BSN 266 HESI V2 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified Solutions | Updated Per
Latest Guidelines | Graded A+ Nightingale.
Core Domains
Medical-Surgical Nursing: Cardiovascular and Respiratory Disorders
Medical-Surgical Nursing: Gastrointestinal, Renal, and Endocrine Disorders
Medical-Surgical Nursing: Neurological and Musculoskeletal Disorders
Pharmacology and Medication Administration
Fluid, Electrolyte, and Acid-Base Balance
Perioperative and Postoperative Nursing Care
Infection Control and Safety
Nursing Leadership, Delegation, and Prioritization
This comprehensive assessment evaluates critical nursing knowledge and clinical decision-making skills essential
for safe, effective medical-surgical nursing practice. The exam assesses mastery of foundational theory, applied
professional knowledge, regulatory compliance, ethics, and professional standards through multiple-choice and
scenario-based questions. Skills and knowledge assessed include pathophysiology recognition, pharmacological
interventions, patient monitoring, emergency response, and therapeutic communication. Questions emphasize
real-world application requiring critical thinking, prioritization, and evidence-based decision-making in diverse
,clinical scenarios. The exam structure presents 100 multiple-choice questions with four options each, simulating
actual healthcare environments. Each question includes verified correct answers with detailed rationales explaining
clinical reasoning. This format prepares nurses for professional certification, licensure, and clinical competency
validation.
SECTION ONE
Questions 1–100
Question 1
A client who underwent a femoral-popliteal bypass graft 12 hours ago reports sudden, severe pain in the
operative leg. The nurse notes that the toes are pale and cool to the touch. Which action should the nurse take
first?
A. Administer prescribed analgesic medication.
B. Notify the healthcare provider immediately.
C. Assess the client's pedal pulses and capillary refill.
D. Elevate the operative leg on two pillows.
🟢 Correct Answer:
C. Assess the client's pedal pulses and capillary refill.
,🔴 RATIONALE:
The nurse should first assess the client's pedal pulses and capillary refill to determine if the graft has occluded.
Pale, cool toes with sudden severe pain are signs of acute arterial occlusion, which is a surgical emergency. After
assessing the pulses, the nurse should notify the healthcare provider immediately.
Question 2
The nurse is providing discharge teaching to a client who has had a carotid endarterectomy. Which instruction
should the nurse include?
A. "You may resume driving immediately."
B. "Report any difficulty swallowing or hoarseness to your healthcare provider."
C. "It is normal to have a fever for the first few days at home."
D. "You do not need to monitor your blood pressure at home."
🟢 Correct Answer:
B. "Report any difficulty swallowing or hoarseness to your healthcare provider."
🔴 RATIONALE:
Difficulty swallowing or hoarseness after carotid endarterectomy may indicate cranial nerve damage, specifically
the hypoglossal or vagus nerves. The client should report these symptoms promptly. Driving should be
, restricted until cleared by the healthcare provider, fever is not normal and should be reported, and blood
pressure monitoring is essential.
Question 3
A client with chronic renal failure has a serum potassium level of 6.5 mEq/L. The nurse should monitor the client
for which dysrhythmia?
A. Sinus tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. First-degree atrioventricular block
🟢 Correct Answer:
B. Ventricular fibrillation
🔴 RATIONALE:
Hyperkalemia (serum potassium > 5.5 mEq/L) can lead to life-threatening dysrhythmias, including ventricular
fibrillation and cardiac arrest. The nurse should place the client on a cardiac monitor and prepare to administer
calcium gluconate, insulin with glucose, and kayexalate as ordered.
Latest Guidelines | Graded A+ Nightingale.
Core Domains
Medical-Surgical Nursing: Cardiovascular and Respiratory Disorders
Medical-Surgical Nursing: Gastrointestinal, Renal, and Endocrine Disorders
Medical-Surgical Nursing: Neurological and Musculoskeletal Disorders
Pharmacology and Medication Administration
Fluid, Electrolyte, and Acid-Base Balance
Perioperative and Postoperative Nursing Care
Infection Control and Safety
Nursing Leadership, Delegation, and Prioritization
This comprehensive assessment evaluates critical nursing knowledge and clinical decision-making skills essential
for safe, effective medical-surgical nursing practice. The exam assesses mastery of foundational theory, applied
professional knowledge, regulatory compliance, ethics, and professional standards through multiple-choice and
scenario-based questions. Skills and knowledge assessed include pathophysiology recognition, pharmacological
interventions, patient monitoring, emergency response, and therapeutic communication. Questions emphasize
real-world application requiring critical thinking, prioritization, and evidence-based decision-making in diverse
,clinical scenarios. The exam structure presents 100 multiple-choice questions with four options each, simulating
actual healthcare environments. Each question includes verified correct answers with detailed rationales explaining
clinical reasoning. This format prepares nurses for professional certification, licensure, and clinical competency
validation.
SECTION ONE
Questions 1–100
Question 1
A client who underwent a femoral-popliteal bypass graft 12 hours ago reports sudden, severe pain in the
operative leg. The nurse notes that the toes are pale and cool to the touch. Which action should the nurse take
first?
A. Administer prescribed analgesic medication.
B. Notify the healthcare provider immediately.
C. Assess the client's pedal pulses and capillary refill.
D. Elevate the operative leg on two pillows.
🟢 Correct Answer:
C. Assess the client's pedal pulses and capillary refill.
,🔴 RATIONALE:
The nurse should first assess the client's pedal pulses and capillary refill to determine if the graft has occluded.
Pale, cool toes with sudden severe pain are signs of acute arterial occlusion, which is a surgical emergency. After
assessing the pulses, the nurse should notify the healthcare provider immediately.
Question 2
The nurse is providing discharge teaching to a client who has had a carotid endarterectomy. Which instruction
should the nurse include?
A. "You may resume driving immediately."
B. "Report any difficulty swallowing or hoarseness to your healthcare provider."
C. "It is normal to have a fever for the first few days at home."
D. "You do not need to monitor your blood pressure at home."
🟢 Correct Answer:
B. "Report any difficulty swallowing or hoarseness to your healthcare provider."
🔴 RATIONALE:
Difficulty swallowing or hoarseness after carotid endarterectomy may indicate cranial nerve damage, specifically
the hypoglossal or vagus nerves. The client should report these symptoms promptly. Driving should be
, restricted until cleared by the healthcare provider, fever is not normal and should be reported, and blood
pressure monitoring is essential.
Question 3
A client with chronic renal failure has a serum potassium level of 6.5 mEq/L. The nurse should monitor the client
for which dysrhythmia?
A. Sinus tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. First-degree atrioventricular block
🟢 Correct Answer:
B. Ventricular fibrillation
🔴 RATIONALE:
Hyperkalemia (serum potassium > 5.5 mEq/L) can lead to life-threatening dysrhythmias, including ventricular
fibrillation and cardiac arrest. The nurse should place the client on a cardiac monitor and prepare to administer
calcium gluconate, insulin with glucose, and kayexalate as ordered.
