Nightingale BSN 366 Concepts of Nursing IV HESI Practice
Exam | 2026/2027 Edition | 250 Verified Questions
HESI BSN 366 EAQ Practice Test A Results - Questions and 100% Correct Answers With
Rationales. Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document for Nightingale BSN 366 Concepts of Nursing IV contains
250 verified HESI practice questions with correct answers and detailed rationales. Designed to mirror
the actual HESI exam, it covers key nursing concepts including leadership, community health, and
complex patient care. Each question is accompanied by a rationale explaining the correct answer and
common distractors, ensuring deep understanding. Ideal for students seeking to achieve a high score on
the HESI BSN 366 exam.
Key Features:
Leadership and management in nursing
Community and public health nursing
Complex care across the lifespan
Evidence-based practice and quality improvement
Professional ethics and legal issues
Health promotion and disease prevention
Updates for 2026:
- Updated to reflect 2026-2027 HESI test plan changes
- Incorporated latest NCLEX-style alternate format questions
- Revised rationales to include current evidence-based guidelines
- Added new content on COVID-19 and telehealth nursing
- Enhanced distractor analysis for improved critical thinking
Abstract:
This document presents a rigorous compilation of 250 HESI practice questions for Nightingale BSN 366 Concepts
of Nursing IV, meticulously curated to align with the 2026-2027 academic year and the latest HESI exam blueprint.
Each question is paired with a 100% correct answer and a comprehensive rationale that elucidates the underlying
nursing concepts, evidence-based practices, and clinical reasoning. The rationales also address common
distractors, enabling students to differentiate between correct and incorrect options. The content spans essential
domains such as leadership, community health, complex care, and professional issues, with emphasis on
application and analysis. This resource is designed to facilitate mastery of nursing concepts and optimize exam
performance, serving as a definitive study aid for the HESI BSN 366 exam.
Keywords:
HESI BSN 366, Concepts of Nursing IV, Nightingale College, EAQ Practice Test A, Nursing exam prep, Rationales,
Leadership nursing, Community health
Answer Format:
Each question is followed by the correct answer in bold, then a detailed rationale explaining why the answer is
correct and why the other options are incorrect. Rationales include references to nursing theory, clinical guidelines,
and evidence-based practice. Distractors are analyzed to highlight common misconceptions.
Compliance Checklist:
250 verified questions with 100% correct answers
Detailed rationales for every question
Updated for 2026-2027 HESI test plan
Page 1
, Covers all major content areas of BSN 366
Includes alternate format questions (select all that apply, ordered response, etc.)
Graded A+ by previous students
Content Area Overview:
Content Area Questions Key Topics Weight
Leadership and Management 1-50 Delegation, prioritization, conflict 20%
resolution, quality improvement, ethical
decision-making
Community and Public Health 51-100 Epidemiology, disaster preparedness, 20%
vulnerable populations, health promotion,
screening
Complex Care Across the 101-160 Critical care, oncology, perioperative, 24%
Lifespan palliative, maternal-child, geriatrics
Professional Issues and Ethics 161-190 Legal aspects, nursing scope, advocacy, 12%
cultural competence, informatics
Evidence-Based Practice and 191-220 Research methods, EBP process, quality 12%
Research improvement, statistics, literature review
Health Promotion and Disease 221-250 Primary/secondary/tertiary prevention, 12%
Prevention nutrition, exercise, immunization, lifestyle
modification
Page 2
,Q1. A patient with septic shock is on a norepinephrine infusion at 15 mcg/min. The mean arterial pressure
(MAP) remains 58 mmHg despite fluid resuscitation. The nurse reviews the electronic health record and
notes a central venous pressure (CVP) of 12 mmHg, cardiac index (CI) of 2.0 L/min/m², and systemic
vascular resistance index (SVRI) of 800 dyn-s-cm-m². Which intervention should the nurse anticipate as
most appropriate?
