,BSN HESI 266 MED SURG EXAM Practice Questions with Rationales –
Comprehensive
1. A nurse is caring for a client with acute pancreatitis who
reports severe abdominal pain radiating to the back. Which
position should the nurse encourage to alleviate the pain?
A. Supine with legs extended
B. Sitting upright and leaning forward
C. Left side-lying with knees flexed
D. Prone with head turned to the side
Correct Answer: B
Rationale: Sitting upright and leaning forward reduces tension on the
pancreas and decreases pain by relieving pressure on the abdominal organs.
Supine position often worsens the pain because it increases pressure on the
pancreas. Side-lying and prone positions do not provide the same relief.
2. A client with chronic kidney disease has a serum creatinine
of 6.2 mg/dL and a potassium of 6.0 mEq/L. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure 150/90 mmHg
B. ECG showing peaked T waves
C. Peripheral edema 2+
D. Fatigue and lethargy
Correct Answer: B
Rationale: Peaked T waves on ECG indicate hyperkalemia, which can lead to
,life-threatening cardiac arrhythmias. This requires immediate intervention
such as calcium gluconate, insulin with glucose, or dialysis. Hypertension,
edema, and fatigue are concerning but not immediately life-threatening.
3. A client with diabetes mellitus type 2 is prescribed
metformin. Which statement by the client indicates a need for
further teaching?
A. "I will take this medication with meals."
B. "I will report any muscle pain to my doctor."
C. "I can drink alcohol occasionally while taking this medication."
D. "I will have my kidney function checked regularly."
Correct Answer: C
Rationale: Alcohol consumption increases the risk of lactic acidosis in clients
taking metformin. Clients should avoid alcohol or limit it significantly. Taking
with meals reduces GI upset; muscle pain may indicate lactic acidosis; kidney
function monitoring is essential.
4. A client with heart failure is receiving IV furosemide. Which
assessment finding indicates the medication is having the
desired therapeutic effect?
A. Heart rate 110 beats/min
B. Weight loss of 2 kg in 24 hours
C. Blood pressure 160/90 mmHg
D. Crackles auscultated in all lung fields
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload. A
, weight loss of 1–2 kg in 24 hours indicates effective diuresis. Tachycardia,
hypertension, and crackles suggest worsening heart failure or inadequate
response.
5. A client with a history of asthma is being discharged with a
prescription for fluticasone/salmeterol (Advair). Which
instruction should the nurse include?
A. "Use this inhaler for acute asthma attacks."
B. "Rinse your mouth after each use to prevent thrush."
C. "Take this medication only when you feel short of breath."
D. "This medication works immediately to open your airways."
Correct Answer: B
Rationale: Fluticasone is a corticosteroid that can cause oral thrush; rinsing
the mouth after use prevents this. Advair is a controller medication, not a
rescue inhaler; it does not work immediately; it should be used daily, not
PRN.
6. A client with cirrhosis has ascites and an elevated ammonia
level. Which medication should the nurse anticipate
administering?
A. Furosemide
B. Lactulose
C. Spironolactone
D. Metronidazole
Correct Answer: B
Rationale: Lactulose reduces serum ammonia by promoting its excretion
Comprehensive
1. A nurse is caring for a client with acute pancreatitis who
reports severe abdominal pain radiating to the back. Which
position should the nurse encourage to alleviate the pain?
A. Supine with legs extended
B. Sitting upright and leaning forward
C. Left side-lying with knees flexed
D. Prone with head turned to the side
Correct Answer: B
Rationale: Sitting upright and leaning forward reduces tension on the
pancreas and decreases pain by relieving pressure on the abdominal organs.
Supine position often worsens the pain because it increases pressure on the
pancreas. Side-lying and prone positions do not provide the same relief.
2. A client with chronic kidney disease has a serum creatinine
of 6.2 mg/dL and a potassium of 6.0 mEq/L. Which
assessment finding requires immediate nursing intervention?
A. Blood pressure 150/90 mmHg
B. ECG showing peaked T waves
C. Peripheral edema 2+
D. Fatigue and lethargy
Correct Answer: B
Rationale: Peaked T waves on ECG indicate hyperkalemia, which can lead to
,life-threatening cardiac arrhythmias. This requires immediate intervention
such as calcium gluconate, insulin with glucose, or dialysis. Hypertension,
edema, and fatigue are concerning but not immediately life-threatening.
3. A client with diabetes mellitus type 2 is prescribed
metformin. Which statement by the client indicates a need for
further teaching?
A. "I will take this medication with meals."
B. "I will report any muscle pain to my doctor."
C. "I can drink alcohol occasionally while taking this medication."
D. "I will have my kidney function checked regularly."
Correct Answer: C
Rationale: Alcohol consumption increases the risk of lactic acidosis in clients
taking metformin. Clients should avoid alcohol or limit it significantly. Taking
with meals reduces GI upset; muscle pain may indicate lactic acidosis; kidney
function monitoring is essential.
4. A client with heart failure is receiving IV furosemide. Which
assessment finding indicates the medication is having the
desired therapeutic effect?
A. Heart rate 110 beats/min
B. Weight loss of 2 kg in 24 hours
C. Blood pressure 160/90 mmHg
D. Crackles auscultated in all lung fields
Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload. A
, weight loss of 1–2 kg in 24 hours indicates effective diuresis. Tachycardia,
hypertension, and crackles suggest worsening heart failure or inadequate
response.
5. A client with a history of asthma is being discharged with a
prescription for fluticasone/salmeterol (Advair). Which
instruction should the nurse include?
A. "Use this inhaler for acute asthma attacks."
B. "Rinse your mouth after each use to prevent thrush."
C. "Take this medication only when you feel short of breath."
D. "This medication works immediately to open your airways."
Correct Answer: B
Rationale: Fluticasone is a corticosteroid that can cause oral thrush; rinsing
the mouth after use prevents this. Advair is a controller medication, not a
rescue inhaler; it does not work immediately; it should be used daily, not
PRN.
6. A client with cirrhosis has ascites and an elevated ammonia
level. Which medication should the nurse anticipate
administering?
A. Furosemide
B. Lactulose
C. Spironolactone
D. Metronidazole
Correct Answer: B
Rationale: Lactulose reduces serum ammonia by promoting its excretion
