BSN HESI 266: Medical-Surgical Nursing Assessment – 50+ Questions
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Medical-Surgical Nursing Assessment s1 s1
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, BSN HESI 266: Medical-Surgical Nursing Assessment – 50+
Questions with Answer|| || Complete Comprehensive Questions and
Correct Verified Answers || 100% Guaranteed Pass
Q1. A patient with heart failure (HF) presents with dyspnea, crackles in both lung
bases, and jugular venous distension (JVD). Which medication does the nurse
prepare to administer first?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B) Furosemide
Explanation: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and dyspnea. Digoxin improves contractility but is not first-
line for acute decompensation. Metoprolol is a beta-blocker for chronic HF;
starting it in acute failure can worsen symptoms. Spironolactone is a potassium-
sparing diuretic used chronically.
Q2. A patient post-myocardial infarction (MI) has a new, harsh, holosystolic
murmur heard best at the apex with radiation to the axilla. What complication
does the nurse suspect?
A) Ventricular septal defect
B) Papillary muscle rupture
, C) Pericarditis
D) Dressler's syndrome
Answer: B) Papillary muscle rupture
Explanation: Papillary muscle rupture causes acute mitral regurgitation, producing
a holosystolic murmur at the apex radiating to the axilla. A ventricular septal
defect produces a harsh holosystolic murmur at the left sternal border.
Pericarditis causes a friction rub. Dressler's syndrome is a late pericarditis
complication.
Q3. The nurse is caring for a patient with an abdominal aortic aneurysm (AAA).
Which finding is most concerning and requires immediate surgical consultation?
A) Back pain and a pulsatile abdominal mass
B) Blood pressure of 138/88 mm Hg
C) Absence of bowel sounds
D) Heart rate of 88 bpm
Answer: A) Back pain and a pulsatile abdominal mass
Explanation: Back pain with a pulsatile mass indicates expansion or impending
rupture of the AAA. This is a surgical emergency. The other findings are either
normal or not immediately life-threatening.
Q4. A patient with peripheral artery disease (PAD) complains of leg pain when
walking that resolves with rest. Which instruction should the nurse prioritize?
A) "Elevate your legs above your heart when resting."
B) "Apply heat packs to relieve pain."
with Answer|| || Complete Comprehensive Questions and Correct
Verified Answers || 100% Guaranteed Pass
Stuvia
s1
THIS DOCUMENT CONTAINS:
s1 s1
BSN HESI 266 s1 s1
Medical-Surgical Nursing Assessment s1 s1
50+ Questions with Answers
s1 s1 s1
Complete Comprehensive Questions and Correct Verified
s1 s1 s1 s1 s1
s1 Answers
100% Guaranteed Pass
s1 s1
, BSN HESI 266: Medical-Surgical Nursing Assessment – 50+
Questions with Answer|| || Complete Comprehensive Questions and
Correct Verified Answers || 100% Guaranteed Pass
Q1. A patient with heart failure (HF) presents with dyspnea, crackles in both lung
bases, and jugular venous distension (JVD). Which medication does the nurse
prepare to administer first?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Spironolactone
Answer: B) Furosemide
Explanation: Furosemide is a loop diuretic that rapidly reduces preload, relieving
pulmonary congestion and dyspnea. Digoxin improves contractility but is not first-
line for acute decompensation. Metoprolol is a beta-blocker for chronic HF;
starting it in acute failure can worsen symptoms. Spironolactone is a potassium-
sparing diuretic used chronically.
Q2. A patient post-myocardial infarction (MI) has a new, harsh, holosystolic
murmur heard best at the apex with radiation to the axilla. What complication
does the nurse suspect?
A) Ventricular septal defect
B) Papillary muscle rupture
, C) Pericarditis
D) Dressler's syndrome
Answer: B) Papillary muscle rupture
Explanation: Papillary muscle rupture causes acute mitral regurgitation, producing
a holosystolic murmur at the apex radiating to the axilla. A ventricular septal
defect produces a harsh holosystolic murmur at the left sternal border.
Pericarditis causes a friction rub. Dressler's syndrome is a late pericarditis
complication.
Q3. The nurse is caring for a patient with an abdominal aortic aneurysm (AAA).
Which finding is most concerning and requires immediate surgical consultation?
A) Back pain and a pulsatile abdominal mass
B) Blood pressure of 138/88 mm Hg
C) Absence of bowel sounds
D) Heart rate of 88 bpm
Answer: A) Back pain and a pulsatile abdominal mass
Explanation: Back pain with a pulsatile mass indicates expansion or impending
rupture of the AAA. This is a surgical emergency. The other findings are either
normal or not immediately life-threatening.
Q4. A patient with peripheral artery disease (PAD) complains of leg pain when
walking that resolves with rest. Which instruction should the nurse prioritize?
A) "Elevate your legs above your heart when resting."
B) "Apply heat packs to relieve pain."
