,BSN 266 HESI Practice Exam: 200 Questions &
Rationales
Section 1: Cardiovascular & Respiratory
(Questions 1-40)
1. A patient with heart failure presents with jugular venous distention, crackles,
and 3+ pitting edema. Which medication does the nurse anticipate administering
first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Correct Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces fluid overload, alleviating
pulmonary congestion and edema. This is the priority intervention for acute fluid overload.
2. A patient with COPD has an oxygen saturation of 88% on room air. The nurse
administers oxygen at 2 L/min via nasal cannula. Which finding indicates the
therapy is effective?
A. Respiratory rate increases from 22 to 28
B. Oxygen saturation increases to 92%
C. Patient becomes more somnolent
D. PaCO2 increases from 48 to 56 mmHg
Correct Answer: B. Oxygen saturation increases to 92%
Rationale: The goal of oxygen therapy in COPD is to maintain SpO2 between 88-92%. An
increase to 92% indicates adequate oxygenation without significant risk of CO2 retention.
,3. A postoperative patient suddenly develops shortness of breath, chest pain, and
hemoptysis. What is the nurse's priority action?
A. Administer prescribed morphine
B. Apply oxygen and notify the provider
C. Encourage deep breathing exercises
D. Ambulate the patient
Correct Answer: B. Apply oxygen and notify the provider
Rationale: These symptoms suggest a pulmonary embolism, a life-threatening emergency.
The priority is to support oxygenation and immediately notify the provider for further
interventions.
4. A patient with atrial fibrillation has a heart rate of 150 bpm and blood pressure
of 88/52 mmHg. Which intervention should the nurse implement first?
A. Administer amiodarone as prescribed
B. Assess the patient's airway and breathing
C. Prepare for synchronized cardioversion
D. Obtain a 12-lead ECG
Correct Answer: B. Assess the patient's airway and breathing
Rationale: The ABCs (Airway, Breathing, Circulation) are always the priority. The patient is
hemodynamically unstable (hypotension, tachycardia), requiring immediate assessment of
airway and breathing before any other intervention.
5. A patient is receiving heparin therapy for a pulmonary embolism. Which
laboratory value requires immediate nursing intervention?
A. aPTT of 60 seconds
B. Platelet count of 80,000/mm³
C. Hemoglobin of 12 g/dL
D. INR of 1.5
Correct Answer: B. Platelet count of 80,000/mm³
Rationale: This indicates heparin-induced thrombocytopenia (HIT), a serious immune-
mediated complication. Heparin should be discontinued immediately, and an alternative
anticoagulant should be initiated.
, 6. The nurse is caring for a patient with chest pain. Which finding is most
consistent with unstable angina?
A. Pain relieved by rest
B. Pain relieved by nitroglycerin
C. Pain occurring at rest or with minimal exertion
D. Pain lasting less than 5 minutes
Correct Answer: C. Pain occurring at rest or with minimal exertion
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is of new
onset, or occurs with minimal exertion. It is a medical emergency indicating an increased
risk of myocardial infarction.
7. A patient with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A. Heart rate of 72 bpm
B. Serum potassium of 4.0 mEq/L
C. Visual disturbances (yellow-green halos)
D. Blood pressure of 120/80 mmHg
Correct Answer: C. Visual disturbances (yellow-green halos)
Rationale: Visual changes, including yellow-green halos around objects, are classic signs of
digoxin toxicity. Other signs include nausea, vomiting, and cardiac arrhythmias.
8. A patient with asthma is prescribed albuterol via nebulizer. The nurse should
monitor for which adverse effect?
A. Bradycardia
B. Hypotension
C. Tachycardia
D. Sedation
Correct Answer: C. Tachycardia
Rationale: Albuterol is a beta-2 agonist that can cause beta-1 stimulation at higher doses,
leading to tachycardia, palpitations, and tremors.
Rationales
Section 1: Cardiovascular & Respiratory
(Questions 1-40)
1. A patient with heart failure presents with jugular venous distention, crackles,
and 3+ pitting edema. Which medication does the nurse anticipate administering
first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Correct Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces fluid overload, alleviating
pulmonary congestion and edema. This is the priority intervention for acute fluid overload.
2. A patient with COPD has an oxygen saturation of 88% on room air. The nurse
administers oxygen at 2 L/min via nasal cannula. Which finding indicates the
therapy is effective?
A. Respiratory rate increases from 22 to 28
B. Oxygen saturation increases to 92%
C. Patient becomes more somnolent
D. PaCO2 increases from 48 to 56 mmHg
Correct Answer: B. Oxygen saturation increases to 92%
Rationale: The goal of oxygen therapy in COPD is to maintain SpO2 between 88-92%. An
increase to 92% indicates adequate oxygenation without significant risk of CO2 retention.
,3. A postoperative patient suddenly develops shortness of breath, chest pain, and
hemoptysis. What is the nurse's priority action?
A. Administer prescribed morphine
B. Apply oxygen and notify the provider
C. Encourage deep breathing exercises
D. Ambulate the patient
Correct Answer: B. Apply oxygen and notify the provider
Rationale: These symptoms suggest a pulmonary embolism, a life-threatening emergency.
The priority is to support oxygenation and immediately notify the provider for further
interventions.
4. A patient with atrial fibrillation has a heart rate of 150 bpm and blood pressure
of 88/52 mmHg. Which intervention should the nurse implement first?
A. Administer amiodarone as prescribed
B. Assess the patient's airway and breathing
C. Prepare for synchronized cardioversion
D. Obtain a 12-lead ECG
Correct Answer: B. Assess the patient's airway and breathing
Rationale: The ABCs (Airway, Breathing, Circulation) are always the priority. The patient is
hemodynamically unstable (hypotension, tachycardia), requiring immediate assessment of
airway and breathing before any other intervention.
5. A patient is receiving heparin therapy for a pulmonary embolism. Which
laboratory value requires immediate nursing intervention?
A. aPTT of 60 seconds
B. Platelet count of 80,000/mm³
C. Hemoglobin of 12 g/dL
D. INR of 1.5
Correct Answer: B. Platelet count of 80,000/mm³
Rationale: This indicates heparin-induced thrombocytopenia (HIT), a serious immune-
mediated complication. Heparin should be discontinued immediately, and an alternative
anticoagulant should be initiated.
, 6. The nurse is caring for a patient with chest pain. Which finding is most
consistent with unstable angina?
A. Pain relieved by rest
B. Pain relieved by nitroglycerin
C. Pain occurring at rest or with minimal exertion
D. Pain lasting less than 5 minutes
Correct Answer: C. Pain occurring at rest or with minimal exertion
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is of new
onset, or occurs with minimal exertion. It is a medical emergency indicating an increased
risk of myocardial infarction.
7. A patient with heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A. Heart rate of 72 bpm
B. Serum potassium of 4.0 mEq/L
C. Visual disturbances (yellow-green halos)
D. Blood pressure of 120/80 mmHg
Correct Answer: C. Visual disturbances (yellow-green halos)
Rationale: Visual changes, including yellow-green halos around objects, are classic signs of
digoxin toxicity. Other signs include nausea, vomiting, and cardiac arrhythmias.
8. A patient with asthma is prescribed albuterol via nebulizer. The nurse should
monitor for which adverse effect?
A. Bradycardia
B. Hypotension
C. Tachycardia
D. Sedation
Correct Answer: C. Tachycardia
Rationale: Albuterol is a beta-2 agonist that can cause beta-1 stimulation at higher doses,
leading to tachycardia, palpitations, and tremors.
