BSN HESI 266 MED SURG EXAM (LATEST) QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A patient with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, increased
sputum production, and purulent secretions. Which finding is most indicative of an acute exacerbation requiring
immediate intervention?
A. Increased anteroposterior chest diameter
B. Use of accessory muscles with a respiratory rate of 28 breaths/min
C. Oxygen saturation of 91% on room air
D. Clubbing of the fingernails
🟢 Correct Answer:
B. Use of accessory muscles with a respiratory rate of 28 breaths/min
🔴 RATIONALE:
Use of accessory muscles indicates the patient is working hard to breathe and is a sign of respiratory distress or
an acute exacerbation. An oxygen saturation of 91% may be acceptable for a COPD patient with a baseline of
88-92%. Clubbing and barrel chest are chronic changes, not acute signs. Tachypnea and accessory muscle use
are priority findings.
,Question 2
A patient with heart failure is receiving furosemide (Lasix) 40 mg IV push. The nurse should monitor for which
adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
🟢 Correct Answer:
B. Hypokalemia
🔴 RATIONALE:
Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption, leading to increased potassium
excretion in the distal tubule. Hypokalemia is a common and potentially dangerous adverse effect that can lead
to cardiac dysrhythmias. Hyperkalemia is associated with potassium-sparing diuretics. Hypoglycemia is not a
direct effect of furosemide.
Question 3
A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse anticipates which
initial intervention?
A. Subcutaneous insulin glargine
B. Intravenous regular insulin infusion
C. Oral metformin
D. Subcutaneous insulin aspart sliding scale
,🟢 Correct Answer:
B. Intravenous regular insulin infusion
🔴 RATIONALE:
The initial treatment for DKA is a continuous IV infusion of regular insulin to rapidly lower blood glucose levels
and halt ketogenesis. Subcutaneous insulin is not used initially because it is less predictable. Metformin is an
oral agent not used in acute DKA management. A sliding scale is not adequate for the initial correction of DKA.
Question 4
A patient with chronic kidney disease has a potassium level of 6.5 mEq/L. Which electrocardiogram (ECG)
change is most consistent with this finding?
A. U waves
B. ST-segment depression
C. Peaked T waves
D. Prolonged PR interval
🟢 Correct Answer:
C. Peaked T waves
🔴 RATIONALE:
Hyperkalemia is characterized by peaked or "tented" T waves on the ECG. U waves are associated with
hypokalemia. ST-segment depression can be seen in myocardial ischemia or digoxin toxicity. A prolonged PR
interval can be seen in first-degree heart block but is not the classic finding for hyperkalemia.
, Question 5
A patient is prescribed warfarin (Coumadin) for atrial fibrillation. The nurse notes an international normalized
ratio (INR) of 1.2. What is the most appropriate nursing action?
A. Administer the next dose of warfarin as prescribed
B. Hold the next dose and notify the healthcare provider
C. Administer vitamin K intramuscularly
D. Increase the dose of warfarin per protocol
🟢 Correct Answer:
A. Administer the next dose of warfarin as prescribed
🔴 RATIONALE:
A therapeutic INR for atrial fibrillation is typically 2.0-3.0. An INR of 1.2 indicates the patient is subtherapeutic
and at increased risk for thromboembolic events, such as a stroke. The nurse should administer the next dose as
prescribed and anticipate a dose adjustment by the provider. Holding the dose would further increase the risk.
Vitamin K is only administered for significant bleeding or an excessively elevated INR.
Question 6
A patient with chest pain is given sublingual nitroglycerin 0.4 mg. Which side effect is most likely to occur?
A. Hypertension
B. Bradycardia
C. Headache
D. Hyperthermia
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A patient with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, increased
sputum production, and purulent secretions. Which finding is most indicative of an acute exacerbation requiring
immediate intervention?
A. Increased anteroposterior chest diameter
B. Use of accessory muscles with a respiratory rate of 28 breaths/min
C. Oxygen saturation of 91% on room air
D. Clubbing of the fingernails
🟢 Correct Answer:
B. Use of accessory muscles with a respiratory rate of 28 breaths/min
🔴 RATIONALE:
Use of accessory muscles indicates the patient is working hard to breathe and is a sign of respiratory distress or
an acute exacerbation. An oxygen saturation of 91% may be acceptable for a COPD patient with a baseline of
88-92%. Clubbing and barrel chest are chronic changes, not acute signs. Tachypnea and accessory muscle use
are priority findings.
,Question 2
A patient with heart failure is receiving furosemide (Lasix) 40 mg IV push. The nurse should monitor for which
adverse effect?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
🟢 Correct Answer:
B. Hypokalemia
🔴 RATIONALE:
Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption, leading to increased potassium
excretion in the distal tubule. Hypokalemia is a common and potentially dangerous adverse effect that can lead
to cardiac dysrhythmias. Hyperkalemia is associated with potassium-sparing diuretics. Hypoglycemia is not a
direct effect of furosemide.
Question 3
A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The nurse anticipates which
initial intervention?
A. Subcutaneous insulin glargine
B. Intravenous regular insulin infusion
C. Oral metformin
D. Subcutaneous insulin aspart sliding scale
,🟢 Correct Answer:
B. Intravenous regular insulin infusion
🔴 RATIONALE:
The initial treatment for DKA is a continuous IV infusion of regular insulin to rapidly lower blood glucose levels
and halt ketogenesis. Subcutaneous insulin is not used initially because it is less predictable. Metformin is an
oral agent not used in acute DKA management. A sliding scale is not adequate for the initial correction of DKA.
Question 4
A patient with chronic kidney disease has a potassium level of 6.5 mEq/L. Which electrocardiogram (ECG)
change is most consistent with this finding?
A. U waves
B. ST-segment depression
C. Peaked T waves
D. Prolonged PR interval
🟢 Correct Answer:
C. Peaked T waves
🔴 RATIONALE:
Hyperkalemia is characterized by peaked or "tented" T waves on the ECG. U waves are associated with
hypokalemia. ST-segment depression can be seen in myocardial ischemia or digoxin toxicity. A prolonged PR
interval can be seen in first-degree heart block but is not the classic finding for hyperkalemia.
, Question 5
A patient is prescribed warfarin (Coumadin) for atrial fibrillation. The nurse notes an international normalized
ratio (INR) of 1.2. What is the most appropriate nursing action?
A. Administer the next dose of warfarin as prescribed
B. Hold the next dose and notify the healthcare provider
C. Administer vitamin K intramuscularly
D. Increase the dose of warfarin per protocol
🟢 Correct Answer:
A. Administer the next dose of warfarin as prescribed
🔴 RATIONALE:
A therapeutic INR for atrial fibrillation is typically 2.0-3.0. An INR of 1.2 indicates the patient is subtherapeutic
and at increased risk for thromboembolic events, such as a stroke. The nurse should administer the next dose as
prescribed and anticipate a dose adjustment by the provider. Holding the dose would further increase the risk.
Vitamin K is only administered for significant bleeding or an excessively elevated INR.
Question 6
A patient with chest pain is given sublingual nitroglycerin 0.4 mg. Which side effect is most likely to occur?
A. Hypertension
B. Bradycardia
C. Headache
D. Hyperthermia