A. Increase norepinephrine to achieve MAP >65 mmHg
B. Administer a dobutamine infusion to increase cardiac output
C. Initiate vasopressin as a second-line vasopressor
D. Administer a 500 mL crystalloid bolus
Correct Answer: B. Administer a dobutamine infusion to increase cardiac output
Rationale: The patient has a low CI (2.0 L/min/m²) despite adequate preload (CVP 12) and afterload (SVRI
low-normal). Dobutamine improves cardiac contractility and output, addressing the low CI. Increasing
norepinephrine would further increase afterload without improving CI. Vasopressin is used when MAP is refractory
to norepinephrine, but here the issue is low CI. A fluid bolus is not indicated with CVP already 12, risking fluid
overload.
Why Wrong:
A - Increasing norepinephrine would elevate afterload, potentially worsening cardiac output in a patient with
already low CI.
C - Vasopressin is typically added when MAP remains low despite high-dose norepinephrine; here, the
primary problem is low CI, not refractory vasodilation.
D - CVP of 12 mmHg suggests adequate preload; additional fluid could cause pulmonary edema without
improving CI.
Reference: Marino, P. L. (2021). The ICU Book, 5th Ed., Ch. 12 & 16; Surviving Sepsis Campaign Guidelines
2021.
Q2. During a code blue, a patient is in pulseless electrical activity (PEA) with a rhythm showing a narrow
QRS complex. The team has performed 2 minutes of CPR and administered 1 mg of epinephrine. The patient
remains pulseless. What is the next priority intervention based on current Advanced Cardiac Life Support
(ACLS) guidelines?
A. Administer amiodarone 300 mg IV push
B. Administer atropine 1 mg IV push
C. Perform endotracheal intubation to secure the airway
D. Identify and treat reversible causes using the H's and T's
Correct Answer: D. Identify and treat reversible causes using the H's and T's
Rationale: In PEA, the priority is to identify and correct reversible causes (e.g., hypoxia, hypovolemia, cardiac
tamponade, tension pneumothorax, etc.) because defibrillation is not indicated and antiarrhythmics like
amiodarone are not recommended. Atropine is no longer recommended for PEA. While airway management is
important, it should not delay the search for reversible causes.
Why Wrong:
A - Amiodarone is indicated for shock-refractory VF/pVT, not for PEA.
B - Atropine is no longer recommended in ACLS for PEA; it was removed from guidelines due to lack of
evidence.
C - Intubation is important but should not delay identification of reversible causes; effective bag-mask
ventilation can be continued.
Reference: American Heart Association. (2020). ACLS Provider Manual, Part 5: PEA Algorithm.
Page 3
, Q3. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation with
settings: tidal volume 6 mL/kg ideal body weight, PEEP 12 cmHO, FiO 0.6. Arterial blood gas shows pH
7.25, PaCO 55 mmHg, PaO 70 mmHg. The nurse is concerned about ventilator-induced lung injury. Which
adjustment should the nurse question if ordered?
A. Increase PEEP to 16 cmHO to improve oxygenation
B. Increase respiratory rate to 24 breaths/min to lower PaCO
C. Increase tidal volume to 8 mL/kg to improve ventilation
D. Administer a neuromuscular blocking agent to reduce oxygen consumption
Correct Answer: C. Increase tidal volume to 8 mL/kg to improve ventilation
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (4-8 mL/kg) to prevent volutrauma. Increasing tidal
volume to 8 mL/kg could worsen lung injury. Permissive hypercapnia (PaCO 55) is tolerated if pH >7.20; increasing
respiratory rate can help correct acidosis but is not the primary concern. Increasing PEEP may improve oxygenation but risks
barotrauma; however, it is a valid strategy. Neuromuscular blockade may be used in severe ARDS.
Why Wrong:
A - Increasing PEEP is an acceptable strategy to improve oxygenation in ARDS, though it requires monitoring for
overdistension.
B - Increasing respiratory rate can help lower PaCO and improve pH, and is consistent with permissive hypercapnia
management.
D - Neuromuscular blockade may be indicated in severe ARDS to improve patient-ventilator synchrony and reduce
oxygen demand.
Reference: The ARDS Network. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for
acute lung injury and the acute respiratory distress syndrome. NEJM, 342(18), 1301-1308.
