BSN HESI 266 MED SURG EXAM STUDY GUIDE | TESTBANK | PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
School of Nursing (BSN Program) – HESI Medical-Surgical Nursing Assessment
TABLE OF CONTENTS
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Neurologic Disorders
4. Renal and Urinary Disorders
5. Endocrine Disorders
6. Gastrointestinal Disorders
7. Hematologic and Immune Disorders
8. Musculoskeletal Disorders
9. Fluid, Electrolyte, and Acid-Base Balance
10. Infectious Diseases
11. Perioperative Nursing
12. Oncology Nursing
13. Pain Management
14. Critical Care Concepts
15. Patient Safety and Prioritization
16. Pharmacologic Management
17. Patient Education
18. Clinical Judgment and Decision-Making
19. Professional Communication
20. Comprehensive Integrated Review
CARDIOVASCULAR NURSING || RESPIRATORY CARE || NEUROLOGICAL DISORDERS
|| ENDOCRINE MANAGEMENT || RENAL FUNCTION || GASTROINTESTINAL
NURSING || FLUID AND ELECTROLYTE BALANCE || ACID-BASE DISORDERS ||
,HEMATOLOGY || IMMUNOLOGY || ONCOLOGY || CRITICAL CARE || PATIENT SAFETY
|| CLINICAL JUDGMENT || PRIORITIZATION || PHARMACOLOGY || PERIOPERATIVE
CARE || INFECTION PREVENTION || EVIDENCE-BASED PRACTICE || PROFESSIONAL
NURSING
QUESTION 1.
A client admitted with acute decompensated heart failure develops worsening
dyspnea, crackles throughout both lung fields, oxygen saturation of 86% despite
supplemental oxygen, and increasing anxiety. Which nursing action should take the
highest priority?
A. Position the client upright and prepare for noninvasive positive-pressure
ventilation.
B. Encourage oral fluids to improve circulation.
C. Administer the scheduled beta-blocker before reassessment.
D. Obtain the client's daily weight.
🔴 Correct Answer: A. Position the client upright and prepare for noninvasive
positive-pressure ventilation.
🔵 Explanation: Immediate interventions should focus on improving oxygenation and
reducing the work of breathing. Upright positioning decreases venous return and
improves ventilation, while noninvasive ventilation can rapidly improve oxygenation.
The remaining interventions are appropriate later but do not address the immediate
threat to oxygenation.
QUESTION 2.
A nurse is caring for a client receiving intravenous unfractionated heparin for
pulmonary embolism. Which laboratory finding requires the most immediate
intervention?
A. INR of 1.3
B. aPTT of 118 seconds with active bleeding from the IV site
,C. Hemoglobin of 13.4 g/dL
D. Platelet count of 210,000/mm³
🔴 Correct Answer: B. aPTT of 118 seconds with active bleeding from the IV site
🔵 Explanation: A markedly prolonged aPTT accompanied by active bleeding indicates
excessive anticoagulation requiring prompt intervention, including stopping the
infusion and notifying the provider. The remaining values are either expected or not
immediately concerning in this context.
QUESTION 3.
A postoperative client suddenly becomes restless, tachypneic, and confused. Pulse
oximetry decreases from 97% to 84% on room air. Which assessment finding most
strongly supports a diagnosis of pulmonary embolism?
A. Bilateral lower-extremity edema
B. Gradual onset productive cough
C. Sudden pleuritic chest pain with tachycardia
D. Hyperactive bowel sounds
🔴 Correct Answer: C. Sudden pleuritic chest pain with tachycardia
🔵 Explanation: Pulmonary embolism commonly presents with abrupt pleuritic chest
pain, tachycardia, dyspnea, and hypoxemia. Bilateral edema and productive cough
suggest other conditions, while bowel sounds are unrelated to pulmonary embolism.
QUESTION 4.
A client with diabetic ketoacidosis begins insulin therapy. Which assessment finding
most clearly indicates that treatment is effective?
A. Blood glucose decreases while serum potassium continues to rise.
B. Urine output remains absent.
C. Respiratory rate increases despite improving laboratory values.
D. Anion gap narrows and serum bicarbonate begins to normalize.
, 🔴 Correct Answer: D. Anion gap narrows and serum bicarbonate begins to
normalize.
🔵 Explanation: Resolution of diabetic ketoacidosis is demonstrated by correction of
metabolic acidosis, reflected by a closing anion gap and improving bicarbonate levels.
Blood glucose improvement alone does not confirm resolution because ketoacidosis
may persist.
QUESTION 5.
A client with chronic kidney disease reports muscle weakness and develops peaked T
waves on the cardiac monitor. Which provider prescription should the nurse
implement first?
A. Oral ferrous sulfate
B. Intravenous calcium gluconate
C. Renal diet education
D. Daily weight measurement
🔴 Correct Answer: B. Intravenous calcium gluconate
🔵 Explanation: Hyperkalemia with electrocardiographic changes is a medical
emergency. Calcium gluconate stabilizes the myocardial membrane while definitive
potassium-lowering therapies are initiated. The remaining interventions do not address
the immediate risk of fatal dysrhythmias.
QUESTION 6.
A nurse is assessing a client after thyroidectomy. Which finding requires immediate
action?
