BSN366 Exit HESI Exam ACTUAL EXAM
2026/2027 | Elsevier Evolve NCSBN
Standards Alignment | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: MANAGEMENT OF CARE & PRIORITIZATION/DELEGATION (25 Questions)
Q1: The nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse
assess first?
A. A 45-year-old with a new colostomy who needs discharge teaching before going home this afternoon
B. A 62-year-old with pneumonia who is receiving IV antibiotics and has a temperature of 38.2°C
(100.8°F)
C. A 78-year-old with COPD who reports shortness of breath and has an oxygen saturation of 86% on 2
L/min nasal cannula [CORRECT]
D. A 55-year-old postoperative patient who is requesting pain medication for a surgical incision rated
6/10
Correct Answer: C
Rationale: The patient with COPD has a critically low oxygen saturation of 86%, indicating severe
hypoxemia and potential respiratory failure. This represents an immediate threat to physiological
integrity (airway and breathing) and requires urgent intervention per the ABC priority framework. The
patient with pneumonia has a low-grade fever consistent with the infectious process. The postoperative
patient with moderate pain and the patient needing discharge teaching have stable conditions that can
be addressed after the respiratory emergency is managed.
Q2: The charge nurse is assigning tasks for the shift. Which task is appropriate to delegate to an
unlicensed assistive personnel (UAP)?
A. Assessing a postoperative patient's surgical incision for signs of infection
B. Administering a subcutaneous insulin injection to a patient with Type 2 diabetes
C. Obtaining vital signs on a stable patient who was admitted 2 days ago for community-acquired
pneumonia [CORRECT]
D. Evaluating a patient's response to pain medication administered 30 minutes ago
,Correct Answer: C
Rationale: Obtaining vital signs on a stable patient is within the scope of practice for a UAP and does not
require clinical judgment or assessment skills. Assessing surgical incisions, administering medications,
and evaluating patient responses to interventions require nursing assessment, clinical decision-making,
and judgment that fall within the registered nurse's scope of practice per state nurse practice acts and
NCSBN delegation guidelines.
Q3: A nurse on a busy telemetry unit receives report on four patients. Which patient should the nurse
see first?
A. A 68-year-old with atrial fibrillation who is due for a scheduled dose of metoprolol
B. A 54-year-old with chest pain whose troponin level is pending and who is resting comfortably
C. A 72-year-old with heart failure who has new onset confusion and a blood pressure of 82/48 mmHg
[CORRECT]
D. A 60-year-old post-cardiac catheterization patient who needs assistance to the bathroom
Correct Answer: C
Rationale: The patient with heart failure presenting with new confusion and hypotension (82/48 mmHg)
is showing signs of poor cerebral perfusion and potential cardiogenic shock, representing a life-
threatening condition requiring immediate assessment and intervention. Confusion in a heart failure
patient with hypotension suggests inadequate cardiac output and possible organ hypoperfusion. The
other patients have stable or expected conditions that can be managed within appropriate timeframes.
Q4: The nurse is caring for a group of patients on a medical unit. Which task should the nurse delegate
to the licensed practical nurse (LPN)?
A. Developing a plan of care for a newly admitted patient with diabetic ketoacidosis
B. Performing sterile wound irrigation and dressing change on a patient with a stage 3 pressure ulcer
[CORRECT]
C. Initiating patient education for a newly diagnosed patient with heart failure
D. Analyzing arterial blood gas results for a patient with respiratory acidosis
Correct Answer: B
Rationale: Performing a sterile wound irrigation and dressing change is within the scope of practice for
an LPN, as it follows a established procedure and does not require complex clinical judgment or care
planning. Developing care plans, initiating patient education for new diagnoses, and analyzing diagnostic
results require the critical thinking, assessment, and clinical judgment skills of a registered nurse.
,Delegation decisions must align with the LPN's training, state regulations, and the stability of the
patient's condition.
