BSN HESI 266 Med Surg Exam (Latest 2024 /
2025) Questions and Verified Answers | 100%
Correct | Grade A - Nightingale
BSN HESI 266 Medical-Surgical Nursing Exam
Comprehensive Test Bank – Verified Questions with Rationales
1. A nurse is caring for a client with syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following findings should the nurse expect?
A. Hyponatremia and decreased urine output
B. Hypernatremia and increased urine output
C. Hypokalemia and metabolic alkalosis
D. Hypercalcemia and polyuria
Answer-: A
Rationale: SIADH is characterized by excessive release of ADH, leading to water
retention, dilutional hyponatremia, and concentrated urine (decreased urine
output, increased specific gravity). Hypernatremia (B) occurs in diabetes insipidus.
Hypokalemia and metabolic alkalosis (C) are associated with hyperaldosteronism.
Hypercalcemia and polyuria (D) occur in hyperparathyroidism.
2. A client with diabetic ketoacidosis (DKA) has an initial serum potassium of 5.8
mEq/L. The nurse understands that this value:
A. Is normal and requires no intervention
B. Indicates total body potassium depletion despite elevated serum level
C. Requires immediate administration of potassium supplements
D. Is a sign of renal failure
Answer-: B
Rationale: In DKA, acidosis causes potassium to shift from intracellular to
,extracellular space, resulting in hyperkalemia despite total body potassium
depletion due to osmotic diuresis and urinary losses. Potassium replacement
should be initiated once serum potassium falls below 4.0–4.5 mEq/L and urine
output is adequate. Administering potassium (C) immediately would be
dangerous.
3. A client is 2 hours post-coronary artery bypass graft (CABG). The nurse
assesses mediastinal chest tube drainage of 300 mL over the past hour. Which
action should the nurse take first?
A. Strip the chest tube to ensure patency
B. Notify the healthcare provider immediately
C. Decrease the suction pressure
D. Document the finding as expected
Answer-: B
Rationale: Chest tube drainage greater than 150–200 mL/hour in the early
postoperative period after cardiac surgery suggests mediastinal hemorrhage and
possible cardiac tamponade. The nurse should immediately notify the HCP.
Stripping chest tubes (A) can increase negative pressure and is not recommended.
Decreasing suction (C) would worsen drainage. This volume is not normal (D).
4. The nurse is caring for a client with acute pancreatitis. Which of the following
laboratory findings is most consistent with this diagnosis?
A. Decreased serum amylase
B. Elevated serum lipase
C. Hypocalcemia
D. Increased hemoglobin
Answer-: B
Rationale: Serum lipase is more specific and remains elevated longer than
amylase in acute pancreatitis. Amylase is usually elevated (not decreased, A).
Hypocalcemia (C) can occur due to saponification but is not the most consistent
,diagnostic finding. Hemoglobin (D) may be elevated due to hemoconcentration
but is not specific.
5. A client with chronic kidney disease (CKD) has a hemoglobin of 8.2 g/dL. The
nurse anticipates administration of which medication?
A. Iron dextran
B. Epoetin alfa
C. Folic acid
D. Vitamin B12
Answer-: B
Rationale: Anemia in CKD is primarily due to decreased erythropoietin
production. Epoetin alfa (recombinant human erythropoietin) is the mainstay of
treatment. Iron deficiency may coexist and require supplementation (A), but
erythropoiesis-stimulating agents are first-line. Folic acid and B12 deficiencies are
less common causes.
6. A nurse is assessing a client who has just returned from hemodialysis. Which
finding requires immediate intervention?
A. Blood pressure 100/68 mmHg (decreased from 128/74 pre-dialysis)
B. Complaint of headache and confusion
C. Weight loss of 2 kg
D. Drowsiness
Answer-: B
Rationale: Headache and confusion may indicate dialysis disequilibrium
syndrome, a neurological complication caused by rapid shifts in osmolality,
cerebral edema, and increased intracranial pressure. This is a medical emergency.
Mild hypotension (A) is common post-dialysis due to fluid removal. Weight loss
(C) is expected. Drowsiness (D) may be fatigue but should be assessed in context.
, 7. The nurse is caring for a client with a pulmonary embolism who is receiving a
continuous heparin infusion. Which laboratory value indicates the heparin dose
is therapeutic?
A. International normalized ratio (INR) 2.5
B. Activated partial thromboplastin time (aPTT) 65 seconds
C. Platelet count 100,000/μL
D. Prothrombin time (PT) 18 seconds
Answer-: B
Rationale: Heparin therapy is monitored by aPTT; therapeutic range is typically
1.5–2.5 times the control value (often 60–80 seconds). INR (A) and PT (D) monitor
warfarin therapy. A platelet count of 100,000 (C) is low and may indicate heparin-
induced thrombocytopenia.
8. A client with ulcerative colitis is scheduled for an ileostomy. Which
preoperative statement indicates a need for further teaching?
A. "I will wear a pouch at all times to collect stool."
B. "I will need to empty the pouch when it is one-third full."
C. "I can expect the stool to be formed and solid."
D. "I should avoid foods that cause gas and odor."
Answer-: C
Rationale: Ileostomy output is liquid to pasty because the large intestine (which
absorbs water) is bypassed. Stool becomes more formed with a colostomy, not an
ileostomy. The other statements are correct: pouch worn at all times (A), empty
when ⅓ full to prevent leakage (B), and avoiding gas-forming/odorous foods (D).
9. A nurse is monitoring a client with a traumatic brain injury (TBI) and
increased intracranial pressure (ICP). Which finding should be reported
immediately?
