BSN HESI 266
BSN HESI 266 Med Surg Exam with Accurate Questions
& Answers (Verified Answers) and Rationales | Latest
(2026/2027) Updated Version - Nightingale
THIS DOCUMENT CONTAINS:
❖BSN HESI 266 Med Surg Exam
❖Accurate Questions & Answers (Verified Answers)
❖Deep Expert Rationales
❖Latest (2026/2027) Updated Version
❖100% Guaranteed Pass
❖Nightingale
,Section 1: Cardiovascular & Hematology
Question 1
A client with heart failure and an ejection fraction (EF) of 25% is prescribed
digoxin and furosemide. Which laboratory value reported to the nurse requires
immediate notification of the healthcare provider before administering digoxin?
• A. Serum sodium $138\text{ mEq/L}$
• B. Serum potassium $3.1\text{ mEq/L}$
• C. Serum creatinine $1.0\text{ mg/dL}$
• D. Hemoglobin $13.5\text{ g/dL}$
• Correct Answer: B. Serum potassium $3.1\text{ mEq/L}$
• Rationale: Furosemide is a loop diuretic that causes potassium excretion.
Hypokalemia (potassium $<3.5\text{ mEq/L}$) significantly increases the
risk of digoxin toxicity, which can lead to life-threatening cardiac
dysrhythmias. The potassium level must be reported and corrected prior to
giving digoxin.
Question 2
A client taking warfarin for atrial fibrillation reports eating a daily salad rich in
spinach and broccoli. Which lab result should the nurse closely monitor, and
what guidance should be provided?
• A. aPTT; instruct the client to stop eating all green vegetables immediately.
• B. Platelet count; instruct the client that leafy greens increase bleeding
risk.
• C. INR; instruct the client to maintain a consistent daily intake of vitamin
K–rich foods.
• D. Hemoglobin; instruct the client that green vegetables inhibit iron
absorption.
• Correct Answer: C. INR; instruct the client to maintain a
consistent daily intake of vitamin K–rich foods
, • Rationale: Vitamin K directly antagonizes the anticoagulant action of
warfarin, which alters the International Normalized Ratio (INR). Rather
than eliminating vitamin K entirely, the client must maintain a steady,
consistent daily intake so the medication dose can be titrated accurately.
Question 3
A client admitted with deep vein thrombosis (DVT) is prescribed subcutaneous
enoxaparin. Which statement by the client indicates a correct understanding of
discharge instructions?
• A. "I will need to visit the clinic twice a week to have my aPTT drawn."
• B. "I should expel the small air bubble in the prefilled syringe before
injecting."
• C. "I will inject the medication into my abdominal skin fold."
• D. "I need to massage the injection site for 1 minute afterward."
• Correct Answer: C. "I will inject the medication into my
abdominal skin fold."
• Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH)
administered subcutaneously into the anterolateral or posterolateral
abdominal wall. The prefilled air bubble should not be expelled (it seals
the dose), no site massaged (prevents hematoma), and routine aPTT
monitoring is not required.
Section 2: Respiratory & Airway Management
Question 4
The nurse is assisting a client with a cuffed tracheostomy tube to prepare for
mealtime. What is the priority nursing action before permitting the client to eat
or drink?
• A. Deflate the tracheostomy cuff completely.
• B. Verify that the tracheostomy cuff is properly inflated.
• C. Suction the inner cannula vigorously for 30 seconds.
, • D. Place the client in a semi-Fowler’s position at 30 degrees.
• Correct Answer: B. Verify that the tracheostomy cuff is properly
inflated
• Rationale: An inflated tracheostomy cuff provides a seal in the trachea
that prevents aspiration of oral secretions, fluids, or food particles into the
lower respiratory tract while eating. Deflating the cuff during meals
dramatically increases aspiration risk.
Question 5
A client with a closed chest drainage system following a thoracotomy has
continuous, vigorous bubbling in the water seal chamber. Which action should
the nurse take first?
• A. Document this as a normal expected finding during chest drainage.
• B. Clamp the chest tube close to the insertion site immediately.
• C. Inspect the system and tubing connections for an air leak.
• D. Increase the suction pressure control setting on the wall regulator.
• Correct Answer: C. Inspect the system and tubing connections
for an air leak
• Rationale: Intermittent bubbling in the water seal chamber during
exhalation or coughing is normal. However, continuous bubbling
indicates an unwanted air leak in the system or around the insertion site,
which must be identified and resolved. Clamping chest tubes routinely is
contraindicated unless specifically ordered or checking for leaks.
Question 6
A client with Chronic Obstructive Pulmonary Disease (COPD) has an oxygen
saturation of $88\%$ on room air and exhibits mild intercostal retraction. Which
nursing intervention is the priority?
• A. Administer $100\%$ oxygen via a non-rebreather mask immediately.
• B. Perform a complete respiratory assessment, including lung sounds and
work of breathing.
