HESI 266 MEDICAL-SURGICAL NURSING ULTIMATE PREP
GUIDE (LATEST 2026-2027 EDITION) VERIFIED ANSWERS
& EXPERT CLINICAL RATIONALES
Cardiorespiratory System (Questions 1–15)
1. A client with chronic obstructive pulmonary
disease (COPD) is receiving oxygen at 2 L/min
per nasal cannula. The nurse notes the client’s
respiratory rate is 22 breaths/min and oxygen
saturation is 89%. Which action should the
nurse take first?
A) Increase the oxygen flow rate to 4 L/min.
B) Notify the healthcare provider immediately.
C) Instruct the client to perform pursed-lip
breathing.
D) Change the delivery system to a non-
rebreather mask.
Answer: C
Rationale: Pursed-lip breathing prolongs
exhalation, prevents airway collapse, and helps
release trapped air, which improves gas
exchange in COPD clients without suppressing
their hypoxic respiratory drive. Increasing
, oxygen too high can suppress breathing in
chronic carbon dioxide retainers.
2. The nurse is caring for a client who is 24 hours
postoperative following a total laryngectomy.
Which assessment finding requires immediate
intervention?
A) Copious amounts of thick, blood-tinged
tracheal secretions.
B) Increased restlessness and a respiratory
rate of 28 breaths/min.
C) Client communication via a picture board and
gestures.
D) Scant serosanguinous drainage on the
surgical dressing.
Answer: B
Rationale: Restlessness, tachypnea, and anxiety
are early signs of hypoxia and airway
obstruction. Postoperative laryngectomy clients
are at high risk for airway occlusion from
mucus plugs, edema, or hemorrhage.
3. A client admitted with acute decompensated
heart failure is coughing up pink, frothy sputum.
, Which medication should the nurse prepare to
administer first?
A) Metoprolol
B) Furosemide
C) Lisinopril
D) Heparin
Answer: B
Rationale: Pink, frothy sputum indicates life-
threatening pulmonary edema. Furosemide is a
rapid-acting loop diuretic that reduces preload,
clears fluid out of the alveoli, and relieves
severe respiratory distress.
4. A client diagnosed with a massive deep vein
thrombosis (DVT) suddenly develops sharp
chest pain and severe dyspnea. Which priority
action should the nurse implement?
A) Place the client in a high-Fowler's position
and apply oxygen.
B) Prepare the client for an immediate chest X-
ray.
C) Start a peripheral intravenous line with
normal saline.
, D) Administer a scheduled dose of oral
warfarin.
Answer: A
Rationale: These symptoms indicate a life-
threatening pulmonary embolism resulting from
a dislodged DVT. Elevating the head of the bed
optimizes lung expansion, and supplemental
oxygen mitigates acute hypoxemia.
5. The nurse is monitoring a client's chest tube
drainage system 4 hours after a lobectomy. The
nurse notes continuous bubbling in the water
seal chamber. How should the nurse interpret
this finding?
A) The system is functioning normally and
expanding the lung.
B) There is an active air leak present in the
system or lung.
C) The suction control chamber needs to have
more water added.
D) The chest tube is obstructed by a large blood
clot.
Answer: B
GUIDE (LATEST 2026-2027 EDITION) VERIFIED ANSWERS
& EXPERT CLINICAL RATIONALES
Cardiorespiratory System (Questions 1–15)
1. A client with chronic obstructive pulmonary
disease (COPD) is receiving oxygen at 2 L/min
per nasal cannula. The nurse notes the client’s
respiratory rate is 22 breaths/min and oxygen
saturation is 89%. Which action should the
nurse take first?
A) Increase the oxygen flow rate to 4 L/min.
B) Notify the healthcare provider immediately.
C) Instruct the client to perform pursed-lip
breathing.
D) Change the delivery system to a non-
rebreather mask.
Answer: C
Rationale: Pursed-lip breathing prolongs
exhalation, prevents airway collapse, and helps
release trapped air, which improves gas
exchange in COPD clients without suppressing
their hypoxic respiratory drive. Increasing
, oxygen too high can suppress breathing in
chronic carbon dioxide retainers.
2. The nurse is caring for a client who is 24 hours
postoperative following a total laryngectomy.
Which assessment finding requires immediate
intervention?
A) Copious amounts of thick, blood-tinged
tracheal secretions.
B) Increased restlessness and a respiratory
rate of 28 breaths/min.
C) Client communication via a picture board and
gestures.
D) Scant serosanguinous drainage on the
surgical dressing.
Answer: B
Rationale: Restlessness, tachypnea, and anxiety
are early signs of hypoxia and airway
obstruction. Postoperative laryngectomy clients
are at high risk for airway occlusion from
mucus plugs, edema, or hemorrhage.
3. A client admitted with acute decompensated
heart failure is coughing up pink, frothy sputum.
, Which medication should the nurse prepare to
administer first?
A) Metoprolol
B) Furosemide
C) Lisinopril
D) Heparin
Answer: B
Rationale: Pink, frothy sputum indicates life-
threatening pulmonary edema. Furosemide is a
rapid-acting loop diuretic that reduces preload,
clears fluid out of the alveoli, and relieves
severe respiratory distress.
4. A client diagnosed with a massive deep vein
thrombosis (DVT) suddenly develops sharp
chest pain and severe dyspnea. Which priority
action should the nurse implement?
A) Place the client in a high-Fowler's position
and apply oxygen.
B) Prepare the client for an immediate chest X-
ray.
C) Start a peripheral intravenous line with
normal saline.
, D) Administer a scheduled dose of oral
warfarin.
Answer: A
Rationale: These symptoms indicate a life-
threatening pulmonary embolism resulting from
a dislodged DVT. Elevating the head of the bed
optimizes lung expansion, and supplemental
oxygen mitigates acute hypoxemia.
5. The nurse is monitoring a client's chest tube
drainage system 4 hours after a lobectomy. The
nurse notes continuous bubbling in the water
seal chamber. How should the nurse interpret
this finding?
A) The system is functioning normally and
expanding the lung.
B) There is an active air leak present in the
system or lung.
C) The suction control chamber needs to have
more water added.
D) The chest tube is obstructed by a large blood
clot.
Answer: B
