BSN 366 EXIT HESI V2 EXAM STUDY
GUIDE 2026/2027 ACCURATE QUESTIONS
WITH CORRECT DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
NIGHTINGALE
1. A 64 year-old client scheduled for surgery with a general anesthetic refuses
to remove a set of dentures prior to leaving the unit for the operating room.
What would be the most appropriate intervention by the nurse? - ANSWER
✔ Ask the client if the preference would be to remove the dentures in the
operating room receiving area
2. The nurse has been teaching adult clients about cardiac risks when they visit
the hypertension clinic. Which form of evaluation would best measure
learning? - ANSWER ✔ Reported behavioral changes
3. The nurse is planning care for an 18 month-old child. Which action should
be included in the child's care? - ANSWER ✔ Encourage the child to feed
himself finger food
4. A partner is concerned because the client frequently daydreams about
moving to Arizona to get away from the pollution and crowding in southern
California. The nurse explains that - ANSWER ✔ Such fantasies can
gratify unconscious wishes or prepare for anticipated future events
5. An appropriate goal for a client with anxiety would be to - ANSWER ✔
Learn self-help techniques
6. While the nurse is administering medications to a client, the client states "I
do not want to take that medicine today." Which of the following responses
, by the nurse would be best? - ANSWER ✔ "Is there a reason why you
don't want to take your medicine?"
7. While caring for a client, the nurse notes a pulsating mass in the client's
periumbilical area. Which of the following assessments is appropriate for the
nurse to perform? - ANSWER ✔ Auscultate the mass
8. A client is admitted to the hospital with a history of confusion. The client
has difficulty remembering recent events and becomes disoriented when
away from home. Which statement would provide the best reality orientation
for this client? - ANSWER ✔ "Good morning. You're in the hospital. I am
your nurse Elaine Jones."
9. The nurse is teaching the parents of a 3 month-old infant about nutrition.
What is the main source of fluids for an infant until about 12 months of age?
- ANSWER ✔ Formula or breast milk
10.On admission to the ambulatory surgery unit, the nurse notices the client's
painted finger nails. On reviewing the pre-op orders, the nurse notes that
pulse oximetry has been ordered. Which statement by the nurse is
appropriate? - ANSWER ✔ "In order to measure your oxygen level, please
remove the polish from at least 2 nails."
11.The nurse is removing a fecal impaction on a 75 year-old client. It is most
important that the nurse remember that - ANSWER ✔ cardiac
dysrhythmias can result during the process
12.When taking the client's blood pressure (BP), the nurse cannot hear the
sounds through the stethoscope. Which action should the nurse take first? -
ANSWER ✔ take the BP again in 2 minutes in the same arm
13.The client with multiple sclerosis has an order to change the nasogastric
tube. To promote safety when removing the tube, the nurse should -
ANSWER ✔ ask the client to hold a breath
14.A client is being discharged home today, and will be taking K-dur 20mEq
per day by mouth. The nurse should reinforce that potassium levels will be
decreased by - ANSWER ✔ frequent daily snacks of black licorice
,15.A client has just returned from the Post-Anesthesia Care Unit (PACU) to the
surgical unit after a cholecystectomy. When initial vital signs are taken the
nurse notes a temperature of 94.8 degrees Fahrenheit. Which first nursing
action is appropriate? - ANSWER ✔ Apply a warm blanket and check the
temperature in 10 minutes
16.The client with amyotrophic lateral sclerosis is scheduled for 160 ml of
enteral feeding as a bolus every 4 hours. Before flushing with water the
nurse aspirates the feeding tube contents and gets back 180 ml of feeding.
What is the next appropriate nursing action? - ANSWER ✔ Hold the next
feeding
17.The nurse is inserting a Foley catheter into the bladder of a female adult
client. The nurse slips the catheter into an opening for four-5 inches and no
urine is obtained. The most probable reason for this is that - ANSWER ✔
the catheter is in the vagina
18.After the death of a client, the family approaches the nurse and requests that
a family member be allowed to perform a ritual bath on the deceased prior to
moving the body. The appropriate response by the nurse is - ANSWER ✔
Is there anything you need from me to perform the ritual bath?
