BSN 366 Exit HESI

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Sample questions from BSN 366 Exit HESI

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

1. 1.In the emergency department, a client with acute pancreatitis reports worsening upper abdominal pain radiating to the back. Which prescribed intervention should the nurse implement first?

   • A.Begin oral fluids to prevent dehydration
   • B.Administer the prescribed IV opioid analgesic
   • C.Offer a low-fat snack
   • D.Encourage the client to lie flat

   Rationale: IV opioid analgesia addresses severe acute pain promptly. Food and oral fluids can stimulate pancreatic activity and are not appropriate during acute severe pancreatitis; lying flat may worsen discomfort. The exam takeaway is to prioritize symptom control and prescribed supportive care while maintaining bowel rest as indicated.

2. 2.Refer to the client's chart. Which actions should the nurse take now to address the client's changing respiratory status? Select all that apply.

   • A.Apply oxygen as prescribed and titrate to the target saturation
   • B.Reassess respiratory status and oxygen saturation frequently
   • C.Notify the rapid response team
   • D.Place the client in high-Fowler position
   • E.Encourage the client to lie flat and rest

   Rationale: The saturation has fallen from 94% to 86% with increasing respiratory rate and distress, so prescribed oxygen, upright positioning, and rapid escalation are appropriate. Frequent reassessment evaluates response and detects further deterioration. Lying flat can worsen ventilation; the exam takeaway is to respond to acute hypoxemia without delay.

3. 3.A client with a new ileostomy has a dusky, dry stoma. Which action is most appropriate?

   • A.Apply a warm compress to the stoma
   • B.Document the appearance as expected during the first day
   • C.Notify the surgeon promptly
   • D.Irrigate the ileostomy with warm water

   Rationale: A healthy stoma is moist and pink to red; dusky coloration and dryness can indicate impaired perfusion. Documenting it as expected or applying heat delays evaluation, and routine irrigation is not appropriate for a new ileostomy. The exam takeaway is to report signs of compromised stoma viability promptly.

4. 4.Which finding in a client with a new arteriovenous fistula requires immediate follow-up?

   • A.The fingers are cool and the radial pulse is weaker than the opposite side
   • B.A bruit is audible over the fistula
   • C.A thrill is palpable over the access
   • D.The hand is warm with brisk capillary refill

   Answer and rationale are in the full material.

5. 5.During a home visit, a client with heart failure reports waking at night gasping for breath and needing three pillows to sleep. Which action should the nurse take first?

   • A.Review the client's daily sodium intake
   • B.Schedule a routine follow-up appointment
   • C.Teach the client to elevate the legs
   • D.Assess respiratory status and oxygen saturation

   Answer and rationale are in the full material.