BSN 266 HESI Med Surg Exam Latest 2026/2027
Update | Complete Test Bank with Verified
Questions and Answers and Rationales | Medical-
Surgical Nursing | Cardiovascular, Respiratory,
Endocrine, GI, Renal, Hematologic | A+ Graded
1. A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse
rate is 43 beats per minute. Which question is a priority for the nurse to ask this
client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Answer: D. "Does the client take digitalis?"
Rationale: Symptoms such as confusion, nausea, vomiting, headache, and bradycardia
are classic signs of digitalis toxicity, especially in elderly clients. Older persons are
particularly susceptible to the buildup of cardiac glycosides to toxic levels. Prompt
assessment of medication history is critical.
2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Answer: B. Perform synchronized cardioversion
,Rationale: With uncontrolled atrial fibrillation and rapid ventricular response, the
treatment of choice is synchronized cardioversion to convert the cardiac rhythm back to
normal sinus rhythm. Lidocaine is used for ventricular arrhythmias. Defibrillation is for
pulseless rhythms. Atropine is for symptomatic bradycardia.
3. The nurse is caring for a client who is one day post-acute myocardial infarction.
The client is receiving oxygen at 2 L/min via nasal cannula and has a peripheral
saline lock. The nurse notes that the client is having eight premature ventricular
contractions (PVCs) per minute. Which action should the nurse take first?
A. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
Rationale: PVCs are common after MI. The first action is to increase oxygen delivery to
reduce myocardial ischemia. Lidocaine may be prescribed if PVCs persist. Assess LOC
and notify provider after oxygen is increased.
4. A client is in cardiogenic shock. Which finding would the nurse expect?
A. Warm, flushed skin
B. Bradycardia
C. Pulmonary edema
D. Hypertension
Answer: C. Pulmonary edema
Rationale: Cardiogenic shock results from pump failure. The heart cannot effectively
pump blood, causing fluid backup into the lungs and pulmonary edema. Skin is cool and
clammy, heart rate is tachycardic, and blood pressure is decreased.
,5. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to
hypokalemia. Hypokalemia can precipitate cardiac arrhythmias, especially in clients
taking digoxin. The nurse should monitor potassium levels closely and assess for signs
of hypokalemia.
6. A client with deep vein thrombosis (DVT) is receiving heparin therapy. Which
laboratory value indicates the therapy is therapeutic?
A. INR 2.0-3.0
B. aPTT 1.5-2.5 times control
C. Platelet count 150,000-400,000/mm³
D. PT 12-15 seconds
Answer: B. aPTT 1.5-2.5 times control
Rationale: Heparin therapy is monitored by aPTT (activated partial thromboplastin
time), with a therapeutic goal of 1.5-2.5 times the control value. INR and PT monitor
warfarin therapy. Platelet count monitors for heparin-induced thrombocytopenia.
7. The nurse is assessing a client with right-sided heart failure. Which finding is
most consistent with this condition?
A. Crackles in the lung bases
B. Jugular vein distention
C. Paroxysmal nocturnal dyspnea
D. Orthopnea
, Answer: B. Jugular vein distention
Rationale: Right-sided heart failure presents with systemic congestion: jugular vein
distention, peripheral edema, hepatomegaly, and ascites. Crackles, paroxysmal nocturnal
dyspnea, and orthopnea are findings associated with left-sided heart failure.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse teach the client to report immediately?
A. Dry cough
B. Dizziness
C. Swelling of the lips or tongue
D. Headache
Answer: C. Swelling of the lips or tongue
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a rare but life-
threatening adverse effect of ACE inhibitors. It requires immediate medical attention.
Dry cough is common but not life-threatening. Dizziness and headache are also
common side effects.
9. The nurse is caring for a client with heart failure who reports sudden onset of
severe dyspnea and coughing up pink, frothy sputum. Which complication does
the nurse suspect?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumonia
D. Pleural effusion
Answer: B. Acute pulmonary edema
Rationale: Pink, frothy sputum is characteristic of acute pulmonary edema from left-
sided heart failure. This is a medical emergency requiring immediate intervention
(oxygen, diuretics, morphine). Pulmonary embolism causes pleuritic chest pain;
pneumonia causes fever and purulent sputum.
