-sided heart failure backing fluid up into the lungs. A PE would
show sudden dyspnea but not typically pink frothy sputum or bilateral crackles. Pneumonia usually has
colored sputum and fever, not frothy pink stuff. And asthma gives you wheezing, not crackles and frothy
sputum.
,Q4: Mr. Henderson is stabilized with diuretics and afterload reduction. On discharge day, the nurse is
teaching him about his new medications. Which statement by the patient indicates a correct
understanding of his heart failure regimen?
A. "I should take my furosemide at bedtime so it doesn't interfere with my day."
B. "If I gain more than 2 to 3 pounds in a day or 5 pounds in a week, I should call my cardiologist."
[CORRECT]
C. "I can stop taking my lisinopril once my blood pressure returns to normal."
D. "I should eat more salty foods to replace what the diuretics take out."
Correct Answer: B
Rationale: The best answer is B. Rapid weight gain is one of the earliest signs of fluid retention in heart
failure—2 to 3 pounds in a day or 5 in a week means fluid is accumulating and the patient needs to call
before it turns into another pulmonary edema episode. Furosemide should be taken in the morning so
you're not up all night peeing. ACE inhibitors like lisinopril are lifelong medications for heart failure, not
something you stop when your BP looks good. And salty foods are exactly what heart failure patients
need to avoid because sodium pulls water with it.
Q5: A nurse is caring for a patient with chronic heart failure who is prescribed digoxin 0.125 mg daily.
Before administering the dose, the nurse checks the patient's apical pulse and notes it is 58 beats per
minute. Which action should the nurse take?
A. Administer the digoxin as ordered since the dose is low
B. Hold the dose and notify the prescriber, as a heart rate below 60 bpm is a contraindication to digoxin
administration [CORRECT]
C. Give the dose and recheck the pulse in one hour
D. Administer the dose with a glass of orange juice to improve absorption
Correct Answer: B
Rationale: The best answer is B. Digoxin slows down the heart rate, and if the patient is already
bradycardic at 58, giving it could push them into dangerous bradycardia or heart block. The standard
rule is to hold digoxin if the apical pulse is below 60 and notify the provider. You don't give it anyway
because the dose is small—toxicity is about the patient's response, not the tablet size. Rechecking in an
hour doesn't change the fact that the pulse is too slow now. And orange juice has nothing to do with
digoxin absorption.
, Q6: A patient with a history of atrial fibrillation is prescribed warfarin. The nurse is reviewing dietary
teaching. Which statement by the patient demonstrates an understanding of warfarin therapy?
A. "I should eat large amounts of leafy green vegetables every day for my health."
B. "I need to keep my vitamin K intake consistent so my INR stays stable, and I'll have regular blood work
to monitor my levels." [CORRECT]
C. "I can take aspirin and ibuprofen whenever I have a headache since they are over-the-counter."
D. "If I miss a dose, I should double up the next day to make up for it."
Correct Answer: B
Rationale: The best answer is B. Warfarin works by antagonizing vitamin K, so the key is consistency—
not avoiding greens entirely, but keeping your vitamin K intake steady so your INR doesn't swing.
Regular INR monitoring is essential because warfarin has a narrow therapeutic window. Large amounts
of leafy greens would mess with your INR. Aspirin and ibuprofen increase bleeding risk and shouldn't be
taken casually on warfarin. And doubling up after a missed dose is a great way to cause bleeding.
Q7: A patient with COPD is admitted with an exacerbation. The nurse notes the patient is using
accessory muscles to breathe, has a respiratory rate of 28, and is sitting in a tripod position. The
patient's ABG results show pH 7.32, PaCO2 58, PaO2 62, HCO3 30. The nurse interprets these results as:
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation [CORRECT]
C. Metabolic acidosis with respiratory compensation
D. Normal ABG values for a patient with COPD
Correct Answer: B
Rationale: The best answer is B. The pH is low at 7.32, so we're in acidosis. The PaCO2 is high at 58,
which points to respiratory acidosis because CO2 is the respiratory component. The HCO3 is elevated at
30, which shows the kidneys have kicked in to compensate by holding onto bicarbonate. This is classic
compensated respiratory acidosis, which is exactly what you see in a COPD exacerbation when the
patient can't blow off CO2 effectively. The pH isn't normal, so it's not just "normal for COPD."
Q8: A nurse is caring for a patient with a pulmonary embolism who is receiving a heparin infusion. The
patient's baseline aPTT is 35 seconds. Four hours after starting the infusion, the aPTT is 92 seconds.
Which action should the nurse take?
