BSN HESI 366 RN Exit Exam V3 — Nightingale
BSN HESI 366 RN Exit Exam V3
Nightingale questions and answers 2026\2027 update
100 Multiple-Choice Questions with Answers and Explanations
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse
monitor most closely?
A) Potassium 3.0 mEq/L B) Sodium 140 mEq/L
C) Calcium 9.5 mg/dL D) Magnesium 2.0 mg/dL
Answer: A
Explanation: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in the
distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common and dangerous electrolyte
imbalance associated with loop diuretics because it can precipitate cardiac dysrhythmias. Sodium 140 mEq/L,
calcium 9.5 mg/dL, and magnesium 2.0 mg/dL are all within normal ranges and are not the priority concern when
administering furosemide. The nurse should monitor potassium levels closely and assess for signs of hypokalemia
including muscle weakness, fatigue, and cardiac irregularities.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest pain.
What is the nurse's priority action?
A) Administer prescribed PRN oxygen B) Elevate the head of the bed
C) Call the rapid response team D) Apply sequential compression devices
Answer: C
Explanation: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are classic signs of
a pulmonary embolism (PE), which is a life-threatening emergency. The nurse should immediately call the rapid
response team because PE requires urgent medical intervention including potential thrombolytic therapy or
anticoagulation. While administering oxygen and elevating the head of the bed are supportive measures, the
priority is to activate the emergency response so that definitive treatment can begin without delay. Applying
sequential compression devices is a preventive measure, not an acute intervention.
3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is most
important for the nurse to include in discharge teaching?
A) Take the medication on an empty stomach B) Avoid consuming alcohol while taking this
medication
C) Expect to gain weight with this medication D) Monitor for signs of hyperglycemia only
Answer: B
Explanation: The most critical instruction for a client taking metformin is to avoid alcohol. Metformin increases
the risk of lactic acidosis, and alcohol consumption further increases this risk because both metformin and alcohol
affect hepatic metabolism. Lactic acidosis is a rare but potentially fatal condition. Metformin should be taken with
meals to reduce gastrointestinal side effects, not on an empty stomach. Unlike insulin or sulfonylureas, metformin
does not typically cause weight gain and may actually promote modest weight loss. Clients should monitor for
both hypoglycemia and hyperglycemia.
1
, BSN HESI 366 RN Exit Exam V3 — Nightingale
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via nasal
cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per minute. What is
the nurse's priority action?
A) Increase the oxygen flow rate B) Decrease the oxygen flow rate
C) Document the findings and continue D) Prepare for endotracheal intubation
monitoring
Answer: B
Explanation: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also known as
CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations. Administering high
concentrations of oxygen eliminates this stimulus, causing decreased respiratory effort and CO2 retention. The
priority action is to decrease the oxygen flow rate to the lowest level that maintains adequate oxygenation
(typically 1-2 L/min). Increasing oxygen would worsen the condition. While preparing for intubation may
eventually be needed, the immediate nursing action is to reduce oxygen delivery.
5. A postoperative client has a Hemovac drain in place. The nurse notes 150 mL of serosanguineous
drainage in the collection device during the first 24 hours. What is the appropriate nursing action?
A) Irrigate the drain with sterile saline B) Continue monitoring the drainage
C) Clamp the drain and notify the provider D) Advance the drain 2 cm
Answer: B
Explanation: Serous drainage with a small amount of blood (serosanguineous) totaling 150 mL in the first 24
hours is an expected finding after surgery. The nurse should continue monitoring the drainage, document the
amount, color, and consistency, and compare it to institutional standards. Drainage output typically decreases over
time as healing progresses. Irrigating the drain is not a standard nursing action and could introduce infection.
Clamping the drain could cause fluid accumulation at the surgical site. Advancing the drain is not within the
nurse's scope of practice and could cause tissue damage.
6. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor for
which adverse effect?