19.The nurse detects blood-tinged fluid leaking from the nose and ears of a
head trauma client. What is the appropriate nursing action? - ANSWER ✔
Apply bulky, loose dressing to nose and ears
20.A nurse manager considers changing staff assignments from 8 hour shifts to
12 hour shifts. A staff-selected planning committee has approved the
change, yet the staff are complaining. As a change agent, the nurse manager
should first - ANSWER ✔ Explore how the planning committee evaluated
barriers to the plan
21.The nurse is caring for a depressed client with a new prescription for an
SSRI antidepressant. In reviewing the admission history and physical, which
of the following should prompt questions about the safety of this
medication? - ANSWER ✔ Prescribed use of an MAO inhibitor
, 22.In preparing medications for a client with a gastrostomy tube, the nurse
should contact the health care provider before administering which of the
following drugs through the tube? - ANSWER ✔ Cardizem SR tablet
(diltiazem)
23.The most common reason for an Apgar score of 8 and 9 in a newborn is an
abnormality of what parameter? - ANSWER ✔ Color
24.A nurse has asked a second staff nurse to sign for a wasted narcotic, which
was not witnessed by another person. This seems to be a recent pattern of
behavior. What is the appropriate initial action? - ANSWER ✔ Report this
immediately to the nurse manager
25.To obtain data for the nursing assessment, the nurse should: - ANSWER ✔
Elicit clients' description of their experiences, thoughts and behaviors
26.The nurse will administer liquid medicine to a 9 month-old child. Which of
the following methods is appropriate? - ANSWER ✔ Administer the
medication with a syringe next to the tongue
27.A client calls the nurse with a complaint of sudden deep throbbing leg pain.
What is the appropriate first action by the nurse? - ANSWER ✔ Maintain
the client on bed rest
28.The nurse is teaching diet restrictions for a client with Addison's disease.
The client would indicate an understanding of the diet by stating - ANSWER
✔ "I will increase sodium and fluids and restrict potassium."
29.A client refuses to take the medication prescribed because the client prefers
to take self-prescribed herbal preparations. What is the initial action the
nurse should take? - ANSWER ✔ Talk with the client to find out about the
preferred herbal preparation
30.During the initial physical assessment on a client who is a Vietnamese
immigrant, the nurse notices small, circular, ecchymotic areas on the client's
knees. The best action for the nurse to take is to - ANSWER ✔ Ask the
client for more information about the nature of the bruises
GUIDE 2026/2027 ACCURATE QUESTIONS
WITH CORRECT DETAILED SOLUTIONS ||
100% GUARANTEED PASS
<NEWEST VERSION>
NIGHTINGALE
1. A 64 year-old client scheduled for surgery with a general anesthetic refuses
to remove a set of dentures prior to leaving the unit for the operating room.
What would be the most appropriate intervention by the nurse? - ANSWER
✔ Ask the client if the preference would be to remove the dentures in the
operating room receiving area
2. The nurse has been teaching adult clients about cardiac risks when they visit
the hypertension clinic. Which form of evaluation would best measure
learning? - ANSWER ✔ Reported behavioral changes
3. The nurse is planning care for an 18 month-old child. Which action should
be included in the child's care? - ANSWER ✔ Encourage the child to feed
himself finger food
4. A partner is concerned because the client frequently daydreams about
moving to Arizona to get away from the pollution and crowding in southern
California. The nurse explains that - ANSWER ✔ Such fantasies can
gratify unconscious wishes or prepare for anticipated future events
5. An appropriate goal for a client with anxiety would be to - ANSWER ✔
Learn self-help techniques
6. While the nurse is administering medications to a client, the client states "I
do not want to take that medicine today." Which of the following responses
, by the nurse would be best? - ANSWER ✔ "Is there a reason why you
don't want to take your medicine?"
7. While caring for a client, the nurse notes a pulsating mass in the client's
periumbilical area. Which of the following assessments is appropriate for the
nurse to perform? - ANSWER ✔ Auscultate the mass
8. A client is admitted to the hospital with a history of confusion. The client
has difficulty remembering recent events and becomes disoriented when
away from home. Which statement would provide the best reality orientation
for this client? - ANSWER ✔ "Good morning. You're in the hospital. I am
your nurse Elaine Jones."
9. The nurse is teaching the parents of a 3 month-old infant about nutrition.
What is the main source of fluids for an infant until about 12 months of age?
- ANSWER ✔ Formula or breast milk
10.On admission to the ambulatory surgery unit, the nurse notices the client's
painted finger nails. On reviewing the pre-op orders, the nurse notes that
pulse oximetry has been ordered. Which statement by the nurse is
appropriate? - ANSWER ✔ "In order to measure your oxygen level, please
remove the polish from at least 2 nails."
