COMPREHENSIVE NURSING PRACTICE
EXAMINATION BSN HESI 366 RN EXIT NGN-STYLE
QUESTIONS AND ANSWERS
MEDICAL-SURGICAL NURSING (Questions 1-33)
Question 1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea, productive cough with purulent sputum, and fever.
Arterial blood gas results reveal pH 7.28, PaCO2 68 mmHg, PaO2 54 mmHg, and HCO3 30
mEq/L. Which intervention should the nurse implement first?
A. Administer prescribed bronchodilators via nebulizer
B. Apply non-invasive positive pressure ventilation
C. Position the patient in high Fowler's position
D. Initiate oxygen therapy at 4 L/min via nasal cannula
Correct Answer: B
Explanation: The patient is in acute respiratory failure with respiratory acidosis. Non-
invasive positive pressure ventilation (NPPV) is the first-line intervention for acute
exacerbation of COPD with respiratory acidosis to improve ventilation and reduce work of
breathing. Oxygen should be administered cautiously in COPD patients to avoid
suppressing the hypoxic drive, and positioning alone is insufficient for this severity.
Question 2
A nurse is caring for a patient 24 hours following a left total hip arthroplasty. The patient
reports sudden onset of sharp chest pain, dyspnea, and diaphoresis. Vital signs show heart
rate 118 bpm, respiratory rate 28/min, blood pressure 98/62 mmHg, and SpO2 88% on
room air. What is the nurse's priority action?
,A. Administer prescribed PRN morphine sulfate
B. Apply oxygen at 4 L/min via nasal cannula
C. Notify the healthcare provider immediately
D. Perform a focused respiratory assessment
Correct Answer: B
Explanation: The patient is exhibiting signs of a pulmonary embolism (sudden chest pain,
dyspnea, tachycardia, hypoxia), a known complication after hip surgery. The priority action
is to apply supplemental oxygen to correct hypoxia. This should be done simultaneously
with notifying the provider. Clinical pearl: Pulmonary embolism is a medical emergency
requiring immediate intervention.
Question 3
A patient with heart failure is receiving intravenous furosemide. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Serum potassium level of 3.2 mEq/L
B. Daily weight decrease of 2 kg in 24 hours
C. Blood pressure increase from 110/70 to 140/90 mmHg
D. Urine output of 30 mL/hour
Correct Answer: B
Explanation: Furosemide is a loop diuretic used to reduce fluid volume in heart failure. A
weight loss of 2 kg (approximately 2 L of fluid) in 24 hours indicates effective diuresis and
reduction of fluid overload. The potassium level is low (hypokalemia is a side effect, not
therapeutic effect), and the blood pressure should decrease, not increase.
Question 4
A 52-year-old female with type 2 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). The patient's blood glucose is 420 mg/dL, serum potassium is 3.0 mEq/L, and serum
bicarbonate is 10 mEq/L. Which prescription should the nurse question?
A. Regular insulin intravenous bolus
B. 0.9% normal saline at 250 mL/hour
C. Potassium chloride 40 mEq IV push
D. Continuous insulin infusion at 0.1 units/kg/hour
,Correct Answer: C
Explanation: Potassium chloride should never be administered as an IV push (bolus)
because it can cause fatal cardiac arrhythmias. It must be diluted and administered via IV
infusion with cardiac monitoring. The potassium is low (3.0 mEq/L), and replacement is
appropriate, but the route and method are incorrect.
Question 5
A patient with cirrhosis of the liver develops asterixis, confusion, and lethargy. Which
laboratory finding is most consistent with this clinical presentation?
A. Elevated serum ammonia level
B. Decreased serum albumin level
C. Elevated serum bilirubin level
D. Prolonged prothrombin time
Correct Answer: A
Explanation: Asterixis (liver flap) and confusion are signs of hepatic encephalopathy,
which is caused by elevated serum ammonia levels. The liver's failure to convert ammonia
to urea allows ammonia to accumulate and cross the blood-brain barrier, causing
neurologic symptoms. Clinical pearl: Assess for asterixis by having the patient extend arms
and dorsiflex wrists.
Question 6
A patient is receiving heparin infusion for treatment of deep vein thrombosis. The activated
partial thromboplastin time (aPTT) result is 98 seconds (normal range 25-35 seconds).
