IBSN 266 HESI MED SURG PRACTICE QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
- Fluid, Electrolyte, and Acid-Base Imbalances
- Cardiovascular and Hematologic Disorders
- Respiratory and Gas Exchange Alterations
- Gastrointestinal and Hepatic Systems
- Endocrine and Metabolic Regulations
- Renal and Urinary Tract Disorders
- Neurological and Sensory Perceptions
- Musculoskeletal and Integumentary Health
- Perioperative Care and Patient Safety
- Immunological, Infectious, and Oncology Nursing
INTRODUCTION
The purpose of this comprehensive examination is to evaluate student readiness for professional clinical
practice and advanced licensure assessments. This test measures critical nursing competencies, clinical
reasoning, and the capability to synthesize complex pathophysiological data into safe patient
interventions. Through a mix of independent multiple-choice questions and complex, scenario-based
vignettes, this assessment evaluates skills across diverse clinical environments. The structural focus
emphasizes real-world nursing application, prioritize-of-care frameworks, ethical accountability,
regulatory alignment, and safe clinical decision-making. By engaging with these rigorous practice items,
candidates will strengthen their analytical skills and establish a defensible foundation for medical-surgical
nursing excellence.
Question 1
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening
dyspnea and a productive cough. The arterial blood gas (ABG) results show: pH 7.31, PaCO2 56 mmHg,
HCO3 26 mEq/L, and PaO2 62 mmHg. Which acid-base imbalance is this patient experiencing?
,A. Metabolic acidosis
B. Respiratory alkalosis
🟢 C. Respiratory acidosis
D. Metabolic alkalosis
🔴 RATIONALE: The low pH (less than 7.35) indicates acidosis. The elevated PaCO2 (greater than 45
mmHg) matches the acidic direction of the pH, indicating a respiratory origin. The normal HCO3 level
indicates that renal compensation has not yet occurred or is incomplete, confirming acute-on-chronic
respiratory acidosis.
Question 2
The nurse is assigned to care for four patients on an oncology unit. Which patient should the nurse
assess first?
A. A patient with lung cancer who reports a new onset of localized bone pain.
🟢 B. A patient with breast cancer who has a serum calcium level of 12.5 mg/dL.
C. A patient receiving chemotherapy who reports a mild metallic taste in the mouth.
D. A patient with a permanent colostomy whose stoma is pink and moist.
🔴 RATIONALE: A serum calcium level of 12.5 mg/dL indicates severe hypercalcemia, an oncologic
emergency commonly associated with bone metastasis. This requires immediate intervention with
aggressive intravenous hydration and bisphosphonates to prevent cardiac dysrhythmias and
neurological collapse.
Question 3
A nurse is preparing to administer packed red blood cells to a patient with severe anemia. Which action
must the nurse perform immediately before initiating the blood transfusion?
🟢 A. Verify the patient's identity and blood compatibility with another registered nurse.
B. Warm the blood unit in a microwave to prevent hypothermia.
C. Administer a prophylactic dose of intravenous furosemide.
D. Flush the blood tubing line completely with 5% dextrose in water.
,🔴 RATIONALE: To prevent a potentially fatal hemolytic transfusion reaction, legal and regulatory
standards mandate that two licensed nurses verify the patient's identity, blood type, Rh factor, and
expiration date at the bedside. Blood should only be run with 0.9% normal saline.
Question 4
A patient who underwent a total hip arthroplasty 24 hours ago reports sudden chest pain and acute
shortness of breath. The nurse notes tachycardia and a localized drop in oxygen saturation to 88%.
Which condition should the nurse suspect first?
A. Myocardial infarction
🟢 B. Pulmonary embolism
C. Atelectasis
D. Spontaneous pneumothorax
🔴 RATIONALE: Patients undergoing major orthopedic surgeries are at high risk for deep vein
thrombosis, which can dislodge and cause a pulmonary embolism. The sudden onset of dyspnea, chest
pain, and hypoxia is a classic triad for this life-threatening complication.
Question 5
An older adult patient with type 2 diabetes mellitus is admitted with a blood glucose level of 720 mg/dL,
severe dehydration, and an altered mental status. The patient's serum osmolality is 350 mOsm/kg, and
urine ketones are negative. Which condition is consistent with these findings?