A. Heart rate 58 bpm
B. Respiratory rate 14/min
2025) Questions and Verified Answers | 100%
Correct | Grade A - Nightingale
BSN HESI 266 Medical-Surgical Nursing Exam
Comprehensive Test Bank – Verified Questions with Rationales
1. A nurse is caring for a client with syndrome of inappropriate antidiuretic
hormone (SIADH). Which of the following findings should the nurse expect?
A. Hyponatremia and decreased urine output
B. Hypernatremia and increased urine output
C. Hypokalemia and metabolic alkalosis
D. Hypercalcemia and polyuria
Answer-: A
Rationale: SIADH is characterized by excessive release of ADH, leading to water
retention, dilutional hyponatremia, and concentrated urine (decreased urine
output, increased specific gravity). Hypernatremia (B) occurs in diabetes insipidus.
Hypokalemia and metabolic alkalosis (C) are associated with hyperaldosteronism.
Hypercalcemia and polyuria (D) occur in hyperparathyroidism.
2. A client with diabetic ketoacidosis (DKA) has an initial serum potassium of 5.8
mEq/L. The nurse understands that this value:
A. Is normal and requires no intervention
B. Indicates total body potassium depletion despite elevated serum level
C. Requires immediate administration of potassium supplements
D. Is a sign of renal failure
Answer-: B
Rationale: In DKA, acidosis causes potassium to shift from intracellular to
,extracellular space, resulting in hyperkalemia despite total body potassium
depletion due to osmotic diuresis and urinary losses. Potassium replacement
should be initiated once serum potassium falls below 4.0–4.5 mEq/L and urine
output is adequate. Administering potassium (C) immediately would be
dangerous.
3. A client is 2 hours post-coronary artery bypass graft (CABG). The nurse
assesses mediastinal chest tube drainage of 300 mL over the past hour. Which
action should the nurse take first?
A. Strip the chest tube to ensure patency
B. Notify the healthcare provider immediately
C. Decrease the suction pressure
D. Document the finding as expected
Answer-: B
Rationale: Chest tube drainage greater than 150–200 mL/hour in the early
postoperative period after cardiac surgery suggests mediastinal hemorrhage and
possible cardiac tamponade. The nurse should immediately notify the HCP.
Stripping chest tubes (A) can increase negative pressure and is not recommended.
Decreasing suction (C) would worsen drainage. This volume is not normal (D).
4. The nurse is caring for a client with acute pancreatitis. Which of the following
laboratory findings is most consistent with this diagnosis?
A. Decreased serum amylase
B. Elevated serum lipase
C. Hypocalcemia
D. Increased hemoglobin
Answer-: B
Rationale: Serum lipase is more specific and remains elevated longer than
amylase in acute pancreatitis. Amylase is usually elevated (not decreased, A).
Hypocalcemia (C) can occur due to saponification but is not the most consistent
,diagnostic finding. Hemoglobin (D) may be elevated due to hemoconcentration
but is not specific.
5. A client with chronic kidney disease (CKD) has a hemoglobin of 8.2 g/dL. The
nurse anticipates administration of which medication?
A. Iron dextran
B. Epoetin alfa
C. Folic acid
D. Vitamin B12
Answer-: B
Rationale: Anemia in CKD is primarily due to decreased erythropoietin
production. Epoetin alfa (recombinant human erythropoietin) is the mainstay of
treatment. Iron deficiency may coexist and require supplementation (A), but
erythropoiesis-stimulating agents are first-line. Folic acid and B12 deficiencies are
less common causes.
6. A nurse is assessing a client who has just returned from hemodialysis. Which
finding requires immediate intervention?
A. Blood pressure 100/68 mmHg (decreased from 128/74 pre-dialysis)
B. Complaint of headache and confusion
C. Weight loss of 2 kg
D. Drowsiness
Answer-: B
Rationale: Headache and confusion may indicate dialysis disequilibrium
syndrome, a neurological complication caused by rapid shifts in osmolality,
cerebral edema, and increased intracranial pressure. This is a medical emergency.
Mild hypotension (A) is common post-dialysis due to fluid removal. Weight loss
(C) is expected. Drowsiness (D) may be fatigue but should be assessed in context.
, 7. The nurse is caring for a client with a pulmonary embolism who is receiving a
continuous heparin infusion. Which laboratory value indicates the heparin dose
is therapeutic?
A. International normalized ratio (INR) 2.5
B. Activated partial thromboplastin time (aPTT) 65 seconds
C. Platelet count 100,000/μL
D. Prothrombin time (PT) 18 seconds
Answer-: B
Rationale: Heparin therapy is monitored by aPTT; therapeutic range is typically
1.5–2.5 times the control value (often 60–80 seconds). INR (A) and PT (D) monitor
warfarin therapy. A platelet count of 100,000 (C) is low and may indicate heparin-
induced thrombocytopenia.
8. A client with ulcerative colitis is scheduled for an ileostomy. Which
preoperative statement indicates a need for further teaching?
A. "I will wear a pouch at all times to collect stool."
B. "I will need to empty the pouch when it is one-third full."
C. "I can expect the stool to be formed and solid."
D. "I should avoid foods that cause gas and odor."
Answer-: C
Rationale: Ileostomy output is liquid to pasty because the large intestine (which
absorbs water) is bypassed. Stool becomes more formed with a colostomy, not an
ileostomy. The other statements are correct: pouch worn at all times (A), empty
when ⅓ full to prevent leakage (B), and avoiding gas-forming/odorous foods (D).
9. A nurse is monitoring a client with a traumatic brain injury (TBI) and
increased intracranial pressure (ICP). Which finding should be reported
immediately?
A. Heart rate 58 bpm
B. Respiratory rate 14/min
