BSN 366 HESI RN Exit Exam V3 (2025/2026) Ultimate Test Bank:
500+ Practice Questions with 100% Verified Answers and Detailed
Clinical Rationales for Prioritization, Pharmacology, Medical-
Surgical, Maternity, and Mental Health Nursing.
How to Use This Test Bank
Focus on understanding the rationales rather than memorizing answers. The exam tests clinical judgment,
prioritization (ABCs, Maslow), and application of nursing knowledge. Pay special attention to Select All That
Apply (SATA) and prioritization questions, as these are heavily featured.
Medical-Surgical Nursing (Questions 1-120)
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the
nurse monitor most closely?
• Answer: A) Potassium 3.0 mEq/L
• Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (potassium
below 3.5 mEq/L) is the most common and dangerous electrolyte imbalance associated with loop
diuretics because it can precipitate cardiac dysrhythmias.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest
pain. What is the nurse's priority action?
• Answer: C) Call the rapid response team
• Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency requiring immediate
intervention.
, 3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is
most important for the nurse to include in discharge teaching?
Answer: B) Avoid consuming alcohol while taking this medication
•
• Rationale: Metformin increases the risk of lactic acidosis, a rare but potentially fatal condition, and
alcohol consumption further increases this risk.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via
nasal cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per
minute. What is the nurse's priority action?
• Answer: B) Decrease the oxygen flow rate
• Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure (CO2
narcosis). Clients with COPD may rely on hypoxic drive to maintain respirations.
5. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor
for which adverse effect?
Answer: B) Bleeding
•
• Rationale: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of
antithrombin III. The primary adverse effect is bleeding.
6. A client who has been taking corticosteroids for 2 months for treatment of COPD has a new
prescription to discontinue the medication. Which instruction should the nurse provide?
Answer: C) The dose must be tapered slowly over 1-2 weeks
•
• Rationale: Corticosteroid therapy suppresses the HPA axis, and abrupt discontinuation can cause
adrenal crisis, a life-threatening condition.
7. A client with cirrhosis develops ascites. Which dietary modification is most appropriate?
• Answer: B) Restrict sodium intake to 2 g per day
• Rationale: Ascites in cirrhosis is primarily caused by portal hypertension and sodium retention.
Sodium restriction is the first-line dietary intervention.
8. A client receiving chemotherapy develops stomatitis. Which intervention should the nurse include
in the plan of care?
• Answer: C) Recommend a soft-bristled toothbrush for oral hygiene
• Rationale: A soft-bristled toothbrush minimizes trauma to the inflamed oral mucosa.
, 9. A male client with stomach cancer returns to the unit following a total gastrectomy. One hour
after admission, the nurse notes 300 mL of blood in the suction canister, HR 155, BP 78/48. Which
action should the nurse implement first?
Answer: D) Increase the infusion rate of Lactated Ringer's solution
•
• Rationale: These symptoms indicate hypovolemic shock. The priority is to restore intravascular
volume.
10. An older client is admitted with fluid volume deficit and dehydration. Which assessment finding
is the best indicator of hydration that the nurse should report to the healthcare provider?
Answer: D) Skin tenting occurs when the client's forearm is pinched
•
• Rationale: Persistent skin tenting is a direct sign of poor tissue turgor and significant dehydration.
11. A client who received hemodialysis yesterday is experiencing BP 200/100, HR 110, RR 36, SOB,
and SpO2 89% on room air. Which action should the nurse take first?
Answer: C) Begin supplemental oxygen
•
• Rationale: An SpO2 of 89% with tachypnea and dyspnea indicates acute respiratory distress; airway
and breathing are the priority.
12. A client with Addison's crisis is admitted. Which findings require immediate action? (Select all
that apply.)
• Answer: A) Headache and tremors, B) Irregular heart rate, E) Pallor and diaphoresis
• Rationale: Addison's crisis can cause severe hypoglycemia (headache/tremors), hyperkalemia
(irregular HR), and shock (pallor/diaphoresis).
13. After an in-service about electronic health record (EHR) security and safeguarding client
information, the nurse observes a colleague going home with printed copies of client information.
Which action should the nurse take?
• Answer: A) File a detailed incident report with the specific hiring facility
• Rationale: Any HIPAA/privacy breach necessitates formal documentation.
14. The nurse is evaluating a tertiary prevention program for clients with cardiovascular disease
(CVD). Which outcome indicates the program is effective?
