BSN366 EXIT HESI EXAM 300 ACTUAL
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY
GRADED A+ ASSURED PASS
This comprehensive BSN366 Exit HESI examination preparation question bank
contains 300 unique, multiple-choice questions organized into six distinct sections:
Fundamentals of Nursing and Patient Safety, Pharmacology and Medication
Administration, Medical-Surgical Nursing, Psychiatric and Mental Health Nursing,
Maternity and Pediatric Nursing, and Leadership, Management, and Delegation.
Each question includes four answer options with a single correct choice,
accompanied by a detailed rationale explaining the underlying clinical or scientific
principle. The questions are designed at an application and critical thinking level,
reflecting the competency-based nature of the actual HESI Exit Exam. This
resource covers essential nursing content across the curriculum, including
medication calculations, priority setting, delegation, therapeutic communication,
and disease management to help students prepare for NCLEX-RN success.
SECTION 1: FUNDAMENTALS OF NURSING AND PATIENT SAFETY
(QUESTIONS 1-50)
1. A nurse is preparing to administer medications to a client. Which action should
the nurse take FIRST to ensure client safety?
a) Check the client's allergy band
b) Verify the client's identity using two identifiers
c) Review the medication administration record (MAR)
d) Perform hand hygiene
Answer: b) Verify the client's identity using two identifiers
Rationale: According to the National Patient Safety Goals, verifying client identity
using two unique identifiers is the first critical step before any medication
,administration to prevent wrong-patient errors. While hand hygiene, checking
allergies, and reviewing the MAR are essential, they occur after confirming the
right patient. This follows the "Five Rights" of medication safety sequence.
2. Which action by the nurse demonstrates proper technique when donning sterile
gloves?
a) Touching the outside of the glove with bare hands to adjust fit
b) Picking up the second glove by grasping the folded cuff edge with the gloved
hand
c) Allowing gloved hands to drop below waist level during procedure
d) Using the dominant hand to pick up the first glove by the cuff
Answer: b) Picking up the second glove by grasping the folded cuff edge with the
gloved hand
Rationale: When donning sterile gloves, the first glove is picked up by the cuff
with the bare hand. The second glove is then picked up by sliding gloved fingers
under the folded cuff of the second glove. Touching the outside sterile surface with
bare hands contaminates the glove. Gloved hands must remain above waist level to
maintain sterility.
3. A nurse is caring for a patient who refuses a blood transfusion due to religious
beliefs. What is the nurse's best response?
a) "You will die without the transfusion."
b) "I respect your decision. Let's discuss alternative treatments with your provider."
c) "You must sign a release form saying you refused."
d) "I will call your family to convince you."
Answer: b) "I respect your decision. Let's discuss alternative treatments with your
provider."
Rationale: Respecting patient autonomy is essential in nursing practice.
Alternatives to blood transfusions, such as erythropoietin, iron supplements, and
volume expanders, may be available. The nurse should respect the patient's
religious beliefs while exploring safe alternatives with the healthcare provider.
4. A client is prescribed 1000 mL of 0.9% sodium chloride to infuse over 8 hours.
The IV tubing has a drop factor of 15 gtt/mL. At how many drops per minute
should the nurse set the infusion?
a) 21 gtt/min
b) 31 gtt/min
c) 42 gtt/min
d) 63 gtt/min
Answer: b) 31 gtt/min
,Rationale: Calculation: (Volume in mL × Drop factor) ÷ Time in minutes = (1000
× 15) ÷ (8 × 60) = 15,000 ÷ 480 = 31.25, rounded to 31 gtt/min. Option A is too
slow, while options C and D would infuse the fluid too rapidly, risking fluid
overload.
5. A nurse is caring for a client with a stage 3 pressure injury on the sacrum. Which
finding indicates the wound is healing?
a) Presence of yellow slough in the wound bed
b) Increase in wound drainage amount
c) Formation of granulation tissue
d) Expansion of wound edges
Answer: c) Formation of granulation tissue
Rationale: Granulation tissue, which appears as beefy red, bumpy tissue, is a key
indicator of wound healing in stage 3 pressure injuries. Yellow slough indicates
necrotic tissue requiring debridement. Increased drainage may signal infection, and
expansion of wound edges suggests wound deterioration, not healing.
6. A parent tells the nurse that their 6-year-old child who normally enjoys school
has not been doing well since the grandmother died 2 months ago. Which
statement most accurately describes thoughts on death and dying at this age?
a) Death is personified as the bogeyman or devil
b) Death is perceived as being irreversible
c) The child feels guilty for the grandmother's death
d) The child is worried that he, too, might die
Answer: c) The child feels guilty for the grandmother's death
Rationale: Preschool and early school-age children often believe their thoughts or
actions caused a death through magical thinking and may feel guilty. They do not
yet understand death as irreversible or universal. Personification of death is more
common in younger children.
