BSN 266 HESI MED SURG EXAM 200 Practice Questions
with Verified Answers & Detailed Rationales
FORMATTING LEGEND:
• Bold Italic = Correct Answer
• Italic = Rationale
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-40)
QUESTION 1
A nurse is caring for a client with heart failure. Which assessment finding requires
immediate intervention?
A) Weight gain of 1 kg (2.2 lbs) in 24 hours
B) Crackles auscultated in the lung bases
C) 2+ pitting edema in the lower extremities
D) Jugular vein distention when sitting upright
CORRECT ANSWER: B) Crackles auscultated in the lung bases
Rationale: Crackles in the lung bases indicate pulmonary congestion (fluid in the alveoli), a
sign of worsening heart failure requiring immediate intervention such as diuretics or
oxygen to prevent respiratory failure. While weight gain and edema indicate fluid
overload, pulmonary congestion is more emergent and directly threatens oxygenation.
,QUESTION 2
A client with hypertension who has just started taking atenolol returns after 2 weeks
with blood pressure unchanged from the previous visit. Which action should the nurse
take first?
A) Tell the patient why a change in drug dosage is needed
B) Ask if the medication is being taken as prescribed
C) Inform the patient that multiple drugs are often needed
D) Question the patient about lifestyle changes made
CORRECT ANSWER: B) Ask if the medication is being taken as prescribed
Rationale: Before assuming the medication is ineffective, the nurse must first determine if
the patient is taking it as prescribed. Non-adherence is a common reason for lack of
therapeutic response. After confirming adherence, the nurse can discuss dosage
adjustments, additional medications, or lifestyle modifications.
QUESTION 3
A client with angina is prescribed a transdermal nitroglycerin patch. Which instruction
should the nurse include?
A) Apply the patch to the same site daily for consistent absorption
B) Remove the patch for 10-12 hours each day to prevent tolerance
C) Apply the patch directly over the chest bone (sternum)
D) Use the patch immediately if chest pain occurs
CORRECT ANSWER: B) Remove the patch for 10-12 hours each day to prevent
tolerance
Rationale: To prevent nitrate tolerance, the patch should be removed for 10-12 hours each
day (usually at night), providing a nitrate-free interval. Sites should be rotated to prevent
skin irritation. The patch is for prevention, not acute treatment.
,QUESTION 4
A client who had a myocardial infarction 2 days ago reports sudden shortness of breath
with crackles in both lungs. What should the nurse do first?
A) Administer sublingual nitroglycerin as prescribed
B) Raise the head of the bed to high-Fowler's position
C) Notify the healthcare provider immediately
D) Administer furosemide IV push as prescribed
CORRECT ANSWER: B) Raise the head of the bed to high-Fowler's position
Rationale: The client is experiencing acute pulmonary edema. The priority intervention is
to position the client upright (high-Fowler's) to reduce venous return (preload) and
facilitate breathing by allowing maximum lung expansion. Oxygen and furosemide are
then given, but positioning is the immediate first step.
QUESTION 5
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates the medication is having the desired effect?
A) Blood pressure 100/60 mm Hg
B) Weight decrease of 2 kg in 24 hours
C) Urine output of 50 mL/hour
D) Clear breath sounds
CORRECT ANSWER: D) Clear breath sounds
Rationale: Furosemide reduces preload by promoting diuresis. The desired effect in heart
failure is relief of pulmonary congestion, evidenced by clear breath sounds. While weight
, loss is expected, it is not immediate; clear breath sounds directly indicate improved fluid
status. Hypotension is a side effect, not the therapeutic goal.
QUESTION 6
A client with chest pain receives sublingual nitroglycerin. Which side effect should the
nurse anticipate?
A) Headache
B) Bradycardia
C) Hypertension
D) Dizziness
CORRECT ANSWER: A) Headache
Rationale: Nitroglycerin causes vasodilation, which can lead to headache due to cerebral
vessel dilation. Hypotension (not hypertension) and reflex tachycardia (not bradycardia)
may occur. Dizziness may occur but headache is the most common side effect.
QUESTION 7
A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse should teach
the client to avoid which food?