Answer: C) Clients who incurred disease complications promptly received rehabilitation
•
• Rationale: Tertiary prevention addresses complications in those already ill; rehab after complications
is a hallmark of effective tertiary measures.
, 15. Which biological practices are federally regulated for healthcare workers? (Select all that apply.)
• Answer: 1) Standard precautions, 2) N-95 tuberculosis standard, 3) Blood-borne pathogen standard
• Rationale: These are delineated by OSHA as basic standards for healthcare workers.
16. The nurse is caring for a client with a nursing problem of "Infection, risk for, related to
inadequate primary defenses as evidenced by surgical incision and IV access." What nursing
intervention should the nurse implement?
• Answer: Assess and document skin condition around the incision and IV site at each shift
• Rationale: Early identification of infection leads to prompt treatment and decreased nosocomial
transmission.
17. A 60-year-old homeless man with cough, fever, and night sweats has a 10 mm induration after
PPD skin test. Which action should the nurse implement?
• Answer: A) Refer for further diagnostic evaluation
• Rationale: The PPD result indicates exposure or latent TB, but further evaluation (chest x-ray, sputum
culture) is needed to rule out active disease.
18. A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch).
What information should the nurse provide?
• Answer: D) Stool is eventually expelled through the rectum
• Rationale: A J pouch preserves the rectal sphincter muscle, so passage of stool through the rectum is
the eventual result.
19. Which contextual factors are considered external environmental influences in the framework for
occupational health programs and services? (Select all that apply.)
• Answer: 1) Economics, 3) Technology, 6) Legislation/regulation
• Rationale: Economics, technology, and legislation/regulation are external environmental influences
that affect workforce productivity and safety.
20. The nurse is analyzing the waveforms of a client's electrocardiogram. What finding indicates a
disturbance in electrical conduction in the ventricles?
• Answer: D) QRS interval of 0.14 second
• Rationale: The normal QRS duration is 0.04 to 0.12 second; a prolonged QRS indicates an electrical
anomaly in the ventricles.
500+ Practice Questions with 100% Verified Answers and Detailed
Clinical Rationales for Prioritization, Pharmacology, Medical-
Surgical, Maternity, and Mental Health Nursing.
How to Use This Test Bank
Focus on understanding the rationales rather than memorizing answers. The exam tests clinical judgment,
prioritization (ABCs, Maslow), and application of nursing knowledge. Pay special attention to Select All That
Apply (SATA) and prioritization questions, as these are heavily featured.
Medical-Surgical Nursing (Questions 1-120)
1. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should the
nurse monitor most closely?
• Answer: A) Potassium 3.0 mEq/L
• Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (potassium
below 3.5 mEq/L) is the most common and dangerous electrolyte imbalance associated with loop
diuretics because it can precipitate cardiac dysrhythmias.
2. A client who had a total hip replacement 2 days ago reports sudden shortness of breath and chest
pain. What is the nurse's priority action?
• Answer: C) Call the rapid response team
• Rationale: Sudden shortness of breath and chest pain in a post-operative orthopedic patient are
classic signs of a pulmonary embolism (PE), which is a life-threatening emergency requiring immediate
intervention.
, 3. A client with type 2 diabetes mellitus is started on metformin (Glucophage). Which instruction is
most important for the nurse to include in discharge teaching?
Answer: B) Avoid consuming alcohol while taking this medication
•
• Rationale: Metformin increases the risk of lactic acidosis, a rare but potentially fatal condition, and
alcohol consumption further increases this risk.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 4 L/min via
nasal cannula. The nurse notes the client appears drowsy and has a respiratory rate of 8 breaths per
minute. What is the nurse's priority action?
• Answer: B) Decrease the oxygen flow rate
• Rationale: The client is exhibiting signs of oxygen-induced hypercapnic respiratory failure (CO2
narcosis). Clients with COPD may rely on hypoxic drive to maintain respirations.
5. A client with a deep vein thrombosis (DVT) is receiving heparin therapy. The nurse should monitor
for which adverse effect?
Answer: B) Bleeding
•
• Rationale: Heparin is an anticoagulant that prevents clot formation by enhancing the activity of
antithrombin III. The primary adverse effect is bleeding.
6. A client who has been taking corticosteroids for 2 months for treatment of COPD has a new
prescription to discontinue the medication. Which instruction should the nurse provide?
Answer: C) The dose must be tapered slowly over 1-2 weeks
•
• Rationale: Corticosteroid therapy suppresses the HPA axis, and abrupt discontinuation can cause
adrenal crisis, a life-threatening condition.
