BSN HESI 266 MED SURG FINAL EXAM
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A client is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding is most indicative of the early stages of ARDS?
A. Rapid onset of severe dyspnea and refractory hypoxemia
B. Intercostal retractions and productive cough
C. Hypercapnia and respiratory acidosis
D. Diffuse crackles and wheezing upon auscultation
Answer: A
Conceptual Explanation: Early ARDS is characterized by severe dyspnea and refractory
hypoxemia, meaning arterial oxygenation does not improve even with supplemental
oxygen administration.
2. A nurse is caring for a patient who had a total hip arthroplasty 24 hours ago. Which
assessment finding should the nurse prioritize?
A. Pain level reported as 6 out of 10
,B. Serosanguinous drainage on the surgical dressing
C. Sudden onset of shortness of breath and chest pain
D. Limited range of motion in the affected hip
Answer: C
Conceptual Explanation: Sudden shortness of breath and chest pain may indicate a
pulmonary embolism, a life-threatening complication common after major orthopedic
surgeries.
3. A client with Type 1 Diabetes Mellitus presents to the ER with Kussmaul respirations and a
blood glucose of 550 mg/dL. Which action should the nurse take first?
A. Administer subcutaneous glargine insulin
B. Obtain a stat arterial blood gas (ABG)
C. Initiate intravenous fluid resuscitation with 0.9% Normal Saline
D. Administer 50% Dextrose intravenously
Answer: C
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation
to restore circulatory volume and stabilize the patient before beginning insulin therapy.
4. The nurse is assessing a patient with a chest tube for a pneumothorax. The nurse notes
continuous bubbling in the water-seal chamber. What does this suggest?
A. The pneumothorax is resolving as expected
, B. The chest tube is occluded
C. The suction level is set too high
D. There is an air leak in the system
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the drainage system or at the insertion site; intermittent bubbling is normal during
expiration or coughing in a patient with a pneumothorax.
5. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse anticipate administering to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Calcium gluconate
D. Regular insulin and D50W
Answer: C
Conceptual Explanation: Calcium gluconate is administered in severe hyperkalemia to
stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
6. A client is being treated for systemic lupus erythematosus (SLE). Which teaching point is
most critical for the nurse to include?
A. Avoid sun exposure and use high-SPF sunscreen
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A client is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding is most indicative of the early stages of ARDS?
A. Rapid onset of severe dyspnea and refractory hypoxemia
B. Intercostal retractions and productive cough
C. Hypercapnia and respiratory acidosis
D. Diffuse crackles and wheezing upon auscultation
Answer: A
Conceptual Explanation: Early ARDS is characterized by severe dyspnea and refractory
hypoxemia, meaning arterial oxygenation does not improve even with supplemental
oxygen administration.
2. A nurse is caring for a patient who had a total hip arthroplasty 24 hours ago. Which
assessment finding should the nurse prioritize?
A. Pain level reported as 6 out of 10
,B. Serosanguinous drainage on the surgical dressing
C. Sudden onset of shortness of breath and chest pain
D. Limited range of motion in the affected hip
Answer: C
Conceptual Explanation: Sudden shortness of breath and chest pain may indicate a
pulmonary embolism, a life-threatening complication common after major orthopedic
surgeries.
3. A client with Type 1 Diabetes Mellitus presents to the ER with Kussmaul respirations and a
blood glucose of 550 mg/dL. Which action should the nurse take first?
A. Administer subcutaneous glargine insulin
B. Obtain a stat arterial blood gas (ABG)
C. Initiate intravenous fluid resuscitation with 0.9% Normal Saline
D. Administer 50% Dextrose intravenously
Answer: C
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation
to restore circulatory volume and stabilize the patient before beginning insulin therapy.
4. The nurse is assessing a patient with a chest tube for a pneumothorax. The nurse notes
continuous bubbling in the water-seal chamber. What does this suggest?
A. The pneumothorax is resolving as expected
, B. The chest tube is occluded
C. The suction level is set too high
D. There is an air leak in the system
Answer: D
Conceptual Explanation: Continuous bubbling in the water-seal chamber indicates an air
leak in the drainage system or at the insertion site; intermittent bubbling is normal during
expiration or coughing in a patient with a pneumothorax.
5. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse anticipate administering to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Calcium gluconate
D. Regular insulin and D50W
Answer: C
Conceptual Explanation: Calcium gluconate is administered in severe hyperkalemia to
stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
6. A client is being treated for systemic lupus erythematosus (SLE). Which teaching point is
most critical for the nurse to include?
A. Avoid sun exposure and use high-SPF sunscreen
