BSN 266 – HESI MEDICAL-SURGICAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Gastrointestinal Disorders
4. Neurological Disorders
5. Renal and Urinary Disorders
6. Endocrine and Metabolic Disorders
7. Musculoskeletal Disorders
8. Hematological and Immunological Disorders
9. Integumentary Disorders
10. Perioperative and Emergency Nursing
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical judgment
skills essential for success in the BSN 266 HESI Medical-Surgical exit exam. It evaluates foundational pathophysiological
concepts, applied professional nursing practice, and the ability to manage complex patient scenarios across a variety of
body systems. The exam utilizes a multiple-choice and scenario-based format to challenge your clinical decision-
making abilities, prioritizing safe, patient-centered care. Emphasis is placed on the application of evidence-based
practice, legal and ethical parameters, and the prioritization of interventions in real-world clinical settings. This
assessment serves as a vital tool to gauge your readiness for professional nursing practice and the NCLEX-RN licensure
examination.
,SECTION ONE: QUESTIONS 1 – 100
1. A patient with heart failure is prescribed digoxin and furosemide. Which laboratory finding places the patient
at the highest risk for digoxin toxicity?
A. Serum sodium of 140 mEq/L
B. Serum magnesium of 2.0 mEq/L
C. Serum calcium of 10.5 mg/dL
D. Serum potassium of 3.0 mEq/L
🟢 D. Serum potassium of 3.0 mEq/L
🔴 Explanation: Hypokalemia, often caused by the potassium-wasting diuretic furosemide, potentiates the action of
digoxin and significantly increases the risk for toxicity. The other electrolyte levels are within normal or near-normal
ranges and do not pose the same level of risk.
2. A nurse is assessing a patient for orthostatic hypotension. Which action should the nurse perform first?
A. Measure the heart rate while the patient is standing.
B. Obtain a baseline blood pressure in the supine position.
C. Ask the patient if they feel dizzy or lightheaded.
D. Assist the patient to a sitting position and wait one minute.
🟢 B. Obtain a baseline blood pressure in the supine position.
🔴 Explanation: The correct procedure for assessing orthostatic hypotension involves first obtaining a baseline
blood pressure and heart rate while the patient is supine. Subsequent measurements are taken after the patient
moves to sitting and then standing positions. This ensures an accurate comparison to identify a significant drop in
blood pressure.
3. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG) result showing:
pH 7.31, PaCO2 58 mm Hg, PaO2 70 mm Hg, and HCO3 28 mEq/L. How should the nurse interpret these results?
,A. Uncompensated metabolic acidosis
B. Partially compensated respiratory acidosis
C. Uncompensated respiratory alkalosis
D. Fully compensated metabolic alkalosis
🟢 B. Partially compensated respiratory acidosis
🔴 Explanation: The ABG shows a low pH (acidosis) and elevated PaCO2 (respiratory acidosis). The HCO3 is elevated
(28 mEq/L) indicating a metabolic compensatory response. However, because the pH is still below the normal range
(7.35-7.45), the compensation is only partial. Normal PaO2 is 80-100 mm Hg, and a value of 70 mm Hg indicates
hypoxemia.
4. A nurse is providing discharge teaching to a patient who had a myocardial infarction. Which statement by the
patient indicates a need for further teaching?
A. "I will start a cardiac rehabilitation program next week."
B. "I should avoid straining on the toilet to prevent vagal stimulation."
C. "I can resume sexual activity when I can climb two flights of stairs without symptoms."
D. "I will stop my statin medication once my cholesterol levels are normal."
🟢 D. "I will stop my statin medication once my cholesterol levels are normal."
🔴 Explanation: Statins are not a cure for hyperlipidemia; they are a maintenance medication that must be taken as
prescribed to manage cholesterol levels and reduce the risk of future cardiac events. Stopping them can lead to a
rebound in cholesterol levels and increased risk. The other statements reflect correct understanding.
5. What is the priority nursing intervention for a patient experiencing an acute asthma exacerbation?
A. Administer oral corticosteroids as prescribed.
B. Provide high-flow oxygen via non-rebreather mask.
C. Administer a short-acting beta-2 agonist (SABA) via nebulizer.
D. Place the patient in a high-Fowler's position.
, 🟢 C. Administer a short-acting beta-2 agonist (SABA) via nebulizer.
🔴 Explanation: The priority is to relieve bronchospasm and restore airway patency by administering a rapid-acting
bronchodilator such as albuterol. Oxygen therapy is also crucial but secondary to opening the airways. Positioning is
an important intervention to facilitate breathing but is not the priority action. Corticosteroids are used for their anti-
inflammatory effect but take several hours to be effective.
6. A patient is receiving a blood transfusion of packed red blood cells (PRBCs). Fifteen minutes after the
transfusion begins, the patient reports chills, low back pain, and a feeling of impending doom. What is the
nurse's priority action?
A. Administer an antihistamine.
B. Stop the transfusion.
C. Slow the infusion rate.
D. Reassure the patient and continue monitoring.
🟢 B. Stop the transfusion.
🔴 Explanation: These symptoms are classic signs of an acute hemolytic transfusion reaction, a life-threatening
emergency. The first and most critical action is to immediately stop the transfusion to prevent further hemolysis.
After stopping the transfusion, the nurse would maintain IV access with new tubing and normal saline, notify the
provider, and send the blood bag and tubing to the lab.
7. A patient with diabetes mellitus type 1 is scheduled for surgery. The nurse notes that the patient's morning
insulin was held. Which action is most appropriate?
