BSN 366 RN EXIT EXAM V3
HESI RN Exit Examination — Nightingale College | Latest Update
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SECTION 1: PRIORITIZATION
1. A nurse on a medical-surgical unit receives report on four clients. Which client should be assessed
FIRST?
A. A client with type 2 diabetes reporting a blood glucose of 180 mg/dL
B. A client 1-day post-appendectomy requesting pain medication rated 5/10
C. A client with COPD whose oxygen saturation has dropped from 94% to 84%
D. A client awaiting discharge who asks when the physician will arrive
Correct Answer: C. A client with COPD whose oxygen saturation has dropped from 94% to 84%
2. A nurse caring for four postoperative clients receives an urgent call light from one client
simultaneously with a physician calling about another. Which action takes priority?
A. Answer the phone call from the physician first
B. Respond to the client's call light immediately
C. Ask the unit secretary to take a message from the physician
D. Finish current documentation before responding
Correct Answer: B. Respond to the client's call light immediately
3. A charge nurse is triaging four clients in the emergency department. Which client requires
IMMEDIATE intervention?
A. A 45-year-old with a sprained ankle, pain rated 6/10
B. A 60-year-old with sudden onset severe headache described as 'the worst of my life'
C. A 30-year-old with a UTI reporting burning on urination
D. A 25-year-old with a mild fever of 38.0°C (100.4°F) and sore throat
Correct Answer: B. A 60-year-old with sudden onset severe headache described as 'the worst of
my life'
4. A nurse is caring for four clients. Which client should receive care FIRST based on Maslow's
hierarchy of needs?
A. A client requesting a visit from the chaplain
B. A client expressing anxiety about a scheduled surgery
C. A client with a new tracheostomy whose airway is partially obstructed with secretions
D. A client reporting difficulty sleeping due to hospital noise
Correct Answer: C. A client with a new tracheostomy whose airway is partially obstructed with
secretions
5. A nurse receives report on a client with heart failure. Which assessment finding requires IMMEDIATE
intervention?
A. Bilateral 1+ pitting edema in the ankles
B. Weight gain of 0.5 kg over the past week
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 1
, C. Respiratory rate of 30/min with pink frothy sputum
D. Fatigue with moderate activity
Correct Answer: C. Respiratory rate of 30/min with pink frothy sputum
6. A postoperative client 4 hours after abdominal surgery suddenly reports severe chest pain with
shortness of breath and the nurse notes the oxygen saturation is 88%. Which action is the FIRST
priority?
A. Notify the physician immediately
B. Apply supplemental oxygen and reposition the client
C. Administer the prescribed PRN analgesic
D. Obtain a 12-lead ECG
Correct Answer: B. Apply supplemental oxygen and reposition the client
7. A nurse on a telemetry unit notes that a client's cardiac monitor shows ventricular fibrillation. The
client is unresponsive and pulseless. What is the PRIORITY action?
A. Administer IV amiodarone as prescribed
B. Call a code and initiate CPR
C. Obtain a stat 12-lead ECG
D. Notify the charge nurse
Correct Answer: B. Call a code and initiate CPR
8. A nurse is managing care for multiple clients. Which client requires FIRST assessment?
A. A client with rheumatoid arthritis reporting joint stiffness in the morning
B. A client with a new ileostomy reporting the bag is full and needs emptying
C. A client who received insulin 30 minutes ago and is now diaphoretic and confused
D. A client with chronic back pain requesting a heating pad
Correct Answer: C. A client who received insulin 30 minutes ago and is now diaphoretic and
confused
9. A nurse is caring for a client receiving a blood transfusion who develops chills, low back pain, and a
temperature of 39.4°C (103°F). What is the PRIORITY nursing action?
A. Slow the transfusion rate and notify the physician
B. Stop the transfusion immediately and maintain IV access with normal saline
C. Administer the prescribed antipyretic and continue the transfusion
D. Obtain blood cultures and document the findings
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline
10. A nurse receives report on a client with chronic kidney disease. Which laboratory value requires
PRIORITY intervention?
A. BUN of 35 mg/dL
B. Creatinine of 3.2 mg/dL
C. Potassium of 6.8 mEq/L
D. Sodium of 132 mEq/L
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 2
, Correct Answer: C. Potassium of 6.8 mEq/L
11. A nurse is caring for a client with a suspected pulmonary embolism. Which assessment finding is
MOST concerning and requires immediate action?