What should the nurse do?
A. Increase the heparin infusion rate
B. Decrease the heparin infusion rate
C. Administer vitamin K
D. Continue the current infusion rate
Correct Answer: B
Explanation: The therapeutic aPTT range for heparin therapy is typically 1.5-2.5 times the
normal control value (approximately 60-85 seconds). An aPTT of 98 seconds is above the
, therapeutic range, indicating the patient is over-anticoagulated. The infusion rate should be
decreased. Vitamin K is the antidote for warfarin, not heparin.
Question 7
A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, and
vomiting. He reports a history of heavy alcohol use. Serum amylase is 580 U/L (normal 30-
110 U/L), and lipase is 1,200 U/L (normal 10-140 U/L). Which nursing intervention is most
appropriate?
A. Encourage oral intake of clear liquids
B. Maintain NPO status and administer IV fluids
C. Administer oral pancreatic enzyme supplements
D. Position patient in a prone position
Correct Answer: B
Explanation: The patient has acute pancreatitis (elevated amylase and lipase, pain
radiating to the back, history of alcohol use). The standard treatment is NPO to reduce
pancreatic stimulation, IV fluid resuscitation to maintain perfusion, and pain management.
Oral intake would stimulate the pancreas and worsen the condition.
Question 8
A patient with chronic kidney disease has a serum creatinine of 4.2 mg/dL and blood urea
nitrogen (BUN) of 85 mg/dL. The patient is scheduled for hemodialysis. Which assessment
finding would indicate the need to hold dialysis and notify the healthcare provider?
A. Serum potassium of 5.8 mEq/L
B. Blood pressure of 160/90 mmHg
C. Temperature of 100.2°F (37.9°C)
D. Hemoglobin of 9.8 g/dL
Correct Answer: C
Explanation: Fever (temperature >100.4°F or 38°C) may indicate infection, and dialysis
should be held until the provider can be notified. Dialysis can cause hypotension and
further complications if the patient is septic. The other options are consistent with chronic
kidney disease and do not require holding dialysis.
EXAMINATION BSN HESI 366 RN EXIT NGN-STYLE
QUESTIONS AND ANSWERS
MEDICAL-SURGICAL NURSING (Questions 1-33)
Question 1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with worsening dyspnea, productive cough with purulent sputum, and fever.
Arterial blood gas results reveal pH 7.28, PaCO2 68 mmHg, PaO2 54 mmHg, and HCO3 30
mEq/L. Which intervention should the nurse implement first?
A. Administer prescribed bronchodilators via nebulizer
B. Apply non-invasive positive pressure ventilation
C. Position the patient in high Fowler's position
D. Initiate oxygen therapy at 4 L/min via nasal cannula
Correct Answer: B
Explanation: The patient is in acute respiratory failure with respiratory acidosis. Non-
invasive positive pressure ventilation (NPPV) is the first-line intervention for acute
exacerbation of COPD with respiratory acidosis to improve ventilation and reduce work of
breathing. Oxygen should be administered cautiously in COPD patients to avoid
suppressing the hypoxic drive, and positioning alone is insufficient for this severity.
Question 2
A nurse is caring for a patient 24 hours following a left total hip arthroplasty. The patient
reports sudden onset of sharp chest pain, dyspnea, and diaphoresis. Vital signs show heart
rate 118 bpm, respiratory rate 28/min, blood pressure 98/62 mmHg, and SpO2 88% on
room air. What is the nurse's priority action?
,A. Administer prescribed PRN morphine sulfate
B. Apply oxygen at 4 L/min via nasal cannula
C. Notify the healthcare provider immediately
D. Perform a focused respiratory assessment
Correct Answer: B
Explanation: The patient is exhibiting signs of a pulmonary embolism (sudden chest pain,
dyspnea, tachycardia, hypoxia), a known complication after hip surgery. The priority action
is to apply supplemental oxygen to correct hypoxia. This should be done simultaneously
with notifying the provider. Clinical pearl: Pulmonary embolism is a medical emergency
requiring immediate intervention.