7. A 67-year-old client with non-insulin dependent diabetes should be instructed to
contact the outpatient clinic immediately if which finding is present?
a) Temperature of 37.5 degrees Celsius with painful urination
b) An open wound on their heel
c) Insomnia and daytime fatigue
d) Nausea with 2 episodes of vomiting
Answer: b) An open wound on their heel
Rationale: An open wound on the heel in a diabetic client is a priority because it
can lead to serious infection, ulceration, and possible amputation. The client should
report this immediately for prompt evaluation and treatment.
, 8. The nurse admits an elderly Mexican-American migrant worker after an
accident that occurred during work. To facilitate communication, the nurse should
initially:
a) Request a Spanish interpreter
b) Speak through the family or co-workers
c) Use pictures, letter boards, or monitoring
d) Assess the client's ability to speak English
Answer: d) Assess the client's ability to speak English
Rationale: The nurse should first assess the client's ability to speak and understand
English before assuming an interpreter is needed. This respects the client's
autonomy and avoids unnecessary interventions.
9. In assessing a postpartum client, the nurse palpates a firm fundus and observes a
constant trickle of bright red blood from the vagina. What is the most likely cause
of these findings?
a) Uterine atony
b) Genital lacerations
c) Retained placenta
d) Clotting disorder
Answer: b) Genital lacerations
Rationale: A firm fundus with a constant trickle of bright red bleeding suggests
genital lacerations rather than uterine atony, which would present with a boggy
fundus. Retained placenta typically causes intermittent bleeding with clots.
10. The nurse notes an abrupt onset of confusion in an elderly patient. Which
recently-ordered medication would most likely contribute to this change?
a) Anticoagulant
b) Liquid antacid
c) Antihistamine
d) Cardiac glycoside
Answer: c) Antihistamine
Rationale: Antihistamines have anticholinergic effects that can cause confusion,
especially in elderly clients. They are known to cross the blood-brain barrier and
affect cognitive function. Anticoagulants, antacids, and cardiac glycosides are less
likely to cause abrupt confusion.
11. The nurse is caring for a client with active tuberculosis who has a history of
noncompliance. Which action by the nurse would represent appropriate care for
this client?
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALE LATEST UPDATE ALREADY
GRADED A+ ASSURED PASS
This comprehensive BSN366 Exit HESI examination preparation question bank
contains 300 unique, multiple-choice questions organized into six distinct sections:
Fundamentals of Nursing and Patient Safety, Pharmacology and Medication
Administration, Medical-Surgical Nursing, Psychiatric and Mental Health Nursing,
Maternity and Pediatric Nursing, and Leadership, Management, and Delegation.
Each question includes four answer options with a single correct choice,
accompanied by a detailed rationale explaining the underlying clinical or scientific
principle. The questions are designed at an application and critical thinking level,
reflecting the competency-based nature of the actual HESI Exit Exam. This
resource covers essential nursing content across the curriculum, including
medication calculations, priority setting, delegation, therapeutic communication,
and disease management to help students prepare for NCLEX-RN success.
SECTION 1: FUNDAMENTALS OF NURSING AND PATIENT SAFETY
(QUESTIONS 1-50)
1. A nurse is preparing to administer medications to a client. Which action should
the nurse take FIRST to ensure client safety?
a) Check the client's allergy band
b) Verify the client's identity using two identifiers
c) Review the medication administration record (MAR)
d) Perform hand hygiene
Answer: b) Verify the client's identity using two identifiers
Rationale: According to the National Patient Safety Goals, verifying client identity
using two unique identifiers is the first critical step before any medication
,administration to prevent wrong-patient errors. While hand hygiene, checking
allergies, and reviewing the MAR are essential, they occur after confirming the
right patient. This follows the "Five Rights" of medication safety sequence.
2. Which action by the nurse demonstrates proper technique when donning sterile
gloves?
a) Touching the outside of the glove with bare hands to adjust fit
b) Picking up the second glove by grasping the folded cuff edge with the gloved
hand
c) Allowing gloved hands to drop below waist level during procedure
d) Using the dominant hand to pick up the first glove by the cuff
Answer: b) Picking up the second glove by grasping the folded cuff edge with the
gloved hand
Rationale: When donning sterile gloves, the first glove is picked up by the cuff
with the bare hand. The second glove is then picked up by sliding gloved fingers
under the folded cuff of the second glove. Touching the outside sterile surface with
bare hands contaminates the glove. Gloved hands must remain above waist level to
maintain sterility.
