BSN HESI 266 Med-Surg Exam 2025-2026 Edition | Nightingale
College | Verified Real Exam Questions & Answers
1. Introduction & Overview
This comprehensive collection features 100 expertly crafted multiple-choice questions
designed to mirror the content and rigor of the HESI Exit Exam and the NCLEX-RN. Derived
directly from a high-yield source containing real 2025-2026 exam content, this resource
provides an authentic test-prep experience. Each question is structured with a realistic clinical
scenario and is presented in a clear Question & Answer format, complete with a single correct
answer and a concise rationale explaining the critical thinking behind it. This guide is an
essential tool for nursing students seeking to assess their knowledge, identify areas for
improvement, and build confidence for their high-stakes licensure and exit exams.
2. Core Content Areas
Medical-Surgical Nursing
Pharmacology
Mental Health Nursing
Nursing Fundamentals & Skills
Patient Safety & Legal/Ethical Issues
Question 1
A client is admitted with syncopal episodes related to a third-degree heart block. After
,the placement of a transcutaneous pacemaker, the nurse observes several episodes of
the pacemaker's failure to sense. What action should the nurse take?
CORRECT ANSWER ✓ Increase the sensitivity.
Rationale: Failure to sense means the pacemaker is not detecting the heart's intrinsic
electrical activity and is firing inappropriately. Increasing the sensitivity makes the
pacemaker more "aware" of the heart's own beats.
Question 2
A client recovering from surgery to remove a pituitary tumor has an 8-hour urine output
of 1500 mL and a specific gravity of 1.001. This finding is consistent with which
complication from the surgery?
CORRECT ANSWER ✓ Diabetes insipidus.
Rationale: This combination of high-volume, dilute urine is the hallmark of Diabetes
Insipidus, which can occur if the pituitary gland or its stalk is damaged during surgery,
leading to a deficiency of antidiuretic hormone (ADH).
Question 3
A client with a small bowel obstruction is experiencing frequent vomiting. Which
instructions are most important for the nurse to provide to the UAP who is completing
morning care for this client?
,CORRECT ANSWER ✓ Measure all emesis accurately.
Rationale: Accurate measurement of emesis is crucial for assessing fluid and electrolyte
balance and determining the client's replacement fluid needs. It is a key nursing
assessment for a client with a bowel obstruction.
Question 4
A male client with Type 1 diabetes mellitus takes a combination of short-acting and
intermediate-acting insulin. He complains of headaches when awakening, and his blood
glucose average for the past week has been 210. The nurse recognizes the client is
experiencing a daily Somogyi effect. Which dosing method is likely to relieve these
symptoms?
CORRECT ANSWER ✓ Move the PM intermediate-acting dose to bedtime.
Rationale: The Somogyi effect is rebound hyperglycemia following nocturnal
hypoglycemia. Moving the intermediate-acting insulin from the evening (PM) to
bedtime can help prevent the blood sugar from dropping too low during the night,
thereby preventing the compensatory rebound hyperglycemia in the morning.
Question 5
A client with type 1 diabetes mellitus is prescribed 10 units of intermediate-acting
insulin to be administered at bedtime. For which health problem is the insulin being
administered at this time of day?
CORRECT ANSWER ✓ Dawn phenomenon.
Rationale: The dawn phenomenon is early morning hyperglycemia due to a natural
, surge of growth hormone, which creates insulin resistance. Administering intermediate-
acting insulin at bedtime provides peak action in the early morning hours to counteract
this effect.
Question 6
An 18-year-old female client is admitted to the unit after ingesting an overdose of
Phenobarbital (Luminal). She is unresponsive and ABG results are: pH 7.18, PaCO2 60
mmHg, and HCO3 26 mEq/L. Which interpretation of the client's ABG results by the
nurse is accurate?
CORRECT ANSWER ✓ Respiratory acidosis, uncompensated.
Rationale: The pH is acidic (<7.35), the PaCO2 is elevated (>45), indicating a respiratory
problem, and the HCO3 is normal, meaning the kidneys have not had time to
compensate. This fits the criteria for uncompensated respiratory acidosis.
Question 7
A male client with multiple myeloma is admitted with pneumonia and pancytopenia. The
nurse reviews the complete blood cell count findings and identifies a platelet count of
20,000 cells/mm3. Which intervention should the nurse include in the client's plan of
care?
CORRECT ANSWER ✓ Avoid intramuscular injections.
