BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
BSN 366 HESI RN Exit Test Questions & Answers
(Latest Update ) | 100% Correct | Grade A —
Nightingale
Nightingale College BSN 366 Course Syllabus • HESI RN Exit Exam Blueprint • NCLEX-RN Test Plan • QSEN
Competencies
Exam Blueprint
Sectio
Content Area # Qs
n
1 Management of Care 20
2 Safety & Infection Control 15
3 Health Promotion & Maintenance 15
4 Psychosocial Integrity 15
5 Basic Care & Comfort 15
6 Pharmacological & Parenteral Therapies 20
7 Reduction of Risk Potential 20
8 Physiological Adaptation 20
9 Comprehensive Integrated Scenarios 10
TOTAL 150
Cognitive Distribution: 20% Recall • 50% Application • 30% Analysis. Style: 75% scenario-based, 25% direct knowledge. Special
Inclusions: 20 priority-setting, 15 pharmacology, 10 delegation, 5 integrated case studies.
Section 1: Management of Care
20 questions — client rights, advocacy, legal/ethical, informed consent, advance directives, delegation, prioritization, SBAR,
documentation, HIPAA, scope of practice.
Q1: A 78-year-old client with metastatic cancer tells the nurse, 'I do not want any more aggressive
treatment.' The healthcare provider insists on continuing chemotherapy. Which ethical principle most
strongly supports the nurse's advocacy for this client?
A. Beneficence, because the chemotherapy offers the best chance of remission
B. Autonomy, because the client has the right to self-determination and to refuse treatment
*[CORRECT]*
C. Justice, because all clients deserve equal access to cancer therapies
D. Nonmaleficence, because stopping chemotherapy will hasten death
Correct Answer: B
Rationale: Autonomy respects the client's right to make informed decisions about their own care, including refusal of
treatment, even when the provider disagrees. Beneficence and nonmaleficence guide the provider's intent but do not override
competent client choice; justice concerns fair distribution of resources. BSN 366 emphasizes that advocacy for autonomous
decisions is a core RN obligation under the Patient Self-Determination Act and ANA Code of Ethics.
Q2: The RN is assigned to four clients. Which client should the RN assess FIRST?
A. A client 2 hours post-colonoscopy requesting a snack
BSN 366 HESI RN Exit — 150 Questions Page 1
,BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
B. A client 4 hours post-thoracotomy with serosanguineous drainage of 80 mL/hr
C. A client receiving IV heparin for DVT whose aPTT is 95 seconds (control 35)
D. A client with COPD whose oxygen saturation dropped from 94% to 88% on room air
*[CORRECT]*
Correct Answer: D
Rationale: Using the ABC prioritization framework, the client with COPD and dropping oxygen saturation has the most acute
physiological threat to airway/breathing and requires immediate assessment. The post-thoracotomy drainage is borderline but
currently stable; the elevated aPTT needs action but is less immediately life-threatening than hypoxemia; the post-colonoscopy
client is lowest priority. HESI RN Exit prioritization rules target the client whose condition is most unstable or poses the greatest
risk to life.
Q3: Which task can the RN safely delegate to a unlicensed assistive personnel (UAP)?
A. Reinforcing a complex wound dressing on a postoperative client
B. Teaching a newly diagnosed diabetic client about insulin administration
C. Ambulating a stable postoperative client to the bathroom for the first time *[CORRECT]*
D. Assessing a client's IV site for signs of phlebitis
Correct Answer: C
Rationale: UAP scope of practice includes activities of daily living such as ambulation, hygiene, and feeding for stable
clients. Wound dressing changes, client teaching, and IV assessment require nursing judgment and are outside UAP scope. The
Five Rights of Delegation (right task, right circumstance, right person, right direction, right supervision) confirm ambulation
of a stable client is appropriate. BSN 366 teaches that RNs retain accountability for assessment, teaching, and evaluation even
when delegating tasks.
