BSN 266 HESI MED SURG EXAM 250 Practice Questions
with Verified Answers & Detailed Rationales
QUESTION 1
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA).
Which laboratory finding is most concerning?
A) Serum glucose 450 mg/dL
B) Serum potassium 2.8 mEq/L
C) Serum sodium 135 mEq/L
D) Serum bicarbonate 18 mEq/L
CORRECT ANSWER: B) Serum potassium 2.8 mEq/L
Rationale: A potassium level of 2.8 mEq/L is critically low (normal 3.5-5.0). In DKA, total
body potassium is depleted despite normal or elevated initial serum levels due to shifting.
Hypokalemia can cause life-threatening cardiac arrhythmias and must be corrected
carefully.
QUESTION 2
A client receiving total parenteral nutrition (TPN) through a central line develops fever,
chills, and hypotension. Which action should the nurse take first?
A) Slow the TPN infusion rate
B) Discontinue the TPN infusion
C) Obtain blood cultures from the central line
D) Notify the provider
CORRECT ANSWER: B) Discontinue the TPN infusion
,Rationale: Fever, chills, and hypotension in a client receiving TPN suggest catheter-related
sepsis. The nurse should immediately discontinue the TPN infusion to prevent further
contamination, then notify the provider and obtain blood cultures.
QUESTION 3
A client with cirrhosis has ascites and is receiving spironolactone. Which laboratory value
should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
CORRECT ANSWER: B) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia.
Clients with cirrhosis and ascites are at increased risk for electrolyte imbalances, and
potassium levels must be closely monitored.
QUESTION 4
A client with chronic kidney disease is receiving sevelamer. The nurse should explain that
this medication works by:
A) Lowering potassium levels
B) Binding phosphate in the gastrointestinal tract
C) Increasing red blood cell production
D) Lowering blood pressure
CORRECT ANSWER: B) Binding phosphate in the gastrointestinal tract
,Rationale: Sevelamer is a phosphate binder used to lower serum phosphate levels in clients
with CKD. It works by binding dietary phosphate in the GI tract, preventing its absorption.
Hyperphosphatemia can lead to bone disease and vascular calcification.
QUESTION 5
A client is admitted with a suspected pulmonary embolism. Which assessment finding
should the nurse expect?
A) Bradycardia and hypotension
B) Pleuritic chest pain and hemoptysis
C) Hypertension and bradypnea
D) Wheezing and productive cough
CORRECT ANSWER: B) Pleuritic chest pain and hemoptysis
Rationale: Pulmonary embolism typically presents with pleuritic chest pain, dyspnea,
tachycardia, and hemoptysis. Hypotension may occur in massive PE, but bradycardia is not
typical. Hypertension and wheezing are not classic signs.
QUESTION 6
A nurse is caring for a client receiving IV heparin for a pulmonary embolism. The aPTT is
110 seconds (control 30 seconds). Which action should the nurse take?
A) Continue the infusion as prescribed
B) Increase the infusion rate
C) Decrease the infusion rate
D) Discontinue the infusion and administer protamine sulfate
CORRECT ANSWER: C) Decrease the infusion rate
, Rationale: The therapeutic aPTT for heparin is 1.5-2.5 times the control (45-75 seconds).
An aPTT of 110 seconds indicates excessive anticoagulation with high bleeding risk. The
infusion rate should be decreased and the provider notified.
QUESTION 7
A client with heart failure is prescribed carvedilol. Which finding requires immediate
notification of the provider?
A) Heart rate 58 bpm
B) Blood pressure 100/60 mm Hg
C) Weight gain of 3 kg in 2 days
D) Mild dizziness when standing
CORRECT ANSWER: C) Weight gain of 3 kg in 2 days
Rationale: Weight gain of 3 kg (6.6 lbs) in 2 days indicates significant fluid retention and
worsening heart failure. This requires immediate provider notification. Heart rate of 58
and BP of 100/60 may be acceptable with beta-blocker therapy.
QUESTION 8
A client with type 2 diabetes is prescribed pioglitazone. Which side effect should the
nurse monitor for?
A) Hypoglycemia
B) Weight loss
C) Fluid retention
D) Tachycardia
CORRECT ANSWER: C) Fluid retention
with Verified Answers & Detailed Rationales
QUESTION 1
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA).
