BSN 366 EXIT HESI STUDY – COMPREHENSIVE QUESTIONS
AND ANSWERS | VERIFIED AND WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
• CORE DOMAINS*
•
• Medical-Surgical Nursing and Adult Health
• Pharmacology and Medication Safety
• Maternal–Newborn Nursing
• Pediatric Nursing
• Mental Health and Psychiatric Nursing
• Community and Public Health Nursing
• Leadership, Management, Delegation, and Prioritization
• Fundamentals of Nursing, Safety, and Infection Prevention
• Health Assessment, Clinical Judgment, and Patient Education
• Professional Practice, Ethics, and Evidence-Based Nursing Care
• INTRODUCTION*
•
This comprehensive BSN 366 Exit HESI study assessment is designed to strengthen the
knowledge, clinical judgment, prioritization, and decision-making skills expected of a senior
nursing student preparing for an exit-level examination. The questions integrate foundational
concepts with application-based situations across adult health, pharmacology, maternal-
newborn, pediatrics, mental health, community health, leadership, safety, and professional
nursing practice. Multiple-choice questions emphasize recognition of expected findings,
identification of complications, appropriate interventions, medication safety, delegation,
prioritization, and patient education. Understanding the rationale behind each answer is
essential because effective nursing practice requires application of principles rather than
memorization alone.
SECTION ONE: QUESTIONS 1–100
Question 1. A nurse is caring for a client with hypovolemic shock following significant blood
loss. Which assessment finding requires the most immediate intervention?
A. Heart rate of 112/min
B. Urine output of 15 mL/hr
C. Respiratory rate of 24/min
D. Cool, clammy skin
Correct Answer: B. Urine output of 15 mL/hr
,Explanation: Urine output reflects renal perfusion and is an important indicator of circulating
volume and cardiac output. Output below approximately 30 mL/hr in an adult suggests
inadequate renal perfusion and worsening shock. Tachycardia, tachypnea, and cool skin can
also occur with hypovolemia, but markedly decreased urine output indicates significant
compromise.
Question 2. A client with heart failure reports increasing shortness of breath and suddenly
develops pink, frothy sputum. What should the nurse do first?
A. Place the client in high-Fowler position
B. Encourage oral fluids
C. Obtain a daily weight
D. Administer a prescribed oral diuretic
Correct Answer: A. Place the client in high-Fowler position
Explanation: Pink, frothy sputum and acute dyspnea suggest acute pulmonary edema. High-
Fowler positioning improves lung expansion and decreases venous return to the heart,
helping reduce pulmonary congestion while additional emergency interventions are
initiated.
Question 3. Which laboratory value is most concerning in a client receiving warfarin
therapy?
A. INR of 1.2
B. INR of 2.4
C. INR of 3.1
D. INR of 6.5
Correct Answer: D. INR of 6.5
Explanation: A markedly elevated INR indicates excessive anticoagulation and substantially
increased bleeding risk. The therapeutic range depends on the indication, but an INR of 6.5
is dangerously elevated and requires prompt evaluation and management.
Question 4. A nurse is assessing a client with diabetic ketoacidosis. Which finding is most
characteristic of this condition?
A. Slow, shallow respirations
B. Kussmaul respirations
C. Severe bradycardia
D. Increased bowel sounds
Correct Answer: B. Kussmaul respirations
,Explanation: Kussmaul respirations are deep and rapid respirations that occur as the body
attempts to compensate for metabolic acidosis by eliminating carbon dioxide. They are a
classic finding in diabetic ketoacidosis.
Question 5. A client with chronic obstructive pulmonary disease is receiving oxygen therapy.
Which oxygen-delivery approach is commonly appropriate when precise oxygen
concentration is needed?
A. Nonrebreather mask
B. Venturi mask
C. Simple face mask
D. Partial-rebreather mask
Correct Answer: B. Venturi mask
Explanation: A Venturi mask delivers a controlled and relatively precise oxygen
concentration, making it useful for clients with COPD who may require carefully titrated
oxygen therapy.
Question 6. A client taking furosemide reports muscle weakness and palpitations. Which
electrolyte imbalance should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C. Hypokalemia
Explanation: Furosemide is a loop diuretic that increases urinary potassium loss.
Hypokalemia can cause muscle weakness, dysrhythmias, and potentially life-threatening
cardiac complications.