11.The nurse is removing a fecal impaction on a 75 year-old client. It is most
important that the nurse remember that - ANSWER ✔ cardiac
dysrhythmias can result during the process
12.When taking the client's blood pressure (BP), the nurse cannot hear the
sounds through the stethoscope. Which action should the nurse take first? -
ANSWER ✔ take the BP again in 2 minutes in the same arm
13.The client with multiple sclerosis has an order to change the nasogastric
tube. To promote safety when removing the tube, the nurse should -
ANSWER ✔ ask the client to hold a breath
14.A client is being discharged home today, and will be taking K-dur 20mEq
per day by mouth. The nurse should reinforce that potassium levels will be
decreased by - ANSWER ✔ frequent daily snacks of black licorice
,15.A client has just returned from the Post-Anesthesia Care Unit (PACU) to the
surgical unit after a cholecystectomy. When initial vital signs are taken the
nurse notes a temperature of 94.8 degrees Fahrenheit. Which first nursing
action is appropriate? - ANSWER ✔ Apply a warm blanket and check the
temperature in 10 minutes
16.The client with amyotrophic lateral sclerosis is scheduled for 160 ml of
enteral feeding as a bolus every 4 hours. Before flushing with water the
nurse aspirates the feeding tube contents and gets back 180 ml of feeding.
What is the next appropriate nursing action? - ANSWER ✔ Hold the next
feeding
17.The nurse is inserting a Foley catheter into the bladder of a female adult
client. The nurse slips the catheter into an opening for four-5 inches and no
urine is obtained. The most probable reason for this is that - ANSWER ✔
the catheter is in the vagina
18.After the death of a client, the family approaches the nurse and requests that
a family member be allowed to perform a ritual bath on the deceased prior to
moving the body. The appropriate response by the nurse is - ANSWER ✔
Is there anything you need from me to perform the ritual bath?
19.The nurse detects blood-tinged fluid leaking from the nose and ears of a
head trauma client. What is the appropriate nursing action? - ANSWER ✔
Apply bulky, loose dressing to nose and ears
20.A nurse manager considers changing staff assignments from 8 hour shifts to
12 hour shifts. A staff-selected planning committee has approved the
change, yet the staff are complaining. As a change agent, the nurse manager
should first - ANSWER ✔ Explore how the planning committee evaluated
barriers to the plan
21.The nurse is caring for a depressed client with a new prescription for an
SSRI antidepressant. In reviewing the admission history and physical, which
of the following should prompt questions about the safety of this
medication? - ANSWER ✔ Prescribed use of an MAO inhibitor
, 22.In preparing medications for a client with a gastrostomy tube, the nurse
should contact the health care provider before administering which of the
following drugs through the tube? - ANSWER ✔ Cardizem SR tablet
(diltiazem)
23.The most common reason for an Apgar score of 8 and 9 in a newborn is an
abnormality of what parameter? - ANSWER ✔ Color
24.A nurse has asked a second staff nurse to sign for a wasted narcotic, which
was not witnessed by another person. This seems to be a recent pattern of
behavior. What is the appropriate initial action? - ANSWER ✔ Report this
immediately to the nurse manager
25.To obtain data for the nursing assessment, the nurse should: - ANSWER ✔
Elicit clients' description of their experiences, thoughts and behaviors
26.The nurse will administer liquid medicine to a 9 month-old child. Which of
the following methods is appropriate? - ANSWER ✔ Administer the
medication with a syringe next to the tongue
27.A client calls the nurse with a complaint of sudden deep throbbing leg pain.
What is the appropriate first action by the nurse? - ANSWER ✔ Maintain
the client on bed rest
28.The nurse is teaching diet restrictions for a client with Addison's disease.
The client would indicate an understanding of the diet by stating - ANSWER
✔ "I will increase sodium and fluids and restrict potassium."
29.A client refuses to take the medication prescribed because the client prefers
to take self-prescribed herbal preparations. What is the initial action the
nurse should take? - ANSWER ✔ Talk with the client to find out about the
preferred herbal preparation
30.During the initial physical assessment on a client who is a Vietnamese
immigrant, the nurse notices small, circular, ecchymotic areas on the client's
knees. The best action for the nurse to take is to - ANSWER ✔ Ask the
client for more information about the nature of the bruises
