BSN HESI 366 RN EXIT EXAM NIGHTINGALE COMPREHENSIVE ACTUAL EXAM PREP 2026 ALL QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES ALREADY A GRADED WITH EXPERT FEEDBACK |NEW AND REVISED

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BSN HESI 366 RN EXIT EXAM NIGHTINGALE
COMPREHENSIVE ACTUAL EXAM PREP 2026
ALL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED

1. A client is admitted with a serum potassium level of 2.8 mEq/L.
Which assessment finding requires the nurse's immediate intervention?
 A) Muscle weakness
 B) Fatigue and lethargy
 C) ECG showing U waves and flattened T waves
 D) Thirst and dry mucous membranes
Rationale: Hypokalemia (K+ < 3.5 mEq/L) can cause life-threatening
cardiac dysrhythmias. ECG changes including U waves, flattened T
waves, and ST depression indicate significant potassium depletion and
require immediate intervention. Muscle weakness and fatigue are
expected findings but are not immediately life-threatening. Thirst and
dry mucous membranes are signs of dehydration, not specifically
hypokalemia.
2. A client with heart failure is prescribed furosemide (Lasix) 40 mg IV
push. Which laboratory value should the nurse monitor most closely
before administering this medication?
 A) Serum potassium
 B) Serum sodium
 C) Serum calcium

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 D) Serum magnesium
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. The nurse must monitor serum potassium closely because
hypokalemia can precipitate cardiac dysrhythmias. While sodium,
calcium, and magnesium may also be affected, potassium is the most
critical to monitor before and during furosemide therapy.
3. A client who had a total hip replacement 3 days ago reports sudden
shortness of breath, chest pain, and diaphoresis. What is the nurse's
priority action?
 A) Administer prescribed PRN oxygen at 2 L/min
 B) Elevate the head of the bed to 45 degrees
 C) Call the rapid response team immediately
 D) Apply sequential compression devices
Rationale: Sudden shortness of breath, chest pain, and diaphoresis in
a post-operative orthopedic patient are classic signs of a pulmonary
embolism (PE), a life-threatening emergency. The nurse should
immediately call the rapid response team to initiate urgent medical
intervention. While oxygen and positioning are supportive measures,
they do not replace the need for immediate emergency response.
4. A client with type 2 diabetes mellitus is started on metformin
(Glucophage). Which instruction is most important for the nurse to
include in discharge teaching?
 A) "Take this medication on an empty stomach for best
absorption."
 B) "Avoid consuming alcohol while taking this medication."
 C) "Expect to gain weight while taking this medication."
 D) "Monitor for signs of hyperglycemia only."

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Rationale: The most critical instruction for a client taking metformin
is to avoid alcohol. Metformin increases the risk of lactic acidosis, and
alcohol consumption further increases this risk because both
metformin and alcohol affect hepatic metabolism. Lactic acidosis is
rare but potentially fatal. Metformin should be taken with meals to
reduce gastrointestinal side effects, and weight loss (not gain) is
commonly associated with this medication.
5. A client is admitted with a diagnosis of chronic obstructive pulmonary
disease (COPD) exacerbation. Which arterial blood gas (ABG) finding
would the nurse expect?
 A) pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
 B) pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
 C) pH 7.36, PaCO₂ 42 mmHg, HCO₃⁻ 24 mEq/L
 D) pH 7.50, PaCO₂ 48 mmHg, HCO₃⁻ 30 mEq/L
Rationale: In COPD exacerbation, the client experiences respiratory
acidosis due to impaired gas exchange and carbon dioxide retention.
The ABG would show a decreased pH (< 7.35) and elevated PaCO₂ (>
45 mmHg). The HCO₃⁻ may be elevated as a compensatory response
(metabolic alkalosis). Option B shows pH 7.30 (acidosis), PaCO₂ 55
mmHg (elevated), and HCO₃⁻ 28 mEq/L (compensatory elevation).
6. A nurse is preparing to administer an intravenous (IV) antibiotic to a
client. Which action should the nurse take first?
 A) Assess the client's allergy status
 B) Verify the client's identity using two identifiers
 C) Calculate the medication dosage
 D) Check the expiration date of the medication

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Rationale: The first action in medication administration is to verify the
client's identity using two unique identifiers (e.g., name and date of
birth) to ensure the right client receives the medication. While
assessing allergy status, calculating dosage, and checking expiration
dates are important, patient identification is the priority to prevent
medication errors.
7. A client with cirrhosis is admitted with ascites and peripheral edema.
Which nursing intervention is most appropriate?
 A) Encourage a high-sodium diet
 B) Monitor daily weight and abdominal girth
 C) Restrict fluid intake to 500 mL daily
 D) Position the client in a supine position
Rationale: Monitoring daily weight and abdominal girth is essential to
track fluid accumulation in ascites. Sodium restriction (not high
sodium) is typically prescribed. Fluid restriction may be prescribed but
is not the primary intervention. Supine positioning may worsen
respiratory compromise; semi-Fowler's position is preferred.
8. A client is receiving a blood transfusion and develops chills, fever,
and low back pain. What is the priority nursing action?
 A) Slow the transfusion rate
 B) Stop the transfusion immediately
 C) Administer an antihistamine
 D) Monitor vital signs
Rationale: Chills, fever, and low back pain are signs of a transfusion
reaction, which could be hemolytic or febrile. The transfusion should
be stopped immediately, and the healthcare provider should be
notified. Slowing the rate is not sufficient; the reaction must be