BSN 366 HESI RN EXIT EXAM V1 (LATEST UPDATE )
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A -
NIGHTINGALE
CORE DOMAINS
Management of Care and Prioritization
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
Maternal-Newborn and Pediatric Nursing
Delegation and Leadership
INTRODUCTION
This comprehensive examination is designed for Bachelor of Science
in Nursing students at Nightingale College preparing for the HESI RN
Exit Exam Version 1. It assesses the clinical judgment, prioritization,
and delegation skills required for safe entry-level nursing practice.
The examination mirrors the Next Generation NCLEX (NGN) format
with scenario-based questions, case studies, and multiple-choice
items covering all Client Needs categories. Emphasis is placed on
critical thinking, evidence-based practice, and the application of the
nursing process to real-world clinical scenarios. Each question is
accompanied by a verified answer and detailed rationale to support
learning and exam readiness.
SECTION ONE: MANAGEMENT OF CARE AND PRIORITIZATION
1. A 78-year-old client with terminal cancer is alert and oriented. The
client's adult daughter demands that the nurse not tell her father his
diagnosis, stating, "It will kill him." Which action by the nurse best
demonstrates advocacy and the ethical principle of autonomy?
,A. Honor the daughter's request to protect the client from emotional
harm.
B. Inform the daughter that the client has the right to know his
diagnosis if he asks.
C. Document the daughter's request and avoid discussing the
diagnosis with the client.
D. Tell the client his diagnosis immediately to ensure full disclosure.
B. Inform the daughter that the client has the right to know his
diagnosis if he asks.
RATIONALE: Autonomy requires that competent clients receive
truthful information about their condition. The nurse advocates by
acknowledging the family's concern while clarifying that the client has
the right to know. Option A violates autonomy and veracity; C avoids
the issue; D disregards cultural and family dynamics and could be
emotionally harmful .
2. A client scheduled for an elective cholecystectomy refuses to sign
the surgical consent after the surgeon has explained the procedure.
What is the nurse's most appropriate initial action?
A. Notify the operating room to cancel the surgery.
B. Ask the client to explain concerns and notify the surgeon of the
refusal.
C. Encourage the client to sign so the scheduled surgery can
proceed.
D. Document the refusal and witness the client's signature on the
refusal form.
B. Ask the client to explain concerns and notify the surgeon of the
refusal.
RATIONALE: Informed consent requires understanding and
voluntary agreement. The nurse's role is to assess the client's
understanding, explore concerns, and notify the surgeon so
additional explanation can occur. The nurse does NOT coerce or
, merely document without further assessment. Canceling the surgery
is premature without surgeon reassessment .
3. A client with a living will specifying no artificial nutrition or
hydration is admitted unconscious after a stroke. The family insists
on placing a feeding tube. Which action should the nurse take first?
A. Insert the feeding tube as requested by the family.
B. Contact the health care provider to clarify the client's advance
directive.
C. Explain to the family that the living will must be followed.
D. Ask the ethics committee to convene an emergency meeting.
C. Explain to the family that the living will must be followed.
RATIONALE: Advance directives are legal documents that must be
honored when the client lacks decision-making capacity. The nurse's
first action is to explain the legal obligation to follow the directive.
Contacting the provider is appropriate but follows the immediate
family explanation. Inserting the tube violates the directive; the ethics
committee is premature unless conflict persists .
4. A nurse discovers that a colleague has been documenting
medications as given when they were actually wasted. After reporting
the issue to the nurse manager, the manager takes no action. What
should the nurse do next according to the Nurse Practice Act and
mandatory reporting requirements?
A. Report the colleague directly to the state Board of Nursing.
B. Continue monitoring the colleague and document additional
observations.
C. Confront the colleague directly about the documentation
discrepancy.
