BSN 266 HESI Exam Package with Solution
Updated 2026Complete Nursing Course
Study Resource
Course
BSN 266 HESI
1. A client with heart failure reports increasing shortness of breath and a 2.5-kg weight gain over
the past three days. Which finding should cause the nurse the greatest concern?
A. Mild ankle edema at the end of the day
B. Increasing orthopnea and difficulty speaking in full sentences
C. Heart rate of 88/min
D. Occasional fatigue after activity
Answer: B
Rationale: Increasing orthopnea and difficulty speaking because of dyspnea suggest significant
worsening pulmonary congestion. This requires prompt assessment and intervention.
2. A client with chronic obstructive pulmonary disease is receiving oxygen. The nurse notices
increasing drowsiness and a respiratory rate of 10/min. What should the nurse do first?
A. Increase oxygen flow substantially
B. Assess respiratory status and oxygen delivery immediately
C. Encourage the client to drink fluids
D. Place the client flat in bed
Answer: B
Rationale: New drowsiness and hypoventilation may indicate worsening carbon dioxide
retention or respiratory failure. The nurse should immediately reassess airway, breathing,
oxygenation, and ventilation.
3. A client with acute kidney injury has urine output of 15 mL/hr for the past three hours. Which
action is most appropriate?
A. Document the finding as expected
B. Encourage a high-potassium diet
C. Assess the client and notify the provider of persistent oliguria
D. Restrict all fluids independently
Answer: C
,Rationale: Persistent oliguria can indicate worsening renal perfusion or kidney injury. The
finding requires assessment and timely communication with the provider.
4. A client with diabetes becomes shaky, sweaty, and confused before lunch. Which action should
the nurse take first?
A. Administer the scheduled insulin
B. Check the blood glucose level
C. Encourage the client to walk
D. Restrict oral intake
Answer: B
Rationale: The symptoms strongly suggest hypoglycemia. Blood glucose should be checked
promptly when feasible, followed by treatment according to the result and clinical condition.
5. A client receiving insulin is found unconscious. What is the nurse's priority?
A. Give oral glucose
B. Assess airway, breathing, and circulation and obtain immediate assistance
C. Administer the next scheduled insulin dose
D. Place food at the bedside
Answer: B
Rationale: An unconscious client cannot safely receive oral glucose. Immediate stabilization of
airway, breathing, circulation, and emergency treatment for suspected severe hypoglycemia take
priority.
6. A client with suspected stroke suddenly develops facial drooping and weakness of the right
arm. Which information is most important to establish?
A. Last known well time
B. Favorite food
C. Previous surgical history only
D. Current weight
Answer: A
Rationale: The time the client was last known to be neurologically normal is crucial when
determining eligibility for time-sensitive stroke interventions.
7. A client with increased intracranial pressure becomes increasingly difficult to arouse. Which
action should the nurse prioritize?
A. Allow the client to sleep undisturbed
B. Perform an immediate neurologic and airway assessment
,C. Encourage oral fluids
D. Lower the head of the bed completely
Answer: B
Rationale: A declining level of consciousness may indicate worsening intracranial pressure and
threatens airway protection. Immediate assessment is required.
8. A client with a gastrointestinal bleed has BP 86/52 mmHg, HR 124/min, cool skin, and
dizziness. Which finding is most concerning?
A. Mild nausea
B. Tachycardia with hypotension and cool skin
C. History of heartburn
D. Decreased appetite
Answer: B
Rationale: The combination suggests significant volume loss and possible hypovolemic shock.
Rapid recognition and intervention are essential.
9. A client with cirrhosis develops increasing abdominal distention and shortness of breath.
Which assessment is most relevant?
A. Abdominal girth and respiratory status
B. Hearing acuity
C. Hand grip strength only
D. Visual acuity
Answer: A
Rationale: Ascites can increase abdominal pressure and impair respiratory expansion.
Monitoring abdominal girth and respiratory status helps evaluate progression.
10. A client with hepatic encephalopathy becomes increasingly confused. Which medication
would the nurse expect to administer as prescribed?
A. Lactulose
B. Warfarin
C. Furosemide only
D. Diphenhydramine
Answer: A
Rationale: Lactulose decreases intestinal ammonia absorption and promotes ammonia
elimination through the stool, helping manage hepatic encephalopathy.
, 11. A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which
intervention is most appropriate?
A. Encourage a large high-fat meal
B. Monitor pain, fluid status, and prescribed treatment response
C. Place the client in Trendelenburg position routinely
D. Encourage alcohol consumption to reduce anxiety
Answer: B
Rationale: Acute pancreatitis can produce severe pain and significant fluid shifts. Monitoring
hemodynamic status, pain, electrolytes, and prescribed therapy is important.
12. A client with a history of peptic ulcer disease suddenly develops severe abdominal pain and a
rigid abdomen. What should the nurse suspect?
A. Constipation
B. Possible perforation
C. Mild gastritis
D. Uncomplicated reflux
Answer: B
Rationale: Sudden severe abdominal pain with rigidity is concerning for perforation and
peritonitis and requires urgent evaluation.
13. A client with hyperkalemia has potassium of 6.7 mEq/L and develops peaked T waves.
Which problem takes priority?
A. Risk for cardiac dysrhythmia
B. Risk for constipation
C. Risk for impaired skin integrity
D. Risk for dehydration only
Answer: A
Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction abnormalities.
ECG changes indicate an urgent cardiac risk.
14. Which assessment finding is most consistent with hypokalemia?
A. Muscle weakness and dysrhythmias
B. Peaked T waves
C. Hyperactive reflexes exclusively
D. Severe hypertension
Answer: A
Updated 2026Complete Nursing Course
Study Resource
Course
BSN 266 HESI
1. A client with heart failure reports increasing shortness of breath and a 2.5-kg weight gain over
the past three days. Which finding should cause the nurse the greatest concern?
