BSN366 Exam 4 Actual Exam Style V3 | BSN 366 HESI RN Exit |
Nightingale - 141 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Nursing: Comprehensive HESI RN Exit Exam
Description This exam simulates the HESI RN Exit exam for senior nursing students, covering
maternal-newborn, pediatrics, med-surg, mental health, critical care, leadership,
community health, pharmacology, ethics, and nutrition. Questions require clinical
reasoning, prioritization, and evidence-based practice.
Expected Grade A+
Total Questions 141
Duration 3 hours
Learning Outcomes 1. Apply critical thinking to complex patient scenarios across the lifespan
2. Prioritize interventions based on patient acuity and safety
3. Interpret laboratory and diagnostic data to guide nursing actions
4. Demonstrate knowledge of pharmacology and medication administration
5. Utilize leadership and delegation principles in team-based care
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) at a
top-tier US research university
Page 1
,1. A client in active labor experiences prolonged second stage. After the fetal
head delivers, it retracts tightly against the perineum. Which sequence of
interventions should the nurse anticipate?
Answer: McRoberts maneuver, suprapubic pressure, Woods' corkscrew,
delivery of posterior arm
Shoulder dystocia management follows a stepwise approach: McRoberts
maneuver (hip flexion) and suprapubic pressure to dislodge the shoulder, then
Woods' corkscrew or Rubin's maneuvers, and delivery of posterior arm if
needed. Fundal pressure is contraindicated as it may worsen impaction.
2. A child with acute asthma exacerbation has a peak expiratory flow rate
(PEFR) of 45% of predicted. Arterial blood gas shows pH 7.32, PaCO2 55 mm
Hg, PaO2 70 mm Hg. Which assessment finding warrants immediate
notification of the healthcare provider?
Answer: PaCO2 rising from 35 to 55 mm Hg with a low pH
A rising PaCO2 with acidosis (respiratory acidosis) indicates impending
respiratory failure in asthma, as the child is tiring. This is more ominous than
hypoxemia alone. Elevated PaCO2 in acute severe asthma is a sign of
decompensation. Options A and B are concerning but expected; D indicates poor
response but not as urgent as the blood gas change.
3. A client on rivaroxaban develops a life-threatening gastrointestinal bleed.
Which agent reverses the anticoagulant effect of rivaroxaban?
Answer: Andexanet alfa
Andexanet alfa is a specific reversal agent for direct factor Xa inhibitors like
rivaroxaban. Vitamin K reverses warfarin, protamine reverses heparin, and
fresh frozen plasma contains clotting factors but is not the first-line for DOACs.
Page 2
,4. For each potential prescription for a client with chronic kidney disease and
serum potassium 6.8 mEq/L, click to specify if it is anticipated (indicated for
hyperkalemia), nonessential, or contraindicated.
Answer: One intervention is contraindicated
Sodium polystyrene sulfonate, calcium gluconate, insulin/dextrose, furosemide,
and sodium bicarbonate are all indicated for hyperkalemia. Spironolactone is a
potassium-sparing diuretic and is contraindicated as it would worsen
hyperkalemia.
5. A client with major depressive disorder states, 'I've finally decided to end
my suffering.' The nurse observes the client has a new wound on the arm.
Which question should the nurse ask first?
Answer: Do you have a specific plan to kill yourself?
The priority is to determine the client's current intent and plan. Asking about a
specific plan assesses imminent risk. The client has ideation and a self-inflicted
wound, so immediate safety is paramount. Options B and D are less direct; C is
important but after establishing if a plan exists.
6. A charge nurse is assigning tasks to the team. Which task is appropriate to
delegate to a licensed practical nurse (LPN)?
Answer: Administering oral medications via a percutaneous endoscopic
gastrostomy (PEG) tube
LPNs can administer medications via established enteral tubes. Transfusion
administration requires RN assessment; initial assessment and care plan are RN
responsibilities.
7. A client on volume-controlled ventilation has an acute rise in peak
inspiratory pressure (PIP) with unchanged plateau pressure. Which condition
most likely explains this finding?
