,BSN HESI 266 MED SURG EXAM Practice Questions with Rationales –
Comprehensive Review 2026
SECTION 1: CARDIOVASCULAR (Questions 1–35)
1. A nurse is caring for a client admitted with left-sided heart
failure. Which assessment finding requires immediate
intervention?
A. Bibasilar crackles
B. Weight gain of 1 lb in 24 hours
C. Dyspnea at rest
D. Jugular vein distention
Correct Answer: C
Rationale: Dyspnea at rest indicates severe pulmonary congestion and
inadequate oxygenation, requiring immediate intervention. Bibasilar crackles
and JVD are expected findings in heart failure. A 1-pound weight gain may
not indicate acute deterioration.
2. A client with diabetic ketoacidosis (DKA) is receiving
intravenous insulin. Which laboratory value should the nurse
monitor most closely?
A. Calcium
B. Potassium
C. Magnesium
D. Sodium
,Correct Answer: B
Rationale: Insulin drives potassium into the cells, which can rapidly cause
hypokalemia. Hypokalemia may lead to life-threatening cardiac arrhythmias.
Calcium, magnesium, and sodium are also affected but potassium is the
priority.
3. A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse teach the client to report?
A. Persistent dry cough
B. Weight gain
C. Tachycardia
D. Polyuria
Correct Answer: A
Rationale: Lisinopril (ACE inhibitor) commonly causes a persistent dry cough
due to bradykinin accumulation. Weight gain, tachycardia, and polyuria are
not typical side effects of ACE inhibitors.
4. A client with heart failure has crackles in the lung bases and
peripheral edema. Which medication is indicated to reduce
fluid overload?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
, Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload,
alleviating crackles and edema. Digoxin improves contractility, metoprolol
reduces heart rate, and lisinopril reduces afterload, but furosemide directly
addresses fluid overload.
5. A client with a myocardial infarction is prescribed aspirin.
What is the primary purpose of this medication?
A. To decrease pain
B. To prevent further clot formation
C. To lower blood pressure
D. To reduce fever
Correct Answer: B
Rationale: Aspirin inhibits platelet aggregation, preventing further thrombus
formation in acute MI. While it has analgesic and antipyretic effects, the
primary purpose is antiplatelet therapy.
6. A client with chronic heart failure is prescribed metoprolol.
Which finding indicates the medication is having the desired
therapeutic effect?
A. Heart rate 110/min
B. Heart rate 64/min and blood pressure 120/78 mmHg
C. Blood pressure 160/90 mmHg
D. Weight gain of 3 lbs in 2 days
Comprehensive Review 2026
SECTION 1: CARDIOVASCULAR (Questions 1–35)
1. A nurse is caring for a client admitted with left-sided heart
failure. Which assessment finding requires immediate
intervention?
A. Bibasilar crackles
B. Weight gain of 1 lb in 24 hours
C. Dyspnea at rest
D. Jugular vein distention
Correct Answer: C
Rationale: Dyspnea at rest indicates severe pulmonary congestion and
inadequate oxygenation, requiring immediate intervention. Bibasilar crackles
and JVD are expected findings in heart failure. A 1-pound weight gain may
not indicate acute deterioration.
2. A client with diabetic ketoacidosis (DKA) is receiving
intravenous insulin. Which laboratory value should the nurse
monitor most closely?
A. Calcium
B. Potassium
C. Magnesium
D. Sodium
,Correct Answer: B
Rationale: Insulin drives potassium into the cells, which can rapidly cause
hypokalemia. Hypokalemia may lead to life-threatening cardiac arrhythmias.
Calcium, magnesium, and sodium are also affected but potassium is the
priority.
3. A client with hypertension is prescribed lisinopril. Which
adverse effect should the nurse teach the client to report?
A. Persistent dry cough
B. Weight gain
C. Tachycardia
D. Polyuria
Correct Answer: A
Rationale: Lisinopril (ACE inhibitor) commonly causes a persistent dry cough
due to bradykinin accumulation. Weight gain, tachycardia, and polyuria are
not typical side effects of ACE inhibitors.
4. A client with heart failure has crackles in the lung bases and
peripheral edema. Which medication is indicated to reduce
fluid overload?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
, Correct Answer: B
Rationale: Furosemide is a loop diuretic that reduces fluid volume overload,
alleviating crackles and edema. Digoxin improves contractility, metoprolol
reduces heart rate, and lisinopril reduces afterload, but furosemide directly
addresses fluid overload.
5. A client with a myocardial infarction is prescribed aspirin.
What is the primary purpose of this medication?
A. To decrease pain
B. To prevent further clot formation
C. To lower blood pressure
D. To reduce fever
Correct Answer: B
Rationale: Aspirin inhibits platelet aggregation, preventing further thrombus
formation in acute MI. While it has analgesic and antipyretic effects, the
primary purpose is antiplatelet therapy.
6. A client with chronic heart failure is prescribed metoprolol.
Which finding indicates the medication is having the desired
therapeutic effect?
A. Heart rate 110/min
B. Heart rate 64/min and blood pressure 120/78 mmHg
C. Blood pressure 160/90 mmHg
D. Weight gain of 3 lbs in 2 days
