BSN 266 – HESI Medical-Surgical Practice Exam V2 (Nightingale College, 2026/2027) Verified Questions, Answers, and Rationales (Grade A, 100% Correct)

BSN 266 – HESI Medical-Surgical Practice
Exam V2 (Nightingale College,
2026/2027) Verified Questions, Answers,
and Rationales (Grade A, 100% Correct)

Question 1
A client with a history of COPD is admitted with an acute exacerbation. Which oxygen
delivery device should the nurse prepare to administer to this client initially?

• A) Nasal cannula at 2 L/min

• B) Non-rebreather mask at 10 L/min

• C) Simple face mask at 6 L/min

• D) Venturi mask at 24% FiO₂

Correct Answer: D) Venturi mask at 24% FiO₂

Rationale: Clients with COPD may rely on a hypoxic drive to stimulate breathing.
Administering high concentrations of oxygen can depress their respiratory drive and
lead to hypoventilation. A Venturi mask delivers the most precise and consistent oxygen
concentration, and a low FiO₂ (24-28%) is recommended initially to provide safe,
controlled oxygen therapy without suppressing the respiratory stimulus .



Question 2
A client with an acute exacerbation of COPD is admitted. Which arterial blood gas (ABG)
finding should the nurse expect?

• A) pH 7.35, PaCO₂ 45, HCO₃ 24

• B) pH 7.30, PaCO₂ 55, HCO₃ 30

• C) pH 7.45, PaCO₂ 35, HCO₃ 22

, • D) pH 7.50, PaCO₂ 30, HCO₃ 20

Correct Answer: B) pH 7.30, PaCO₂ 55, HCO₃ 30

Rationale: A COPD exacerbation typically results in respiratory acidosis with metabolic
compensation. This is characterized by a low pH (<7.35), elevated PaCO₂ (>45 mmHg),
and a compensatory increase in HCO₃ (>26 mEq/L) as the kidneys attempt to buffer the
acidosis .



Question 3
The nurse is caring for a client with a chest tube connected to a closed water-seal
drainage system. Which finding indicates a problem with the system?

• A) Tidaling in the water seal chamber

• B) Bubbling in the suction control chamber

• C) Continuous bubbling in the water seal chamber

• D) Fluctuation of the drainage level with respirations

Correct Answer: C) Continuous bubbling in the water seal chamber

Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
chest tube system or at the insertion site. Tidaling (fluctuation with respirations) is an
expected finding. Bubbling in the suction control chamber is also expected when suction
is applied .



Question 4
A client with a new tracheostomy is being discharged. Which instruction should the
nurse include in the discharge teaching?

• A) Use tap water to clean the inner cannula

• B) Have a spare tracheostomy tube and obturator available at all times

• C) Suction the tracheostomy tube every 15 minutes

• D) Apply oil-based lubricant to the stoma

,Correct Answer: B) Have a spare tracheostomy tube and obturator available at all
times

Rationale: Clients with tracheostomies should have a spare tracheostomy tube and
obturator available at all times in case of emergency. Sterile technique should be used
for cleaning, suctioning should be done as needed (not routinely every 15 minutes), and
oil-based lubricants should be avoided as they can damage the tube .



Question 5
A client with pneumonia has a fever of 102°F, productive cough with green sputum, and
crackles. Which nursing intervention is most effective to promote airway clearance?

• A) Encourage increased oral fluid intake

• B) Administer oxygen via mask

• C) Place the client in a supine position

• D) Instruct the client to cough forcefully

Correct Answer: A) Encourage increased oral fluid intake

Rationale: Increased oral fluid intake helps to liquefy secretions, making them easier to
expectorate and promoting airway clearance. Coughing forcefully without adequate
hydration can be less effective and exhausting. The supine position would impair lung
expansion.



Question 6
A client with asthma has a peak flow reading in the yellow zone (50-80% of personal
best). What should the nurse instruct the client to do?

• A) Use the rescue inhaler and reassess

• B) Continue regular medication

• C) Go to the emergency room

• D) Increase long-term control medication

Correct Answer: A) Use the rescue inhaler and reassess

, Rationale: The yellow zone (50-80% of personal best) indicates caution and the need
for rescue medication. The client should use the rescue inhaler and reassess the peak
flow. The red zone (<50%) would require emergency care.



Question 7
Which instruction is most important for the nurse to emphasize in discharge teaching
for a client with COPD?

• A) Report any changes in sputum color

• B) Increase fluid intake to 3 L daily

• C) Use pursed-lip breathing during exercise

• D) Avoid crowds and people with infections

Correct Answer: A) Report any changes in sputum color

Rationale: Changes in sputum color (e.g., yellow, green, or blood-tinged) can indicate
infection and require immediate antibiotic therapy to prevent an acute and prolonged
exacerbation of COPD. While all options are important, reporting sputum changes is the
priority for early intervention.



Question 8
A client with lung cancer is receiving radiation therapy. Which is the priority nursing
intervention?

• A) Administer antiemetics

• B) Monitor for signs of infection

• C) Encourage high-fat foods

• D) Restrict fluid intake

Correct Answer: B) Monitor for signs of infection

Rationale: Radiation therapy can cause myelosuppression, increasing the risk of
infection. Monitoring for signs of infection is the priority. Antiemetics may be needed,
and nutritional support is important, but infection risk is the most immediate concern .