A) Broccoli
B) Apples
C) Rice
D) Chicken
CORRECT ANSWER: A) Broccoli
with Verified Answers & Detailed Rationales
FORMATTING LEGEND:
• Bold Italic = Correct Answer
• Italic = Rationale
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-40)
QUESTION 1
A nurse is caring for a client with heart failure. Which assessment finding requires
immediate intervention?
A) Weight gain of 1 kg (2.2 lbs) in 24 hours
B) Crackles auscultated in the lung bases
C) 2+ pitting edema in the lower extremities
D) Jugular vein distention when sitting upright
CORRECT ANSWER: B) Crackles auscultated in the lung bases
Rationale: Crackles in the lung bases indicate pulmonary congestion (fluid in the alveoli), a
sign of worsening heart failure requiring immediate intervention such as diuretics or
oxygen to prevent respiratory failure. While weight gain and edema indicate fluid
overload, pulmonary congestion is more emergent and directly threatens oxygenation.
,QUESTION 2
A client with hypertension who has just started taking atenolol returns after 2 weeks
with blood pressure unchanged from the previous visit. Which action should the nurse
take first?
A) Tell the patient why a change in drug dosage is needed
B) Ask if the medication is being taken as prescribed
C) Inform the patient that multiple drugs are often needed
D) Question the patient about lifestyle changes made
CORRECT ANSWER: B) Ask if the medication is being taken as prescribed
Rationale: Before assuming the medication is ineffective, the nurse must first determine if
the patient is taking it as prescribed. Non-adherence is a common reason for lack of
therapeutic response. After confirming adherence, the nurse can discuss dosage
adjustments, additional medications, or lifestyle modifications.
QUESTION 3
A client with angina is prescribed a transdermal nitroglycerin patch. Which instruction
should the nurse include?
A) Apply the patch to the same site daily for consistent absorption
B) Remove the patch for 10-12 hours each day to prevent tolerance
C) Apply the patch directly over the chest bone (sternum)
D) Use the patch immediately if chest pain occurs
CORRECT ANSWER: B) Remove the patch for 10-12 hours each day to prevent
tolerance
Rationale: To prevent nitrate tolerance, the patch should be removed for 10-12 hours each
day (usually at night), providing a nitrate-free interval. Sites should be rotated to prevent
skin irritation. The patch is for prevention, not acute treatment.
,QUESTION 4
A client who had a myocardial infarction 2 days ago reports sudden shortness of breath
with crackles in both lungs. What should the nurse do first?
A) Administer sublingual nitroglycerin as prescribed
B) Raise the head of the bed to high-Fowler's position
C) Notify the healthcare provider immediately
D) Administer furosemide IV push as prescribed
CORRECT ANSWER: B) Raise the head of the bed to high-Fowler's position
Rationale: The client is experiencing acute pulmonary edema. The priority intervention is
to position the client upright (high-Fowler's) to reduce venous return (preload) and
facilitate breathing by allowing maximum lung expansion. Oxygen and furosemide are
then given, but positioning is the immediate first step.
QUESTION 5
A client with heart failure has an order for furosemide (Lasix) 40 mg IV push. Which
assessment finding indicates the medication is having the desired effect?
A) Blood pressure 100/60 mm Hg
B) Weight decrease of 2 kg in 24 hours
C) Urine output of 50 mL/hour
D) Clear breath sounds
CORRECT ANSWER: D) Clear breath sounds
Rationale: Furosemide reduces preload by promoting diuresis. The desired effect in heart
failure is relief of pulmonary congestion, evidenced by clear breath sounds. While weight
, loss is expected, it is not immediate; clear breath sounds directly indicate improved fluid
status. Hypotension is a side effect, not the therapeutic goal.
QUESTION 6
A client with chest pain receives sublingual nitroglycerin. Which side effect should the
nurse anticipate?
A) Headache
B) Bradycardia
C) Hypertension
D) Dizziness
CORRECT ANSWER: A) Headache
Rationale: Nitroglycerin causes vasodilation, which can lead to headache due to cerebral
vessel dilation. Hypotension (not hypertension) and reflex tachycardia (not bradycardia)
may occur. Dizziness may occur but headache is the most common side effect.
QUESTION 7
A client with atrial fibrillation is prescribed warfarin (Coumadin). The nurse should teach
the client to avoid which food?
A) Broccoli
B) Apples
C) Rice
D) Chicken
CORRECT ANSWER: A) Broccoli
