BSN366 Exit HESI Exam — 2026/2027
BSN366 EXIT HESI EXAM
2026/2027
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Comprehensive Pre-Licensure Nursing Competency Assessment
for RN Licensure Readiness
Elsevier Evolve / NCSBN Standards Alignment
150 MCQ Questions | 300 Minutes Testing Time
Passing Score: 900 HESI Score or 75–80% (112–120/150 Correct)
Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
HESI Exit–Aligned Format
Core Domains: Adult Medical-Surgical & Pharmacology • Fundamentals of Nursing & Care Concepts • Mental
Health & Psychiatric Nursing • Maternity & Newborn Nursing • Pediatric & Adolescent Nursing • Population
Health, Community & Leadership
Page 1
, BSN366 Exit HESI Exam — 2026/2027
Introduction
This BSN366 Exit HESI Exam format for 2026/2027 reflects the standardized comprehensive competency
assessment used to evaluate pre-licensure BSN students' readiness for the NCLEX-RN and entry-level nursing
practice. The official examination consists of exactly 150 multiple-choice questions (MCQ) covering critical
domains: adult medical-surgical and pharmacology, fundamentals of nursing, mental health, maternity and
newborn, pediatrics, and population health and leadership. The exam measures cumulative knowledge essential
for safe, effective, and evidence-based practice across the lifespan, aligned with current NCSBN NCLEX-RN test
plans, Elsevier HESI exit exam blueprints, and institutional nursing program learning outcomes.
• Format: Fixed-format objective assessment with 150 MCQ questions
• Item Types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, and clinical judgment application questions
• Testing Time: 300 minutes (computer-based, proctored via Elsevier Evolve testing platform)
• Passing Score: Typically 900 HESI score or 75–80% required for program progression and NCLEX readiness
• Focus: Evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model (CJMM),
prioritization, delegation, and professional judgment aligned with the NCLEX-RN test plan
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Adult Medical-Surgical & 40 Cardiovascular, Respiratory, Neuro, Endocrine, GI, 26.7%
Pharmacology Renal Disorders, Pharmacokinetics, Med Math,
Antidotes
Fundamentals of Nursing 25 Infection Control, Safety, Mobility, Elimination, 16.7%
& Care Concepts Oxygenation, Fluid/Electrolytes, Basic Care Comfort
Mental Health & 20 Therapeutic Communication, Psychopharmacology, 13.3%
Psychiatric Nursing Mood/Anxiety/Psychotic Disorders, Suicide Risk,
Abuse
Maternity & Newborn 20 Antepartum/Intrapartum/Postpartum Care, FHR 13.3%
Nursing Monitoring, High-Risk Pregnancy, Newborn
Transition, APGAR
Pediatric & Adolescent 20 Growth & Development, Immunizations, Pediatric 13.3%
Nursing Respiratory/GI/Neuro Disorders, Family-Centered
Care
Population Health, 25 Delegation, Prioritization, Care Management, 16.7%
Community & Leadership Epidemiology, Health Policy, Ethics, Quality
Improvement
TOTAL 150 Comprehensive BSN Exit Competency 100%
Domain: Adult Medical-Surgical & Pharmacology
Topics: Cardiovascular, Respiratory, Neuro, Endocrine, GI, Renal Disorders, Pharmacokinetics, Med Math,
Antidotes | Questions: 40 | Weight: 26.7%
1. A client with heart failure is prescribed digoxin 0.25 mg PO daily. Before administering the
medication, the nurse checks the client's apical pulse, which is 58 beats/min. What is the nurse's
priority action?
A. Administer the medication as prescribed
B. Hold the medication and notify the healthcare provider
C. Administer the medication and document the heart rate
D. Reposition the client and recheck the apical pulse in 15 minutes
Correct Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The standard protocol is to hold the
medication and notify the provider if the apical pulse is below 60 beats/min in an adult, as administering it
Page 2
, BSN366 Exit HESI Exam — 2026/2027
could cause severe bradycardia or heart block. Repositioning (D) will not change the physiological effect of the
drug on the SA/AV node.
