BSN HESI 266 Med Surg Exam – Nightingale
College Best Practice Questions with
Answers & Rationales latest update this Year
instant pdf
Master your BSN HESI 266 Medical-Surgical Exam with this complete set of exam-style practice
questions, each with the correct answer and clear, concise rationale.
This resource is designed for BSN students in Med-Surg courses preparing for the HESI 266 exit or
course exam, and it also supports long-term success for the NCLEX-RN by building strong clinical
judgment and prioritization skills.
High-Yield Topics Covered
Cardiovascular: Heart failure, MI/ACS, hypertension, dysrhythmias, anticoagulants, ACE
inhibitors, beta-blockers
Respiratory: COPD, asthma, pneumonia, pulmonary embolism, ABGs, oxygen therapy, inhalers
and spacers
Renal & Electrolytes: CKD, acute kidney injury, dialysis, hyperkalemia, metabolic acidosis,
phosphate binders
Endocrine: Type 1 & 2 diabetes, DKA vs HHS, thyroid disorders, adrenal and aldosterone
changes
GI & Hepatic: Ulcer disease, GI bleed, pancreatitis, cirrhosis, ascites, lactulose, PPI use
Neuro & Stroke: Ischemic stroke, tPA, increased ICP, myasthenia gravis, Wernicke
encephalopathy
Hematology & Pharmacology: Anemia, epoetin, iron, warfarin, heparin, DOACs, digoxin, opioids,
antibiotics
Musculoskeletal & Other: Osteoporosis, rheumatoid arthritis, fat embolism, venous/arterial
disease, wound and stoma care
Safety & Priority: ABCs, Maslow, delegation concepts, early vs late complications, when to call
911 or the provider
,1. The nurse is caring for a client with chronic heart failure who reports increased shortness
of breath when walking to the bathroom and a 3-lb weight gain in 2 days. Which
assessment should the nurse prioritize to determine if the client’s condition is worsening?
A. Ask about the client’s usual daily sodium intake
B. Check the client’s capillary blood glucose level
C. Auscultate lung sounds for new crackles or wheezes
D. Assess the client’s bowel sounds in all four quadrants
Answer: C
Rationale: Increased dyspnea and rapid weight gain suggest fluid volume overload; new or
worsening crackles indicate pulmonary congestion and HF exacerbation.
2. A client with chronic obstructive pulmonary disease (COPD) is admitted with increasing
shortness of breath and a productive cough of thick yellow sputum. The nurse notes a
respiratory rate of 28/min, use of accessory muscles, and an oxygen saturation of 88% on
room air. Which intervention should the nurse implement first?
A. Encourage the client to increase oral fluid intake to 3 L/day
B. Place the client in high Fowler’s position and apply prescribed oxygen
C. Obtain a sputum sample before starting the prescribed antibiotics
D. Teach the client how to perform incentive spirometry
Answer: B
Rationale: The immediate priority is to improve ventilation and gas exchange by positioning
and applying oxygen; sputum collection and teaching follow once the client is stabilized.
3. A nurse is caring for a postoperative client 12 hours after abdominal surgery who reports
new onset shortness of breath and sharp chest pain that worsens with inspiration. The
,client’s heart rate is 118/min, respiratory rate 32/min, and oxygen saturation 86% on 2 L via
nasal cannula. What is the nurse’s priority action?
A. Encourage the client to use the incentive spirometer hourly
B. Increase the IV fluid rate to improve circulation
C. Notify the provider and prepare the client for diagnostic testing
D. Administer PRN acetaminophen for pain relief
Answer: C
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and low SpO₂ post-op
suggest possible pulmonary embolism; rapid provider notification and diagnostic evaluation
are priority.
4. A client with type 1 diabetes arrives in the emergency department with polyuria,
polydipsia, abdominal pain, and a fruity odor to the breath. The blood glucose is 510 mg/dL,
blood pressure is 90/60 mm Hg, and the client is lethargic but arousable. Which prescription
should the nurse anticipate implementing first?
A. Administer IV regular insulin by continuous infusion
B. Start large-bore IV access and infuse normal saline bolus
C. Administer subcutaneous long-acting insulin glargine
D. Restrict oral fluids until the client is fully alert
Answer: B
Rationale: In diabetic ketoacidosis, the priority is rapid fluid resuscitation with isotonic saline
to treat hypovolemia and shock before initiating insulin therapy.
5. The nurse is teaching a client with newly diagnosed hypertension about lifestyle
modifications. Which client statement indicates a need for further teaching?
, A. “I will check my blood pressure at home and record it in a log.”
B. “I plan to reduce my sodium intake and avoid canned soups and chips.”
C. “I will stop taking my blood pressure pills when my readings become normal.”
D. “I will try to walk at least 30 minutes most days of the week.”
Answer: C
Rationale: Antihypertensive medications must usually be continued even when readings
improve; stopping them abruptly can cause rebound hypertension or complications.
6. A hospitalized client with cirrhosis develops increasing confusion, irritability, and a musty
odor to the breath. The nurse notes a positive asterixis (liver flap) when the client extends
the arms. Which laboratory test does the nurse expect to be most elevated?
A. Serum lipase
B. Serum ammonia
C. Serum creatinine
D. Serum calcium
Answer: B
Rationale: Neuro changes, asterixis, and fetor hepaticus suggest hepatic encephalopathy,
which is associated with elevated serum ammonia levels.
7. A client with a history of chronic kidney disease is being discharged on furosemide and a
low-sodium, low-potassium diet. Which menu choice indicates the client understands the
discharge teaching?
