BSN HESI 266 Med Surg Exam
Comprehensive Practice Guide and Verified Exam Solutions (2026–2027 Edition)
1. A patient with heart failure reports a 4-pound weight gain over 2 days and increased
dyspnea. Which clinical finding requires immediate nursing intervention?
A) Crackles heard bilaterally in lung bases
B) Trace pedal edema (+1) at the ankles
C) Pitting sacral edema in a bedbound position
D) Jugular venous distension when supine
Correct Answer: A) Crackles heard bilaterally in lung bases
Explanation: Bilateral crackles indicate pulmonary congestion and fluid backing up into the alveoli,
threatening airway oxygenation. Trace pedal edema and supine JVD are expected baseline
manifestations of right-sided fluid volume overload.
2. A nurse cares for a patient receiving continuous IV regular insulin for Diabetic
Ketoacidosis (DKA). Which lab result warrants immediate administration of IV potassium
chloride?
A) Serum potassium of 5.8 mEq/L
B) Serum potassium of 3.3 mEq/L
C) Blood glucose of 240 mg/dL
D) Arterial pH of 7.28
Correct Answer: B) Serum potassium of 3.3 mEq/L
Explanation: Insulin drives potassium back into cells, dropping serum potassium rapidly. Administering
insulin when potassium is below 3.5 mEq/L risks fatal cardiac arrhythmias, requiring prompt potassium
replacement.
3. A patient admitted with acute appendicitis suddenly reports sudden relief of abdominal
pain followed by severe, diffuse abdominal rigidity. What complication does the nurse
suspect?
, A) Paralytic ileus
B) Intestinal obstruction
C) Ruptured appendix leading to peritonitis
D) Renal colic crisis
Correct Answer: C) Ruptured appendix leading to peritonitis
Explanation: Sudden relief of localized right lower quadrant pain indicates appendiceal rupture,
releasing infected contents into the peritoneal cavity and causing a board-like rigid abdomen. Paralytic
ileus causes distension without sudden initial pain relief.
4. Which medication should the nurse prepare first for a patient experiencing an acute
asthma exacerbation with severe wheezing and peak flow in the red zone?
A) IV methylprednisolone
B) Inhaled fluticasone
C) Inhaled albuterol
D) Oral montelukast
Correct Answer: C) Inhaled albuterol
Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly relaxes bronchial smooth
muscle during acute bronchospasm. Corticosteroids reduce airway inflammation but take hours to
work.
5. A patient with end-stage renal disease (ESRD) presents with a serum potassium of 6.9
mEq/L and tall, peaked T waves on the EKG monitor. Which initial IV medication protects
the myocardium?
A) Sodium polystyrene sulfonate
B) Regular insulin with 50% dextrose
C) Sodium bicarbonate
D) Calcium gluconate
Correct Answer: D) Calcium gluconate
Explanation: IV calcium gluconate stabilizes myocardial cell membranes to prevent hyperkalemia-
induced lethal arrhythmias. Regular insulin shifts potassium intracellularly but does not immediately
protect cardiac membrane threshold.
, 6. A patient with decompensated liver cirrhosis develops hepatic encephalopathy. What
therapeutic outcome indicates lactulose is achieving its intended target?
A) Serum bilirubin drops below 1.2 mg/dL
B) The patient passes 2 to 3 soft stools daily and demonstrates improved mental clarity
C) Blood pressure stabilizes above 110/70 mmHg
D) Abdominal girth decreases by 3 inches
Correct Answer: B) The patient passes 2 to 3 soft stools daily and demonstrates
improved mental clarity
Explanation: Lactulose traps ammonia in the colon for excretion, reducing neurotoxic serum ammonia
levels and reversing confusion. Titration aims for 2–3 soft bowel movements daily.
7. A patient with chronic obstructive pulmonary disease (COPD) receives oxygen at 2
L/min via nasal cannula. Which physiological mechanism explains keeping oxygen flow
low in chronic retention?
A) High oxygen flow suppresses the hypoxic respiratory drive
B) High oxygen flow causes immediate metabolic acidosis
C) Low oxygen flow prevents atelectasis in upper lung lobes
D) Low oxygen flow reduces pulmonary artery hypertension
Correct Answer: A) High oxygen flow suppresses the hypoxic respiratory drive
Explanation: Patients with chronic hypercapnia rely on low arterial PaO2 levels (hypoxic drive) to
stimulate breathing. High oxygen concentrations reduce hypoxemia, which can decrease respiratory
drive and worsen CO2 retention.
8. A patient recovering from a percutaneous coronary intervention (PCI) via the right
femoral artery develops low back pain and blood pressure drops to 86/50 mmHg. What
complication should the nurse assess first?
