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BSN HESI 366 RN Exit Exam V2 (New 2026/ 2027
Update) Questions and Verified Answers|100% Correct|
Grade A- Nightingale
Institution: Nightingale College
Course: BSN 366 HESI RN Exit
Exam: Version 2 (V2) – 2024/2025 Academic Year
Format: 160 questions (multiple-choice, SATA, ordered response, NGN)
Score required to pass: 850–900 (recommended)
QUESTION 1 (Fundamentals / Prioritization)
A client with a traumatic brain injury becomes progressively less responsive to stimuli. The client has a
"Do Not Resuscitate" (DNR) prescription, and the nurse observes that the unlicensed assistive personnel
(UAP) has stopped turning the client from side to side as previously scheduled. What action should the
nurse take?
A) Encourage the UAP to provide comfort care measures only.
B) Assign a practical nurse to assist the UAP in turning the client.
C) Advise the UAP to resume positioning the client on schedule. ✅
D) Assume total care of the client to monitor neurologic function.
Rationale: The DNR prescription does not mean the client should not receive routine care and
interventions to maintain their comfort. Positioning is a standard of care to prevent pressure injuries
and maintain respiratory function. The nurse should correct the UAP's misunderstanding and instruct
them to resume scheduled turning.
QUESTION 2 (Safety & Infection Control / SATA)
Which biological practices are federally regulated for healthcare workers? (Select all that apply.)
A) Standard precautions.
B) N-95 tuberculosis standard.
C) Blood-borne pathogen standard. ✅
D) Biological product exposure limit (BPEL).
E) Resource Conservation and Recovery Act (RCRA). ✅
F) As Low as Reasonably Allowable standard (ALARA).
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Rationale: Basic standards for healthcare workers, as delineated by OSHA, include standard precautions,
droplet precautions using N-95 masks when caring for a client who is positive for tuberculosis, and
required annual updates about blood-borne pathogen transmission, methods of minimizing exposure,
and employee rights. BPEL and ALARA are not federally regulated in the same context.
QUESTION 3 (Psychosocial Integrity / Therapeutic Communication)
A client with severe depression tells the nurse, "I do not know why you bother with me or give me pills. I
am never going to get well." What is the most therapeutic response?
A) "You need to stop thinking negative thoughts. They get in the way of your recovery."
B) "You are no bother to me or to the staff. We want you to get well and not feel sad anymore."
C) "I have known many clients with depression who have felt better after several weeks of
treatment." ✅
D) "You are feeling very pessimistic, but that is part of your illness. It should go away as you recover."
Rationale: Stating the observation that others have recovered can give a client hope. Telling a person to
stop negative thinking is ineffective because the client must be taught cognitive strategies to stop
negative thinking. Stating the person is "no bother" is arguing with the client's beliefs and attempting to
tell him how to feel, both of which are not therapeutic responses. Bringing up pessimistic feelings
interprets the client's feelings and does not provide the same degree of hope.
QUESTION 4 (Fundamentals / Nursing Process)
The nurse is caring for a client with a nursing problem of, "Infection, risk for, related to inadequate
primary defenses as evidenced by surgical incision and IV access." What nursing intervention should the
nurse implement?
A) Limit visitors to immediate family to decrease exposure to infection.
B) Maintain "clean" technique in the change of wound dressing and IV site.
C) Assess and document skin condition around the incision and IV site at each shift. ✅
D) Require the use of a face mask by staff when providing care.
Rationale: Assessment is the first step of the nursing process. Before implementing interventions to
reduce infection risk, the nurse must assess the condition of the skin around the incision and IV site to
establish a baseline and detect early signs of infection.
QUESTION 5 (Health Promotion / Suicide Prevention)
When teaching suicide prevention to the parents of a 15-year-old who recently attempted suicide, the
nurse describes which behavioral cue as a warning sign?
A) Giving away valued personal items. ✅
B) Sleeping more than usual.
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C) Increased appetite.
D) Avoiding social media.
Rationale: Giving away prized possessions is a significant warning sign for suicide, as the individual may
be preparing for death. Other warning signs include talking about wanting to die, expressing
hopelessness, withdrawing from others, and sudden calmness after a period of depression.
