BSN HESI 266 MED SURG EXAM –QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
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Core Domains:
- Fluid, Electrolyte, and Acid-Base Imbalances
- Cardiovascular and Peripheral Vascular Disorders
- Respiratory and Ventilatory Support Management
- Gastrointestinal, Hepatic, and Pancreatic Disorders
- Renal, Urinary, and Genitourinary Systems
- Neurological and Sensory Alterations
- Endocrine and Metabolic Regulations
- Musculoskeletal and Integumentary Systems
- Perioperative Care and Patient Safety Standards
- Hematological and Immunological Disorders
Introduction:
The BSN HESI 266 Medical-Surgical Examination is a comprehensive assessment tool designed to evaluate the clinical competence, safe practice,
and critical decision-making skills of baccalaureate-level nursing students. This exam measures the synthesis of foundational pathophysiological
theory, nursing care planning, evidence-based interventions, and regulatory compliance across diverse adult patient populations. Utilizing multiple-
choice and complex scenario-based inquiries, the assessment emphasizes real-world application, prioritization, and ethical accountability.
Candidates must demonstrate proficiency in analyzing diagnostic data, managing acute and chronic alterations in health, and implementing
collaborative care strategies essential for transitioning into professional nursing practice as an effective healthcare provider.
Section One: Questions 1–100
1. A nurse is assessing a patient who is 4 hours postoperative following a subtotal thyroidectomy. The patient reports numbness and tingling
around the mouth and in the fingertips. Which action should the nurse take first?
A. Check the patient's serum potassium level.
B. Obtain an order for an oral calcium supplement.
C. Assess for Trousseau's or Chvostek's sign.
D. Administer an intravenous bolus of normal saline.
🟢 C. Assess for Trousseau's or Chvostek's sign.
🔴 RATIONALE: Hypocalcemia is a potential complication of a thyroidectomy due to accidental damage or removal of the parathyroid glands.
Numbness and tingling around the mouth and fingertips are early signs of neuromuscular hyperexcitabilty. The nurse must assess for latent tetany
using Trousseau's or Chvostek's signs before implementing interventions.
, 2. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory distress. The oxygen saturation is
86% on room air. Which oxygen delivery method should the nurse initiate first to provide a precise, low-to-moderate concentration of oxygen?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28%
C. Simple face mask at 6 L/min
D. Nasal cannula at 6 L/min
🟢 B. Venturi mask at 28%
🔴 RATIONALE: The Venturi mask is the most accurate device for delivering fixed, precise concentrations of oxygen, which is essential for patients
with COPD who rely on a hypoxic drive to breathe. High concentrations can depress their respiratory drive.
3. The nurse is caring for a patient who is receiving a continuous intravenous infusion of heparin for a deep vein thrombosis. The patient's
activated partial thromboplastin time (aPTT) is 110 seconds. The control value is 30 seconds. Which action should the nurse take
immediately?
A. Stop the infusion and prepare to administer protamine sulfate.
B. Decrease the heparin infusion rate by 100 units per hour.
C. Continue the infusion and recheck the aPTT in 4 hours.
D. Document the finding as a therapeutic level.
🟢 A. Stop the infusion and prepare to administer protamine sulfate.
🔴 RATIONALE: A therapeutic aPTT level is typically 1.5 to 2.5 times the control value (45 to 75 seconds). An aPTT of 110 seconds is significantly
elevated above the therapeutic range, putting the patient at critical risk for severe bleeding. The infusion must be stopped and the antidote,
protamine sulfate, prepared.
4. A nurse is preparing to administer blood to a patient. Which verification action is required by professional standards and regulatory guidelines
to prevent a hemolytic transfusion reaction?
A. Verify the patient's identity with one identifier and check the blood type on the bag alone.
B. Have two licensed nurses independently verify the patient's identity, blood component type, and compatibility data.
C. Check the patient's wristband against the medical chart without another staff member present.
D. Confirm the patient's room number and bed number match the blood product tag.
🟢 B. Have two licensed nurses independently verify the patient's identity, blood component type, and compatibility data.
🔴 RATIONALE: Joint Commission and professional nursing standards require a dual verification process by two licensed professionals at the
bedside before administering blood products to prevent catastrophic clerical errors and ABO incompatibility reactions.
