BSN 266 HESI Med Surg Study Guide (2025) –
400+ Questions & Answers NGN Style Case
Scenarios | Next Generation NCLEX (NGN)
Format 400 Questions with Correct Answers &
Expert Rationales
,1. A client who underwent cardiac stent placement 4 days ago arrives to the
emergency department reporting sudden onset chest pressure and shortness of
breath.
Which action should the nurse take next?
a. Administer prescribed nitroglycerin sublingually.
b. Obtain a 12-lead electrocardiogram (ECG) and begin continuous cardiac
monitoring.
c. Give oxygen at 2 liters per minute via nasal cannula.
d. Prepare the client for immediate cardiac catheterization.
Correct Answer: b
*Rationale: A client with sudden chest pressure and shortness of breath after recent
stenting is at high risk for acute stent thrombosis or myocardial infarction (MI).
Immediate acquisition of a 12-lead ECG is critical to assess for ischemic changes
and to prioritize timely reperfusion therapy if needed. Continuous cardiac
monitoring is essential to detect arrhythmias. Although oxygen and nitroglycerin
may be administered per protocol, assessment data guides further interventions.
Immediate preparation for catheterization is premature before diagnostic
confirmation.*
2. While completing a health assessment for a client with migraine headaches, the
nurse identifies bilateral weakness in the client’s hand grips. The client reports
joint pain and difficulty twisting a door knob due to weakness.
Which action should the nurse take next?
a. Teach the client relaxation techniques to manage migraine pain.
b. Document the findings and continue with the neurological assessment.
c. Gather additional assessment data about the pain and weakness.
d. Refer the client immediately to a neurologist.
Correct Answer: c
Rationale: Bilateral hand weakness and joint pain suggest possible systemic or
neurological disease beyond migraines (e.g., rheumatoid arthritis, neuropathy).
Further assessment to clarify onset, duration, associated symptoms, and functional
impact is needed before specialist referral. Immediate referral without data may
delay appropriate care; documenting without further inquiry risks missing early
diagnostic clues.
,3. The nurse is caring for a client diagnosed with psoriasis vulgaris receiving
psoralen and ultraviolet A light (PUVA) treatment.
Which assessment finding indicates overexposure to treatment?
a. Increased thickening and scaling of plaques.
b. Tenderness upon palpation and generalized erythema.
c. Development of vesicular lesions on treated skin.
d. Mild tanning of treated areas.
Correct Answer: b
Rationale: PUVA therapy carries a risk of phototoxic reactions causing erythema,
tenderness, and burning which signal overexposure. Tenderness with generalized
erythema suggests a burn-like reaction requiring treatment modification. Vesicular
lesions are rare but possible. Mild tanning is expected, while increased plaque
scaling indicates disease progression, not treatment toxicity.
4. A client with heart failure is receiving furosemide 40 mg IV daily. Which
laboratory value requires immediate intervention?
a. Serum potassium 3.8 mEq/L
b. Serum sodium 135 mEq/L
c. Serum magnesium 1.0 mg/dL
d. Serum creatinine 0.9 mg/dL
Correct Answer: c
*Rationale: Magnesium level of 1.0 mg/dL is below normal range (1.5-2.5 mg/dL).
Hypomagnesemia is a common adverse effect of loop diuretics and can lead to
ventricular arrhythmias, especially in patients with heart failure. Potassium and
sodium are within normal limits; creatinine is normal.*
5. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The nurse administers oxygen at 2 L/min via nasal
cannula. Fifteen minutes later, the client becomes lethargic and is difficult to
arouse. Which action should the nurse take first?
a. Increase oxygen to 4 L/min
b. Administer naloxone
, c. Decrease oxygen to 1 L/min
d. Prepare for endotracheal intubation
Correct Answer: c
*Rationale: Clients with COPD who are chronic carbon dioxide retainers may
develop CO2 narcosis with excessive oxygen administration. Decreasing oxygen to
1 L/min or switching to a Venturi mask can reduce the risk. Increasing oxygen
would worsen the condition. Naloxone is for opioid overdose; intubation may be
needed if the client does not improve.*
6. A client with type 2 diabetes mellitus is admitted with hyperglycemia. The nurse
notes a blood glucose level of 650 mg/dL and serum potassium of 5.8 mEq/L.
Which intervention should the nurse anticipate first?
a. Administer intravenous regular insulin
b. Infuse 0.9% normal saline at 250 mL/hour
c. Administer sodium polystyrene sulfonate
d. Obtain an arterial blood gas
Correct Answer: b
Rationale: In hyperglycemic hyperosmolar state (HHS) or diabetic ketoacidosis
(DKA), the priority is volume resuscitation with isotonic fluids. Hyperkalemia in
the setting of hyperglycemia is often pseudohyperkalemia due to osmotic shifts;
insulin will lower glucose and shift potassium into cells. Fluid replacement is the
first step to restore perfusion.
7. A client is admitted with acute pancreatitis. Which laboratory finding is most
specific for this diagnosis?
a. Elevated serum amylase
b. Elevated serum lipase
c. Elevated white blood cell count
d. Elevated blood glucose
Correct Answer: b
*Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than
amylase, with levels rising within 4-8 hours and remaining elevated for 8-14 days.