Q5: A nurse manager is reviewing staffing for the evening shift. Which patient assignment demonstrates
appropriate delegation principles?
A. Assigning a new graduate nurse to care for a critically ill patient on a ventilator with multiple
vasopressor drips
B. Assigning a float nurse from the pediatric unit to care for a stable adult patient admitted for cellulitis
[CORRECT]
C. Assigning an LPN to perform the initial assessment on a patient admitted with acute chest pain
D. Assigning a UAP to monitor and document a patient's intake and output for a patient on strict I&O
Correct Answer: B
Rationale: Assigning a float nurse to a stable patient with a condition within their general competency
(cellulitis is a basic medical-surgical condition) demonstrates appropriate matching of nurse competency
to patient acuity. A new graduate should not be assigned to a critically unstable patient. An LPN cannot
perform the initial comprehensive assessment, which requires RN-level assessment skills. While a UAP
can measure intake and output, monitoring and documenting requires nursing judgment about trends
and significance, which is an RN responsibility.
Q6: The nurse is caring for four patients on a postoperative unit. Which patient should the nurse
prioritize for immediate assessment?
A. A 35-year-old who had an appendectomy 8 hours ago and reports pain of 4/10 at the incision site
B. A 50-year-old who had a cholecystectomy 2 days ago and is requesting a shower
C. A 68-year-old who had a total hip replacement 12 hours ago and has a dressing saturated with bright
red blood [CORRECT]
D. A 42-year-old who had a hysterectomy 1 day ago and needs pre-discharge instructions
Correct Answer: C
Rationale: A dressing saturated with bright red blood 12 hours post-total hip replacement indicates
active hemorrhage, a potentially life-threatening complication requiring immediate assessment and
intervention. Postoperative hemorrhage can lead to hypovolemic shock, anemia, and hemodynamic
instability. The other patients have stable, expected postoperative conditions: moderate pain is normal,
a shower request is appropriate for a 2-day postoperative patient, and discharge teaching can be
completed within the shift.
, Q7: Which action by the nurse demonstrates appropriate use of the five rights of delegation?
A. Delegating the assessment of a patient with new-onset chest pain to a UAP
B. Delegating medication administration to an LPN without verifying the patient's allergies
C. Delegating ambulation of a stable postoperative patient to a UAP after providing clear instructions
and supervision parameters [CORRECT]
D. Delegating discharge planning for a complex patient to a new graduate nurse without orientation
Correct Answer: C
Rationale: The five rights of delegation include the right task, right circumstance, right person, right
direction/communication, and right supervision. Delegating ambulation of a stable patient to a UAP with
clear instructions and defined supervision parameters meets all five rights. Assessing chest pain requires
RN-level assessment. Delegating medication administration without verifying allergies violates patient
safety. Delegating complex discharge planning to an inexperienced nurse without proper orientation
violates the right person and right supervision principles.
Q8: The nurse is reviewing the assignments for the shift. Which patient should be assigned to the most
experienced RN?
A. A 25-year-old admitted for observation following a mild concussion with a stable neurological exam
B. A 70-year-old with newly diagnosed heart failure who requires extensive patient education and
medication teaching
C. A 58-year-old with septic shock on three vasopressor drips, mechanical ventilation, and continuous
renal replacement therapy [CORRECT]
D. A 45-year-old admitted for elective knee replacement surgery scheduled for tomorrow
Correct Answer: C
Rationale: The patient with septic shock on multiple vasopressors, mechanical ventilation, and CRRT
represents the highest acuity and requires advanced clinical judgment, critical care expertise, and rapid
response to hemodynamic changes. Patient assignments should match nurse competency and
experience to patient acuity and complexity. The other patients have stable conditions or needs that can
be managed by nurses with varying levels of experience.
Q9: A nurse on a busy unit receives a phone call from the laboratory reporting a critical value. Which
action should the nurse take first?