Q4: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the client signs the consent form. Thirty minutes later, the client 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 has explained everything and the procedure is routine
B. Notify the surgeon that the client may not have understood the procedure and consent may be
invalid *[CORRECT]*
C. Explain the surgical procedure to the client in detail
D. Ask the client to sign a new consent form after the nurse re-explains
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. When the
nurse discovers the client does not understand, the surgeon must be notified so consent can be re-obtained; the nurse's role is to
witness and verify, not to provide the primary explanation. Reassuring the client dismisses the problem; nurse-led
re-explanation oversteps the nurse's role. BSN 366 curriculum stresses that consent is invalid if understanding is absent.
Q5: An LPN is assigned to care for a client with a chest tube. Which intervention should the LPN NOT
perform and the RN should retain?
A. Measuring and recording chest tube output every shift
B. Assessing lung sounds and evaluating chest tube effectiveness *[CORRECT]*
C. Repositioning the client and providing hygiene
D. Reporting changes in the amount or color of drainage to the RN
Correct Answer: B
Rationale: Comprehensive assessment and evaluation of chest tube effectiveness require RN-level judgment and are not
delegated to LPNs, whose scope focuses on routine care and data collection. LPNs may measure output, reposition clients, and
report changes. The Nurse Practice Act and NCSBN delegation guidelines confirm that clinical judgment and evaluation
remain RN responsibilities. BSN 366 emphasizes scope-of-practice boundaries as a high-yield HESI topic.
BSN 366 HESI RN Exit — 150 Questions Page 2
,BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
Q6: A client's family member approaches the nurse in the hallway and asks, 'How is my mother doing after
her surgery?' The mother has not given permission to share information with this person. Which response
by the nurse is MOST appropriate?
A. She's stable and recovering well, you can go in and see her
B. I cannot share any information without your mother's permission *[CORRECT]*
C. She had a cholecystectomy and is doing fine
D. Let me check her chart and I will tell you everything
Correct Answer: B
Rationale: Under HIPAA, protected health information (PHI) cannot be disclosed without the client's authorization, even to
family members, unless the client has been given the opportunity to agree or object. The other options either disclose PHI or
appear to disclose it. BSN 366 HIPAA content stresses that the nurse must verify the client's wishes before sharing any
information with anyone.
Q7: A nurse witnesses a colleague documenting medications as given that were not actually administered.
Which action by the nurse is MOST appropriate FIRST?
A. Report the colleague to the state Board of Nursing immediately
B. Discuss the observation directly with the colleague and encourage self-reporting *[CORRECT]*
C. Notify the supervisor and complete an incident report
D. Confront the colleague in front of other staff to ensure accountability
Correct Answer: B
Rationale: The ethical first step is to address the colleague directly to clarify the situation and encourage self-reporting, as this
may resolve a misunderstanding without escalation. If unresolved, the chain of command (supervisor and incident report)
follows. Immediate Board reporting without internal resolution is premature, and public confrontation violates professional
conduct. BSN 366 professional issues module emphasizes the use of the chain of command and just culture principles.
Q8: A client with end-stage renal disease has a signed advance directive stating no cardiopulmonary
resuscitation (DNR). The client goes into cardiac arrest and the family screams, 'Please do something!'
What is the nurse's BEST action?
A. Initiate CPR and call a code because the family is requesting it
B. Honor the DNR and provide comfort measures while explaining to the family *[CORRECT]*
C. Call the healthcare provider for clarification before doing anything
D. Initiate CPR and document that the family requested it
Correct Answer: B
Rationale: An advance directive is a legally binding document that must be honored even if the family disagrees; the client's
autonomous decision takes precedence after death is not imminent. Initiating CPR would constitute battery. Calling the
provider delays needed communication with the family. BSN 366 (Patient Self-Determination Act content) requires nurses to
honor advance directives and act as the client's advocate.
Q9: Which situation requires the nurse to obtain informed consent BEFORE proceeding?
