BSN HESI 266 MED SURG EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
This complete set of 300 unique, high-level medical-surgical nursing questions
is designed for BSN HESI 266 exam preparation. Each question presents a
distinct clinical scenario covering critical topics including cardiology,
pulmonology, endocrinology, neurology, gastroenterology, nephrology,
oncology, infectious diseases, and pharmacology. Every question includes four
multiple-choice options, a correct answer, and a detailed rationale explaining
the pathophysiology, nursing interventions, medication mechanisms, and
priority actions. No questions are repeated across the entire collection. This
comprehensive resource strengthens clinical judgment, reinforces evidence-
based practice, and prepares nursing students for the NCLEX-RN by testing
assessment, prioritization, and pharmacological knowledge in adult health
settings.
1. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) result of pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L, and
PaO2 50 mm Hg. Which intervention should the nurse prioritize?
A) Administer oxygen at 4 L/min via nasal cannula
B) Apply non-invasive positive pressure ventilation (NIPPV)
C) Administer a bronchodilator nebulizer treatment
D) Reposition the patient to the left side-lying position
Answer: B
Rationale: The ABG shows respiratory acidosis with hypoxemia (pH low, PaCO2
high). NIPPV helps improve ventilation and gas exchange without the need for
invasive intubation. Oxygen should be administered cautiously, and
bronchodilators are adjunctive but not the primary intervention for acute
respiratory acidosis. Repositioning alone will not correct severe hypercapnia.
2. A patient with heart failure is receiving furosemide (Lasix) intravenously.
Which assessment finding indicates a therapeutic effect?
A) Increased heart rate
B) Increased urine output and decreased blood pressure
,C) Decreased jugular venous distension
D) Increased blood pressure and decreased urine output
Answer: C
Rationale: Furosemide reduces preload by promoting diuresis, which decreases
fluid volume and venous pressure, thereby reducing jugular venous distension.
Increased urine output is expected, but the therapeutic goal is reduction of fluid
overload symptoms. A decreased heart rate and increased blood pressure are not
direct effects of furosemide.
3. A diabetic patient on an insulin pump develops nausea and vomiting. What is
the nurse's priority action?
A) Stop the insulin pump immediately
B) Monitor blood glucose every 1–2 hours and check for ketones
C) Encourage the patient to drink clear liquids only
D) Administer antiemetic medication
Answer: B
Rationale: Illness can lead to hyperglycemia and diabetic ketoacidosis (DKA) due
to stress hormones. Insulin should not be stopped; the patient may need
supplemental doses. Frequent glucose monitoring and ketone testing are essential
to prevent DKA. Encouraging clear liquids is important, but only after glucose
stability is assessed.
4. A postoperative patient has a hemoglobin level of 7.2 g/dL and is symptomatic
with tachycardia and pallor. Which action should the nurse take first?
A) Administer oral iron supplements
B) Administer erythropoietin stimulating agent
C) Encourage oral fluid intake
D) Prepare to administer packed red blood cells as ordered
Answer: D
Rationale: A hemoglobin below 7–8 g/dL with symptoms of anemia warrants
blood transfusion to restore oxygen-carrying capacity. Iron supplements and EPO
take days to weeks to be effective. Oral fluids will not address the low hemoglobin.
5. A patient with acute pancreatitis reports severe abdominal pain that radiates to
the back. Which laboratory value is most specific for this diagnosis?
A) Serum lipase
B) Serum amylase
C) Serum AST
D) Serum bilirubin
Answer: A
,Rationale: Serum lipase is more specific and remains elevated longer than amylase
in acute pancreatitis. Elevated AST and bilirubin suggest hepatobiliary causes but
are not specific. Serum calcium may decrease in pancreatitis but is not diagnostic.
6. A patient with cirrhosis develops ascites and is started on spironolactone. Which
finding indicates the medication is effective?
A) Increased abdominal girth
B) Decrease in abdominal girth
C) Increased blood pressure
D) Decreased urine output
Answer: B
Rationale: Spironolactone is an aldosterone antagonist that promotes fluid
excretion, reducing ascites and abdominal girth. Increased urine output is expected,
but the therapeutic endpoint is reduced fluid accumulation. Weight loss is also
desired, but daily weight monitoring is more accurate; blood pressure should be
monitored but is not the primary indicator.
7. A patient with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement immediately?
A) Restrict dietary potassium
B) Administer oral Kayexalate
C) Administer calcium gluconate intravenously
D) Administer insulin with dextrose intravenously
Answer: C
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias. Calcium
gluconate stabilizes the cardiac membrane and is the first-line intervention in acute
hyperkalemia. Kayexalate and insulin with dextrose help remove potassium but
take longer to act. Restricting dietary potassium is a long-term measure.
