NIGHTINGALE COLLEGE BSN 366 FINAL EXIT HESI
| CONCEPTS OF NURSING IV | QUESTIONS WITH
CORRECT ANSWERS & NGN CASE STUDIES | 2026.
100 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NIGHTINGALE COLLEGE BSN 366 FINAL EXIT HESI | CONCEPTS OF NURSING IV | QUESTIONS WITH
CORRECT ANSWERS & NGN CASE STUDIES | 2026.. It contains 100 carefully selected questions that reflect
the most current exam content and testing strategies. Each question is accompanied by a correct answer and a
detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 100 Questions
Foundations - Application - Nightingale College BSN 366 EXIT HESI Concepts OF Nursing IV WITH
Correct & NGN CASE Studies 2026 Concepts OF Nursing IV Comprehensive EXIT HESI Preparation
Undergraduate YEAR 4 / BSN
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-17 Appropriate, Acute, Finding, Requires, Septic Shock
Safety AND Infection Control 18-34 Acute, Kidney, Finding, Sepsis, Injury
Health Promotion AND 35-51 Finding, Indicates, Blood, Receiving, Prescribed
Maintenance
Psychosocial Integrity 52-68 Blood, Finding, Immediate, Indicates, Report
Basic CARE AND Comfort 69-85 Appropriate, Finding, Intervention, Acute, Develops
Pharmacological Therapies 86-100 Receiving, Infusion, Blood, Pressure, Immediate
TOTAL 100 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
A nurse is caring for a patient with septic shock who has been unresponsive to fluid
resuscitation and vasopressors. Which intervention should the nurse anticipate as the
next priority according to the Surviving Sepsis Campaign guidelines?
A. Initiate broad-spectrum antibiotics within B. Administer intravenous corticosteroids
1 hour of recognition
C. Start low-dose vasopressin therapy D. Prepare for renal replacement therapy
Correct: A - Initiate broad-spectrum antibiotics within 1 hour of recognition
Rationale:According to the Surviving Sepsis Campaign, for septic shock, broad-spectrum
antibiotics should be initiated within 1 hour of recognition, ideally after blood cultures but not
delayed. While vasopressin and corticosteroids are later adjuncts, they are not the next
priority after fluid and vasopressor failure. Renal replacement therapy is reserved for specific
indications like acute kidney injury with fluid overload or metabolic derangements.
Why the other answers are wrong:
B. Corticosteroids are only considered if hemodynamic stability is not achieved with fluids and
moderate-to-high dose vasopressors; they are not the immediate next step.
C. Vasopressin is a second-line vasopressor added to norepinephrine when target MAP is not
achieved, but antibiotic timing is more critical.
D. Renal replacement therapy is not indicated solely for refractory shock; it is for specific renal
complications.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock: 2016. Critical Care Medicine.
Q2.
A patient with heart failure and chronic kidney disease is prescribed spironolactone. The
nurse reviews the latest lab results: potassium 5.2 mEq/L, BUN 38 mg/dL, creatinine 2.4
mg/dL. Which action is most appropriate?
A. Administer the spironolactone as B. Hold the spironolactone and notify the
prescribed provider
C. Administer spironolactone with a loop D. Ask the patient if they have been taking
diuretic potassium supplements
Correct: B - Hold the spironolactone and notify the provider
Page 3
, Section A - Management OF CARE
Rationale: Spironolactone is a potassium-sparing diuretic; in a patient with chronic kidney
disease (elevated creatinine) and potassium of 5.2 mEq/L (hyperkalemia), it is contraindicated
due to high risk of life-threatening hyperkalemia. The nurse should hold the medication and
notify the provider. Administering with a loop diuretic may reduce risk but is not sufficient in
this setting; asking about supplements is not the immediate priority.
Why the other answers are wrong:
A. Administering spironolactone with potassium 5.2 and renal impairment is unsafe and could
precipitate severe hyperkalemia.
C. Loop diuretics may promote potassium loss, but the combination does not eliminate the risk,
and the medication should still be held.
D. While assessing for potassium supplements is relevant, the lab values already indicate
hyperkalemia and require action.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 40.
Q3.
A nurse is leading a rapid response team for a patient who is deteriorating. The team is
discussing the next steps, and there is disagreement about the urgency of intubation.
Which communication strategy is most effective to ensure safe and timely
decision-making?
A. Use the SBAR technique to present the B. Encourage open discussion until
situation and recommendation consensus is reached
C. Defer to the most senior physician's D. Document the disagreement and proceed
opinion with the most common approach
Correct: A - Use the SBAR technique to present the situation and recommendation
Rationale:SBAR (Situation, Background, Assessment, Recommendation) is a structured
communication tool that facilitates clear, concise, and assertive communication in urgent
situations, ensuring the team has the necessary information to make timely decisions. Open
discussion may delay care, deferring to hierarchy can lead to errors, and documenting without
action is inappropriate in an emergency.
Why the other answers are wrong:
B. While collaboration is important, open discussion without structure can delay critical
interventions in a deteriorating patient.
C. Deferring to hierarchy may suppress important input from other team members, increasing
error risk.
D. Documentation alone does not address the immediate need for action and can be seen as
avoidance.
Reference: Institute for Healthcare Improvement. (2026). SBAR Tool:
Situation-Background-Assessment-Recommendation.
