BSN HESI 266 Medical-Surgical Exit Exam Prep Bank | Actual
Premium Next-Gen Q&As with Detailed Rationales (Latest 2026
Edition) Nightingale College
OVERVIEW
Secure an elite score on your exit examination and master the highest-weighted section of your BSN track
with the ultimate study companion for the BSN HESI Medical-Surgical Exam. This premium preparation
bank features 200 elite, highly realistic multiple-choice questions meticulously structured to mirror the exact
critical thinking patterns, prioritization rules, and clinical scenarios tested by HESI and the NCLEX. Every
question includes a verified correct answer highlighted immediately, followed by an in-depth clinical
rationale with distinct, scannable spacing.
CORE CLINICAL SYSTEMS & PRIORITIZATION SCOPE
Cardiovascular Excellence: Master telemetry strip analysis for lethal and non-perfusing rhythms
(Ventricular Fibrillation vs. VTach), Atrial Fibrillation with rapid ventricular response (RVR), heart
failure mapping (Left-sided pulmonary congestion vs. Right-sided systemic JVD/edema),
Abdominal Aortic Aneurysm (AAA) rupture emergencies, and chronic cardiac medications (Digoxin
bradycardia parameters & Nitroglycerin tolerance thresholds).
Advanced Pulmonology & Airway Care: Complete tracking of Acute Respiratory Distress
Syndrome (ARDS) with PEEP mechanical parameters, emergency chest tube troubleshooting
(continuous vs. intermittent bubbling, dislodgement protocols, and collection system tilt-over
recovery), the ominous "silent chest" asthma crisis, and post-laryngectomy/post-mastectomy
lymphedema positioning.
Renal, Dialysis, & Fluid Resuscitation: In-depth sorting of Peritoneal Dialysis peritonitis
indicators (cloudy dialysate), permanent arteriovenous (AV) fistula patency assessments
(thrill/bruit), pre-dialysis dietary protein restrictions, post-TURP continuous bladder irrigation (CBI)
clot obstructions, and the complex Parkland fluid shifts/electrolyte shocks (third-spacing and
hyperkalemia) during the emergent burn phase.
, Endocrine & Metabolic Crises: Step-by-step differentiation between Diabetic Ketoacidosis
(DKA) and Hyperosmolar Hyperglycemic State (HHS), SIADH dilutional hyponatremia water
locks, Diabetes Insipidus polyuria management, adrenal failure dynamics (Cushing’s disease vs.
Addisonian crisis stress dosing), and paroxysmal pheochromocytoma surges.
Gastrointestinal, Hepatic, & Pancreatic Failure: Pathophysiological tracking of liver cirrhosis,
portal hypertension, caput medusae, ammonia accumulation driving Hepatic Encephalopathy
(asterixis), post-gastrectomy dumping syndrome management, ruptured esophageal varices
mechanical tamponade (Sengstaken-Blakemore tubes), acute pancreatitis enzyme leaking
(lipase/amylase saponification), and rigid board-like abdomen peritonitis indicators.
Electrolyte Prioritizations & High-Yield Markers: Rapid-fire grading of severe hypokalemia
cardiac risks (2.8 mEq/L alert limits), hyperkalemia membrane stabilization (IV Calcium Gluconate
vs. Insulin shifts), hypocalcemia tetany (Chvostek’s and Trousseau’s signs), purine restriction
rules for acute Gout, and emergency stroke exclusions (tPA thrombolytic timelines).
ABG Interpretation Mastery: Fluid-loss compensation matrices mapping uncompensated,
partially compensated, and fully compensated Respiratory/Metabolic Acidosis and Alkalosis
values, featuring Kussmaul hyperventilation responses.
1. A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. The client reports a tingling sensation around the mouth and muscle
twitching in the fingers. Which action should the nurse take first?
A. Check the client's arterial blood gas (ABG) results.
B. Obtain an order to check the serum calcium level.
C. Assess the client for Trousseau's and Chvostek's signs.
D. Administer a scheduled dose of thyroid hormone replacement.
Correct Answer: C
Tingling around the mouth (perioral paresthesia) and muscle twitching are early clinical
manifestations of hypocalcemia, a common complication of thyroidectomy if the parathyroid
,glands are accidentally damaged or removed. The nurse must immediately assess the client
for Trousseau's sign (carpopedal spasm induced by blood pressure cuff inflation) and
Chvostek's sign (facial muscle twitching elicited by tapping the facial nerve) to confirm
neuromuscular irritability before calling the healthcare provider for emergency calcium
gluconate.
2. A nurse is assessing a client who was admitted with an acute exacerbation of left-
sided heart failure. Which clinical manifestation should the nurse expect to find?
