BSN 246 HESI COMPLETE EXAM 2026/2027 | Over
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1. A client with chronic heart failure (NYHA class III) is admitted with acute decompensation.
Vital signs: BP 90/60, HR 110, RR 24, SpO2 88% on room air. The client is on carvedilol, lisinopril,
furosemide, and spironolactone. Which intervention should the nurse question?
A. Administer intravenous furosemide 40 mg bolus.
B. Hold the next dose of carvedilol.
C. Start intravenous dopamine at 5 mcg/kg/min.
D. Give a normal saline bolus of 500 mL over 30 minutes.
Answer: D
Rationale: The client has signs of low cardiac output and pulmonary congestion. A saline bolus could
worsen pulmonary edema. Furosemide is appropriate to reduce preload. Carvedilol may be held due to
hypotension. Dopamine supports blood pressure and cardiac output.
2. A nurse is evaluating a 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA) in a
client suspected of having carcinoid syndrome. Which instruction is most critical for the nurse to
reinforce with the client before and during the collection?
A. Avoid foods high in tryptophan, such as bananas and walnuts.
B. Discontinue all medications that affect serotonin metabolism.
C. Collect urine in a container with hydrochloric acid as preservative.
D. Refrigerate the urine sample immediately after each void.
Answer: C
Rationale: 5-HIAA is unstable in alkaline urine; a preservative (usually HCl) is required. While dietary
restrictions and medication adjustments are important, the preservative is critical for accurate results.
Refrigeration alone is insufficient.
3. A nurse in the intensive care unit is caring for a client with acute respiratory distress syndrome
(ARDS) who is on volume-controlled mechanical ventilation. The ventilator alarms indicate high
peak inspiratory pressure (PIP) and low tidal volume delivery. Which action should the nurse take
first?
A. Suction the artificial airway.
B. Check for a kinked ventilator circuit.
C. Request a chest radiograph.
D. Decrease the tidal volume setting.
Answer: B
Rationale: High PIP with low delivered tidal volume suggests a mechanical obstruction or circuit
problem. Checking the circuit is quick and non-invasive. Suctioning may be needed if mucus plugging is
suspected, but circuit kinking is a common cause and should be ruled out first.
Page 1
,4. A client with a history of chronic alcoholism is admitted with confusion, ataxia, and nystagmus.
The nurse suspects Wernicke encephalopathy. Which of the following laboratory findings would
most likely be present?
A. Elevated serum ammonia level.
B. Decreased red blood cell transketolase activity.
C. Increased serum homocysteine level.
D. Low serum vitamin B12 level.
Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency. Transketolase is a
thiamine-dependent enzyme; its activity is reduced in thiamine deficiency. Ammonia elevation is
associated with hepatic encephalopathy. Homocysteine and B12 are related to other deficiencies.
5. A nurse is assessing a client who is receiving a blood transfusion of packed red blood cells.
Fifteen minutes after the infusion starts, the client develops a temperature of 38.9°C (102°F), chills,
and low back pain. What is the nurse's priority action?
A. Slow the transfusion rate and administer antipyretics.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Obtain a blood culture and notify the healthcare provider.
D. Administer diphenhydramine and monitor vital signs.
Answer: B
Rationale: The symptoms suggest an acute hemolytic transfusion reaction, which is life-threatening. The
priority is to stop the transfusion to prevent further hemolysis. Maintaining IV access with normal saline
is essential for potential resuscitation. Antipyretics and antihistamines are not first-line for hemolytic
reactions.
6. A nurse is providing discharge teaching to a client who had a laparoscopic cholecystectomy.
Which statement by the client indicates a need for further instruction?
A. I should avoid heavy lifting for about a week.
B. If I have shoulder pain, I can take ibuprofen.
C. I will resume my normal diet immediately.
D. I should report any yellowing of my skin.
Answer: C
Rationale: After cholecystectomy, clients should gradually advance their diet, starting with low-fat foods
to avoid digestive upset. Resuming a normal diet immediately can cause discomfort. Heavy lifting should
be avoided for a week. Shoulder pain from CO2 insufflation is common. Jaundice indicates bile duct
injury.
7. A nurse is evaluating a client's arterial blood gas results: pH 7.32, PaCO2 50 mm Hg, HCO3- 24
mEq/L, PaO2 85 mm Hg. Which condition does the nurse identify?
A. Metabolic acidosis, uncompensated.
B. Respiratory acidosis, uncompensated.
C. Respiratory acidosis, partially compensated.
Page 2
,D. Metabolic alkalosis, fully compensated.