Domain: Fundamentals of Nursing & Care Concepts
Topics: Infection Control, Safety, Mobility, Elimination, Oxygenation, Fluid/Electrolytes, Basic Care Comfort |
Questions: 25 | Weight: 16.7%
2. The nurse is preparing to suction a client's tracheostomy. Which action demonstrates proper
infection control and airway management technique?
A. Apply suction while inserting the catheter into the airway
B. Hyperoxygenate the client before and after each suctioning pass
C. Limit each suctioning pass to no more than 30 seconds
D. Use a clean, non-sterile glove for the procedure
Correct Answer: B
Rationale: Hyperoxygenating before and after suctioning prevents hypoxemia, which is a major risk during
the procedure. Suction should only be applied while withdrawing the catheter and twirling it, not during
insertion (A is incorrect). Each pass should be limited to 10-15 seconds, not 30 seconds (C is incorrect).
Tracheostomy suctioning requires strict sterile technique to prevent lower respiratory tract infections (D is
incorrect).
Domain: Mental Health & Psychiatric Nursing
Topics: Therapeutic Communication, Psychopharmacology, Mood/Anxiety/Psychotic Disorders, Suicide Risk,
Abuse | Questions: 20 | Weight: 13.3%
3. A client with bipolar disorder is taking lithium carbonate. The nurse reviews laboratory
results and notes a serum lithium level of 1.8 mEq/L. Which clinical manifestation should the
nurse anticipate assessing in this client?
A. Fine hand tremors and polyuria
B. Coarse tremors, ataxia, and confusion
C. Hypotension and bradycardia
D. Tinnitus and blurred vision
Correct Answer: B
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L indicates lithium toxicity.
Signs of toxicity (levels >1.5 mEq/L) include coarse tremors, ataxia, confusion, slurred speech, and vomiting.
Fine tremors and polyuria (A) are common, expected side effects at therapeutic levels, not signs of acute
toxicity.
Domain: Pediatric & Adolescent Nursing
Topics: Growth & Development, Immunizations, Pediatric Respiratory/GI/Neuro Disorders, Family-Centered
Care | Questions: 20 | Weight: 13.3%
4. The nurse is providing discharge teaching to the parents of a school-aged child newly
diagnosed with cystic fibrosis (CF). Which statement by the parents indicates a correct
understanding of the child's pancreatic enzyme replacement therapy?
A. "We will give the enzymes only when the child has a greasy stool."
B. "We should crush the enteric-coated beads and mix them with applesauce."
C. "The enzymes should be taken right before or during meals and snacks."
D. "We can stop the enzymes once the child's weight reaches the 50th percentile."
Correct Answer: C
Rationale: Pancreatic enzymes must be taken with all meals and snacks to aid in the digestion and absorption
of fats and proteins. They should not be given PRN for steatorrhea (A is incorrect). Enteric-coated beads should
never be crushed or chewed, as stomach acid will destroy the coating and the enzyme will be inactivated (B is
incorrect). Enzyme replacement is a lifelong therapy for CF (D is incorrect).
Page 3
, BSN366 Exit HESI Exam — 2026/2027
Domain: Population Health, Community & Leadership
Topics: Delegation, Prioritization, Care Management, Epidemiology, Health Policy, Ethics, Quality
Improvement | Questions: 25 | Weight: 16.7%
5. The RN is making client care assignments for the shift. Which task is most appropriate to
delegate to the Unlicensed Assistive Personnel (UAP)?
A. Assessing a client's pain level 1 hour after receiving analgesia
B. Teaching a client how to use an incentive spirometer postoperatively
C. Measuring the intake and output of a client with heart failure
D. Evaluating a client's ability to perform activities of daily living (ADLs)
Correct Answer: C
Rationale: Measuring and recording intake and output is a standard, non-invasive task that falls within the
UAP's scope of practice. Assessment (A, D), teaching (B), and evaluation are responsibilities of the RN and
cannot be delegated to unlicensed personnel. The RN must always retain the tasks that require nursing
judgment, clinical assessment, and patient education.
Domain: Adult Medical-Surgical & Pharmacology
Topics: Cardiovascular, Respiratory, Neuro, Endocrine, GI, Renal Disorders, Pharmacokinetics, Med Math,
Antidotes | Questions: 40 | Weight: 26.7%
6. A client is receiving a continuous IV infusion of heparin for deep vein thrombosis (DVT). The
client's aPTT is reported as 110 seconds (control is 30 seconds). Which medication should the
nurse anticipate administering?