Update | Complete Test Bank with Verified
Questions and Answers and Rationales | Medical-
Surgical Nursing | Cardiovascular, Respiratory,
Endocrine, GI, Renal, Hematologic | A+ Graded
1. A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse
rate is 43 beats per minute. Which question is a priority for the nurse to ask this
client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Answer: D. "Does the client take digitalis?"
Rationale: Symptoms such as confusion, nausea, vomiting, headache, and bradycardia
are classic signs of digitalis toxicity, especially in elderly clients. Older persons are
particularly susceptible to the buildup of cardiac glycosides to toxic levels. Prompt
assessment of medication history is critical.
2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid
ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Answer: B. Perform synchronized cardioversion
,Rationale: With uncontrolled atrial fibrillation and rapid ventricular response, the
treatment of choice is synchronized cardioversion to convert the cardiac rhythm back to
normal sinus rhythm. Lidocaine is used for ventricular arrhythmias. Defibrillation is for
pulseless rhythms. Atropine is for symptomatic bradycardia.
3. The nurse is caring for a client who is one day post-acute myocardial infarction.
The client is receiving oxygen at 2 L/min via nasal cannula and has a peripheral
saline lock. The nurse notes that the client is having eight premature ventricular
contractions (PVCs) per minute. Which action should the nurse take first?
A. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
Rationale: PVCs are common after MI. The first action is to increase oxygen delivery to
reduce myocardial ischemia. Lidocaine may be prescribed if PVCs persist. Assess LOC
and notify provider after oxygen is increased.
4. A client is in cardiogenic shock. Which finding would the nurse expect?
A. Warm, flushed skin
B. Bradycardia
C. Pulmonary edema
D. Hypertension
Answer: C. Pulmonary edema
Rationale: Cardiogenic shock results from pump failure. The heart cannot effectively
pump blood, causing fluid backup into the lungs and pulmonary edema. Skin is cool and
clammy, heart rate is tachycardic, and blood pressure is decreased.
,5. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Blood urea nitrogen
D. Hemoglobin
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium loss, leading to
hypokalemia. Hypokalemia can precipitate cardiac arrhythmias, especially in clients
taking digoxin. The nurse should monitor potassium levels closely and assess for signs
of hypokalemia.
6. A client with deep vein thrombosis (DVT) is receiving heparin therapy. Which
laboratory value indicates the therapy is therapeutic?
A. INR 2.0-3.0
B. aPTT 1.5-2.5 times control
C. Platelet count 150,000-400,000/mm³
D. PT 12-15 seconds
Answer: B. aPTT 1.5-2.5 times control
Rationale: Heparin therapy is monitored by aPTT (activated partial thromboplastin
time), with a therapeutic goal of 1.5-2.5 times the control value. INR and PT monitor
warfarin therapy. Platelet count monitors for heparin-induced thrombocytopenia.
7. The nurse is assessing a client with right-sided heart failure. Which finding is
most consistent with this condition?
A. Crackles in the lung bases
B. Jugular vein distention
C. Paroxysmal nocturnal dyspnea
D. Orthopnea
, Answer: B. Jugular vein distention
Rationale: Right-sided heart failure presents with systemic congestion: jugular vein
distention, peripheral edema, hepatomegaly, and ascites. Crackles, paroxysmal nocturnal
dyspnea, and orthopnea are findings associated with left-sided heart failure.
8. A client with hypertension is prescribed lisinopril. Which adverse effect should
the nurse teach the client to report immediately?
A. Dry cough
B. Dizziness
C. Swelling of the lips or tongue
D. Headache
Answer: C. Swelling of the lips or tongue
Rationale: Angioedema (swelling of the lips, tongue, or throat) is a rare but life-
threatening adverse effect of ACE inhibitors. It requires immediate medical attention.
Dry cough is common but not life-threatening. Dizziness and headache are also
common side effects.
9. The nurse is caring for a client with heart failure who reports sudden onset of
severe dyspnea and coughing up pink, frothy sputum. Which complication does
the nurse suspect?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumonia
D. Pleural effusion
Answer: B. Acute pulmonary edema
Rationale: Pink, frothy sputum is characteristic of acute pulmonary edema from left-
sided heart failure. This is a medical emergency requiring immediate intervention
(oxygen, diuretics, morphine). Pulmonary embolism causes pleuritic chest pain;
pneumonia causes fever and purulent sputum.