A. Mild pleuritic chest pain on deep inspiration
B. Heart rate of 92 beats/min
C. Sudden hypotension with a blood pressure of 72/40 mmHg
D. Low-grade fever of 37.8°C (100°F)
Correct Answer: C. Sudden hypotension with a blood pressure of 72/40 mmHg
12. A nurse is caring for four postpartum clients. Which client should be assessed FIRST?
A. A client 12 hours postdelivery requesting assistance to ambulate for the first time
B. A client 6 hours postpartum with lochia rubra saturating one pad per hour
C. A client 2 hours postpartum whose fundus is boggy and displaced to the right
D. A client breastfeeding for the first time who asks for help with latch technique
Correct Answer: C. A client 2 hours postpartum whose fundus is boggy and displaced to the
right
13. A nurse is preparing to administer medications to a client with myasthenia gravis. Which finding
requires the nurse to HOLD the medication and notify the physician?
A. The client reports mild fatigue after physical therapy
B. The client has difficulty swallowing and reports increased weakness
C. The client's pupil response is equal and reactive bilaterally
D. The client's blood pressure is 118/72 mmHg
Correct Answer: B. The client has difficulty swallowing and reports increased weakness
14. A nurse working the night shift receives report on four clients. Which client requires the FIRST
assessment?
A. A client with pneumonia who has a temperature of 38.2°C (100.8°F)
B. A client on a heparin infusion with an aPTT result just called in as 200 seconds
C. A client with hip fracture requesting positioning assistance
D. A client with GERD requesting an antacid
Correct Answer: B. A client on a heparin infusion with an aPTT result just called in as 200
seconds
15. A nurse caring for a client post-craniotomy notes the client's pupils are unequal, with the left pupil
fixed and dilated. What is the PRIORITY action?
A. Document the finding and reassess in 15 minutes
B. Elevate the head of the bed to 90 degrees
C. Notify the physician immediately — this indicates brain herniation
D. Administer the prescribed PRN analgesic
Correct Answer: C. Notify the physician immediately — this indicates brain herniation
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 3
, 16. A nurse caring for a client with Addison's disease notes the following: blood pressure 82/50 mmHg,
heart rate 118 bpm, temperature 39.6°C (103.3°F), nausea, and severe weakness. Which action takes
PRIORITY?
A. Administer prescribed IV hydrocortisone immediately
B. Obtain a cortisol level before any intervention
C. Encourage oral fluid intake
D. Apply a cooling blanket for fever management
Correct Answer: A. Administer prescribed IV hydrocortisone immediately
17. A nurse assesses a client with a chest tube drainage system and notes sudden cessation of tidaling
(fluctuation) in the water seal chamber. What is the FIRST nursing action?
A. Milk the chest tube toward the drainage system
B. Check for kinks or obstructions in the tubing
C. Clamp the chest tube and notify the physician
D. Increase the suction level on the drainage system
Correct Answer: B. Check for kinks or obstructions in the tubing
18. A nurse is triaging four clients who present to the emergency department simultaneously. Which
client is the HIGHEST priority?
A. A 10-year-old with a forearm fracture, neurovascularly intact, crying
B. A 55-year-old with acute ST-elevation myocardial infarction on the ECG
C. A 70-year-old with a UTI, fever of 38.1°C (100.6°F), and flank pain
D. A 28-year-old with migraine rated 9/10 requesting pain medication
Correct Answer: B. A 55-year-old with acute ST-elevation myocardial infarction on the ECG
19. A nurse is caring for a client receiving a magnesium sulfate infusion for preeclampsia. Which
assessment finding is MOST critical and requires immediate action?
A. Urinary output of 35 mL/hr
B. Deep tendon reflexes rated +1
C. Respiratory rate of 10 breaths/min
D. Serum magnesium level of 6 mg/dL
Correct Answer: C. Respiratory rate of 10 breaths/min
20. A nurse receives a phone call from a client who states, 'I took twice my prescribed warfarin dose by
mistake.' What is the PRIORITY nursing action?
A. Advise the client to come to the emergency department immediately
B. Instruct the client to take half the next scheduled dose to compensate
C. Ask the client if they have any bleeding symptoms before advising
D. Tell the client not to worry as one extra dose is unlikely to cause harm
Correct Answer: A. Advise the client to come to the emergency department immediately
21. A nurse is caring for a 2-year-old child with suspected epiglottitis. Which action is the PRIORITY?
A. Perform a throat assessment using a tongue depressor
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 4
HESI RN Exit Examination — Nightingale College | Latest Update
\
SECTION 1: PRIORITIZATION
1. A nurse on a medical-surgical unit receives report on four clients. Which client should be assessed
FIRST?