Question 7. A nurse is teaching a client prescribed subcutaneous insulin. Which statement
demonstrates correct understanding?
A. “I should massage the injection site after administration.”
B. “I should rotate injection sites within the same general area.”
C. “I should inject insulin into scar tissue for better absorption.”
D. “I should always use the same exact injection site.”
Correct Answer: B. “I should rotate injection sites within the same general area.”
Explanation: Rotating sites helps prevent lipodystrophy and promotes predictable insulin
absorption. Massaging an insulin injection site can alter absorption and should be avoided.
Question 8. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and anxiety. Which complication should the nurse suspect?
, A. Pulmonary embolism
B. Atelectasis
C. Fluid overload
D. Pneumonia
Correct Answer: A. Pulmonary embolism
Explanation: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are classic
warning signs of pulmonary embolism. This is an emergency requiring immediate
assessment and intervention.
Question 9. Which assessment finding in a client with increased intracranial pressure
requires immediate reporting?
A. Mild headache
B. Increasing level of consciousness
C. Unequal pupils
D. Occasional nausea
Correct Answer: C. Unequal pupils
Explanation: Unequal or newly dilated pupils may indicate neurological deterioration and
possible brain herniation. This finding requires immediate intervention and notification of
the appropriate provider.
Question 10. A nurse is caring for a client with suspected meningitis. Which intervention is
appropriate?
A. Initiate appropriate isolation precautions according to institutional policy
B. Encourage unrestricted visitors
C. Keep the room brightly illuminated
D. Encourage vigorous neck flexion exercises
Correct Answer: A. Initiate appropriate isolation precautions according to institutional policy
Explanation: Suspected bacterial meningitis can be transmitted through respiratory droplets.
Appropriate precautions help protect healthcare workers and other clients while diagnostic
testing and antimicrobial therapy are initiated.
Question 11. A client taking lisinopril develops swelling of the lips and tongue. What is the
nurse’s priority action?
A. Give the next dose with food
B. Document the finding as an expected effect
C. Hold the medication and assess the airway immediately
D. Encourage increased fluid intake
Correct Answer: C. Hold the medication and assess the airway immediately
AND ANSWERS | VERIFIED AND WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
• CORE DOMAINS*
•
• Medical-Surgical Nursing and Adult Health
• Pharmacology and Medication Safety
• Maternal–Newborn Nursing
• Pediatric Nursing
• Mental Health and Psychiatric Nursing
• Community and Public Health Nursing
• Leadership, Management, Delegation, and Prioritization
• Fundamentals of Nursing, Safety, and Infection Prevention
• Health Assessment, Clinical Judgment, and Patient Education
• Professional Practice, Ethics, and Evidence-Based Nursing Care
• INTRODUCTION*
•
This comprehensive BSN 366 Exit HESI study assessment is designed to strengthen the
knowledge, clinical judgment, prioritization, and decision-making skills expected of a senior
nursing student preparing for an exit-level examination. The questions integrate foundational
concepts with application-based situations across adult health, pharmacology, maternal-
newborn, pediatrics, mental health, community health, leadership, safety, and professional
nursing practice. Multiple-choice questions emphasize recognition of expected findings,
identification of complications, appropriate interventions, medication safety, delegation,
prioritization, and patient education. Understanding the rationale behind each answer is
essential because effective nursing practice requires application of principles rather than
memorization alone.
SECTION ONE: QUESTIONS 1–100
Question 1. A nurse is caring for a client with hypovolemic shock following significant blood
loss. Which assessment finding requires the most immediate intervention?
A. Heart rate of 112/min
B. Urine output of 15 mL/hr
C. Respiratory rate of 24/min
D. Cool, clammy skin
Correct Answer: B. Urine output of 15 mL/hr
,Explanation: Urine output reflects renal perfusion and is an important indicator of circulating
volume and cardiac output. Output below approximately 30 mL/hr in an adult suggests
inadequate renal perfusion and worsening shock. Tachycardia, tachypnea, and cool skin can
also occur with hypovolemia, but markedly decreased urine output indicates significant
compromise.
Question 2. A client with heart failure reports increasing shortness of breath and suddenly
develops pink, frothy sputum. What should the nurse do first?