A. Document the critical value in the patient's electronic health record
B. Notify the healthcare provider of the critical value immediately [CORRECT]
2026/2027 | Elsevier Evolve NCSBN
Standards Alignment | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: MANAGEMENT OF CARE & PRIORITIZATION/DELEGATION (25 Questions)
Q1: The nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse
assess first?
A. A 45-year-old with a new colostomy who needs discharge teaching before going home this afternoon
B. A 62-year-old with pneumonia who is receiving IV antibiotics and has a temperature of 38.2°C
(100.8°F)
C. A 78-year-old with COPD who reports shortness of breath and has an oxygen saturation of 86% on 2
L/min nasal cannula [CORRECT]
D. A 55-year-old postoperative patient who is requesting pain medication for a surgical incision rated
6/10
Correct Answer: C
Rationale: The patient with COPD has a critically low oxygen saturation of 86%, indicating severe
hypoxemia and potential respiratory failure. This represents an immediate threat to physiological
integrity (airway and breathing) and requires urgent intervention per the ABC priority framework. The
patient with pneumonia has a low-grade fever consistent with the infectious process. The postoperative
patient with moderate pain and the patient needing discharge teaching have stable conditions that can
be addressed after the respiratory emergency is managed.
Q2: The charge nurse is assigning tasks for the shift. Which task is appropriate to delegate to an
unlicensed assistive personnel (UAP)?
A. Assessing a postoperative patient's surgical incision for signs of infection
B. Administering a subcutaneous insulin injection to a patient with Type 2 diabetes
C. Obtaining vital signs on a stable patient who was admitted 2 days ago for community-acquired
pneumonia [CORRECT]
D. Evaluating a patient's response to pain medication administered 30 minutes ago
,Correct Answer: C
Rationale: Obtaining vital signs on a stable patient is within the scope of practice for a UAP and does not
require clinical judgment or assessment skills. Assessing surgical incisions, administering medications,
and evaluating patient responses to interventions require nursing assessment, clinical decision-making,
and judgment that fall within the registered nurse's scope of practice per state nurse practice acts and
NCSBN delegation guidelines.
Q3: A nurse on a busy telemetry unit receives report on four patients. Which patient should the nurse
see first?
A. A 68-year-old with atrial fibrillation who is due for a scheduled dose of metoprolol
B. A 54-year-old with chest pain whose troponin level is pending and who is resting comfortably
C. A 72-year-old with heart failure who has new onset confusion and a blood pressure of 82/48 mmHg
[CORRECT]
D. A 60-year-old post-cardiac catheterization patient who needs assistance to the bathroom
Correct Answer: C
Rationale: The patient with heart failure presenting with new confusion and hypotension (82/48 mmHg)
is showing signs of poor cerebral perfusion and potential cardiogenic shock, representing a life-
threatening condition requiring immediate assessment and intervention. Confusion in a heart failure
patient with hypotension suggests inadequate cardiac output and possible organ hypoperfusion. The
other patients have stable or expected conditions that can be managed within appropriate timeframes.
Q4: The nurse is caring for a group of patients on a medical unit. Which task should the nurse delegate
to the licensed practical nurse (LPN)?
A. Developing a plan of care for a newly admitted patient with diabetic ketoacidosis
B. Performing sterile wound irrigation and dressing change on a patient with a stage 3 pressure ulcer
[CORRECT]
C. Initiating patient education for a newly diagnosed patient with heart failure
D. Analyzing arterial blood gas results for a patient with respiratory acidosis
Correct Answer: B
Rationale: Performing a sterile wound irrigation and dressing change is within the scope of practice for
an LPN, as it follows a established procedure and does not require complex clinical judgment or care
planning. Developing care plans, initiating patient education for new diagnoses, and analyzing diagnostic
results require the critical thinking, assessment, and clinical judgment skills of a registered nurse.
,Delegation decisions must align with the LPN's training, state regulations, and the stability of the
patient's condition.
Q5: A nurse manager is reviewing staffing for the evening shift. Which patient assignment demonstrates
appropriate delegation principles?
