, BSN HESI 266 Med-Surg Exam V4:
High-Yield Questions, Answers, &
Rationales 2026/2027 Update
Question 1: Cardiovascular & Acute Coronary Syndrome
A client is admitted to the emergency department with
substernal crushing chest pressure radiating to the left shoulder
and jaw. The 12-lead electrocardiogram reveals ST-segment
depression and T-wave inversion in leads V1 through V4. The
nurse recognizes that these findings indicate which underlying
condition?
A. Transmural ST-elevation myocardial infarction
(STEMI) of the inferior wall.
B. Non-ST-elevation myocardial infarction (NSTEMI) or
ischemia involving the anterior wall.
C. Acute pericarditis affecting the entire epicardial surface.
D. Right ventricular infarction secondary to coronary
vasospasm.
Correct Answer: B. Non-ST-elevation myocardial infarction
(NSTEMI) or ischemia involving the anterior wall.
Explanation: ST-segment depression and T-wave inversion
typically indicate myocardial ischemia or a non-ST-elevation
myocardial infarction (NSTEMI). Leads V1 through V4 focus
on the anterior surface of the left ventricle.
Question 2: Respiratory & Chest Tube Management
,A client with a right-sided chest tube connected to a water-seal
suction system is ambulating in the hallway when the chest tube
accidentally disconnects from the drainage unit. What is the
nurse's immediate priority action?
A. Clamp the chest tube securely with padded metal
hemostats near the insertion site.
B. Submerge the end of the chest tubing momentarily in a
sterile container of sterile water to maintain the water seal.
C. Pull the chest tube out rapidly while instructing the
client to perform the Valsalva maneuver.
D. Leave the tubing open to room air while applying
pressure dressings.
Correct Answer: B. Submerge the end of the chest tubing
momentarily in a sterile container of sterile water to
maintain the water seal.
Explanation: If a chest tube disconnects from the drainage unit,
submerging the distal end in sterile water re-establishes a water
seal immediately, preventing air from entering the pleural space
and causing a tension pneumothorax. Clamping should be
avoided unless specifically ordered or checking for leaks, as it
can cause tension pneumothorax.
Question 3: Endocrine & Diabetic Ketoacidosis (DKA)
Management
A client is admitted to the intensive care unit in diabetic
ketoacidosis (DKA). The current blood glucose is 420 mg/dL,
serum potassium is 3.2 mEq/L, and pH is 7.15. Which
, prescription should the nurse clarify with the healthcare provider
before initiating therapy?
A. Initiate a continuous intravenous regular insulin infusion
at 0.1 units/kg/hour.
B. Administer 0.9% Normal Saline IV bolus rapidly.
C. Administer intravenous potassium chloride
supplementation.
D. Hold insulin administration until potassium is corrected
to ≥ 3.3 mEq/L.
Correct Answer: A. Initiate a continuous intravenous
regular insulin infusion at 0.1 units/kg/hour.
Explanation: Insulin drives potassium into cells, which will
lower serum potassium even further. If the serum potassium is
below 3.3 mEq/L, insulin must be withheld and potassium
repleted first to prevent fatal cardiac dysrhythmias.
Question 4: Renal & Continuous Ambulatory Peritoneal
Dialysis (CAPD)
While performing a routine exchange for a client undergoing
continuous ambulatory peritoneal dialysis (CAPD), the nurse
notes that the drainage outflow has stopped prematurely and the
effluent is minimal. What is the nurse's best initial action?
A. Flush the peritoneal catheter forcefully with 50 mL of
sterile heparinized saline.
B. Reposition the client to their side, check the tubing for
kinks, or have them walk briefly.
C. Clamp the peritoneal catheter permanently and prepare
for emergent hemodialysis.
High-Yield Questions, Answers, &
Rationales 2026/2027 Update
Question 1: Cardiovascular & Acute Coronary Syndrome
A client is admitted to the emergency department with
substernal crushing chest pressure radiating to the left shoulder
and jaw. The 12-lead electrocardiogram reveals ST-segment
depression and T-wave inversion in leads V1 through V4. The
nurse recognizes that these findings indicate which underlying
condition?
A. Transmural ST-elevation myocardial infarction
(STEMI) of the inferior wall.
B. Non-ST-elevation myocardial infarction (NSTEMI) or
ischemia involving the anterior wall.
C. Acute pericarditis affecting the entire epicardial surface.
D. Right ventricular infarction secondary to coronary
vasospasm.
Correct Answer: B. Non-ST-elevation myocardial infarction
(NSTEMI) or ischemia involving the anterior wall.
Explanation: ST-segment depression and T-wave inversion
typically indicate myocardial ischemia or a non-ST-elevation
myocardial infarction (NSTEMI). Leads V1 through V4 focus
on the anterior surface of the left ventricle.
Question 2: Respiratory & Chest Tube Management
,A client with a right-sided chest tube connected to a water-seal
suction system is ambulating in the hallway when the chest tube
accidentally disconnects from the drainage unit. What is the
nurse's immediate priority action?
A. Clamp the chest tube securely with padded metal
hemostats near the insertion site.
B. Submerge the end of the chest tubing momentarily in a
sterile container of sterile water to maintain the water seal.
C. Pull the chest tube out rapidly while instructing the
client to perform the Valsalva maneuver.
D. Leave the tubing open to room air while applying
pressure dressings.
Correct Answer: B. Submerge the end of the chest tubing
momentarily in a sterile container of sterile water to
maintain the water seal.
Explanation: If a chest tube disconnects from the drainage unit,
submerging the distal end in sterile water re-establishes a water
seal immediately, preventing air from entering the pleural space
and causing a tension pneumothorax. Clamping should be
avoided unless specifically ordered or checking for leaks, as it
can cause tension pneumothorax.
Question 3: Endocrine & Diabetic Ketoacidosis (DKA)
Management
A client is admitted to the intensive care unit in diabetic
ketoacidosis (DKA). The current blood glucose is 420 mg/dL,
serum potassium is 3.2 mEq/L, and pH is 7.15. Which
, prescription should the nurse clarify with the healthcare provider
before initiating therapy?
A. Initiate a continuous intravenous regular insulin infusion
at 0.1 units/kg/hour.
B. Administer 0.9% Normal Saline IV bolus rapidly.
C. Administer intravenous potassium chloride
supplementation.
D. Hold insulin administration until potassium is corrected
to ≥ 3.3 mEq/L.
Correct Answer: A. Initiate a continuous intravenous
regular insulin infusion at 0.1 units/kg/hour.
Explanation: Insulin drives potassium into cells, which will
lower serum potassium even further. If the serum potassium is
below 3.3 mEq/L, insulin must be withheld and potassium
repleted first to prevent fatal cardiac dysrhythmias.
Question 4: Renal & Continuous Ambulatory Peritoneal
Dialysis (CAPD)
While performing a routine exchange for a client undergoing
continuous ambulatory peritoneal dialysis (CAPD), the nurse
notes that the drainage outflow has stopped prematurely and the
effluent is minimal. What is the nurse's best initial action?
A. Flush the peritoneal catheter forcefully with 50 mL of
sterile heparinized saline.
B. Reposition the client to their side, check the tubing for
kinks, or have them walk briefly.
C. Clamp the peritoneal catheter permanently and prepare
for emergent hemodialysis.
