BSN 366 HESI RN Exit Exam V2
ACTUAL EXAM 2026/2027 | HESI Exit
Comprehensive Review | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT — MANAGEMENT OF CARE (Q1–Q20)
Q1. The nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse
assess first?
A. A 72-year-old with pneumonia who reports shortness of breath and has SpO₂ 89% on room air
B. A 55-year-old post-op cholecystectomy requesting pain medication rated 6/10
C. A 38-year-old with a new colostomy who needs discharge teaching
D. A 60-year-old with stable atrial fibrillation awaiting discharge
Correct Answer: A
Rationale: The patient with pneumonia and SpO₂ 89% has compromised oxygenation, which is a life-
threatening priority per the ABCs (Airway, Breathing, Circulation). This patient requires immediate
assessment and intervention. Option B is important but pain is not life-threatening. Option C is a routine
discharge need. Option D is stable and awaiting discharge.
Q2. A registered nurse (RN) is delegating tasks to unlicensed assistive personnel (UAP) and a licensed
practical nurse (LPN). Which task is most appropriate to delegate to the LPN?
A. Administering a newly prescribed IV antibiotic to a patient with sepsis
B. Assisting a patient with ambulation for the first time after surgery
C. Performing a sterile dressing change on a patient with a surgical wound
D. Reinforcing teaching about a low-sodium diet to a patient with heart failure
Correct Answer: C
Rationale: Performing a sterile dressing change is within the LPN scope of practice in most states, as it is
a predictable, routine procedure. Option A (IV antibiotics for sepsis) requires RN assessment and
,judgment. Option B (first ambulation post-op) requires RN assessment of stability. Option D (teaching) is
an RN responsibility; LPNs may reinforce but not initiate teaching.
Q3. The charge nurse is making assignments for the shift. Which patient should be assigned to the most
experienced RN?
A. A patient with newly diagnosed type 2 diabetes mellitus requiring dietary teaching
B. A patient 2 hours post-op from a total knee replacement with a morphine PCA
C. A patient admitted for observation following a syncopal episode with an irregular rhythm
D. A patient with hypertension awaiting discharge after medication reconciliation
Correct Answer: C
Rationale: The patient with syncope and an irregular rhythm has an undifferentiated, potentially
unstable condition requiring advanced assessment, ECG interpretation, and rapid clinical decision-
making—best suited for the most experienced RN. Option A is stable teaching. Option B is routine post-
op care. Option D is discharge preparation.
Q4. A nurse receives a telephone order from a physician for a new medication. What is the priority
nursing action?
A. Write the order in the patient's medical record
B. Repeat the order back to the physician for verification
C. Administer the medication immediately
D. Notify the pharmacist of the new order
Correct Answer: B
Rationale: Per The Joint Commission National Patient Safety Goal, telephone orders must be read back
and verified for accuracy to prevent medication errors. This is the priority action before documenting
(A), administering (C), or notifying pharmacy (D).
Q5. A patient with terminal cancer expresses a desire to refuse further chemotherapy. The patient's
family insists the treatment continue. What is the best initial nursing action?
A. Contact the hospital ethics committee immediately
B. Explain to the family that the patient has the right to refuse treatment
C. Support the patient's autonomy and explore the patient's understanding of the decision
D. Ask the physician to convince the patient to continue treatment
Correct Answer: C
Rationale: The nurse's priority is to support patient autonomy while ensuring the patient is making an
,informed decision. Exploring the patient's understanding respects autonomy and assesses decision-
making capacity. Option A may be needed later but is not the first step. Option B may create conflict.
Option D violates patient autonomy.
Q6. A nurse discovers that a medication error occurred 2 hours ago. The patient is stable and
asymptomatic. What is the first action the nurse should take?
A. Complete an incident report
B. Notify the patient's family
C. Assess the patient thoroughly
D. Notify the physician and nursing supervisor
Correct Answer: C
Rationale: Even though the patient appears stable, a thorough assessment is the first priority to identify
any adverse effects before they become critical. After assessment, the nurse should notify the physician
and supervisor (D), then complete the incident report (A). Notifying the family (B) is not the first step.
Q7. A nurse is caring for a patient who has an advance directive stating "do not resuscitate" (DNR). The
patient becomes unresponsive and pulseless. A family member shouts, "Do something! Save her!" What
is the most appropriate nursing action?
A. Begin CPR immediately because the family revoked the DNR
B. Honor the DNR order and provide comfort measures only
C. Call a code blue and begin resuscitation while clarifying the order
D. Ask the family to produce the written DNR document before withholding CPR
Correct Answer: B
Rationale: A valid DNR order is a legally binding advance directive. The nurse must honor the patient's
wishes and provide comfort care. Family members cannot override a valid DNR. Option A is incorrect
because family cannot revoke a DNR verbally in the moment. Option C violates the patient's wishes.
