BSN 266 HESI Med Surg Proctored
Exam 2026/2027 – 100% Verified Full
Exam Actual Test Bank | Nightingale
College | Graded A+
Q01 A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client
asks the nurse, “Why do I have to give myself insulin injections?” Which of the following
responses by the nurse is appropriate?
Answer: "Your body is no longer producing insulin, so you must take insulin by injection to
control your blood glucose levels."
Rationale: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells,
resulting in absolute insulin deficiency. Exogenous insulin is required for survival.
Q02 A client who has diabetic ketoacidosis (DKA) is receiving IV fluids and regular insulin.
Which of the following laboratory findings indicates the client is responding to treatment?
Answer: Decreasing anion gap
Rationale: The anion gap reflects ketoacid accumulation. A decreasing anion gap indicates that
insulin is suppressing ketogenesis and the client is responding appropriately to treatment.
Q03 A nurse is assessing a client who has heart failure and is receiving furosemide. Which of the
following findings is an adverse effect of this medication?
Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the distal
tubule, leading to hypokalemia as the most common electrolyte abnormality.
,Q04 A client who has chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy via nasal cannula at 2 L/min. The nurse should monitor for which of the following
adverse effects?
Answer: Oxygen-induced hypercapnia
Rationale: In clients with COPD, high-flow oxygen can suppress hypoxic respiratory drive,
leading to CO₂ retention and respiratory acidosis (hypercapnia).
Q05 A nurse is caring for a client who has a new prescription for lisinopril. The nurse should
monitor the client for which of the following adverse effects?
Answer: Angioedema
Rationale: Angioedema is a rare but potentially life-threatening adverse effect of ACE inhibitors
(lisinopril) caused by increased bradykinin levels.
Q06 A client who has a history of atrial fibrillation is prescribed warfarin. The nurse should
instruct the client to report which of the following symptoms immediately?
Answer: Unusual bruising or pink-tinged urine
Rationale: These are signs of bleeding, which is the most serious adverse effect of warfarin
therapy.
Q07 A nurse is caring for a client who has a prescription for digoxin. Which of the following
findings should the nurse withhold the medication and notify the provider?
Answer: Apical pulse rate 52 beats per minute
Rationale: Digoxin should be withheld if the apical pulse is less than 60 beats per minute in
adults due to the risk of bradycardia and toxicity.
Q08 A nurse is caring for a client who has a prescription for enoxaparin. Which of the following
laboratory values should the nurse monitor?
Answer: Platelet count
, Rationale: Enoxaparin (low-molecular-weight heparin) can cause heparin-induced
thrombocytopenia (HIT); platelet count should be monitored regularly.
Q09 A nurse is reinforcing teaching with a client who has a new prescription for clopidogrel.
Which of the following instructions should the nurse include?
Answer: "Do not take omeprazole while taking this medication."
Rationale: Omeprazole inhibits CYP2C19, reducing the activation of clopidogrel and decreasing
its antiplatelet effectiveness.
Q10 A nurse is caring for a client who has a prescription for spironolactone. Which of the
following laboratory values should the nurse monitor closely?
Answer: Potassium
Rationale: Spironolactone is potassium-sparing and can cause hyperkalemia, especially when
combined with ACE inhibitors or ARBs.
Q11 A nurse is caring for a client who has a prescription for theophylline. The nurse should
monitor serum theophylline levels to prevent which of the following adverse effects?
Answer: Tachycardia and dysrhythmias
Rationale: Theophylline has a narrow therapeutic index; toxicity can cause serious cardiac
effects, including tachycardia and dysrhythmias.
Q12 A nurse is reinforcing teaching with a client who has a new prescription for methotrexate
for rheumatoid arthritis. Which of the following instructions should the nurse include?
Answer: "Take folic acid daily to reduce toxicity."
Rationale: Folic acid supplementation reduces gastrointestinal and hematologic toxicity
associated with methotrexate.
