200 NCLEX/HESI-STYLE PRACTICE
QUESTIONS FOR BSN 266: THE
COMPLETE EXAM PREP GUIDE WITH
VERIFIED QUESTIONS AND ANSWERS
| GRADED A+ | MOST RECENT!!
Question 1
A patient who is 2 days post-operative following a colectomy has a hemoglobin of
7.8 g/dL and is prescribed 1 unit of packed red blood cells (PRBCs). The patient
reports new onset of chills and low back pain 15 minutes after the transfusion begins.
What is the nurse's priority action?
• A. Slow the infusion rate and monitor the patient's vital signs.
• B. Stop the transfusion and infuse normal saline with new tubing.
• C. Notify the healthcare provider immediately.
• D. Administer diphenhydramine (Benadryl) as prescribed.
Answer: B
Rationale: The patient is exhibiting classic signs of an acute hemolytic transfusion
reaction (chills, low back pain). The priority action is to immediately stop the
transfusion to prevent further infusion of incompatible blood and infuse normal
saline with new tubing to maintain IV access. The healthcare provider should be
notified after stopping the transfusion.
Question 2
A client with chronic heart failure has an ejection fraction of 25% and is receiving
digoxin. Which assessment finding indicates digoxin toxicity?
• A. Heart rate of 68 bpm
• B. Blood pressure of 120/80 mmHg
• C. Nausea and visual changes (yellow halos)
• D. Weight gain of 2 pounds in 24 hours
Answer: C
Rationale: Nausea, vomiting, and visual disturbances like seeing yellow-green halos
,are classic signs of digoxin toxicity. A heart rate of 68 and BP of 120/80 are normal.
Weight gain indicates fluid retention from worsening heart failure, not toxicity.
Question 3
A client is prescribed enoxaparin (Lovenox) subcutaneously for DVT prevention.
Which technique is correct for the nurse to use?
• A. Aspirate before injecting the medication.
• B. Rub the injection site after administration.
• C. Administer in the vastus lateralis muscle.
• D. Inject into the abdominal fat fold.
Answer: D
Rationale: Enoxaparin is given subcutaneously in the abdominal fat fold. The nurse
pinches the skin, inserts at 90°, and injects without aspirating. The site should not be
rubbed to prevent bruising.
Question 4
A patient with pneumonia has an SpO₂ of 91% on 2 L/min O₂ via nasal cannula. What
is the nurse's priority action?
• A. Call the rapid response team.
• B. Increase the oxygen to 4 L/min.
• C. Position the patient supine.
• D. Suction the airway.
Answer: B
Rationale: An SpO₂ of 91% is below normal (95–100%), indicating inadequate
oxygenation. The nurse should first increase the oxygen flow. If no improvement,
reassess and consider other interventions.
Question 5
A client taking lisinopril (ACE inhibitor) for hypertension should be monitored for
which common adverse effect?
• A. Weight gain
, • B. Constipation
• C. Dry, hacking cough
• D. Blurred vision
Answer: C
Rationale: A persistent, dry, non-productive cough is a common adverse effect of
ACE inhibitors (5–20% of patients). If severe, the provider may switch to an ARB.
Question 6
A client on a heparin infusion for DVT has an aPTT of 96 seconds (control 30
seconds). What is the nurse's priority action?
• A. Continue the infusion at current rate.
• B. Stop the infusion for 1 hour and reduce rate per protocol.
• C. Notify the healthcare provider immediately.
• D. Administer protamine sulfate.
Answer: B
Rationale: Therapeutic aPTT is 1.5–2.5x control (45–75 sec). 96 seconds is elevated
and increases bleeding risk. The nurse should stop and reduce the rate per protocol,
then notify the provider.
Question 7
A nurse is caring for a client with left-sided heart failure. Which findings are
expected? (Select all that apply)
• A. Crackles in the lungs
• B. Jugular venous distension
• C. Dyspnea and orthopnea
• D. Peripheral edema
• E. Paroxysmal nocturnal dyspnea
Answer: A, C, E
Rationale: Left-sided failure causes pulmonary congestion → crackles, dyspnea,
orthopnea, and PND. JVD (B) and peripheral edema (D) are signs of right-sided
failure (systemic congestion).
, Question 8
A client has a serum potassium of 3.0 mEq/L and is prescribed furosemide (Lasix).
What should the nurse do?
• A. Administer the furosemide as prescribed.
• B. Hold the furosemide and notify the healthcare provider.
• C. Give a potassium supplement with the furosemide.
• D. Increase the client's fluid intake.
Answer: B
Rationale: Furosemide is potassium-wasting. A K⁺ of 3.0 is below normal (3.5–5.0),
indicating hypokalemia. Giving furosemide could worsen this and increase risk of
arrhythmias. Hold and notify the provider.
Question 9
A patient who smokes 2 packs/day is diagnosed with a gastric ulcer. What is the
most important discharge teaching?
• A. Information about smoking cessation.
• B. Diet instructions for a low-residue diet.
• C. Instructions on a weight-loss program.
• D. The importance of increasing milk in the diet.
Answer: A
Rationale: Smoking is a major contributor to ulcer formation and impairs healing.
Smoking cessation is the most critical lifestyle modification for this patient.
Question 10
A client receiving chemotherapy asks, "Why is so much of my hair falling out?" Which
response is most accurate?
• A. "Chemotherapy affects rapidly dividing cells, both normal and malignant."
• B. "Alopecia is a side effect of long-term steroid therapy."
• C. "Your hair will grow back completely after treatment."
• D. "Chemotherapy causes permanent hair follicle alterations."