, 5. A patient with type 1 diabetes mellitus presents to the emergency department with a blood glucose level of 480 mg/dL, positive serum
ketones, and arterial blood gas results showing metabolic acidosis. Which intravenous fluid should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.9% Sodium Chloride
C. 5% Dextrose in Water
D. Lactated Ringer's solution
🟢 B. 0.9% Sodium Chloride
🔴 RATIONALE: In diabetic ketoacidosis (DKA), the initial therapeutic priority is rehydration to restore extracellular fluid volume and stabilize
perfusion. 0.9% Sodium Chloride (normal saline) is the isotonic fluid of choice for initial fluid resuscitation. Dextrose is added only after blood glucose
levels drop to around 250 mg/dL.
6. While assessing a patient with a chest tube inserted for a pneumothorax, the nurse notes continuous, vigorous bubbling in the water-seal
chamber. How should the nurse interpret this finding?
A. This is a normal, expected finding indicating system patency.
B. The pneumothorax has completely resolved.
C. There is a leak somewhere within the drainage system or at the insertion site.
D. The suction pressure on the wall regulator is set too high.
🟢 C. There is a leak somewhere within the drainage system or at the insertion site.
🔴 RATIONALE: Intermittent bubbling in the water-seal chamber is normal during exhalation or coughing with a pneumothorax. However,
continuous, rapid bubbling indicates a persistent air leak in the chest tube system or connections, requiring immediate troubleshooting.
7. A patient is admitted to the medical unit with an exacerbation of right-sided heart failure. Which clinical manifestation should the nurse expect
to find during the physical assessment?
A. Pulmonary crackles and wheezes
B. Dyspnea and orthopnea
C. Jugular venous distention and peripheral edema
D. Pink, frothy sputum production
🟢 C. Jugular venous distention and peripheral edema
🔴 RATIONALE: Right-sided heart failure leads to systemic venous congestion, causing manifestations such as jugular venous distention,
dependent peripheral edema, hepatomegaly, and ascites. Pulmonary symptoms are classic indicators of left-sided heart failure.
8. The nurse is caring for a patient who is 12 hours postoperative following an abdominal hysterectomy. The patient has a prescription for PCA
morphine. The nurse notes the patient's respiratory rate is 8 breaths/minute and they are difficult to arouse. Which action should the nurse
, execute immediately?
A. Stop the PCA pump and administer naloxone intravenously as prescribed.
B. Increase the primary intravenous fluid rate to flush the medication.
C. Stimulate the patient and encourage deep breathing exercises.
D. Obtain a 12-lead electrocardiogram.
🟢 A. Stop the PCA pump and administer naloxone intravenously as prescribed.
🔴 RATIONALE: A respiratory rate below 10 breaths/minute combined with altered consciousness indicates severe opioid-induced respiratory
depression. The nurse must immediately halt the opioid delivery and administer the opioid antagonist, naloxone.
9. An older adult patient is admitted with a diagnosis of acute pyelonephritis. Which atypical clinical manifestation should the nurse anticipate
observing in an older adult patient compared to a younger adult?
A. High spiking fevers and severe chills
B. Altered mental status and confusion
C. Acute flank pain radiating to the groin
D. Burning on urination with gross hematuria
🟢 B. Altered mental status and confusion
🔴 RATIONALE: Older adults frequently present with atypical symptoms of infections like pyelonephritis or urinary tract infections. Instead of classic
signs like high fevers and localized pain, they often display acute confusion, delirium, or a decline in functional baseline.
10. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which provider prescription should the nurse
implement first to protect the patient from life-threatening cardiac arrhythmias?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate
C. Continuous nebulized albuterol
D. Intravenous regular insulin and dextrose
🟢 B. Intravenous calcium gluconate
🔴 RATIONALE: While insulin/dextrose and sodium polystyrene sulfonate help lower serum potassium levels, intravenous calcium gluconate does
not lower potassium but immediately stabilizes the myocardial cell membrane, reducing the risk of lethal dysrhythmias. It is the priority action for
severe hyperkalemia with cardiac risks.
11. The nurse is preparing a patient for an scheduled colonoscopy. Which pre-procedural instruction is accurate and critical for patient safety and
diagnostic success?