QUESTION 6 (Medical-Surgical / Prioritization)
After receiving report on an inpatient acute care unit, which client should the nurse assess first?
A) The client with an obstruction of the large intestine who is experiencing abdominal distention.
B) The client who had surgery yesterday and is experiencing a paralytic ileus with absent bowel sounds.
C) The client with a small bowel obstruction who has a nasogastric tube that is draining greenish fluid.
D) The client with a bowel obstruction due to a volvulus who is experiencing abdominal rigidity. ✅
Rationale: Abdominal rigidity is a sign of peritonitis, a life-threatening complication of bowel
obstruction, especially with a volvulus. This client is at highest risk for deterioration and requires
immediate assessment. Paralytic ileus with absent bowel sounds (B) is expected postoperatively. NG
tube draining greenish fluid (C) is expected with small bowel obstruction. Abdominal distention (A) is
concerning but less urgent than rigidity.
QUESTION 7 (Pharmacology / Endocrine)
The healthcare provider prescribes acarbose, an alpha-glucosidase inhibitor, for a client with type 2
diabetes. Which information provides the best indicator of the drug's effectiveness?
A) Body mass index between 20 and 24.
B) Blood pressure readings less than 120/80.
C) Self-reported glucose levels 120 to 150.
D) Hemoglobin A1c readings less than 7%. ✅
Rationale: Hemoglobin A1c reflects average blood glucose over the past 2–3 months and is the gold
standard for evaluating long-term glycemic control in diabetes. A1c <7% indicates effective diabetes
management. Self-reported glucose levels are less reliable than A1c.
QUESTION 8 (Pediatrics / Neurological)
The nurse is completing the admission assessment of a 3-year-old who is admitted with bacterial
meningitis and hydrocephalus. Which assessment finding is evidence that the child is experiencing
increased intracranial pressure (ICP)?
A) Tachycardia and tachypnea.
B) Sluggish and unequal pupillary responses. ✅
, 4
C) Increased head circumference and bulging fontanels.
D) Blood pressure fluctuations and syncope.
Rationale: Sluggish and unequal pupillary responses are late signs of increased ICP indicating brainstem
compression. In a 3-year-old, the fontanels are already closed, so increased head circumference and
bulging fontanels are not applicable (these are signs in infants). Cushing's triad (bradycardia, irregular
respirations, hypertension) is seen with increased ICP, not tachycardia.
QUESTION 9 (Medical-Surgical / GI)
A client with acute pancreatitis is admitted with severe, piercing abdominal pain and an elevated serum
amylase. Which additional information is the client most likely to report to the nurse?
A) Abdominal pain decreases when lying supine. ✅
B) Pain lasts an hour and leaves the abdomen tender.
C) Right upper quadrant pain refers to right scapula.
D) Drinks alcohol until intoxicated at least twice weekly.
Rationale: In acute pancreatitis, pain is often relieved by assuming a supine position or leaning forward.
The pain of pancreatitis is typically constant, severe, and may radiate to the back. Alcohol use is a risk
factor, but the question asks for what the client is most likely to report (the pain relief behavior).
QUESTION 10 (Fundamentals / Delegation)
The charge nurse is making assignments for one practical nurse (PN) and three registered nurses (RNs)
who are caring for neurologically compromised clients. Which client with which change in status is best
to assign to the PN?
A) Subdural hematoma whose blood pressure changed from 150/80 to 170/60.
B) Viral meningitis whose temperature changed from 101°F to 102°F. ✅
C) Diabetic ketoacidosis whose Glasgow Coma Scale score changed from 10 to 7.
D) Myxedema whose blood pressure changed from 80/50 to 70/40.
Rationale: The PN can care for stable clients with predictable outcomes. A client with viral meningitis
who has a slight temperature increase (101°F to 102°F) is relatively stable. The other clients have more
significant changes (BP changes, decreased GCS) that require RN assessment and intervention.
QUESTION 11 (Pharmacology / Dosage Calculation)
The healthcare provider prescribes dalteparin 200 units per kilogram subcutaneously once a day for a
client who weighs 154 pounds. The medication is available as 25,000 units per milliliter vial. How many
milliliters should the nurse administer? (Enter numerical value only. If rounding is required, round to the
nearest tenth.)