Option D delays appropriate care.
Q8. A nurse is reviewing informed consent with a patient scheduled for surgery. Which statement by the
nurse indicates a correct understanding of informed consent?
A. "I will witness your signature to confirm you understand the procedure."
B. "The surgeon must explain the risks, benefits, and alternatives to you."
C. "As your nurse, I am responsible for obtaining your informed consent."
D. "You can sign the consent form after receiving preoperative sedation."
, Correct Answer: B
Rationale: The surgeon (or provider performing the procedure) is responsible for explaining risks,
benefits, and alternatives and obtaining informed consent. The nurse's role is to witness the signature,
confirming the patient signed voluntarily (A is partially correct but not the best answer). The nurse does
not obtain consent (C). Consent must be obtained before sedation (D).
Q9. A nurse is using Maslow's hierarchy of needs to prioritize care for four patients. Which patient need
represents the highest priority?
A. A patient expressing fear about an upcoming surgery
B. A patient with a potassium level of 2.8 mEq/L
C. A patient requesting help contacting family members
D. A patient asking questions about discharge planning
Correct Answer: B
Rationale: Maslow's hierarchy prioritizes physiological needs first. A potassium of 2.8 mEq/L (normal
3.5–5.0) is a life-threatening electrolyte imbalance that can cause fatal cardiac dysrhythmias. This is a
physiological priority over safety/security (A), love/belonging (C), or self-actualization (D).
Q10. A nurse is caring for a patient with HIV. A nursing student asks the nurse why the patient is not in
isolation. What is the best response?
A. "HIV is not transmitted through casual contact, so standard precautions are sufficient."
B. "The patient is on antiretroviral therapy, so they are no longer infectious."
C. "HIV requires only droplet precautions because it spreads through respiratory secretions."
D. "The physician has not ordered isolation, so it is not necessary."
Correct Answer: A
Rationale: HIV is transmitted through blood, semen, vaginal fluids, and breast milk—not casual contact.
Standard precautions (hand hygiene, PPE for blood/body fluid exposure) are sufficient. Option B is
incorrect—ART reduces but does not eliminate transmission risk. Option C is incorrect—HIV is not
droplet-transmitted. Option D incorrectly places the decision on the physician.
Q11. The nurse is reviewing discharge instructions with a patient going home on warfarin. Which
statement by the patient indicates a need for further teaching?
A. "I will eat the same amount of leafy green vegetables every day."
B. "I will have my INR checked weekly until it is stable."
ACTUAL EXAM 2026/2027 | HESI Exit
Comprehensive Review | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT — MANAGEMENT OF CARE (Q1–Q20)
Q1. The nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse
assess first?
A. A 72-year-old with pneumonia who reports shortness of breath and has SpO₂ 89% on room air
B. A 55-year-old post-op cholecystectomy requesting pain medication rated 6/10
C. A 38-year-old with a new colostomy who needs discharge teaching
D. A 60-year-old with stable atrial fibrillation awaiting discharge
Correct Answer: A
Rationale: The patient with pneumonia and SpO₂ 89% has compromised oxygenation, which is a life-
threatening priority per the ABCs (Airway, Breathing, Circulation). This patient requires immediate
assessment and intervention. Option B is important but pain is not life-threatening. Option C is a routine
discharge need. Option D is stable and awaiting discharge.
Q2. A registered nurse (RN) is delegating tasks to unlicensed assistive personnel (UAP) and a licensed
practical nurse (LPN). Which task is most appropriate to delegate to the LPN?
A. Administering a newly prescribed IV antibiotic to a patient with sepsis
B. Assisting a patient with ambulation for the first time after surgery
C. Performing a sterile dressing change on a patient with a surgical wound
D. Reinforcing teaching about a low-sodium diet to a patient with heart failure
Correct Answer: C
Rationale: Performing a sterile dressing change is within the LPN scope of practice in most states, as it is
a predictable, routine procedure. Option A (IV antibiotics for sepsis) requires RN assessment and
,judgment. Option B (first ambulation post-op) requires RN assessment of stability. Option D (teaching) is
an RN responsibility; LPNs may reinforce but not initiate teaching.
Q3. The charge nurse is making assignments for the shift. Which patient should be assigned to the most
experienced RN?
A. A patient with newly diagnosed type 2 diabetes mellitus requiring dietary teaching
B. A patient 2 hours post-op from a total knee replacement with a morphine PCA
C. A patient admitted for observation following a syncopal episode with an irregular rhythm
D. A patient with hypertension awaiting discharge after medication reconciliation
Correct Answer: C
Rationale: The patient with syncope and an irregular rhythm has an undifferentiated, potentially
unstable condition requiring advanced assessment, ECG interpretation, and rapid clinical decision-
making—best suited for the most experienced RN. Option A is stable teaching. Option B is routine post-
op care. Option D is discharge preparation.
