BSN 266 – HESI MEDICAL-SURGICAL EXAM – EXAM-STYLE QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A patient with chronic obstructive pulmonary disease (COPD) exhibits
increased dyspnea and a productive cough with thick, tenacious sputum.
Which intervention should the nurse prioritize to improve airway clearance?
A. Administer a prescribed mucolytic agent.
B. Encourage the patient to increase oral fluid intake.
C. Position the patient in a high-Fowler's position.
D. Perform chest physiotherapy (CPT) with postural drainage.
Correct Answer: A. Administer a prescribed mucolytic agent.
Rationale: While all options can be part of a comprehensive plan, the priority is
to administer a prescribed mucolytic agent (e.g., acetylcysteine). This directly
breaks down the chemical bonds in the thick mucus, reducing its viscosity and
making it easier to expectorate. Increasing fluids (B) and positioning (C) are
supportive but do not directly address the chemical composition of the sputum.
CPT (D) is effective but can be fatiguing and is often contraindicated or less
effective if the secretions remain too thick to mobilize. The immediate priority is
to alter the property of the secretions for effective clearance.***
2. A nurse is caring for a patient on a medical-surgical unit who is prescribed
furosemide for heart failure. Which laboratory value requires the most
immediate intervention?
,A. Serum sodium of 135 mEq/L.
B. Serum potassium of 3.0 mEq/L.
C. Serum calcium of 10.2 mg/dL.
D. Serum magnesium of 1.8 mEq/L.
Correct Answer: B. Serum potassium of 3.0 mEq/L.
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss,
leading to hypokalemia. A serum potassium of 3.0 mEq/L is critically low and
places the patient at high risk for life-threatening cardiac dysrhythmias. A sodium
of 135 mEq/L is slightly low but not immediately critical (A). A calcium of 10.2
mg/dL is near the upper limit of normal and not an emergency (C). A magnesium
of 1.8 mEq/L is mildly low but does not present the same immediate life-
threatening risk as hypokalemia (D).***
3. A patient who is one day post-operative from a total hip arthroplasty reports
sudden chest pain and shortness of breath. The nurse notes the patient is
tachycardic and hypoxic. What is the nurse's priority action?
A. Encourage deep breathing and coughing.
B. Administer prescribed PRN pain medication.
C. Assess the surgical site for bleeding.
D. Initiate oxygen therapy and notify the healthcare provider.
Correct Answer: D. Initiate oxygen therapy and notify the healthcare provider.
Rationale: This clinical picture is highly suggestive of a pulmonary embolism (PE),
a life-threatening complication following major orthopedic surgery. The priority
,actions are to stabilize the patient's oxygenation and immediately notify the
provider to get orders for diagnostic testing and definitive treatment. Deep
breathing (A) and pain medication (B) will not address the underlying embolus.
Assessing the surgical site (C) is not the priority when a patient is experiencing
acute respiratory distress from a suspected PE.***
4. A nurse is preparing to administer a blood transfusion of packed red blood
cells to an anemic patient. Before starting the transfusion, which action is
essential for patient safety?
A. Prime the IV tubing with 5% dextrose in water.
B. Verify the patient's identity and blood compatibility with another licensed
nurse.
C. Administer a prophylactic dose of diphenhydramine.
D. Pre-medicate the patient with acetaminophen for fever prevention.
Correct Answer: B. Verify the patient's identity and blood compatibility with
another licensed nurse.
Rationale: The most critical step before any blood transfusion is the two-person
verification process to ensure the right blood is given to the right patient. This
involves checking the patient's identification band and the blood product label
against the provider's order. Priming with D5W (A) is incorrect as blood should be
primed with normal saline. Prophylactic administration of diphenhydramine (C) or
acetaminophen (D) is not a standard safety requirement for all patients and is not
a substitute for proper verification.***
, 5. A patient with diabetes mellitus type 2 is scheduled for a coronary artery
bypass graft (CABG). The provider orders a sliding scale of regular insulin for
blood glucose management. The nurse understands the primary rationale for
this tight glycemic control is to:
A. Prevent the development of diabetic ketoacidosis (DKA).
B. Promote wound healing and reduce the risk of infection.
C. Compensate for the glucose load from the intravenous fluids.
D. Reduce the risk of hypoglycemia during the surgical procedure.
Correct Answer: B. Promote wound healing and reduce the risk of infection.
Rationale: Hyperglycemia impairs the function of white blood cells, including
chemotaxis, phagocytosis, and bacterial killing, thereby increasing the risk for
surgical site infections. It also negatively impacts wound healing by affecting
collagen deposition and tissue repair. While tight control can help prevent DKA
(A), the primary reason for this specific protocol in the perioperative period is to
minimize the risk of infection and optimize healing. It is not meant to directly
compensate for IV fluids (C) and increases the risk of hypoglycemia (D), not
reduces it.***
6. When caring for a patient with acute pancreatitis, the nurse monitors for
which of the following complications that indicates a poor prognosis?