Q4. A patient with chronic kidney disease stage 4 (eGFR 25 mL/min) is prescribed enoxaparin 1 mg/kg
subcutaneously twice daily for acute coronary syndrome. The nurse reviews the medication and notes the
patient's weight is 80 kg. Which action is most appropriate?
A. Administer the standard dose of 80 mg subcutaneously twice daily
B. Hold the dose and notify the prescriber for dose adjustment due to renal impairment
C. Administer 40 mg subcutaneously once daily as renal dosing
D. Administer 80 mg intravenously as a bolus instead of subcutaneously
Correct Answer: B. Hold the dose and notify the prescriber for dose adjustment due to renal impairment
Rationale: Enoxaparin is primarily renally cleared and accumulates in patients with CrCl <30 mL/min (eGFR 25).
The recommended dose adjustment is 1 mg/kg once daily, not twice daily. The nurse should hold the dose and
consult the prescriber for appropriate adjustment. Administering the full dose twice daily increases bleeding risk.
Renal dosing is 1 mg/kg once daily, not 40 mg. Intravenous administration is not indicated for enoxaparin.
Why Wrong:
A - Standard twice-daily dosing is contraindicated in severe renal impairment due to accumulation and
bleeding risk.
C - While the once-daily regimen is correct, the dose should be weight-based (80 mg) not fixed at 40 mg.
D - Enoxaparin is not given intravenously; it is only for subcutaneous administration.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 36: Anticoagulant and Antiplatelet
Drugs.
Q5. A patient admitted for diabetic ketoacidosis has the following laboratory results: serum glucose 480
mg/dL, potassium 3.2 mEq/L, bicarbonate 12 mEq/L, pH 7.1, anion gap 20. The patient has received 2 liters
of normal saline and an insulin infusion at 0.1 units/kg/hr. The nurse reviews the orders. Which order should
the nurse question?
A. Administer 40 mEq potassium chloride in the next liter of IV fluids
B. Change IV fluids to 5% dextrose in 0.45% normal saline when serum glucose reaches 250 mg/dL
Page 4
Exam | 2026/2027 Edition | 250 Verified Questions
HESI BSN 366 EAQ Practice Test A Results - Questions and 100% Correct Answers With
Rationales. Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document for Nightingale BSN 366 Concepts of Nursing IV contains
250 verified HESI practice questions with correct answers and detailed rationales. Designed to mirror
the actual HESI exam, it covers key nursing concepts including leadership, community health, and
complex patient care. Each question is accompanied by a rationale explaining the correct answer and
common distractors, ensuring deep understanding. Ideal for students seeking to achieve a high score on
the HESI BSN 366 exam.
Key Features:
Leadership and management in nursing
Community and public health nursing
Complex care across the lifespan
Evidence-based practice and quality improvement
Professional ethics and legal issues
Health promotion and disease prevention
Updates for 2026:
- Updated to reflect 2026-2027 HESI test plan changes
- Incorporated latest NCLEX-style alternate format questions
- Revised rationales to include current evidence-based guidelines
- Added new content on COVID-19 and telehealth nursing
- Enhanced distractor analysis for improved critical thinking
Abstract:
This document presents a rigorous compilation of 250 HESI practice questions for Nightingale BSN 366 Concepts
of Nursing IV, meticulously curated to align with the 2026-2027 academic year and the latest HESI exam blueprint.
Each question is paired with a 100% correct answer and a comprehensive rationale that elucidates the underlying
nursing concepts, evidence-based practices, and clinical reasoning. The rationales also address common
distractors, enabling students to differentiate between correct and incorrect options. The content spans essential
domains such as leadership, community health, complex care, and professional issues, with emphasis on
application and analysis. This resource is designed to facilitate mastery of nursing concepts and optimize exam
performance, serving as a definitive study aid for the HESI BSN 366 exam.
Keywords:
HESI BSN 366, Concepts of Nursing IV, Nightingale College, EAQ Practice Test A, Nursing exam prep, Rationales,
Leadership nursing, Community health
Answer Format:
Each question is followed by the correct answer in bold, then a detailed rationale explaining why the answer is
correct and why the other options are incorrect. Rationales include references to nursing theory, clinical guidelines,
and evidence-based practice. Distractors are analyzed to highlight common misconceptions.
