1. Management of Care (15–22%) — Delegation, supervision, prioritization,
legal/ethical issues, informed consent, advance directives, advocacy, chain of
command, scope of practice (RN vs. LPN vs. UAP), case management, and
resource allocation . 3 4 8
2. Safety and Infection Control (8–14%) — Standard precautions, isolation
protocols, hand hygiene, fall prevention, restraint safety, error prevention,
emergency response, and biohazard disposal . 3 8 14
3. Health Promotion and Maintenance (6–12%) — Developmental stages,
immunizations (Pneumovax, influenza), screening (colonoscopy, prenatal),
lifestyle counseling, aging, and preventive care across the lifespan . 3 4 9
4. Psychosocial Integrity (6–12%) — Therapeutic communication, mental health
assessment, crisis intervention, coping mechanisms, cultural sensitivity, grief,
and suicide risk evaluation . 3 6 13
5. Basic Care and Comfort (10–12%) — ADLs, pain management (PQRST),
nutrition (enteral feeding), elimination (24-hour urine, constipation), mobility,
rest/sleep, and end-of-life comfort . 3 5 8
6. Pharmacological and Parenteral Therapies (13–19%) — Medication
administration rights, high-alert medications (IV opioids), side effects,
interactions, IV therapy calculations, dosage calculations, and parenteral
therapies . 3 7 8
7. Reduction of Risk Potential (10–16%) — Diagnostic tests, lab value
interpretation (potassium, aPTT, hemoglobin), complication prevention
, (drainage amounts, transfusion reactions), pre/post-op care, and ECG
monitoring . 3 5 8
8. Physiological Adaptation (11–17%) — Acute/chronic conditions (COPD,
Parkinson’s, renal failure, diabetes), fluid/electrolyte balance, pathophysiology,
emergency care (cord prolapse), wound healing, and multi-system disorders
. 3 8 9
9. Maternal-Newborn and Pediatric Nursing — Prenatal complications (diabetes
in pregnancy), newborn anomalies (hypospadias), pediatric assessments (RSV,
nephrotic syndrome), and labor emergencies . 6 15
10. Prioritization, Delegation & Leadership — ABC framework, unstable vs. stable
client assignment, five rights of delegation, charge nurse decision-making, and
supervision of LPN/UAP . 1 6 13
BSN 366 / BSN366 RN Exit HESI Exam Nightingale
College
250 Detailed Multiple-Choice Questions with Answers
and Rationales
1. A client with COPD has an oxygen saturation of 86% on room air and is visibly
struggling to breathe. Which action should the nurse take first?
A. Administer a PRN anti-anxiety medication
B. Apply supplemental oxygen per protocol and reassess
,C. Document the finding and continue monitoring
D. Notify the provider after completing the assessment
Answer: B
Rationale: Airway and breathing are the highest priority under the ABC framework.
A saturation of 86% with visible distress indicates hypoxemia requiring immediate
intervention, not documentation or delayed notification . 1
2. The nurse is caring for four clients. Which client should the nurse assess first
based on the ABC prioritization framework?
A. A client with a postoperative hemoglobin of 9.8 g/dL
B. A client requesting pain medication for chronic back pain
C. A client with COPD whose oxygen saturation is dropping
D. A client with an elevated aPTT awaiting results
Answer: C
Rationale: A dropping oxygen saturation directly threatens airway and breathing,
making this the most acute physiological threat. The other clients are stable or
have findings that require action but are less immediately life-threatening . 1
3. Which task can the RN safely delegate to unlicensed assistive personnel
(UAP)?
A. Reinforcing teaching about insulin administration
B. Ambulating a stable postoperative client to the bathroom
C. Assessing a client’s IV site for signs of phlebitis
D. Changing a complex wound dressing with packing
Answer: B
, Rationale: UAP scope includes ADLs and ambulation for stable clients. Teaching,
IV assessment, and complex wound care require nursing judgment and remain RN
responsibilities under the Five Rights of Delegation . 1 13
4. A client scheduled for an elective cholecystectomy tells the nurse, “I’m not
really sure what they’re going to do.” What is the nurse’s best action?
A. Reassure the client that the surgeon explained everything already
B. Notify the surgeon that the client may not have understood the procedure
C. Explain the surgical procedure to the client in detail
D. Ask the client to sign the consent form after the nurse re-explains
Answer: B
Rationale: Informed consent requires understanding of procedure, risks, and
alternatives. The nurse witnesses consent but does not provide the primary
explanation; the surgeon must be notified to re-obtain consent . 1 13
5. An LPN is assigned to care for a client with a chest tube. Which intervention
should the RN retain rather than delegate?
