Ultimate BSN HESI Medical Surgical proctored exam version 1
study guide (2026) | 150 highly-predicted questions and answers
bundle pack with comprehensive rationales
1. A nurse is caring for a client who is 48 hours post-operative following an
abdominal hysterectomy. The client’s breath sounds are clear, but their serum
sodium level is 130 mEq/L. Which of the following IV fluids should the nurse expect
the provider to prescribe?
Answer: 0.9% Sodium Chloride (Normal Saline).
Rationale: A serum sodium level of 130 mEq/L indicates hyponatremia, a common post-
operative dilutional fluid imbalance. Normal saline is an isotonic fluid that adds intravascular
sodium volume without triggering severe cellular fluid shifts.
2. A client with chronic kidney disease (CKD) presents to the emergency department
with a potassium level of 6.8 mEq/L and tall, tented T waves on their ECG. Which of
the following medications should the nurse prepare to administer first to stabilize the
cardiac membrane?
Answer: Calcium gluconate IV.
, Rationale: While insulin and dextrose shift potassium into cells, calcium gluconate must be
given first during severe hyperkalemic emergencies. It directly antagonizes potassium's
toxic effects on the myocardium, preventing lethal ventricular dysrhythmias.
3. A nurse is assessing a client with acute decompensated heart failure who is
receiving a continuous infusion of furosemide. Which of the following findings
requires the nurse to intervene immediately?
Answer: Muscle weakness, hyporeflexia, and a flat T wave on the ECG monitor.
Rationale: Loop diuretics waste potassium. These neuromuscular signs, paired with
flattening T waves, indicate severe hypokalemia, which poses an immediate risk for cardiac
arrest or digoxin toxicity.
4. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI).
Which of the following fluid planning restrictions should the nurse expect to
implement?
Answer: Restrict intake to the previous 24-hour total urine output plus 500 to 600 mL.
Rationale: During the oliguric phase, the kidneys cannot excrete excess fluid. Calculating
replacement based on output plus insensible losses (500–600 mL) prevents life-threatening
fluid overload, pulmonary edema, and severe hypertension.
5. A client who has an aggressive nasogastric (NG) tube set to continuous high
suction is at risk for developing which of the following acid-base imbalances?
, Answer: Metabolic alkalosis.
Rationale: Nasogastric suction removes massive amounts of gastric secretions, which are
highly rich in hydrochloric acid. Loss of hydrogen and chloride ions leads to a relative
systemic excess of bicarbonate ions.
Cardiovascular & Hematology Systems
6. A nurse on a telemetry unit is analyzing an ECG strip for an adult client and notes
an absent P wave, an irregular rhythm, and chaotic, fibrillatory baseline waves. Which
of the following dysrhythmias should the nurse document?
Answer: Atrial fibrillation.
Rationale: Atrial fibrillation is characterized by the total absence of distinct P waves, an
irregularly irregular ventricular response, and disorganized atrial activity. The main clinical
goal is ventricular rate control and thromboembolism prevention.
7. A nurse is reviewing discharge instructions with a client who has a new
mechanical heart valve replacement and a prescription for warfarin. Which of the
following safety statements by the client indicates a correct understanding?
, Answer: "I will avoid changing my daily intake of spinach, broccoli, and other green
vegetables."
Rationale: Green leafy vegetables contain Vitamin K, the direct antidote to warfarin. The
client does not need to eliminate these foods entirely but must keep their consumption
consistent to maintain a stable, therapeutic INR.
8. A client is admitted with deep vein thrombosis (DVT) and is placed on a continuous
intravenous heparin infusion. The client's aPTT is 98 seconds (control value: 35
seconds). Which of the following actions should the nurse take?
Answer: Hold the infusion and notify the healthcare provider.
Rationale: A therapeutic aPTT level for a client on heparin is typically 1.5 to 2.5 times the
control value (approx. 52 to 87 seconds). An aPTT of 98 seconds is sub-toxic and increases
the immediate risk of severe internal hemorrhage.
9. A nurse is assessing a client 4 hours post-percutaneous coronary intervention
(PCI) with femoral artery access. The nurse notes that the client’s left pedal pulse is
faint compared to the right, and the left foot is cool to the touch. Which of the
following actions is the priority?
Answer: Notify the healthcare provider or interventional cardiology team immediately.