A. Vitamin K (Phytonadione)
B. Protamine sulfate
C. Aminocaproic acid
D. Fresh frozen plasma (FFP)
Correct Answer: B
Rationale: The therapeutic aPTT for a client on heparin is typically 1.5 to 2.5 times the control value (45 to 75
seconds in this case). An aPTT of 110 seconds indicates a significantly prolonged clotting time and a high risk
for bleeding. The specific antidote for heparin is protamine sulfate. Vitamin K (A) is the antidote for warfarin.
Aminocaproic acid (C) is an antifibrinolytic, and FFP (D) contains all clotting factors but is not the specific
first-line antidote for heparin.
7. Select All That Apply: The nurse is caring for a client in diabetic ketoacidosis (DKA). Which
interventions should the nurse include in the plan of care? (Select All That Apply)
☐ A. Administer regular insulin via continuous IV infusion
☐ B. Prepare to administer sodium bicarbonate IV push immediately
☐ C. Monitor serum potassium levels closely during treatment
☐ D. Initiate a rapid infusion of 0.9% normal saline
Correct Answer: A,C,D
Rationale: The primary treatment for DKA includes continuous IV regular insulin (A) to lower blood glucose
and stop ketogenesis, aggressive fluid resuscitation with 0.9% normal saline (D) to restore intravascular
volume, and close monitoring of potassium (C) because insulin drives potassium into the cells, risking severe
hypokalemia. Sodium bicarbonate (B) is rarely used and only considered if the pH is severely low (<6.9), not
as an immediate routine intervention.
Domain: Fundamentals of Nursing & Care Concepts
Topics: Infection Control, Safety, Mobility, Elimination, Oxygenation, Fluid/Electrolytes, Basic Care Comfort |
Questions: 25 | Weight: 16.7%
8. Select All That Apply: The nurse is implementing fall prevention strategies for an older adult
client identified as high risk for falls. Which actions are appropriate? (Select All That Apply)
Page 4
BSN366 EXIT HESI EXAM
2026/2027
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━
Comprehensive Pre-Licensure Nursing Competency Assessment
for RN Licensure Readiness
Elsevier Evolve / NCSBN Standards Alignment
150 MCQ Questions | 300 Minutes Testing Time
Passing Score: 900 HESI Score or 75–80% (112–120/150 Correct)
Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
HESI Exit–Aligned Format
Core Domains: Adult Medical-Surgical & Pharmacology • Fundamentals of Nursing & Care Concepts • Mental
Health & Psychiatric Nursing • Maternity & Newborn Nursing • Pediatric & Adolescent Nursing • Population
Health, Community & Leadership
Page 1
, BSN366 Exit HESI Exam — 2026/2027
Introduction
This BSN366 Exit HESI Exam format for 2026/2027 reflects the standardized comprehensive competency
assessment used to evaluate pre-licensure BSN students' readiness for the NCLEX-RN and entry-level nursing
practice. The official examination consists of exactly 150 multiple-choice questions (MCQ) covering critical
domains: adult medical-surgical and pharmacology, fundamentals of nursing, mental health, maternity and
newborn, pediatrics, and population health and leadership. The exam measures cumulative knowledge essential
for safe, effective, and evidence-based practice across the lifespan, aligned with current NCSBN NCLEX-RN test
plans, Elsevier HESI exit exam blueprints, and institutional nursing program learning outcomes.
