BSN HESI 266 MED SURG EXAM
PRACTICE QUESTIONS AND ANSWERS
1. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding should the nurse prioritize as an early indicator of deteriorating gas exchange?
A. Intercostal retractions
B. Increased restlessness and agitation
C. Cyanosis of the nail beds
D. Production of frothy, pink sputum
Answer: B
Conceptual Explanation: Restlessness, agitation, and confusion are early signs of hypoxia.
Cyanosis and frothy sputum are late signs, while retractions indicate increased work of
breathing but often follow mental status changes.
2. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula at 2L/min. The nurse notes the client’s respiratory rate has decreased from 20 to 10
breaths/minute and the client is lethargic. What is the nurse’s priority action?
A. Increase the oxygen flow to 4L/min
,B. Prepare for immediate endotracheal intubation
C. Perform a sternal rub to arouse the client
D. Stop the oxygen and notify the healthcare provider
Answer: D
Conceptual Explanation: In some COPD patients, high oxygen concentrations can abolish
the hypoxic drive to breathe, leading to CO2 narcosis and respiratory depression. The
nurse should reduce or stop oxygen and notify the provider.
3. Which arterial blood gas (ABG) result would the nurse expect in a client with severe
persistent vomiting for the past 24 hours?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.28, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 48, HCO3 32
Answer: B
Conceptual Explanation: Vomiting causes loss of gastric acid (HCl), leading to metabolic
alkalosis. This is characterized by an elevated pH (>7.45) and elevated bicarbonate (>26).
Option D shows compensation, but B is the primary metabolic alkalosis state.
, 4. A client is receiving a continuous intravenous infusion of Heparin for a Pulmonary
Embolism. The latest aPTT is 110 seconds (Control: 30-40 seconds). Which action should the
nurse take first?
A. Decrease the infusion rate according to the nomogram
B. Administer Protamine Sulfate immediately
C. Stop the infusion and notify the healthcare provider
D. Check the client for signs of hematuria or bruising
Answer: C
Conceptual Explanation: An aPTT of 110 seconds is significantly above the therapeutic
range (usually 1.5 to 2.5 times the control). The priority is to stop the infusion to prevent
hemorrhage, then notify the provider.
5. The nurse is caring for a client with Heart Failure who is prescribed Furosemide. Which
assessment finding is most important to report to the healthcare provider?
A. Blood pressure 110/70 mmHg
B. Increased urinary output
C. Muscle weakness and leg cramps
D. Weight loss of 2 lbs in 24 hours
Answer: C
PRACTICE QUESTIONS AND ANSWERS
1. A client is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding should the nurse prioritize as an early indicator of deteriorating gas exchange?
A. Intercostal retractions
B. Increased restlessness and agitation
C. Cyanosis of the nail beds
D. Production of frothy, pink sputum
Answer: B
Conceptual Explanation: Restlessness, agitation, and confusion are early signs of hypoxia.
Cyanosis and frothy sputum are late signs, while retractions indicate increased work of
breathing but often follow mental status changes.
2. A client with Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal
cannula at 2L/min. The nurse notes the client’s respiratory rate has decreased from 20 to 10
breaths/minute and the client is lethargic. What is the nurse’s priority action?
A. Increase the oxygen flow to 4L/min
,B. Prepare for immediate endotracheal intubation
C. Perform a sternal rub to arouse the client
D. Stop the oxygen and notify the healthcare provider
Answer: D
Conceptual Explanation: In some COPD patients, high oxygen concentrations can abolish
the hypoxic drive to breathe, leading to CO2 narcosis and respiratory depression. The
nurse should reduce or stop oxygen and notify the provider.
3. Which arterial blood gas (ABG) result would the nurse expect in a client with severe
persistent vomiting for the past 24 hours?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.28, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 48, HCO3 32
Answer: B
Conceptual Explanation: Vomiting causes loss of gastric acid (HCl), leading to metabolic
alkalosis. This is characterized by an elevated pH (>7.45) and elevated bicarbonate (>26).
Option D shows compensation, but B is the primary metabolic alkalosis state.
, 4. A client is receiving a continuous intravenous infusion of Heparin for a Pulmonary
Embolism. The latest aPTT is 110 seconds (Control: 30-40 seconds). Which action should the
nurse take first?
A. Decrease the infusion rate according to the nomogram
B. Administer Protamine Sulfate immediately
C. Stop the infusion and notify the healthcare provider
D. Check the client for signs of hematuria or bruising
Answer: C
Conceptual Explanation: An aPTT of 110 seconds is significantly above the therapeutic
range (usually 1.5 to 2.5 times the control). The priority is to stop the infusion to prevent
hemorrhage, then notify the provider.
5. The nurse is caring for a client with Heart Failure who is prescribed Furosemide. Which
assessment finding is most important to report to the healthcare provider?
A. Blood pressure 110/70 mmHg
B. Increased urinary output
C. Muscle weakness and leg cramps
D. Weight loss of 2 lbs in 24 hours
Answer: C
