BSN 366 HESI RN Exit Exam V3 (2025/2026) Questions and
100% Verified Answers
Medical-Surgical Nursing
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse
monitor most closely?
A) Potassium 3.0 mEq/L
B) Sodium 140 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mg/dL
Answer: A) Potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in
the distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common and dangerous
electrolyte imbalance associated with loop diuretics because it can precipitate cardiac dysrhythmias.
The nurse should monitor potassium levels closely and assess for signs of hypokalemia including
muscle weakness, fatigue, and cardiac irregularities.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest
pain. What is the nurse's priority action?
A) Administer prescribed PRN oxygen
B) Elevate the head of the bed
C) Call the rapid response team
D) Apply sequential compression devices
Answer: C) Call the rapid response team
,Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency. The nurse should
immediately call the rapid response team because PE requires urgent medical intervention including
potential thrombolytic therapy or anticoagulation. While administering oxygen and elevating the
head of the bed are supportive measures, the priority is to activate the emergency response so that
definitive treatment can begin without delay.
3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is
most important for the nurse to include in discharge teaching?
A) Take the medication on an empty stomach
B) Avoid consuming alcohol while taking this medication
C) Expect to gain weight with this medication
D) Monitor for signs of hyperglycemia only
Answer: B) Avoid consuming alcohol while taking this medication
Rationale: The most critical instruction for a client taking metformin is to avoid alcohol. Metformin
increases the risk of lactic acidosis, a rare but potentially fatal condition, and alcohol consumption
further increases this risk because both metformin and alcohol affect hepatic metabolism. Metformin
should be taken with meals to reduce gastrointestinal side effects. Unlike insulin or sulfonylureas,
metformin does not typically cause weight gain and may actually promote modest weight loss.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via nasal
cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per minute.
What is the nurse's priority action?
A) Increase the oxygen flow rate
B) Decrease the oxygen flow rate
C) Document the findings and continue monitoring
D) Prepare for endotracheal intubation
Answer: B) Decrease the oxygen flow rate
,Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also known
as CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations. Administering
high concentrations of oxygen eliminates this stimulus, causing decreased respiratory effort and CO2
retention. The priority action is to decrease the oxygen flow rate to the lowest level that maintains
adequate oxygenation (typically 1-2 L/min). Increasing oxygen would worsen the condition.
5. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor
for which adverse effect?
A) Hypertension
B) Bleeding
C) Constipation
D) Urinary retention
Answer: B) Bleeding
Rationale: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of
antithrombin III. The primary adverse effect of heparin therapy is bleeding, which can range from
minor bruising to life-threatening hemorrhage. The nurse should monitor for signs of bleeding
including hematuria, melena, petechiae, ecchymosis, prolonged bleeding from puncture sites, and
changes in vital signs such as hypotension and tachycardia. The aPTT should be monitored regularly
to ensure therapeutic levels are maintained.
6. A client who has been taking corticosteroids for 2 months for treatment of COPD has a new
prescription to discontinue the medication. Which instruction should the nurse provide?
A) The medication can be stopped immediately
B) Take the medication with an antacid at bedtime
C) The dose must be tapered slowly over 1-2 weeks
D) Expect symptoms to improve within 24 hours
Answer: C) The dose must be tapered slowly over 1-2 weeks
Rationale: Corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis, and
abrupt discontinuation can cause adrenal crisis, a life-threatening condition characterized by
, hypotension, shock, and death. The client must be instructed to taper the medication gradually under
medical supervision. Corticosteroids should be taken with food to reduce GI irritation. They cause
potassium wasting, not retention, so the client may need to increase potassium-rich foods.
7. A client with cirrhosis develops ascites. Which dietary modification is most appropriate?
A) Increase protein intake to 120 g/day
B) Restrict sodium intake to 2 g per day
C) Increase fluid intake to 3 L per day
D) Add potassium-rich foods to the diet
Answer: B) Restrict sodium intake to 2 g per day
Rationale: Ascites in cirrhosis is primarily caused by portal hypertension and sodium retention.
Sodium restriction to 2 g per day is the first-line dietary intervention to reduce fluid accumulation.
Diuretics such as spironolactone may also be prescribed. While protein restrictions were previously
recommended for hepatic encephalopathy, current guidelines support adequate protein intake (1-1.5
g/kg/day) to prevent malnutrition. Fluid restriction is typically not required unless the serum sodium
is below 120 mEq/L.
8. A client receiving chemotherapy develops stomatitis. Which intervention should the nurse include
in the plan of care?
A) Provide mouth care with commercial mouthwash
B) Encourage consumption of hot, spicy foods
C) Recommend a soft-bristled toothbrush for oral hygiene
D) Limit oral fluid intake to reduce discomfort
Answer: C) Recommend a soft-bristled toothbrush for oral hygiene
Rationale: Stomatitis, or inflammation of the oral mucosa, is a common side effect of chemotherapy.
The nurse should recommend using a soft-bristled toothbrush to minimize trauma to the oral mucosa.
Commercial mouthwashes often contain alcohol which can further irritate inflamed tissues. Hot, spicy,
and acidic foods should be avoided. Adequate hydration is important, so fluids should be encouraged,
not limited.