A. Baked chicken, white rice, steamed green beans, and apple slices
B. Baked salmon, baked potato with skin, and spinach salad with tomatoes
C. Ham sandwich with cheese, pickles, and a banana
College Best Practice Questions with
Answers & Rationales latest update this Year
instant pdf
Master your BSN HESI 266 Medical-Surgical Exam with this complete set of exam-style practice
questions, each with the correct answer and clear, concise rationale.
This resource is designed for BSN students in Med-Surg courses preparing for the HESI 266 exit or
course exam, and it also supports long-term success for the NCLEX-RN by building strong clinical
judgment and prioritization skills.
High-Yield Topics Covered
Cardiovascular: Heart failure, MI/ACS, hypertension, dysrhythmias, anticoagulants, ACE
inhibitors, beta-blockers
Respiratory: COPD, asthma, pneumonia, pulmonary embolism, ABGs, oxygen therapy, inhalers
and spacers
Renal & Electrolytes: CKD, acute kidney injury, dialysis, hyperkalemia, metabolic acidosis,
phosphate binders
Endocrine: Type 1 & 2 diabetes, DKA vs HHS, thyroid disorders, adrenal and aldosterone
changes
GI & Hepatic: Ulcer disease, GI bleed, pancreatitis, cirrhosis, ascites, lactulose, PPI use
Neuro & Stroke: Ischemic stroke, tPA, increased ICP, myasthenia gravis, Wernicke
encephalopathy
Hematology & Pharmacology: Anemia, epoetin, iron, warfarin, heparin, DOACs, digoxin, opioids,
antibiotics
Musculoskeletal & Other: Osteoporosis, rheumatoid arthritis, fat embolism, venous/arterial
disease, wound and stoma care
Safety & Priority: ABCs, Maslow, delegation concepts, early vs late complications, when to call
911 or the provider
,1. The nurse is caring for a client with chronic heart failure who reports increased shortness
of breath when walking to the bathroom and a 3-lb weight gain in 2 days. Which
assessment should the nurse prioritize to determine if the client’s condition is worsening?
A. Ask about the client’s usual daily sodium intake
B. Check the client’s capillary blood glucose level
C. Auscultate lung sounds for new crackles or wheezes
D. Assess the client’s bowel sounds in all four quadrants
Answer: C
Rationale: Increased dyspnea and rapid weight gain suggest fluid volume overload; new or
worsening crackles indicate pulmonary congestion and HF exacerbation.
2. A client with chronic obstructive pulmonary disease (COPD) is admitted with increasing
shortness of breath and a productive cough of thick yellow sputum. The nurse notes a
respiratory rate of 28/min, use of accessory muscles, and an oxygen saturation of 88% on
room air. Which intervention should the nurse implement first?
A. Encourage the client to increase oral fluid intake to 3 L/day
B. Place the client in high Fowler’s position and apply prescribed oxygen
C. Obtain a sputum sample before starting the prescribed antibiotics
D. Teach the client how to perform incentive spirometry
Answer: B
Rationale: The immediate priority is to improve ventilation and gas exchange by positioning
and applying oxygen; sputum collection and teaching follow once the client is stabilized.
3. A nurse is caring for a postoperative client 12 hours after abdominal surgery who reports
new onset shortness of breath and sharp chest pain that worsens with inspiration. The
,client’s heart rate is 118/min, respiratory rate 32/min, and oxygen saturation 86% on 2 L via
nasal cannula. What is the nurse’s priority action?
A. Encourage the client to use the incentive spirometer hourly
B. Increase the IV fluid rate to improve circulation
C. Notify the provider and prepare the client for diagnostic testing
D. Administer PRN acetaminophen for pain relief
Answer: C
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and low SpO₂ post-op
suggest possible pulmonary embolism; rapid provider notification and diagnostic evaluation
are priority.
4. A client with type 1 diabetes arrives in the emergency department with polyuria,
polydipsia, abdominal pain, and a fruity odor to the breath. The blood glucose is 510 mg/dL,
blood pressure is 90/60 mm Hg, and the client is lethargic but arousable. Which prescription
should the nurse anticipate implementing first?
A. Administer IV regular insulin by continuous infusion
B. Start large-bore IV access and infuse normal saline bolus
C. Administer subcutaneous long-acting insulin glargine
D. Restrict oral fluids until the client is fully alert
Answer: B
Rationale: In diabetic ketoacidosis, the priority is rapid fluid resuscitation with isotonic saline
to treat hypovolemia and shock before initiating insulin therapy.
5. The nurse is teaching a client with newly diagnosed hypertension about lifestyle
modifications. Which client statement indicates a need for further teaching?
, A. “I will check my blood pressure at home and record it in a log.”
B. “I plan to reduce my sodium intake and avoid canned soups and chips.”
C. “I will stop taking my blood pressure pills when my readings become normal.”
D. “I will try to walk at least 30 minutes most days of the week.”
Answer: C
Rationale: Antihypertensive medications must usually be continued even when readings
improve; stopping them abruptly can cause rebound hypertension or complications.
6. A hospitalized client with cirrhosis develops increasing confusion, irritability, and a musty
odor to the breath. The nurse notes a positive asterixis (liver flap) when the client extends
the arms. Which laboratory test does the nurse expect to be most elevated?
A. Serum lipase
B. Serum ammonia
C. Serum creatinine
D. Serum calcium
Answer: B
Rationale: Neuro changes, asterixis, and fetor hepaticus suggest hepatic encephalopathy,
which is associated with elevated serum ammonia levels.
7. A client with a history of chronic kidney disease is being discharged on furosemide and a
low-sodium, low-potassium diet. Which menu choice indicates the client understands the
discharge teaching?
A. Baked chicken, white rice, steamed green beans, and apple slices
B. Baked salmon, baked potato with skin, and spinach salad with tomatoes
C. Ham sandwich with cheese, pickles, and a banana