A) Hypertension B) Bleeding
C) Constipation D) Urinary retention
Answer: B
Explanation: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of antithrombin
III. The primary adverse effect of heparin therapy is bleeding, which can range from minor bruising to life-
threatening hemorrhage. The nurse should monitor for signs of bleeding including hematuria, melena, petechiae,
ecchymosis, prolonged bleeding from puncture sites, and changes in vital signs such as hypotension and
tachycardia. The activated partial thromboplastin time (aPTT) should be monitored regularly to ensure therapeutic
levels are maintained. Hypertension, constipation, and urinary retention are not expected adverse effects of
heparin.
2
, BSN HESI 366 RN Exit Exam V3 — Nightingale
7. A client with Addison's disease is admitted with fatigue, weight loss, and hypotension. Which medication
does the nurse anticipate the provider will prescribe?
A) Methylprednisolone B) Levothyroxine
C) Spironolactone D) Methimazole
Answer: A
Explanation: Addison's disease, or primary adrenal insufficiency, results from the destruction of the adrenal
cortex, leading to deficient production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone). The
primary treatment is replacement with glucocorticoids such as methylprednisolone or hydrocortisone.
Mineralocorticoid replacement with fludrocortisone may also be needed. Levothyroxine is used for
hypothyroidism, not adrenal insufficiency. Spironolactone is a potassium-sparing diuretic, not a replacement
hormone. Methimazole is used to treat hyperthyroidism.
8. A client with a cerebrovascular accident (CVA) has left-sided hemiparesis. When assisting the client with
eating, the nurse should place food on which side of the client's mouth?
A) Left side B) Right side
C) Either side D) The client's dominant side
Answer: B
Explanation: A client with left-sided hemiparesis (weakness on the left side) following a right hemisphere stroke
likely has unilateral neglect syndrome, which causes the client to be unaware of the left side of their body and
environment. Placing food on the right (unaffected) side ensures the client can see and attend to the food.
Additionally, swallowing difficulties (dysphagia) may be more pronounced when food is placed on the affected
side. The nurse should also assess the client's gag reflex before feeding, position the client upright, and monitor
for signs of aspiration.
9. A client is receiving total parenteral nutrition (TPN) through a central venous catheter. The nurse
discovers the TPN bag is empty and a new bag has not arrived from the pharmacy. What should the nurse
do?
A) Discontinue the infusion until the new bag B) Infuse 10% dextrose in water (D10W) at the
arrives same rate
C) Flush the central line with heparin D) Increase the IV fluid rate of the maintenance
solution
Answer: B
Explanation: TPN contains a high concentration of dextrose. If TPN is suddenly discontinued, the client is at risk
for hypoglycemia because the pancreas has been producing insulin in response to the constant glucose infusion.
The nurse should infuse 10% dextrose in water (D10W) at the same rate as the TPN to prevent hypoglycemia until
the new TPN bag arrives. Discontinuing the infusion without replacement glucose could cause dangerous
hypoglycemia. Flushing the line does not address the metabolic concern. The nurse should never increase IV
fluids without a provider's order.
3
, BSN HESI 366 RN Exit Exam V3 — Nightingale
10. A client with peptic ulcer disease asks the nurse about lifestyle modifications to prevent recurrence.
Which response by the nurse is most appropriate?
A) Drink milk to coat the stomach lining B) Avoid caffeine and alcohol consumption
C) Eat three large meals per day D) Take aspirin for pain relief
Answer: B
Explanation: Caffeine and alcohol stimulate gastric acid secretion and irritate the gastric mucosa, increasing the
risk of ulcer formation and recurrence. The client should be advised to avoid these substances. Contrary to popular
belief, milk increases gastric acid secretion despite providing temporary relief, so it is not recommended. The
client should eat small, frequent meals rather than large meals to reduce gastric acid production and distention.
Aspirin and other NSAIDs inhibit prostaglandin production, which protects the gastric mucosa, and should be
avoided. Acetaminophen is a safer alternative for pain relief.
