BSN 366 HESI RN Exit Exam V1 (Latest Update 2026/2027) Quest...
OBJECTIVE ASSESSMENT - EXAM
BSN 366 HESI RN Exit Exam V1
(Latest Update 2026/2027) Questions
and Verified Answers | 100% Correct
| Grade A - Nightingale
75 QUESTIONS VERIFIED ANSWERS 2026/2027
2026/2027 EDITION
TOPICS COVERED
• Medical-Surgical Nursing • Mental Health & Psychiatric Nursing
• Pharmacology & Medication Administration • Leadership, Management & Community Health
• Maternal-Newborn & Pediatric Nursing
COVER PAGE - 1
, SECTION 1: Medical-Surgical Nursing
Q1.
A 68-year-old male is admitted with community-acquired pneumonia and a history of chronic obstructive pulmonary
disease. His vital signs are temperature 38.6C, heart rate 102 bpm, respiratory rate 26/min, blood pressure 142/88
mmHg, and SpO2 89% on room air. He is started on ceftriaxone and azithromycin. On day 3 of hospitalization, the
nurse notes that his urine output has decreased to 20 mL/hr and his serum creatinine has risen from 1.1 to 2.4
mg/dL. Which intervention should the nurse prioritize?
A. Increase the intravenous fluid rate to 150 mL/hr
B. Notify the provider and review current medications for nephrotoxic agents
C. Obtain a stat urinalysis and urine culture
D. Administer furosemide 40 mg intravenously to increase urine output
Correct Answer: B
Rationale:
The patient is developing acute kidney injury, likely from a combination of dehydration, sepsis, and potential nephrotoxic
medications. The nurse should first notify the provider and review medications including the azithromycin and any contrast
studies. Increasing fluids without provider orders is unsafe. A urine culture is not the priority. Furosemide is inappropriate
for prerenal azotemia.
Q2.
A 54-year-old woman with type 2 diabetes mellitus is admitted for diabetic foot ulcer debridement. Her fasting blood
glucose is 248 mg/dL, and her HbA1c is 9.2%. She is on a basal-bolus insulin regimen. Before breakfast, her
point-of-care glucose is 62 mg/dL. She is alert and oriented but reports feeling shaky. Which action should the
nurse take first?
A. Administer 15 grams of fast-acting carbohydrate and recheck in 15 minutes
B. Hold the rapid-acting insulin and notify the provider
C. Give half the scheduled rapid-acting insulin dose
D. Start a dextrose 5% intravenous infusion at 75 mL/hr
Correct Answer: A
Rationale:
The 15-15 rule is the standard treatment for hypoglycemia in conscious patients: 15 grams of fast-acting carbohydrate
followed by rechecking glucose in 15 minutes. The patient is alert and can safely take oral carbohydrates. Holding insulin
does not address the current hypoglycemia. IV dextrose is reserved for unconscious or NPO patients.
Q3.
A 72-year-old male with a history of atrial fibrillation on warfarin presents with acute onset of right-sided weakness
and aphasia. His INR is 3.2, and a CT head shows no hemorrhage. The time of last known well was 2 hours ago.
Which finding would most strongly contraindicate the administration of intravenous alteplase?
A. An INR above 3.0 in a patient on warfarin therapy
B. A blood pressure of 178/96 mmHg that responds to labetalol
C.
, A history of gastrointestinal bleeding 6 months ago
D. A glucose level of 142 mg/dL on admission
Correct Answer: A
Rationale:
An INR greater than 1.7 is an absolute contraindication to intravenous thrombolysis due to the high risk of intracranial
hemorrhage. The patient's INR of 3.2 makes thrombolysis unsafe regardless of the time window. Hypertension can be
treated, remote GI bleeding is a relative contraindication, and mild hyperglycemia does not exclude thrombolysis.
Q4.
