BSN 266 HESI MED SURG EXAM — COMPREHENSIVE PRACTICE
QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS AND
DETAILED RATIONALE
Q1. A 68-year-old male patient with chronic obstructive pulmonary
disease (COPD) is admitted with worsening dyspnea. His arterial blood
gas results show pH 7.31, PaCO2 68 mmHg, PaO2 55 mmHg, and HCO3-
32 mEq/L. Which interpretation of these results is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis) and PaCO2 is elevated (respiratory
acidosis). The HCO3- is elevated, indicating renal compensation.
Because the pH remains abnormal (not normalized), this is partially
compensated respiratory acidosis. Full compensation would show a
normal pH.
Q2. A nurse is assessing a patient with pericarditis. Which finding would
the nurse expect to observe?
A. Bradycardia with weak peripheral pulses
B. Friction rub heard at the left sternal border
,C. Distended jugular veins with clear lung sounds
D. Holosystolic murmur at the apex
Correct Answer: B
Rationale: Pericarditis is inflammation of the pericardium. A pericardial
friction rub is a classic finding, heard best at the left sternal border
when the patient leans forward and exhales. This scratchy, high-pitched
sound results from inflamed pericardial layers rubbing together.
Q3. A patient with diabetes mellitus type 1 is found unresponsive. The
nurse notes dry skin, fruity breath odor, and deep, rapid respirations.
Which laboratory value would the nurse expect to find?
A. Serum glucose 850 mg/dL with low serum bicarbonate
B. Serum glucose 65 mg/dL with normal bicarbonate
C. Serum glucose 450 mg/dL with elevated serum bicarbonate
D. Serum glucose 120 mg/dL with elevated ketones
Correct Answer: A
Rationale: The patient is presenting with diabetic ketoacidosis (DKA).
Classic findings include hyperglycemia (typically >250 mg/dL), metabolic
acidosis with low serum bicarbonate, ketonemia, and Kussmaul
respirations. The fruity breath odor is from acetone.
Q4. A 72-year-old patient is receiving digoxin for heart failure. Which
assessment finding indicates digoxin toxicity?
A. Heart rate 78 beats per minute with bounding pulses
B. Yellow-green halos around visual images
,C. Serum potassium level of 4.2 mEq/L
D. Blood pressure 145/88 mmHg
Correct Answer: B
Rationale: Visual disturbances such as yellow-green halos (xanthopsia)
are classic signs of digoxin toxicity. Other signs include gastrointestinal
symptoms (nausea, vomiting, anorexia) and cardiac dysrhythmias,
particularly bradycardia and heart block.
Q5. A patient with cirrhosis develops ascites. Which intervention is
most important for the nurse to implement?
A. Administer albumin intravenously as prescribed
B. Restrict dietary sodium to 2 grams per day
C. Measure abdominal girth daily at the umbilicus
D. Place the patient in semi-Fowler's position
Correct Answer: C
Rationale: Daily measurement of abdominal girth at the umbilicus
provides objective data to monitor the progression or resolution of
ascites. This assessment helps evaluate the effectiveness of
interventions such as diuretics and dietary sodium restriction.
Q6. A patient is admitted with a suspected pulmonary embolism. Which
finding is the nurse most likely to observe?
A. Decreased respiratory rate and bradycardia
B. Sudden onset of pleuritic chest pain and dyspnea
, C. Productive cough with green sputum
D. Oxygen saturation of 98% on room air
Correct Answer: B
Rationale: Pulmonary embolism typically presents with sudden onset of
pleuritic chest pain, dyspnea, tachycardia, tachypnea, and hypoxia. The
pain is often sharp and worsens with inspiration. Hemoptysis may also
occur.
Q7. A patient with chronic kidney disease has a serum potassium level
of 6.5 mEq/L. Which intervention should the nurse anticipate
implementing?
A. Administer potassium chloride IV
B. Prepare for hemodialysis treatment
C. Encourage intake of potassium-rich foods
D. Administer sodium polystyrene sulfonate (Kayexalate)
Correct Answer: D
Rationale: Sodium polystyrene sulfonate is a cation-exchange resin that
binds potassium in the gastrointestinal tract, promoting its excretion.
This is a conservative measure for hyperkalemia. For severely elevated
potassium (>6.5 mEq/L), emergency interventions such as IV calcium
gluconate, insulin with dextrose, and possibly hemodialysis may be
needed.
