BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
BSN 366 HESI RN EXIT EXAM
Latest Update
Review Questions and Verified Answers
100% Correct | Grade A
150 9 2026/27
Questions Sections Edition
Aligned with Nightingale College BSN 366 Course Syllabus,
HESI RN Exit Exam Blueprint, NCLEX-RN Test Plan, and QSEN Competencies
Nightingale
Grade A Preparation Resource
Page 1 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
,BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
SECTION 1: MANAGEMENT OF CARE
Q1: The charge nurse on a medical-surgical unit is assigned four clients. Which client should the charge nurse
assign to the RN who floated from the postanesthesia care unit (PACU)?
A. A 68-year-old client admitted with dehydration receiving IV fluids
B. A 45-year-old client who is 8 hours post-colectomy with a JP drain *[CORRECT]*
C. A 72-year-old client with chronic heart failure on telemetry
D. A 56-year-old client with pneumonia receiving oral antibiotics
Correct Answer: B
Rationale: The PACU float RN has specialized postoperative assessment expertise, making the fresh post-colectomy client the
best assignment (BSN 366 Management of Care: matching competency to acuity). Clients A, C, and D require ongoing
medical-surgical monitoring that is better suited to a floor RN. Delegation by competency, not convenience, aligns with the
Nurse Practice Act and ANA Principles of Delegation.
Q2: An RN delegates vital signs to a UAP for a client who is 4 hours post-cardiac catheterization. Which
statement by the RN reflects appropriate delegation?
A. "Let me know if you notice anything unusual with the client."
B. "Take the vital signs every 15 minutes x 4, then every 30 minutes x 2, and report any systolic BP < 90."
*[CORRECT]*
C. "Watch the client carefully and report when you're done."
D. "Just take vitals every hour and tell me at the end of your shift."
Correct Answer: B
Rationale: Effective delegation requires clear direction, specific parameters, and a defined timeframe (the Five Rights of
Delegation: right task, circumstance, person, direction/communication, supervision). Option B provides measurable parameters
matching post-catheterization risk for bleeding/ hematoma. Options A, C, and D lack specificity and supervisory structure,
violating QSEN Safety and the ANA delegation principles emphasized in BSN 366.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the consent form, stating "I'm scared
and I need more time." Which action by the nurse is most appropriate?
A. Notify the surgeon and document the client's refusal *[CORRECT]*
B. Explain the risks of delaying surgery to encourage consent
C. Ask the family to convince the client to sign
D. Sign the consent as a witness since the client was informed
Correct Answer: A
Rationale: Autonomy requires that the nurse respect the client's right to refuse (BSN 366 ethical principles). The nurse must
notify the surgeon and document the refusal; coercion (B, C) violates informed consent. Witnessing a signature (D) when consent
has not been freely given is unethical and legally indefensible. This aligns with the Patient Self-Determination Act and ANA Code
of Ethics.
Page 2 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
,BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
Q4: Which task is most appropriate for the RN to delegate to a licensed practical nurse (LPN)?
A. Initial admission assessment of a client with acute GI bleeding
B. Teaching insulin self-administration to a newly diagnosed diabetic client
C. Administering oral medications to stable clients on a medical unit *[CORRECT]*
D. Developing a plan of care for a client with new-onset heart failure
Correct Answer: C
Rationale: The LPN scope includes administering oral medications to stable clients (NCSBN delegation rules; BSN 366 scope of
practice). Initial assessments (A), complex teaching (B), and care plan development (D) require RN-level judgment. The Five
Rights of Delegation confirm that stable, routine tasks with predictable outcomes are appropriate for LPN assignment.
Q5: A nurse discovers a coworker diverting controlled substances. Which action should the nurse take first?
A. Confront the coworker privately
B. Document observations and report to the nurse manager *[CORRECT]*
C. Wait until there is definitive proof before acting
D. Discuss the concern with other staff members
Correct Answer: B
Rationale: Substance diversion is a patient-safety and legal issue requiring factual documentation and chain-of-command
reporting (BSN 366 mandatory reporting; HIPAA; DEA regulations). Confrontation (A) may destroy evidence and endanger
patients; waiting (C) prolongs risk; gossiping (D) violates confidentiality. Mandatory reporting protects clients and supports the
impaired colleague toward treatment.