A. Jugular venous distension (JVD) and peripheral dependent edema
B. Dyspnea, orthopnea, and crackles in the lung bases
C. Hepatosplenomegaly and ascites
D. Right upper quadrant abdominal tenderness
Correct Answer: B
Left-sided heart failure causes blood to back up into the left atrium and pulmonary veins,
leading to pulmonary congestion. This fluid shift results in respiratory symptoms such as
dyspnea, orthopnea (difficulty breathing while lying flat), paroxysmal nocturnal dyspnea, and
audible crackles upon lung auscultation. Right-sided heart failure causes systemic venous
backup, leading to JVD, peripheral edema, and hepatomegaly.
3. A client is admitted to the emergency department with a history of severe vomiting
for 3 days. The client’s arterial blood gas (ABG) results are: pH 7.51, PaCO2 46
mmHg, and HCO3 32 mEq/L. How should the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated metabolic acidosis
D. Uncompensated respiratory alkalosis
Correct Answer: B
, The pH is elevated (>7.45), indicating alkalosis. The HCO3 is elevated (>26 mEq/L),
indicating that the origin is metabolic. The PaCO2 is elevated (>45 mmHg), which means
the respiratory system is attempting to compensate by retaining carbon dioxide
(hypoventilation) to normalize the pH. Because the pH is still abnormal, it is partially
compensated.
4. A nurse is reviewing the laboratory results of a client who is receiving a continuous
intravenous heparin infusion for a deep vein thrombosis (DVT). The client's activated
partial thromboplastin time (aPTT) is 98 seconds. The control value is 30 seconds.
Which action should the nurse take?
A. Increase the heparin infusion rate by 100 units/hour.
B. Stop the infusion immediately and prepare to administer protamine sulfate if
ordered.
C. Maintain the current infusion rate and recheck the aPTT in 12 hours.
D. Administer Vitamin K intramuscularly.
Correct Answer: B
The therapeutic range for a client receiving heparin is typically 1.5 to 2.5 times the normal
control value. With a control value of 30 seconds, the target therapeutic range is 45 to 75
seconds. An aPTT of 98 seconds indicates excessive anticoagulation, placing the client at
high risk for spontaneous hemorrhage. The infusion must be stopped, and protamine sulfate
(the antidote for heparin) should be available.
5. A nurse is providing discharge teaching to a client who has been diagnosed with
chronic Addison's disease. Which instruction is most critical for the nurse to include?
A. Follow a strict low-sodium, high-potassium diet.
B. Double or triple the corticosteroid dose during periods of physical stress or illness.
C. Restrict fluid intake to less than 1,000 mL per day.
Premium Next-Gen Q&As with Detailed Rationales (Latest 2026
Edition) Nightingale College
OVERVIEW
Secure an elite score on your exit examination and master the highest-weighted section of your BSN track
with the ultimate study companion for the BSN HESI Medical-Surgical Exam. This premium preparation
bank features 200 elite, highly realistic multiple-choice questions meticulously structured to mirror the exact
critical thinking patterns, prioritization rules, and clinical scenarios tested by HESI and the NCLEX. Every
question includes a verified correct answer highlighted immediately, followed by an in-depth clinical
rationale with distinct, scannable spacing.
CORE CLINICAL SYSTEMS & PRIORITIZATION SCOPE
Cardiovascular Excellence: Master telemetry strip analysis for lethal and non-perfusing rhythms
(Ventricular Fibrillation vs. VTach), Atrial Fibrillation with rapid ventricular response (RVR), heart
failure mapping (Left-sided pulmonary congestion vs. Right-sided systemic JVD/edema),
Abdominal Aortic Aneurysm (AAA) rupture emergencies, and chronic cardiac medications (Digoxin
bradycardia parameters & Nitroglycerin tolerance thresholds).
Advanced Pulmonology & Airway Care: Complete tracking of Acute Respiratory Distress
Syndrome (ARDS) with PEEP mechanical parameters, emergency chest tube troubleshooting
(continuous vs. intermittent bubbling, dislodgement protocols, and collection system tilt-over
recovery), the ominous "silent chest" asthma crisis, and post-laryngectomy/post-mastectomy
lymphedema positioning.
Renal, Dialysis, & Fluid Resuscitation: In-depth sorting of Peritoneal Dialysis peritonitis
indicators (cloudy dialysate), permanent arteriovenous (AV) fistula patency assessments
(thrill/bruit), pre-dialysis dietary protein restrictions, post-TURP continuous bladder irrigation (CBI)
clot obstructions, and the complex Parkland fluid shifts/electrolyte shocks (third-spacing and
hyperkalemia) during the emergent burn phase.
, Endocrine & Metabolic Crises: Step-by-step differentiation between Diabetic Ketoacidosis
(DKA) and Hyperosmolar Hyperglycemic State (HHS), SIADH dilutional hyponatremia water
locks, Diabetes Insipidus polyuria management, adrenal failure dynamics (Cushing’s disease vs.
Addisonian crisis stress dosing), and paroxysmal pheochromocytoma surges.