QUESTIONS COMPLETE WITH 100% VERIFIED ANSWERS AND
DETAILED RATIONALE
Q1. A 68-year-old male patient with chronic obstructive pulmonary
disease (COPD) is admitted with worsening dyspnea. His arterial blood
gas results show pH 7.31, PaCO2 68 mmHg, PaO2 55 mmHg, and HCO3-
32 mEq/L. Which interpretation of these results is correct?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Correct Answer: B
Rationale: The pH is low (acidosis) and PaCO2 is elevated (respiratory
acidosis). The HCO3- is elevated, indicating renal compensation.
Because the pH remains abnormal (not normalized), this is partially
compensated respiratory acidosis. Full compensation would show a
normal pH.
Q2. A nurse is assessing a patient with pericarditis. Which finding would
the nurse expect to observe?
A. Bradycardia with weak peripheral pulses
B. Friction rub heard at the left sternal border
,C. Distended jugular veins with clear lung sounds
D. Holosystolic murmur at the apex
Correct Answer: B
Rationale: Pericarditis is inflammation of the pericardium. A pericardial
friction rub is a classic finding, heard best at the left sternal border
when the patient leans forward and exhales. This scratchy, high-pitched
sound results from inflamed pericardial layers rubbing together.
Q3. A patient with diabetes mellitus type 1 is found unresponsive. The
nurse notes dry skin, fruity breath odor, and deep, rapid respirations.
Which laboratory value would the nurse expect to find?
A. Serum glucose 850 mg/dL with low serum bicarbonate
B. Serum glucose 65 mg/dL with normal bicarbonate
C. Serum glucose 450 mg/dL with elevated serum bicarbonate
D. Serum glucose 120 mg/dL with elevated ketones
Correct Answer: A
Rationale: The patient is presenting with diabetic ketoacidosis (DKA).
Classic findings include hyperglycemia (typically >250 mg/dL), metabolic
acidosis with low serum bicarbonate, ketonemia, and Kussmaul
respirations. The fruity breath odor is from acetone.
Q4. A 72-year-old patient is receiving digoxin for heart failure. Which
assessment finding indicates digoxin toxicity?
A. Heart rate 78 beats per minute with bounding pulses
B. Yellow-green halos around visual images
,C. Serum potassium level of 4.2 mEq/L
D. Blood pressure 145/88 mmHg
Correct Answer: B
Rationale: Visual disturbances such as yellow-green halos (xanthopsia)
are classic signs of digoxin toxicity. Other signs include gastrointestinal
symptoms (nausea, vomiting, anorexia) and cardiac dysrhythmias,
particularly bradycardia and heart block.
Q5. A patient with cirrhosis develops ascites. Which intervention is
most important for the nurse to implement?
A. Administer albumin intravenously as prescribed
B. Restrict dietary sodium to 2 grams per day
C. Measure abdominal girth daily at the umbilicus
D. Place the patient in semi-Fowler's position
Correct Answer: C
Rationale: Daily measurement of abdominal girth at the umbilicus
provides objective data to monitor the progression or resolution of
ascites. This assessment helps evaluate the effectiveness of
interventions such as diuretics and dietary sodium restriction.
Q6. A patient is admitted with a suspected pulmonary embolism. Which
finding is the nurse most likely to observe?
A. Decreased respiratory rate and bradycardia
B. Sudden onset of pleuritic chest pain and dyspnea
, C. Productive cough with green sputum
D. Oxygen saturation of 98% on room air
Correct Answer: B
Rationale: Pulmonary embolism typically presents with sudden onset of
pleuritic chest pain, dyspnea, tachycardia, tachypnea, and hypoxia. The
pain is often sharp and worsens with inspiration. Hemoptysis may also
occur.
Q7. A patient with chronic kidney disease has a serum potassium level
of 6.5 mEq/L. Which intervention should the nurse anticipate
implementing?
A. Administer potassium chloride IV
B. Prepare for hemodialysis treatment
C. Encourage intake of potassium-rich foods
D. Administer sodium polystyrene sulfonate (Kayexalate)
Correct Answer: D
Rationale: Sodium polystyrene sulfonate is a cation-exchange resin that
binds potassium in the gastrointestinal tract, promoting its excretion.
This is a conservative measure for hyperkalemia. For severely elevated
potassium (>6.5 mEq/L), emergency interventions such as IV calcium
gluconate, insulin with dextrose, and possibly hemodialysis may be
needed.