Compliance Checklist:
250 verified questions with 100% correct answers
Detailed rationales for every question
Updated for 2026-2027 HESI test plan
Page 1
, Covers all major content areas of BSN 366
Includes alternate format questions (select all that apply, ordered response, etc.)
Graded A+ by previous students
Content Area Overview:
Content Area Questions Key Topics Weight
Leadership and Management 1-50 Delegation, prioritization, conflict 20%
resolution, quality improvement, ethical
decision-making
Community and Public Health 51-100 Epidemiology, disaster preparedness, 20%
vulnerable populations, health promotion,
screening
Complex Care Across the 101-160 Critical care, oncology, perioperative, 24%
Lifespan palliative, maternal-child, geriatrics
Professional Issues and Ethics 161-190 Legal aspects, nursing scope, advocacy, 12%
cultural competence, informatics
Evidence-Based Practice and 191-220 Research methods, EBP process, quality 12%
Research improvement, statistics, literature review
Health Promotion and Disease 221-250 Primary/secondary/tertiary prevention, 12%
Prevention nutrition, exercise, immunization, lifestyle
modification
Page 2
,Q1. A patient with septic shock is on a norepinephrine infusion at 15 mcg/min. The mean arterial pressure
(MAP) remains 58 mmHg despite fluid resuscitation. The nurse reviews the electronic health record and
notes a central venous pressure (CVP) of 12 mmHg, cardiac index (CI) of 2.0 L/min/m², and systemic
vascular resistance index (SVRI) of 800 dyn-s-cm-m². Which intervention should the nurse anticipate as
most appropriate?
A. Increase norepinephrine to achieve MAP >65 mmHg
B. Administer a dobutamine infusion to increase cardiac output
C. Initiate vasopressin as a second-line vasopressor
D. Administer a 500 mL crystalloid bolus
Correct Answer: B. Administer a dobutamine infusion to increase cardiac output
Rationale: The patient has a low CI (2.0 L/min/m²) despite adequate preload (CVP 12) and afterload (SVRI
low-normal). Dobutamine improves cardiac contractility and output, addressing the low CI. Increasing
norepinephrine would further increase afterload without improving CI. Vasopressin is used when MAP is refractory
to norepinephrine, but here the issue is low CI. A fluid bolus is not indicated with CVP already 12, risking fluid
overload.
Why Wrong:
A - Increasing norepinephrine would elevate afterload, potentially worsening cardiac output in a patient with
already low CI.
C - Vasopressin is typically added when MAP remains low despite high-dose norepinephrine; here, the
primary problem is low CI, not refractory vasodilation.
D - CVP of 12 mmHg suggests adequate preload; additional fluid could cause pulmonary edema without
improving CI.
Reference: Marino, P. L. (2021). The ICU Book, 5th Ed., Ch. 12 & 16; Surviving Sepsis Campaign Guidelines
2021.
Q2. During a code blue, a patient is in pulseless electrical activity (PEA) with a rhythm showing a narrow
QRS complex. The team has performed 2 minutes of CPR and administered 1 mg of epinephrine. The patient
remains pulseless. What is the next priority intervention based on current Advanced Cardiac Life Support
(ACLS) guidelines?
A. Administer amiodarone 300 mg IV push
B. Administer atropine 1 mg IV push
C. Perform endotracheal intubation to secure the airway
D. Identify and treat reversible causes using the H's and T's
Correct Answer: D. Identify and treat reversible causes using the H's and T's
Rationale: In PEA, the priority is to identify and correct reversible causes (e.g., hypoxia, hypovolemia, cardiac
tamponade, tension pneumothorax, etc.) because defibrillation is not indicated and antiarrhythmics like
amiodarone are not recommended. Atropine is no longer recommended for PEA. While airway management is
important, it should not delay the search for reversible causes.
Why Wrong:
A - Amiodarone is indicated for shock-refractory VF/pVT, not for PEA.
