ESTUDYR
BSN 246 HESI UPDATED EXAM WITH MOST TESTED
QUESTIONS AND ANSWERS | GRADED A+ | ASSURED SUCCESS
WITH DETAILED RATIONALES
Which action can be assigned to the unlicensed assistive personnel (UAP)?
A. Administer oral medications
B. Insert a urinary catheter
C. Measure the client's urinary output ✔
D. Evaluate pain control interventions
Rationale: Measuring and recording intake/output is a delegated, monitoring task appropriate
for UAP.
When a client reports pain, the nurse's best initial response is:
A. “Take this pain med and rest.”
B. “How bad is it on a scale?”
C. “Describe the location and type of pain you are having.” ✔
D. “You must learn to tolerate it.”
Rationale: Ask a focused, open question to assess pain characteristics before interventions.
Which assessment data support giving pain medication first? (Select best set)
A. Pain 2/10; HR 78; BP 110/70
B. Pain 3/10; HR 86; BP 118/72
C. Pain 6/10; HR 102; BP 132/76 ✔
D. Pain 1/10; HR 60; BP 98/64
Rationale: Moderate pain with tachycardia and elevated BP supports analgesia as priority.
Which action should the nurse implement first for a patient in pain?
A. Reassess in 30 minutes
B. Offer water
C. Administer an analgesic ✔
D. Change position only
Rationale: Treating pain promptly is priority when assessment indicates moderate–severe pain.
For a patient on multiple immunosuppressants, important plan items include: (Select all that
apply)
A. Allow fresh flowers at bedside
B. Instruct client to wear a mask in hallways ✔
C. Instruct visitors that fresh flowers should not be taken into the room ✔
,ESTUDYR
D. Ignore drug level monitoring
E. Monitor immunosuppression drug levels regularly ✔
Rationale: Reduce infection risk and monitor drug levels to avoid toxicity or under-
immunosuppression.
Which intervention should the nurse ensure is included immediately postoperatively?
A. Assess incision every shift
B. Encourage IS daily
C. Monitor NG tube q4h
D. Monitor urinary output hourly using a urimeter ✔
Rationale: Hourly urine output is a key indicator of perfusion and early postop renal function.
Priority nursing assessment during first 24-hr postoperative period:
A. Neuro check
B. Wound inspection
C. Vital signs ✔
D. Diet tolerance
Rationale: Vital signs detect hemodynamic instability and complications early.
Teaching about fluid management between dialysis: the best instruction is:
A. Drink as much as possible
B. Skip dialysis if feeling well
C. Limit fluids between treatments to minimize removal requirements ✔
D. Avoid sodium restrictions
Rationale: Fluid restriction prevents excessive interdialytic weight gain and complications.
Expected diet teaching outcome for a dialysis patient:
A. Client will eat canned soups daily
B. Client will increase processed snacks
C. Client will avoid canned and processed foods ✔
D. Client will drink 3 L fluid/day
Rationale: Canned/processed foods are high in sodium and phosphorus, harmful in CKD.
Which dialysis graft assessment findings require immediate HCP notification? (Select all that
apply)
A. Pink incision drainage
B. Yellow, purulent drainage from graft incision ✔
C. Absence of a thrill over the graft site ✔
D. Thrill present and loud bruit
,ESTUDYR
E. Capillary refill >10 seconds in hand with graft ✔
Rationale: Infection, loss of thrill, and poor perfusion are urgent access complications.
Which plan items should be included for a dual-lumen catheter? (Select all that apply)
A. Instruct labs to draw from dual-lumen (wrong)
B. Perform sterile dressing changes at catheter site ✔
C. Empty graft tubing drainage regularly (not applicable)
D. Rotate IV insertion sites above/below graft (not relevant)
E. Assess distal pulses/circulation in the arm with access ✔
Rationale: Sterile site care prevents catheter infection; distal perfusion must be monitored.
Documentation that best describes a functioning AV graft:
A. No bruit noted
B. Weak pulse over graft
C. Thrill present and palpated ✔
D. Incision red and warm
Rationale: Thrill is expected; absence suggests thrombosis or occlusion.
Best explanation of palliative care: (Select all that apply)
A. Cures life-limiting illness
B. Provides relief from symptoms including pain ✔
C. Supports holistic care and improves quality of life ✔
D. Only for last 24 hours of life
Rationale: Palliative care focuses on symptom relief and quality of life at any stage of serious
illness.
What complication is most concerning with peritoneal dialysis?