Exam 2026/2027 – 100% Verified Full
Exam Actual Test Bank | Nightingale
College | Graded A+
Q01 A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client
asks the nurse, “Why do I have to give myself insulin injections?” Which of the following
responses by the nurse is appropriate?
Answer: "Your body is no longer producing insulin, so you must take insulin by injection to
control your blood glucose levels."
Rationale: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells,
resulting in absolute insulin deficiency. Exogenous insulin is required for survival.
Q02 A client who has diabetic ketoacidosis (DKA) is receiving IV fluids and regular insulin.
Which of the following laboratory findings indicates the client is responding to treatment?
Answer: Decreasing anion gap
Rationale: The anion gap reflects ketoacid accumulation. A decreasing anion gap indicates that
insulin is suppressing ketogenesis and the client is responding appropriately to treatment.
Q03 A nurse is assessing a client who has heart failure and is receiving furosemide. Which of the
following findings is an adverse effect of this medication?
Answer: Hypokalemia
Rationale: Furosemide is a loop diuretic that causes significant potassium loss in the distal
tubule, leading to hypokalemia as the most common electrolyte abnormality.
,Q04 A client who has chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy via nasal cannula at 2 L/min. The nurse should monitor for which of the following
adverse effects?
Answer: Oxygen-induced hypercapnia
Rationale: In clients with COPD, high-flow oxygen can suppress hypoxic respiratory drive,
leading to CO₂ retention and respiratory acidosis (hypercapnia).
Q05 A nurse is caring for a client who has a new prescription for lisinopril. The nurse should
monitor the client for which of the following adverse effects?
Answer: Angioedema
Rationale: Angioedema is a rare but potentially life-threatening adverse effect of ACE inhibitors
(lisinopril) caused by increased bradykinin levels.
Q06 A client who has a history of atrial fibrillation is prescribed warfarin. The nurse should
instruct the client to report which of the following symptoms immediately?
Answer: Unusual bruising or pink-tinged urine
Rationale: These are signs of bleeding, which is the most serious adverse effect of warfarin
therapy.
Q07 A nurse is caring for a client who has a prescription for digoxin. Which of the following
findings should the nurse withhold the medication and notify the provider?
Answer: Apical pulse rate 52 beats per minute
Rationale: Digoxin should be withheld if the apical pulse is less than 60 beats per minute in
adults due to the risk of bradycardia and toxicity.
Q08 A nurse is caring for a client who has a prescription for enoxaparin. Which of the following
laboratory values should the nurse monitor?
Answer: Platelet count
, Rationale: Enoxaparin (low-molecular-weight heparin) can cause heparin-induced
thrombocytopenia (HIT); platelet count should be monitored regularly.
Q09 A nurse is reinforcing teaching with a client who has a new prescription for clopidogrel.
Which of the following instructions should the nurse include?
Answer: "Do not take omeprazole while taking this medication."
Rationale: Omeprazole inhibits CYP2C19, reducing the activation of clopidogrel and decreasing
its antiplatelet effectiveness.
Q10 A nurse is caring for a client who has a prescription for spironolactone. Which of the
following laboratory values should the nurse monitor closely?
Answer: Potassium
Rationale: Spironolactone is potassium-sparing and can cause hyperkalemia, especially when
combined with ACE inhibitors or ARBs.
Q11 A nurse is caring for a client who has a prescription for theophylline. The nurse should
monitor serum theophylline levels to prevent which of the following adverse effects?
Answer: Tachycardia and dysrhythmias
Rationale: Theophylline has a narrow therapeutic index; toxicity can cause serious cardiac
effects, including tachycardia and dysrhythmias.
Q12 A nurse is reinforcing teaching with a client who has a new prescription for methotrexate
for rheumatoid arthritis. Which of the following instructions should the nurse include?
Answer: "Take folic acid daily to reduce toxicity."
Rationale: Folic acid supplementation reduces gastrointestinal and hematologic toxicity
associated with methotrexate.