A. Administration of a routine influenza vaccination
B. Insertion of a urinary catheter for a postoperative client
C. Performing a lumbar puncture for diagnostic evaluation *[CORRECT]*
D. Routine assessment of vital signs
Correct Answer: C
Rationale: Invasive diagnostic procedures such as lumbar puncture require informed consent because they carry significant
risks. Routine vaccinations, urinary catheterizations for therapeutic reasons, and vital sign assessments do not require separate
informed consent. BSN 366 legal/ethical content specifies that informed consent is required for anesthesia, surgery, invasive
procedures, blood administration, and certain high-risk treatments.
BSN 366 HESI RN Exit — 150 Questions Page 3
, BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
Q10: A new graduate nurse is preparing to administer IV morphine to a postoperative client. The charge
nurse should intervene if the new graduate plans to:
A. Verify the medication order against the MAR and the client's armband
B. Ask the client to state their name and date of birth
C. Leave the medication at the bedside so the client can self-administer when needed
*[CORRECT]*
D. Document the medication immediately after administration
Correct Answer: C
Rationale: High-alert medications such as IV opioids cannot be left at the bedside for self-administration due to risk of
overdose, diversion, or adverse effects; they require direct RN administration and monitoring. Verifying order and identity,
using two identifiers, and timely documentation are correct actions. BSN 366 pharmacology content classifies opioids as
high-alert medications requiring special safeguards.
Q11: An RN is working on a medical unit with one LPN and one UAP. The RN has just received report on
four clients. Which client should the RN assign to the LPN?
A. A client admitted 2 hours ago with acute GI bleeding, receiving IV fluids
B. A client with new-onset atrial fibrillation requiring IV diltiazem
C. A stable client 3 days post-stroke requiring feeding and hygiene *[CORRECT]*
D. A client receiving a blood transfusion for the first time
Correct Answer: C
Rationale: The LPN scope best matches the stable post-stroke client requiring routine care; clients with acute bleeding, new
arrhythmias, or initial blood transfusions need RN-level assessment and intervention. The NCSBN delegation guidelines and
BSN 366 assignment content specify that LPNs care for stable clients with predictable outcomes, while RNs retain clients with
high acuity or unstable conditions.
Q12: When using SBAR to communicate a change in client status to a healthcare provider, which statement
reflects the 'A' (Assessment)?
A. 'The client is a 68-year-old admitted for pneumonia'
B. 'I think the client is becoming septic based on the changing vital signs' *[CORRECT]*
C. 'The client's heart rate increased from 90 to 130, blood pressure dropped from 120/80 to 90/50'
D. 'I would like you to come evaluate the client and consider IV fluids'
Correct Answer: B
Rationale: The 'A' in SBAR represents the nurse's Assessment or professional judgment about the situation. Stating 'I think the
client is becoming septic' is the nurse's assessment. Option C is the Situation with objective data, option D is the
Recommendation, and option A is background information. BSN 366 communication module teaches SBAR as the standard
for interdisciplinary communication and handoffs.
Q13: A nurse administers the wrong dose of a medication. After ensuring the client is stable, what is the
nurse's PRIORITY action?
A. Notify the healthcare provider and complete a formal incident report *[CORRECT]*
B. Document the error in the client's medical record only
C. Tell the client and family and ask them not to mention it
D. Wait until the end of the shift to report the error to the supervisor
Correct Answer: A
Rationale: After ensuring client safety, the priority is to notify the provider and complete a formal incident report for quality
improvement and risk management. Documenting only in the medical record fails to trigger system review, withholding from
client/family violates ethical transparency, and delay threatens safety culture. BSN 366 quality and safety content requires
prompt reporting through institutional channels per The Joint Commission standards.
