,BSN 266 Medical-Surgical Nursing
HESI Exam Prep | 150+ New
Questions | Updated for 2026
1. A patient with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor most closely?
a) Serum sodium
b) Serum potassium
c) Serum calcium
d) Serum magnesium
Answer: b) Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting.
Hypokalemia can precipitate cardiac dysrhythmias, especially in patients taking
digoxin.
2. A client with COPD and chronic hypercapnia has an SpO2 of 88%. The nurse
administers oxygen at 2 L/min. Which finding indicates an adverse reaction?
a) Increased respiratory rate
b) Decreased level of consciousness
c) Improved exercise tolerance
d) Productive cough
Answer: b) Decreased level of consciousness
Rationale: Clients with chronic hypercapnia rely on a hypoxic drive to breathe. Oxygen
administration can suppress this drive, leading to CO2 narcosis and decreased LOC.
3. A patient is 12 hours post-cardiac catheterization via the right femoral artery.
The right foot is cool, pale, and pulseless. What is the nurse's priority action?
a) Apply a warming blanket
b) Elevate the right leg
c) Notify the healthcare provider immediately
d) Administer prescribed anticoagulants
Answer: c) Notify the healthcare provider immediately
Rationale: A cool, pale, pulseless extremity indicates acute arterial occlusion or
thrombus formation, which is a medical emergency requiring immediate intervention.
,4. Which clinical manifestation is most characteristic of right-sided heart
failure?
a) Dyspnea on exertion
b) Pulmonary crackles
c) Jugular venous distention
d) Orthopnea
Answer: c) Jugular venous distention
Rationale: Right-sided heart failure causes systemic venous congestion, leading to
jugular venous distention, peripheral edema, and hepatomegaly.
5. A client with heart failure with reduced ejection fraction (HFrEF) should be
prescribed which first-line medication combination?
a) ACE inhibitor and beta-blocker
b) Calcium channel blocker and diuretic
c) Digoxin and ARB
d) Nitrate and hydralazine
Answer: a) ACE inhibitor and beta-blocker
Rationale: ACE inhibitors and beta-blockers are the cornerstone of HFrEF therapy as
they improve mortality, reduce hospitalizations, and slow disease progression.
6. The nurse is caring for a patient with peptic ulcer disease who suddenly
develops severe, sharp abdominal pain with a rigid, board-like abdomen. What
is the priority action?
a) Administer oral antacids
b) Insert a nasogastric tube to low suction
c) Prepare for emergency surgery
d) Give IV morphine for pain
Answer: c) Prepare for emergency surgery
Rationale: A rigid, board-like abdomen with severe pain suggests a perforated ulcer
causing peritonitis, which requires immediate surgical intervention.
, 7. A client with Crohn's disease asks about dietary modifications. Which
response is most appropriate?
a) Avoid all dairy products permanently
b) Maintain a high-fiber diet to promote bowel health
c) Follow a low-residue diet during acute exacerbations
d) Eliminate all gluten-containing foods
Answer: c) Follow a low-residue diet during acute exacerbations
Rationale: During acute exacerbations, a low-residue diet reduces mechanical irritation
and stool volume, helping to rest the bowel.
8. A patient with chronic kidney disease (CKD) is scheduled to start dialysis.
Which condition contraindicates peritoneal dialysis?
a) Severe hypertension
b) History of diverticulosis
c) Recent abdominal surgery with adhesions
d) Type 2 diabetes mellitus
Answer: c) Recent abdominal surgery with adhesions
Rationale: Abdominal adhesions and prior abdominal surgery reduce the surface area
for peritoneal diffusion and increase the risk of catheter failure and infection.
9. A client receiving chemotherapy has a platelet count of 20,000/µL. Which
nursing intervention is a priority?
a) Administer prescribed epoetin alfa
b) Apply pressure to all venipuncture sites for 5 minutes
c) Place the client in protective isolation
d) Encourage vigorous oral hygiene
Answer: b) Apply pressure to all venipuncture sites for 5 minutes
Rationale: Severe thrombocytopenia (platelets < 50,000) increases bleeding risk.
Prolonged pressure is essential to prevent hematoma formation.