DOWNLOAD PDF.
Core Domains:
- Fluid, Electrolyte, and Acid-Base Imbalances
- Cardiovascular and Peripheral Vascular Disorders
- Respiratory and Ventilatory Support Management
- Gastrointestinal, Hepatic, and Pancreatic Disorders
- Renal, Urinary, and Genitourinary Systems
- Neurological and Sensory Alterations
- Endocrine and Metabolic Regulations
- Musculoskeletal and Integumentary Systems
- Perioperative Care and Patient Safety Standards
- Hematological and Immunological Disorders
Introduction:
The BSN HESI 266 Medical-Surgical Examination is a comprehensive assessment tool designed to evaluate the clinical competence, safe practice,
and critical decision-making skills of baccalaureate-level nursing students. This exam measures the synthesis of foundational pathophysiological
theory, nursing care planning, evidence-based interventions, and regulatory compliance across diverse adult patient populations. Utilizing multiple-
choice and complex scenario-based inquiries, the assessment emphasizes real-world application, prioritization, and ethical accountability.
Candidates must demonstrate proficiency in analyzing diagnostic data, managing acute and chronic alterations in health, and implementing
collaborative care strategies essential for transitioning into professional nursing practice as an effective healthcare provider.
Section One: Questions 1–100
1. A nurse is assessing a patient who is 4 hours postoperative following a subtotal thyroidectomy. The patient reports numbness and tingling
around the mouth and in the fingertips. Which action should the nurse take first?
A. Check the patient's serum potassium level.
B. Obtain an order for an oral calcium supplement.
C. Assess for Trousseau's or Chvostek's sign.
D. Administer an intravenous bolus of normal saline.
🟢 C. Assess for Trousseau's or Chvostek's sign.
🔴 RATIONALE: Hypocalcemia is a potential complication of a thyroidectomy due to accidental damage or removal of the parathyroid glands.
Numbness and tingling around the mouth and fingertips are early signs of neuromuscular hyperexcitabilty. The nurse must assess for latent tetany
using Trousseau's or Chvostek's signs before implementing interventions.
, 2. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory distress. The oxygen saturation is
86% on room air. Which oxygen delivery method should the nurse initiate first to provide a precise, low-to-moderate concentration of oxygen?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28%
C. Simple face mask at 6 L/min
D. Nasal cannula at 6 L/min
🟢 B. Venturi mask at 28%
🔴 RATIONALE: The Venturi mask is the most accurate device for delivering fixed, precise concentrations of oxygen, which is essential for patients
with COPD who rely on a hypoxic drive to breathe. High concentrations can depress their respiratory drive.
3. The nurse is caring for a patient who is receiving a continuous intravenous infusion of heparin for a deep vein thrombosis. The patient's
activated partial thromboplastin time (aPTT) is 110 seconds. The control value is 30 seconds. Which action should the nurse take
immediately?
A. Stop the infusion and prepare to administer protamine sulfate.
B. Decrease the heparin infusion rate by 100 units per hour.
C. Continue the infusion and recheck the aPTT in 4 hours.
D. Document the finding as a therapeutic level.
🟢 A. Stop the infusion and prepare to administer protamine sulfate.
🔴 RATIONALE: A therapeutic aPTT level is typically 1.5 to 2.5 times the control value (45 to 75 seconds). An aPTT of 110 seconds is significantly
elevated above the therapeutic range, putting the patient at critical risk for severe bleeding. The infusion must be stopped and the antidote,
protamine sulfate, prepared.
4. A nurse is preparing to administer blood to a patient. Which verification action is required by professional standards and regulatory guidelines
to prevent a hemolytic transfusion reaction?
A. Verify the patient's identity with one identifier and check the blood type on the bag alone.
B. Have two licensed nurses independently verify the patient's identity, blood component type, and compatibility data.
C. Check the patient's wristband against the medical chart without another staff member present.
D. Confirm the patient's room number and bed number match the blood product tag.
🟢 B. Have two licensed nurses independently verify the patient's identity, blood component type, and compatibility data.
🔴 RATIONALE: Joint Commission and professional nursing standards require a dual verification process by two licensed professionals at the
bedside before administering blood products to prevent catastrophic clerical errors and ABO incompatibility reactions.