A. Place the client in high-Fowler position
B. Encourage oral fluids
C. Obtain a daily weight
D. Administer a prescribed oral diuretic
Correct Answer: A. Place the client in high-Fowler position
Explanation: Pink, frothy sputum and acute dyspnea suggest acute pulmonary edema. High-
Fowler positioning improves lung expansion and decreases venous return to the heart,
helping reduce pulmonary congestion while additional emergency interventions are
initiated.
Question 3. Which laboratory value is most concerning in a client receiving warfarin
therapy?
A. INR of 1.2
B. INR of 2.4
C. INR of 3.1
D. INR of 6.5
Correct Answer: D. INR of 6.5
Explanation: A markedly elevated INR indicates excessive anticoagulation and substantially
increased bleeding risk. The therapeutic range depends on the indication, but an INR of 6.5
is dangerously elevated and requires prompt evaluation and management.
Question 4. A nurse is assessing a client with diabetic ketoacidosis. Which finding is most
characteristic of this condition?
A. Slow, shallow respirations
B. Kussmaul respirations
C. Severe bradycardia
D. Increased bowel sounds
Correct Answer: B. Kussmaul respirations
,Explanation: Kussmaul respirations are deep and rapid respirations that occur as the body
attempts to compensate for metabolic acidosis by eliminating carbon dioxide. They are a
classic finding in diabetic ketoacidosis.
Question 5. A client with chronic obstructive pulmonary disease is receiving oxygen therapy.
Which oxygen-delivery approach is commonly appropriate when precise oxygen
concentration is needed?
A. Nonrebreather mask
B. Venturi mask
C. Simple face mask
D. Partial-rebreather mask
Correct Answer: B. Venturi mask
Explanation: A Venturi mask delivers a controlled and relatively precise oxygen
concentration, making it useful for clients with COPD who may require carefully titrated
oxygen therapy.
Question 6. A client taking furosemide reports muscle weakness and palpitations. Which
electrolyte imbalance should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypokalemia
D. Hypermagnesemia
Correct Answer: C. Hypokalemia
Explanation: Furosemide is a loop diuretic that increases urinary potassium loss.
Hypokalemia can cause muscle weakness, dysrhythmias, and potentially life-threatening
cardiac complications.
Question 7. A nurse is teaching a client prescribed subcutaneous insulin. Which statement
demonstrates correct understanding?
A. “I should massage the injection site after administration.”
B. “I should rotate injection sites within the same general area.”
C. “I should inject insulin into scar tissue for better absorption.”
D. “I should always use the same exact injection site.”
Correct Answer: B. “I should rotate injection sites within the same general area.”
Explanation: Rotating sites helps prevent lipodystrophy and promotes predictable insulin
absorption. Massaging an insulin injection site can alter absorption and should be avoided.
Question 8. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and anxiety. Which complication should the nurse suspect?
, A. Pulmonary embolism
B. Atelectasis
C. Fluid overload
D. Pneumonia
Correct Answer: A. Pulmonary embolism
Explanation: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are classic
warning signs of pulmonary embolism. This is an emergency requiring immediate
assessment and intervention.
Question 9. Which assessment finding in a client with increased intracranial pressure
requires immediate reporting?
A. Mild headache
B. Increasing level of consciousness
C. Unequal pupils
D. Occasional nausea
Correct Answer: C. Unequal pupils
Explanation: Unequal or newly dilated pupils may indicate neurological deterioration and
possible brain herniation. This finding requires immediate intervention and notification of
the appropriate provider.
Question 10. A nurse is caring for a client with suspected meningitis. Which intervention is
appropriate?
A. Initiate appropriate isolation precautions according to institutional policy
B. Encourage unrestricted visitors
C. Keep the room brightly illuminated
D. Encourage vigorous neck flexion exercises
Correct Answer: A. Initiate appropriate isolation precautions according to institutional policy
Explanation: Suspected bacterial meningitis can be transmitted through respiratory droplets.
Appropriate precautions help protect healthcare workers and other clients while diagnostic
testing and antimicrobial therapy are initiated.
Question 11. A client taking lisinopril develops swelling of the lips and tongue. What is the
nurse’s priority action?
A. Give the next dose with food
B. Document the finding as an expected effect
C. Hold the medication and assess the airway immediately
D. Encourage increased fluid intake
Correct Answer: C. Hold the medication and assess the airway immediately
