,Nightingale BSN 366 Exam 4 – Complete Practice Bank (Actual
Style V3)
200+ High-Acuity Medical-Surgical & Critical Care Questions |
HESI RN Exit Exam Prep
INTRODUCTION
This comprehensive question bank is designed to match
the Nightingale College BSN 366 Exam 4 Actual Style
V3 blueprint. It provides high-yield, high-acuity medical-surgical
and critical care questions modeled after the rigorous HESI RN
Exit examination criteria. Each question includes verified
correct answers and detailed clinical rationales to sharpen
priority-setting skills and prepare for program completion.
SECTION 1: CARDIAC & CRITICAL CARE
1. A client with an acute myocardial infarction develops
dysrhythmias. Which finding indicates a positive response to
amiodarone therapy?
A) Decreased heart rate from 140 to 110 bpm
B) Increased QTc interval to 520 msec
C) Resolution of ventricular tachycardia
D) Increased pulmonary artery pressure
Correct Answer: C
,Rationale: Amiodarone is a Class III antidysrhythmic drug used
for life-threatening ventricular tachycardia. Positive response is
evidenced by resolution of dysrhythmia. QTc prolongation is a
side effect requiring monitoring. Pulmonary artery pressure
increase is a complication of heart failure, not a positive
response.
2. A client with heart failure has an ejection fraction of 25%
and is prescribed carvedilol. The nurse understands that this
medication:
A) Increases cardiac output by increasing heart rate
B) Blocks beta-1 receptors to reduce myocardial oxygen
demand
C) Acts as a positive inotrope to increase contractility
D) Increases vasoconstriction to improve perfusion
Correct Answer: B
Rationale: Carvedilol is a nonselective beta-blocker that
reduces mortality in heart failure by decreasing myocardial
oxygen demand and preventing remodeling. It blocks beta-1
and beta-2 receptors and has alpha-1 blocking effects.
3. A client receiving IV dopamine for cardiogenic shock has an
infiltration at the IV site. Which finding indicates potential
tissue necrosis?
, A) Pallor at the infiltration site
B) Warmth and erythema at the site
C) Blistering and skin sloughing
D) Edema without discoloration
Correct Answer: C
Rationale: Dopamine is a potent vasoconstrictor that can cause
tissue necrosis if infiltration occurs. Signs of ischemia include
blanching, coolness, and pain, progressing to blistering and
tissue necrosis. Phentolamine is the antidote for extravasation
of vasopressors.
4. A client with end-stage renal disease (ESRD) develops
severe hyperkalemia with a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate?
A) Oral potassium supplements
B) IV calcium gluconate
C) IV sodium bicarbonate
D) Both B and C
Correct Answer: D
Rationale: Hyperkalemia requires immediate treatment to
prevent cardiac arrest. IV calcium gluconate stabilizes the
cardiac membrane. IV sodium bicarbonate and insulin with
dextrose shift potassium into cells. Kayexalate binds potassium
in the GI tract. Dialysis may be required for severe
hyperkalemia.
Style V3)
200+ High-Acuity Medical-Surgical & Critical Care Questions |
HESI RN Exit Exam Prep
INTRODUCTION
This comprehensive question bank is designed to match
the Nightingale College BSN 366 Exam 4 Actual Style
V3 blueprint. It provides high-yield, high-acuity medical-surgical
and critical care questions modeled after the rigorous HESI RN
Exit examination criteria. Each question includes verified
correct answers and detailed clinical rationales to sharpen
priority-setting skills and prepare for program completion.
SECTION 1: CARDIAC & CRITICAL CARE
1. A client with an acute myocardial infarction develops
dysrhythmias. Which finding indicates a positive response to
amiodarone therapy?
A) Decreased heart rate from 140 to 110 bpm
B) Increased QTc interval to 520 msec
C) Resolution of ventricular tachycardia
D) Increased pulmonary artery pressure
Correct Answer: C
,Rationale: Amiodarone is a Class III antidysrhythmic drug used
for life-threatening ventricular tachycardia. Positive response is
evidenced by resolution of dysrhythmia. QTc prolongation is a
side effect requiring monitoring. Pulmonary artery pressure
increase is a complication of heart failure, not a positive
response.
2. A client with heart failure has an ejection fraction of 25%
and is prescribed carvedilol. The nurse understands that this
medication:
A) Increases cardiac output by increasing heart rate
B) Blocks beta-1 receptors to reduce myocardial oxygen
demand
C) Acts as a positive inotrope to increase contractility
D) Increases vasoconstriction to improve perfusion
Correct Answer: B
Rationale: Carvedilol is a nonselective beta-blocker that
reduces mortality in heart failure by decreasing myocardial
oxygen demand and preventing remodeling. It blocks beta-1
and beta-2 receptors and has alpha-1 blocking effects.
3. A client receiving IV dopamine for cardiogenic shock has an
infiltration at the IV site. Which finding indicates potential
tissue necrosis?
, A) Pallor at the infiltration site
B) Warmth and erythema at the site
C) Blistering and skin sloughing
D) Edema without discoloration
Correct Answer: C
Rationale: Dopamine is a potent vasoconstrictor that can cause
tissue necrosis if infiltration occurs. Signs of ischemia include
blanching, coolness, and pain, progressing to blistering and
tissue necrosis. Phentolamine is the antidote for extravasation
of vasopressors.
4. A client with end-stage renal disease (ESRD) develops
severe hyperkalemia with a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate?
A) Oral potassium supplements
B) IV calcium gluconate
C) IV sodium bicarbonate
D) Both B and C
Correct Answer: D
Rationale: Hyperkalemia requires immediate treatment to
prevent cardiac arrest. IV calcium gluconate stabilizes the
cardiac membrane. IV sodium bicarbonate and insulin with
dextrose shift potassium into cells. Kayexalate binds potassium
in the GI tract. Dialysis may be required for severe
hyperkalemia.
