BSN HESI 266 Medical Surgical Exam 2026/2027 | Nightingale | Practice Questions & Accurate Solutions | 100% Correct

BSN HESI 266 Medical Surgical Exam 2026/2027 | Nightingale | Practice Questions & Accurate Solutions | 100% Correct The nurse is caring for a client admitted to the unit for possible hyperthyroidism. The client describes weakness, nervousness, a racing heartbeat, and recent weight loss of 15 pounds (6.8 kg). Which action should the nurse implement first? Monitor the client's vital signs frequently. 3 multiple choice options The nurse administers galantamine hydrobromide to a client with early onset Alzheimer's disease. Which nursing problem addresses its therapeutic use? Disturbed thought processes. 2 multiple choice options A client in the operating room received succinylcholine. The client is experiencing muscle rigidity and has an extremely high temperature. Which action should the nurse implement? Call the postanesthetic care unit (PACU) nurse to prepare for prolonged ventilatory support. 3 multiple choice options A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the nurse to report to the healthcare provider? Distended, hard, and rigid abdomen. When assessing a client on the first postoperative day following abdominal surgery, the nurse does not hear any bowel sounds. In response to this finding, which action should the nurse implement? Document the assessment finding. The nurse assists a client with Parkinson's disease to ambulate in the hallway. The client appears to "freeze" and then carefully lifts on leg and steps forward. The client tells the nurse of pretending to step over a crack on the floor. How should the nurse respond? Confirm that this is an effective technique to help with ambulation. The nurse is teaching a client with glomerulonephritis about self care. Which dietary recommendation should the nurse encourage the client to follow? Restrict protein intake by limiting meats and other high protein foods. a 37 year old female client reports to the preoperative area for her scheduled bariatric surgery. The decision to have bariatric surgery came after multiple attempts to lose weight by diet and exercise which resulted in intial weight attempts were not sustained... Choose the most likely options for the information missing from the statement by selecting from the lists of options provided? The nurse recognizes that the most common serious complica- tion after having gastric bypass surgery is ___ as evidenced by increased back, shoulder, or abdominal pain, restlessness, ___ and tachcardia. First line - Anastomotic leak Second Line - Arrythmia A client is diagnosed with chronic kidney disease and needs to begin dialysis. Which condition entered on the client's medical record should the nurse recognize as a contraindication for peri- toneal dialysis? Crohn's disease with colectomy A client is admitted to the hospital for treatment of a simple goiter, and levothyroxine sodium is prescribed. Which symptoms indicate to the nurse that the prescribed dosage is too high for this client? Palpitations and shortness of breath. A client with a fracture of the right femur has had skeletal traction applied. Which intervention should the nurse include in the client's nursing care plan? Assess the pin sites for signs of infection. A client with a renal calculus reports severe right flank pain, nausea, and vomiting. Which nursing problem has the highest priority? Risk for aspiration related to vomiting. An adult client who recently diagnosed with glaucoma tells the nurse, "it feels like I am driving through a tunnel." The client expresses great concern about going blind. Which nursing in- struction is most important for the nurse to provide this client? Maintain prescribed eye drop regimen After falling down the basement steps, a client brought to the emergency department. X-ray results confirm that the client's right leg is fractures. Following application of a leg cast, which assess- ment finding warrants immediate intervention by the nurse? Right foot pale with sluggish capillary refill. A client is admitted to the medical unit during an exacerbation of systemic lupus erythematosus (SLE). It is most important for the nurse to report which assessment finding to the healthcare provider? Hematuria A client with leukemia is receiving chemotherapy. The nurse observes the client is weak, pale, and febrile. After reviewing the client's most recent laboratory data which reveals a platelet count of 25,000/mm^3 (25 x 10^9/L), which intervention should the nurse include in the plan of care? Reference Range Platelet [150,000 to 400,000/mm^3 (150 to 400 x 10^9/L)] Assess urine and stool for occult blood The nurse is caring for a client with chronic pancreatitis who reports persistent gnawing abdominal pain. To help the client manage the pain, which assessment data is most important for the nurse to obtain? Eating patterns of dietary intake A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout: Which finding(s) in the client's health record should the nurse recognize places the client at a greater risk of developing gout? Select all that apply. - Daily aspirin (c) - Drinks beer nightly (c) - Obesity (c) - Type 2 Diabetes Mellitus (c) - Hypertension (c) A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout: Exhibits The nurse is reviewing the client's medical record to better under- stand the previous gout attacks. Click to indicate if the findings are consistent