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BSN HESI 266 MED-SURG EXAM BANK (2026–2027) – 200 VERIFIED QUESTIONS,
ANSWERS & RATIONALES | UPDATED & GRADED A+
1. A nurse is caring for a client with COPD who is receiving oxygen therapy at 4
L/min via nasal cannula. Which action should the nurse take first?
A) Encourage coughing and deep breathing
B) Lower the oxygen flow rate to 2 L/min
C) Notify the healthcare provider
D) Assess the client’s respiratory status and SpO₂
Correct Answer: D
Rationale: Always assess first. High O₂ can suppress hypoxic drive, but assessment
determines whether oxygen should be titrated.
2. Which lab result is most important to monitor for a client receiving IV
furosemide?
A) Sodium
B) Potassium
C) Calcium
D) Glucose
Correct Answer: B
Rationale: Furosemide (a loop diuretic) causes potassium loss, leading to
hypokalemia and possible dysrhythmias.
3. A client post-thyroidectomy reports tingling in fingers and around lips. What
should the nurse do?
A) Check the client’s incision
B) Obtain a blood glucose level
C) Check for Chvostek’s sign
D) Reassure the client this is expected
Correct Answer: C
Rationale: Tingling can indicate hypocalcemia from accidental parathyroid
removal. Chvostek’s sign confirms tetany.
4. A client with cirrhosis is at risk for hepatic encephalopathy. Which dietary
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modification is most appropriate?
A) Increase protein intake
B) Reduce sodium intake
C) Increase potassium intake
D) Restrict protein intake
Correct Answer: D
Rationale: High protein increases ammonia levels, worsening encephalopathy.
Protein restriction helps manage symptoms.
5. Which assessment finding indicates left-sided heart failure?
A) Peripheral edema
B) Jugular vein distention
C) Crackles in lung bases
D) Hepatomegaly
Correct Answer: C
Rationale: Left-sided failure causes pulmonary congestion, leading to crackles,
dyspnea, and orthopnea.
6. The nurse is preparing to administer digoxin. Which assessment is most
important?
A) Apical pulse for 1 full minute
B) Respiratory rate
C) Bowel sounds
D) Oxygen saturation
Correct Answer: A
Rationale: Digoxin slows AV node conduction. Hold if apical pulse <60 bpm to
prevent severe bradycardia.
7. A client has a blood glucose of 40 mg/dL. Which action is priority?
A) Administer 50% dextrose IV
B) Give 8 oz skim milk
C) Recheck blood glucose
D) Call the provider
Correct Answer: A
Rationale: Severe hypoglycemia (<50 mg/dL) requires immediate IV dextrose for
rapid correction.
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8. A nurse is caring for a client with a chest tube. The water-seal chamber shows
continuous bubbling. What should the nurse suspect?
A) Normal finding
B) Air leak
C) Chest tube blockage
D) Pleural effusion resolving
Correct Answer: B
Rationale: Continuous bubbling indicates an air leak; should be investigated to
prevent loss of negative pressure.
9. Which client is at highest risk for developing a pulmonary embolism?
A) Post-hip replacement surgery client
B) Client with pneumonia
C) Client with asthma
D) Client with pancreatitis
Correct Answer: A
Rationale: Post-orthopedic surgery + immobility increases DVT risk, which can
lead to pulmonary embolism.
10. A client is receiving heparin infusion. Which lab value requires immediate
intervention?
A) Platelets 180,000
B) aPTT 75 sec
C) Hemoglobin 10.8 g/dL
D) Platelets 45,000
Correct Answer: D
Rationale: Platelets <50,000 suggest HIT (heparin-induced thrombocytopenia).
Stop heparin immediately.
11. Which instruction should be included for a client with GERD?
A) Eat a large meal at bedtime
B) Elevate head of bed 30°
C) Drink citrus juice with meals
D) Wear tight-fitting clothing
Correct Answer: B
Rationale: Elevation reduces reflux by using gravity to keep stomach contents
from regurgitating.
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12. Which finding in a client with DKA indicates improvement?
A) Fruity breath odor
B) Blood glucose 450 mg/dL
C) pH 7.34
D) Kussmaul respirations
Correct Answer: C
Rationale: pH nearing normal (7.35–7.45) shows resolution of metabolic acidosis.
13. A client with acute pancreatitis should receive which initial management?
A) High-fat diet
B) NPO status with IV fluids
C) Oral antibiotics
D) Increase ambulation
Correct Answer: B
Rationale: NPO prevents pancreatic stimulation; fluids prevent hypovolemic
shock.
14. Which assessment is most concerning in a client with a blood transfusion
running for 10 minutes?
A) Mild back pain
B) Increased urine output
C) Slight elevation in BP
D) Feeling drowsy
Correct Answer: A
Rationale: Back/flank pain early in transfusion may indicate hemolytic reaction;
stop transfusion immediately.
15. Which nursing intervention is most important for a client with myasthenia
gravis?
A) Encourage fluids before meals
B) Group activities in evening
C) Administer anticholinesterase meds before meals
D) Provide soft, high-protein snacks
Correct Answer: C
Rationale: Meds given 30–60 min before meals optimize muscle strength for
chewing/swallowing.
