BSN 266 HESI MED SURG PRACTICE
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. The nurse notes the patient’s respiratory rate has decreased from 20 to
10 breaths/min and the patient is becoming lethargic. Which action should the nurse take
first?
A. Stop the oxygen flow and notify the healthcare provider.
B. Increase the oxygen flow rate to 4 L/min.
C. Prepare for immediate endotracheal intubation.
D. Change the delivery device to a Venturi mask at 24%.
Answer: A
Conceptual Explanation: In COPD patients, a high concentration of oxygen can suppress
the hypoxic drive, leading to respiratory depression and CO2 narcosis. If the respiratory
rate drops significantly and the patient becomes lethargic, the oxygen should be stopped or
reduced, and the provider notified immediately.
,2. The nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingertips and around the mouth. Which assessment should the nurse perform
next?
A. Evaluate the patient’s voice for hoarseness.
B. Check the patient’s temperature for thyroid storm.
C. Assess the surgical dressing for bleeding.
D. Assess for Chvostek’s sign.
Answer: D
Conceptual Explanation: Tingling in the extremities and circumoral area are signs of
hypocalcemia, a potential complication of thyroidectomy if the parathyroid glands are
accidentally damaged or removed. Chvostek’s sign (facial twitching) is a clinical indicator of
hypocalcemia.
3. Which clinical manifestation should the nurse expect to find in a patient diagnosed with
late-stage cirrhosis?
A. Hyperalbuminemia
B. Hypobilirubinemia
C. Asterixis
D. Increased Vitamin K absorption
Answer: C
, Conceptual Explanation: Asterixis, or ‘liver flap,’ is a coarse tremor characterized by
rapid, non-rhythmic extensions and flexions in the wrist and fingers, common in late-stage
cirrhosis due to hepatic encephalopathy and elevated ammonia levels.
4. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS).
Which arterial blood gas (ABG) result is most consistent with the early stage of this condition?
A. pH 7.35, PaCO2 45, HCO3 28, PaO2 70
B. pH 7.30, PaCO2 50, HCO3 22, PaO2 60
C. pH 7.48, PaCO2 30, HCO3 24, PaO2 55
D. pH 7.50, PaCO2 48, HCO3 30, PaO2 80
Answer: C
Conceptual Explanation: In the early stages of ARDS, patients typically exhibit respiratory
alkalosis (high pH, low PaCO2) due to hyperventilation in response to initial hypoxemia
(low PaO2).
5. The nurse is monitoring a patient receiving a blood transfusion. After 15 minutes, the
patient reports back pain and dyspnea. Which action is the priority?
A. Stop the infusion and disconnect the tubing at the hub.
B. Administer diphenhydramine as ordered.
C. Slow the infusion rate and notify the provider.
D. Recheck the patient’s identification and blood compatibility.
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal
cannula at 2 L/min. The nurse notes the patient’s respiratory rate has decreased from 20 to
10 breaths/min and the patient is becoming lethargic. Which action should the nurse take
first?
A. Stop the oxygen flow and notify the healthcare provider.
B. Increase the oxygen flow rate to 4 L/min.
C. Prepare for immediate endotracheal intubation.
D. Change the delivery device to a Venturi mask at 24%.
Answer: A
Conceptual Explanation: In COPD patients, a high concentration of oxygen can suppress
the hypoxic drive, leading to respiratory depression and CO2 narcosis. If the respiratory
rate drops significantly and the patient becomes lethargic, the oxygen should be stopped or
reduced, and the provider notified immediately.
,2. The nurse is caring for a patient who is 24 hours post-thyroidectomy. The patient reports
tingling in the fingertips and around the mouth. Which assessment should the nurse perform
next?
A. Evaluate the patient’s voice for hoarseness.
B. Check the patient’s temperature for thyroid storm.
C. Assess the surgical dressing for bleeding.
D. Assess for Chvostek’s sign.
Answer: D
Conceptual Explanation: Tingling in the extremities and circumoral area are signs of
hypocalcemia, a potential complication of thyroidectomy if the parathyroid glands are
accidentally damaged or removed. Chvostek’s sign (facial twitching) is a clinical indicator of
hypocalcemia.
3. Which clinical manifestation should the nurse expect to find in a patient diagnosed with
late-stage cirrhosis?
A. Hyperalbuminemia
B. Hypobilirubinemia
C. Asterixis
D. Increased Vitamin K absorption
Answer: C
, Conceptual Explanation: Asterixis, or ‘liver flap,’ is a coarse tremor characterized by
rapid, non-rhythmic extensions and flexions in the wrist and fingers, common in late-stage
cirrhosis due to hepatic encephalopathy and elevated ammonia levels.
4. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS).
Which arterial blood gas (ABG) result is most consistent with the early stage of this condition?
A. pH 7.35, PaCO2 45, HCO3 28, PaO2 70
B. pH 7.30, PaCO2 50, HCO3 22, PaO2 60
C. pH 7.48, PaCO2 30, HCO3 24, PaO2 55
D. pH 7.50, PaCO2 48, HCO3 30, PaO2 80
Answer: C
Conceptual Explanation: In the early stages of ARDS, patients typically exhibit respiratory
alkalosis (high pH, low PaCO2) due to hyperventilation in response to initial hypoxemia
(low PaO2).
5. The nurse is monitoring a patient receiving a blood transfusion. After 15 minutes, the
patient reports back pain and dyspnea. Which action is the priority?
A. Stop the infusion and disconnect the tubing at the hub.
B. Administer diphenhydramine as ordered.
C. Slow the infusion rate and notify the provider.
D. Recheck the patient’s identification and blood compatibility.
