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
Needs
800-849
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.
Question 8
A nurse is caring for a client following a thyroidectomy. Which assessment
finding requires immediate action?
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
Needs
800-849
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.
Question 8
A nurse is caring for a client following a thyroidectomy. Which assessment
finding requires immediate action?