BSN HESI 266 Med Surg Exam with Accurate Questions
& Answers (Verified Answers) and Rationales | Latest
(2026/2027) Updated Version - Nightingale
THIS DOCUMENT CONTAINS:
❖BSN HESI 266 Med Surg Exam
❖Accurate Questions & Answers (Verified Answers)
❖Deep Expert Rationales
❖Latest (2026/2027) Updated Version
❖100% Guaranteed Pass
❖Nightingale
,Section 1: Cardiovascular & Hematology
Question 1
A client with heart failure and an ejection fraction (EF) of 25% is prescribed
digoxin and furosemide. Which laboratory value reported to the nurse requires
immediate notification of the healthcare provider before administering digoxin?
• A. Serum sodium $138\text{ mEq/L}$
• B. Serum potassium $3.1\text{ mEq/L}$
• C. Serum creatinine $1.0\text{ mg/dL}$
• D. Hemoglobin $13.5\text{ g/dL}$
• Correct Answer: B. Serum potassium $3.1\text{ mEq/L}$
• Rationale: Furosemide is a loop diuretic that causes potassium excretion.
Hypokalemia (potassium $<3.5\text{ mEq/L}$) significantly increases the
risk of digoxin toxicity, which can lead to life-threatening cardiac
dysrhythmias. The potassium level must be reported and corrected prior to
giving digoxin.
Question 2
A client taking warfarin for atrial fibrillation reports eating a daily salad rich in
spinach and broccoli. Which lab result should the nurse closely monitor, and
what guidance should be provided?
• A. aPTT; instruct the client to stop eating all green vegetables immediately.
• B. Platelet count; instruct the client that leafy greens increase bleeding
risk.
• C. INR; instruct the client to maintain a consistent daily intake of vitamin
K–rich foods.
• D. Hemoglobin; instruct the client that green vegetables inhibit iron
absorption.
• Correct Answer: C. INR; instruct the client to maintain a
consistent daily intake of vitamin K–rich foods
, • Rationale: Vitamin K directly antagonizes the anticoagulant action of
warfarin, which alters the International Normalized Ratio (INR). Rather
than eliminating vitamin K entirely, the client must maintain a steady,
consistent daily intake so the medication dose can be titrated accurately.
Question 3
A client admitted with deep vein thrombosis (DVT) is prescribed subcutaneous
enoxaparin. Which statement by the client indicates a correct understanding of
discharge instructions?
• A. "I will need to visit the clinic twice a week to have my aPTT drawn."
• B. "I should expel the small air bubble in the prefilled syringe before
injecting."
• C. "I will inject the medication into my abdominal skin fold."
• D. "I need to massage the injection site for 1 minute afterward."
• Correct Answer: C. "I will inject the medication into my
abdominal skin fold."
• Rationale: Enoxaparin is a low-molecular-weight heparin (LMWH)
administered subcutaneously into the anterolateral or posterolateral
abdominal wall. The prefilled air bubble should not be expelled (it seals
the dose), no site massaged (prevents hematoma), and routine aPTT
monitoring is not required.
Section 2: Respiratory & Airway Management
Question 4
The nurse is assisting a client with a cuffed tracheostomy tube to prepare for
mealtime. What is the priority nursing action before permitting the client to eat
or drink?
• A. Deflate the tracheostomy cuff completely.
• B. Verify that the tracheostomy cuff is properly inflated.
• C. Suction the inner cannula vigorously for 30 seconds.
, • D. Place the client in a semi-Fowler’s position at 30 degrees.
• Correct Answer: B. Verify that the tracheostomy cuff is properly
inflated
• Rationale: An inflated tracheostomy cuff provides a seal in the trachea
that prevents aspiration of oral secretions, fluids, or food particles into the
lower respiratory tract while eating. Deflating the cuff during meals
dramatically increases aspiration risk.
Question 5
A client with a closed chest drainage system following a thoracotomy has
continuous, vigorous bubbling in the water seal chamber. Which action should
the nurse take first?
• A. Document this as a normal expected finding during chest drainage.
• B. Clamp the chest tube close to the insertion site immediately.
• C. Inspect the system and tubing connections for an air leak.
• D. Increase the suction pressure control setting on the wall regulator.
• Correct Answer: C. Inspect the system and tubing connections
for an air leak
• Rationale: Intermittent bubbling in the water seal chamber during
exhalation or coughing is normal. However, continuous bubbling
indicates an unwanted air leak in the system or around the insertion site,
which must be identified and resolved. Clamping chest tubes routinely is
contraindicated unless specifically ordered or checking for leaks.
Question 6
A client with Chronic Obstructive Pulmonary Disease (COPD) has an oxygen
saturation of $88\%$ on room air and exhibits mild intercostal retraction. Which
nursing intervention is the priority?
• A. Administer $100\%$ oxygen via a non-rebreather mask immediately.
• B. Perform a complete respiratory assessment, including lung sounds and
work of breathing.