Amylase can be elevated in other conditions (e.g., salivary gland disorders). WBC
and glucose are non-specific.*
400+ Questions & Answers NGN Style Case
Scenarios | Next Generation NCLEX (NGN)
Format 400 Questions with Correct Answers &
Expert Rationales
,1. A client who underwent cardiac stent placement 4 days ago arrives to the
emergency department reporting sudden onset chest pressure and shortness of
breath.
Which action should the nurse take next?
a. Administer prescribed nitroglycerin sublingually.
b. Obtain a 12-lead electrocardiogram (ECG) and begin continuous cardiac
monitoring.
c. Give oxygen at 2 liters per minute via nasal cannula.
d. Prepare the client for immediate cardiac catheterization.
Correct Answer: b
*Rationale: A client with sudden chest pressure and shortness of breath after recent
stenting is at high risk for acute stent thrombosis or myocardial infarction (MI).
Immediate acquisition of a 12-lead ECG is critical to assess for ischemic changes
and to prioritize timely reperfusion therapy if needed. Continuous cardiac
monitoring is essential to detect arrhythmias. Although oxygen and nitroglycerin
may be administered per protocol, assessment data guides further interventions.
Immediate preparation for catheterization is premature before diagnostic
confirmation.*
2. While completing a health assessment for a client with migraine headaches, the
nurse identifies bilateral weakness in the client’s hand grips. The client reports
joint pain and difficulty twisting a door knob due to weakness.
Which action should the nurse take next?
a. Teach the client relaxation techniques to manage migraine pain.
b. Document the findings and continue with the neurological assessment.
c. Gather additional assessment data about the pain and weakness.
d. Refer the client immediately to a neurologist.
Correct Answer: c
Rationale: Bilateral hand weakness and joint pain suggest possible systemic or
neurological disease beyond migraines (e.g., rheumatoid arthritis, neuropathy).
Further assessment to clarify onset, duration, associated symptoms, and functional
impact is needed before specialist referral. Immediate referral without data may
delay appropriate care; documenting without further inquiry risks missing early
diagnostic clues.
,3. The nurse is caring for a client diagnosed with psoriasis vulgaris receiving
psoralen and ultraviolet A light (PUVA) treatment.
Which assessment finding indicates overexposure to treatment?
a. Increased thickening and scaling of plaques.
b. Tenderness upon palpation and generalized erythema.
c. Development of vesicular lesions on treated skin.
d. Mild tanning of treated areas.
Correct Answer: b
Rationale: PUVA therapy carries a risk of phototoxic reactions causing erythema,
tenderness, and burning which signal overexposure. Tenderness with generalized
erythema suggests a burn-like reaction requiring treatment modification. Vesicular
lesions are rare but possible. Mild tanning is expected, while increased plaque
scaling indicates disease progression, not treatment toxicity.
4. A client with heart failure is receiving furosemide 40 mg IV daily. Which
laboratory value requires immediate intervention?
a. Serum potassium 3.8 mEq/L
b. Serum sodium 135 mEq/L
c. Serum magnesium 1.0 mg/dL
d. Serum creatinine 0.9 mg/dL
Correct Answer: c
*Rationale: Magnesium level of 1.0 mg/dL is below normal range (1.5-2.5 mg/dL).
Hypomagnesemia is a common adverse effect of loop diuretics and can lead to
ventricular arrhythmias, especially in patients with heart failure. Potassium and
sodium are within normal limits; creatinine is normal.*
5. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The nurse administers oxygen at 2 L/min via nasal
cannula. Fifteen minutes later, the client becomes lethargic and is difficult to
arouse. Which action should the nurse take first?
a. Increase oxygen to 4 L/min
b. Administer naloxone
, c. Decrease oxygen to 1 L/min
d. Prepare for endotracheal intubation
Correct Answer: c
*Rationale: Clients with COPD who are chronic carbon dioxide retainers may
develop CO2 narcosis with excessive oxygen administration. Decreasing oxygen to
1 L/min or switching to a Venturi mask can reduce the risk. Increasing oxygen
would worsen the condition. Naloxone is for opioid overdose; intubation may be
needed if the client does not improve.*
6. A client with type 2 diabetes mellitus is admitted with hyperglycemia. The nurse
notes a blood glucose level of 650 mg/dL and serum potassium of 5.8 mEq/L.
Which intervention should the nurse anticipate first?
a. Administer intravenous regular insulin
b. Infuse 0.9% normal saline at 250 mL/hour
c. Administer sodium polystyrene sulfonate
d. Obtain an arterial blood gas
Correct Answer: b
Rationale: In hyperglycemic hyperosmolar state (HHS) or diabetic ketoacidosis
(DKA), the priority is volume resuscitation with isotonic fluids. Hyperkalemia in
the setting of hyperglycemia is often pseudohyperkalemia due to osmotic shifts;
insulin will lower glucose and shift potassium into cells. Fluid replacement is the
first step to restore perfusion.
7. A client is admitted with acute pancreatitis. Which laboratory finding is most
specific for this diagnosis?
a. Elevated serum amylase
b. Elevated serum lipase
c. Elevated white blood cell count
d. Elevated blood glucose
Correct Answer: b
*Rationale: Serum lipase is more specific and sensitive for acute pancreatitis than
amylase, with levels rising within 4-8 hours and remaining elevated for 8-14 days.
Amylase can be elevated in other conditions (e.g., salivary gland disorders). WBC
and glucose are non-specific.*
