BSN HESI 366 RN Exit Exam (2023-2025) VERSION LATEST
UPDATE WITH 100% PASSING RATE
Candidate Name: _________________________
Date: _________________________
Time Allowed: 4 Hours (240 minutes)
Total Questions: 100
Exam Instructions:
• Each question has one (1) correct answer unless specified as "Select All That
Apply" (SATA)
• Mark your answers clearly on the answer sheet
• Read each rationale carefully after the exam for remediation
• Passing standard: 850+ HESI score equivalent (approximately 70-75% correct)
Topics Covered:
• Medical-Surgical Nursing (25%)
• Maternity & Women's Health (10%)
• Pediatrics (10%)
• Psychiatric/Mental Health (10%)
• Pharmacology (15%)
• Leadership/Management/Delegation (15%)
• Fundamentals/Patient Safety (15%)
Scoring Guidelines:
Score Range Performance Level
900-1500 Excellent
850-899 Satisfactory
800-849 Needs Improvement
<800 Unsatisfactory
,SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-25)
Question 1
A nurse is caring for a client with heart failure who has crackles in both lung bases, an S3
heart sound, and jugular vein distension. Which medication does the nurse anticipate
administering first?
• A) Digoxin
• B) Furosemide ✓
• C) Metoprolol
• D) Lisinopril
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting
diuresis, relieving pulmonary congestion (crackles) and reducing JVD. This addresses the
client's acute fluid overload symptoms first. Digoxin improves contractility but takes
longer; metoprolol is a beta-blocker for chronic management; lisinopril is an ACE
inhibitor for long-term afterload reduction.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has an SpO2 of 88% on
room air. The nurse applies oxygen at 2 L/min via nasal cannula. Which finding indicates
an adverse reaction to oxygen therapy?
• A) Respiratory rate of 18 breaths/min
• B) Respiratory rate of 8 breaths/min ✓
• C) SpO2 increasing to 92%
• D) Client reports less dyspnea
Rationale: Clients with chronic hypercapnia (CO2 retention) rely on a hypoxic drive to
breathe. Excess oxygen can depress this drive, leading to hypoventilation and respiratory
acidosis. A decreased respiratory rate indicates this dangerous complication. The target
SpO2 for COPD clients is 88-92%.
,Question 3
A nurse is assessing a client 6 hours after a myocardial infarction. Which finding requires
immediate intervention?
• A) Blood pressure 110/70 mmHg
• B) Crackles auscultated in mid-lung fields ✓
• C) Pain rated 2/10 at the incision site
• D) Heart rate of 88 beats/min
Rationale: Crackles in mid-lung fields indicate pulmonary edema from left ventricular
failure, a life-threatening complication post-MI. This requires immediate intervention
(diuretics, oxygen, positioning). The other findings are stable or expected.
Question 4
A client with diabetes mellitus type 2 has a blood glucose level of 45 mg/dL and is
unconscious. Which action should the nurse take first?
• A) Administer glucagon 1 mg subcutaneously
• B) Administer 50% dextrose IV push ✓
• C) Give orange juice via nasogastric tube
• D) Recheck blood glucose in 15 minutes
Rationale: For an unconscious hypoglycemic client, IV dextrose is the fastest and most
reliable route to restore consciousness. Glucagon can be used if IV access is unavailable
but takes longer. Oral glucose is contraindicated in an unconscious client due to
aspiration risk.
Question 5
A client with cirrhosis develops asterixis and confusion. Which laboratory value is most
concerning?
• A) Serum sodium 135 mEq/L
• B) Serum potassium 4.0 mEq/L
• C) Serum ammonia 180 mcg/dL ✓
• D) Albumin 3.5 g/dL
, Rationale: Asterixis (liver flap) and confusion indicate hepatic encephalopathy, caused
by elevated ammonia levels (normal 15-60 mcg/dL). The brain cannot metabolize
ammonia, leading to neurotoxicity. Treatment includes lactulose to excrete ammonia.
Question 6
A nurse is teaching a client with hypertension about the DASH diet. Which meal choice
indicates understanding?
• A) Cheeseburger with french fries and soda
• B) Fried chicken, mashed potatoes with gravy, and coleslaw
• C) Grilled salmon, brown rice, steamed broccoli, and an orange ✓
• D) Pepperoni pizza and a side salad with ranch dressing
Rationale: The DASH diet emphasizes fruits, vegetables, whole grains, lean protein, and
low sodium. Grilled salmon (omega-3s), brown rice (fiber), broccoli (potassium), and
orange (vitamin C) align with DASH principles. The other options are high in sodium,
saturated fat, and refined carbohydrates.
Question 7
A client with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which
electrocardiogram (ECG) change does the nurse expect to see?
• A) U waves
• B) Tall peaked T waves ✓
• C) Prolonged QT interval
• D) ST segment depression
Rationale: Hyperkalemia (K+ >5.5 mEq/L) causes tall, peaked T waves, widened QRS,
flat P waves, and eventually sine wave pattern leading to cardiac arrest. U waves are
seen in hypokalemia. Prolonged QT occurs with hypocalcemia or certain medications.