A. A client with type 2 diabetes reporting a blood glucose of 180 mg/dL
B. A client 1-day post-appendectomy requesting pain medication rated 5/10
C. A client with COPD whose oxygen saturation has dropped from 94% to 84%
D. A client awaiting discharge who asks when the physician will arrive
Correct Answer: C. A client with COPD whose oxygen saturation has dropped from 94% to 84%
2. A nurse caring for four postoperative clients receives an urgent call light from one client
simultaneously with a physician calling about another. Which action takes priority?
A. Answer the phone call from the physician first
B. Respond to the client's call light immediately
C. Ask the unit secretary to take a message from the physician
D. Finish current documentation before responding
Correct Answer: B. Respond to the client's call light immediately
3. A charge nurse is triaging four clients in the emergency department. Which client requires
IMMEDIATE intervention?
A. A 45-year-old with a sprained ankle, pain rated 6/10
B. A 60-year-old with sudden onset severe headache described as 'the worst of my life'
C. A 30-year-old with a UTI reporting burning on urination
D. A 25-year-old with a mild fever of 38.0°C (100.4°F) and sore throat
Correct Answer: B. A 60-year-old with sudden onset severe headache described as 'the worst of
my life'
4. A nurse is caring for four clients. Which client should receive care FIRST based on Maslow's
hierarchy of needs?
A. A client requesting a visit from the chaplain
B. A client expressing anxiety about a scheduled surgery
C. A client with a new tracheostomy whose airway is partially obstructed with secretions
D. A client reporting difficulty sleeping due to hospital noise
Correct Answer: C. A client with a new tracheostomy whose airway is partially obstructed with
secretions
5. A nurse receives report on a client with heart failure. Which assessment finding requires IMMEDIATE
intervention?
A. Bilateral 1+ pitting edema in the ankles
B. Weight gain of 0.5 kg over the past week
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 1
, C. Respiratory rate of 30/min with pink frothy sputum
D. Fatigue with moderate activity
Correct Answer: C. Respiratory rate of 30/min with pink frothy sputum
6. A postoperative client 4 hours after abdominal surgery suddenly reports severe chest pain with
shortness of breath and the nurse notes the oxygen saturation is 88%. Which action is the FIRST
priority?
A. Notify the physician immediately
B. Apply supplemental oxygen and reposition the client
C. Administer the prescribed PRN analgesic
D. Obtain a 12-lead ECG
Correct Answer: B. Apply supplemental oxygen and reposition the client
7. A nurse on a telemetry unit notes that a client's cardiac monitor shows ventricular fibrillation. The
client is unresponsive and pulseless. What is the PRIORITY action?
A. Administer IV amiodarone as prescribed
B. Call a code and initiate CPR
C. Obtain a stat 12-lead ECG
D. Notify the charge nurse
Correct Answer: B. Call a code and initiate CPR
8. A nurse is managing care for multiple clients. Which client requires FIRST assessment?
A. A client with rheumatoid arthritis reporting joint stiffness in the morning
B. A client with a new ileostomy reporting the bag is full and needs emptying
C. A client who received insulin 30 minutes ago and is now diaphoretic and confused
D. A client with chronic back pain requesting a heating pad
Correct Answer: C. A client who received insulin 30 minutes ago and is now diaphoretic and
confused
9. A nurse is caring for a client receiving a blood transfusion who develops chills, low back pain, and a
temperature of 39.4°C (103°F). What is the PRIORITY nursing action?
A. Slow the transfusion rate and notify the physician
B. Stop the transfusion immediately and maintain IV access with normal saline
C. Administer the prescribed antipyretic and continue the transfusion
D. Obtain blood cultures and document the findings
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline
10. A nurse receives report on a client with chronic kidney disease. Which laboratory value requires
PRIORITY intervention?
A. BUN of 35 mg/dL
B. Creatinine of 3.2 mg/dL
C. Potassium of 6.8 mEq/L
D. Sodium of 132 mEq/L
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 2
, Correct Answer: C. Potassium of 6.8 mEq/L
11. A nurse is caring for a client with a suspected pulmonary embolism. Which assessment finding is
MOST concerning and requires immediate action?
