, BSN 266 HESI Med-Surg Exam: 200+ Practice
Questions, Verified Answers & Detailed
Rationales – 2026 NGN-Style Update | Instant
Digital Download
Question 1:
A client with a diagnosis of myocardial infarction ten hours ago would likely exhibit
which laboratory test result?
A) Elevated troponin
B) Elevated LDH
C) Elevated CK-MB
D) Elevated BNP
Answer: B) Elevated LDH
Rationale: Following a myocardial infarction, LDH levels rise within 12-24 hours and
peak at 48-72 hours, remaining elevated for up to 14 days . Troponin rises within 3-4
hours and is the most cardiac-specific marker. CK-MB rises within 4-6 hours. BNP is
elevated in heart failure, not MI.
Question 2:
When should a nurse withhold a dose of digoxin in a client with congestive heart
failure?
A) If the apical pulse is below 60/min
B) If the apical pulse is absent
C) If the client reports nausea
D) If the client reports headache
Answer: B) If the apical pulse is absent
Rationale: Digoxin should be withheld if the apical pulse is absent, as this indicates
potential cardiac arrest or severe bradycardia . The standard parameter for withholding
,digoxin is an apical pulse <60/min in adults. Nausea and headache are side effects but
not indications to withhold without further assessment.
Question 3:
What treatment protocol should a nurse prepare for a client with atrial fibrillation based
on analysis?
A) Anticoagulation therapy
B) Antihypertensive therapy
C) Antiarrhythmic therapy
D) Thrombolytic therapy
Answer: A) Anticoagulation therapy
Rationale: Atrial fibrillation significantly increases the risk of thromboembolic events
due to stagnant blood flow in the atria . Anticoagulation therapy is indicated to prevent
stroke. Antiarrhythmic therapy may be used for rate control, but anticoagulation is a
priority based on CHA₂DS₂-VASc score.
Question 4:
In a client diagnosed with primary aldosteronism, the nurse expects laboratory test
results to indicate a decreased serum level of which substance?
A) Sodium
B) Phosphate
C) Potassium
D) Glucose
Answer: C) Potassium
Rationale: Clients with primary aldosteronism exhibit profound decline in serum
potassium levels (hypokalemia) due to excessive aldosterone secretion promoting
potassium excretion . Hypertension is the most prominent sign. Serum sodium is normal
or elevated. Phosphate is influenced by PTH, and glucose is not directly affected.
, Question 5:
A client with heart failure is experiencing shortness of breath and peripheral edema.
Which assessment finding is the priority to report?
A) Weight gain of 2 pounds in 24 hours
B) Crackles auscultated in the lung bases
C) Blood pressure of 145/90 mmHg
D) Heart rate of 102 bpm
Answer: B) Crackles auscultated in the lung bases
Rationale: Crackles in the lung bases indicate pulmonary congestion, a sign of
worsening heart failure that requires immediate intervention . While weight gain,
elevated blood pressure, and tachycardia are concerning, crackles indicate fluid
accumulation in the lungs, which can lead to respiratory distress and requires urgent
action.
Question 6:
A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse
include in the teaching?
A) "Take ibuprofen for headaches"
B) "Maintain a consistent intake of leafy green vegetables"
C) "Avoid all vitamin K-containing foods"
D) "Take the medication with milk"
Answer: B) "Maintain a consistent intake of leafy green vegetables"
Rationale: Warfarin's anticoagulant effect is antagonized by vitamin K. Patients should
maintain a consistent intake of vitamin K-rich foods (leafy greens) to keep INR stable .
Avoiding all vitamin K foods is not recommended and can cause INR fluctuations.
Question 7:
When auscultating heart sounds, which technique is used to listen for an S3 heart
sound?
Questions, Verified Answers & Detailed
Rationales – 2026 NGN-Style Update | Instant
Digital Download
Question 1:
A client with a diagnosis of myocardial infarction ten hours ago would likely exhibit
which laboratory test result?
A) Elevated troponin
B) Elevated LDH
C) Elevated CK-MB
D) Elevated BNP
Answer: B) Elevated LDH
Rationale: Following a myocardial infarction, LDH levels rise within 12-24 hours and
peak at 48-72 hours, remaining elevated for up to 14 days . Troponin rises within 3-4
hours and is the most cardiac-specific marker. CK-MB rises within 4-6 hours. BNP is
elevated in heart failure, not MI.
Question 2:
When should a nurse withhold a dose of digoxin in a client with congestive heart
failure?
A) If the apical pulse is below 60/min
B) If the apical pulse is absent
C) If the client reports nausea
D) If the client reports headache
Answer: B) If the apical pulse is absent
Rationale: Digoxin should be withheld if the apical pulse is absent, as this indicates
potential cardiac arrest or severe bradycardia . The standard parameter for withholding
,digoxin is an apical pulse <60/min in adults. Nausea and headache are side effects but
not indications to withhold without further assessment.
Question 3:
What treatment protocol should a nurse prepare for a client with atrial fibrillation based
on analysis?
A) Anticoagulation therapy
B) Antihypertensive therapy
C) Antiarrhythmic therapy
D) Thrombolytic therapy
Answer: A) Anticoagulation therapy
Rationale: Atrial fibrillation significantly increases the risk of thromboembolic events
due to stagnant blood flow in the atria . Anticoagulation therapy is indicated to prevent
stroke. Antiarrhythmic therapy may be used for rate control, but anticoagulation is a
priority based on CHA₂DS₂-VASc score.
Question 4:
In a client diagnosed with primary aldosteronism, the nurse expects laboratory test
results to indicate a decreased serum level of which substance?
A) Sodium
B) Phosphate
C) Potassium
D) Glucose
Answer: C) Potassium
Rationale: Clients with primary aldosteronism exhibit profound decline in serum
potassium levels (hypokalemia) due to excessive aldosterone secretion promoting
potassium excretion . Hypertension is the most prominent sign. Serum sodium is normal
or elevated. Phosphate is influenced by PTH, and glucose is not directly affected.
, Question 5:
A client with heart failure is experiencing shortness of breath and peripheral edema.
Which assessment finding is the priority to report?
A) Weight gain of 2 pounds in 24 hours
B) Crackles auscultated in the lung bases
C) Blood pressure of 145/90 mmHg
D) Heart rate of 102 bpm
Answer: B) Crackles auscultated in the lung bases
Rationale: Crackles in the lung bases indicate pulmonary congestion, a sign of
worsening heart failure that requires immediate intervention . While weight gain,
elevated blood pressure, and tachycardia are concerning, crackles indicate fluid
accumulation in the lungs, which can lead to respiratory distress and requires urgent
action.
Question 6:
A client is prescribed warfarin for atrial fibrillation. Which instruction should the nurse
include in the teaching?
A) "Take ibuprofen for headaches"
B) "Maintain a consistent intake of leafy green vegetables"
C) "Avoid all vitamin K-containing foods"
D) "Take the medication with milk"
Answer: B) "Maintain a consistent intake of leafy green vegetables"
Rationale: Warfarin's anticoagulant effect is antagonized by vitamin K. Patients should
maintain a consistent intake of vitamin K-rich foods (leafy greens) to keep INR stable .
Avoiding all vitamin K foods is not recommended and can cause INR fluctuations.
Question 7:
When auscultating heart sounds, which technique is used to listen for an S3 heart
sound?