with an acute gout attack, chronic gout, or both. Each row must have at least one, but may have more than one, response option selected. A. Renal dysfunction B. Visible tophi C. Low grade fever D. Pain at the affected joint E. Occur in more than 1 joint Chronic gout: A. Renal Dysfunction B. Visible Tophi E. Occur in more than 1 joint Acute gout: C. Low grade fever D. Pain at the affected joint E. Occur in more than 1 joint A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout: Question: Medications used for the treatment of a client with gout include colchicine, naproxen, prednisone, and allopurinol. - Colchicine is an antigout medication that decreases pain through the re- duction of inflammation. Clients should be taughto avoid grape- fuit juice when taking this medication because it can increase colchicine levels. - Naproxen is a nonsteroidal antinfammatory medication that manages pain from inflammation caused by gout. Clent should notake more than the prescibed dose as it can cause liver toxicty: - Prednisone is a corticosteroid that reduces inflammation. Clients should be taught to report signs of adrenal insuficieng induding nausea, anorexia, and confusion. - Allopurinol is an antigout, antihyperuricemic, medication that lowers the amount of serum uric acid. Clients should be taught to consume at least 2 liters of fluid per day when prescribed this medication. A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout: Question possibly on client teach on foods to avoid. - Purine - Alcohol can increase uric acid levels which can lead to gout. (Teach client with gout to keep low purine diet that is free from alcohol to limit gout attacks.) A 59-year-old male client presents to the clinic, reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout, which he has had on 2 other occasions in the last 4 months. The client tells the nurses that the pain started about 9 days ago in the evening and that it got very painful and swollen shortly there- after. In the past, the gout attacks have resolved without treatment after about 5 days, but the client reports that his condition has not improved and that he is unable to walk or work Exhibits Select the 3 dietary choices that are not part of the recommended diet for a client with gout. A. Garlic B. Liver C. Spinach D. Oatmeal E. Chicken F. Shrimp G. Lentil H. Quinoa I. Oranges J. Sardines B. Organ meats (e.g. liver) F. Shrimp (shellfish) J. Sardines (Oily fish) The nurse is providing teaching to a client about self-manage- ment to type 2 diabetes mellitus. Which information provided by the client indicates understanding? Get an influenze vaccine every year as soon as possible. The nurse is obtaining a client's fingerstick glucose level. After gently milking the client's finger, the nurse observes that the distal tip of the finger appears redded and engorged. Which action should the nurse take? Apply pressure to the site. The healthcare provided prescribes penicillin 200,000 units IM for a client with pneumonia. The available vial is labeled, "Penicillin 500,000 units/mL." How many mL should the nurse administer to this client? (Enter numerical value only. If rounding is required, round to the nearest tenth.) 200,000/500,000 = 0.4 The nurse is caring for a client in the post anesthesia care unit (PACU) who underwent a thoracotomy two hours ago. The nurse observes vital signs of a heart rate of 140 beats/minute, a respiratory rate of 26 breaths/minute, and a blood pressure of 140/90 mm Hg. Which intervention is most important for the nurse to implement? Medicate for pain and monitor vital signs according to protocol. A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he just couldn't catch his breath. The client reports that symptoms seem worse when outdoors and when exercising and that episodes like this make him extremely nervous. The client reports that it has been a couple of months since he had an asthma attack, and he came to the ED today because he noticed that his inhaler was expired and was worried the medication was not working. The nurse reviews the client history of the presenting illness in the electronic medical record. Click to highlight the two pieces of key subjective data which indicate the client is in need of health interventions. - Using a rescue inhaler three times - Just couldn't catch his breath "Using a rescue inhaler three times" (is subjective data provided by a dient. Symptoms that remain unresolved after three administrations of a rescue Inhaler indicate that a dient is in need of further interventions.) "Just couldn't catch his breath" (is subjective data provided by a client that indicates the client has a compromised airway consistent with the disease process for asthma which includes: Reversible airway obstruction, airway infammation, airway tissue hypersensitivity, bronchoconstriction, bronchospasm, bronchial smooth muscle contracion, increased bronchial mucus production and impaired gas exchange.) Based on the client's history and assessment data, the nurse's hypothesis is In an acute episode of asthma, the disease process includes: - Airway constriction leading to increased respiratory rate - Hypoxia, leading to an increased heart rate - Airway constricion leading to a decrease in oxygen saturation - The compensatory mechanism of the heart rate may lead to blood pressure elevations Rescue mediations used for an acute episode of asthma can cause the following symptoms: - Increased heart rate - Inceased blood pressure Neither the disease process nor medication has a significant effect on body temperature. Disease process of Asthma: - Heart rate: 112 beats/minute - Blood pressure 130/86 - Oxygen saturation: 88% on room air Rescue Medications can cause: - Increased heart rate - Increased blood pressue Neither Disease Process nor Medication use: - Temperature: 98.9F (37.1C) A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. ... Complete the following sentences by choosing from the lists of corresponding options. Based on history and assessment data, the nurse should prioritize ___________ as the priority problem for this client, as evidenced by the client's statement, __. - First line: Impaired gas exchange - Second line: "I just can't catch my breath." Rationale: The rationale for selecting impaired gas exchange is based on the clinical manifestations presented by the client. The client's difficulty in breathing, the need to pause to catch breath, the ineffectiveness of the rescue inhaler, and the expressed feeling of nervousness during episodes are indicative of a compromised gas exchange. This is further supported by the objective data: an oxygen saturation of 88% on room air is below normal levels, suggesting that the client is not receiving adequate oxygen. Expiratory wheezes indicate an obstruction of airflow, commonly seen in asthma attacks, which can impair gas exchange. There- fore, the nurse's assessment and the client's symptoms align with the diagnosis of impaired gas exchange, necessitating immediate intervention to improve the client's respiratory function. A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he says he just couldn't catch his breath. Based on the client history and the assessment data, which actions should the PN anticipate? Select all that apply. - Apply oxygen via nasal cannula. - Ask the client for a list of current medications. - Reinforce client teaching - Administer medications as ordered. After administration of medications, the client remains short of breath. What actions should the nurse take next? Select all that apply: A. Increase oxygen flow B. Take and monitor vital signs C. Provide client incentive spirometer and instruct on use D. Administer addition nebulizer treatment as ordered E. Apply a nonrebreather oxygen mask F. Raise the head of the bed22 A. Increase oxygen flow B. Take and monitor vital signs D. Administer additional nebulizer treatment as ordered E. Apply a nonrebreather oxygen mask F. Raise the head of the bed A 34-year-old male client presents to the emergency department (ED) for an acute asthma attack which began after jogging through a local park. The client is able to answer questions, pausing every few words to catch his breath. The client reports using a rescue inhaler three times, but he just couldn't catch his breath. The nurse has Implemented additional needed actions. Click the assessment data which indicates the interventions were successful and which assessment data provides no indication that the interventions were successful. Each column must have at least one, but may have more than one answer selected. A. Lung sounds clear B. Client can now speak in full sentences without pausing C. Respirations 16 breaths/minute D. Client reports, "It's a lot easier to breathe now." E. Blood Pressure 122/84 mmHg F. Heart rate: 86 beats per meat Interventions were sucessful: A. Lung sounds clear B. Client can now speak in full sentences without pausing C. Respirations 16 breaths/minute D. Client reports, "It's a lot easier to breathe now." E. Blood Pressure 122/84 mmHg No indication that the interventions were successful: The nurse is developing a plan of care who reports blurred vision and who is newly diagnosed with cardiovascular disease. Which outcome should the nurse include in the plan of care for this client? The client's daily blood pressure will be less than 140/80 mm Hg this month. The nurse is assessing a client who has herpes zoster. Which question will allow the nurse to gather further information about this condition? Has everyone at home already had varicella? A client presents to the emergency department reporting chest pain that is radiating to the left arm, shortness of breath, and diaphoresis. Which medication does the nurse anticipate being prescribed by the healthcare provider? Morphine The nurse is preparing a client for surgery who was admitted to the emergency center following a motor vehicle collision. The client has an open fracture of the femur and is bleeding moderately from the bone protrusion site. During the preoperative assess- ment, the nurse determines that the client currently receives he- parin sodium 5,000 units subcutaneously daily. What is the priority nursing action? Notify the healthcare provider of the client's medication history. The nursing is caring for a client who is receiving teletherapy radiation for a malignant tumor. Which instruction regarding skin care of the portal site should the nurse provide? Protect the skin of the radiation portal site from sunlight exposure. While caring for a client with a full thickness burn covering 40% of the body, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should review which of the client's laboratory values? White blood cell (WBC) count The nurse is caring for a client who tests positive for the sexually transmitted infection (STI) gonorrhea. The client reports having sex with someone who has many partners. Which