A. Hoarse voice immediately after surgery
B. Temperature of 99°F (37.2°C)
C. Tingling around the mouth and fingertips
D. Mild incisional discomfort
QUESTIONS & ANSWERS | EXAM PREPARATION | ADVANCED REVIEW |
COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE 2026/2027
Examiner:
School of Nursing (BSN Program) – HESI Medical-Surgical Nursing Assessment
TABLE OF CONTENTS
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Neurologic Disorders
4. Renal and Urinary Disorders
5. Endocrine Disorders
6. Gastrointestinal Disorders
7. Hematologic and Immune Disorders
8. Musculoskeletal Disorders
9. Fluid, Electrolyte, and Acid-Base Balance
10. Infectious Diseases
11. Perioperative Nursing
12. Oncology Nursing
13. Pain Management
14. Critical Care Concepts
15. Patient Safety and Prioritization
16. Pharmacologic Management
17. Patient Education
18. Clinical Judgment and Decision-Making
19. Professional Communication
20. Comprehensive Integrated Review
CARDIOVASCULAR NURSING || RESPIRATORY CARE || NEUROLOGICAL DISORDERS
|| ENDOCRINE MANAGEMENT || RENAL FUNCTION || GASTROINTESTINAL
NURSING || FLUID AND ELECTROLYTE BALANCE || ACID-BASE DISORDERS ||
,HEMATOLOGY || IMMUNOLOGY || ONCOLOGY || CRITICAL CARE || PATIENT SAFETY
|| CLINICAL JUDGMENT || PRIORITIZATION || PHARMACOLOGY || PERIOPERATIVE
CARE || INFECTION PREVENTION || EVIDENCE-BASED PRACTICE || PROFESSIONAL
NURSING
QUESTION 1.
A client admitted with acute decompensated heart failure develops worsening
dyspnea, crackles throughout both lung fields, oxygen saturation of 86% despite
supplemental oxygen, and increasing anxiety. Which nursing action should take the
highest priority?
A. Position the client upright and prepare for noninvasive positive-pressure
ventilation.
B. Encourage oral fluids to improve circulation.
C. Administer the scheduled beta-blocker before reassessment.
D. Obtain the client's daily weight.
🔴 Correct Answer: A. Position the client upright and prepare for noninvasive
positive-pressure ventilation.
🔵 Explanation: Immediate interventions should focus on improving oxygenation and
reducing the work of breathing. Upright positioning decreases venous return and
improves ventilation, while noninvasive ventilation can rapidly improve oxygenation.
The remaining interventions are appropriate later but do not address the immediate
threat to oxygenation.
QUESTION 2.
A nurse is caring for a client receiving intravenous unfractionated heparin for
pulmonary embolism. Which laboratory finding requires the most immediate
intervention?
A. INR of 1.3
B. aPTT of 118 seconds with active bleeding from the IV site
,C. Hemoglobin of 13.4 g/dL
D. Platelet count of 210,000/mm³
🔴 Correct Answer: B. aPTT of 118 seconds with active bleeding from the IV site
🔵 Explanation: A markedly prolonged aPTT accompanied by active bleeding indicates
excessive anticoagulation requiring prompt intervention, including stopping the
infusion and notifying the provider. The remaining values are either expected or not
immediately concerning in this context.
QUESTION 3.
A postoperative client suddenly becomes restless, tachypneic, and confused. Pulse
oximetry decreases from 97% to 84% on room air. Which assessment finding most
strongly supports a diagnosis of pulmonary embolism?
A. Bilateral lower-extremity edema
B. Gradual onset productive cough
C. Sudden pleuritic chest pain with tachycardia
D. Hyperactive bowel sounds
🔴 Correct Answer: C. Sudden pleuritic chest pain with tachycardia
🔵 Explanation: Pulmonary embolism commonly presents with abrupt pleuritic chest
pain, tachycardia, dyspnea, and hypoxemia. Bilateral edema and productive cough
suggest other conditions, while bowel sounds are unrelated to pulmonary embolism.
QUESTION 4.
A client with diabetic ketoacidosis begins insulin therapy. Which assessment finding
most clearly indicates that treatment is effective?
A. Blood glucose decreases while serum potassium continues to rise.
B. Urine output remains absent.
C. Respiratory rate increases despite improving laboratory values.
D. Anion gap narrows and serum bicarbonate begins to normalize.
, 🔴 Correct Answer: D. Anion gap narrows and serum bicarbonate begins to
normalize.
🔵 Explanation: Resolution of diabetic ketoacidosis is demonstrated by correction of
metabolic acidosis, reflected by a closing anion gap and improving bicarbonate levels.
Blood glucose improvement alone does not confirm resolution because ketoacidosis
may persist.
QUESTION 5.
A client with chronic kidney disease reports muscle weakness and develops peaked T
waves on the cardiac monitor. Which provider prescription should the nurse
implement first?
A. Oral ferrous sulfate
B. Intravenous calcium gluconate
C. Renal diet education
D. Daily weight measurement
🔴 Correct Answer: B. Intravenous calcium gluconate
🔵 Explanation: Hyperkalemia with electrocardiographic changes is a medical
emergency. Calcium gluconate stabilizes the myocardial membrane while definitive
potassium-lowering therapies are initiated. The remaining interventions do not address
the immediate risk of fatal dysrhythmias.
QUESTION 6.
A nurse is assessing a client after thyroidectomy. Which finding requires immediate
action?
A. Hoarse voice immediately after surgery
B. Temperature of 99°F (37.2°C)
C. Tingling around the mouth and fingertips
D. Mild incisional discomfort