Answer: B
Rationale: The pH is acidic (7.32), PaCO2 is elevated (50), and HCO3- is normal (24). This indicates
respiratory acidosis with no renal compensation (since HCO3- is not elevated). Uncompensated
respiratory acidosis is present because the primary problem is respiratory and the metabolic system has
not yet responded.
8. A nurse is caring for a client with acute pancreatitis. Which finding is most concerning and
requires immediate intervention?
A. Serum calcium 8.0 mg/dL.
B. Grey-Turner sign.
C. Serum amylase 600 units/L.
D. Epigastric pain radiating to the back.
Answer: B
Rationale: Grey-Turner sign (ecchymosis of the flanks) indicates retroperitoneal hemorrhage and is a
sign of severe necrotizing pancreatitis with high mortality. Hypocalcemia (8.0 mg/dL) is common and
not immediately life-threatening. Elevated amylase is expected. Pain is typical.
9. A nurse is reviewing a client's preoperative laboratory results. The client is scheduled for a total
hip replacement. Which finding would cause the nurse to notify the surgeon?
A. Hemoglobin 13.5 g/dL.
B. Platelet count 150,000/mm3.
C. International normalized ratio (INR) 2.8.
D. White blood cell count 8,000/mm3.
Answer: C
Rationale: An INR of 2.8 indicates a significantly elevated risk of bleeding. For elective surgery, INR
should be 1.5 (or as per surgeon preference). Hemoglobin and platelet count are within normal limits.
WBC count is normal, ruling out active infection.
10. A nurse is assessing a client with suspected meningococcal meningitis. Which assessment
finding warrants immediate isolation precautions?
A. Nuchal rigidity and photophobia.
B. Petechial rash on the trunk and extremities.
C. Positive Kernig sign.
D. Headache and fever.
Answer: B
Rationale: Meningococcal meningitis is transmitted via respiratory droplets. A petechial rash is a
hallmark of meningococcemia and indicates high infectivity. Droplet precautions should be initiated
immediately. Nuchal rigidity, Kernig sign, headache, and fever are common but do not alone indicate
the need for isolation.
Page 3
, 11. A patient with a history of chronic heart failure is admitted with acute dyspnea and pulmonary
edema. The nurse notes jugular venous distention and a third heart sound. Which hemodynamic
parameter is most indicative of the underlying pathophysiology requiring immediate intervention?
A. Decreased pulmonary artery wedge pressure
B. Increased cardiac output
C. Elevated pulmonary artery wedge pressure
D. Decreased central venous pressure
Answer: C
Rationale: Elevated pulmonary artery wedge pressure (PAWP) reflects increased left ventricular
end-diastolic pressure, confirming left-sided heart failure and pulmonary congestion. Decreased PAWP,
increased CO, or decreased CVP are inconsistent with acute decompensated heart failure.
12. Which of the following best describes the mechanism of action of metformin in the management
of type 2 diabetes mellitus?
A. Stimulates pancreatic beta cells to secrete more insulin
B. Inhibits hepatic gluconeogenesis and improves peripheral insulin sensitivity
C. Slows carbohydrate absorption in the small intestine
D. Increases renal glucose excretion
Answer: B
Rationale: Metformin primarily reduces hepatic glucose production and enhances insulin sensitivity in
muscle and adipose tissue. It does not stimulate insulin secretion (sulfonylureas do), does not
significantly affect carbohydrate absorption (acarbose), and does not increase renal glucose excretion
(SGLT2 inhibitors).
13. A patient receiving vancomycin therapy develops red man syndrome during infusion. Which
nursing intervention is most appropriate?
A. Administer diphenhydramine and slow the infusion rate
B. Discontinue the infusion immediately and notify the provider
C. Apply a cold compress to the patient's face and neck
D. Increase the infusion rate to complete the dose quickly
Answer: A
Rationale: Red man syndrome is a histamine-mediated reaction to rapid vancomycin infusion. Slowing
the infusion rate and pre-treating with antihistamines (e.g., diphenhydramine) can prevent or manage
symptoms. Discontinuation is not typically necessary unless severe; cold compresses are supportive but
not primary; increasing rate worsens reaction.