Gastrointestinal, Hepatic, & Pancreatic Failure: Pathophysiological tracking of liver cirrhosis,
portal hypertension, caput medusae, ammonia accumulation driving Hepatic Encephalopathy
(asterixis), post-gastrectomy dumping syndrome management, ruptured esophageal varices
mechanical tamponade (Sengstaken-Blakemore tubes), acute pancreatitis enzyme leaking
(lipase/amylase saponification), and rigid board-like abdomen peritonitis indicators.
Electrolyte Prioritizations & High-Yield Markers: Rapid-fire grading of severe hypokalemia
cardiac risks (2.8 mEq/L alert limits), hyperkalemia membrane stabilization (IV Calcium Gluconate
vs. Insulin shifts), hypocalcemia tetany (Chvostek’s and Trousseau’s signs), purine restriction
rules for acute Gout, and emergency stroke exclusions (tPA thrombolytic timelines).
ABG Interpretation Mastery: Fluid-loss compensation matrices mapping uncompensated,
partially compensated, and fully compensated Respiratory/Metabolic Acidosis and Alkalosis
values, featuring Kussmaul hyperventilation responses.
1. A nurse is caring for a client who is 24 hours postoperative following a total
thyroidectomy. The client reports a tingling sensation around the mouth and muscle
twitching in the fingers. Which action should the nurse take first?
A. Check the client's arterial blood gas (ABG) results.
B. Obtain an order to check the serum calcium level.
C. Assess the client for Trousseau's and Chvostek's signs.
D. Administer a scheduled dose of thyroid hormone replacement.
Correct Answer: C
Tingling around the mouth (perioral paresthesia) and muscle twitching are early clinical
manifestations of hypocalcemia, a common complication of thyroidectomy if the parathyroid
,glands are accidentally damaged or removed. The nurse must immediately assess the client
for Trousseau's sign (carpopedal spasm induced by blood pressure cuff inflation) and
Chvostek's sign (facial muscle twitching elicited by tapping the facial nerve) to confirm
neuromuscular irritability before calling the healthcare provider for emergency calcium
gluconate.
2. A nurse is assessing a client who was admitted with an acute exacerbation of left-
sided heart failure. Which clinical manifestation should the nurse expect to find?
A. Jugular venous distension (JVD) and peripheral dependent edema
B. Dyspnea, orthopnea, and crackles in the lung bases
C. Hepatosplenomegaly and ascites
D. Right upper quadrant abdominal tenderness
Correct Answer: B
Left-sided heart failure causes blood to back up into the left atrium and pulmonary veins,
leading to pulmonary congestion. This fluid shift results in respiratory symptoms such as
dyspnea, orthopnea (difficulty breathing while lying flat), paroxysmal nocturnal dyspnea, and
audible crackles upon lung auscultation. Right-sided heart failure causes systemic venous
backup, leading to JVD, peripheral edema, and hepatomegaly.
3. A client is admitted to the emergency department with a history of severe vomiting
for 3 days. The client’s arterial blood gas (ABG) results are: pH 7.51, PaCO2 46
mmHg, and HCO3 32 mEq/L. How should the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated metabolic acidosis
D. Uncompensated respiratory alkalosis
Correct Answer: B
, The pH is elevated (>7.45), indicating alkalosis. The HCO3 is elevated (>26 mEq/L),
indicating that the origin is metabolic. The PaCO2 is elevated (>45 mmHg), which means
the respiratory system is attempting to compensate by retaining carbon dioxide
(hypoventilation) to normalize the pH. Because the pH is still abnormal, it is partially
compensated.
4. A nurse is reviewing the laboratory results of a client who is receiving a continuous
intravenous heparin infusion for a deep vein thrombosis (DVT). The client's activated
partial thromboplastin time (aPTT) is 98 seconds. The control value is 30 seconds.
Which action should the nurse take?
A. Increase the heparin infusion rate by 100 units/hour.
B. Stop the infusion immediately and prepare to administer protamine sulfate if
ordered.
C. Maintain the current infusion rate and recheck the aPTT in 12 hours.
D. Administer Vitamin K intramuscularly.
Correct Answer: B
The therapeutic range for a client receiving heparin is typically 1.5 to 2.5 times the normal
control value. With a control value of 30 seconds, the target therapeutic range is 45 to 75
seconds. An aPTT of 98 seconds indicates excessive anticoagulation, placing the client at
high risk for spontaneous hemorrhage. The infusion must be stopped, and protamine sulfate
(the antidote for heparin) should be available.
5. A nurse is providing discharge teaching to a client who has been diagnosed with
chronic Addison's disease. Which instruction is most critical for the nurse to include?
A. Follow a strict low-sodium, high-potassium diet.
B. Double or triple the corticosteroid dose during periods of physical stress or illness.
C. Restrict fluid intake to less than 1,000 mL per day.
