BSN 266 HESI MED SURG EXAM — 400 UNIQUE
QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES LATEST UPDATE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–75)
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Q1. A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse
rate is 43 beats per minute. Which question is a priority for the nurse to ask this
client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Correct Answer: D
Rationale: Symptoms such as confusion, nausea, vomiting, headache, and
bradycardia are classic signs of digitalis toxicity, especially in elderly clients.
Older persons are particularly susceptible to the buildup of cardiac glycosides to
toxic levels. Prompt assessment of medication history is critical.
---
1
,Q2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a
rapid ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Correct Answer: B
Rationale: With uncontrolled atrial fibrillation and rapid ventricular response, the
treatment of choice is synchronized cardioversion to convert the cardiac rhythm
back to normal sinus rhythm. Lidocaine is used for ventricular arrhythmias.
Defibrillation is for pulseless rhythms. Atropine is for symptomatic bradycardia.
---
Q3. The nurse is caring for a client who is one day post-acute myocardial
infarction. The client is receiving oxygen at 2 L/min via nasal cannula and has a
peripheral saline lock. The nurse notes that the client is having eight premature
ventricular contractions (PVCs) per minute. Which action should the nurse take
first?
A. Administer lidocaine intravenously as prescribed
B. Assess the client's serum potassium level
C. Increase the oxygen to 4 L/min via nasal cannula
2
,D. Notify the healthcare provider immediately
Correct Answer: B
Rationale: PVCs after an MI can be caused by hypokalemia, hypomagnesemia, or
myocardial irritability. The nurse should first assess the potassium level because
electrolyte imbalance is a common and reversible cause. While lidocaine may be
indicated, the underlying cause should be identified first.
---
Q4. A client with heart failure reports worsening dyspnea and 3+ pitting edema in
both legs. Which intervention should the nurse implement first?
A. Administer furosemide IV push
B. Place the client in high-Fowler's position
C. Restrict oral fluids to 1.5 L/day
D. Check serum potassium level
Correct Answer: B
Rationale: Placing the client in high-Fowler's position reduces preload and
improves ventilation; ABCs prioritize positioning before medication or labs. This
intervention immediately facilitates breathing and reduces venous return to the
heart.
---
3
, Q5. A patient with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance should the nurse monitor most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia, which increases the risk of digoxin toxicity and arrhythmias.
Monitoring serum potassium is essential for patient safety.
---
Q6. A patient with heart failure with reduced ejection fraction (HFrEF) should be
prescribed which first-line medications?
A. ACE inhibitor and beta-blocker
B. Calcium channel blocker and loop diuretic
C. Digoxin and spironolactone
D. Hydralazine and isosorbide dinitrate
Correct Answer: A
4
QUESTIONS AND ANSWERS WITH DETAILED
RATIONALES LATEST UPDATE
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–75)
---
Q1. A 77-year-old female client is admitted to the hospital. She is confused, has no
appetite, is nauseated and vomiting, and is complaining of a headache. Her pulse
rate is 43 beats per minute. Which question is a priority for the nurse to ask this
client or her family on admission?
A. "Does the client have her own teeth or dentures?"
B. "Does the client take aspirin and if so, how much?"
C. "Does the client take nitroglycerin?"
D. "Does the client take digitalis?"
Correct Answer: D
Rationale: Symptoms such as confusion, nausea, vomiting, headache, and
bradycardia are classic signs of digitalis toxicity, especially in elderly clients.
Older persons are particularly susceptible to the buildup of cardiac glycosides to
toxic levels. Prompt assessment of medication history is critical.
---
1
,Q2. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a
rapid ventricular response. Based on this finding, the nurse anticipates assisting the
physician with which treatment?
A. Administer lidocaine, 75 mg intravenous push
B. Perform synchronized cardioversion
C. Defibrillate the client at 200 joules
D. Administer atropine, 0.5 mg intravenous push
Correct Answer: B
Rationale: With uncontrolled atrial fibrillation and rapid ventricular response, the
treatment of choice is synchronized cardioversion to convert the cardiac rhythm
back to normal sinus rhythm. Lidocaine is used for ventricular arrhythmias.
Defibrillation is for pulseless rhythms. Atropine is for symptomatic bradycardia.
---
Q3. The nurse is caring for a client who is one day post-acute myocardial
infarction. The client is receiving oxygen at 2 L/min via nasal cannula and has a
peripheral saline lock. The nurse notes that the client is having eight premature
ventricular contractions (PVCs) per minute. Which action should the nurse take
first?
A. Administer lidocaine intravenously as prescribed
B. Assess the client's serum potassium level
C. Increase the oxygen to 4 L/min via nasal cannula
2
,D. Notify the healthcare provider immediately
Correct Answer: B
Rationale: PVCs after an MI can be caused by hypokalemia, hypomagnesemia, or
myocardial irritability. The nurse should first assess the potassium level because
electrolyte imbalance is a common and reversible cause. While lidocaine may be
indicated, the underlying cause should be identified first.
---
Q4. A client with heart failure reports worsening dyspnea and 3+ pitting edema in
both legs. Which intervention should the nurse implement first?
A. Administer furosemide IV push
B. Place the client in high-Fowler's position
C. Restrict oral fluids to 1.5 L/day
D. Check serum potassium level
Correct Answer: B
Rationale: Placing the client in high-Fowler's position reduces preload and
improves ventilation; ABCs prioritize positioning before medication or labs. This
intervention immediately facilitates breathing and reduces venous return to the
heart.
---
3
, Q5. A patient with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance should the nurse monitor most closely?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalemia, which increases the risk of digoxin toxicity and arrhythmias.
Monitoring serum potassium is essential for patient safety.
---
Q6. A patient with heart failure with reduced ejection fraction (HFrEF) should be
prescribed which first-line medications?
A. ACE inhibitor and beta-blocker
B. Calcium channel blocker and loop diuretic
C. Digoxin and spironolactone
D. Hydralazine and isosorbide dinitrate
Correct Answer: A
4
