BSN366 EXIT HESI EXAM — 2026/2027
EXACT OFFICIAL COUNT: 150 QUESTIONS | COMPLETE EXAM-STYLE QUESTIONS
WITH DETAILED RATIONALES | 100% VERIFIED | GRADED A+
BSN366 Exit HESI Examination – Comprehensive NCLEX-RN Readiness Competency Assessment
(Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment)
Examination Structure
• Exact official question count: 150 multiple-choice questions (MCQ)
• All questions in MCQ format with four options (A, B, C, D)
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, dosage calculation items, and clinical judgment application
questions
• Focus on evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model
(CJMM) application
• Total testing time: 180 minutes
• Passing score: 850 HESI score or 75–80% (113–120/150 correct)
Answer Format
All correct answers appear in bold, each question appears in bold, and all rationales are written in italic).
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Management of Care 22 Delegation, 15%
Supervision,
Prioritization,
Legal/Ethical Issues,
Case Management,
Resource Allocation
Safety and Infection 18 Standard Precautions, 12%
Control Isolation, Fall
Prevention, Error
Prevention, Emergency
Response, Hand
Hygiene
Health Promotion and 15 Developmental Stages, 10%
Maintenance Screening, Prevention,
Lifestyle Counseling,
Aging, Immunizations
Psychosocial Integrity 15 Therapeutic 10%
Communication,
Mental Health, Crisis
Intervention, Coping,
Cultural Sensitivity,
Grief
Basic Care and Comfort 18 ADLs, Pain 12%
Management,
Nutrition, Elimination,
, Mobility, Rest/Sleep,
Comfort Measures,
Hygiene
Pharmacological and 22 Medication 15%
Parenteral Therapies Administration, Rights
of Medication, Side
Effects, Interactions, IV
Therapy, Dosage
Calculations, High-
Alert Medications
Reduction of Risk 20 Diagnostic Tests, Vital 13%
Potential Signs, Complication
Prevention,
Therapeutic
Procedures, Pre/Post-
Op Care, Lab Values
Physiological 20 Acute/Chronic 13%
Adaptation Conditions,
Fluid/Electrolytes,
Pathophysiology,
Emergency Care,
Wound Healing, Multi-
System Disorders
,Domain: Management of Care
1. The RN is assigned to care for four clients. Which client should the RN assess first?
A. A client with COPD who has an oxygen saturation of 92% on 2L nasal cannula
B. A client with heart failure who reports increased shortness of breath when lying flat
C. A client with diabetes whose blood glucose is 180 mg/dL before lunch
D. A client with a fractured femur who is requesting pain medication
Correct Answer: B
The client with heart failure reporting increased shortness of breath when lying flat (orthopnea) is
showing signs of worsening heart failure and potential pulmonary edema, which requires immediate
assessment and intervention. While the other clients need attention, the heart failure client's symptoms
suggest a potentially life-threatening deterioration. Prioritization follows ABCs (Airway, Breathing,
Circulation); breathing difficulties take precedence over pain management, stable glucose levels, or
acceptable oxygen saturation on supplemental oxygen.
2. Select All That Apply: Which tasks are appropriate for the RN to delegate to an
unlicensed assistive personnel (UAP)?
A. Assisting a stable client with activities of daily living (bathing, feeding)
B. Obtaining vital signs on a postoperative client
C. Assessing a client's pain level using a validated pain scale
D. Administering oral medications to a stable client
Correct Answer: A, B
Appropriate delegation to UAP includes: assisting with activities of daily living (A) and obtaining vital
signs on stable clients (B). Assessment of pain (C) and medication administration (D) require licensed
nursing judgment and cannot be delegated. The Five Rights of Delegation (right task, right
circumstance, right person, right direction, right supervision) guide safe delegation practices.
Delegating appropriately allows the RN to focus on higher-level responsibilities while ensuring client
care needs are met.
3. A newly licensed RN is asking about how to prioritize client care. Which principle should
guide the RN's decision-making?
A. Tasks that are quickest to complete should be done first
B. The ABCs (Airway, Breathing, Circulation) should guide prioritization decisions
C. Family requests should always take precedence over clinical needs
D. Tasks from physicians should be completed before nursing assessments
Correct Answer: B
The ABCs (Airway, Breathing, Circulation) is the fundamental framework for prioritization in nursing.
Life-threatening conditions affecting airway, breathing, or circulation always take priority. This aligns
with Maslow's hierarchy and the nursing process. Quick tasks (A) may mask urgent needs. Family
requests (C) are important but not always priority. Physician tasks (D) may be important but clinical
assessment should guide care.
4. The RN is supervising a student nurse who is providing care to a client. Which action by
the student nurse requires the RN to intervene immediately?