A. Assigning a new graduate nurse to care for a critically ill patient on a ventilator with multiple
vasopressor drips
B. Assigning a float nurse from the pediatric unit to care for a stable adult patient admitted for cellulitis
[CORRECT]
C. Assigning an LPN to perform the initial assessment on a patient admitted with acute chest pain
D. Assigning a UAP to monitor and document a patient's intake and output for a patient on strict I&O
Correct Answer: B
Rationale: Assigning a float nurse to a stable patient with a condition within their general competency
(cellulitis is a basic medical-surgical condition) demonstrates appropriate matching of nurse competency
to patient acuity. A new graduate should not be assigned to a critically unstable patient. An LPN cannot
perform the initial comprehensive assessment, which requires RN-level assessment skills. While a UAP
can measure intake and output, monitoring and documenting requires nursing judgment about trends
and significance, which is an RN responsibility.
Q6: The nurse is caring for four patients on a postoperative unit. Which patient should the nurse
prioritize for immediate assessment?
A. A 35-year-old who had an appendectomy 8 hours ago and reports pain of 4/10 at the incision site
B. A 50-year-old who had a cholecystectomy 2 days ago and is requesting a shower
C. A 68-year-old who had a total hip replacement 12 hours ago and has a dressing saturated with bright
red blood [CORRECT]
D. A 42-year-old who had a hysterectomy 1 day ago and needs pre-discharge instructions
Correct Answer: C
Rationale: A dressing saturated with bright red blood 12 hours post-total hip replacement indicates
active hemorrhage, a potentially life-threatening complication requiring immediate assessment and
intervention. Postoperative hemorrhage can lead to hypovolemic shock, anemia, and hemodynamic
instability. The other patients have stable, expected postoperative conditions: moderate pain is normal,
a shower request is appropriate for a 2-day postoperative patient, and discharge teaching can be
completed within the shift.
, Q7: Which action by the nurse demonstrates appropriate use of the five rights of delegation?
A. Delegating the assessment of a patient with new-onset chest pain to a UAP
B. Delegating medication administration to an LPN without verifying the patient's allergies
C. Delegating ambulation of a stable postoperative patient to a UAP after providing clear instructions
and supervision parameters [CORRECT]
D. Delegating discharge planning for a complex patient to a new graduate nurse without orientation
Correct Answer: C
Rationale: The five rights of delegation include the right task, right circumstance, right person, right
direction/communication, and right supervision. Delegating ambulation of a stable patient to a UAP with
clear instructions and defined supervision parameters meets all five rights. Assessing chest pain requires
RN-level assessment. Delegating medication administration without verifying allergies violates patient
safety. Delegating complex discharge planning to an inexperienced nurse without proper orientation
violates the right person and right supervision principles.
Q8: The nurse is reviewing the assignments for the shift. Which patient should be assigned to the most
experienced RN?
A. A 25-year-old admitted for observation following a mild concussion with a stable neurological exam
B. A 70-year-old with newly diagnosed heart failure who requires extensive patient education and
medication teaching
C. A 58-year-old with septic shock on three vasopressor drips, mechanical ventilation, and continuous
renal replacement therapy [CORRECT]
D. A 45-year-old admitted for elective knee replacement surgery scheduled for tomorrow
Correct Answer: C
Rationale: The patient with septic shock on multiple vasopressors, mechanical ventilation, and CRRT
represents the highest acuity and requires advanced clinical judgment, critical care expertise, and rapid
response to hemodynamic changes. Patient assignments should match nurse competency and
experience to patient acuity and complexity. The other patients have stable conditions or needs that can
be managed by nurses with varying levels of experience.
Q9: A nurse on a busy unit receives a phone call from the laboratory reporting a critical value. Which
action should the nurse take first?
A. Document the critical value in the patient's electronic health record
B. Notify the healthcare provider of the critical value immediately [CORRECT]