3. A nurse is caring for a patient who refuses a blood transfusion due to religious
beliefs. What is the nurse's best response?
a) "You will die without the transfusion."
b) "I respect your decision. Let's discuss alternative treatments with your provider."
c) "You must sign a release form saying you refused."
d) "I will call your family to convince you."
Answer: b) "I respect your decision. Let's discuss alternative treatments with your
provider."
Rationale: Respecting patient autonomy is essential in nursing practice.
Alternatives to blood transfusions, such as erythropoietin, iron supplements, and
volume expanders, may be available. The nurse should respect the patient's
religious beliefs while exploring safe alternatives with the healthcare provider.
4. A client is prescribed 1000 mL of 0.9% sodium chloride to infuse over 8 hours.
The IV tubing has a drop factor of 15 gtt/mL. At how many drops per minute
should the nurse set the infusion?
a) 21 gtt/min
b) 31 gtt/min
c) 42 gtt/min
d) 63 gtt/min
Answer: b) 31 gtt/min
,Rationale: Calculation: (Volume in mL × Drop factor) ÷ Time in minutes = (1000
× 15) ÷ (8 × 60) = 15,000 ÷ 480 = 31.25, rounded to 31 gtt/min. Option A is too
slow, while options C and D would infuse the fluid too rapidly, risking fluid
overload.
5. A nurse is caring for a client with a stage 3 pressure injury on the sacrum. Which
finding indicates the wound is healing?
a) Presence of yellow slough in the wound bed
b) Increase in wound drainage amount
c) Formation of granulation tissue
d) Expansion of wound edges
Answer: c) Formation of granulation tissue
Rationale: Granulation tissue, which appears as beefy red, bumpy tissue, is a key
indicator of wound healing in stage 3 pressure injuries. Yellow slough indicates
necrotic tissue requiring debridement. Increased drainage may signal infection, and
expansion of wound edges suggests wound deterioration, not healing.
6. A parent tells the nurse that their 6-year-old child who normally enjoys school
has not been doing well since the grandmother died 2 months ago. Which
statement most accurately describes thoughts on death and dying at this age?
a) Death is personified as the bogeyman or devil
b) Death is perceived as being irreversible
c) The child feels guilty for the grandmother's death
d) The child is worried that he, too, might die
Answer: c) The child feels guilty for the grandmother's death
Rationale: Preschool and early school-age children often believe their thoughts or
actions caused a death through magical thinking and may feel guilty. They do not
yet understand death as irreversible or universal. Personification of death is more
common in younger children.
7. A 67-year-old client with non-insulin dependent diabetes should be instructed to
contact the outpatient clinic immediately if which finding is present?
a) Temperature of 37.5 degrees Celsius with painful urination
b) An open wound on their heel
c) Insomnia and daytime fatigue
d) Nausea with 2 episodes of vomiting
Answer: b) An open wound on their heel
Rationale: An open wound on the heel in a diabetic client is a priority because it
can lead to serious infection, ulceration, and possible amputation. The client should
report this immediately for prompt evaluation and treatment.
, 8. The nurse admits an elderly Mexican-American migrant worker after an
accident that occurred during work. To facilitate communication, the nurse should
initially:
a) Request a Spanish interpreter
b) Speak through the family or co-workers
c) Use pictures, letter boards, or monitoring
d) Assess the client's ability to speak English
Answer: d) Assess the client's ability to speak English
Rationale: The nurse should first assess the client's ability to speak and understand
English before assuming an interpreter is needed. This respects the client's
autonomy and avoids unnecessary interventions.
9. In assessing a postpartum client, the nurse palpates a firm fundus and observes a
constant trickle of bright red blood from the vagina. What is the most likely cause
of these findings?
a) Uterine atony
b) Genital lacerations
c) Retained placenta
d) Clotting disorder
Answer: b) Genital lacerations
Rationale: A firm fundus with a constant trickle of bright red bleeding suggests
genital lacerations rather than uterine atony, which would present with a boggy
fundus. Retained placenta typically causes intermittent bleeding with clots.
10. The nurse notes an abrupt onset of confusion in an elderly patient. Which
recently-ordered medication would most likely contribute to this change?
a) Anticoagulant
b) Liquid antacid
c) Antihistamine
d) Cardiac glycoside
Answer: c) Antihistamine
Rationale: Antihistamines have anticholinergic effects that can cause confusion,
especially in elderly clients. They are known to cross the blood-brain barrier and
affect cognitive function. Anticoagulants, antacids, and cardiac glycosides are less
likely to cause abrupt confusion.
11. The nurse is caring for a client with active tuberculosis who has a history of
noncompliance. Which action by the nurse would represent appropriate care for
this client?