• Format: Fixed-format objective assessment with 150 MCQ questions
• Item Types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend recognition, matrix
multiple-choice, prioritization scenarios, and clinical judgment application questions
• Testing Time: 300 minutes (computer-based, proctored via Elsevier Evolve testing platform)
• Passing Score: Typically 900 HESI score or 75–80% required for program progression and NCLEX readiness
• Focus: Evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model (CJMM),
prioritization, delegation, and professional judgment aligned with the NCLEX-RN test plan
Examination Overview (2026/2027)
Domain Questions Key Topics Weight
Adult Medical-Surgical & 40 Cardiovascular, Respiratory, Neuro, Endocrine, GI, 26.7%
Pharmacology Renal Disorders, Pharmacokinetics, Med Math,
Antidotes
Fundamentals of Nursing 25 Infection Control, Safety, Mobility, Elimination, 16.7%
& Care Concepts Oxygenation, Fluid/Electrolytes, Basic Care Comfort
Mental Health & 20 Therapeutic Communication, Psychopharmacology, 13.3%
Psychiatric Nursing Mood/Anxiety/Psychotic Disorders, Suicide Risk,
Abuse
Maternity & Newborn 20 Antepartum/Intrapartum/Postpartum Care, FHR 13.3%
Nursing Monitoring, High-Risk Pregnancy, Newborn
Transition, APGAR
Pediatric & Adolescent 20 Growth & Development, Immunizations, Pediatric 13.3%
Nursing Respiratory/GI/Neuro Disorders, Family-Centered
Care
Population Health, 25 Delegation, Prioritization, Care Management, 16.7%
Community & Leadership Epidemiology, Health Policy, Ethics, Quality
Improvement
TOTAL 150 Comprehensive BSN Exit Competency 100%
Domain: Adult Medical-Surgical & Pharmacology
Topics: Cardiovascular, Respiratory, Neuro, Endocrine, GI, Renal Disorders, Pharmacokinetics, Med Math,
Antidotes | Questions: 40 | Weight: 26.7%
1. A client with heart failure is prescribed digoxin 0.25 mg PO daily. Before administering the
medication, the nurse checks the client's apical pulse, which is 58 beats/min. What is the nurse's
priority action?
A. Administer the medication as prescribed
B. Hold the medication and notify the healthcare provider
C. Administer the medication and document the heart rate
D. Reposition the client and recheck the apical pulse in 15 minutes
Correct Answer: B
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The standard protocol is to hold the
medication and notify the provider if the apical pulse is below 60 beats/min in an adult, as administering it
Page 2
, BSN366 Exit HESI Exam — 2026/2027
could cause severe bradycardia or heart block. Repositioning (D) will not change the physiological effect of the
drug on the SA/AV node.
Domain: Fundamentals of Nursing & Care Concepts
Topics: Infection Control, Safety, Mobility, Elimination, Oxygenation, Fluid/Electrolytes, Basic Care Comfort |
Questions: 25 | Weight: 16.7%
2. The nurse is preparing to suction a client's tracheostomy. Which action demonstrates proper
infection control and airway management technique?
A. Apply suction while inserting the catheter into the airway
B. Hyperoxygenate the client before and after each suctioning pass
C. Limit each suctioning pass to no more than 30 seconds
D. Use a clean, non-sterile glove for the procedure
Correct Answer: B
Rationale: Hyperoxygenating before and after suctioning prevents hypoxemia, which is a major risk during
the procedure. Suction should only be applied while withdrawing the catheter and twirling it, not during
insertion (A is incorrect). Each pass should be limited to 10-15 seconds, not 30 seconds (C is incorrect).
Tracheostomy suctioning requires strict sterile technique to prevent lower respiratory tract infections (D is
incorrect).
Domain: Mental Health & Psychiatric Nursing
Topics: Therapeutic Communication, Psychopharmacology, Mood/Anxiety/Psychotic Disorders, Suicide Risk,
Abuse | Questions: 20 | Weight: 13.3%
3. A client with bipolar disorder is taking lithium carbonate. The nurse reviews laboratory
results and notes a serum lithium level of 1.8 mEq/L. Which clinical manifestation should the
nurse anticipate assessing in this client?
A. Fine hand tremors and polyuria
B. Coarse tremors, ataxia, and confusion
C. Hypotension and bradycardia
D. Tinnitus and blurred vision
Correct Answer: B
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L indicates lithium toxicity.
Signs of toxicity (levels >1.5 mEq/L) include coarse tremors, ataxia, confusion, slurred speech, and vomiting.
Fine tremors and polyuria (A) are common, expected side effects at therapeutic levels, not signs of acute
toxicity.
Domain: Pediatric & Adolescent Nursing
Topics: Growth & Development, Immunizations, Pediatric Respiratory/GI/Neuro Disorders, Family-Centered
Care | Questions: 20 | Weight: 13.3%
4. The nurse is providing discharge teaching to the parents of a school-aged child newly
diagnosed with cystic fibrosis (CF). Which statement by the parents indicates a correct
understanding of the child's pancreatic enzyme replacement therapy?
