BSN HESI 266 Med Surg Exam (Latest
) Questions & Correct Answers
With Rationales, 100% Guaranteed Pass ||
Complete A+ Guide - Nightingale
Section 1: Cardiovascular Disorders
1. A client with heart failure (HF) presents with dyspnea at rest, crackles in both lung bases, and
jugular venous distension. Which medication does the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Spironolactone
Answer: B – Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving pulmonary congestion.
Digoxin and spironolactone are used for chronic management; metoprolol is started only after the
patient is stable.
2. A client with atrial fibrillation is prescribed warfarin. Which instruction is most important to
include?
A. “Take ibuprofen for minor pain.”
B. “Avoid eating large amounts of green leafy vegetables.”
C. “Increase your intake of vitamin K-rich foods.”
D. “Take warfarin at different times each day.”
Answer: B – Avoid eating large amounts of green leafy vegetables
Rationale: Green leafy vegetables contain vitamin K, which antagonizes warfarin’s effects. Consistent
vitamin K intake is key; avoiding large amounts prevents INR fluctuations.
3. A client post–cardiac catheterization has a femoral sheath in place. Which finding requires
immediate action?
A. Pulse oximetry 95%
B. Urine output 60 mL in 2 hours
C. Expanding right groin hematoma
D. Complaints of mild back pain
, Answer: C – Expanding right groin hematoma
Rationale: An expanding hematoma suggests bleeding at the puncture site, which can lead to
retroperitoneal bleeding and hemodynamic instability. The provider must be notified immediately.
Section 2: Respiratory Disorders
4. A client with COPD has an oxygen saturation of 86% on room air. Which oxygen delivery method
is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2–3 L/min
C. Venturi mask at 50% FiO2
D. Simple face mask at 6 L/min
Answer: B – Nasal cannula at 2–3 L/min
*Rationale: COPD clients rely on hypoxic drive; low-flow oxygen (2–3 L/min) prevents hypercapnia
while improving oxygenation. A Venturi mask is used for precise FiO2 but is not first-line for mild
hypoxemia in COPD.*
5. A client with a pulmonary embolism is on heparin drip. Which lab value indicates therapeutic
anticoagulation?
A. INR 2.0
B. aPTT 60 seconds (control 30 seconds)
C. Platelets 50,000/μL
D. Hemoglobin 10 g/dL
Answer: B – aPTT 60 seconds (control 30 seconds)
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times control. INR monitors warfarin, not heparin.
6. A client with pneumonia has a new onset of confusion and blood pressure 88/52 mmHg. Which
action should the nurse take first?
A. Notify the rapid response team.
B. Increase oxygen to 10 L/min via mask.
C. Administer IV antibiotics.
D. Recheck blood pressure in 15 minutes.
Answer: A – Notify the rapid response team
Rationale: Confusion + hypotension in pneumonia suggests sepsis/septic shock. Rapid response/ICU
involvement is critical. Antibiotics and oxygen are important but after activating help.
Section 3: Endocrine Disorders
7. A client with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL and potassium of 3.2
mEq/L. Which IV order is most appropriate?
A. Regular insulin IV bolus then dextrose 5% with KCl
B. 0.9% NS with regular insulin at 0.1 U/kg/hour and KCl
) Questions & Correct Answers
With Rationales, 100% Guaranteed Pass ||
Complete A+ Guide - Nightingale
Section 1: Cardiovascular Disorders
1. A client with heart failure (HF) presents with dyspnea at rest, crackles in both lung bases, and
jugular venous distension. Which medication does the nurse anticipate administering first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Spironolactone
Answer: B – Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving pulmonary congestion.
Digoxin and spironolactone are used for chronic management; metoprolol is started only after the
patient is stable.
2. A client with atrial fibrillation is prescribed warfarin. Which instruction is most important to
include?
A. “Take ibuprofen for minor pain.”
B. “Avoid eating large amounts of green leafy vegetables.”
C. “Increase your intake of vitamin K-rich foods.”
D. “Take warfarin at different times each day.”
Answer: B – Avoid eating large amounts of green leafy vegetables
Rationale: Green leafy vegetables contain vitamin K, which antagonizes warfarin’s effects. Consistent
vitamin K intake is key; avoiding large amounts prevents INR fluctuations.
3. A client post–cardiac catheterization has a femoral sheath in place. Which finding requires
immediate action?
A. Pulse oximetry 95%
B. Urine output 60 mL in 2 hours
C. Expanding right groin hematoma
D. Complaints of mild back pain
, Answer: C – Expanding right groin hematoma
Rationale: An expanding hematoma suggests bleeding at the puncture site, which can lead to
retroperitoneal bleeding and hemodynamic instability. The provider must be notified immediately.
Section 2: Respiratory Disorders
4. A client with COPD has an oxygen saturation of 86% on room air. Which oxygen delivery method
is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2–3 L/min
C. Venturi mask at 50% FiO2
D. Simple face mask at 6 L/min
Answer: B – Nasal cannula at 2–3 L/min
*Rationale: COPD clients rely on hypoxic drive; low-flow oxygen (2–3 L/min) prevents hypercapnia
while improving oxygenation. A Venturi mask is used for precise FiO2 but is not first-line for mild
hypoxemia in COPD.*
5. A client with a pulmonary embolism is on heparin drip. Which lab value indicates therapeutic
anticoagulation?
A. INR 2.0
B. aPTT 60 seconds (control 30 seconds)
C. Platelets 50,000/μL
D. Hemoglobin 10 g/dL
Answer: B – aPTT 60 seconds (control 30 seconds)
Rationale: Therapeutic aPTT for heparin is 1.5–2.5 times control. INR monitors warfarin, not heparin.
6. A client with pneumonia has a new onset of confusion and blood pressure 88/52 mmHg. Which
action should the nurse take first?
A. Notify the rapid response team.
B. Increase oxygen to 10 L/min via mask.
C. Administer IV antibiotics.
D. Recheck blood pressure in 15 minutes.
Answer: A – Notify the rapid response team
Rationale: Confusion + hypotension in pneumonia suggests sepsis/septic shock. Rapid response/ICU
involvement is critical. Antibiotics and oxygen are important but after activating help.
Section 3: Endocrine Disorders
7. A client with diabetic ketoacidosis (DKA) has a blood glucose of 480 mg/dL and potassium of 3.2
mEq/L. Which IV order is most appropriate?
A. Regular insulin IV bolus then dextrose 5% with KCl
B. 0.9% NS with regular insulin at 0.1 U/kg/hour and KCl