A. Diabetic ketoacidosis
B. Hypoglycemic unawareness
C. Somogyi effect
🟢 D. Hyperosmolar hyperglycemic state
🔴 RATIONALE: Hyperosmolar hyperglycemic state (HHS) is characterized by extreme hyperglycemia
(greater than 600 mg/dL), high serum osmolality, severe dehydration, and an absence of significant
ketosis. This occurs typically in type 2 diabetics who retain enough insulin to prevent lipolysis.
, Question 6
The nurse provides discharge teaching to a patient newly diagnosed with Addison's disease. Which
instruction is most critical for the nurse to include in the educational plan?
🟢 A. Increase your steroid medication dosage during periods of high physical or emotional stress.
B. Restrict your dietary sodium intake to prevent fluid retention and hypertension.
C. Avoid taking your daily medications if you develop nausea or vomiting.
D. Schedule routine blood draws to monitor for signs of worsening hypokalemia.
🔴 RATIONALE: Patients with Addison's disease lack adequate endogenous cortisol production. During
stress, infection, or surgery, they require increased exogenous glucocorticoids to prevent an acute
adrenal (Addisonian) crisis, which can lead to vascular collapse and shock.
Question 7
A nurse is caring for a patient who returned from a thyroidectomy 4 hours ago. The patient reports a
tingling sensation around the mouth and fingers. Which action should the nurse take next?
A. Check the patient's temperature for signs of a thyroid storm.
🟢 B. Assess for Trousseau's and Chvostek's signs and check serum calcium.
C. Document this as a normal and expected post-operative nerve sensation.
D. Loosen the neck dressing to relieve direct pressure on the trachea.
🔴 RATIONALE: Accidental removal or injury to the parathyroid glands during a thyroidectomy can
cause hypocalcemia. Perioral numbness and digital tingling are early clinical manifestations of
neuromuscular irritability related to low calcium levels.
Question 8
A patient with liver cirrhosis presents to the emergency department with severe hematemesis. The
medical team suspects bleeding esophageal varices. Which medication should the nurse anticipate
administering immediately to reduce portal vein pressure?
A. Pantoprazole
🟢 B. Octreotide
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
CORE DOMAINS
- Fluid, Electrolyte, and Acid-Base Imbalances
- Cardiovascular and Hematologic Disorders
- Respiratory and Gas Exchange Alterations
- Gastrointestinal and Hepatic Systems
- Endocrine and Metabolic Regulations
- Renal and Urinary Tract Disorders
- Neurological and Sensory Perceptions
- Musculoskeletal and Integumentary Health
- Perioperative Care and Patient Safety
- Immunological, Infectious, and Oncology Nursing
INTRODUCTION
The purpose of this comprehensive examination is to evaluate student readiness for professional clinical
practice and advanced licensure assessments. This test measures critical nursing competencies, clinical
reasoning, and the capability to synthesize complex pathophysiological data into safe patient
interventions. Through a mix of independent multiple-choice questions and complex, scenario-based
vignettes, this assessment evaluates skills across diverse clinical environments. The structural focus
emphasizes real-world nursing application, prioritize-of-care frameworks, ethical accountability,
regulatory alignment, and safe clinical decision-making. By engaging with these rigorous practice items,
candidates will strengthen their analytical skills and establish a defensible foundation for medical-surgical
nursing excellence.
Question 1
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening
dyspnea and a productive cough. The arterial blood gas (ABG) results show: pH 7.31, PaCO2 56 mmHg,
HCO3 26 mEq/L, and PaO2 62 mmHg. Which acid-base imbalance is this patient experiencing?
,A. Metabolic acidosis
B. Respiratory alkalosis
🟢 C. Respiratory acidosis
D. Metabolic alkalosis
🔴 RATIONALE: The low pH (less than 7.35) indicates acidosis. The elevated PaCO2 (greater than 45
mmHg) matches the acidic direction of the pH, indicating a respiratory origin. The normal HCO3 level
indicates that renal compensation has not yet occurred or is incomplete, confirming acute-on-chronic
respiratory acidosis.
Question 2
The nurse is assigned to care for four patients on an oncology unit. Which patient should the nurse
assess first?
A. A patient with lung cancer who reports a new onset of localized bone pain.
🟢 B. A patient with breast cancer who has a serum calcium level of 12.5 mg/dL.