A. Administer the patient's usual morning insulin dose.
B. Request an order for a sliding-scale insulin regimen.
C. Initiate a continuous infusion of normal saline.
D. Instruct the patient to eat a light breakfast.
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Gastrointestinal Disorders
4. Neurological Disorders
5. Renal and Urinary Disorders
6. Endocrine and Metabolic Disorders
7. Musculoskeletal Disorders
8. Hematological and Immunological Disorders
9. Integumentary Disorders
10. Perioperative and Emergency Nursing
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, critical thinking, and clinical judgment
skills essential for success in the BSN 266 HESI Medical-Surgical exit exam. It evaluates foundational pathophysiological
concepts, applied professional nursing practice, and the ability to manage complex patient scenarios across a variety of
body systems. The exam utilizes a multiple-choice and scenario-based format to challenge your clinical decision-
making abilities, prioritizing safe, patient-centered care. Emphasis is placed on the application of evidence-based
practice, legal and ethical parameters, and the prioritization of interventions in real-world clinical settings. This
assessment serves as a vital tool to gauge your readiness for professional nursing practice and the NCLEX-RN licensure
examination.
,SECTION ONE: QUESTIONS 1 – 100
1. A patient with heart failure is prescribed digoxin and furosemide. Which laboratory finding places the patient
at the highest risk for digoxin toxicity?
A. Serum sodium of 140 mEq/L
B. Serum magnesium of 2.0 mEq/L
C. Serum calcium of 10.5 mg/dL
D. Serum potassium of 3.0 mEq/L
🟢 D. Serum potassium of 3.0 mEq/L
🔴 Explanation: Hypokalemia, often caused by the potassium-wasting diuretic furosemide, potentiates the action of
digoxin and significantly increases the risk for toxicity. The other electrolyte levels are within normal or near-normal
ranges and do not pose the same level of risk.
2. A nurse is assessing a patient for orthostatic hypotension. Which action should the nurse perform first?
A. Measure the heart rate while the patient is standing.
B. Obtain a baseline blood pressure in the supine position.
C. Ask the patient if they feel dizzy or lightheaded.
D. Assist the patient to a sitting position and wait one minute.
🟢 B. Obtain a baseline blood pressure in the supine position.
🔴 Explanation: The correct procedure for assessing orthostatic hypotension involves first obtaining a baseline
blood pressure and heart rate while the patient is supine. Subsequent measurements are taken after the patient
moves to sitting and then standing positions. This ensures an accurate comparison to identify a significant drop in
blood pressure.
3. A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas (ABG) result showing:
pH 7.31, PaCO2 58 mm Hg, PaO2 70 mm Hg, and HCO3 28 mEq/L. How should the nurse interpret these results?
,A. Uncompensated metabolic acidosis
B. Partially compensated respiratory acidosis
C. Uncompensated respiratory alkalosis
D. Fully compensated metabolic alkalosis
🟢 B. Partially compensated respiratory acidosis
🔴 Explanation: The ABG shows a low pH (acidosis) and elevated PaCO2 (respiratory acidosis). The HCO3 is elevated
(28 mEq/L) indicating a metabolic compensatory response. However, because the pH is still below the normal range
(7.35-7.45), the compensation is only partial. Normal PaO2 is 80-100 mm Hg, and a value of 70 mm Hg indicates
hypoxemia.
4. A nurse is providing discharge teaching to a patient who had a myocardial infarction. Which statement by the
patient indicates a need for further teaching?
A. "I will start a cardiac rehabilitation program next week."
B. "I should avoid straining on the toilet to prevent vagal stimulation."
C. "I can resume sexual activity when I can climb two flights of stairs without symptoms."
D. "I will stop my statin medication once my cholesterol levels are normal."
🟢 D. "I will stop my statin medication once my cholesterol levels are normal."
🔴 Explanation: Statins are not a cure for hyperlipidemia; they are a maintenance medication that must be taken as
prescribed to manage cholesterol levels and reduce the risk of future cardiac events. Stopping them can lead to a
rebound in cholesterol levels and increased risk. The other statements reflect correct understanding.
5. What is the priority nursing intervention for a patient experiencing an acute asthma exacerbation?
A. Administer oral corticosteroids as prescribed.
B. Provide high-flow oxygen via non-rebreather mask.
C. Administer a short-acting beta-2 agonist (SABA) via nebulizer.
D. Place the patient in a high-Fowler's position.
, 🟢 C. Administer a short-acting beta-2 agonist (SABA) via nebulizer.
🔴 Explanation: The priority is to relieve bronchospasm and restore airway patency by administering a rapid-acting
bronchodilator such as albuterol. Oxygen therapy is also crucial but secondary to opening the airways. Positioning is
an important intervention to facilitate breathing but is not the priority action. Corticosteroids are used for their anti-
inflammatory effect but take several hours to be effective.
6. A patient is receiving a blood transfusion of packed red blood cells (PRBCs). Fifteen minutes after the
transfusion begins, the patient reports chills, low back pain, and a feeling of impending doom. What is the
nurse's priority action?
A. Administer an antihistamine.
B. Stop the transfusion.
C. Slow the infusion rate.
D. Reassure the patient and continue monitoring.
🟢 B. Stop the transfusion.
🔴 Explanation: These symptoms are classic signs of an acute hemolytic transfusion reaction, a life-threatening
emergency. The first and most critical action is to immediately stop the transfusion to prevent further hemolysis.
After stopping the transfusion, the nurse would maintain IV access with new tubing and normal saline, notify the
provider, and send the blood bag and tubing to the lab.
7. A patient with diabetes mellitus type 1 is scheduled for surgery. The nurse notes that the patient's morning
insulin was held. Which action is most appropriate?
A. Administer the patient's usual morning insulin dose.
B. Request an order for a sliding-scale insulin regimen.
C. Initiate a continuous infusion of normal saline.
D. Instruct the patient to eat a light breakfast.
