BSN HESI 266 Med Surg Exam Questions &
Correct Answers With Rationales, 100%
Guaranteed Pass || Complete A+ Guide -
Nightingale
Question 1
Question 44 of 55
While caring for a client with a full thickness burn covering 40% of the body, the
nurse observes purulent drainage at the wound. Before reporting this finding to
the healthcare provider, the nurse should review which of the client's laboratory
values?
- A Hematocrit
- B Blood pH level.
- C White blood cell (WBC) count.
- D Platelet count
Correct Answer
- C White blood cell (WBC) count.
Question 2
The nurse is performing an initial assessment of an adult client. Which finding
indicates that the nurse should evaluate the client for a pulse deficit?
a. Point of maximal impulse at anterior axillary line
b. Radial pulse of 56 beats/minute
c. Dorsalis pedis pulse volume is +1
d. Frequent premature beats auscultated at apical site
Correct Answer
d. Frequent premature beats auscultated at apical site
The presence of a pulse deficit indicates that there may be an issue with cardiac
function or efficiency. When a pulse deficit is detected, it means that the
volume of blood pumped from the heart may not be sufficient to meet the
needs of your body's tissues. Listening to the apical pulse is listening directly to
your heart. It's the most efficient way to evaluate heart function.
If your pulse is outside of the normal range or you have an irregular heartbeat,
your doctor will evaluate you further.
Page 1 of 214
,Question 3
After three days of persistent epigastric pain, a female client presents to the clinic.
She has been taking oral antacids without relief. Her vital signs are heart rate 122
beats/min. respiration 16 breaths/min. oxygen saturation 96%, and blood
pressure 116/70 mmhg. The nurse obtains a 12-lead electrocardiogram (ECG).
Which assessment finding is most crucial?
a. Irregular pulse rate
b. Bile colored emesis
c. ST elevation in three leads
d. Complaint of radiating jaw pain
Correct Answer
c. ST elevation in three leads
Remember STEMI
Question 4
While caring for a client with Amyotrophic Lateral Sclerosis (ALS), the nurse
performs a neurological assessment every four hours. Which assessment finding
warrants immediate intervention by the nurse?
a. Inappropriate laughter.
b. Weakened cough effort.
c. Asymmetrical weakness.
d. Increasing anxiety.
Correct Answer
b. Weakened cough effort.
Page 2 of 214
,Question 5
Question 30 of 55
The nurse is preparing a client for discharge who was recently diagnosed with
Addison's disease. Which instruction is most important for the nurse to include in
this client's discharge teaching plan?
- A: Avoid extreme environmental temperatures.
- B: Take prescribed cortisone accurately.
- C: Use a walker when weakness occurs.
- D: Increase daily intake of sodium in the diet.
Correct Answer
- B: Take prescribed cortisone accurately.
Question 6
Question 42 of 55
A client who has small cell carcinoma of the lung is admitted with symptoms of
syndrome of inappropriate antidiuretic hormone (SIADH). As the client responds
to treatment, the client's serum sodium level increases from 120 mEq/L (120
mmol/L) to 125 mEq/L (125 mmol/L). Based on this finding, which intervention
should the nurse implement?
- A: Withhold next scheduled dose of treatment.
- B: Increase neurologic checks to every 2 hours.
- C: Assess for increasing fluid volume overload.
- D: Maintain the prescribed fluid restriction.
Correct Answer
- D: Maintain the prescribed fluid restriction.
Page 3 of 214
, Question 7
The nurse calls the healthcare provider because a client diagnosed with an
abdominal aortic aneurysm (AAA) is complaining of low back pain. Which
additional information about the client would be important for the nurse to tell
the healthcare provider?
a. White blood cell count and pulse rate
b. Serum amylase and level of consciousness
c. Hematocrit and blood pressure
d. Calcium level and skin condition
Correct Answer
c. hematocrit and blood pressure
The nurse should inform the healthcare provider about the client's hematocrit
and blood pressure. Hematocrit is a measure of the proportion of red blood
cells in the blood, which can indicate if there's internal bleeding, a possible
complication of an AAA. Blood pressure is also crucial as high blood pressure
can cause the aneurysm to rupture. The other options (white blood cell count,
pulse, serum amylase, level of consciousness, calcium level, skin condition) are
less directly related to the condition and symptoms of an AAA.
Question 8
Question 18 of 55
The nurse is caring for a client admitted to the hospital with a tentative diagnosis
of bacterial meningitis. Which diagnostic procedure should the nurse prepare the
client for the healthcare provider?
- A Magnetic resonance imaging (MRI).
- B Lumbar puncture.
- C Computerized tomography (CT) scan.
- D Skull radiography.
Correct Answer
- B Lumbar puncture.