14. A nurse is assessing a patient with suspected Cushing's syndrome. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum potassium
B. Decreased serum cortisol level
C. Elevated serum sodium and decreased potassium
D. Increased adrenocorticotropic hormone (ACTH) level
Page 4
| Nightingale College | Pass Guaranteed - A+ Graded
1. A client with chronic heart failure (NYHA class III) is admitted with acute decompensation.
Vital signs: BP 90/60, HR 110, RR 24, SpO2 88% on room air. The client is on carvedilol, lisinopril,
furosemide, and spironolactone. Which intervention should the nurse question?
A. Administer intravenous furosemide 40 mg bolus.
B. Hold the next dose of carvedilol.
C. Start intravenous dopamine at 5 mcg/kg/min.
D. Give a normal saline bolus of 500 mL over 30 minutes.
Answer: D
Rationale: The client has signs of low cardiac output and pulmonary congestion. A saline bolus could
worsen pulmonary edema. Furosemide is appropriate to reduce preload. Carvedilol may be held due to
hypotension. Dopamine supports blood pressure and cardiac output.
2. A nurse is evaluating a 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA) in a
client suspected of having carcinoid syndrome. Which instruction is most critical for the nurse to
reinforce with the client before and during the collection?
A. Avoid foods high in tryptophan, such as bananas and walnuts.
B. Discontinue all medications that affect serotonin metabolism.
C. Collect urine in a container with hydrochloric acid as preservative.
D. Refrigerate the urine sample immediately after each void.
Answer: C
Rationale: 5-HIAA is unstable in alkaline urine; a preservative (usually HCl) is required. While dietary
restrictions and medication adjustments are important, the preservative is critical for accurate results.
Refrigeration alone is insufficient.
3. A nurse in the intensive care unit is caring for a client with acute respiratory distress syndrome
(ARDS) who is on volume-controlled mechanical ventilation. The ventilator alarms indicate high
peak inspiratory pressure (PIP) and low tidal volume delivery. Which action should the nurse take
first?
A. Suction the artificial airway.
B. Check for a kinked ventilator circuit.
C. Request a chest radiograph.
D. Decrease the tidal volume setting.
Answer: B
Rationale: High PIP with low delivered tidal volume suggests a mechanical obstruction or circuit
problem. Checking the circuit is quick and non-invasive. Suctioning may be needed if mucus plugging is
suspected, but circuit kinking is a common cause and should be ruled out first.
Page 1
,4. A client with a history of chronic alcoholism is admitted with confusion, ataxia, and nystagmus.
The nurse suspects Wernicke encephalopathy. Which of the following laboratory findings would
most likely be present?
A. Elevated serum ammonia level.
B. Decreased red blood cell transketolase activity.
C. Increased serum homocysteine level.
D. Low serum vitamin B12 level.
Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (vitamin B1) deficiency. Transketolase is a
thiamine-dependent enzyme; its activity is reduced in thiamine deficiency. Ammonia elevation is
associated with hepatic encephalopathy. Homocysteine and B12 are related to other deficiencies.
5. A nurse is assessing a client who is receiving a blood transfusion of packed red blood cells.
Fifteen minutes after the infusion starts, the client develops a temperature of 38.9°C (102°F), chills,
and low back pain. What is the nurse's priority action?
A. Slow the transfusion rate and administer antipyretics.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Obtain a blood culture and notify the healthcare provider.
D. Administer diphenhydramine and monitor vital signs.
Answer: B
Rationale: The symptoms suggest an acute hemolytic transfusion reaction, which is life-threatening. The
priority is to stop the transfusion to prevent further hemolysis. Maintaining IV access with normal saline
is essential for potential resuscitation. Antipyretics and antihistamines are not first-line for hemolytic
reactions.
6. A nurse is providing discharge teaching to a client who had a laparoscopic cholecystectomy.
Which statement by the client indicates a need for further instruction?
A. I should avoid heavy lifting for about a week.
B. If I have shoulder pain, I can take ibuprofen.
C. I will resume my normal diet immediately.
D. I should report any yellowing of my skin.
Answer: C
Rationale: After cholecystectomy, clients should gradually advance their diet, starting with low-fat foods
to avoid digestive upset. Resuming a normal diet immediately can cause discomfort. Heavy lifting should
be avoided for a week. Shoulder pain from CO2 insufflation is common. Jaundice indicates bile duct
injury.
7. A nurse is evaluating a client's arterial blood gas results: pH 7.32, PaCO2 50 mm Hg, HCO3- 24
mEq/L, PaO2 85 mm Hg. Which condition does the nurse identify?
A. Metabolic acidosis, uncompensated.
B. Respiratory acidosis, uncompensated.
C. Respiratory acidosis, partially compensated.
Page 2
,D. Metabolic alkalosis, fully compensated.