A. Pulmonary embolism
B. Abdominal infection / peritonitis ✔
C. Myocardial infarction
D. Cerebral bleed
Rationale: Peritonitis is a common and serious PD complication.
Statements indicating need for further education about hemodialysis: (Select all that apply)
A. “Hemodialysis will restore kidney function to normal.” ✔
B. Hemodialysis requires vascular access
C. “Bowel or bladder perforation may occur with hemodialysis catheter placement.” ✔
D. Anticoagulation may be used during dialysis
Rationale: Hemodialysis replaces renal function but does not cure; catheter placement rarely
causes bowel/bladder perforation—this is misleading.
, ESTUDYR
After an HCP phone order conflict, the nurse should: (Select all that apply)
A. Ignore phone call
B. Document both phone calls and HCP prescriptions ✔
C. Notify the charge nurse and activate chain of command ✔
D. Hold potassium chloride (if ordered to hold) ✔
Rationale: Clear documentation, escalation, and medication hold are appropriate when orders
conflict or safety is at risk.
When a critical lab (high K+) arrives, the nurse's top intervention:
A. Give oral meds
B. Schedule later labs
C. Hold the dose of potassium chloride and contact HCP to report serum K+ ✔
D. Feed the patient high-K foods
Rationale: Holding K+ and notifying HCP prevents hyperkalemia complications.
A supportive nursing intervention for a newly diagnosed patient is:
A. Avoid discussing diagnosis
B. Minimize patient questions
C. Encourage client to ask questions and discuss fears about diagnosis ✔
D. Provide only written information
Rationale: Patient-centered communication and emotional support aid adjustment and
adherence.
Which assessment indicates epoetin alfa desired outcome?
A. Hemoglobin 7.8 g/dL
B. Pale conjunctiva
C. Conjunctival sac returns to a reddish-pink color ✔
D. Persistent fatigue
Rationale: Improved mucous membrane color indicates improved oxygenation/hemoglobin
status.
Which assessment measures losartan effectiveness?
A. Serum potassium only
B. Urine output
C. Blood pressure ✔
D. Blood glucose
Rationale: ARB therapy is titrated to BP control.
Desired outcome of calcium acetate (phosphate binder) is shown by:
A. Serum calcium 12 mg/dL
BSN 246 HESI UPDATED EXAM WITH MOST TESTED
QUESTIONS AND ANSWERS | GRADED A+ | ASSURED SUCCESS
WITH DETAILED RATIONALES
Which action can be assigned to the unlicensed assistive personnel (UAP)?
A. Administer oral medications
B. Insert a urinary catheter
C. Measure the client's urinary output ✔
D. Evaluate pain control interventions
Rationale: Measuring and recording intake/output is a delegated, monitoring task appropriate
for UAP.
When a client reports pain, the nurse's best initial response is:
A. “Take this pain med and rest.”
B. “How bad is it on a scale?”
C. “Describe the location and type of pain you are having.” ✔
D. “You must learn to tolerate it.”
Rationale: Ask a focused, open question to assess pain characteristics before interventions.
Which assessment data support giving pain medication first? (Select best set)
A. Pain 2/10; HR 78; BP 110/70
B. Pain 3/10; HR 86; BP 118/72
C. Pain 6/10; HR 102; BP 132/76 ✔
D. Pain 1/10; HR 60; BP 98/64
Rationale: Moderate pain with tachycardia and elevated BP supports analgesia as priority.
Which action should the nurse implement first for a patient in pain?
A. Reassess in 30 minutes
B. Offer water
C. Administer an analgesic ✔
D. Change position only
Rationale: Treating pain promptly is priority when assessment indicates moderate–severe pain.
For a patient on multiple immunosuppressants, important plan items include: (Select all that
apply)
A. Allow fresh flowers at bedside
B. Instruct client to wear a mask in hallways ✔
C. Instruct visitors that fresh flowers should not be taken into the room ✔
,ESTUDYR
D. Ignore drug level monitoring
E. Monitor immunosuppression drug levels regularly ✔
Rationale: Reduce infection risk and monitor drug levels to avoid toxicity or under-
immunosuppression.
Which intervention should the nurse ensure is included immediately postoperatively?
A. Assess incision every shift
B. Encourage IS daily
C. Monitor NG tube q4h
D. Monitor urinary output hourly using a urimeter ✔
Rationale: Hourly urine output is a key indicator of perfusion and early postop renal function.