Answer: Bronchospasm or mucous plug
Elevated PIP with normal plateau indicates increased airway resistance (e.g.,
bronchospasm, secretions, or mucous plug). Tension pneumothorax and
pulmonary edema decrease compliance, raising both PIP and plateau. Increased
lung compliance would lower pressures.
Page 3
, 8. In a mass casualty incident, a client with an open femur fracture, weak
radial pulse, and respiratory rate 30 breaths/min is classified using the Simple
Triage and Rapid Treatment (START) system. Which color tag should the
client receive?
Answer: Red (immediate)
START triage: respiratory rate >30 or <10, capillary refill >2 seconds, or
inability to follow commands indicates immediate (red). The client has RR 30
(borderline but over 30) and weak pulse (cap refill likely >2 sec) so red. Yellow is
for delayed, green for minor, black for deceased.
9. A nurse is obtaining a signature on an informed consent form for a surgery
scheduled for tomorrow. The client says, 'The doctor explained this, but I don't
remember what I'm supposed to have done.' Which action should the nurse
take?
Answer: Notify the healthcare provider to clarify the procedure again
Informed consent requires that the client understands the procedure. The nurse's
role is to witness the signature after ensuring the client has received information
and appears to understand. If the client lacks understanding, the provider must
re-explain. The nurse cannot educate about the surgical details.
10. A client receiving total parenteral nutrition (TPN) via a central line has a
serum glucose level of 350 mg/dL. The rate is 100 mL/h of a standard TPN
solution. Which intervention should the nurse anticipate?
Answer: Decrease the TPN rate to 50 mL/h and administer subcutaneous
insulin
Hyperglycemia is a common complication. Decreasing the rate and giving insulin
subcutaneously is a standard approach. Abruptly stopping TPN can cause
rebound hypoglycemia; adding insulin to the bag may be done but takes time to
mix and is not immediate. Changing concentration takes time to obtain new
order. Decreasing rate is first step.
Page 4
Nightingale - 141 Questions and Answers Already Graded A+
Premium Exam Tested And Verified
Subject Area Nursing: Comprehensive HESI RN Exit Exam
Description This exam simulates the HESI RN Exit exam for senior nursing students, covering
maternal-newborn, pediatrics, med-surg, mental health, critical care, leadership,
community health, pharmacology, ethics, and nutrition. Questions require clinical
reasoning, prioritization, and evidence-based practice.
Expected Grade A+
Total Questions 141
Duration 3 hours
Learning Outcomes 1. Apply critical thinking to complex patient scenarios across the lifespan
2. Prioritize interventions based on patient acuity and safety
3. Interpret laboratory and diagnostic data to guide nursing actions
4. Demonstrate knowledge of pharmacology and medication administration
5. Utilize leadership and delegation principles in team-based care
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) at a
top-tier US research university
Page 1
,1. A client in active labor experiences prolonged second stage. After the fetal
head delivers, it retracts tightly against the perineum. Which sequence of
interventions should the nurse anticipate?
Answer: McRoberts maneuver, suprapubic pressure, Woods' corkscrew,
delivery of posterior arm
Shoulder dystocia management follows a stepwise approach: McRoberts
maneuver (hip flexion) and suprapubic pressure to dislodge the shoulder, then
Woods' corkscrew or Rubin's maneuvers, and delivery of posterior arm if
needed. Fundal pressure is contraindicated as it may worsen impaction.
2. A child with acute asthma exacerbation has a peak expiratory flow rate
(PEFR) of 45% of predicted. Arterial blood gas shows pH 7.32, PaCO2 55 mm
Hg, PaO2 70 mm Hg. Which assessment finding warrants immediate
notification of the healthcare provider?
Answer: PaCO2 rising from 35 to 55 mm Hg with a low pH
A rising PaCO2 with acidosis (respiratory acidosis) indicates impending
respiratory failure in asthma, as the child is tiring. This is more ominous than
hypoxemia alone. Elevated PaCO2 in acute severe asthma is a sign of
decompensation. Options A and B are concerning but expected; D indicates poor
response but not as urgent as the blood gas change.