Q6: A client with a terminal illness states, "I want everything done to keep me alive." The client has no
advance directive. Which nursing action best supports the client's right to self-determination?
A. Encourage the client to consider a Do-Not-Resuscitate order
B. Document the client's wishes and ensure they are communicated to the healthcare team *[CORRECT]*
C. Refer the client to palliative care to reconsider the decision
D. Contact the ethics committee to override the request
Correct Answer: B
Rationale: The Patient Self-Determination Act requires that the nurse document and communicate the client's autonomous
wishes (autonomy; BSN 366 advance directives). Encouraging a DNR (A) or palliative referral to change the client's mind (C)
imposes the nurse's values. The ethics committee (D) is consulted for dilemmas, not for overriding expressed wishes. Veracity
and fidelity require honoring the client's choice.
Q7: During shift report using SBAR, which statement by the RN represents the "A" (Assessment)
component?
A. "The client may be developing hypovolemia." *[CORRECT]*
B. "Heart rate is 122, BP 88/52, urine output 15 mL/hr."
C. "I think we need to increase the IV fluid rate."
D. "The client was admitted yesterday with pneumonia."
Correct Answer: A
Rationale: In SBAR, Assessment is the nurse's professional interpretation of the Situation and Background data (BSN 366 SBAR
communication). Option B is the Situation/Background objective data; C is the Recommendation; D is Background. The
clinician's hypothesis ("may be developing hypovolemia") is the Assessment. SBAR standardizes handoff communication and
reduces sentinel events (QSEN Safety; Joint Commission National Patient Safety Goals).
Page 3 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
, BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
Q8: A client is admitted with injuries suggestive of intimate partner violence. The client begs the nurse not to
report the abuse. Which nursing action is most appropriate?
A. Honor the client's wishes to maintain trust
B. Report the abuse according to state law and offer protective resources *[CORRECT]*
C. Wait until the client is ready before taking action
D. Confront the partner about the injuries
Correct Answer: B
Rationale: Most states mandate reporting of injuries from weapons, assaults, or crimes; intimate partner violence reporting
varies by state but the nurse must follow the law (BSN 366 mandatory reporting). The nurse should also offer protective
resources such as shelters and crisis hotlines. Options A and C delay safety; D endangers the client. Beneficence and
nonmaleficence require protective action.
Q9: A nurse administers the wrong dose of a high-alert medication. After ensuring the client is stable, what
should the nurse do next?
A. Wait to see if the client develops symptoms before documenting
B. Document the error in an incident report and notify the provider *[CORRECT]*
C. Document only in the medical record that a medication error occurred
D. Ask a coworker to report the error to avoid self-incrimination
Correct Answer: B
Rationale: Medication errors require prompt provider notification, client monitoring, factual documentation in the medical
record, and completion of an incident report (a separate quality-improvement document not part of the legal record) per BSN
366 documentation rules and QSEN Quality Improvement. Waiting (A), incomplete documentation (C), or shifting responsibility
(D) violates patient safety and veracity. Incident reports drive root cause analysis.
Q10: A client asks the nurse, "Did my test results come back positive for cancer?" The provider has not yet
spoken with the client. Which response by the nurse is most appropriate?
A. "I'm not allowed to discuss results; please ask your doctor."
B. "The results are in, but your provider will discuss them with you shortly." *[CORRECT]*
C. "Yes, the biopsy confirmed cancer; I'll stay with you while you process this."
D. "Everything looks fine, don't worry."
Correct Answer: B
Rationale: Disclosure of a serious diagnosis is the provider's responsibility; the nurse should acknowledge the results are
available without revealing them, while offering emotional support (BSN 366 therapeutic communication; HIPAA). Option A is
dismissive, C bypasses the provider's role, and D is dishonest (violates veracity) and risks a false reassurance claim. The nurse
can support the client once the provider shares the news.