A. Mild ankle edema at the end of the day
B. Increasing orthopnea and difficulty speaking in full sentences
C. Heart rate of 88/min
D. Occasional fatigue after activity
Answer: B
Rationale: Increasing orthopnea and difficulty speaking because of dyspnea suggest significant
worsening pulmonary congestion. This requires prompt assessment and intervention.
2. A client with chronic obstructive pulmonary disease is receiving oxygen. The nurse notices
increasing drowsiness and a respiratory rate of 10/min. What should the nurse do first?
A. Increase oxygen flow substantially
B. Assess respiratory status and oxygen delivery immediately
C. Encourage the client to drink fluids
D. Place the client flat in bed
Answer: B
Rationale: New drowsiness and hypoventilation may indicate worsening carbon dioxide
retention or respiratory failure. The nurse should immediately reassess airway, breathing,
oxygenation, and ventilation.
3. A client with acute kidney injury has urine output of 15 mL/hr for the past three hours. Which
action is most appropriate?
A. Document the finding as expected
B. Encourage a high-potassium diet
C. Assess the client and notify the provider of persistent oliguria
D. Restrict all fluids independently
Answer: C
,Rationale: Persistent oliguria can indicate worsening renal perfusion or kidney injury. The
finding requires assessment and timely communication with the provider.
4. A client with diabetes becomes shaky, sweaty, and confused before lunch. Which action should
the nurse take first?
A. Administer the scheduled insulin
B. Check the blood glucose level
C. Encourage the client to walk
D. Restrict oral intake
Answer: B
Rationale: The symptoms strongly suggest hypoglycemia. Blood glucose should be checked
promptly when feasible, followed by treatment according to the result and clinical condition.
5. A client receiving insulin is found unconscious. What is the nurse's priority?
A. Give oral glucose
B. Assess airway, breathing, and circulation and obtain immediate assistance
C. Administer the next scheduled insulin dose
D. Place food at the bedside
Answer: B
Rationale: An unconscious client cannot safely receive oral glucose. Immediate stabilization of
airway, breathing, circulation, and emergency treatment for suspected severe hypoglycemia take
priority.
6. A client with suspected stroke suddenly develops facial drooping and weakness of the right
arm. Which information is most important to establish?
A. Last known well time
B. Favorite food
C. Previous surgical history only
D. Current weight
Answer: A
Rationale: The time the client was last known to be neurologically normal is crucial when
determining eligibility for time-sensitive stroke interventions.
7. A client with increased intracranial pressure becomes increasingly difficult to arouse. Which
action should the nurse prioritize?
A. Allow the client to sleep undisturbed
B. Perform an immediate neurologic and airway assessment
,C. Encourage oral fluids
D. Lower the head of the bed completely
Answer: B
Rationale: A declining level of consciousness may indicate worsening intracranial pressure and
threatens airway protection. Immediate assessment is required.
8. A client with a gastrointestinal bleed has BP 86/52 mmHg, HR 124/min, cool skin, and
dizziness. Which finding is most concerning?
A. Mild nausea
B. Tachycardia with hypotension and cool skin
C. History of heartburn
D. Decreased appetite
Answer: B
Rationale: The combination suggests significant volume loss and possible hypovolemic shock.
Rapid recognition and intervention are essential.
9. A client with cirrhosis develops increasing abdominal distention and shortness of breath.
Which assessment is most relevant?
A. Abdominal girth and respiratory status
B. Hearing acuity
C. Hand grip strength only
D. Visual acuity
Answer: A
Rationale: Ascites can increase abdominal pressure and impair respiratory expansion.
Monitoring abdominal girth and respiratory status helps evaluate progression.
10. A client with hepatic encephalopathy becomes increasingly confused. Which medication
would the nurse expect to administer as prescribed?
A. Lactulose
B. Warfarin
C. Furosemide only
D. Diphenhydramine
Answer: A
Rationale: Lactulose decreases intestinal ammonia absorption and promotes ammonia
elimination through the stool, helping manage hepatic encephalopathy.
, 11. A client with acute pancreatitis reports severe epigastric pain radiating to the back. Which
intervention is most appropriate?
A. Encourage a large high-fat meal
B. Monitor pain, fluid status, and prescribed treatment response
C. Place the client in Trendelenburg position routinely
D. Encourage alcohol consumption to reduce anxiety
Answer: B
Rationale: Acute pancreatitis can produce severe pain and significant fluid shifts. Monitoring
hemodynamic status, pain, electrolytes, and prescribed therapy is important.
12. A client with a history of peptic ulcer disease suddenly develops severe abdominal pain and a
rigid abdomen. What should the nurse suspect?
A. Constipation
B. Possible perforation
C. Mild gastritis
D. Uncomplicated reflux
Answer: B
Rationale: Sudden severe abdominal pain with rigidity is concerning for perforation and
peritonitis and requires urgent evaluation.
13. A client with hyperkalemia has potassium of 6.7 mEq/L and develops peaked T waves.
Which problem takes priority?
A. Risk for cardiac dysrhythmia
B. Risk for constipation
C. Risk for impaired skin integrity
D. Risk for dehydration only
Answer: A
Rationale: Severe hyperkalemia can cause life-threatening cardiac conduction abnormalities.
ECG changes indicate an urgent cardiac risk.
14. Which assessment finding is most consistent with hypokalemia?
A. Muscle weakness and dysrhythmias
B. Peaked T waves
C. Hyperactive reflexes exclusively
D. Severe hypertension
Answer: A