11. A client with chronic kidney disease (CKD) has a hemoglobin of 8.2 g/dL and hematocrit of 25%.
Which medication should the nurse anticipate administering?
A) Ferrous sulfate B) Epoetin alfa (Epogen)
C) Vitamin B12 injections D) Warfarin (Coumadin)
Answer: B
Explanation: Anemia in chronic kidney disease is primarily caused by decreased production of erythropoietin by
the damaged kidneys. Epoetin alfa (Epogen) is a synthetic form of erythropoietin that stimulates red blood cell
production. While iron supplementation may be needed alongside epoetin alfa to support red blood cell synthesis,
the primary treatment for CKD-associated anemia is erythropoiesis-stimulating agents. Vitamin B12 deficiency
causes pernicious anemia, which is not related to CKD. Warfarin is an anticoagulant and has no role in treating
anemia. The nurse should monitor hemoglobin levels and blood pressure closely when administering epoetin alfa.
12. A client with a new colostomy expresses concern about odor. Which dietary modification should the
nurse recommend?
A) Increase intake of dairy products B) Eat more eggs and fish
C) Avoid onions, garlic, and cabbage D) Limit fluid intake to 1 L per day
Answer: C
Explanation: Certain foods are known to increase ostomy odor, including onions, garlic, cabbage, fish, eggs, and
beans. The nurse should advise the client to identify and avoid personal trigger foods through trial and error. Dairy
products are generally well-tolerated and do not significantly contribute to odor. Fluid intake should be
maintained at adequate levels (at least 2 L/day unless contraindicated) to prevent dehydration and promote normal
output consistency. The client should be reassured that odor concerns are common and can be effectively
managed through dietary modifications.
13. A client with myasthenia gravis is prescribed pyridostigmine (Mestinon). Which instruction should the
nurse include in the teaching plan?
A) Take the medication on an empty stomach B) Skip a dose if feeling well
4
BSN HESI 366 RN Exit Exam V3
Nightingale questions and answers 2026\2027 update
100 Multiple-Choice Questions with Answers and Explanations
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse
monitor most closely?
A) Potassium 3.0 mEq/L B) Sodium 140 mEq/L
C) Calcium 9.5 mg/dL D) Magnesium 2.0 mg/dL
Answer: A
Explanation: Furosemide is a loop diuretic that causes potassium wasting through increased excretion in the
distal tubule. Hypokalemia (potassium below 3.5 mEq/L) is the most common and dangerous electrolyte
imbalance associated with loop diuretics because it can precipitate cardiac dysrhythmias. Sodium 140 mEq/L,
calcium 9.5 mg/dL, and magnesium 2.0 mg/dL are all within normal ranges and are not the priority concern when
administering furosemide. The nurse should monitor potassium levels closely and assess for signs of hypokalemia
including muscle weakness, fatigue, and cardiac irregularities.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest pain.
What is the nurse's priority action?
A) Administer prescribed PRN oxygen B) Elevate the head of the bed
C) Call the rapid response team D) Apply sequential compression devices
Answer: C
Explanation: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are classic signs of
a pulmonary embolism (PE), which is a life-threatening emergency. The nurse should immediately call the rapid
response team because PE requires urgent medical intervention including potential thrombolytic therapy or
anticoagulation. While administering oxygen and elevating the head of the bed are supportive measures, the
priority is to activate the emergency response so that definitive treatment can begin without delay. Applying
sequential compression devices is a preventive measure, not an acute intervention.
3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is most
important for the nurse to include in discharge teaching?
A) Take the medication on an empty stomach B) Avoid consuming alcohol while taking this
medication
C) Expect to gain weight with this medication D) Monitor for signs of hyperglycemia only
Answer: B
Explanation: The most critical instruction for a client taking metformin is to avoid alcohol. Metformin increases
the risk of lactic acidosis, and alcohol consumption further increases this risk because both metformin and alcohol
affect hepatic metabolism. Lactic acidosis is a rare but potentially fatal condition. Metformin should be taken with
meals to reduce gastrointestinal side effects, not on an empty stomach. Unlike insulin or sulfonylureas, metformin
does not typically cause weight gain and may actually promote modest weight loss. Clients should monitor for
both hypoglycemia and hyperglycemia.