Page 4
| CONCEPTS OF NURSING IV | QUESTIONS WITH
CORRECT ANSWERS & NGN CASE STUDIES | 2026.
100 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NIGHTINGALE COLLEGE BSN 366 FINAL EXIT HESI | CONCEPTS OF NURSING IV | QUESTIONS WITH
CORRECT ANSWERS & NGN CASE STUDIES | 2026.. It contains 100 carefully selected questions that reflect
the most current exam content and testing strategies. Each question is accompanied by a correct answer and a
detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 100 Questions
Foundations - Application - Nightingale College BSN 366 EXIT HESI Concepts OF Nursing IV WITH
Correct & NGN CASE Studies 2026 Concepts OF Nursing IV Comprehensive EXIT HESI Preparation
Undergraduate YEAR 4 / BSN
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Management OF CARE 1-17 Appropriate, Acute, Finding, Requires, Septic Shock
Safety AND Infection Control 18-34 Acute, Kidney, Finding, Sepsis, Injury
Health Promotion AND 35-51 Finding, Indicates, Blood, Receiving, Prescribed
Maintenance
Psychosocial Integrity 52-68 Blood, Finding, Immediate, Indicates, Report
Basic CARE AND Comfort 69-85 Appropriate, Finding, Intervention, Acute, Develops
Pharmacological Therapies 86-100 Receiving, Infusion, Blood, Pressure, Immediate
TOTAL 100 All questions include answers and detailed rationales
,Section A - Management OF CARE
Q1.
A nurse is caring for a patient with septic shock who has been unresponsive to fluid
resuscitation and vasopressors. Which intervention should the nurse anticipate as the
next priority according to the Surviving Sepsis Campaign guidelines?
A. Initiate broad-spectrum antibiotics within B. Administer intravenous corticosteroids
1 hour of recognition
C. Start low-dose vasopressin therapy D. Prepare for renal replacement therapy
Correct: A - Initiate broad-spectrum antibiotics within 1 hour of recognition
Rationale:According to the Surviving Sepsis Campaign, for septic shock, broad-spectrum
antibiotics should be initiated within 1 hour of recognition, ideally after blood cultures but not
delayed. While vasopressin and corticosteroids are later adjuncts, they are not the next
priority after fluid and vasopressor failure. Renal replacement therapy is reserved for specific
indications like acute kidney injury with fluid overload or metabolic derangements.
Why the other answers are wrong:
B. Corticosteroids are only considered if hemodynamic stability is not achieved with fluids and
moderate-to-high dose vasopressors; they are not the immediate next step.
C. Vasopressin is a second-line vasopressor added to norepinephrine when target MAP is not
achieved, but antibiotic timing is more critical.
D. Renal replacement therapy is not indicated solely for refractory shock; it is for specific renal
complications.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock: 2016. Critical Care Medicine.
Q2.
A patient with heart failure and chronic kidney disease is prescribed spironolactone. The
nurse reviews the latest lab results: potassium 5.2 mEq/L, BUN 38 mg/dL, creatinine 2.4
mg/dL. Which action is most appropriate?
A. Administer the spironolactone as B. Hold the spironolactone and notify the
prescribed provider
C. Administer spironolactone with a loop D. Ask the patient if they have been taking
diuretic potassium supplements
Correct: B - Hold the spironolactone and notify the provider
Page 3
, Section A - Management OF CARE
Rationale: Spironolactone is a potassium-sparing diuretic; in a patient with chronic kidney
disease (elevated creatinine) and potassium of 5.2 mEq/L (hyperkalemia), it is contraindicated
due to high risk of life-threatening hyperkalemia. The nurse should hold the medication and
notify the provider. Administering with a loop diuretic may reduce risk but is not sufficient in
this setting; asking about supplements is not the immediate priority.
Why the other answers are wrong:
A. Administering spironolactone with potassium 5.2 and renal impairment is unsafe and could
precipitate severe hyperkalemia.
C. Loop diuretics may promote potassium loss, but the combination does not eliminate the risk,
and the medication should still be held.
D. While assessing for potassium supplements is relevant, the lab values already indicate
hyperkalemia and require action.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 40.
Q3.
A nurse is leading a rapid response team for a patient who is deteriorating. The team is
discussing the next steps, and there is disagreement about the urgency of intubation.
Which communication strategy is most effective to ensure safe and timely
decision-making?
A. Use the SBAR technique to present the B. Encourage open discussion until
situation and recommendation consensus is reached
C. Defer to the most senior physician's D. Document the disagreement and proceed
opinion with the most common approach
Correct: A - Use the SBAR technique to present the situation and recommendation
Rationale:SBAR (Situation, Background, Assessment, Recommendation) is a structured
communication tool that facilitates clear, concise, and assertive communication in urgent
situations, ensuring the team has the necessary information to make timely decisions. Open
discussion may delay care, deferring to hierarchy can lead to errors, and documenting without
action is inappropriate in an emergency.
Why the other answers are wrong:
B. While collaboration is important, open discussion without structure can delay critical
interventions in a deteriorating patient.
C. Deferring to hierarchy may suppress important input from other team members, increasing
error risk.
D. Documentation alone does not address the immediate need for action and can be seen as
avoidance.
Reference: Institute for Healthcare Improvement. (2026). SBAR Tool:
Situation-Background-Assessment-Recommendation.
Page 4