A 47-year-old female is postoperative day 2 after total abdominal hysterectomy. She reports increasing abdominal
pain and has not passed flatus. Her abdomen is distended and tympanic to percussion. Bowel sounds are absent in
all four quadrants. Her temperature is 37.8C and white blood cell count is 11,200 per mm3. Which nursing
intervention is most appropriate at this time?
A. Insert a nasogastric tube to low intermittent suction and maintain NPO status
B. Administer a Fleet enema to stimulate bowel movement
C. Encourage ambulation and increase oral fluid intake
D. Start metoclopramide 10 mg intravenously every 6 hours
Correct Answer: A
Rationale:
Absent bowel sounds with abdominal distension and failure to pass flatus after abdominal surgery suggests a paralytic
ileus. Nasogastric decompression with NPO status is the priority to rest the bowel and prevent vomiting and aspiration.
Enemas are contraindicated. Ambulation is helpful but insufficient alone. Metoclopramide may worsen obstruction.
Q5.
A 61-year-old male with end-stage renal disease on hemodialysis three times weekly presents with shortness of
breath and bilateral crackles on auscultation. His weight has increased by 4.5 kg since his last dialysis session 2
days ago. His blood pressure is 168/102 mmHg, and he has 2+ pitting edema in both lower extremities. Which
assessment finding would most strongly indicate fluid volume excess?
A. Blood pressure elevation to 168/102 mmHg from a baseline of 138/84 mmHg
B. Jugular venous distension visible at 45 degrees
C. A heart rate of 88 bpm with regular rhythm
D. Dry mucous membranes and poor skin turgor
Correct Answer: B
Rationale:
Jugular venous distension at 45 degrees is a reliable indicator of elevated central venous pressure and fluid volume
overload in renal failure patients. While hypertension and edema suggest fluid excess, JVD directly reflects right atrial
pressure. A normal heart rate does not indicate volume status. Dry mucous membranes suggest dehydration, not overload.
Q6.
A 58-year-old woman with a history of breast cancer status post mastectomy and axillary lymph node dissection 2
years ago reports new swelling in her right arm. The circumference of her right upper arm is 4 cm larger than her
OBJECTIVE ASSESSMENT - EXAM
BSN 366 HESI RN Exit Exam V1
(Latest Update 2026/2027) Questions
and Verified Answers | 100% Correct
| Grade A - Nightingale
75 QUESTIONS VERIFIED ANSWERS 2026/2027
2026/2027 EDITION
TOPICS COVERED
• Medical-Surgical Nursing • Mental Health & Psychiatric Nursing
• Pharmacology & Medication Administration • Leadership, Management & Community Health
• Maternal-Newborn & Pediatric Nursing
COVER PAGE - 1
, SECTION 1: Medical-Surgical Nursing
Q1.
A 68-year-old male is admitted with community-acquired pneumonia and a history of chronic obstructive pulmonary
disease. His vital signs are temperature 38.6C, heart rate 102 bpm, respiratory rate 26/min, blood pressure 142/88
mmHg, and SpO2 89% on room air. He is started on ceftriaxone and azithromycin. On day 3 of hospitalization, the
nurse notes that his urine output has decreased to 20 mL/hr and his serum creatinine has risen from 1.1 to 2.4
mg/dL. Which intervention should the nurse prioritize?
A. Increase the intravenous fluid rate to 150 mL/hr
B. Notify the provider and review current medications for nephrotoxic agents
C. Obtain a stat urinalysis and urine culture
D. Administer furosemide 40 mg intravenously to increase urine output
Correct Answer: B
Rationale:
The patient is developing acute kidney injury, likely from a combination of dehydration, sepsis, and potential nephrotoxic
medications. The nurse should first notify the provider and review medications including the azithromycin and any contrast
studies. Increasing fluids without provider orders is unsafe. A urine culture is not the priority. Furosemide is inappropriate
for prerenal azotemia.
Q2.