D. Transfer to a different unit to avoid further involvement.
A. Report the colleague directly to the state Board of Nursing.
RATIONALE: Falsification of medical records is a violation of the
Nurse Practice Act and constitutes professional misconduct. When
QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT | GRADE A -
NIGHTINGALE
CORE DOMAINS
Management of Care and Prioritization
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
Maternal-Newborn and Pediatric Nursing
Delegation and Leadership
INTRODUCTION
This comprehensive examination is designed for Bachelor of Science
in Nursing students at Nightingale College preparing for the HESI RN
Exit Exam Version 1. It assesses the clinical judgment, prioritization,
and delegation skills required for safe entry-level nursing practice.
The examination mirrors the Next Generation NCLEX (NGN) format
with scenario-based questions, case studies, and multiple-choice
items covering all Client Needs categories. Emphasis is placed on
critical thinking, evidence-based practice, and the application of the
nursing process to real-world clinical scenarios. Each question is
accompanied by a verified answer and detailed rationale to support
learning and exam readiness.
SECTION ONE: MANAGEMENT OF CARE AND PRIORITIZATION
1. A 78-year-old client with terminal cancer is alert and oriented. The
client's adult daughter demands that the nurse not tell her father his
diagnosis, stating, "It will kill him." Which action by the nurse best
demonstrates advocacy and the ethical principle of autonomy?
,A. Honor the daughter's request to protect the client from emotional
harm.
B. Inform the daughter that the client has the right to know his
diagnosis if he asks.
C. Document the daughter's request and avoid discussing the
diagnosis with the client.
D. Tell the client his diagnosis immediately to ensure full disclosure.
B. Inform the daughter that the client has the right to know his
diagnosis if he asks.
RATIONALE: Autonomy requires that competent clients receive
truthful information about their condition. The nurse advocates by
acknowledging the family's concern while clarifying that the client has
the right to know. Option A violates autonomy and veracity; C avoids
the issue; D disregards cultural and family dynamics and could be
emotionally harmful .
2. A client scheduled for an elective cholecystectomy refuses to sign
the surgical consent after the surgeon has explained the procedure.
What is the nurse's most appropriate initial action?
A. Notify the operating room to cancel the surgery.
B. Ask the client to explain concerns and notify the surgeon of the
refusal.
C. Encourage the client to sign so the scheduled surgery can
proceed.
D. Document the refusal and witness the client's signature on the
refusal form.
B. Ask the client to explain concerns and notify the surgeon of the
refusal.
RATIONALE: Informed consent requires understanding and
voluntary agreement. The nurse's role is to assess the client's
understanding, explore concerns, and notify the surgeon so
additional explanation can occur. The nurse does NOT coerce or
, merely document without further assessment. Canceling the surgery
is premature without surgeon reassessment .
3. A client with a living will specifying no artificial nutrition or
hydration is admitted unconscious after a stroke. The family insists
on placing a feeding tube. Which action should the nurse take first?
A. Insert the feeding tube as requested by the family.
B. Contact the health care provider to clarify the client's advance
directive.
C. Explain to the family that the living will must be followed.
D. Ask the ethics committee to convene an emergency meeting.
C. Explain to the family that the living will must be followed.
RATIONALE: Advance directives are legal documents that must be
honored when the client lacks decision-making capacity. The nurse's
first action is to explain the legal obligation to follow the directive.
Contacting the provider is appropriate but follows the immediate
family explanation. Inserting the tube violates the directive; the ethics
committee is premature unless conflict persists .
4. A nurse discovers that a colleague has been documenting
medications as given when they were actually wasted. After reporting
the issue to the nurse manager, the manager takes no action. What
should the nurse do next according to the Nurse Practice Act and
mandatory reporting requirements?
A. Report the colleague directly to the state Board of Nursing.
B. Continue monitoring the colleague and document additional
observations.
C. Confront the colleague directly about the documentation
discrepancy.
D. Transfer to a different unit to avoid further involvement.
A. Report the colleague directly to the state Board of Nursing.
RATIONALE: Falsification of medical records is a violation of the
Nurse Practice Act and constitutes professional misconduct. When