A. Leukocytosis
B. Elevated serum amylase
C. Hypocalcemia
D. Abdominal pain radiating to the back
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A patient with chronic obstructive pulmonary disease (COPD) exhibits
increased dyspnea and a productive cough with thick, tenacious sputum.
Which intervention should the nurse prioritize to improve airway clearance?
A. Administer a prescribed mucolytic agent.
B. Encourage the patient to increase oral fluid intake.
C. Position the patient in a high-Fowler's position.
D. Perform chest physiotherapy (CPT) with postural drainage.
Correct Answer: A. Administer a prescribed mucolytic agent.
Rationale: While all options can be part of a comprehensive plan, the priority is
to administer a prescribed mucolytic agent (e.g., acetylcysteine). This directly
breaks down the chemical bonds in the thick mucus, reducing its viscosity and
making it easier to expectorate. Increasing fluids (B) and positioning (C) are
supportive but do not directly address the chemical composition of the sputum.
CPT (D) is effective but can be fatiguing and is often contraindicated or less
effective if the secretions remain too thick to mobilize. The immediate priority is
to alter the property of the secretions for effective clearance.***
2. A nurse is caring for a patient on a medical-surgical unit who is prescribed
furosemide for heart failure. Which laboratory value requires the most
immediate intervention?
,A. Serum sodium of 135 mEq/L.
B. Serum potassium of 3.0 mEq/L.
C. Serum calcium of 10.2 mg/dL.
D. Serum magnesium of 1.8 mEq/L.
Correct Answer: B. Serum potassium of 3.0 mEq/L.
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss,
leading to hypokalemia. A serum potassium of 3.0 mEq/L is critically low and
places the patient at high risk for life-threatening cardiac dysrhythmias. A sodium
of 135 mEq/L is slightly low but not immediately critical (A). A calcium of 10.2
mg/dL is near the upper limit of normal and not an emergency (C). A magnesium
of 1.8 mEq/L is mildly low but does not present the same immediate life-
threatening risk as hypokalemia (D).***
3. A patient who is one day post-operative from a total hip arthroplasty reports
sudden chest pain and shortness of breath. The nurse notes the patient is
tachycardic and hypoxic. What is the nurse's priority action?
A. Encourage deep breathing and coughing.
B. Administer prescribed PRN pain medication.
C. Assess the surgical site for bleeding.
D. Initiate oxygen therapy and notify the healthcare provider.
Correct Answer: D. Initiate oxygen therapy and notify the healthcare provider.
Rationale: This clinical picture is highly suggestive of a pulmonary embolism (PE),
a life-threatening complication following major orthopedic surgery. The priority
,actions are to stabilize the patient's oxygenation and immediately notify the
provider to get orders for diagnostic testing and definitive treatment. Deep
breathing (A) and pain medication (B) will not address the underlying embolus.
Assessing the surgical site (C) is not the priority when a patient is experiencing
acute respiratory distress from a suspected PE.***
4. A nurse is preparing to administer a blood transfusion of packed red blood
cells to an anemic patient. Before starting the transfusion, which action is
essential for patient safety?
A. Prime the IV tubing with 5% dextrose in water.
B. Verify the patient's identity and blood compatibility with another licensed
nurse.
C. Administer a prophylactic dose of diphenhydramine.
D. Pre-medicate the patient with acetaminophen for fever prevention.
Correct Answer: B. Verify the patient's identity and blood compatibility with
another licensed nurse.
Rationale: The most critical step before any blood transfusion is the two-person
verification process to ensure the right blood is given to the right patient. This
involves checking the patient's identification band and the blood product label
against the provider's order. Priming with D5W (A) is incorrect as blood should be
primed with normal saline. Prophylactic administration of diphenhydramine (C) or
acetaminophen (D) is not a standard safety requirement for all patients and is not
a substitute for proper verification.***
, 5. A patient with diabetes mellitus type 2 is scheduled for a coronary artery
bypass graft (CABG). The provider orders a sliding scale of regular insulin for
blood glucose management. The nurse understands the primary rationale for
this tight glycemic control is to:
A. Prevent the development of diabetic ketoacidosis (DKA).
B. Promote wound healing and reduce the risk of infection.
C. Compensate for the glucose load from the intravenous fluids.
D. Reduce the risk of hypoglycemia during the surgical procedure.
Correct Answer: B. Promote wound healing and reduce the risk of infection.
Rationale: Hyperglycemia impairs the function of white blood cells, including
chemotaxis, phagocytosis, and bacterial killing, thereby increasing the risk for
surgical site infections. It also negatively impacts wound healing by affecting
collagen deposition and tissue repair. While tight control can help prevent DKA
(A), the primary reason for this specific protocol in the perioperative period is to
minimize the risk of infection and optimize healing. It is not meant to directly
compensate for IV fluids (C) and increases the risk of hypoglycemia (D), not
reduces it.***
6. When caring for a patient with acute pancreatitis, the nurse monitors for
which of the following complications that indicates a poor prognosis?
A. Leukocytosis
B. Elevated serum amylase
C. Hypocalcemia
D. Abdominal pain radiating to the back