BSN 366 HESI RN Exit — 150 Questions Page 4
BSN 366 HESI RN Exit Test Questions & Answers
(Latest Update ) | 100% Correct | Grade A —
Nightingale
Nightingale College BSN 366 Course Syllabus • HESI RN Exit Exam Blueprint • NCLEX-RN Test Plan • QSEN
Competencies
Exam Blueprint
Sectio
Content Area # Qs
n
1 Management of Care 20
2 Safety & Infection Control 15
3 Health Promotion & Maintenance 15
4 Psychosocial Integrity 15
5 Basic Care & Comfort 15
6 Pharmacological & Parenteral Therapies 20
7 Reduction of Risk Potential 20
8 Physiological Adaptation 20
9 Comprehensive Integrated Scenarios 10
TOTAL 150
Cognitive Distribution: 20% Recall • 50% Application • 30% Analysis. Style: 75% scenario-based, 25% direct knowledge. Special
Inclusions: 20 priority-setting, 15 pharmacology, 10 delegation, 5 integrated case studies.
Section 1: Management of Care
20 questions — client rights, advocacy, legal/ethical, informed consent, advance directives, delegation, prioritization, SBAR,
documentation, HIPAA, scope of practice.
Q1: A 78-year-old client with metastatic cancer tells the nurse, 'I do not want any more aggressive
treatment.' The healthcare provider insists on continuing chemotherapy. Which ethical principle most
strongly supports the nurse's advocacy for this client?
A. Beneficence, because the chemotherapy offers the best chance of remission
B. Autonomy, because the client has the right to self-determination and to refuse treatment
*[CORRECT]*
C. Justice, because all clients deserve equal access to cancer therapies
D. Nonmaleficence, because stopping chemotherapy will hasten death
Correct Answer: B
Rationale: Autonomy respects the client's right to make informed decisions about their own care, including refusal of
treatment, even when the provider disagrees. Beneficence and nonmaleficence guide the provider's intent but do not override
competent client choice; justice concerns fair distribution of resources. BSN 366 emphasizes that advocacy for autonomous
decisions is a core RN obligation under the Patient Self-Determination Act and ANA Code of Ethics.
Q2: The RN is assigned to four clients. Which client should the RN assess FIRST?
A. A client 2 hours post-colonoscopy requesting a snack
BSN 366 HESI RN Exit — 150 Questions Page 1
,BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
B. A client 4 hours post-thoracotomy with serosanguineous drainage of 80 mL/hr
C. A client receiving IV heparin for DVT whose aPTT is 95 seconds (control 35)
D. A client with COPD whose oxygen saturation dropped from 94% to 88% on room air
*[CORRECT]*
Correct Answer: D
Rationale: Using the ABC prioritization framework, the client with COPD and dropping oxygen saturation has the most acute
physiological threat to airway/breathing and requires immediate assessment. The post-thoracotomy drainage is borderline but
currently stable; the elevated aPTT needs action but is less immediately life-threatening than hypoxemia; the post-colonoscopy
client is lowest priority. HESI RN Exit prioritization rules target the client whose condition is most unstable or poses the greatest
risk to life.
Q3: Which task can the RN safely delegate to a unlicensed assistive personnel (UAP)?
A. Reinforcing a complex wound dressing on a postoperative client
B. Teaching a newly diagnosed diabetic client about insulin administration
C. Ambulating a stable postoperative client to the bathroom for the first time *[CORRECT]*
D. Assessing a client's IV site for signs of phlebitis
Correct Answer: C
Rationale: UAP scope of practice includes activities of daily living such as ambulation, hygiene, and feeding for stable
clients. Wound dressing changes, client teaching, and IV assessment require nursing judgment and are outside UAP scope. The
Five Rights of Delegation (right task, right circumstance, right person, right direction, right supervision) confirm ambulation
of a stable client is appropriate. BSN 366 teaches that RNs retain accountability for assessment, teaching, and evaluation even
when delegating tasks.