Page 4 of 214
Correct Answers With Rationales, 100%
Guaranteed Pass || Complete A+ Guide -
Nightingale
Question 1
Question 44 of 55
While caring for a client with a full thickness burn covering 40% of the body, the
nurse observes purulent drainage at the wound. Before reporting this finding to
the healthcare provider, the nurse should review which of the client's laboratory
values?
- A Hematocrit
- B Blood pH level.
- C White blood cell (WBC) count.
- D Platelet count
Correct Answer
- C White blood cell (WBC) count.
Question 2
The nurse is performing an initial assessment of an adult client. Which finding
indicates that the nurse should evaluate the client for a pulse deficit?
a. Point of maximal impulse at anterior axillary line
b. Radial pulse of 56 beats/minute
c. Dorsalis pedis pulse volume is +1
d. Frequent premature beats auscultated at apical site
Correct Answer
d. Frequent premature beats auscultated at apical site
The presence of a pulse deficit indicates that there may be an issue with cardiac
function or efficiency. When a pulse deficit is detected, it means that the
volume of blood pumped from the heart may not be sufficient to meet the
needs of your body's tissues. Listening to the apical pulse is listening directly to
your heart. It's the most efficient way to evaluate heart function.
If your pulse is outside of the normal range or you have an irregular heartbeat,
your doctor will evaluate you further.
Page 1 of 214
,Question 3
After three days of persistent epigastric pain, a female client presents to the clinic.
She has been taking oral antacids without relief. Her vital signs are heart rate 122
beats/min. respiration 16 breaths/min. oxygen saturation 96%, and blood
pressure 116/70 mmhg. The nurse obtains a 12-lead electrocardiogram (ECG).
Which assessment finding is most crucial?
a. Irregular pulse rate
b. Bile colored emesis
c. ST elevation in three leads
d. Complaint of radiating jaw pain
Correct Answer
c. ST elevation in three leads
Remember STEMI
Question 4
While caring for a client with Amyotrophic Lateral Sclerosis (ALS), the nurse
performs a neurological assessment every four hours. Which assessment finding
warrants immediate intervention by the nurse?
a. Inappropriate laughter.
b. Weakened cough effort.
c. Asymmetrical weakness.
d. Increasing anxiety.
Correct Answer
b. Weakened cough effort.
Page 2 of 214
,Question 5
Question 30 of 55
The nurse is preparing a client for discharge who was recently diagnosed with
Addison's disease. Which instruction is most important for the nurse to include in
this client's discharge teaching plan?
- A: Avoid extreme environmental temperatures.
- B: Take prescribed cortisone accurately.
- C: Use a walker when weakness occurs.
- D: Increase daily intake of sodium in the diet.
Correct Answer
- B: Take prescribed cortisone accurately.
Question 6
Question 42 of 55
A client who has small cell carcinoma of the lung is admitted with symptoms of
syndrome of inappropriate antidiuretic hormone (SIADH). As the client responds
to treatment, the client's serum sodium level increases from 120 mEq/L (120
mmol/L) to 125 mEq/L (125 mmol/L). Based on this finding, which intervention
should the nurse implement?
- A: Withhold next scheduled dose of treatment.
- B: Increase neurologic checks to every 2 hours.
- C: Assess for increasing fluid volume overload.
- D: Maintain the prescribed fluid restriction.
Correct Answer
- D: Maintain the prescribed fluid restriction.
Page 3 of 214
, Question 7
The nurse calls the healthcare provider because a client diagnosed with an
abdominal aortic aneurysm (AAA) is complaining of low back pain. Which
additional information about the client would be important for the nurse to tell
the healthcare provider?
a. White blood cell count and pulse rate
b. Serum amylase and level of consciousness
c. Hematocrit and blood pressure
d. Calcium level and skin condition
Correct Answer
c. hematocrit and blood pressure
The nurse should inform the healthcare provider about the client's hematocrit
and blood pressure. Hematocrit is a measure of the proportion of red blood
cells in the blood, which can indicate if there's internal bleeding, a possible
complication of an AAA. Blood pressure is also crucial as high blood pressure
can cause the aneurysm to rupture. The other options (white blood cell count,
pulse, serum amylase, level of consciousness, calcium level, skin condition) are
less directly related to the condition and symptoms of an AAA.
Question 8
Question 18 of 55
The nurse is caring for a client admitted to the hospital with a tentative diagnosis
of bacterial meningitis. Which diagnostic procedure should the nurse prepare the
client for the healthcare provider?
- A Magnetic resonance imaging (MRI).
- B Lumbar puncture.
- C Computerized tomography (CT) scan.
- D Skull radiography.
Correct Answer
- B Lumbar puncture.
Page 4 of 214