Which laboratory finding is most concerning?
A) Serum glucose 450 mg/dL
B) Serum potassium 2.8 mEq/L
C) Serum sodium 135 mEq/L
D) Serum bicarbonate 18 mEq/L
CORRECT ANSWER: B) Serum potassium 2.8 mEq/L
Rationale: A potassium level of 2.8 mEq/L is critically low (normal 3.5-5.0). In DKA, total
body potassium is depleted despite normal or elevated initial serum levels due to shifting.
Hypokalemia can cause life-threatening cardiac arrhythmias and must be corrected
carefully.
QUESTION 2
A client receiving total parenteral nutrition (TPN) through a central line develops fever,
chills, and hypotension. Which action should the nurse take first?
A) Slow the TPN infusion rate
B) Discontinue the TPN infusion
C) Obtain blood cultures from the central line
D) Notify the provider
CORRECT ANSWER: B) Discontinue the TPN infusion
,Rationale: Fever, chills, and hypotension in a client receiving TPN suggest catheter-related
sepsis. The nurse should immediately discontinue the TPN infusion to prevent further
contamination, then notify the provider and obtain blood cultures.
QUESTION 3
A client with cirrhosis has ascites and is receiving spironolactone. Which laboratory value
should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
CORRECT ANSWER: B) Serum potassium
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia.
Clients with cirrhosis and ascites are at increased risk for electrolyte imbalances, and
potassium levels must be closely monitored.
QUESTION 4
A client with chronic kidney disease is receiving sevelamer. The nurse should explain that
this medication works by:
A) Lowering potassium levels
B) Binding phosphate in the gastrointestinal tract
C) Increasing red blood cell production
D) Lowering blood pressure
CORRECT ANSWER: B) Binding phosphate in the gastrointestinal tract
,Rationale: Sevelamer is a phosphate binder used to lower serum phosphate levels in clients
with CKD. It works by binding dietary phosphate in the GI tract, preventing its absorption.
Hyperphosphatemia can lead to bone disease and vascular calcification.
QUESTION 5
A client is admitted with a suspected pulmonary embolism. Which assessment finding
should the nurse expect?
A) Bradycardia and hypotension
B) Pleuritic chest pain and hemoptysis
C) Hypertension and bradypnea
D) Wheezing and productive cough
CORRECT ANSWER: B) Pleuritic chest pain and hemoptysis
Rationale: Pulmonary embolism typically presents with pleuritic chest pain, dyspnea,
tachycardia, and hemoptysis. Hypotension may occur in massive PE, but bradycardia is not
typical. Hypertension and wheezing are not classic signs.
QUESTION 6
A nurse is caring for a client receiving IV heparin for a pulmonary embolism. The aPTT is
110 seconds (control 30 seconds). Which action should the nurse take?
A) Continue the infusion as prescribed
B) Increase the infusion rate
C) Decrease the infusion rate
D) Discontinue the infusion and administer protamine sulfate
CORRECT ANSWER: C) Decrease the infusion rate
, Rationale: The therapeutic aPTT for heparin is 1.5-2.5 times the control (45-75 seconds).
An aPTT of 110 seconds indicates excessive anticoagulation with high bleeding risk. The
infusion rate should be decreased and the provider notified.
QUESTION 7
A client with heart failure is prescribed carvedilol. Which finding requires immediate
notification of the provider?
A) Heart rate 58 bpm
B) Blood pressure 100/60 mm Hg
C) Weight gain of 3 kg in 2 days
D) Mild dizziness when standing
CORRECT ANSWER: C) Weight gain of 3 kg in 2 days
Rationale: Weight gain of 3 kg (6.6 lbs) in 2 days indicates significant fluid retention and
worsening heart failure. This requires immediate provider notification. Heart rate of 58
and BP of 100/60 may be acceptable with beta-blocker therapy.
QUESTION 8
A client with type 2 diabetes is prescribed pioglitazone. Which side effect should the
nurse monitor for?
A) Hypoglycemia
B) Weight loss
C) Fluid retention
D) Tachycardia
CORRECT ANSWER: C) Fluid retention