UPDATE WITH 100% PASSING RATE
Candidate Name: _________________________
Date: _________________________
Time Allowed: 4 Hours (240 minutes)
Total Questions: 100
Exam Instructions:
• Each question has one (1) correct answer unless specified as "Select All That
Apply" (SATA)
• Mark your answers clearly on the answer sheet
• Read each rationale carefully after the exam for remediation
• Passing standard: 850+ HESI score equivalent (approximately 70-75% correct)
Topics Covered:
• Medical-Surgical Nursing (25%)
• Maternity & Women's Health (10%)
• Pediatrics (10%)
• Psychiatric/Mental Health (10%)
• Pharmacology (15%)
• Leadership/Management/Delegation (15%)
• Fundamentals/Patient Safety (15%)
Scoring Guidelines:
Score Range Performance Level
900-1500 Excellent
850-899 Satisfactory
800-849 Needs Improvement
<800 Unsatisfactory
,SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-25)
Question 1
A nurse is caring for a client with heart failure who has crackles in both lung bases, an S3
heart sound, and jugular vein distension. Which medication does the nurse anticipate
administering first?
• A) Digoxin
• B) Furosemide ✓
• C) Metoprolol
• D) Lisinopril
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting
diuresis, relieving pulmonary congestion (crackles) and reducing JVD. This addresses the
client's acute fluid overload symptoms first. Digoxin improves contractility but takes
longer; metoprolol is a beta-blocker for chronic management; lisinopril is an ACE
inhibitor for long-term afterload reduction.
Question 2
A client with chronic obstructive pulmonary disease (COPD) has an SpO2 of 88% on
room air. The nurse applies oxygen at 2 L/min via nasal cannula. Which finding indicates
an adverse reaction to oxygen therapy?
• A) Respiratory rate of 18 breaths/min
• B) Respiratory rate of 8 breaths/min ✓
• C) SpO2 increasing to 92%
• D) Client reports less dyspnea
Rationale: Clients with chronic hypercapnia (CO2 retention) rely on a hypoxic drive to
breathe. Excess oxygen can depress this drive, leading to hypoventilation and respiratory
acidosis. A decreased respiratory rate indicates this dangerous complication. The target
SpO2 for COPD clients is 88-92%.
,Question 3
A nurse is assessing a client 6 hours after a myocardial infarction. Which finding requires
immediate intervention?
• A) Blood pressure 110/70 mmHg
• B) Crackles auscultated in mid-lung fields ✓
• C) Pain rated 2/10 at the incision site
• D) Heart rate of 88 beats/min
Rationale: Crackles in mid-lung fields indicate pulmonary edema from left ventricular
failure, a life-threatening complication post-MI. This requires immediate intervention
(diuretics, oxygen, positioning). The other findings are stable or expected.
Question 4
A client with diabetes mellitus type 2 has a blood glucose level of 45 mg/dL and is
unconscious. Which action should the nurse take first?
• A) Administer glucagon 1 mg subcutaneously
• B) Administer 50% dextrose IV push ✓
• C) Give orange juice via nasogastric tube
• D) Recheck blood glucose in 15 minutes
Rationale: For an unconscious hypoglycemic client, IV dextrose is the fastest and most
reliable route to restore consciousness. Glucagon can be used if IV access is unavailable
but takes longer. Oral glucose is contraindicated in an unconscious client due to
aspiration risk.
Question 5
A client with cirrhosis develops asterixis and confusion. Which laboratory value is most
concerning?
• A) Serum sodium 135 mEq/L
• B) Serum potassium 4.0 mEq/L
• C) Serum ammonia 180 mcg/dL ✓
• D) Albumin 3.5 g/dL
, Rationale: Asterixis (liver flap) and confusion indicate hepatic encephalopathy, caused
by elevated ammonia levels (normal 15-60 mcg/dL). The brain cannot metabolize
ammonia, leading to neurotoxicity. Treatment includes lactulose to excrete ammonia.
Question 6
A nurse is teaching a client with hypertension about the DASH diet. Which meal choice
indicates understanding?
• A) Cheeseburger with french fries and soda
• B) Fried chicken, mashed potatoes with gravy, and coleslaw
• C) Grilled salmon, brown rice, steamed broccoli, and an orange ✓
• D) Pepperoni pizza and a side salad with ranch dressing
Rationale: The DASH diet emphasizes fruits, vegetables, whole grains, lean protein, and
low sodium. Grilled salmon (omega-3s), brown rice (fiber), broccoli (potassium), and
orange (vitamin C) align with DASH principles. The other options are high in sodium,
saturated fat, and refined carbohydrates.
Question 7
A client with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. Which
electrocardiogram (ECG) change does the nurse expect to see?
• A) U waves
• B) Tall peaked T waves ✓
• C) Prolonged QT interval
• D) ST segment depression
Rationale: Hyperkalemia (K+ >5.5 mEq/L) causes tall, peaked T waves, widened QRS,
flat P waves, and eventually sine wave pattern leading to cardiac arrest. U waves are
seen in hypokalemia. Prolonged QT occurs with hypocalcemia or certain medications.