10. Which finding in a client with a migraine headache warrants immediate
intervention?
a) Photophobia and phonophobia
b) Nausea and vomiting
c) Sudden onset of "worst headache of my life"
HESI Exam Prep | 150+ New
Questions | Updated for 2026
1. A patient with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor most closely?
a) Serum sodium
b) Serum potassium
c) Serum calcium
d) Serum magnesium
Answer: b) Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting.
Hypokalemia can precipitate cardiac dysrhythmias, especially in patients taking
digoxin.
2. A client with COPD and chronic hypercapnia has an SpO2 of 88%. The nurse
administers oxygen at 2 L/min. Which finding indicates an adverse reaction?
a) Increased respiratory rate
b) Decreased level of consciousness
c) Improved exercise tolerance
d) Productive cough
Answer: b) Decreased level of consciousness
Rationale: Clients with chronic hypercapnia rely on a hypoxic drive to breathe. Oxygen
administration can suppress this drive, leading to CO2 narcosis and decreased LOC.
3. A patient is 12 hours post-cardiac catheterization via the right femoral artery.
The right foot is cool, pale, and pulseless. What is the nurse's priority action?
a) Apply a warming blanket
b) Elevate the right leg
c) Notify the healthcare provider immediately
d) Administer prescribed anticoagulants
Answer: c) Notify the healthcare provider immediately
Rationale: A cool, pale, pulseless extremity indicates acute arterial occlusion or
thrombus formation, which is a medical emergency requiring immediate intervention.
,4. Which clinical manifestation is most characteristic of right-sided heart
failure?
a) Dyspnea on exertion
b) Pulmonary crackles
c) Jugular venous distention
d) Orthopnea
Answer: c) Jugular venous distention
Rationale: Right-sided heart failure causes systemic venous congestion, leading to
jugular venous distention, peripheral edema, and hepatomegaly.
5. A client with heart failure with reduced ejection fraction (HFrEF) should be
prescribed which first-line medication combination?
a) ACE inhibitor and beta-blocker
b) Calcium channel blocker and diuretic
c) Digoxin and ARB
d) Nitrate and hydralazine
Answer: a) ACE inhibitor and beta-blocker
Rationale: ACE inhibitors and beta-blockers are the cornerstone of HFrEF therapy as
they improve mortality, reduce hospitalizations, and slow disease progression.
6. The nurse is caring for a patient with peptic ulcer disease who suddenly
develops severe, sharp abdominal pain with a rigid, board-like abdomen. What
is the priority action?
a) Administer oral antacids
b) Insert a nasogastric tube to low suction
c) Prepare for emergency surgery
d) Give IV morphine for pain
Answer: c) Prepare for emergency surgery
Rationale: A rigid, board-like abdomen with severe pain suggests a perforated ulcer
causing peritonitis, which requires immediate surgical intervention.
, 7. A client with Crohn's disease asks about dietary modifications. Which
response is most appropriate?
a) Avoid all dairy products permanently
b) Maintain a high-fiber diet to promote bowel health
c) Follow a low-residue diet during acute exacerbations
d) Eliminate all gluten-containing foods
Answer: c) Follow a low-residue diet during acute exacerbations
Rationale: During acute exacerbations, a low-residue diet reduces mechanical irritation
and stool volume, helping to rest the bowel.
8. A patient with chronic kidney disease (CKD) is scheduled to start dialysis.
Which condition contraindicates peritoneal dialysis?
a) Severe hypertension
b) History of diverticulosis
c) Recent abdominal surgery with adhesions
d) Type 2 diabetes mellitus
Answer: c) Recent abdominal surgery with adhesions
Rationale: Abdominal adhesions and prior abdominal surgery reduce the surface area
for peritoneal diffusion and increase the risk of catheter failure and infection.
9. A client receiving chemotherapy has a platelet count of 20,000/µL. Which
nursing intervention is a priority?
a) Administer prescribed epoetin alfa
b) Apply pressure to all venipuncture sites for 5 minutes
c) Place the client in protective isolation
d) Encourage vigorous oral hygiene
Answer: b) Apply pressure to all venipuncture sites for 5 minutes
Rationale: Severe thrombocytopenia (platelets < 50,000) increases bleeding risk.
Prolonged pressure is essential to prevent hematoma formation.
10. Which finding in a client with a migraine headache warrants immediate
intervention?
a) Photophobia and phonophobia
b) Nausea and vomiting
c) Sudden onset of "worst headache of my life"
