,2026 BSN 266 HESI Med Surg Exams | NGN Case
Scenarios | Questions & Answers | (Digital Download)
1. 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?"
Answer: D. "Does the client take digitalis?"
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.
,2. 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
Answer: B. Perform synchronized cardioversion
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.
, 3. 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. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
Rationale: PVCs are common after MI. The first
action is to increase oxygen delivery to reduce
myocardial ischemia. Lidocaine may be prescribed if
PVCs persist. Assess LOC and notify provider after
oxygen is increased.
4. A client is in cardiogenic shock. Which finding
would the nurse expect?
Scenarios | Questions & Answers | (Digital Download)
1. 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?"
Answer: D. "Does the client take digitalis?"
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.
,2. 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
Answer: B. Perform synchronized cardioversion
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.
, 3. 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. Increase the client's oxygen flow rate
B. Administer a lidocaine bolus as prescribed
C. Assess the client's level of consciousness
D. Notify the healthcare provider immediately
Answer: A. Increase the client's oxygen flow rate
Rationale: PVCs are common after MI. The first
action is to increase oxygen delivery to reduce
myocardial ischemia. Lidocaine may be prescribed if
PVCs persist. Assess LOC and notify provider after
oxygen is increased.
4. A client is in cardiogenic shock. Which finding
would the nurse expect?
