, BSN HESI 266 Med-Surg Exam V5:
High-Yield Questions, Answers, &
Rationales 2026/2027 Update
Question 1: Cardiovascular & Acute Coronary Syndrome
A client is admitted to the emergency department reporting
substernal chest pressure that began 2 hours ago. The 12-lead
electrocardiogram (ECG) reveals ST-segment elevation in leads
II, III, and aVF. The nurse recognizes that these findings
indicate which underlying condition?
A. Lateral wall ischemia.
B. Inferior wall ST-elevation myocardial infarction
(STEMI).
C. Anterior wall non-ST-elevation myocardial infarction
(NSTEMI).
D. Right ventricular hypertrophy.
Correct Answer: B. Inferior wall ST-elevation myocardial
infarction (STEMI).
Explanation: Leads II, III, and aVF view the inferior wall of the
left ventricle. ST-segment elevation in these leads indicates an
acute inferior wall myocardial injury (STEMI), which typically
involves the right coronary artery.
Question 2: Respiratory & Chest Tube Management
While assisting a client with a chest tube connected to a dry
suction water-seal system, the nurse notices continuous bubbling
in the water-seal chamber. What is the nurse's priority action?
, A. Document the finding as normal continuous bubbling.
B. Clamp the chest tube immediately close to the chest
wall.
C. Inspect the entire system from the insertion site down to
the unit to locate and correct an air leak.
D. Increase the suction pressure control dial on the wall
regulator.
Correct Answer: C. Inspect the entire system from the
insertion site down to the unit to locate and correct an air
leak.
Explanation: Continuous bubbling in the water-seal chamber
indicates an air leak in the system. (Intermittent bubbling that
coincides with exhalation or coughing is normal because it
indicates removal of intrapleural air). The nurse should
systematically check the tubing connections, dressing, and
insertion site.
Question 3: Endocrine & Diabetic Ketoacidosis (DKA) Fluid
Management
A client is admitted to the intensive care unit with diabetic
ketoacidosis (DKA). The initial laboratory results show a blood
glucose of 510 mg/dL, serum sodium of 130 mEq/L, and a
serum potassium of 4.2 mEq/L. Which intravenous fluid order
should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline at 150 mL/hour.
B. 0.9% Normal Saline IV bolus at 1,000 mL/hour.
C. 0.45% Normal Saline IV at 50 mL/hour.
D. 3% Sodium Chloride IV bolus.
, Correct Answer: B. 0.9% Normal Saline IV bolus at 1,000
mL/hour.
Explanation: The primary initial goal in DKA management is
aggressive intravascular volume restoration to improve renal
perfusion and lower blood glucose via dilution and excretion.
An initial rapid infusion of 0.9% Normal Saline is standard.
Question 4: Renal & Peritoneal Dialysis Effluent Assessment
A client undergoing continuous ambulatory peritoneal dialysis
(CAPD) calls the clinic reporting that the peritoneal effluent is
cloudy and mixed with fibrin strands. The client reports a mild
abdominal ache and a low-grade fever. What condition does the
nurse suspect?
A. Normal expected effluent after an extended dwell time.
B. Peritonitis.
C. Bowel obstruction.
D. Bladder perforation.
Correct Answer: B. Peritonitis.
Explanation: Cloudy effluent is the hallmark primary sign of
peritonitis in clients receiving peritoneal dialysis. It is frequently
accompanied by abdominal pain, tenderness, and fever,
requiring immediate analysis of the effluent and antibiotic
therapy.
Question 5: Gastrointestinal & Upper GI Bleed
A client with a history of cirrhosis is admitted with hematemesis
and signs of hypovolemic shock. An
High-Yield Questions, Answers, &
Rationales 2026/2027 Update
Question 1: Cardiovascular & Acute Coronary Syndrome
A client is admitted to the emergency department reporting
substernal chest pressure that began 2 hours ago. The 12-lead
electrocardiogram (ECG) reveals ST-segment elevation in leads
II, III, and aVF. The nurse recognizes that these findings
indicate which underlying condition?
A. Lateral wall ischemia.
B. Inferior wall ST-elevation myocardial infarction
(STEMI).
C. Anterior wall non-ST-elevation myocardial infarction
(NSTEMI).
D. Right ventricular hypertrophy.
Correct Answer: B. Inferior wall ST-elevation myocardial
infarction (STEMI).
Explanation: Leads II, III, and aVF view the inferior wall of the
left ventricle. ST-segment elevation in these leads indicates an
acute inferior wall myocardial injury (STEMI), which typically
involves the right coronary artery.
Question 2: Respiratory & Chest Tube Management
While assisting a client with a chest tube connected to a dry
suction water-seal system, the nurse notices continuous bubbling
in the water-seal chamber. What is the nurse's priority action?
, A. Document the finding as normal continuous bubbling.
B. Clamp the chest tube immediately close to the chest
wall.
C. Inspect the entire system from the insertion site down to
the unit to locate and correct an air leak.
D. Increase the suction pressure control dial on the wall
regulator.
Correct Answer: C. Inspect the entire system from the
insertion site down to the unit to locate and correct an air
leak.
Explanation: Continuous bubbling in the water-seal chamber
indicates an air leak in the system. (Intermittent bubbling that
coincides with exhalation or coughing is normal because it
indicates removal of intrapleural air). The nurse should
systematically check the tubing connections, dressing, and
insertion site.
Question 3: Endocrine & Diabetic Ketoacidosis (DKA) Fluid
Management
A client is admitted to the intensive care unit with diabetic
ketoacidosis (DKA). The initial laboratory results show a blood
glucose of 510 mg/dL, serum sodium of 130 mEq/L, and a
serum potassium of 4.2 mEq/L. Which intravenous fluid order
should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline at 150 mL/hour.
B. 0.9% Normal Saline IV bolus at 1,000 mL/hour.
C. 0.45% Normal Saline IV at 50 mL/hour.
D. 3% Sodium Chloride IV bolus.
, Correct Answer: B. 0.9% Normal Saline IV bolus at 1,000
mL/hour.
Explanation: The primary initial goal in DKA management is
aggressive intravascular volume restoration to improve renal
perfusion and lower blood glucose via dilution and excretion.
An initial rapid infusion of 0.9% Normal Saline is standard.
Question 4: Renal & Peritoneal Dialysis Effluent Assessment
A client undergoing continuous ambulatory peritoneal dialysis
(CAPD) calls the clinic reporting that the peritoneal effluent is
cloudy and mixed with fibrin strands. The client reports a mild
abdominal ache and a low-grade fever. What condition does the
nurse suspect?
A. Normal expected effluent after an extended dwell time.
B. Peritonitis.
C. Bowel obstruction.
D. Bladder perforation.
Correct Answer: B. Peritonitis.
Explanation: Cloudy effluent is the hallmark primary sign of
peritonitis in clients receiving peritoneal dialysis. It is frequently
accompanied by abdominal pain, tenderness, and fever,
requiring immediate analysis of the effluent and antibiotic
therapy.
Question 5: Gastrointestinal & Upper GI Bleed
A client with a history of cirrhosis is admitted with hematemesis
and signs of hypovolemic shock. An
