BSN HESI 266 MED SURG PRACTICE
EXAM 2026/2027 QUESTIONS AND
ANSWERS
1. A patient with Chronic Kidney Disease (CKD) has a potassium level of 6.2 mEq/L. Which
medication should the nurse expect to administer first to protect the heart from
arrhythmias?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Regular Insulin and Dextrose
D. Furosemide (Lasix)
Answer: A
Conceptual Explanation: Calcium Gluconate is administered first in severe hyperkalemia
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias,
although it does not lower the potassium level itself.
,2. A nurse is assessing a patient with suspected Left-sided Heart Failure. Which clinical
manifestation is most characteristic of this condition?
A. Crackles and wheezes on lung auscultation
B. Dependent edema in the lower extremities
C. Jugular Venous Distension (JVD)
D. Hepatosplenomegaly
Answer: A
Conceptual Explanation: Left-sided heart failure causes pulmonary congestion, leading to
symptoms like dyspnea, crackles, and orthopnea. The other options are symptoms of Right-
sided heart failure.
3. Which arterial blood gas (ABG) result indicates compensated Metabolic Acidosis?
A. pH 7.32, PaCO2 40 mmHg, HCO3 20 mEq/L
B. pH 7.30, PaCO2 48 mmHg, HCO3 28 mEq/L
C. pH 7.48, PaCO2 35 mmHg, HCO3 30 mEq/L
D. pH 7.36, PaCO2 30 mmHg, HCO3 18 mEq/L
Answer: D
Conceptual Explanation: A pH within normal range (7.36) but on the acidic side,
combined with low HCO3 and a low PaCO2 (compensatory hyperventilation), indicates
fully compensated metabolic acidosis.
, 4. A patient is admitted with a suspected Myocardial Infarction. Which cardiac biomarker is
the most specific for identifying myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I
D. C-reactive protein
Answer: C
Conceptual Explanation: Troponin I is highly specific to cardiac muscle and remains
elevated longer than CK-MB, making it the gold standard for diagnosing MI.
5. A patient with cirrhosis is showing signs of Hepatic Encephalopathy. The nurse monitors
which laboratory value to assess the effectiveness of Lactulose therapy?
A. Serum Bilirubin
B. Serum Albumin
C. Prothrombin Time (PT)
D. Ammonia levels
Answer: D
Conceptual Explanation: Lactulose is given to promote the excretion of ammonia in the
stool. A decrease in serum ammonia levels indicates effective treatment for hepatic
encephalopathy.
EXAM 2026/2027 QUESTIONS AND
ANSWERS
1. A patient with Chronic Kidney Disease (CKD) has a potassium level of 6.2 mEq/L. Which
medication should the nurse expect to administer first to protect the heart from
arrhythmias?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Regular Insulin and Dextrose
D. Furosemide (Lasix)
Answer: A
Conceptual Explanation: Calcium Gluconate is administered first in severe hyperkalemia
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias,
although it does not lower the potassium level itself.
,2. A nurse is assessing a patient with suspected Left-sided Heart Failure. Which clinical
manifestation is most characteristic of this condition?
A. Crackles and wheezes on lung auscultation
B. Dependent edema in the lower extremities
C. Jugular Venous Distension (JVD)
D. Hepatosplenomegaly
Answer: A
Conceptual Explanation: Left-sided heart failure causes pulmonary congestion, leading to
symptoms like dyspnea, crackles, and orthopnea. The other options are symptoms of Right-
sided heart failure.
3. Which arterial blood gas (ABG) result indicates compensated Metabolic Acidosis?
A. pH 7.32, PaCO2 40 mmHg, HCO3 20 mEq/L
B. pH 7.30, PaCO2 48 mmHg, HCO3 28 mEq/L
C. pH 7.48, PaCO2 35 mmHg, HCO3 30 mEq/L
D. pH 7.36, PaCO2 30 mmHg, HCO3 18 mEq/L
Answer: D
Conceptual Explanation: A pH within normal range (7.36) but on the acidic side,
combined with low HCO3 and a low PaCO2 (compensatory hyperventilation), indicates
fully compensated metabolic acidosis.
, 4. A patient is admitted with a suspected Myocardial Infarction. Which cardiac biomarker is
the most specific for identifying myocardial injury?
A. CK-MB
B. Myoglobin
C. Troponin I
D. C-reactive protein
Answer: C
Conceptual Explanation: Troponin I is highly specific to cardiac muscle and remains
elevated longer than CK-MB, making it the gold standard for diagnosing MI.
5. A patient with cirrhosis is showing signs of Hepatic Encephalopathy. The nurse monitors
which laboratory value to assess the effectiveness of Lactulose therapy?
A. Serum Bilirubin
B. Serum Albumin
C. Prothrombin Time (PT)
D. Ammonia levels
Answer: D
Conceptual Explanation: Lactulose is given to promote the excretion of ammonia in the
stool. A decrease in serum ammonia levels indicates effective treatment for hepatic
encephalopathy.