A 54-year-old woman with type 2 diabetes mellitus is admitted for diabetic foot ulcer debridement. Her fasting blood
glucose is 248 mg/dL, and her HbA1c is 9.2%. She is on a basal-bolus insulin regimen. Before breakfast, her
point-of-care glucose is 62 mg/dL. She is alert and oriented but reports feeling shaky. Which action should the
nurse take first?
A. Administer 15 grams of fast-acting carbohydrate and recheck in 15 minutes
B. Hold the rapid-acting insulin and notify the provider
C. Give half the scheduled rapid-acting insulin dose
D. Start a dextrose 5% intravenous infusion at 75 mL/hr
Correct Answer: A
Rationale:
The 15-15 rule is the standard treatment for hypoglycemia in conscious patients: 15 grams of fast-acting carbohydrate
followed by rechecking glucose in 15 minutes. The patient is alert and can safely take oral carbohydrates. Holding insulin
does not address the current hypoglycemia. IV dextrose is reserved for unconscious or NPO patients.
Q3.
A 72-year-old male with a history of atrial fibrillation on warfarin presents with acute onset of right-sided weakness
and aphasia. His INR is 3.2, and a CT head shows no hemorrhage. The time of last known well was 2 hours ago.
Which finding would most strongly contraindicate the administration of intravenous alteplase?
A. An INR above 3.0 in a patient on warfarin therapy
B. A blood pressure of 178/96 mmHg that responds to labetalol
C.
, A history of gastrointestinal bleeding 6 months ago
D. A glucose level of 142 mg/dL on admission
Correct Answer: A
Rationale:
An INR greater than 1.7 is an absolute contraindication to intravenous thrombolysis due to the high risk of intracranial
hemorrhage. The patient's INR of 3.2 makes thrombolysis unsafe regardless of the time window. Hypertension can be
treated, remote GI bleeding is a relative contraindication, and mild hyperglycemia does not exclude thrombolysis.
Q4.
A 47-year-old female is postoperative day 2 after total abdominal hysterectomy. She reports increasing abdominal
pain and has not passed flatus. Her abdomen is distended and tympanic to percussion. Bowel sounds are absent in
all four quadrants. Her temperature is 37.8C and white blood cell count is 11,200 per mm3. Which nursing
intervention is most appropriate at this time?
A. Insert a nasogastric tube to low intermittent suction and maintain NPO status
B. Administer a Fleet enema to stimulate bowel movement
C. Encourage ambulation and increase oral fluid intake
D. Start metoclopramide 10 mg intravenously every 6 hours
Correct Answer: A
Rationale:
Absent bowel sounds with abdominal distension and failure to pass flatus after abdominal surgery suggests a paralytic
ileus. Nasogastric decompression with NPO status is the priority to rest the bowel and prevent vomiting and aspiration.
Enemas are contraindicated. Ambulation is helpful but insufficient alone. Metoclopramide may worsen obstruction.
Q5.
A 61-year-old male with end-stage renal disease on hemodialysis three times weekly presents with shortness of
breath and bilateral crackles on auscultation. His weight has increased by 4.5 kg since his last dialysis session 2
days ago. His blood pressure is 168/102 mmHg, and he has 2+ pitting edema in both lower extremities. Which
assessment finding would most strongly indicate fluid volume excess?
A. Blood pressure elevation to 168/102 mmHg from a baseline of 138/84 mmHg
B. Jugular venous distension visible at 45 degrees
C. A heart rate of 88 bpm with regular rhythm
D. Dry mucous membranes and poor skin turgor
Correct Answer: B
Rationale:
Jugular venous distension at 45 degrees is a reliable indicator of elevated central venous pressure and fluid volume
overload in renal failure patients. While hypertension and edema suggest fluid excess, JVD directly reflects right atrial
pressure. A normal heart rate does not indicate volume status. Dry mucous membranes suggest dehydration, not overload.
Q6.
A 58-year-old woman with a history of breast cancer status post mastectomy and axillary lymph node dissection 2
years ago reports new swelling in her right arm. The circumference of her right upper arm is 4 cm larger than her