Answer: B
Rationale: The pH is acidic (7.32), PaCO2 is elevated (50), and HCO3- is normal (24). This indicates
respiratory acidosis with no renal compensation (since HCO3- is not elevated). Uncompensated
respiratory acidosis is present because the primary problem is respiratory and the metabolic system has
not yet responded.
8. A nurse is caring for a client with acute pancreatitis. Which finding is most concerning and
requires immediate intervention?
A. Serum calcium 8.0 mg/dL.
B. Grey-Turner sign.
C. Serum amylase 600 units/L.
D. Epigastric pain radiating to the back.
Answer: B
Rationale: Grey-Turner sign (ecchymosis of the flanks) indicates retroperitoneal hemorrhage and is a
sign of severe necrotizing pancreatitis with high mortality. Hypocalcemia (8.0 mg/dL) is common and
not immediately life-threatening. Elevated amylase is expected. Pain is typical.
9. A nurse is reviewing a client's preoperative laboratory results. The client is scheduled for a total
hip replacement. Which finding would cause the nurse to notify the surgeon?
A. Hemoglobin 13.5 g/dL.
B. Platelet count 150,000/mm3.
C. International normalized ratio (INR) 2.8.
D. White blood cell count 8,000/mm3.
Answer: C
Rationale: An INR of 2.8 indicates a significantly elevated risk of bleeding. For elective surgery, INR
should be 1.5 (or as per surgeon preference). Hemoglobin and platelet count are within normal limits.
WBC count is normal, ruling out active infection.
10. A nurse is assessing a client with suspected meningococcal meningitis. Which assessment
finding warrants immediate isolation precautions?
A. Nuchal rigidity and photophobia.
B. Petechial rash on the trunk and extremities.
C. Positive Kernig sign.
D. Headache and fever.
Answer: B
Rationale: Meningococcal meningitis is transmitted via respiratory droplets. A petechial rash is a
hallmark of meningococcemia and indicates high infectivity. Droplet precautions should be initiated
immediately. Nuchal rigidity, Kernig sign, headache, and fever are common but do not alone indicate
the need for isolation.
Page 3
, 11. A patient with a history of chronic heart failure is admitted with acute dyspnea and pulmonary
edema. The nurse notes jugular venous distention and a third heart sound. Which hemodynamic
parameter is most indicative of the underlying pathophysiology requiring immediate intervention?
A. Decreased pulmonary artery wedge pressure
B. Increased cardiac output
C. Elevated pulmonary artery wedge pressure
D. Decreased central venous pressure
Answer: C
Rationale: Elevated pulmonary artery wedge pressure (PAWP) reflects increased left ventricular
end-diastolic pressure, confirming left-sided heart failure and pulmonary congestion. Decreased PAWP,
increased CO, or decreased CVP are inconsistent with acute decompensated heart failure.
12. Which of the following best describes the mechanism of action of metformin in the management
of type 2 diabetes mellitus?
A. Stimulates pancreatic beta cells to secrete more insulin
B. Inhibits hepatic gluconeogenesis and improves peripheral insulin sensitivity
C. Slows carbohydrate absorption in the small intestine
D. Increases renal glucose excretion
Answer: B
Rationale: Metformin primarily reduces hepatic glucose production and enhances insulin sensitivity in
muscle and adipose tissue. It does not stimulate insulin secretion (sulfonylureas do), does not
significantly affect carbohydrate absorption (acarbose), and does not increase renal glucose excretion
(SGLT2 inhibitors).
13. A patient receiving vancomycin therapy develops red man syndrome during infusion. Which
nursing intervention is most appropriate?
A. Administer diphenhydramine and slow the infusion rate
B. Discontinue the infusion immediately and notify the provider
C. Apply a cold compress to the patient's face and neck
D. Increase the infusion rate to complete the dose quickly
Answer: A
Rationale: Red man syndrome is a histamine-mediated reaction to rapid vancomycin infusion. Slowing
the infusion rate and pre-treating with antihistamines (e.g., diphenhydramine) can prevent or manage
symptoms. Discontinuation is not typically necessary unless severe; cold compresses are supportive but
not primary; increasing rate worsens reaction.
14. A nurse is assessing a patient with suspected Cushing's syndrome. Which laboratory finding is
most consistent with this diagnosis?
A. Elevated serum potassium
B. Decreased serum cortisol level
C. Elevated serum sodium and decreased potassium
D. Increased adrenocorticotropic hormone (ACTH) level
Page 4