A. Measuring and recording chest tube output every shift
B. Repositioning the client and providing hygiene
C. Assessing lung sounds and evaluating chest tube effectiveness
D. Reporting changes in drainage color to the charge nurse
Answer: C
Rationale: Comprehensive assessment and evaluation of chest tube effectiveness
require RN-level clinical judgment. LPNs may measure output and reposition but
cannot perform the evaluative assessment . 1 13
legal/ethical issues, informed consent, advance directives, advocacy, chain of
command, scope of practice (RN vs. LPN vs. UAP), case management, and
resource allocation . 3 4 8
2. Safety and Infection Control (8–14%) — Standard precautions, isolation
protocols, hand hygiene, fall prevention, restraint safety, error prevention,
emergency response, and biohazard disposal . 3 8 14
3. Health Promotion and Maintenance (6–12%) — Developmental stages,
immunizations (Pneumovax, influenza), screening (colonoscopy, prenatal),
lifestyle counseling, aging, and preventive care across the lifespan . 3 4 9
4. Psychosocial Integrity (6–12%) — Therapeutic communication, mental health
assessment, crisis intervention, coping mechanisms, cultural sensitivity, grief,
and suicide risk evaluation . 3 6 13
5. Basic Care and Comfort (10–12%) — ADLs, pain management (PQRST),
nutrition (enteral feeding), elimination (24-hour urine, constipation), mobility,
rest/sleep, and end-of-life comfort . 3 5 8
6. Pharmacological and Parenteral Therapies (13–19%) — Medication
administration rights, high-alert medications (IV opioids), side effects,
interactions, IV therapy calculations, dosage calculations, and parenteral
therapies . 3 7 8
7. Reduction of Risk Potential (10–16%) — Diagnostic tests, lab value
interpretation (potassium, aPTT, hemoglobin), complication prevention
, (drainage amounts, transfusion reactions), pre/post-op care, and ECG
monitoring . 3 5 8
8. Physiological Adaptation (11–17%) — Acute/chronic conditions (COPD,
Parkinson’s, renal failure, diabetes), fluid/electrolyte balance, pathophysiology,
emergency care (cord prolapse), wound healing, and multi-system disorders
. 3 8 9
9. Maternal-Newborn and Pediatric Nursing — Prenatal complications (diabetes
in pregnancy), newborn anomalies (hypospadias), pediatric assessments (RSV,
nephrotic syndrome), and labor emergencies . 6 15
10. Prioritization, Delegation & Leadership — ABC framework, unstable vs. stable
client assignment, five rights of delegation, charge nurse decision-making, and
supervision of LPN/UAP . 1 6 13
BSN 366 / BSN366 RN Exit HESI Exam Nightingale
College
250 Detailed Multiple-Choice Questions with Answers
and Rationales
1. A client with COPD has an oxygen saturation of 86% on room air and is visibly
struggling to breathe. Which action should the nurse take first?
A. Administer a PRN anti-anxiety medication
B. Apply supplemental oxygen per protocol and reassess
,C. Document the finding and continue monitoring
D. Notify the provider after completing the assessment
Answer: B
Rationale: Airway and breathing are the highest priority under the ABC framework.
A saturation of 86% with visible distress indicates hypoxemia requiring immediate
intervention, not documentation or delayed notification . 1
2. The nurse is caring for four clients. Which client should the nurse assess first
based on the ABC prioritization framework?
A. A client with a postoperative hemoglobin of 9.8 g/dL
B. A client requesting pain medication for chronic back pain
C. A client with COPD whose oxygen saturation is dropping
D. A client with an elevated aPTT awaiting results
Answer: C
Rationale: A dropping oxygen saturation directly threatens airway and breathing,
making this the most acute physiological threat. The other clients are stable or
have findings that require action but are less immediately life-threatening . 1
3. Which task can the RN safely delegate to unlicensed assistive personnel
(UAP)?
A. Reinforcing teaching about insulin administration
B. Ambulating a stable postoperative client to the bathroom
C. Assessing a client’s IV site for signs of phlebitis
D. Changing a complex wound dressing with packing
Answer: B
, Rationale: UAP scope includes ADLs and ambulation for stable clients. Teaching,
IV assessment, and complex wound care require nursing judgment and remain RN
responsibilities under the Five Rights of Delegation . 1 13
4. A client scheduled for an elective cholecystectomy tells the nurse, “I’m not
really sure what they’re going to do.” What is the nurse’s best action?
A. Reassure the client that the surgeon explained everything already
B. Notify the surgeon that the client may not have understood the procedure
C. Explain the surgical procedure to the client in detail
D. Ask the client to sign the consent form after the nurse re-explains
Answer: B
Rationale: Informed consent requires understanding of procedure, risks, and
alternatives. The nurse witnesses consent but does not provide the primary
explanation; the surgeon must be notified to re-obtain consent . 1 13
5. An LPN is assigned to care for a client with a chest tube. Which intervention
should the RN retain rather than delegate?
A. Measuring and recording chest tube output every shift
B. Repositioning the client and providing hygiene
C. Assessing lung sounds and evaluating chest tube effectiveness
D. Reporting changes in drainage color to the charge nurse
Answer: C
Rationale: Comprehensive assessment and evaluation of chest tube effectiveness
require RN-level clinical judgment. LPNs may measure output and reposition but
cannot perform the evaluative assessment . 1 13