Page 4 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
BSN 366 HESI RN EXIT EXAM
Latest Update
Review Questions and Verified Answers
100% Correct | Grade A
150 9 2026/27
Questions Sections Edition
Aligned with Nightingale College BSN 366 Course Syllabus,
HESI RN Exit Exam Blueprint, NCLEX-RN Test Plan, and QSEN Competencies
Nightingale
Grade A Preparation Resource
Page 1 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
,BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
SECTION 1: MANAGEMENT OF CARE
Q1: The charge nurse on a medical-surgical unit is assigned four clients. Which client should the charge nurse
assign to the RN who floated from the postanesthesia care unit (PACU)?
A. A 68-year-old client admitted with dehydration receiving IV fluids
B. A 45-year-old client who is 8 hours post-colectomy with a JP drain *[CORRECT]*
C. A 72-year-old client with chronic heart failure on telemetry
D. A 56-year-old client with pneumonia receiving oral antibiotics
Correct Answer: B
Rationale: The PACU float RN has specialized postoperative assessment expertise, making the fresh post-colectomy client the
best assignment (BSN 366 Management of Care: matching competency to acuity). Clients A, C, and D require ongoing
medical-surgical monitoring that is better suited to a floor RN. Delegation by competency, not convenience, aligns with the
Nurse Practice Act and ANA Principles of Delegation.
Q2: An RN delegates vital signs to a UAP for a client who is 4 hours post-cardiac catheterization. Which
statement by the RN reflects appropriate delegation?
A. "Let me know if you notice anything unusual with the client."
B. "Take the vital signs every 15 minutes x 4, then every 30 minutes x 2, and report any systolic BP < 90."
*[CORRECT]*
C. "Watch the client carefully and report when you're done."
D. "Just take vitals every hour and tell me at the end of your shift."
Correct Answer: B
Rationale: Effective delegation requires clear direction, specific parameters, and a defined timeframe (the Five Rights of
Delegation: right task, circumstance, person, direction/communication, supervision). Option B provides measurable parameters
matching post-catheterization risk for bleeding/ hematoma. Options A, C, and D lack specificity and supervisory structure,
violating QSEN Safety and the ANA delegation principles emphasized in BSN 366.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the consent form, stating "I'm scared
and I need more time." Which action by the nurse is most appropriate?
A. Notify the surgeon and document the client's refusal *[CORRECT]*
B. Explain the risks of delaying surgery to encourage consent
C. Ask the family to convince the client to sign
D. Sign the consent as a witness since the client was informed
Correct Answer: A
Rationale: Autonomy requires that the nurse respect the client's right to refuse (BSN 366 ethical principles). The nurse must
notify the surgeon and document the refusal; coercion (B, C) violates informed consent. Witnessing a signature (D) when consent
has not been freely given is unethical and legally indefensible. This aligns with the Patient Self-Determination Act and ANA Code
of Ethics.
Page 2 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
,BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
Q4: Which task is most appropriate for the RN to delegate to a licensed practical nurse (LPN)?
A. Initial admission assessment of a client with acute GI bleeding
B. Teaching insulin self-administration to a newly diagnosed diabetic client
C. Administering oral medications to stable clients on a medical unit *[CORRECT]*
D. Developing a plan of care for a client with new-onset heart failure
Correct Answer: C
Rationale: The LPN scope includes administering oral medications to stable clients (NCSBN delegation rules; BSN 366 scope of
practice). Initial assessments (A), complex teaching (B), and care plan development (D) require RN-level judgment. The Five
Rights of Delegation confirm that stable, routine tasks with predictable outcomes are appropriate for LPN assignment.
Q5: A nurse discovers a coworker diverting controlled substances. Which action should the nurse take first?
A. Confront the coworker privately
B. Document observations and report to the nurse manager *[CORRECT]*
C. Wait until there is definitive proof before acting
D. Discuss the concern with other staff members
Correct Answer: B
Rationale: Substance diversion is a patient-safety and legal issue requiring factual documentation and chain-of-command
reporting (BSN 366 mandatory reporting; HIPAA; DEA regulations). Confrontation (A) may destroy evidence and endanger
patients; waiting (C) prolongs risk; gossiping (D) violates confidentiality. Mandatory reporting protects clients and supports the
impaired colleague toward treatment.
