BSN 266 HESI MED SURG PRACTICE
EXAM VERSION 1 (2026/2027 UPDATE)
1. A patient is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding most clearly indicates a progression toward respiratory failure
despite oxygen therapy?
A. Increased respiratory rate and use of accessory muscles
B. Development of bilateral crackles on lung auscultation
C. Refractory hypoxemia, where PaO2 remains low despite high FiO2
D. Respiratory alkalosis shown on initial arterial blood gas analysis
Answer: C
Conceptual Explanation: Refractory hypoxemia is the hallmark of ARDS. It occurs when
the arterial oxygen level remains low even though the patient is receiving high
concentrations of supplemental oxygen, indicating severe shunting and alveolar collapse.
,2. A nurse is caring for a patient with a spinal cord injury at the T6 level. The patient reports a
sudden, throbbing headache and is found to be hypertensive and bradycardic. What is the
priority nursing action?
A. Administer an ordered PRN dose of antihypertensive medication
B. Notify the healthcare provider immediately of the change in status
C. Check for bladder distention or other noxious stimuli
D. Elevate the head of the bed to 45 degrees or higher
Answer: D
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The
immediate priority is to elevate the head of the bed to help decrease blood pressure
through orthostatic effects before searching for the cause or calling the doctor.
3. When interpreting Arterial Blood Gas (ABG) results for a patient with Chronic Obstructive
Pulmonary Disease (COPD), the nurse notes pH 7.32, PaCO2 58 mmHg, and HCO3 30 mEq/L.
How should the nurse interpret this result?
A. Uncompensated respiratory acidosis
B. Fully compensated metabolic alkalosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic acidosis
Answer: C
, Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45), and the HCO3
is high (>26). Since the HCO3 is attempting to move the pH toward normal but hasn’t
reached 7.35 yet, it is partially compensated respiratory acidosis.
4. A patient with systemic lupus erythematosus (SLE) is prescribed long-term corticosteroid
therapy. Which laboratory result should the nurse monitor most closely for potential
complications?
A. Serum glucose levels
B. Serum potassium levels
C. Serum creatinine levels
D. Complete blood count (CBC)
Answer: A
Conceptual Explanation: Corticosteroids cause insulin resistance and stimulate
gluconeogenesis, frequently leading to hyperglycemia or steroid-induced diabetes. While
potassium and WBCs may be affected, glucose monitoring is critical for long-term
management.
5. A patient is receiving a continuous intravenous infusion of heparin for a pulmonary
embolism. The nurse notes the following: aPTT 110 seconds (Control 30-40). What is the
nurse’s immediate action?
A. Continue the infusion at the current rate and recheck aPTT in 4 hours
B. Stop the infusion and prepare to administer protamine sulfate
EXAM VERSION 1 (2026/2027 UPDATE)
1. A patient is admitted with a suspected diagnosis of Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding most clearly indicates a progression toward respiratory failure
despite oxygen therapy?
A. Increased respiratory rate and use of accessory muscles
B. Development of bilateral crackles on lung auscultation
C. Refractory hypoxemia, where PaO2 remains low despite high FiO2
D. Respiratory alkalosis shown on initial arterial blood gas analysis
Answer: C
Conceptual Explanation: Refractory hypoxemia is the hallmark of ARDS. It occurs when
the arterial oxygen level remains low even though the patient is receiving high
concentrations of supplemental oxygen, indicating severe shunting and alveolar collapse.
,2. A nurse is caring for a patient with a spinal cord injury at the T6 level. The patient reports a
sudden, throbbing headache and is found to be hypertensive and bradycardic. What is the
priority nursing action?
A. Administer an ordered PRN dose of antihypertensive medication
B. Notify the healthcare provider immediately of the change in status
C. Check for bladder distention or other noxious stimuli
D. Elevate the head of the bed to 45 degrees or higher
Answer: D
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The
immediate priority is to elevate the head of the bed to help decrease blood pressure
through orthostatic effects before searching for the cause or calling the doctor.
3. When interpreting Arterial Blood Gas (ABG) results for a patient with Chronic Obstructive
Pulmonary Disease (COPD), the nurse notes pH 7.32, PaCO2 58 mmHg, and HCO3 30 mEq/L.
How should the nurse interpret this result?
A. Uncompensated respiratory acidosis
B. Fully compensated metabolic alkalosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic acidosis
Answer: C
, Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45), and the HCO3
is high (>26). Since the HCO3 is attempting to move the pH toward normal but hasn’t
reached 7.35 yet, it is partially compensated respiratory acidosis.
4. A patient with systemic lupus erythematosus (SLE) is prescribed long-term corticosteroid
therapy. Which laboratory result should the nurse monitor most closely for potential
complications?
A. Serum glucose levels
B. Serum potassium levels
C. Serum creatinine levels
D. Complete blood count (CBC)
Answer: A
Conceptual Explanation: Corticosteroids cause insulin resistance and stimulate
gluconeogenesis, frequently leading to hyperglycemia or steroid-induced diabetes. While
potassium and WBCs may be affected, glucose monitoring is critical for long-term
management.
5. A patient is receiving a continuous intravenous infusion of heparin for a pulmonary
embolism. The nurse notes the following: aPTT 110 seconds (Control 30-40). What is the
nurse’s immediate action?
A. Continue the infusion at the current rate and recheck aPTT in 4 hours
B. Stop the infusion and prepare to administer protamine sulfate