1
, BSN HESI 366 RN Exit Exam V3 — Nightingale
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via nasal
cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per minute. What is
the nurse's priority action?
A) Increase the oxygen flow rate B) Decrease the oxygen flow rate
C) Document the findings and continue D) Prepare for endotracheal intubation
monitoring
Answer: B
Explanation: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure, also known as
CO2 narcosis. Clients with COPD often rely on hypoxic drive to maintain respirations. Administering high
concentrations of oxygen eliminates this stimulus, causing decreased respiratory effort and CO2 retention. The
priority action is to decrease the oxygen flow rate to the lowest level that maintains adequate oxygenation
(typically 1-2 L/min). Increasing oxygen would worsen the condition. While preparing for intubation may
eventually be needed, the immediate nursing action is to reduce oxygen delivery.
5. A postoperative client has a Hemovac drain in place. The nurse notes 150 mL of serosanguineous
drainage in the collection device during the first 24 hours. What is the appropriate nursing action?
A) Irrigate the drain with sterile saline B) Continue monitoring the drainage
C) Clamp the drain and notify the provider D) Advance the drain 2 cm
Answer: B
Explanation: Serous drainage with a small amount of blood (serosanguineous) totaling 150 mL in the first 24
hours is an expected finding after surgery. The nurse should continue monitoring the drainage, document the
amount, color, and consistency, and compare it to institutional standards. Drainage output typically decreases over
time as healing progresses. Irrigating the drain is not a standard nursing action and could introduce infection.
Clamping the drain could cause fluid accumulation at the surgical site. Advancing the drain is not within the
nurse's scope of practice and could cause tissue damage.
6. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor for
which adverse effect?
A) Hypertension B) Bleeding
C) Constipation D) Urinary retention
Answer: B
Explanation: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of antithrombin
III. The primary adverse effect of heparin therapy is bleeding, which can range from minor bruising to life-
threatening hemorrhage. The nurse should monitor for signs of bleeding including hematuria, melena, petechiae,
ecchymosis, prolonged bleeding from puncture sites, and changes in vital signs such as hypotension and
tachycardia. The activated partial thromboplastin time (aPTT) should be monitored regularly to ensure therapeutic
levels are maintained. Hypertension, constipation, and urinary retention are not expected adverse effects of
heparin.
2
, BSN HESI 366 RN Exit Exam V3 — Nightingale
7. A client with Addison's disease is admitted with fatigue, weight loss, and hypotension. Which medication
does the nurse anticipate the provider will prescribe?
A) Methylprednisolone B) Levothyroxine
C) Spironolactone D) Methimazole
Answer: A
Explanation: Addison's disease, or primary adrenal insufficiency, results from the destruction of the adrenal
cortex, leading to deficient production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone). The
primary treatment is replacement with glucocorticoids such as methylprednisolone or hydrocortisone.
Mineralocorticoid replacement with fludrocortisone may also be needed. Levothyroxine is used for
hypothyroidism, not adrenal insufficiency. Spironolactone is a potassium-sparing diuretic, not a replacement
hormone. Methimazole is used to treat hyperthyroidism.
8. A client with a cerebrovascular accident (CVA) has left-sided hemiparesis. When assisting the client with
eating, the nurse should place food on which side of the client's mouth?
A) Left side B) Right side
C) Either side D) The client's dominant side
Answer: B
Explanation: A client with left-sided hemiparesis (weakness on the left side) following a right hemisphere stroke
likely has unilateral neglect syndrome, which causes the client to be unaware of the left side of their body and
environment. Placing food on the right (unaffected) side ensures the client can see and attend to the food.
