BSN HESI 266 MEDICAL-SURGICAL
NURSING ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient with a history of chronic heart failure is prescribed digoxin. Which assessment
finding should the nurse prioritize as a potential sign of toxicity?
A. Increased appetite and weight gain
B. Visual disturbances such as seeing yellow-green halos
C. Heart rate of 88 beats per minute
D. Occasional dry cough
Answer: B
Conceptual Explanation: Visual disturbances, including yellow-green halos or blurred
vision, are classic signs of digoxin toxicity, alongside gastrointestinal symptoms like nausea
and vomiting.
2. Following a thyroidectomy, a patient reports tingling in the fingertips and around the
mouth. Which action should the nurse take first?
A. Encourage the patient to cough and deep breathe
B. Check the surgical dressing for hemorrhage
,C. Administer a PRN dose of levothyroxine
D. Assess the patient’s Chvostek sign
Answer: D
Conceptual Explanation: Tingling around the mouth and extremities suggests
hypocalcemia, a complication of accidental parathyroid removal during thyroidectomy.
Checking Chvostek’s sign evaluates for neuromuscular irritability associated with low
calcium.
3. A client is admitted with Diabetic Ketoacidosis (DKA). Which arterial blood gas (ABG) result
is most consistent with this diagnosis?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.50, PaCO2 40, HCO3 30
C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.30, PaCO2 35, HCO3 18
Answer: D
Conceptual Explanation: DKA results in metabolic acidosis. A low pH (<7.35) and a low
bicarbonate level (<22 mEq/L) indicate metabolic acidosis, which is characteristic of
ketone accumulation.
, 4. A patient is recovering from a total hip arthroplasty. Which intervention is most important
to prevent a common postoperative complication?
A. Limit fluid intake to 1 liter per day
B. Encourage high-fiber diet to prevent constipation
C. Maintain the affected leg in an adducted position
D. Apply sequential compression devices (SCDs) while in bed
Answer: D
Conceptual Explanation: Deep vein thrombosis (DVT) and pulmonary embolism are high
risks after orthopedic surgery. SCDs promote venous return and prevent stasis.
5. A nurse assesses a patient with a chest tube and notes continuous bubbling in the water
seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally
B. There is an air leak in the system
C. The patient’s lung has fully re-expanded
D. The suction pressure is set too high
Answer: B
Conceptual Explanation: Intermittent bubbling in the water seal chamber is normal with
expiration or coughing, but continuous bubbling indicates a leak in the tube or the
connection.
NURSING ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient with a history of chronic heart failure is prescribed digoxin. Which assessment
finding should the nurse prioritize as a potential sign of toxicity?
A. Increased appetite and weight gain
B. Visual disturbances such as seeing yellow-green halos
C. Heart rate of 88 beats per minute
D. Occasional dry cough
Answer: B
Conceptual Explanation: Visual disturbances, including yellow-green halos or blurred
vision, are classic signs of digoxin toxicity, alongside gastrointestinal symptoms like nausea
and vomiting.
2. Following a thyroidectomy, a patient reports tingling in the fingertips and around the
mouth. Which action should the nurse take first?
A. Encourage the patient to cough and deep breathe
B. Check the surgical dressing for hemorrhage
,C. Administer a PRN dose of levothyroxine
D. Assess the patient’s Chvostek sign
Answer: D
Conceptual Explanation: Tingling around the mouth and extremities suggests
hypocalcemia, a complication of accidental parathyroid removal during thyroidectomy.
Checking Chvostek’s sign evaluates for neuromuscular irritability associated with low
calcium.
3. A client is admitted with Diabetic Ketoacidosis (DKA). Which arterial blood gas (ABG) result
is most consistent with this diagnosis?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.50, PaCO2 40, HCO3 30
C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.30, PaCO2 35, HCO3 18
Answer: D
Conceptual Explanation: DKA results in metabolic acidosis. A low pH (<7.35) and a low
bicarbonate level (<22 mEq/L) indicate metabolic acidosis, which is characteristic of
ketone accumulation.
, 4. A patient is recovering from a total hip arthroplasty. Which intervention is most important
to prevent a common postoperative complication?
A. Limit fluid intake to 1 liter per day
B. Encourage high-fiber diet to prevent constipation
C. Maintain the affected leg in an adducted position
D. Apply sequential compression devices (SCDs) while in bed
Answer: D
Conceptual Explanation: Deep vein thrombosis (DVT) and pulmonary embolism are high
risks after orthopedic surgery. SCDs promote venous return and prevent stasis.
5. A nurse assesses a patient with a chest tube and notes continuous bubbling in the water
seal chamber. How should the nurse interpret this finding?
A. The system is functioning normally
B. There is an air leak in the system
C. The patient’s lung has fully re-expanded
D. The suction pressure is set too high
Answer: B
Conceptual Explanation: Intermittent bubbling in the water seal chamber is normal with
expiration or coughing, but continuous bubbling indicates a leak in the tube or the
connection.