C. A patient receiving chemotherapy who reports a mild metallic taste in the mouth.
D. A patient with a permanent colostomy whose stoma is pink and moist.
🔴 RATIONALE: A serum calcium level of 12.5 mg/dL indicates severe hypercalcemia, an oncologic
emergency commonly associated with bone metastasis. This requires immediate intervention with
aggressive intravenous hydration and bisphosphonates to prevent cardiac dysrhythmias and
neurological collapse.
Question 3
A nurse is preparing to administer packed red blood cells to a patient with severe anemia. Which action
must the nurse perform immediately before initiating the blood transfusion?
🟢 A. Verify the patient's identity and blood compatibility with another registered nurse.
B. Warm the blood unit in a microwave to prevent hypothermia.
C. Administer a prophylactic dose of intravenous furosemide.
D. Flush the blood tubing line completely with 5% dextrose in water.
,🔴 RATIONALE: To prevent a potentially fatal hemolytic transfusion reaction, legal and regulatory
standards mandate that two licensed nurses verify the patient's identity, blood type, Rh factor, and
expiration date at the bedside. Blood should only be run with 0.9% normal saline.
Question 4
A patient who underwent a total hip arthroplasty 24 hours ago reports sudden chest pain and acute
shortness of breath. The nurse notes tachycardia and a localized drop in oxygen saturation to 88%.
Which condition should the nurse suspect first?
A. Myocardial infarction
🟢 B. Pulmonary embolism
C. Atelectasis
D. Spontaneous pneumothorax
🔴 RATIONALE: Patients undergoing major orthopedic surgeries are at high risk for deep vein
thrombosis, which can dislodge and cause a pulmonary embolism. The sudden onset of dyspnea, chest
pain, and hypoxia is a classic triad for this life-threatening complication.
Question 5
An older adult patient with type 2 diabetes mellitus is admitted with a blood glucose level of 720 mg/dL,
severe dehydration, and an altered mental status. The patient's serum osmolality is 350 mOsm/kg, and
urine ketones are negative. Which condition is consistent with these findings?
A. Diabetic ketoacidosis
B. Hypoglycemic unawareness
C. Somogyi effect
🟢 D. Hyperosmolar hyperglycemic state
🔴 RATIONALE: Hyperosmolar hyperglycemic state (HHS) is characterized by extreme hyperglycemia
(greater than 600 mg/dL), high serum osmolality, severe dehydration, and an absence of significant
ketosis. This occurs typically in type 2 diabetics who retain enough insulin to prevent lipolysis.
, Question 6
The nurse provides discharge teaching to a patient newly diagnosed with Addison's disease. Which
instruction is most critical for the nurse to include in the educational plan?
🟢 A. Increase your steroid medication dosage during periods of high physical or emotional stress.
B. Restrict your dietary sodium intake to prevent fluid retention and hypertension.
C. Avoid taking your daily medications if you develop nausea or vomiting.
D. Schedule routine blood draws to monitor for signs of worsening hypokalemia.
🔴 RATIONALE: Patients with Addison's disease lack adequate endogenous cortisol production. During
stress, infection, or surgery, they require increased exogenous glucocorticoids to prevent an acute
adrenal (Addisonian) crisis, which can lead to vascular collapse and shock.
Question 7
A nurse is caring for a patient who returned from a thyroidectomy 4 hours ago. The patient reports a
tingling sensation around the mouth and fingers. Which action should the nurse take next?
A. Check the patient's temperature for signs of a thyroid storm.
🟢 B. Assess for Trousseau's and Chvostek's signs and check serum calcium.
C. Document this as a normal and expected post-operative nerve sensation.
D. Loosen the neck dressing to relieve direct pressure on the trachea.
🔴 RATIONALE: Accidental removal or injury to the parathyroid glands during a thyroidectomy can
cause hypocalcemia. Perioral numbness and digital tingling are early clinical manifestations of
neuromuscular irritability related to low calcium levels.
Question 8
A patient with liver cirrhosis presents to the emergency department with severe hematemesis. The
medical team suspects bleeding esophageal varices. Which medication should the nurse anticipate
administering immediately to reduce portal vein pressure?
A. Pantoprazole
🟢 B. Octreotide