Q4: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and the client signs the consent form. Thirty minutes later, the client 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 has explained everything and the procedure is routine
B. Notify the surgeon that the client may not have understood the procedure and consent may be
invalid *[CORRECT]*
C. Explain the surgical procedure to the client in detail
D. Ask the client to sign a new consent form after the nurse re-explains
Correct Answer: B
Rationale: Informed consent requires that the client understands the procedure, risks, benefits, and alternatives. When the
nurse discovers the client does not understand, the surgeon must be notified so consent can be re-obtained; the nurse's role is to
witness and verify, not to provide the primary explanation. Reassuring the client dismisses the problem; nurse-led
re-explanation oversteps the nurse's role. BSN 366 curriculum stresses that consent is invalid if understanding is absent.
Q5: An LPN is assigned to care for a client with a chest tube. Which intervention should the LPN NOT
perform and the RN should retain?
A. Measuring and recording chest tube output every shift
B. Assessing lung sounds and evaluating chest tube effectiveness *[CORRECT]*
C. Repositioning the client and providing hygiene
D. Reporting changes in the amount or color of drainage to the RN
Correct Answer: B
Rationale: Comprehensive assessment and evaluation of chest tube effectiveness require RN-level judgment and are not
delegated to LPNs, whose scope focuses on routine care and data collection. LPNs may measure output, reposition clients, and
report changes. The Nurse Practice Act and NCSBN delegation guidelines confirm that clinical judgment and evaluation
remain RN responsibilities. BSN 366 emphasizes scope-of-practice boundaries as a high-yield HESI topic.
BSN 366 HESI RN Exit — 150 Questions Page 2
,BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
Q6: A client's family member approaches the nurse in the hallway and asks, 'How is my mother doing after
her surgery?' The mother has not given permission to share information with this person. Which response
by the nurse is MOST appropriate?
A. She's stable and recovering well, you can go in and see her
B. I cannot share any information without your mother's permission *[CORRECT]*
C. She had a cholecystectomy and is doing fine
D. Let me check her chart and I will tell you everything
Correct Answer: B
Rationale: Under HIPAA, protected health information (PHI) cannot be disclosed without the client's authorization, even to
family members, unless the client has been given the opportunity to agree or object. The other options either disclose PHI or
appear to disclose it. BSN 366 HIPAA content stresses that the nurse must verify the client's wishes before sharing any
information with anyone.
Q7: A nurse witnesses a colleague documenting medications as given that were not actually administered.
Which action by the nurse is MOST appropriate FIRST?
A. Report the colleague to the state Board of Nursing immediately
B. Discuss the observation directly with the colleague and encourage self-reporting *[CORRECT]*
C. Notify the supervisor and complete an incident report
D. Confront the colleague in front of other staff to ensure accountability
Correct Answer: B
Rationale: The ethical first step is to address the colleague directly to clarify the situation and encourage self-reporting, as this
may resolve a misunderstanding without escalation. If unresolved, the chain of command (supervisor and incident report)
follows. Immediate Board reporting without internal resolution is premature, and public confrontation violates professional
conduct. BSN 366 professional issues module emphasizes the use of the chain of command and just culture principles.
Q8: A client with end-stage renal disease has a signed advance directive stating no cardiopulmonary
resuscitation (DNR). The client goes into cardiac arrest and the family screams, 'Please do something!'
What is the nurse's BEST action?
A. Initiate CPR and call a code because the family is requesting it
B. Honor the DNR and provide comfort measures while explaining to the family *[CORRECT]*
C. Call the healthcare provider for clarification before doing anything
D. Initiate CPR and document that the family requested it
Correct Answer: B
Rationale: An advance directive is a legally binding document that must be honored even if the family disagrees; the client's
autonomous decision takes precedence after death is not imminent. Initiating CPR would constitute battery. Calling the
provider delays needed communication with the family. BSN 366 (Patient Self-Determination Act content) requires nurses to
honor advance directives and act as the client's advocate.
Q9: Which situation requires the nurse to obtain informed consent BEFORE proceeding?