Rationale: A diminished peripheral pulse and cool extremity following femoral artery
catheterization indicate arterial occlusion or severe hematoma compression. This is a
vascular emergency requiring immediate intervention to prevent tissue ischemia.
study guide (2026) | 150 highly-predicted questions and answers
bundle pack with comprehensive rationales
1. A nurse is caring for a client who is 48 hours post-operative following an
abdominal hysterectomy. The client’s breath sounds are clear, but their serum
sodium level is 130 mEq/L. Which of the following IV fluids should the nurse expect
the provider to prescribe?
Answer: 0.9% Sodium Chloride (Normal Saline).
Rationale: A serum sodium level of 130 mEq/L indicates hyponatremia, a common post-
operative dilutional fluid imbalance. Normal saline is an isotonic fluid that adds intravascular
sodium volume without triggering severe cellular fluid shifts.
2. A client with chronic kidney disease (CKD) presents to the emergency department
with a potassium level of 6.8 mEq/L and tall, tented T waves on their ECG. Which of
the following medications should the nurse prepare to administer first to stabilize the
cardiac membrane?
Answer: Calcium gluconate IV.
, Rationale: While insulin and dextrose shift potassium into cells, calcium gluconate must be
given first during severe hyperkalemic emergencies. It directly antagonizes potassium's
toxic effects on the myocardium, preventing lethal ventricular dysrhythmias.
3. A nurse is assessing a client with acute decompensated heart failure who is
receiving a continuous infusion of furosemide. Which of the following findings
requires the nurse to intervene immediately?
Answer: Muscle weakness, hyporeflexia, and a flat T wave on the ECG monitor.
Rationale: Loop diuretics waste potassium. These neuromuscular signs, paired with
flattening T waves, indicate severe hypokalemia, which poses an immediate risk for cardiac
arrest or digoxin toxicity.
4. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI).
Which of the following fluid planning restrictions should the nurse expect to
implement?
Answer: Restrict intake to the previous 24-hour total urine output plus 500 to 600 mL.
Rationale: During the oliguric phase, the kidneys cannot excrete excess fluid. Calculating
replacement based on output plus insensible losses (500–600 mL) prevents life-threatening
fluid overload, pulmonary edema, and severe hypertension.
5. A client who has an aggressive nasogastric (NG) tube set to continuous high
suction is at risk for developing which of the following acid-base imbalances?
, Answer: Metabolic alkalosis.
Rationale: Nasogastric suction removes massive amounts of gastric secretions, which are
highly rich in hydrochloric acid. Loss of hydrogen and chloride ions leads to a relative
systemic excess of bicarbonate ions.
Cardiovascular & Hematology Systems
6. A nurse on a telemetry unit is analyzing an ECG strip for an adult client and notes
an absent P wave, an irregular rhythm, and chaotic, fibrillatory baseline waves. Which
of the following dysrhythmias should the nurse document?
Answer: Atrial fibrillation.
Rationale: Atrial fibrillation is characterized by the total absence of distinct P waves, an
irregularly irregular ventricular response, and disorganized atrial activity. The main clinical
goal is ventricular rate control and thromboembolism prevention.
7. A nurse is reviewing discharge instructions with a client who has a new
mechanical heart valve replacement and a prescription for warfarin. Which of the
following safety statements by the client indicates a correct understanding?
, Answer: "I will avoid changing my daily intake of spinach, broccoli, and other green
vegetables."
Rationale: Green leafy vegetables contain Vitamin K, the direct antidote to warfarin. The
client does not need to eliminate these foods entirely but must keep their consumption
consistent to maintain a stable, therapeutic INR.
8. A client is admitted with deep vein thrombosis (DVT) and is placed on a continuous
intravenous heparin infusion. The client's aPTT is 98 seconds (control value: 35
seconds). Which of the following actions should the nurse take?
Answer: Hold the infusion and notify the healthcare provider.
Rationale: A therapeutic aPTT level for a client on heparin is typically 1.5 to 2.5 times the
control value (approx. 52 to 87 seconds). An aPTT of 98 seconds is sub-toxic and increases
the immediate risk of severe internal hemorrhage.
9. A nurse is assessing a client 4 hours post-percutaneous coronary intervention
(PCI) with femoral artery access. The nurse notes that the client’s left pedal pulse is
faint compared to the right, and the left foot is cool to the touch. Which of the
following actions is the priority?
Answer: Notify the healthcare provider or interventional cardiology team immediately.
Rationale: A diminished peripheral pulse and cool extremity following femoral artery
catheterization indicate arterial occlusion or severe hematoma compression. This is a
vascular emergency requiring immediate intervention to prevent tissue ischemia.