re- sponse should the nurse provide? Teach importance of medication regimen and follow-up protocol. The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compro- mised peripheral arterial circulation of the lower extremity? Uneven hair distribution (c) The nurse reviews discharge instructions with a client who has gastroesophageal reflex disease (GERD). Which instruction is most important for the nurse to emphasize? Remain upright following meals What dietary instruction is most important for the nurse to explain to a client who has had gastric bypass surgery? Eat small frequent meals A client with psoriasis returns to the clinic reporting the per- sistence of several silvery, scaly areas on the elbows and palms that frequently burn and sometimes blood. Which prescription should the nurse teach the client to use for the skin condition? Topical corticosteroids. A client receives a prescription for 3 liters of lactated Ringer's IV to infuse over 24 hours. How many mL/hr should the nurse program the infusion pump? (Enter numerical value only.) 125 mL/hr To calculate the infusion rate in mL/hr, you would convert the total volume of lactated Ringer's IV from liters to milliliters (since there are 1,000 milliliters in a liter, 3 liters is equivalent to 3,000 milliliters) and then divide by the total number of hours over which the infusion is to be administered. In this case, 3,000 mL divided by 24 hours results in an infusion rate of 125 mL/hr. A college student comes to the school's health clinic troubled by urinary frequency and burning with right lower back pain. Which intervention should the nurse implement first? Measure the temperature and pulse rate. The nurse is caring for a client who reports a sudden, severe headache, and facial numbness. The nurse asks the client to smile and observes an uneven smile with facial drop to the right side and a hand grasp strength that is weaker on the right than the left. The client denies a recent history of headaches or trauma. Which intervention should the nurse perform in the immediate management of the client? Start two large-bore IV catheters and review inclusion criteria for IV fibrinolytic therapy. Which findings during the admission assessment should the nurse document that are related to a client diagnosed with Cush- ing's syndrome? Central type obesity, with the extremeties. (c) A client who works as a data entry clerk is concerned as to how a recent diagnosis of Raynaud's syndrome is going to affect the client's job performance. Which instruction should the nurse provide this client? Obtain a keyboard designed to limit wrist flexion. A client receives a prescription for 1 L of lactated Ringers to be infused IV over 8 hours. The IV administration set delivers 15 gtt/mL. How many mL/hr should the nurse program the infusion pump to deliver? (Enter numerical values only.) - 125mL/hr Step 1 is to convert the volume of the prescription from liters to milliliters. 1 liter is equal to 1000 mL. So, the prescription is for 1000 mL of lactated Ringer's. Step 2 is to divide the total volume by the total time. The prescrip- tion is to be infused over 8 hours. So, 1000 mL ÷ 8 hours = 125 mL/hr. Therefore, the nurse should program the infusion pump to deliver 125 mL/hr. A client who has colon surgery 3 days ago is anxious and requesting assistance to reposition. While the nurse is turning the client, the dehiscences and eviscerates. The nurse moistens an available sterile dressing and places it over the wound. What intervention should the nurse implement next? Prepare the client to return to the operating room. (c) A client with bilateral carpal tunnel syndrome reports to the nurse that the pain and tingling experienced worsens at night. Which client teaching should the nurse provide? Wear braces on both wrists during the night (c) A client with stage IV bone cancer is admitted to the hospital for pain control. The client verbalizes continuous, severe pain of 8 on a 0 to 10 scale. Which intervention should the nurse implement? Administer opioid and non-opioid medications simultaneously (c) Methotrexate is prescibed for a client with rheumatoid arthritis (RA) who is also taking aspirin. Which is the best explanation the nurse to provide as to why a second medication has been added? Methotrexate slows the disease progression while aspirin controls the symptoms. While caring for a client with amyotrophic lateral sclerosis (ALS), the nurse performs a neurological assessment every four hours. Which assessment finding warrants immediate intervention by the nurse? Weakened cough effort. A client arrives to the medical-surgical unit 4 hours after a transurethral resection of the prostate (TURP). A triple lumen catheter for continuous bladder irrigation with 0.9% sodium chlo- ride is infusing and the nurse observes dark, pink-tinged outflow with blood clots in the tubing and collection bag. Which action should the nurse take? Monitor catheter drainage. The nurse is caring for a client after a coronary artery bypass graft surgery. The client is exhibiting pitting edema of the lower extremities and jugular venous distention with increased centrel venous pressure. Which condition should the nurse suspect the client is experiencing based on these findings? Right-sided heart failure. When conducting discharge teaching for a client diagnosed with diverticulosis, which diet instruction should the nurse in- clude? Eat a high fiber diet and increase fluid intake.