100% Verified Answers
Medical-Surgical Nursing
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse
monitor most closely?
A) Potassium 3.0 mEq/L
B) Sodium 140 mEq/L
C) Calcium 9.5 mg/dL
D) Magnesium 2.0 mg/dL
Answer: A) Potassium 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in
the distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common and dangerous
electrolyte imbalance associated with loop diuretics because it can precipitate cardiac dysrhythmias.
The nurse should monitor potassium levels closely and assess for signs of hypokalemia including
muscle weakness, fatigue, and cardiac irregularities.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest
pain. What is the nurse's priority action?
A) Administer prescribed PRN oxygen
B) Elevate the head of the bed
C) Call the rapid response team
D) Apply sequential compression devices
Answer: C) Call the rapid response team
,Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency. The nurse should
immediately call the rapid response team because PE requires urgent medical intervention including
potential thrombolytic therapy or anticoagulation. While administering oxygen and elevating the
head of the bed are supportive measures, the priority is to activate the emergency response so that
definitive treatment can begin without delay.
3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is
most important for the nurse to include in discharge teaching?
A) Take the medication on an empty stomach
B) Avoid consuming alcohol while taking this medication
C) Expect to gain weight with this medication
D) Monitor for signs of hyperglycemia only
Answer: B) Avoid consuming alcohol while taking this medication
Rationale: The most critical instruction for a client taking metformin is to avoid alcohol. Metformin
increases the risk of lactic acidosis, a rare but potentially fatal condition, and alcohol consumption
further increases this risk because both metformin and alcohol affect hepatic metabolism. Metformin
should be taken with meals to reduce gastrointestinal side effects. Unlike insulin or sulfonylureas,
metformin does not typically cause weight gain and may actually promote modest weight loss.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via nasal
cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per minute.
What is the nurse's priority action?
A) Increase the oxygen flow rate
B) Decrease the oxygen flow rate
C) Document the findings and continue monitoring
D) Prepare for endotracheal intubation
Answer: B) Decrease the oxygen flow rate
,Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also known
as CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations. Administering
high concentrations of oxygen eliminates this stimulus, causing decreased respiratory effort and CO2
retention. The priority action is to decrease the oxygen flow rate to the lowest level that maintains
adequate oxygenation (typically 1-2 L/min). Increasing oxygen would worsen the condition.
5. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor
for which adverse effect?
A) Hypertension
B) Bleeding
C) Constipation
D) Urinary retention
Answer: B) Bleeding
Rationale: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of
antithrombin III. The primary adverse effect of heparin therapy is bleeding, which can range from
minor bruising to life-threatening hemorrhage. The nurse should monitor for signs of bleeding
including hematuria, melena, petechiae, ecchymosis, prolonged bleeding from puncture sites, and
changes in vital signs such as hypotension and tachycardia. The aPTT should be monitored regularly
to ensure therapeutic levels are maintained.
6. A client who has been taking corticosteroids for 2 months for treatment of COPD has a new
prescription to discontinue the medication. Which instruction should the nurse provide?
A) The medication can be stopped immediately
B) Take the medication with an antacid at bedtime
C) The dose must be tapered slowly over 1-2 weeks
D) Expect symptoms to improve within 24 hours
Answer: C) The dose must be tapered slowly over 1-2 weeks
Rationale: Corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis, and
abrupt discontinuation can cause adrenal crisis, a life-threatening condition characterized by
, hypotension, shock, and death. The client must be instructed to taper the medication gradually under
medical supervision. Corticosteroids should be taken with food to reduce GI irritation. They cause
potassium wasting, not retention, so the client may need to increase potassium-rich foods.
7. A client with cirrhosis develops ascites. Which dietary modification is most appropriate?
A) Increase protein intake to 120 g/day
B) Restrict sodium intake to 2 g per day
C) Increase fluid intake to 3 L per day
D) Add potassium-rich foods to the diet
Answer: B) Restrict sodium intake to 2 g per day
Rationale: Ascites in cirrhosis is primarily caused by portal hypertension and sodium retention.
Sodium restriction to 2 g per day is the first-line dietary intervention to reduce fluid accumulation.
Diuretics such as spironolactone may also be prescribed. While protein restrictions were previously
recommended for hepatic encephalopathy, current guidelines support adequate protein intake (1-1.5
g/kg/day) to prevent malnutrition. Fluid restriction is typically not required unless the serum sodium
is below 120 mEq/L.
8. A client receiving chemotherapy develops stomatitis. Which intervention should the nurse include
in the plan of care?
A) Provide mouth care with commercial mouthwash
B) Encourage consumption of hot, spicy foods
C) Recommend a soft-bristled toothbrush for oral hygiene
D) Limit oral fluid intake to reduce discomfort
Answer: C) Recommend a soft-bristled toothbrush for oral hygiene
Rationale: Stomatitis, or inflammation of the oral mucosa, is a common side effect of chemotherapy.
The nurse should recommend using a soft-bristled toothbrush to minimize trauma to the oral mucosa.
Commercial mouthwashes often contain alcohol which can further irritate inflamed tissues. Hot, spicy,
and acidic foods should be avoided. Adequate hydration is important, so fluids should be encouraged,
not limited.