Rationale: A platelet count this low indicates a high risk for spontaneous bleeding.
College | Verified Real Exam Questions & Answers
1. Introduction & Overview
This comprehensive collection features 100 expertly crafted multiple-choice questions
designed to mirror the content and rigor of the HESI Exit Exam and the NCLEX-RN. Derived
directly from a high-yield source containing real 2025-2026 exam content, this resource
provides an authentic test-prep experience. Each question is structured with a realistic clinical
scenario and is presented in a clear Question & Answer format, complete with a single correct
answer and a concise rationale explaining the critical thinking behind it. This guide is an
essential tool for nursing students seeking to assess their knowledge, identify areas for
improvement, and build confidence for their high-stakes licensure and exit exams.
2. Core Content Areas
Medical-Surgical Nursing
Pharmacology
Mental Health Nursing
Nursing Fundamentals & Skills
Patient Safety & Legal/Ethical Issues
Question 1
A client is admitted with syncopal episodes related to a third-degree heart block. After
,the placement of a transcutaneous pacemaker, the nurse observes several episodes of
the pacemaker's failure to sense. What action should the nurse take?
CORRECT ANSWER ✓ Increase the sensitivity.
Rationale: Failure to sense means the pacemaker is not detecting the heart's intrinsic
electrical activity and is firing inappropriately. Increasing the sensitivity makes the
pacemaker more "aware" of the heart's own beats.
Question 2
A client recovering from surgery to remove a pituitary tumor has an 8-hour urine output
of 1500 mL and a specific gravity of 1.001. This finding is consistent with which
complication from the surgery?
CORRECT ANSWER ✓ Diabetes insipidus.
Rationale: This combination of high-volume, dilute urine is the hallmark of Diabetes
Insipidus, which can occur if the pituitary gland or its stalk is damaged during surgery,
leading to a deficiency of antidiuretic hormone (ADH).
Question 3
A client with a small bowel obstruction is experiencing frequent vomiting. Which
instructions are most important for the nurse to provide to the UAP who is completing
morning care for this client?
,CORRECT ANSWER ✓ Measure all emesis accurately.
Rationale: Accurate measurement of emesis is crucial for assessing fluid and electrolyte
balance and determining the client's replacement fluid needs. It is a key nursing
assessment for a client with a bowel obstruction.
Question 4
A male client with Type 1 diabetes mellitus takes a combination of short-acting and
intermediate-acting insulin. He complains of headaches when awakening, and his blood
glucose average for the past week has been 210. The nurse recognizes the client is
experiencing a daily Somogyi effect. Which dosing method is likely to relieve these
symptoms?
CORRECT ANSWER ✓ Move the PM intermediate-acting dose to bedtime.
Rationale: The Somogyi effect is rebound hyperglycemia following nocturnal
hypoglycemia. Moving the intermediate-acting insulin from the evening (PM) to
bedtime can help prevent the blood sugar from dropping too low during the night,
thereby preventing the compensatory rebound hyperglycemia in the morning.
Question 5
A client with type 1 diabetes mellitus is prescribed 10 units of intermediate-acting
insulin to be administered at bedtime. For which health problem is the insulin being
administered at this time of day?
CORRECT ANSWER ✓ Dawn phenomenon.
Rationale: The dawn phenomenon is early morning hyperglycemia due to a natural
, surge of growth hormone, which creates insulin resistance. Administering intermediate-
acting insulin at bedtime provides peak action in the early morning hours to counteract
this effect.
Question 6
An 18-year-old female client is admitted to the unit after ingesting an overdose of
Phenobarbital (Luminal). She is unresponsive and ABG results are: pH 7.18, PaCO2 60
mmHg, and HCO3 26 mEq/L. Which interpretation of the client's ABG results by the
nurse is accurate?
CORRECT ANSWER ✓ Respiratory acidosis, uncompensated.
Rationale: The pH is acidic (<7.35), the PaCO2 is elevated (>45), indicating a respiratory
problem, and the HCO3 is normal, meaning the kidneys have not had time to
compensate. This fits the criteria for uncompensated respiratory acidosis.
Question 7
A male client with multiple myeloma is admitted with pneumonia and pancytopenia. The
nurse reviews the complete blood cell count findings and identifies a platelet count of
20,000 cells/mm3. Which intervention should the nurse include in the client's plan of
care?
CORRECT ANSWER ✓ Avoid intramuscular injections.
Rationale: A platelet count this low indicates a high risk for spontaneous bleeding.