BSN HESI 366 RN Exit Exam V2 (New 2026/ 2027
Update) Questions and Verified Answers|100% Correct|
Grade A- Nightingale
Institution: Nightingale College
Course: BSN 366 HESI RN Exit
Exam: Version 2 (V2) – 2024/2025 Academic Year
Format: 160 questions (multiple-choice, SATA, ordered response, NGN)
Score required to pass: 850–900 (recommended)
QUESTION 1 (Fundamentals / Prioritization)
A client with a traumatic brain injury becomes progressively less responsive to stimuli. The client has a
"Do Not Resuscitate" (DNR) prescription, and the nurse observes that the unlicensed assistive personnel
(UAP) has stopped turning the client from side to side as previously scheduled. What action should the
nurse take?
A) Encourage the UAP to provide comfort care measures only.
B) Assign a practical nurse to assist the UAP in turning the client.
C) Advise the UAP to resume positioning the client on schedule. ✅
D) Assume total care of the client to monitor neurologic function.
Rationale: The DNR prescription does not mean the client should not receive routine care and
interventions to maintain their comfort. Positioning is a standard of care to prevent pressure injuries
and maintain respiratory function. The nurse should correct the UAP's misunderstanding and instruct
them to resume scheduled turning.
QUESTION 2 (Safety & Infection Control / SATA)
Which biological practices are federally regulated for healthcare workers? (Select all that apply.)
A) Standard precautions.
B) N-95 tuberculosis standard.
C) Blood-borne pathogen standard. ✅
D) Biological product exposure limit (BPEL).
E) Resource Conservation and Recovery Act (RCRA). ✅
F) As Low as Reasonably Allowable standard (ALARA).
,2
Rationale: Basic standards for healthcare workers, as delineated by OSHA, include standard precautions,
droplet precautions using N-95 masks when caring for a client who is positive for tuberculosis, and
required annual updates about blood-borne pathogen transmission, methods of minimizing exposure,
and employee rights. BPEL and ALARA are not federally regulated in the same context.
QUESTION 3 (Psychosocial Integrity / Therapeutic Communication)
A client with severe depression tells the nurse, "I do not know why you bother with me or give me pills. I
am never going to get well." What is the most therapeutic response?
A) "You need to stop thinking negative thoughts. They get in the way of your recovery."
B) "You are no bother to me or to the staff. We want you to get well and not feel sad anymore."
C) "I have known many clients with depression who have felt better after several weeks of
treatment." ✅
D) "You are feeling very pessimistic, but that is part of your illness. It should go away as you recover."
Rationale: Stating the observation that others have recovered can give a client hope. Telling a person to
stop negative thinking is ineffective because the client must be taught cognitive strategies to stop
negative thinking. Stating the person is "no bother" is arguing with the client's beliefs and attempting to
tell him how to feel, both of which are not therapeutic responses. Bringing up pessimistic feelings
interprets the client's feelings and does not provide the same degree of hope.
QUESTION 4 (Fundamentals / Nursing Process)
The nurse is caring for a client with a nursing problem of, "Infection, risk for, related to inadequate
primary defenses as evidenced by surgical incision and IV access." What nursing intervention should the
nurse implement?
A) Limit visitors to immediate family to decrease exposure to infection.
B) Maintain "clean" technique in the change of wound dressing and IV site.
C) Assess and document skin condition around the incision and IV site at each shift. ✅
D) Require the use of a face mask by staff when providing care.
Rationale: Assessment is the first step of the nursing process. Before implementing interventions to
reduce infection risk, the nurse must assess the condition of the skin around the incision and IV site to
establish a baseline and detect early signs of infection.
QUESTION 5 (Health Promotion / Suicide Prevention)
When teaching suicide prevention to the parents of a 15-year-old who recently attempted suicide, the
nurse describes which behavioral cue as a warning sign?
A) Giving away valued personal items. ✅
B) Sleeping more than usual.
,3
C) Increased appetite.
D) Avoiding social media.
Rationale: Giving away prized possessions is a significant warning sign for suicide, as the individual may
be preparing for death. Other warning signs include talking about wanting to die, expressing
hopelessness, withdrawing from others, and sudden calmness after a period of depression.