A. Administration of a routine influenza vaccination
B. Insertion of a urinary catheter for a postoperative client
C. Performing a lumbar puncture for diagnostic evaluation *[CORRECT]*
D. Routine assessment of vital signs
Correct Answer: C
Rationale: Invasive diagnostic procedures such as lumbar puncture require informed consent because they carry significant
risks. Routine vaccinations, urinary catheterizations for therapeutic reasons, and vital sign assessments do not require separate
informed consent. BSN 366 legal/ethical content specifies that informed consent is required for anesthesia, surgery, invasive
procedures, blood administration, and certain high-risk treatments.
BSN 366 HESI RN Exit — 150 Questions Page 3
, BSN 366 — HESI RN Exit Examination (2026/2027 Edition) Nightingale College | Grade A Preparation
Q10: A new graduate nurse is preparing to administer IV morphine to a postoperative client. The charge
nurse should intervene if the new graduate plans to:
A. Verify the medication order against the MAR and the client's armband
B. Ask the client to state their name and date of birth
C. Leave the medication at the bedside so the client can self-administer when needed
*[CORRECT]*
D. Document the medication immediately after administration
Correct Answer: C
Rationale: High-alert medications such as IV opioids cannot be left at the bedside for self-administration due to risk of
overdose, diversion, or adverse effects; they require direct RN administration and monitoring. Verifying order and identity,
using two identifiers, and timely documentation are correct actions. BSN 366 pharmacology content classifies opioids as
high-alert medications requiring special safeguards.
Q11: An RN is working on a medical unit with one LPN and one UAP. The RN has just received report on
four clients. Which client should the RN assign to the LPN?
A. A client admitted 2 hours ago with acute GI bleeding, receiving IV fluids
B. A client with new-onset atrial fibrillation requiring IV diltiazem
C. A stable client 3 days post-stroke requiring feeding and hygiene *[CORRECT]*
D. A client receiving a blood transfusion for the first time
Correct Answer: C
Rationale: The LPN scope best matches the stable post-stroke client requiring routine care; clients with acute bleeding, new
arrhythmias, or initial blood transfusions need RN-level assessment and intervention. The NCSBN delegation guidelines and
BSN 366 assignment content specify that LPNs care for stable clients with predictable outcomes, while RNs retain clients with
high acuity or unstable conditions.
Q12: When using SBAR to communicate a change in client status to a healthcare provider, which statement
reflects the 'A' (Assessment)?
A. 'The client is a 68-year-old admitted for pneumonia'
B. 'I think the client is becoming septic based on the changing vital signs' *[CORRECT]*
C. 'The client's heart rate increased from 90 to 130, blood pressure dropped from 120/80 to 90/50'
D. 'I would like you to come evaluate the client and consider IV fluids'
Correct Answer: B
Rationale: The 'A' in SBAR represents the nurse's Assessment or professional judgment about the situation. Stating 'I think the
client is becoming septic' is the nurse's assessment. Option C is the Situation with objective data, option D is the
Recommendation, and option A is background information. BSN 366 communication module teaches SBAR as the standard
for interdisciplinary communication and handoffs.
Q13: A nurse administers the wrong dose of a medication. After ensuring the client is stable, what is the
nurse's PRIORITY action?
A. Notify the healthcare provider and complete a formal incident report *[CORRECT]*
B. Document the error in the client's medical record only
C. Tell the client and family and ask them not to mention it
D. Wait until the end of the shift to report the error to the supervisor
Correct Answer: A
Rationale: After ensuring client safety, the priority is to notify the provider and complete a formal incident report for quality
improvement and risk management. Documenting only in the medical record fails to trigger system review, withholding from
client/family violates ethical transparency, and delay threatens safety culture. BSN 366 quality and safety content requires
prompt reporting through institutional channels per The Joint Commission standards.
BSN 366 HESI RN Exit — 150 Questions Page 4
