BSN 366 EXIT HESI STUDY NOTES
NIGHTINGALE COLLEGE EXAM SCRIPT
2026 FULL SCENARIOS WITH TESTED
ANSWERS GRADED A+
⩥ . An older client is being admitted to a rehabilitation unit from a
medical-surgical unit following a left hip replacement. When reviewing
the client's prescribed medications, which intervention should the nurse
implement FIRST?
a. reconcile prescribed medication dosages with published recommended
dosage ranges
b. compare admission prescriptions with the list of medications
previously taken by the client
c. determine which medications may be given in generic form rather
than brand name only
d. provide client teaching regarding the desired effects of the client's
admission prescriptions.
Answer: b. compare admission prescriptions with the list of medications
previously taken by the client
⩥ A new nurse preparing to irrigate an intravenous cath is attaching a
24-gauge action should the charge nurse implement
A. Suggest the nurse use a 20-gauge
B. Direct the nurse to change IV tubing
,C. Instruct the nurse to remove the needle
D. Prompt the nurse to apply pressure to the site.
Answer: C-Instruct the nurse to remove the needle
⩥ The nurse observes an unlicensed assistive personnel (UAP) applying
an alcohol-based hand rub while leaving a client's room after taking vital
signs. What action should the nurse take?
A. Instruct the UAP to return to the client's room to perform
handwashing
B. Supervise the UAP in the next client's room to evaluate hand hygiene
C. Remind the UAP to continue rubbing the hands together until they are
dry
D. Advice the UAP to wear gloves when obtaining vital signs for all
clients.
Answer: C. Remind the UAP to continue rubbing the hands together
until they are dry
⩥ A client is undergoing peritoneal dialysis. After several fluid
exchanges, the abdomen is distended, blood pressure is elevated, and
6500 mL were infused while 5,500 mL were drained. In response to this
finding, what action should the nurse take?
A. Instruct the client to cough
B. turn the client from side to side
C. irrigate the drainage tube with normal Saline
,D.lower the head of the bed.
Answer: B.turn the client from side to side
⩥ The nurse is developing the plan of care for a client with pneumonia
and includes the nursing problem of Ineffective airway clearance related
to thick pulmonary secretions. Which intervention is most important for
the nurse to include in the client's plan of care?
A. Provide frequent rest periods.
B. Administer at minute per nasal cannula.
C. Increase fluid intake to 3,000 mL/ daily.
D. Maintain the client in a semi-Fowler's position..
Answer: C. Increase fluid intake to 3,000 mL/ daily.
⩥ 10. The adult child of an older adult client who has Parkinson's
disease, calls the clinic and reports that the client has been confused for
the past week. Which action Should the nurse take? Select all that apply.
A.
Determine if the mother has recently experienced a fall.
B.
Review the client's current food and medication allergies.
C.
Encourage increased intake of high-protein foods.
D.
, Instruct the daughter to check her mother's temperature.
E.
Ask if the mother is experiencing any pain with urination..
Answer: A.
Determine if the mother has recently experienced a fall.
D.
Instruct the daughter to check her mother's temperature.
E.
Ask if the mother is experiencing any pain with urination.
⩥ The psychiatric nurse is caring for clients on an adolescent unit.
Which client requires the nurse's immediate attention?
A.
16 year old client diagnosed with major depression who refuses to
participate in group
B.
a 17 year old client diagnosed with bipolar disorder who is pacing
around the lobby
C.
an 18 year old client with antisocial behaviour who is being yelled at by
the other clients
D.
NIGHTINGALE COLLEGE EXAM SCRIPT
2026 FULL SCENARIOS WITH TESTED
ANSWERS GRADED A+
⩥ . An older client is being admitted to a rehabilitation unit from a
medical-surgical unit following a left hip replacement. When reviewing
the client's prescribed medications, which intervention should the nurse
implement FIRST?
a. reconcile prescribed medication dosages with published recommended
dosage ranges
b. compare admission prescriptions with the list of medications
previously taken by the client
c. determine which medications may be given in generic form rather
than brand name only
d. provide client teaching regarding the desired effects of the client's
admission prescriptions.
Answer: b. compare admission prescriptions with the list of medications
previously taken by the client
⩥ A new nurse preparing to irrigate an intravenous cath is attaching a
24-gauge action should the charge nurse implement
A. Suggest the nurse use a 20-gauge
B. Direct the nurse to change IV tubing
,C. Instruct the nurse to remove the needle
D. Prompt the nurse to apply pressure to the site.
Answer: C-Instruct the nurse to remove the needle
⩥ The nurse observes an unlicensed assistive personnel (UAP) applying
an alcohol-based hand rub while leaving a client's room after taking vital
signs. What action should the nurse take?
A. Instruct the UAP to return to the client's room to perform
handwashing
B. Supervise the UAP in the next client's room to evaluate hand hygiene
C. Remind the UAP to continue rubbing the hands together until they are
dry
D. Advice the UAP to wear gloves when obtaining vital signs for all
clients.
Answer: C. Remind the UAP to continue rubbing the hands together
until they are dry
⩥ A client is undergoing peritoneal dialysis. After several fluid
exchanges, the abdomen is distended, blood pressure is elevated, and
6500 mL were infused while 5,500 mL were drained. In response to this
finding, what action should the nurse take?
A. Instruct the client to cough
B. turn the client from side to side
C. irrigate the drainage tube with normal Saline
,D.lower the head of the bed.
Answer: B.turn the client from side to side
⩥ The nurse is developing the plan of care for a client with pneumonia
and includes the nursing problem of Ineffective airway clearance related
to thick pulmonary secretions. Which intervention is most important for
the nurse to include in the client's plan of care?
A. Provide frequent rest periods.
B. Administer at minute per nasal cannula.
C. Increase fluid intake to 3,000 mL/ daily.
D. Maintain the client in a semi-Fowler's position..
Answer: C. Increase fluid intake to 3,000 mL/ daily.
⩥ 10. The adult child of an older adult client who has Parkinson's
disease, calls the clinic and reports that the client has been confused for
the past week. Which action Should the nurse take? Select all that apply.
A.
Determine if the mother has recently experienced a fall.
B.
Review the client's current food and medication allergies.
C.
Encourage increased intake of high-protein foods.
D.
, Instruct the daughter to check her mother's temperature.
E.
Ask if the mother is experiencing any pain with urination..
Answer: A.
Determine if the mother has recently experienced a fall.
D.
Instruct the daughter to check her mother's temperature.
E.
Ask if the mother is experiencing any pain with urination.
⩥ The psychiatric nurse is caring for clients on an adolescent unit.
Which client requires the nurse's immediate attention?
A.
16 year old client diagnosed with major depression who refuses to
participate in group
B.
a 17 year old client diagnosed with bipolar disorder who is pacing
around the lobby
C.
an 18 year old client with antisocial behaviour who is being yelled at by
the other clients
D.