B - Atropine is no longer recommended in ACLS for PEA; it was removed from guidelines due to lack of
evidence.
C - Intubation is important but should not delay identification of reversible causes; effective bag-mask
ventilation can be continued.
Reference: American Heart Association. (2020). ACLS Provider Manual, Part 5: PEA Algorithm.
Page 3
, Q3. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation with
settings: tidal volume 6 mL/kg ideal body weight, PEEP 12 cmHO, FiO 0.6. Arterial blood gas shows pH
7.25, PaCO 55 mmHg, PaO 70 mmHg. The nurse is concerned about ventilator-induced lung injury. Which
adjustment should the nurse question if ordered?
A. Increase PEEP to 16 cmHO to improve oxygenation
B. Increase respiratory rate to 24 breaths/min to lower PaCO
C. Increase tidal volume to 8 mL/kg to improve ventilation
D. Administer a neuromuscular blocking agent to reduce oxygen consumption
Correct Answer: C. Increase tidal volume to 8 mL/kg to improve ventilation
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (4-8 mL/kg) to prevent volutrauma. Increasing tidal
volume to 8 mL/kg could worsen lung injury. Permissive hypercapnia (PaCO 55) is tolerated if pH >7.20; increasing
respiratory rate can help correct acidosis but is not the primary concern. Increasing PEEP may improve oxygenation but risks
barotrauma; however, it is a valid strategy. Neuromuscular blockade may be used in severe ARDS.
Why Wrong:
A - Increasing PEEP is an acceptable strategy to improve oxygenation in ARDS, though it requires monitoring for
overdistension.
B - Increasing respiratory rate can help lower PaCO and improve pH, and is consistent with permissive hypercapnia
management.
D - Neuromuscular blockade may be indicated in severe ARDS to improve patient-ventilator synchrony and reduce
oxygen demand.
Reference: The ARDS Network. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for
acute lung injury and the acute respiratory distress syndrome. NEJM, 342(18), 1301-1308.
Q4. A patient with chronic kidney disease stage 4 (eGFR 25 mL/min) is prescribed enoxaparin 1 mg/kg
subcutaneously twice daily for acute coronary syndrome. The nurse reviews the medication and notes the
patient's weight is 80 kg. Which action is most appropriate?
A. Administer the standard dose of 80 mg subcutaneously twice daily
B. Hold the dose and notify the prescriber for dose adjustment due to renal impairment
C. Administer 40 mg subcutaneously once daily as renal dosing
D. Administer 80 mg intravenously as a bolus instead of subcutaneously
Correct Answer: B. Hold the dose and notify the prescriber for dose adjustment due to renal impairment
Rationale: Enoxaparin is primarily renally cleared and accumulates in patients with CrCl <30 mL/min (eGFR 25).
The recommended dose adjustment is 1 mg/kg once daily, not twice daily. The nurse should hold the dose and
consult the prescriber for appropriate adjustment. Administering the full dose twice daily increases bleeding risk.
Renal dosing is 1 mg/kg once daily, not 40 mg. Intravenous administration is not indicated for enoxaparin.
Why Wrong:
A - Standard twice-daily dosing is contraindicated in severe renal impairment due to accumulation and
bleeding risk.
C - While the once-daily regimen is correct, the dose should be weight-based (80 mg) not fixed at 40 mg.
D - Enoxaparin is not given intravenously; it is only for subcutaneous administration.
Reference: Lehne, R. A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 36: Anticoagulant and Antiplatelet
Drugs.
Q5. A patient admitted for diabetic ketoacidosis has the following laboratory results: serum glucose 480
mg/dL, potassium 3.2 mEq/L, bicarbonate 12 mEq/L, pH 7.1, anion gap 20. The patient has received 2 liters
of normal saline and an insulin infusion at 0.1 units/kg/hr. The nurse reviews the orders. Which order should
the nurse question?
A. Administer 40 mEq potassium chloride in the next liter of IV fluids
B. Change IV fluids to 5% dextrose in 0.45% normal saline when serum glucose reaches 250 mg/dL
Page 4