8. A patient with hypothyroidism presents with bradycardia, lethargy, and cold
intolerance. Which medication should the nurse expect to administer?
A) Methimazole
B) Levothyroxine
C) Propylthiouracil
D) Prednisone
Answer: B
Rationale: Levothyroxine is synthetic T4 used to replace thyroid hormone in
hypothyroidism. Methimazole and propylthiouracil are used for hyperthyroidism.
Prednisone is used for inflammation or adrenal insufficiency.
, 9. A patient with sickle cell crisis reports severe joint pain. What is the most
appropriate nursing intervention?
A) Apply ice packs to the affected joints
B) Encourage range of motion exercises
C) Administer opioid analgesics as prescribed
D) Restrict oral fluids
Answer: C
Rationale: Pain in sickle cell crisis is vaso-occlusive and often severe, requiring
opioid analgesics for adequate relief. Hydration is important, but pain relief is the
priority. Heat applications may help, but ice can cause vasoconstriction and worsen
the crisis.
10. A patient with pneumonia has a fever, productive cough, and pleuritic chest
pain. Which position should the nurse encourage to promote effective breathing?
A) Supine position
B) High Fowler's position
C) Prone position
D) Left side-lying position
Answer: B
Rationale: High Fowler's position allows maximum lung expansion and facilitates
deeper breathing and coughing. Supine and prone positions restrict diaphragmatic
movement, and left side-lying may not promote optimal ventilation.
11. A patient with a history of atrial fibrillation is on warfarin. Which international
normalized ratio (INR) indicates a therapeutic range for this patient?
A) 1.0
B) 2.5
C) 3.5
D) 4.5
Answer: B
Rationale: For atrial fibrillation, the target INR is typically 2.0 to 3.0. An INR of
1.0 is subtherapeutic; 3.5 and 4.5 are supratherapeutic and increase bleeding risk.
12. A patient with a spinal cord injury at the T6 level develops hypertension,
bradycardia, and severe headache. Which complication should the nurse suspect?
A) Autonomic dysreflexia
B) Neurogenic shock
C) Malignant hyperthermia
D) Pulmonary embolism
Answer: A
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
This complete set of 300 unique, high-level medical-surgical nursing questions
is designed for BSN HESI 266 exam preparation. Each question presents a
distinct clinical scenario covering critical topics including cardiology,
pulmonology, endocrinology, neurology, gastroenterology, nephrology,
oncology, infectious diseases, and pharmacology. Every question includes four
multiple-choice options, a correct answer, and a detailed rationale explaining
the pathophysiology, nursing interventions, medication mechanisms, and
priority actions. No questions are repeated across the entire collection. This
comprehensive resource strengthens clinical judgment, reinforces evidence-
based practice, and prepares nursing students for the NCLEX-RN by testing
assessment, prioritization, and pharmacological knowledge in adult health
settings.
1. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) result of pH 7.30, PaCO2 58 mm Hg, HCO3 26 mEq/L, and
PaO2 50 mm Hg. Which intervention should the nurse prioritize?
A) Administer oxygen at 4 L/min via nasal cannula
B) Apply non-invasive positive pressure ventilation (NIPPV)
C) Administer a bronchodilator nebulizer treatment
D) Reposition the patient to the left side-lying position
Answer: B
Rationale: The ABG shows respiratory acidosis with hypoxemia (pH low, PaCO2
high). NIPPV helps improve ventilation and gas exchange without the need for
invasive intubation. Oxygen should be administered cautiously, and
bronchodilators are adjunctive but not the primary intervention for acute
respiratory acidosis. Repositioning alone will not correct severe hypercapnia.
2. A patient with heart failure is receiving furosemide (Lasix) intravenously.
Which assessment finding indicates a therapeutic effect?
A) Increased heart rate
B) Increased urine output and decreased blood pressure
,C) Decreased jugular venous distension
D) Increased blood pressure and decreased urine output
Answer: C
Rationale: Furosemide reduces preload by promoting diuresis, which decreases
fluid volume and venous pressure, thereby reducing jugular venous distension.
Increased urine output is expected, but the therapeutic goal is reduction of fluid
overload symptoms. A decreased heart rate and increased blood pressure are not
direct effects of furosemide.
3. A diabetic patient on an insulin pump develops nausea and vomiting. What is
the nurse's priority action?
