HESI BSN 266

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Sample questions from HESI BSN 266

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client in the emergency department reports crushing chest pressure for 30 minutes. Blood pressure is 146/88 mm Hg, heart rate is 104/min, and oxygen saturation is 96% on room air. The ECG shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Apply oxygen at 4 L/min by nasal cannula.
   • B.Activate the emergency coronary reperfusion pathway.
   • C.Wait for the troponin result before notifying the provider.
   • D.Administer the prescribed IV morphine before further intervention.

   Rationale: ST elevation with ischemic symptoms requires immediate activation of the reperfusion pathway to limit myocardial damage. Supplemental oxygen is not routinely indicated with an oxygen saturation of 96%. Waiting for troponin or giving morphine before activating the pathway delays definitive treatment. The priority is rapid reperfusion rather than confirmation by biomarkers or symptom relief alone.

2. 2.A 74-year-old client on a medical unit has pneumonia, new confusion, temperature 39.1 C, heart rate 124/min, blood pressure 82/46 mm Hg, and lactate 4.6 mmol/L. Blood cultures have been collected, antibiotics are infusing, and an isotonic crystalloid bolus is prescribed. Which action should the nurse take next?

   • A.Administer acetaminophen and reassess the blood pressure in 1 hour.
   • B.Place the client upright and restrict additional fluids.
   • C.Begin the prescribed crystalloid bolus and reassess perfusion frequently.
   • D.Collect a sputum specimen before beginning the fluid bolus.

   Rationale: Hypotension, altered mentation, and elevated lactate indicate sepsis-associated hypoperfusion requiring prompt fluid resuscitation. Acetaminophen may improve comfort but does not restore circulating volume. Fluid restriction is inappropriate without evidence of overload, and sputum collection must not delay resuscitation. Prioritize perfusion while monitoring the response and signs of fluid intolerance.

3. 3.A 23-year-old client in the emergency department has type 1 diabetes, vomiting, and deep respirations. Glucose is 526 mg/dL, pH is 7.18, bicarbonate is 11 mEq/L, and potassium is 3.0 mEq/L. Isotonic fluids are infusing, and an IV insulin infusion is prescribed. Which action is most appropriate?

   • A.Start insulin immediately to correct the acidosis.
   • B.Hold insulin temporarily and obtain a prescription for potassium replacement.
   • C.Administer sodium bicarbonate before replacing potassium.
   • D.Change the IV fluid to dextrose 5% in water.

   Rationale: Insulin should be delayed when potassium is significantly low because it shifts potassium into cells and can provoke lethal dysrhythmias. Starting insulin immediately worsens the potassium deficit. Bicarbonate is not routinely indicated at this pH, and dextrose alone is not the initial fluid for marked hyperglycemia and hypovolemia. In diabetic ketoacidosis, assess and correct dangerously low potassium before administering insulin.

4. 4.A 79-year-old client arrives at a stroke center 70 minutes after developing aphasia and right-sided weakness. Blood pressure is 176/98 mm Hg, glucose is 108 mg/dL, and a noncontrast head CT shows no hemorrhage. The client takes no anticoagulants and has no identified contraindications to thrombolysis. Which action should the nurse anticipate?

   • A.Administer aspirin before the reperfusion decision is made.
   • B.Lower the systolic blood pressure to below 120 mm Hg.
   • C.Delay treatment until an MRI confirms the infarction.
   • D.Prepare for IV thrombolytic therapy according to the stroke protocol.

   Answer and rationale are in the full material.

5. 5.A 71-year-old client hospitalized for a COPD exacerbation is receiving oxygen at 2 L/min. The client becomes drowsy with a respiratory rate of 8/min, oxygen saturation of 89%, pH of 7.25, and PaCO2 of 72 mm Hg. Which action is the priority?

   • A.Activate rapid response and prepare to support ventilation.
   • B.Remove the oxygen to restore the client's respiratory drive.
   • C.Coach pursed-lip breathing and reassess in 30 minutes.
   • D.Increase oxygen to 6 L/min as the only intervention.

   Answer and rationale are in the full material.