A. The student administers medications via the wrong route
B. The student documents care provided 30 minutes after completion
, C. The student asks the RN to verify a high-alert medication dose
D. The student reports changes in client condition to the RN
Correct Answer: A
Administering medications via the wrong route is a serious medication error that could cause harm and
requires immediate intervention. Documentation 30 minutes after care (B) should be addressed but is
not an immediate safety concern. Asking to verify high-alert medications (C) shows appropriate safety
awareness. Reporting changes (D) demonstrates good clinical judgment. Wrong route administration
can cause severe harm and violates the 'right route' principle of medication administration.
5. A client with end-stage renal disease refuses dialysis treatment. The client's family asks
the nurse to convince the client to change their decision. How should the RN respond?
A. Explain the benefits of dialysis to help the client make an informed decision
B. Respect the client's autonomy and inform the family that the client has the right to refuse treatment
C. Contact the healthcare provider to discuss the situation
D. Ask the family to speak with the client directly since it is a family matter
Correct Answer: B
The client has the right to refuse treatment, including dialysis, based on the ethical principle of
autonomy. The RN should respect this decision and explain to the family that the client has the right to
make their own healthcare decisions. Trying to convince the client (A) would be coercive. Contacting the
provider (C) doesn't address the ethical issue. Asking family to intervene (D) may pressure the client.
Respecting autonomy is a fundamental nursing principle.
6. Which assignment is most appropriate for a newly hired RN who is still in the
orientation period?
A. A client with complicated wound care requiring specialized dressings
B. A client who is stable and requires routine morning care and medication administration
C. A client with a new tracheostomy requiring suctioning every 2 hours
D. A client who is actively dying and requires complex end-of-life care
Correct Answer: B
A stable client requiring routine care is appropriate for a newly hired RN during orientation.
Complicated wound care (A) requires specialized expertise. New tracheostomy care (C) requires
competency verification. End-of-life care (D) is complex and emotionally demanding. Appropriate
assignment based on competency level ensures safe client care while supporting new nurse
development.
7. The RN discovers that a client has an advanced directive stating they do not want CPR.
The client is now unresponsive with no pulse. What action should the RN take first?
A. Begin CPR immediately since the client's wishes are unknown
B. Honor the advance directive and begin post-mortem care
C. Verify the advance directive is current and authentic
D. Call the provider to confirm the directive's validity
Correct Answer: C
The RN should first verify the advance directive is current and authentic before acting on it. If verified,
the directive should be honored. Beginning CPR (A) without verification could violate the client's wishes.
EXACT OFFICIAL COUNT: 150 QUESTIONS | COMPLETE EXAM-STYLE QUESTIONS
WITH DETAILED RATIONALES | 100% VERIFIED | GRADED A+
BSN366 Exit HESI Examination – Comprehensive NCLEX-RN Readiness Competency Assessment
(Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment)
Examination Structure
• Exact official question count: 150 multiple-choice questions (MCQ)
• All questions in MCQ format with four options (A, B, C, D)
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, dosage calculation items, and clinical judgment application
questions
• Focus on evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model
(CJMM) application
• Total testing time: 180 minutes
• Passing score: 850 HESI score or 75–80% (113–120/150 correct)
Answer Format
All correct answers appear in bold, each question appears in bold, and all rationales are written in italic).
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Management of Care 22 Delegation, 15%
Supervision,
Prioritization,
Legal/Ethical Issues,
Case Management,
Resource Allocation
Safety and Infection 18 Standard Precautions, 12%
Control Isolation, Fall
Prevention, Error
Prevention, Emergency
Response, Hand
Hygiene
Health Promotion and 15 Developmental Stages, 10%
Maintenance Screening, Prevention,
Lifestyle Counseling,
Aging, Immunizations
Psychosocial Integrity 15 Therapeutic 10%
Communication,
Mental Health, Crisis
Intervention, Coping,
Cultural Sensitivity,
Grief
Basic Care and Comfort 18 ADLs, Pain 12%
Management,
Nutrition, Elimination,
, Mobility, Rest/Sleep,
Comfort Measures,
Hygiene
Pharmacological and 22 Medication 15%
Parenteral Therapies Administration, Rights
of Medication, Side
Effects, Interactions, IV
Therapy, Dosage
Calculations, High-
Alert Medications
Reduction of Risk 20 Diagnostic Tests, Vital 13%
Potential Signs, Complication
Prevention,
Therapeutic
Procedures, Pre/Post-
Op Care, Lab Values
Physiological 20 Acute/Chronic 13%
Adaptation Conditions,
Fluid/Electrolytes,
Pathophysiology,
Emergency Care,
Wound Healing, Multi-
System Disorders
,Domain: Management of Care
1. The RN is assigned to care for four clients. Which client should the RN assess first?
A. A client with COPD who has an oxygen saturation of 92% on 2L nasal cannula
B. A client with heart failure who reports increased shortness of breath when lying flat
C. A client with diabetes whose blood glucose is 180 mg/dL before lunch
D. A client with a fractured femur who is requesting pain medication
Correct Answer: B
The client with heart failure reporting increased shortness of breath when lying flat (orthopnea) is
showing signs of worsening heart failure and potential pulmonary edema, which requires immediate
assessment and intervention. While the other clients need attention, the heart failure client's symptoms
suggest a potentially life-threatening deterioration. Prioritization follows ABCs (Airway, Breathing,
Circulation); breathing difficulties take precedence over pain management, stable glucose levels, or
acceptable oxygen saturation on supplemental oxygen.