Question 3
A patient with heart failure is receiving intravenous furosemide. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Serum potassium level of 3.2 mEq/L
B. Daily weight decrease of 2 kg in 24 hours
C. Blood pressure increase from 110/70 to 140/90 mmHg
D. Urine output of 30 mL/hour
Correct Answer: B
Explanation: Furosemide is a loop diuretic used to reduce fluid volume in heart failure. A
weight loss of 2 kg (approximately 2 L of fluid) in 24 hours indicates effective diuresis and
reduction of fluid overload. The potassium level is low (hypokalemia is a side effect, not
therapeutic effect), and the blood pressure should decrease, not increase.
Question 4
A 52-year-old female with type 2 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). The patient's blood glucose is 420 mg/dL, serum potassium is 3.0 mEq/L, and serum
bicarbonate is 10 mEq/L. Which prescription should the nurse question?
A. Regular insulin intravenous bolus
B. 0.9% normal saline at 250 mL/hour
C. Potassium chloride 40 mEq IV push
D. Continuous insulin infusion at 0.1 units/kg/hour
,Correct Answer: C
Explanation: Potassium chloride should never be administered as an IV push (bolus)
because it can cause fatal cardiac arrhythmias. It must be diluted and administered via IV
infusion with cardiac monitoring. The potassium is low (3.0 mEq/L), and replacement is
appropriate, but the route and method are incorrect.
Question 5
A patient with cirrhosis of the liver develops asterixis, confusion, and lethargy. Which
laboratory finding is most consistent with this clinical presentation?
A. Elevated serum ammonia level
B. Decreased serum albumin level
C. Elevated serum bilirubin level
D. Prolonged prothrombin time
Correct Answer: A
Explanation: Asterixis (liver flap) and confusion are signs of hepatic encephalopathy,
which is caused by elevated serum ammonia levels. The liver's failure to convert ammonia
to urea allows ammonia to accumulate and cross the blood-brain barrier, causing
neurologic symptoms. Clinical pearl: Assess for asterixis by having the patient extend arms
and dorsiflex wrists.
Question 6
A patient is receiving heparin infusion for treatment of deep vein thrombosis. The activated
partial thromboplastin time (aPTT) result is 98 seconds (normal range 25-35 seconds).
What should the nurse do?
A. Increase the heparin infusion rate
B. Decrease the heparin infusion rate
C. Administer vitamin K
D. Continue the current infusion rate
Correct Answer: B
Explanation: The therapeutic aPTT range for heparin therapy is typically 1.5-2.5 times the
normal control value (approximately 60-85 seconds). An aPTT of 98 seconds is above the
, therapeutic range, indicating the patient is over-anticoagulated. The infusion rate should be
decreased. Vitamin K is the antidote for warfarin, not heparin.
Question 7
A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, and
vomiting. He reports a history of heavy alcohol use. Serum amylase is 580 U/L (normal 30-
110 U/L), and lipase is 1,200 U/L (normal 10-140 U/L). Which nursing intervention is most
appropriate?
A. Encourage oral intake of clear liquids
B. Maintain NPO status and administer IV fluids
C. Administer oral pancreatic enzyme supplements
D. Position patient in a prone position
Correct Answer: B
Explanation: The patient has acute pancreatitis (elevated amylase and lipase, pain
radiating to the back, history of alcohol use). The standard treatment is NPO to reduce
pancreatic stimulation, IV fluid resuscitation to maintain perfusion, and pain management.
Oral intake would stimulate the pancreas and worsen the condition.
Question 8
A patient with chronic kidney disease has a serum creatinine of 4.2 mg/dL and blood urea
nitrogen (BUN) of 85 mg/dL. The patient is scheduled for hemodialysis. Which assessment
finding would indicate the need to hold dialysis and notify the healthcare provider?
A. Serum potassium of 5.8 mEq/L
B. Blood pressure of 160/90 mmHg
C. Temperature of 100.2°F (37.9°C)
D. Hemoglobin of 9.8 g/dL
Correct Answer: C
Explanation: Fever (temperature >100.4°F or 38°C) may indicate infection, and dialysis
should be held until the provider can be notified. Dialysis can cause hypotension and
further complications if the patient is septic. The other options are consistent with chronic
kidney disease and do not require holding dialysis.