Additionally, swallowing difficulties (dysphagia) may be more pronounced when food is placed on the affected
side. The nurse should also assess the client's gag reflex before feeding, position the client upright, and monitor
for signs of aspiration.
9. A client is receiving total parenteral nutrition (TPN) through a central venous catheter. The nurse
discovers the TPN bag is empty and a new bag has not arrived from the pharmacy. What should the nurse
do?
A) Discontinue the infusion until the new bag B) Infuse 10% dextrose in water (D10W) at the
arrives same rate
C) Flush the central line with heparin D) Increase the IV fluid rate of the maintenance
solution
Answer: B
Explanation: TPN contains a high concentration of dextrose. If TPN is suddenly discontinued, the client is at risk
for hypoglycemia because the pancreas has been producing insulin in response to the constant glucose infusion.
The nurse should infuse 10% dextrose in water (D10W) at the same rate as the TPN to prevent hypoglycemia until
the new TPN bag arrives. Discontinuing the infusion without replacement glucose could cause dangerous
hypoglycemia. Flushing the line does not address the metabolic concern. The nurse should never increase IV
fluids without a provider's order.
3
, BSN HESI 366 RN Exit Exam V3 — Nightingale
10. A client with peptic ulcer disease asks the nurse about lifestyle modifications to prevent recurrence.
Which response by the nurse is most appropriate?
A) Drink milk to coat the stomach lining B) Avoid caffeine and alcohol consumption
C) Eat three large meals per day D) Take aspirin for pain relief
Answer: B
Explanation: Caffeine and alcohol stimulate gastric acid secretion and irritate the gastric mucosa, increasing the
risk of ulcer formation and recurrence. The client should be advised to avoid these substances. Contrary to popular
belief, milk increases gastric acid secretion despite providing temporary relief, so it is not recommended. The
client should eat small, frequent meals rather than large meals to reduce gastric acid production and distention.
Aspirin and other NSAIDs inhibit prostaglandin production, which protects the gastric mucosa, and should be
avoided. Acetaminophen is a safer alternative for pain relief.
11. A client with chronic kidney disease (CKD) has a hemoglobin of 8.2 g/dL and hematocrit of 25%.
Which medication should the nurse anticipate administering?
A) Ferrous sulfate B) Epoetin alfa (Epogen)
C) Vitamin B12 injections D) Warfarin (Coumadin)
Answer: B
Explanation: Anemia in chronic kidney disease is primarily caused by decreased production of erythropoietin by
the damaged kidneys. Epoetin alfa (Epogen) is a synthetic form of erythropoietin that stimulates red blood cell
production. While iron supplementation may be needed alongside epoetin alfa to support red blood cell synthesis,
the primary treatment for CKD-associated anemia is erythropoiesis-stimulating agents. Vitamin B12 deficiency
causes pernicious anemia, which is not related to CKD. Warfarin is an anticoagulant and has no role in treating
anemia. The nurse should monitor hemoglobin levels and blood pressure closely when administering epoetin alfa.
12. A client with a new colostomy expresses concern about odor. Which dietary modification should the
nurse recommend?
A) Increase intake of dairy products B) Eat more eggs and fish
C) Avoid onions, garlic, and cabbage D) Limit fluid intake to 1 L per day
Answer: C
Explanation: Certain foods are known to increase ostomy odor, including onions, garlic, cabbage, fish, eggs, and
beans. The nurse should advise the client to identify and avoid personal trigger foods through trial and error. Dairy
products are generally well-tolerated and do not significantly contribute to odor. Fluid intake should be
maintained at adequate levels (at least 2 L/day unless contraindicated) to prevent dehydration and promote normal
output consistency. The client should be reassured that odor concerns are common and can be effectively
managed through dietary modifications.
13. A client with myasthenia gravis is prescribed pyridostigmine (Mestinon). Which instruction should the
nurse include in the teaching plan?
A) Take the medication on an empty stomach B) Skip a dose if feeling well
4