3. A client on rivaroxaban develops a life-threatening gastrointestinal bleed.
Which agent reverses the anticoagulant effect of rivaroxaban?
Answer: Andexanet alfa
Andexanet alfa is a specific reversal agent for direct factor Xa inhibitors like
rivaroxaban. Vitamin K reverses warfarin, protamine reverses heparin, and
fresh frozen plasma contains clotting factors but is not the first-line for DOACs.
Page 2
,4. For each potential prescription for a client with chronic kidney disease and
serum potassium 6.8 mEq/L, click to specify if it is anticipated (indicated for
hyperkalemia), nonessential, or contraindicated.
Answer: One intervention is contraindicated
Sodium polystyrene sulfonate, calcium gluconate, insulin/dextrose, furosemide,
and sodium bicarbonate are all indicated for hyperkalemia. Spironolactone is a
potassium-sparing diuretic and is contraindicated as it would worsen
hyperkalemia.
5. A client with major depressive disorder states, 'I've finally decided to end
my suffering.' The nurse observes the client has a new wound on the arm.
Which question should the nurse ask first?
Answer: Do you have a specific plan to kill yourself?
The priority is to determine the client's current intent and plan. Asking about a
specific plan assesses imminent risk. The client has ideation and a self-inflicted
wound, so immediate safety is paramount. Options B and D are less direct; C is
important but after establishing if a plan exists.
6. A charge nurse is assigning tasks to the team. Which task is appropriate to
delegate to a licensed practical nurse (LPN)?
Answer: Administering oral medications via a percutaneous endoscopic
gastrostomy (PEG) tube
LPNs can administer medications via established enteral tubes. Transfusion
administration requires RN assessment; initial assessment and care plan are RN
responsibilities.
7. A client on volume-controlled ventilation has an acute rise in peak
inspiratory pressure (PIP) with unchanged plateau pressure. Which condition
most likely explains this finding?
Answer: Bronchospasm or mucous plug
Elevated PIP with normal plateau indicates increased airway resistance (e.g.,
bronchospasm, secretions, or mucous plug). Tension pneumothorax and
pulmonary edema decrease compliance, raising both PIP and plateau. Increased
lung compliance would lower pressures.
Page 3
, 8. In a mass casualty incident, a client with an open femur fracture, weak
radial pulse, and respiratory rate 30 breaths/min is classified using the Simple
Triage and Rapid Treatment (START) system. Which color tag should the
client receive?
Answer: Red (immediate)
START triage: respiratory rate >30 or <10, capillary refill >2 seconds, or
inability to follow commands indicates immediate (red). The client has RR 30
(borderline but over 30) and weak pulse (cap refill likely >2 sec) so red. Yellow is
for delayed, green for minor, black for deceased.
9. A nurse is obtaining a signature on an informed consent form for a surgery
scheduled for tomorrow. The client says, 'The doctor explained this, but I don't
remember what I'm supposed to have done.' Which action should the nurse
take?
Answer: Notify the healthcare provider to clarify the procedure again
Informed consent requires that the client understands the procedure. The nurse's
role is to witness the signature after ensuring the client has received information
and appears to understand. If the client lacks understanding, the provider must
re-explain. The nurse cannot educate about the surgical details.
10. A client receiving total parenteral nutrition (TPN) via a central line has a
serum glucose level of 350 mg/dL. The rate is 100 mL/h of a standard TPN
solution. Which intervention should the nurse anticipate?
Answer: Decrease the TPN rate to 50 mL/h and administer subcutaneous
insulin
Hyperglycemia is a common complication. Decreasing the rate and giving insulin
subcutaneously is a standard approach. Abruptly stopping TPN can cause
rebound hypoglycemia; adding insulin to the bag may be done but takes time to
mix and is not immediate. Changing concentration takes time to obtain new
order. Decreasing rate is first step.
Page 4