Answer: A
Rationale: Chemotherapy targets rapidly dividing cells, including cancer cells and
QUESTIONS FOR BSN 266: THE
COMPLETE EXAM PREP GUIDE WITH
VERIFIED QUESTIONS AND ANSWERS
| GRADED A+ | MOST RECENT!!
Question 1
A patient who is 2 days post-operative following a colectomy has a hemoglobin of
7.8 g/dL and is prescribed 1 unit of packed red blood cells (PRBCs). The patient
reports new onset of chills and low back pain 15 minutes after the transfusion begins.
What is the nurse's priority action?
• A. Slow the infusion rate and monitor the patient's vital signs.
• B. Stop the transfusion and infuse normal saline with new tubing.
• C. Notify the healthcare provider immediately.
• D. Administer diphenhydramine (Benadryl) as prescribed.
Answer: B
Rationale: The patient is exhibiting classic signs of an acute hemolytic transfusion
reaction (chills, low back pain). The priority action is to immediately stop the
transfusion to prevent further infusion of incompatible blood and infuse normal
saline with new tubing to maintain IV access. The healthcare provider should be
notified after stopping the transfusion.
Question 2
A client with chronic heart failure has an ejection fraction of 25% and is receiving
digoxin. Which assessment finding indicates digoxin toxicity?
• A. Heart rate of 68 bpm
• B. Blood pressure of 120/80 mmHg
• C. Nausea and visual changes (yellow halos)
• D. Weight gain of 2 pounds in 24 hours
Answer: C
Rationale: Nausea, vomiting, and visual disturbances like seeing yellow-green halos
,are classic signs of digoxin toxicity. A heart rate of 68 and BP of 120/80 are normal.
Weight gain indicates fluid retention from worsening heart failure, not toxicity.
Question 3
A client is prescribed enoxaparin (Lovenox) subcutaneously for DVT prevention.
Which technique is correct for the nurse to use?
• A. Aspirate before injecting the medication.
• B. Rub the injection site after administration.
• C. Administer in the vastus lateralis muscle.
• D. Inject into the abdominal fat fold.
Answer: D
Rationale: Enoxaparin is given subcutaneously in the abdominal fat fold. The nurse
pinches the skin, inserts at 90°, and injects without aspirating. The site should not be
rubbed to prevent bruising.
Question 4
A patient with pneumonia has an SpO₂ of 91% on 2 L/min O₂ via nasal cannula. What
is the nurse's priority action?
• A. Call the rapid response team.
• B. Increase the oxygen to 4 L/min.
• C. Position the patient supine.
• D. Suction the airway.
Answer: B
Rationale: An SpO₂ of 91% is below normal (95–100%), indicating inadequate
oxygenation. The nurse should first increase the oxygen flow. If no improvement,
reassess and consider other interventions.
Question 5
A client taking lisinopril (ACE inhibitor) for hypertension should be monitored for
which common adverse effect?
• A. Weight gain
, • B. Constipation
• C. Dry, hacking cough
• D. Blurred vision
Answer: C
Rationale: A persistent, dry, non-productive cough is a common adverse effect of
ACE inhibitors (5–20% of patients). If severe, the provider may switch to an ARB.
Question 6
A client on a heparin infusion for DVT has an aPTT of 96 seconds (control 30
seconds). What is the nurse's priority action?
• A. Continue the infusion at current rate.
• B. Stop the infusion for 1 hour and reduce rate per protocol.
• C. Notify the healthcare provider immediately.
• D. Administer protamine sulfate.
Answer: B
Rationale: Therapeutic aPTT is 1.5–2.5x control (45–75 sec). 96 seconds is elevated
and increases bleeding risk. The nurse should stop and reduce the rate per protocol,
then notify the provider.
Question 7
A nurse is caring for a client with left-sided heart failure. Which findings are
expected? (Select all that apply)
• A. Crackles in the lungs
• B. Jugular venous distension
• C. Dyspnea and orthopnea
• D. Peripheral edema
• E. Paroxysmal nocturnal dyspnea
Answer: A, C, E
Rationale: Left-sided failure causes pulmonary congestion → crackles, dyspnea,
orthopnea, and PND. JVD (B) and peripheral edema (D) are signs of right-sided
failure (systemic congestion).
, Question 8
A client has a serum potassium of 3.0 mEq/L and is prescribed furosemide (Lasix).
What should the nurse do?
• A. Administer the furosemide as prescribed.
• B. Hold the furosemide and notify the healthcare provider.
• C. Give a potassium supplement with the furosemide.
• D. Increase the client's fluid intake.
Answer: B
Rationale: Furosemide is potassium-wasting. A K⁺ of 3.0 is below normal (3.5–5.0),
indicating hypokalemia. Giving furosemide could worsen this and increase risk of
arrhythmias. Hold and notify the provider.
Question 9
A patient who smokes 2 packs/day is diagnosed with a gastric ulcer. What is the
most important discharge teaching?
• A. Information about smoking cessation.
• B. Diet instructions for a low-residue diet.
• C. Instructions on a weight-loss program.
• D. The importance of increasing milk in the diet.
Answer: A
Rationale: Smoking is a major contributor to ulcer formation and impairs healing.
Smoking cessation is the most critical lifestyle modification for this patient.
Question 10
A client receiving chemotherapy asks, "Why is so much of my hair falling out?" Which
response is most accurate?
• A. "Chemotherapy affects rapidly dividing cells, both normal and malignant."
• B. "Alopecia is a side effect of long-term steroid therapy."
• C. "Your hair will grow back completely after treatment."
• D. "Chemotherapy causes permanent hair follicle alterations."
Answer: A
Rationale: Chemotherapy targets rapidly dividing cells, including cancer cells and