7. A client with cirrhosis develops ascites. Which dietary modification is most appropriate?
• Answer: B) Restrict sodium intake to 2 g per day
• Rationale: Ascites in cirrhosis is primarily caused by portal hypertension and sodium retention.
Sodium restriction is the first-line dietary intervention.
8. A client receiving chemotherapy develops stomatitis. Which intervention should the nurse include
in the plan of care?
• Answer: C) Recommend a soft-bristled toothbrush for oral hygiene
• Rationale: A soft-bristled toothbrush minimizes trauma to the inflamed oral mucosa.
, 9. A male client with stomach cancer returns to the unit following a total gastrectomy. One hour
after admission, the nurse notes 300 mL of blood in the suction canister, HR 155, BP 78/48. Which
action should the nurse implement first?
Answer: D) Increase the infusion rate of Lactated Ringer's solution
•
• Rationale: These symptoms indicate hypovolemic shock. The priority is to restore intravascular
volume.
10. An older client is admitted with fluid volume deficit and dehydration. Which assessment finding
is the best indicator of hydration that the nurse should report to the healthcare provider?
Answer: D) Skin tenting occurs when the client's forearm is pinched
•
• Rationale: Persistent skin tenting is a direct sign of poor tissue turgor and significant dehydration.
11. A client who received hemodialysis yesterday is experiencing BP 200/100, HR 110, RR 36, SOB,
and SpO2 89% on room air. Which action should the nurse take first?
Answer: C) Begin supplemental oxygen
•
• Rationale: An SpO2 of 89% with tachypnea and dyspnea indicates acute respiratory distress; airway
and breathing are the priority.
12. A client with Addison's crisis is admitted. Which findings require immediate action? (Select all
that apply.)
• Answer: A) Headache and tremors, B) Irregular heart rate, E) Pallor and diaphoresis
• Rationale: Addison's crisis can cause severe hypoglycemia (headache/tremors), hyperkalemia
(irregular HR), and shock (pallor/diaphoresis).
13. After an in-service about electronic health record (EHR) security and safeguarding client
information, the nurse observes a colleague going home with printed copies of client information.
Which action should the nurse take?
• Answer: A) File a detailed incident report with the specific hiring facility
• Rationale: Any HIPAA/privacy breach necessitates formal documentation.
14. The nurse is evaluating a tertiary prevention program for clients with cardiovascular disease
(CVD). Which outcome indicates the program is effective?
Answer: C) Clients who incurred disease complications promptly received rehabilitation
•
• Rationale: Tertiary prevention addresses complications in those already ill; rehab after complications
is a hallmark of effective tertiary measures.
, 15. Which biological practices are federally regulated for healthcare workers? (Select all that apply.)
• Answer: 1) Standard precautions, 2) N-95 tuberculosis standard, 3) Blood-borne pathogen standard
• Rationale: These are delineated by OSHA as basic standards for healthcare workers.
16. The nurse is caring for a client with a nursing problem of "Infection, risk for, related to
inadequate primary defenses as evidenced by surgical incision and IV access." What nursing
intervention should the nurse implement?
• Answer: Assess and document skin condition around the incision and IV site at each shift
• Rationale: Early identification of infection leads to prompt treatment and decreased nosocomial
transmission.
17. A 60-year-old homeless man with cough, fever, and night sweats has a 10 mm induration after
PPD skin test. Which action should the nurse implement?
• Answer: A) Refer for further diagnostic evaluation
• Rationale: The PPD result indicates exposure or latent TB, but further evaluation (chest x-ray, sputum
culture) is needed to rule out active disease.
18. A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch).
What information should the nurse provide?
• Answer: D) Stool is eventually expelled through the rectum
• Rationale: A J pouch preserves the rectal sphincter muscle, so passage of stool through the rectum is
the eventual result.
19. Which contextual factors are considered external environmental influences in the framework for
occupational health programs and services? (Select all that apply.)
• Answer: 1) Economics, 3) Technology, 6) Legislation/regulation
• Rationale: Economics, technology, and legislation/regulation are external environmental influences
that affect workforce productivity and safety.
20. The nurse is analyzing the waveforms of a client's electrocardiogram. What finding indicates a
disturbance in electrical conduction in the ventricles?
• Answer: D) QRS interval of 0.14 second
• Rationale: The normal QRS duration is 0.04 to 0.12 second; a prolonged QRS indicates an electrical
anomaly in the ventricles.
