HESI Exit BSN 366 Fall Semester

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Sample questions from HESI Exit BSN 366 Fall Semester

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A client's potassium is 6.3 mEq/L, and the cardiac monitor shows peaked T waves. Which prescription should the nurse implement first?

   • A.Encourage the client to drink water
   • B.Administer IV calcium gluconate
   • C.Administer the scheduled oral potassium supplement
   • D.Give oral sodium polystyrene sulfonate

   Rationale: IV calcium gluconate stabilizes the myocardium and is the priority when hyperkalemia is accompanied by ECG changes. Sodium polystyrene sulfonate may help remove potassium but does not provide immediate cardiac membrane stabilization. Water does not rapidly correct this risk, and administering a potassium supplement would worsen the hyperkalemia.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the client's changing condition? Select all that apply.

   • A.Reassess respiratory effort and oxygen saturation frequently
   • B.Notify the rapid response team or provider about the acute deterioration
   • C.Encourage the client to walk to improve ventilation
   • D.Apply oxygen to maintain the prescribed oxygen saturation target
   • E.Place the client in high-Fowler position

   Rationale: The oxygen saturation has fallen from 91% to 84% while respiratory rate and heart rate have increased, so oxygen, upright positioning, escalation, and frequent reassessment are appropriate. Walking is unsafe during acute respiratory distress and could increase oxygen demand. The charted trend, rather than the client's chronic COPD diagnosis alone, indicates an acute change requiring prompt response.

3. 3.In the emergency department, a client with chest pressure has a 12-lead ECG showing ST-segment elevation. Which action has the highest priority?

   • A.Obtain a fasting lipid panel
   • B.Provide discharge teaching about a low-fat diet
   • C.Schedule an exercise stress test
   • D.Activate the facility's reperfusion protocol

   Rationale: ST-segment elevation with acute chest pressure suggests an acute myocardial infarction requiring rapid reperfusion evaluation and treatment. A lipid panel is useful but does not address the immediate threat to myocardial tissue. Diet teaching and stress testing are inappropriate priorities during a suspected acute infarction.

4. 4.A client states, "I take my levothyroxine with breakfast and my calcium tablet." Which teaching should the nurse provide?

   • A.Take levothyroxine on an empty stomach and separate it from calcium by at least 4 hours
   • B.Take both medications with breakfast to reduce stomach irritation
   • C.Stop calcium because it permanently inactivates thyroid hormone
   • D.Take levothyroxine only on days when fatigue is present

   Answer and rationale are in the full material.

5. 5.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client with chronic kidney disease whose morning weight is 0.5 kg above yesterday's weight
   • B.A client with a urinary tract infection whose temperature is 37.8 C
   • C.A client 2 hours after thyroidectomy who reports tingling around the mouth
   • D.A client with osteoarthritis requesting a scheduled analgesic

   Answer and rationale are in the full material.