Q4. A nurse receives a telephone order from a physician for a new medication. What is the priority
nursing action?
A. Write the order in the patient's medical record
B. Repeat the order back to the physician for verification
C. Administer the medication immediately
D. Notify the pharmacist of the new order
Correct Answer: B
Rationale: Per The Joint Commission National Patient Safety Goal, telephone orders must be read back
and verified for accuracy to prevent medication errors. This is the priority action before documenting
(A), administering (C), or notifying pharmacy (D).
Q5. A patient with terminal cancer expresses a desire to refuse further chemotherapy. The patient's
family insists the treatment continue. What is the best initial nursing action?
A. Contact the hospital ethics committee immediately
B. Explain to the family that the patient has the right to refuse treatment
C. Support the patient's autonomy and explore the patient's understanding of the decision
D. Ask the physician to convince the patient to continue treatment
Correct Answer: C
Rationale: The nurse's priority is to support patient autonomy while ensuring the patient is making an
,informed decision. Exploring the patient's understanding respects autonomy and assesses decision-
making capacity. Option A may be needed later but is not the first step. Option B may create conflict.
Option D violates patient autonomy.
Q6. A nurse discovers that a medication error occurred 2 hours ago. The patient is stable and
asymptomatic. What is the first action the nurse should take?
A. Complete an incident report
B. Notify the patient's family
C. Assess the patient thoroughly
D. Notify the physician and nursing supervisor
Correct Answer: C
Rationale: Even though the patient appears stable, a thorough assessment is the first priority to identify
any adverse effects before they become critical. After assessment, the nurse should notify the physician
and supervisor (D), then complete the incident report (A). Notifying the family (B) is not the first step.
Q7. A nurse is caring for a patient who has an advance directive stating "do not resuscitate" (DNR). The
patient becomes unresponsive and pulseless. A family member shouts, "Do something! Save her!" What
is the most appropriate nursing action?
A. Begin CPR immediately because the family revoked the DNR
B. Honor the DNR order and provide comfort measures only
C. Call a code blue and begin resuscitation while clarifying the order
D. Ask the family to produce the written DNR document before withholding CPR
Correct Answer: B
Rationale: A valid DNR order is a legally binding advance directive. The nurse must honor the patient's
wishes and provide comfort care. Family members cannot override a valid DNR. Option A is incorrect
because family cannot revoke a DNR verbally in the moment. Option C violates the patient's wishes.
Option D delays appropriate care.
Q8. A nurse is reviewing informed consent with a patient scheduled for surgery. Which statement by the
nurse indicates a correct understanding of informed consent?
A. "I will witness your signature to confirm you understand the procedure."
B. "The surgeon must explain the risks, benefits, and alternatives to you."
C. "As your nurse, I am responsible for obtaining your informed consent."
D. "You can sign the consent form after receiving preoperative sedation."
, Correct Answer: B
Rationale: The surgeon (or provider performing the procedure) is responsible for explaining risks,
benefits, and alternatives and obtaining informed consent. The nurse's role is to witness the signature,
confirming the patient signed voluntarily (A is partially correct but not the best answer). The nurse does
not obtain consent (C). Consent must be obtained before sedation (D).
Q9. A nurse is using Maslow's hierarchy of needs to prioritize care for four patients. Which patient need
represents the highest priority?
A. A patient expressing fear about an upcoming surgery
B. A patient with a potassium level of 2.8 mEq/L
C. A patient requesting help contacting family members
D. A patient asking questions about discharge planning
Correct Answer: B
Rationale: Maslow's hierarchy prioritizes physiological needs first. A potassium of 2.8 mEq/L (normal
3.5–5.0) is a life-threatening electrolyte imbalance that can cause fatal cardiac dysrhythmias. This is a
physiological priority over safety/security (A), love/belonging (C), or self-actualization (D).
Q10. A nurse is caring for a patient with HIV. A nursing student asks the nurse why the patient is not in
isolation. What is the best response?
A. "HIV is not transmitted through casual contact, so standard precautions are sufficient."
B. "The patient is on antiretroviral therapy, so they are no longer infectious."
C. "HIV requires only droplet precautions because it spreads through respiratory secretions."
D. "The physician has not ordered isolation, so it is not necessary."
Correct Answer: A
Rationale: HIV is transmitted through blood, semen, vaginal fluids, and breast milk—not casual contact.
Standard precautions (hand hygiene, PPE for blood/body fluid exposure) are sufficient. Option B is
incorrect—ART reduces but does not eliminate transmission risk. Option C is incorrect—HIV is not
droplet-transmitted. Option D incorrectly places the decision on the physician.
Q11. The nurse is reviewing discharge instructions with a patient going home on warfarin. Which
statement by the patient indicates a need for further teaching?
A. "I will eat the same amount of leafy green vegetables every day."
B. "I will have my INR checked weekly until it is stable."