2. Select All That Apply: Which tasks are appropriate for the RN to delegate to an
unlicensed assistive personnel (UAP)?
A. Assisting a stable client with activities of daily living (bathing, feeding)
B. Obtaining vital signs on a postoperative client
C. Assessing a client's pain level using a validated pain scale
D. Administering oral medications to a stable client
Correct Answer: A, B
Appropriate delegation to UAP includes: assisting with activities of daily living (A) and obtaining vital
signs on stable clients (B). Assessment of pain (C) and medication administration (D) require licensed
nursing judgment and cannot be delegated. The Five Rights of Delegation (right task, right
circumstance, right person, right direction, right supervision) guide safe delegation practices.
Delegating appropriately allows the RN to focus on higher-level responsibilities while ensuring client
care needs are met.
3. A newly licensed RN is asking about how to prioritize client care. Which principle should
guide the RN's decision-making?
A. Tasks that are quickest to complete should be done first
B. The ABCs (Airway, Breathing, Circulation) should guide prioritization decisions
C. Family requests should always take precedence over clinical needs
D. Tasks from physicians should be completed before nursing assessments
Correct Answer: B
The ABCs (Airway, Breathing, Circulation) is the fundamental framework for prioritization in nursing.
Life-threatening conditions affecting airway, breathing, or circulation always take priority. This aligns
with Maslow's hierarchy and the nursing process. Quick tasks (A) may mask urgent needs. Family
requests (C) are important but not always priority. Physician tasks (D) may be important but clinical
assessment should guide care.
4. The RN is supervising a student nurse who is providing care to a client. Which action by
the student nurse requires the RN to intervene immediately?
A. The student administers medications via the wrong route
B. The student documents care provided 30 minutes after completion
, C. The student asks the RN to verify a high-alert medication dose
D. The student reports changes in client condition to the RN
Correct Answer: A
Administering medications via the wrong route is a serious medication error that could cause harm and
requires immediate intervention. Documentation 30 minutes after care (B) should be addressed but is
not an immediate safety concern. Asking to verify high-alert medications (C) shows appropriate safety
awareness. Reporting changes (D) demonstrates good clinical judgment. Wrong route administration
can cause severe harm and violates the 'right route' principle of medication administration.
5. A client with end-stage renal disease refuses dialysis treatment. The client's family asks
the nurse to convince the client to change their decision. How should the RN respond?
A. Explain the benefits of dialysis to help the client make an informed decision
B. Respect the client's autonomy and inform the family that the client has the right to refuse treatment
C. Contact the healthcare provider to discuss the situation
D. Ask the family to speak with the client directly since it is a family matter
Correct Answer: B
The client has the right to refuse treatment, including dialysis, based on the ethical principle of
autonomy. The RN should respect this decision and explain to the family that the client has the right to
make their own healthcare decisions. Trying to convince the client (A) would be coercive. Contacting the
provider (C) doesn't address the ethical issue. Asking family to intervene (D) may pressure the client.
Respecting autonomy is a fundamental nursing principle.
6. Which assignment is most appropriate for a newly hired RN who is still in the
orientation period?
A. A client with complicated wound care requiring specialized dressings
B. A client who is stable and requires routine morning care and medication administration
C. A client with a new tracheostomy requiring suctioning every 2 hours
D. A client who is actively dying and requires complex end-of-life care
Correct Answer: B
A stable client requiring routine care is appropriate for a newly hired RN during orientation.
Complicated wound care (A) requires specialized expertise. New tracheostomy care (C) requires
competency verification. End-of-life care (D) is complex and emotionally demanding. Appropriate
assignment based on competency level ensures safe client care while supporting new nurse
development.
7. The RN discovers that a client has an advanced directive stating they do not want CPR.
The client is now unresponsive with no pulse. What action should the RN take first?
A. Begin CPR immediately since the client's wishes are unknown
B. Honor the advance directive and begin post-mortem care
C. Verify the advance directive is current and authentic
D. Call the provider to confirm the directive's validity
Correct Answer: C
The RN should first verify the advance directive is current and authentic before acting on it. If verified,
the directive should be honored. Beginning CPR (A) without verification could violate the client's wishes.