A. Mild pleuritic chest pain on deep inspiration
B. Heart rate of 92 beats/min
C. Sudden hypotension with a blood pressure of 72/40 mmHg
D. Low-grade fever of 37.8°C (100°F)
Correct Answer: C. Sudden hypotension with a blood pressure of 72/40 mmHg
12. A nurse is caring for four postpartum clients. Which client should be assessed FIRST?
A. A client 12 hours postdelivery requesting assistance to ambulate for the first time
B. A client 6 hours postpartum with lochia rubra saturating one pad per hour
C. A client 2 hours postpartum whose fundus is boggy and displaced to the right
D. A client breastfeeding for the first time who asks for help with latch technique
Correct Answer: C. A client 2 hours postpartum whose fundus is boggy and displaced to the
right
13. A nurse is preparing to administer medications to a client with myasthenia gravis. Which finding
requires the nurse to HOLD the medication and notify the physician?
A. The client reports mild fatigue after physical therapy
B. The client has difficulty swallowing and reports increased weakness
C. The client's pupil response is equal and reactive bilaterally
D. The client's blood pressure is 118/72 mmHg
Correct Answer: B. The client has difficulty swallowing and reports increased weakness
14. A nurse working the night shift receives report on four clients. Which client requires the FIRST
assessment?
A. A client with pneumonia who has a temperature of 38.2°C (100.8°F)
B. A client on a heparin infusion with an aPTT result just called in as 200 seconds
C. A client with hip fracture requesting positioning assistance
D. A client with GERD requesting an antacid
Correct Answer: B. A client on a heparin infusion with an aPTT result just called in as 200
seconds
15. A nurse caring for a client post-craniotomy notes the client's pupils are unequal, with the left pupil
fixed and dilated. What is the PRIORITY action?
A. Document the finding and reassess in 15 minutes
B. Elevate the head of the bed to 90 degrees
C. Notify the physician immediately — this indicates brain herniation
D. Administer the prescribed PRN analgesic
Correct Answer: C. Notify the physician immediately — this indicates brain herniation
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 3
, 16. A nurse caring for a client with Addison's disease notes the following: blood pressure 82/50 mmHg,
heart rate 118 bpm, temperature 39.6°C (103.3°F), nausea, and severe weakness. Which action takes
PRIORITY?
A. Administer prescribed IV hydrocortisone immediately
B. Obtain a cortisol level before any intervention
C. Encourage oral fluid intake
D. Apply a cooling blanket for fever management
Correct Answer: A. Administer prescribed IV hydrocortisone immediately
17. A nurse assesses a client with a chest tube drainage system and notes sudden cessation of tidaling
(fluctuation) in the water seal chamber. What is the FIRST nursing action?
A. Milk the chest tube toward the drainage system
B. Check for kinks or obstructions in the tubing
C. Clamp the chest tube and notify the physician
D. Increase the suction level on the drainage system
Correct Answer: B. Check for kinks or obstructions in the tubing
18. A nurse is triaging four clients who present to the emergency department simultaneously. Which
client is the HIGHEST priority?
A. A 10-year-old with a forearm fracture, neurovascularly intact, crying
B. A 55-year-old with acute ST-elevation myocardial infarction on the ECG
C. A 70-year-old with a UTI, fever of 38.1°C (100.6°F), and flank pain
D. A 28-year-old with migraine rated 9/10 requesting pain medication
Correct Answer: B. A 55-year-old with acute ST-elevation myocardial infarction on the ECG
19. A nurse is caring for a client receiving a magnesium sulfate infusion for preeclampsia. Which
assessment finding is MOST critical and requires immediate action?
A. Urinary output of 35 mL/hr
B. Deep tendon reflexes rated +1
C. Respiratory rate of 10 breaths/min
D. Serum magnesium level of 6 mg/dL
Correct Answer: C. Respiratory rate of 10 breaths/min
20. A nurse receives a phone call from a client who states, 'I took twice my prescribed warfarin dose by
mistake.' What is the PRIORITY nursing action?
A. Advise the client to come to the emergency department immediately
B. Instruct the client to take half the next scheduled dose to compensate
C. Ask the client if they have any bleeding symptoms before advising
D. Tell the client not to worry as one extra dose is unlikely to cause harm
Correct Answer: A. Advise the client to come to the emergency department immediately
21. A nurse is caring for a 2-year-old child with suspected epiglottitis. Which action is the PRIORITY?
A. Perform a throat assessment using a tongue depressor
BSN 366 RN Exit Exam V3 | HESI Exit — Nightingale College | 2026/2027 | Page 4