A. "We will give the enzymes only when the child has a greasy stool."
B. "We should crush the enteric-coated beads and mix them with applesauce."
C. "The enzymes should be taken right before or during meals and snacks."
D. "We can stop the enzymes once the child's weight reaches the 50th percentile."
Correct Answer: C
Rationale: Pancreatic enzymes must be taken with all meals and snacks to aid in the digestion and absorption
of fats and proteins. They should not be given PRN for steatorrhea (A is incorrect). Enteric-coated beads should
never be crushed or chewed, as stomach acid will destroy the coating and the enzyme will be inactivated (B is
incorrect). Enzyme replacement is a lifelong therapy for CF (D is incorrect).
Page 3
, BSN366 Exit HESI Exam — 2026/2027
Domain: Population Health, Community & Leadership
Topics: Delegation, Prioritization, Care Management, Epidemiology, Health Policy, Ethics, Quality
Improvement | Questions: 25 | Weight: 16.7%
5. The RN is making client care assignments for the shift. Which task is most appropriate to
delegate to the Unlicensed Assistive Personnel (UAP)?
A. Assessing a client's pain level 1 hour after receiving analgesia
B. Teaching a client how to use an incentive spirometer postoperatively
C. Measuring the intake and output of a client with heart failure
D. Evaluating a client's ability to perform activities of daily living (ADLs)
Correct Answer: C
Rationale: Measuring and recording intake and output is a standard, non-invasive task that falls within the
UAP's scope of practice. Assessment (A, D), teaching (B), and evaluation are responsibilities of the RN and
cannot be delegated to unlicensed personnel. The RN must always retain the tasks that require nursing
judgment, clinical assessment, and patient education.
Domain: Adult Medical-Surgical & Pharmacology
Topics: Cardiovascular, Respiratory, Neuro, Endocrine, GI, Renal Disorders, Pharmacokinetics, Med Math,
Antidotes | Questions: 40 | Weight: 26.7%
6. A client is receiving a continuous IV infusion of heparin for deep vein thrombosis (DVT). The
client's aPTT is reported as 110 seconds (control is 30 seconds). Which medication should the
nurse anticipate administering?
A. Vitamin K (Phytonadione)
B. Protamine sulfate
C. Aminocaproic acid
D. Fresh frozen plasma (FFP)
Correct Answer: B
Rationale: The therapeutic aPTT for a client on heparin is typically 1.5 to 2.5 times the control value (45 to 75
seconds in this case). An aPTT of 110 seconds indicates a significantly prolonged clotting time and a high risk
for bleeding. The specific antidote for heparin is protamine sulfate. Vitamin K (A) is the antidote for warfarin.
Aminocaproic acid (C) is an antifibrinolytic, and FFP (D) contains all clotting factors but is not the specific
first-line antidote for heparin.
7. Select All That Apply: The nurse is caring for a client in diabetic ketoacidosis (DKA). Which
interventions should the nurse include in the plan of care? (Select All That Apply)
☐ A. Administer regular insulin via continuous IV infusion
☐ B. Prepare to administer sodium bicarbonate IV push immediately
☐ C. Monitor serum potassium levels closely during treatment
☐ D. Initiate a rapid infusion of 0.9% normal saline
Correct Answer: A,C,D
Rationale: The primary treatment for DKA includes continuous IV regular insulin (A) to lower blood glucose
and stop ketogenesis, aggressive fluid resuscitation with 0.9% normal saline (D) to restore intravascular
volume, and close monitoring of potassium (C) because insulin drives potassium into the cells, risking severe
hypokalemia. Sodium bicarbonate (B) is rarely used and only considered if the pH is severely low (<6.9), not
as an immediate routine intervention.
Domain: Fundamentals of Nursing & Care Concepts
Topics: Infection Control, Safety, Mobility, Elimination, Oxygenation, Fluid/Electrolytes, Basic Care Comfort |
Questions: 25 | Weight: 16.7%
8. Select All That Apply: The nurse is implementing fall prevention strategies for an older adult
client identified as high risk for falls. Which actions are appropriate? (Select All That Apply)
Page 4
