Nightingale College BSN 366 Exit HESI V2 Study Guide

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Sample questions from Nightingale College BSN 366 Exit HESI V2 Study Guide

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.The RN receives reports on four clients. Which client should the RN assess first?

   • A.D. A client awaiting discharge who needs anticoagulant teaching
   • B.C. A client with diabetes who has a premeal glucose of 184 mg/dL
   • C.B. A client one hour after thyroidectomy who develops stridor
   • D.A. A client with chronic heart failure who has unchanged 1+ ankle edema

   Rationale: B is correct because new stridor after neck surgery suggests an immediately threatened airway. A describes a stable chronic finding. C requires routine management rather than emergency prioritization. D is important but can wait until the airway threat is addressed.

2. 2.An older adult with suspected pneumonia has new confusion, respiratory rate 30/min, blood pressure 92/54 mm Hg, and urine output 20 mL during the last hour. What is the best nursing response?

   • A.D. Wait for a positive blood culture before escalating care
   • B.C. Activate urgent sepsis evaluation and assess oxygenation and perfusion
   • C.A. Reorient the client and repeat vital signs in four hours
   • D.B. Restrict fluids because older adults commonly develop overload

   Rationale: C is correct because infection plus acute neurological, respiratory, circulatory, and renal cues suggests possible sepsis with hypoperfusion. A delays care. B imposes an unsupported blanket restriction rather than individualized resuscitation. D delays treatment while waiting for a result that may take many hours.

3. 3.A client with suspected acute coronary syndrome reports taking tadalafil 24 hours earlier. Which prescription should the nurse clarify before administration?

   • A.B. A 12-lead electrocardiogram
   • B.D. Continuous cardiac monitoring
   • C.C. Serial troponin measurements
   • D.A. Sublingual nitroglycerin

   Rationale: A is correct because tadalafil within the preceding 48 hours generally contraindicates nitrates due to severe hypotension risk. B and C are appropriate diagnostic measures. D supports early recognition of dysrhythmias and is not contraindicated by tadalafil use.

4. 4.A client having a severe asthma exacerbation becomes drowsy. Wheezing is now barely audible, and air movement is markedly reduced. How should the nurse interpret this change?

   • A.D. Airflow may be critically reduced and respiratory failure may be developing
   • B.C. The client can be safely switched to routine oral therapy
   • C.B. Anxiety is decreasing and the client needs rest
   • D.A. Bronchodilator therapy has resolved the obstruction

   Answer and rationale are in the full material.

5. 5.A client develops sudden right arm weakness and difficulty speaking. The symptoms were discovered at 0800, but the client was last observed without deficits at 0630. Which action is most appropriate?

   • A.A. Document 0800 as the definite onset and offer water
   • B.D. Reassess after breakfast to determine whether symptoms persist
   • C.B. Activate the stroke pathway, check glucose, and report 0630 as last known well
   • D.C. Give aspirin before brain imaging to reduce clot extension

   Answer and rationale are in the full material.