Priority nursing assessment during first 24-hr postoperative period:
A. Neuro check
B. Wound inspection
C. Vital signs ✔
D. Diet tolerance
Rationale: Vital signs detect hemodynamic instability and complications early.
Teaching about fluid management between dialysis: the best instruction is:
A. Drink as much as possible
B. Skip dialysis if feeling well
C. Limit fluids between treatments to minimize removal requirements ✔
D. Avoid sodium restrictions
Rationale: Fluid restriction prevents excessive interdialytic weight gain and complications.
Expected diet teaching outcome for a dialysis patient:
A. Client will eat canned soups daily
B. Client will increase processed snacks
C. Client will avoid canned and processed foods ✔
D. Client will drink 3 L fluid/day
Rationale: Canned/processed foods are high in sodium and phosphorus, harmful in CKD.
Which dialysis graft assessment findings require immediate HCP notification? (Select all that
apply)
A. Pink incision drainage
B. Yellow, purulent drainage from graft incision ✔
C. Absence of a thrill over the graft site ✔
D. Thrill present and loud bruit
,ESTUDYR
E. Capillary refill >10 seconds in hand with graft ✔
Rationale: Infection, loss of thrill, and poor perfusion are urgent access complications.
Which plan items should be included for a dual-lumen catheter? (Select all that apply)
A. Instruct labs to draw from dual-lumen (wrong)
B. Perform sterile dressing changes at catheter site ✔
C. Empty graft tubing drainage regularly (not applicable)
D. Rotate IV insertion sites above/below graft (not relevant)
E. Assess distal pulses/circulation in the arm with access ✔
Rationale: Sterile site care prevents catheter infection; distal perfusion must be monitored.
Documentation that best describes a functioning AV graft:
A. No bruit noted
B. Weak pulse over graft
C. Thrill present and palpated ✔
D. Incision red and warm
Rationale: Thrill is expected; absence suggests thrombosis or occlusion.
Best explanation of palliative care: (Select all that apply)
A. Cures life-limiting illness
B. Provides relief from symptoms including pain ✔
C. Supports holistic care and improves quality of life ✔
D. Only for last 24 hours of life
Rationale: Palliative care focuses on symptom relief and quality of life at any stage of serious
illness.
What complication is most concerning with peritoneal dialysis?
A. Pulmonary embolism
B. Abdominal infection / peritonitis ✔
C. Myocardial infarction
D. Cerebral bleed
Rationale: Peritonitis is a common and serious PD complication.
Statements indicating need for further education about hemodialysis: (Select all that apply)
A. “Hemodialysis will restore kidney function to normal.” ✔
B. Hemodialysis requires vascular access
C. “Bowel or bladder perforation may occur with hemodialysis catheter placement.” ✔
D. Anticoagulation may be used during dialysis
Rationale: Hemodialysis replaces renal function but does not cure; catheter placement rarely
causes bowel/bladder perforation—this is misleading.
, ESTUDYR
After an HCP phone order conflict, the nurse should: (Select all that apply)
A. Ignore phone call
B. Document both phone calls and HCP prescriptions ✔
C. Notify the charge nurse and activate chain of command ✔
D. Hold potassium chloride (if ordered to hold) ✔
Rationale: Clear documentation, escalation, and medication hold are appropriate when orders
conflict or safety is at risk.
When a critical lab (high K+) arrives, the nurse's top intervention:
A. Give oral meds
B. Schedule later labs
C. Hold the dose of potassium chloride and contact HCP to report serum K+ ✔
D. Feed the patient high-K foods
Rationale: Holding K+ and notifying HCP prevents hyperkalemia complications.
A supportive nursing intervention for a newly diagnosed patient is:
A. Avoid discussing diagnosis
B. Minimize patient questions
C. Encourage client to ask questions and discuss fears about diagnosis ✔
D. Provide only written information
Rationale: Patient-centered communication and emotional support aid adjustment and
adherence.
Which assessment indicates epoetin alfa desired outcome?
A. Hemoglobin 7.8 g/dL
B. Pale conjunctiva
C. Conjunctival sac returns to a reddish-pink color ✔
D. Persistent fatigue
Rationale: Improved mucous membrane color indicates improved oxygenation/hemoglobin
status.
Which assessment measures losartan effectiveness?
A. Serum potassium only
B. Urine output
C. Blood pressure ✔
D. Blood glucose
Rationale: ARB therapy is titrated to BP control.
Desired outcome of calcium acetate (phosphate binder) is shown by:
A. Serum calcium 12 mg/dL