, 5. A patient with type 1 diabetes mellitus presents to the emergency department with a blood glucose level of 480 mg/dL, positive serum
ketones, and arterial blood gas results showing metabolic acidosis. Which intravenous fluid should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.9% Sodium Chloride
C. 5% Dextrose in Water
D. Lactated Ringer's solution
🟢 B. 0.9% Sodium Chloride
🔴 RATIONALE: In diabetic ketoacidosis (DKA), the initial therapeutic priority is rehydration to restore extracellular fluid volume and stabilize
perfusion. 0.9% Sodium Chloride (normal saline) is the isotonic fluid of choice for initial fluid resuscitation. Dextrose is added only after blood glucose
levels drop to around 250 mg/dL.
6. While assessing a patient with a chest tube inserted for a pneumothorax, the nurse notes continuous, vigorous bubbling in the water-seal
chamber. How should the nurse interpret this finding?
A. This is a normal, expected finding indicating system patency.
B. The pneumothorax has completely resolved.
C. There is a leak somewhere within the drainage system or at the insertion site.
D. The suction pressure on the wall regulator is set too high.
🟢 C. There is a leak somewhere within the drainage system or at the insertion site.
🔴 RATIONALE: Intermittent bubbling in the water-seal chamber is normal during exhalation or coughing with a pneumothorax. However,
continuous, rapid bubbling indicates a persistent air leak in the chest tube system or connections, requiring immediate troubleshooting.
7. A patient is admitted to the medical unit with an exacerbation of right-sided heart failure. Which clinical manifestation should the nurse expect
to find during the physical assessment?
A. Pulmonary crackles and wheezes
B. Dyspnea and orthopnea
C. Jugular venous distention and peripheral edema
D. Pink, frothy sputum production
🟢 C. Jugular venous distention and peripheral edema
🔴 RATIONALE: Right-sided heart failure leads to systemic venous congestion, causing manifestations such as jugular venous distention,
dependent peripheral edema, hepatomegaly, and ascites. Pulmonary symptoms are classic indicators of left-sided heart failure.
8. The nurse is caring for a patient who is 12 hours postoperative following an abdominal hysterectomy. The patient has a prescription for PCA
morphine. The nurse notes the patient's respiratory rate is 8 breaths/minute and they are difficult to arouse. Which action should the nurse
, execute immediately?
A. Stop the PCA pump and administer naloxone intravenously as prescribed.
B. Increase the primary intravenous fluid rate to flush the medication.
C. Stimulate the patient and encourage deep breathing exercises.
D. Obtain a 12-lead electrocardiogram.
🟢 A. Stop the PCA pump and administer naloxone intravenously as prescribed.
🔴 RATIONALE: A respiratory rate below 10 breaths/minute combined with altered consciousness indicates severe opioid-induced respiratory
depression. The nurse must immediately halt the opioid delivery and administer the opioid antagonist, naloxone.
9. An older adult patient is admitted with a diagnosis of acute pyelonephritis. Which atypical clinical manifestation should the nurse anticipate
observing in an older adult patient compared to a younger adult?
A. High spiking fevers and severe chills
B. Altered mental status and confusion
C. Acute flank pain radiating to the groin
D. Burning on urination with gross hematuria
🟢 B. Altered mental status and confusion
🔴 RATIONALE: Older adults frequently present with atypical symptoms of infections like pyelonephritis or urinary tract infections. Instead of classic
signs like high fevers and localized pain, they often display acute confusion, delirium, or a decline in functional baseline.
10. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which provider prescription should the nurse
implement first to protect the patient from life-threatening cardiac arrhythmias?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate
C. Continuous nebulized albuterol
D. Intravenous regular insulin and dextrose
🟢 B. Intravenous calcium gluconate
🔴 RATIONALE: While insulin/dextrose and sodium polystyrene sulfonate help lower serum potassium levels, intravenous calcium gluconate does
not lower potassium but immediately stabilizes the myocardial cell membrane, reducing the risk of lethal dysrhythmias. It is the priority action for
severe hyperkalemia with cardiac risks.
11. The nurse is preparing a patient for an scheduled colonoscopy. Which pre-procedural instruction is accurate and critical for patient safety and
diagnostic success?