BSN HESI 266 MED-SURG EXAM BANK (2026–2027) – 200 VERIFIED QUESTIONS,
ANSWERS & RATIONALES | UPDATED & GRADED A+
1. A nurse is caring for a client with COPD who is receiving oxygen therapy at 4
L/min via nasal cannula. Which action should the nurse take first?
A) Encourage coughing and deep breathing
B) Lower the oxygen flow rate to 2 L/min
C) Notify the healthcare provider
D) Assess the client’s respiratory status and SpO₂
Correct Answer: D
Rationale: Always assess first. High O₂ can suppress hypoxic drive, but assessment
determines whether oxygen should be titrated.
2. Which lab result is most important to monitor for a client receiving IV
furosemide?
A) Sodium
B) Potassium
C) Calcium
D) Glucose
Correct Answer: B
Rationale: Furosemide (a loop diuretic) causes potassium loss, leading to
hypokalemia and possible dysrhythmias.
3. A client post-thyroidectomy reports tingling in fingers and around lips. What
should the nurse do?
A) Check the client’s incision
B) Obtain a blood glucose level
C) Check for Chvostek’s sign
D) Reassure the client this is expected
Correct Answer: C
Rationale: Tingling can indicate hypocalcemia from accidental parathyroid
removal. Chvostek’s sign confirms tetany.
4. A client with cirrhosis is at risk for hepatic encephalopathy. Which dietary
,2|Page
modification is most appropriate?
A) Increase protein intake
B) Reduce sodium intake
C) Increase potassium intake
D) Restrict protein intake
Correct Answer: D
Rationale: High protein increases ammonia levels, worsening encephalopathy.
Protein restriction helps manage symptoms.
5. Which assessment finding indicates left-sided heart failure?
A) Peripheral edema
B) Jugular vein distention
C) Crackles in lung bases
D) Hepatomegaly
Correct Answer: C
Rationale: Left-sided failure causes pulmonary congestion, leading to crackles,
dyspnea, and orthopnea.
6. The nurse is preparing to administer digoxin. Which assessment is most
important?
A) Apical pulse for 1 full minute
B) Respiratory rate
C) Bowel sounds
D) Oxygen saturation
Correct Answer: A
Rationale: Digoxin slows AV node conduction. Hold if apical pulse <60 bpm to
prevent severe bradycardia.
7. A client has a blood glucose of 40 mg/dL. Which action is priority?
A) Administer 50% dextrose IV
B) Give 8 oz skim milk
C) Recheck blood glucose
D) Call the provider
Correct Answer: A
Rationale: Severe hypoglycemia (<50 mg/dL) requires immediate IV dextrose for
rapid correction.
,3|Page
8. A nurse is caring for a client with a chest tube. The water-seal chamber shows
continuous bubbling. What should the nurse suspect?
A) Normal finding
B) Air leak
C) Chest tube blockage
D) Pleural effusion resolving
Correct Answer: B
Rationale: Continuous bubbling indicates an air leak; should be investigated to
prevent loss of negative pressure.
9. Which client is at highest risk for developing a pulmonary embolism?
A) Post-hip replacement surgery client
B) Client with pneumonia
C) Client with asthma
D) Client with pancreatitis
Correct Answer: A
Rationale: Post-orthopedic surgery + immobility increases DVT risk, which can
lead to pulmonary embolism.
10. A client is receiving heparin infusion. Which lab value requires immediate
intervention?
A) Platelets 180,000
B) aPTT 75 sec
C) Hemoglobin 10.8 g/dL
D) Platelets 45,000
Correct Answer: D
Rationale: Platelets <50,000 suggest HIT (heparin-induced thrombocytopenia).
Stop heparin immediately.
11. Which instruction should be included for a client with GERD?
A) Eat a large meal at bedtime
B) Elevate head of bed 30°
C) Drink citrus juice with meals
D) Wear tight-fitting clothing
Correct Answer: B
Rationale: Elevation reduces reflux by using gravity to keep stomach contents
from regurgitating.
, 4|Page
12. Which finding in a client with DKA indicates improvement?
A) Fruity breath odor
B) Blood glucose 450 mg/dL
C) pH 7.34
D) Kussmaul respirations
Correct Answer: C
Rationale: pH nearing normal (7.35–7.45) shows resolution of metabolic acidosis.
13. A client with acute pancreatitis should receive which initial management?
A) High-fat diet
B) NPO status with IV fluids
C) Oral antibiotics
D) Increase ambulation
Correct Answer: B
Rationale: NPO prevents pancreatic stimulation; fluids prevent hypovolemic
shock.
14. Which assessment is most concerning in a client with a blood transfusion
running for 10 minutes?
A) Mild back pain
B) Increased urine output
C) Slight elevation in BP
D) Feeling drowsy
Correct Answer: A
Rationale: Back/flank pain early in transfusion may indicate hemolytic reaction;
stop transfusion immediately.
15. Which nursing intervention is most important for a client with myasthenia
gravis?
A) Encourage fluids before meals
B) Group activities in evening
C) Administer anticholinesterase meds before meals
D) Provide soft, high-protein snacks
Correct Answer: C
Rationale: Meds given 30–60 min before meals optimize muscle strength for
chewing/swallowing.