A) Acute renal artery occlusion
B) Retroperitoneal hemorrhage
C) Left ventricular failure
Comprehensive Practice Guide and Verified Exam Solutions (2026–2027 Edition)
1. A patient with heart failure reports a 4-pound weight gain over 2 days and increased
dyspnea. Which clinical finding requires immediate nursing intervention?
A) Crackles heard bilaterally in lung bases
B) Trace pedal edema (+1) at the ankles
C) Pitting sacral edema in a bedbound position
D) Jugular venous distension when supine
Correct Answer: A) Crackles heard bilaterally in lung bases
Explanation: Bilateral crackles indicate pulmonary congestion and fluid backing up into the alveoli,
threatening airway oxygenation. Trace pedal edema and supine JVD are expected baseline
manifestations of right-sided fluid volume overload.
2. A nurse cares for a patient receiving continuous IV regular insulin for Diabetic
Ketoacidosis (DKA). Which lab result warrants immediate administration of IV potassium
chloride?
A) Serum potassium of 5.8 mEq/L
B) Serum potassium of 3.3 mEq/L
C) Blood glucose of 240 mg/dL
D) Arterial pH of 7.28
Correct Answer: B) Serum potassium of 3.3 mEq/L
Explanation: Insulin drives potassium back into cells, dropping serum potassium rapidly. Administering
insulin when potassium is below 3.5 mEq/L risks fatal cardiac arrhythmias, requiring prompt potassium
replacement.
3. A patient admitted with acute appendicitis suddenly reports sudden relief of abdominal
pain followed by severe, diffuse abdominal rigidity. What complication does the nurse
suspect?
, A) Paralytic ileus
B) Intestinal obstruction
C) Ruptured appendix leading to peritonitis
D) Renal colic crisis
Correct Answer: C) Ruptured appendix leading to peritonitis
Explanation: Sudden relief of localized right lower quadrant pain indicates appendiceal rupture,
releasing infected contents into the peritoneal cavity and causing a board-like rigid abdomen. Paralytic
ileus causes distension without sudden initial pain relief.
4. Which medication should the nurse prepare first for a patient experiencing an acute
asthma exacerbation with severe wheezing and peak flow in the red zone?
A) IV methylprednisolone
B) Inhaled fluticasone
C) Inhaled albuterol
D) Oral montelukast
Correct Answer: C) Inhaled albuterol
Explanation: Albuterol is a short-acting beta-2 agonist (SABA) that rapidly relaxes bronchial smooth
muscle during acute bronchospasm. Corticosteroids reduce airway inflammation but take hours to
work.
5. A patient with end-stage renal disease (ESRD) presents with a serum potassium of 6.9
mEq/L and tall, peaked T waves on the EKG monitor. Which initial IV medication protects
the myocardium?
A) Sodium polystyrene sulfonate
B) Regular insulin with 50% dextrose
C) Sodium bicarbonate
D) Calcium gluconate
Correct Answer: D) Calcium gluconate
Explanation: IV calcium gluconate stabilizes myocardial cell membranes to prevent hyperkalemia-
induced lethal arrhythmias. Regular insulin shifts potassium intracellularly but does not immediately
protect cardiac membrane threshold.
, 6. A patient with decompensated liver cirrhosis develops hepatic encephalopathy. What
therapeutic outcome indicates lactulose is achieving its intended target?
A) Serum bilirubin drops below 1.2 mg/dL
B) The patient passes 2 to 3 soft stools daily and demonstrates improved mental clarity
C) Blood pressure stabilizes above 110/70 mmHg
D) Abdominal girth decreases by 3 inches
Correct Answer: B) The patient passes 2 to 3 soft stools daily and demonstrates
improved mental clarity
Explanation: Lactulose traps ammonia in the colon for excretion, reducing neurotoxic serum ammonia
levels and reversing confusion. Titration aims for 2–3 soft bowel movements daily.
7. A patient with chronic obstructive pulmonary disease (COPD) receives oxygen at 2
L/min via nasal cannula. Which physiological mechanism explains keeping oxygen flow
low in chronic retention?
A) High oxygen flow suppresses the hypoxic respiratory drive
B) High oxygen flow causes immediate metabolic acidosis
C) Low oxygen flow prevents atelectasis in upper lung lobes
D) Low oxygen flow reduces pulmonary artery hypertension
Correct Answer: A) High oxygen flow suppresses the hypoxic respiratory drive
Explanation: Patients with chronic hypercapnia rely on low arterial PaO2 levels (hypoxic drive) to
stimulate breathing. High oxygen concentrations reduce hypoxemia, which can decrease respiratory
drive and worsen CO2 retention.
8. A patient recovering from a percutaneous coronary intervention (PCI) via the right
femoral artery develops low back pain and blood pressure drops to 86/50 mmHg. What
complication should the nurse assess first?
A) Acute renal artery occlusion
B) Retroperitoneal hemorrhage
C) Left ventricular failure