A) Stop the insulin pump immediately
B) Monitor blood glucose every 1–2 hours and check for ketones
C) Encourage the patient to drink clear liquids only
D) Administer antiemetic medication
Answer: B
Rationale: Illness can lead to hyperglycemia and diabetic ketoacidosis (DKA) due
to stress hormones. Insulin should not be stopped; the patient may need
supplemental doses. Frequent glucose monitoring and ketone testing are essential
to prevent DKA. Encouraging clear liquids is important, but only after glucose
stability is assessed.
4. A postoperative patient has a hemoglobin level of 7.2 g/dL and is symptomatic
with tachycardia and pallor. Which action should the nurse take first?
A) Administer oral iron supplements
B) Administer erythropoietin stimulating agent
C) Encourage oral fluid intake
D) Prepare to administer packed red blood cells as ordered
Answer: D
Rationale: A hemoglobin below 7–8 g/dL with symptoms of anemia warrants
blood transfusion to restore oxygen-carrying capacity. Iron supplements and EPO
take days to weeks to be effective. Oral fluids will not address the low hemoglobin.
5. A patient with acute pancreatitis reports severe abdominal pain that radiates to
the back. Which laboratory value is most specific for this diagnosis?
A) Serum lipase
B) Serum amylase
C) Serum AST
D) Serum bilirubin
Answer: A
,Rationale: Serum lipase is more specific and remains elevated longer than amylase
in acute pancreatitis. Elevated AST and bilirubin suggest hepatobiliary causes but
are not specific. Serum calcium may decrease in pancreatitis but is not diagnostic.
6. A patient with cirrhosis develops ascites and is started on spironolactone. Which
finding indicates the medication is effective?
A) Increased abdominal girth
B) Decrease in abdominal girth
C) Increased blood pressure
D) Decreased urine output
Answer: B
Rationale: Spironolactone is an aldosterone antagonist that promotes fluid
excretion, reducing ascites and abdominal girth. Increased urine output is expected,
but the therapeutic endpoint is reduced fluid accumulation. Weight loss is also
desired, but daily weight monitoring is more accurate; blood pressure should be
monitored but is not the primary indicator.
7. A patient with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement immediately?
A) Restrict dietary potassium
B) Administer oral Kayexalate
C) Administer calcium gluconate intravenously
D) Administer insulin with dextrose intravenously
Answer: C
Rationale: Hyperkalemia can cause life-threatening cardiac arrhythmias. Calcium
gluconate stabilizes the cardiac membrane and is the first-line intervention in acute
hyperkalemia. Kayexalate and insulin with dextrose help remove potassium but
take longer to act. Restricting dietary potassium is a long-term measure.
8. A patient with hypothyroidism presents with bradycardia, lethargy, and cold
intolerance. Which medication should the nurse expect to administer?
A) Methimazole
B) Levothyroxine
C) Propylthiouracil
D) Prednisone
Answer: B
Rationale: Levothyroxine is synthetic T4 used to replace thyroid hormone in
hypothyroidism. Methimazole and propylthiouracil are used for hyperthyroidism.
Prednisone is used for inflammation or adrenal insufficiency.
, 9. A patient with sickle cell crisis reports severe joint pain. What is the most
appropriate nursing intervention?
A) Apply ice packs to the affected joints
B) Encourage range of motion exercises
C) Administer opioid analgesics as prescribed
D) Restrict oral fluids
Answer: C
Rationale: Pain in sickle cell crisis is vaso-occlusive and often severe, requiring
opioid analgesics for adequate relief. Hydration is important, but pain relief is the
priority. Heat applications may help, but ice can cause vasoconstriction and worsen
the crisis.
10. A patient with pneumonia has a fever, productive cough, and pleuritic chest
pain. Which position should the nurse encourage to promote effective breathing?
A) Supine position
B) High Fowler's position
C) Prone position
D) Left side-lying position
Answer: B
Rationale: High Fowler's position allows maximum lung expansion and facilitates
deeper breathing and coughing. Supine and prone positions restrict diaphragmatic
movement, and left side-lying may not promote optimal ventilation.
11. A patient with a history of atrial fibrillation is on warfarin. Which international
normalized ratio (INR) indicates a therapeutic range for this patient?
A) 1.0
B) 2.5
C) 3.5
D) 4.5
Answer: B
Rationale: For atrial fibrillation, the target INR is typically 2.0 to 3.0. An INR of
1.0 is subtherapeutic; 3.5 and 4.5 are supratherapeutic and increase bleeding risk.
12. A patient with a spinal cord injury at the T6 level develops hypertension,
bradycardia, and severe headache. Which complication should the nurse suspect?
A) Autonomic dysreflexia
B) Neurogenic shock
C) Malignant hyperthermia
D) Pulmonary embolism
Answer: A
