BSN 266-RN Med-Surg

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Sample questions from BSN 266-RN Med-Surg

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

1. 1.In the emergency department, a client reports crushing chest pressure radiating to the jaw and has ST-segment elevation on the electrocardiogram. Which action should the nurse anticipate as the priority if there are no contraindications?

   • A.Administer a sublingual nitrate and delay further evaluation until the pain resolves
   • B.Arrange for immediate reperfusion therapy, such as percutaneous coronary intervention
   • C.Obtain a fasting lipid panel before initiating treatment
   • D.Encourage the client to walk to assess exercise tolerance

   Rationale: ST-segment elevation with ischemic chest pain indicates an acute myocardial infarction requiring rapid reperfusion to limit myocardial injury. A lipid panel is useful for long-term risk management but must not delay reperfusion. Nitrates may relieve pain but do not replace reperfusion, and ambulation is unsafe during an acute event. The exam takeaway is to prioritize time-sensitive restoration of coronary blood flow.

2. 2.During a school health screening, a 7-year-old has a blood pressure above the expected range on an initial reading. Which action should the nurse take first?

   • A.Repeat the measurement using a correctly sized cuff after the child has rested
   • B.Arrange emergency transfer without assessing for symptoms
   • C.Ask the child to perform exercise and recheck the blood pressure immediately
   • D.Document hypertension based on the single reading

   Rationale: A single elevated reading does not establish hypertension in a child; measurement should be repeated with an appropriately sized cuff after rest and interpreted using age, sex, and height-based standards. Documenting a diagnosis from one reading is premature. Exercise can temporarily raise blood pressure, making the result less useful. Emergency transfer is not indicated solely by an elevated screening value in an otherwise well child.

3. 3.Refer to the client's chart. Which actions should the nurse take in response to the client's current findings? Select all that apply.

   • A.Administer prescribed chewable aspirin if no allergy or active bleeding is present
   • B.Assist the client to walk to determine whether the chest discomfort worsens
   • C.Place the client on continuous cardiac monitoring and obtain a 12-lead ECG promptly
   • D.Activate the facility's rapid response or emergency cardiac response process
   • E.Encourage oral fluids and reassess the blood pressure in one hour

   Rationale: The new chest pressure, diaphoresis, and worsening hypotension require an immediate response; the heart rate has risen from 96 to 112/min while blood pressure has fallen from 118/72 to 92/58 mm Hg. Continuous monitoring and a prompt 12-lead ECG help identify a potentially evolving ischemic event, and prescribed aspirin is appropriate when contraindications are absent. Oral fluids and delayed reassessment would postpone urgent evaluation, while walking increases myocardial oxygen demand and is unsafe. The exam takeaway is to respond to acute chest symptoms and hemodynamic deterioration rather than wait for more definitive results.

4. 4.A client taking warfarin for atrial fibrillation asks which food habit is most important for keeping the medication effect stable. Which response is best?

   • A.Increase vitamin K intake whenever a bruise appears
   • B.Avoid all vegetables that contain vitamin K
   • C.Take an extra dose of warfarin after eating a large serving of greens
   • D.Keep intake of vitamin K-containing foods reasonably consistent from week to week

   Answer and rationale are in the full material.

5. 5.Which finding in a 16-year-old with a history of congenital heart disease should the nurse report promptly because it may indicate worsening heart failure?

   • A.A capillary refill time of 2 seconds in warm fingers
   • B.A regular pulse of 78/min while sitting quietly
   • C.New shortness of breath at rest with oxygen saturation of 91%
   • D.Mild fatigue after a full day at school that resolves with rest

   Answer and rationale are in the full material.