BSN HESI 266 MED SURG FINAL EXAM
STUDY GUIDE (2026/2027 UPDATES)
QUESTIONS AND ANSWERS
1. A patient with heart failure is receiving Furosemide and Digoxin. Which laboratory result
should the nurse prioritize for immediate follow-up?
A. Serum sodium level of 136 mEq/L
B. Serum potassium level of 3.1 mEq/L
C. Serum creatinine level of 1.1 mg/dL
D. Serum Digoxin level of 1.2 ng/mL
Answer: B
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of digoxin toxicity because potassium and digoxin compete for binding sites on the
sodium-potassium ATPase pump.
2. A client with a T4 spinal cord injury reports a sudden, severe headache and is found to have
a blood pressure of 190/100 mmHg. What is the priority nursing action?
A. Administer an ordered PRN antihypertensive medication
,B. Check the client’s urinary catheter for kinks or obstruction
C. Place the client in a high-Fowler’s position
D. Assess the client for a fecal impaction
Answer: C
Conceptual Explanation: The client is experiencing autonomic dysreflexia. The first
priority is to sit the patient up (high-Fowler’s) to help lower blood pressure via orthostatic
effect before investigating the stimulus (bladder or bowel).
3. Which arterial blood gas (ABG) result would the nurse expect to find in a patient with an
exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?
A. pH 7.50, PaCO2 30, HCO3 22
B. pH 7.45, PaCO2 48, HCO3 32
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.30, PaCO2 55, HCO3 28
Answer: D
Conceptual Explanation: COPD patients typically experience respiratory acidosis due to
CO2 retention. A pH of 7.30 (acidotic), PaCO2 of 55 (high), and HCO3 of 28 (partially
compensated) is characteristic.
, 4. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 650 mg/dL and a
potassium level of 3.8 mEq/L. The nurse starts an insulin infusion. What is the most critical
assessment during the first hour?
A. Hourly urine output monitoring
B. Frequent monitoring of blood glucose levels
C. Continuous cardiac monitoring for dysrhythmias
D. Assessing for signs of metabolic alkalosis
Answer: C
Conceptual Explanation: Insulin causes potassium to shift into the cells, which can lead to
life-threatening hypokalemia. Since the baseline potassium is already at the low end of
normal (3.8), the patient is at high risk for dysrhythmias during insulin therapy.
5. A client is 24 hours post-thyroidectomy. The nurse notes that the client has a positive
Chvostek’s sign. Which medication should the nurse have readily available?
A. Potassium chloride
B. Magnesium sulfate
C. Sodium bicarbonate
D. Calcium gluconate
Answer: D
STUDY GUIDE (2026/2027 UPDATES)
QUESTIONS AND ANSWERS
1. A patient with heart failure is receiving Furosemide and Digoxin. Which laboratory result
should the nurse prioritize for immediate follow-up?
A. Serum sodium level of 136 mEq/L
B. Serum potassium level of 3.1 mEq/L
C. Serum creatinine level of 1.1 mg/dL
D. Serum Digoxin level of 1.2 ng/mL
Answer: B
Conceptual Explanation: Hypokalemia (potassium < 3.5 mEq/L) significantly increases
the risk of digoxin toxicity because potassium and digoxin compete for binding sites on the
sodium-potassium ATPase pump.
2. A client with a T4 spinal cord injury reports a sudden, severe headache and is found to have
a blood pressure of 190/100 mmHg. What is the priority nursing action?
A. Administer an ordered PRN antihypertensive medication
,B. Check the client’s urinary catheter for kinks or obstruction
C. Place the client in a high-Fowler’s position
D. Assess the client for a fecal impaction
Answer: C
Conceptual Explanation: The client is experiencing autonomic dysreflexia. The first
priority is to sit the patient up (high-Fowler’s) to help lower blood pressure via orthostatic
effect before investigating the stimulus (bladder or bowel).
3. Which arterial blood gas (ABG) result would the nurse expect to find in a patient with an
exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?
A. pH 7.50, PaCO2 30, HCO3 22
B. pH 7.45, PaCO2 48, HCO3 32
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.30, PaCO2 55, HCO3 28
Answer: D
Conceptual Explanation: COPD patients typically experience respiratory acidosis due to
CO2 retention. A pH of 7.30 (acidotic), PaCO2 of 55 (high), and HCO3 of 28 (partially
compensated) is characteristic.
, 4. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 650 mg/dL and a
potassium level of 3.8 mEq/L. The nurse starts an insulin infusion. What is the most critical
assessment during the first hour?
A. Hourly urine output monitoring
B. Frequent monitoring of blood glucose levels
C. Continuous cardiac monitoring for dysrhythmias
D. Assessing for signs of metabolic alkalosis
Answer: C
Conceptual Explanation: Insulin causes potassium to shift into the cells, which can lead to
life-threatening hypokalemia. Since the baseline potassium is already at the low end of
normal (3.8), the patient is at high risk for dysrhythmias during insulin therapy.
5. A client is 24 hours post-thyroidectomy. The nurse notes that the client has a positive
Chvostek’s sign. Which medication should the nurse have readily available?
A. Potassium chloride
B. Magnesium sulfate
C. Sodium bicarbonate
D. Calcium gluconate
Answer: D