Q6: A client with a terminal illness states, "I want everything done to keep me alive." The client has no
advance directive. Which nursing action best supports the client's right to self-determination?
A. Encourage the client to consider a Do-Not-Resuscitate order
B. Document the client's wishes and ensure they are communicated to the healthcare team *[CORRECT]*
C. Refer the client to palliative care to reconsider the decision
D. Contact the ethics committee to override the request
Correct Answer: B
Rationale: The Patient Self-Determination Act requires that the nurse document and communicate the client's autonomous
wishes (autonomy; BSN 366 advance directives). Encouraging a DNR (A) or palliative referral to change the client's mind (C)
imposes the nurse's values. The ethics committee (D) is consulted for dilemmas, not for overriding expressed wishes. Veracity
and fidelity require honoring the client's choice.
Q7: During shift report using SBAR, which statement by the RN represents the "A" (Assessment)
component?
A. "The client may be developing hypovolemia." *[CORRECT]*
B. "Heart rate is 122, BP 88/52, urine output 15 mL/hr."
C. "I think we need to increase the IV fluid rate."
D. "The client was admitted yesterday with pneumonia."
Correct Answer: A
Rationale: In SBAR, Assessment is the nurse's professional interpretation of the Situation and Background data (BSN 366 SBAR
communication). Option B is the Situation/Background objective data; C is the Recommendation; D is Background. The
clinician's hypothesis ("may be developing hypovolemia") is the Assessment. SBAR standardizes handoff communication and
reduces sentinel events (QSEN Safety; Joint Commission National Patient Safety Goals).
Page 3 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
, BSN 366 HESI RN Exit Exam Review (2026/2027) | Nightingale College
Q8: A client is admitted with injuries suggestive of intimate partner violence. The client begs the nurse not to
report the abuse. Which nursing action is most appropriate?
A. Honor the client's wishes to maintain trust
B. Report the abuse according to state law and offer protective resources *[CORRECT]*
C. Wait until the client is ready before taking action
D. Confront the partner about the injuries
Correct Answer: B
Rationale: Most states mandate reporting of injuries from weapons, assaults, or crimes; intimate partner violence reporting
varies by state but the nurse must follow the law (BSN 366 mandatory reporting). The nurse should also offer protective
resources such as shelters and crisis hotlines. Options A and C delay safety; D endangers the client. Beneficence and
nonmaleficence require protective action.
Q9: A nurse administers the wrong dose of a high-alert medication. After ensuring the client is stable, what
should the nurse do next?
A. Wait to see if the client develops symptoms before documenting
B. Document the error in an incident report and notify the provider *[CORRECT]*
C. Document only in the medical record that a medication error occurred
D. Ask a coworker to report the error to avoid self-incrimination
Correct Answer: B
Rationale: Medication errors require prompt provider notification, client monitoring, factual documentation in the medical
record, and completion of an incident report (a separate quality-improvement document not part of the legal record) per BSN
366 documentation rules and QSEN Quality Improvement. Waiting (A), incomplete documentation (C), or shifting responsibility
(D) violates patient safety and veracity. Incident reports drive root cause analysis.
Q10: A client asks the nurse, "Did my test results come back positive for cancer?" The provider has not yet
spoken with the client. Which response by the nurse is most appropriate?
A. "I'm not allowed to discuss results; please ask your doctor."
B. "The results are in, but your provider will discuss them with you shortly." *[CORRECT]*
C. "Yes, the biopsy confirmed cancer; I'll stay with you while you process this."
D. "Everything looks fine, don't worry."
Correct Answer: B
Rationale: Disclosure of a serious diagnosis is the provider's responsibility; the nurse should acknowledge the results are
available without revealing them, while offering emotional support (BSN 366 therapeutic communication; HIPAA). Option A is
dismissive, C bypasses the provider's role, and D is dishonest (violates veracity) and risks a false reassurance claim. The nurse
can support the client once the provider shares the news.
Page 4 | BSN 366 HESI RN Exit Review (Latest Update 2026/2027)