QUESTION 6 (Medical-Surgical / Prioritization)
After receiving report on an inpatient acute care unit, which client should the nurse assess first?
A) The client with an obstruction of the large intestine who is experiencing abdominal distention.
B) The client who had surgery yesterday and is experiencing a paralytic ileus with absent bowel sounds.
C) The client with a small bowel obstruction who has a nasogastric tube that is draining greenish fluid.
D) The client with a bowel obstruction due to a volvulus who is experiencing abdominal rigidity. ✅
Rationale: Abdominal rigidity is a sign of peritonitis, a life-threatening complication of bowel
obstruction, especially with a volvulus. This client is at highest risk for deterioration and requires
immediate assessment. Paralytic ileus with absent bowel sounds (B) is expected postoperatively. NG
tube draining greenish fluid (C) is expected with small bowel obstruction. Abdominal distention (A) is
concerning but less urgent than rigidity.
QUESTION 7 (Pharmacology / Endocrine)
The healthcare provider prescribes acarbose, an alpha-glucosidase inhibitor, for a client with type 2
diabetes. Which information provides the best indicator of the drug's effectiveness?
A) Body mass index between 20 and 24.
B) Blood pressure readings less than 120/80.
C) Self-reported glucose levels 120 to 150.
D) Hemoglobin A1c readings less than 7%. ✅
Rationale: Hemoglobin A1c reflects average blood glucose over the past 2–3 months and is the gold
standard for evaluating long-term glycemic control in diabetes. A1c <7% indicates effective diabetes
management. Self-reported glucose levels are less reliable than A1c.
QUESTION 8 (Pediatrics / Neurological)
The nurse is completing the admission assessment of a 3-year-old who is admitted with bacterial
meningitis and hydrocephalus. Which assessment finding is evidence that the child is experiencing
increased intracranial pressure (ICP)?
A) Tachycardia and tachypnea.
B) Sluggish and unequal pupillary responses. ✅
, 4
C) Increased head circumference and bulging fontanels.
D) Blood pressure fluctuations and syncope.
Rationale: Sluggish and unequal pupillary responses are late signs of increased ICP indicating brainstem
compression. In a 3-year-old, the fontanels are already closed, so increased head circumference and
bulging fontanels are not applicable (these are signs in infants). Cushing's triad (bradycardia, irregular
respirations, hypertension) is seen with increased ICP, not tachycardia.
QUESTION 9 (Medical-Surgical / GI)
A client with acute pancreatitis is admitted with severe, piercing abdominal pain and an elevated serum
amylase. Which additional information is the client most likely to report to the nurse?
A) Abdominal pain decreases when lying supine. ✅
B) Pain lasts an hour and leaves the abdomen tender.
C) Right upper quadrant pain refers to right scapula.
D) Drinks alcohol until intoxicated at least twice weekly.
Rationale: In acute pancreatitis, pain is often relieved by assuming a supine position or leaning forward.
The pain of pancreatitis is typically constant, severe, and may radiate to the back. Alcohol use is a risk
factor, but the question asks for what the client is most likely to report (the pain relief behavior).
QUESTION 10 (Fundamentals / Delegation)
The charge nurse is making assignments for one practical nurse (PN) and three registered nurses (RNs)
who are caring for neurologically compromised clients. Which client with which change in status is best
to assign to the PN?
A) Subdural hematoma whose blood pressure changed from 150/80 to 170/60.
B) Viral meningitis whose temperature changed from 101°F to 102°F. ✅
C) Diabetic ketoacidosis whose Glasgow Coma Scale score changed from 10 to 7.
D) Myxedema whose blood pressure changed from 80/50 to 70/40.
Rationale: The PN can care for stable clients with predictable outcomes. A client with viral meningitis
who has a slight temperature increase (101°F to 102°F) is relatively stable. The other clients have more
significant changes (BP changes, decreased GCS) that require RN assessment and intervention.
QUESTION 11 (Pharmacology / Dosage Calculation)
The healthcare provider prescribes dalteparin 200 units per kilogram subcutaneously once a day for a
client who weighs 154 pounds. The medication is available as 25,000 units per milliliter vial. How many
milliliters should the nurse administer? (Enter numerical value only. If rounding is required, round to the
nearest tenth.)
