HESI RN Exit Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 68-year-old patient is admitted with chest pain described as "crushing" and
radiating to the left arm. Vital signs: BP 88/50 mmHg, HR 112/min, RR 26/min, SpO2
89%. What should the nurse do FIRST?
A. Obtain a 12-lead ECG
B. Administer oxygen 2 L/min via nasal cannula
C. Give sublingual nitroglycerin
D. Draw cardiac enzymes
Correct Answer: B
Rationale: The patient shows signs of acute MI with hypoxemia (SpO2 89%) and
hypotension. Oxygen is the priority to improve myocardial oxygenation and prevent
further ischemia. While ECG is important, oxygen must be given first to stabilize the
patient. Nitroglycerin is contraindicated with systolic BP <90 mmHg. Cardiac enzymes
can wait until the patient is stabilized.
Q2: A patient with heart failure is receiving digoxin 0.25 mg daily. Which finding requires
immediate intervention?
A. Potassium level 3.8 mEq/L
B. Apical pulse 54/min before administration
C. Patient reports yellow-green halos around lights
D. BUN 22 mg/dL
Correct Answer: C
,Rationale: Yellow-green halos are classic signs of digoxin toxicity, requiring immediate
discontinuation and possible digoxin immune Fab. A pulse <60/min warrants
withholding but isn't as urgent as toxicity symptoms. Potassium 3.8 is borderline low
but acceptable. Elevated BUN is expected in heart failure.
Q3: Four days post-MI, a patient develops sudden dyspnea and chest pain. BP drops to
80/50 mmHg, heart sounds reveal a loud holosystolic murmur at the apex radiating to
the axilla. What complication has occurred?
A. Ventricular septal rupture
B. Papillary muscle rupture with acute mitral regurgitation
C. Dressler's syndrome
D. Left ventricular aneurysm
Correct Answer: B
Rationale: Papillary muscle rupture typically occurs 3-7 days post-MI, causing acute
mitral regurgitation with a new holosystolic murmur and cardiogenic shock. Ventricular
septal rupture would have a murmur at the left sternal border. Dressler's syndrome
presents later with fever and pericarditis. LV aneurysm doesn't cause acute murmur.
Q4: A patient with DVT receiving heparin infusion has aPTT 120 seconds (control 30
seconds). What is the priority nursing action?
A. Continue infusion as ordered
B. Stop infusion and notify provider immediately
C. Decrease infusion rate by 50%
D. Draw PT/INR level
Correct Answer: B
Rationale: aPTT >3 times control (90 seconds) indicates severe over-anticoagulation
with bleeding risk. The infusion must be stopped immediately. Continuing or just
decreasing could cause hemorrhage. PT/INR isn't affected by heparin.
, Q5: A patient with iron deficiency anemia receiving ferrous sulfate reports "my stools
are black and I have constipation." What is the appropriate response?
A. Discontinue medication immediately
B. Increase fluid and fiber intake, reassure about black stools
C. Obtain stool for occult blood test
D. Switch to IV iron preparation
Correct Answer: B
Rationale: Black stools are expected with oral iron and harmless. Constipation is
common; increasing fluids/fiber helps. Discontinuing would treat the medication
incorrectly. Occult blood testing would be positive from the iron itself. IV iron isn't
indicated for this minor side effect.
Q6: Post-cardiac catheterization via right femoral artery, the nurse notes the patient's
right foot is cool and mottled with absent pedal pulse. What should the nurse do FIRST?
A. Elevate the extremity
B. Check pulse with Doppler
C. Remove the pressure dressing
D. Notify the interventional cardiologist immediately
Correct Answer: D
Rationale: These are classic signs of acute arterial occlusion, a medical emergency
requiring immediate intervention (possible thrombectomy). Elevating could worsen
ischemia. Doppler confirms but delays treatment. Removing dressing could cause
hemorrhage.
Q7: A patient with pericarditis complains of increased chest pain when lying flat and
relieved by sitting up. What type of pain is this describing?
A. Pleuritic pain
B. Pericardial friction rub pain
C. Positional pericardial pain
D. Referred cardiac pain
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A 68-year-old patient is admitted with chest pain described as "crushing" and
radiating to the left arm. Vital signs: BP 88/50 mmHg, HR 112/min, RR 26/min, SpO2
89%. What should the nurse do FIRST?
A. Obtain a 12-lead ECG
B. Administer oxygen 2 L/min via nasal cannula
C. Give sublingual nitroglycerin
D. Draw cardiac enzymes
Correct Answer: B
Rationale: The patient shows signs of acute MI with hypoxemia (SpO2 89%) and
hypotension. Oxygen is the priority to improve myocardial oxygenation and prevent
further ischemia. While ECG is important, oxygen must be given first to stabilize the
patient. Nitroglycerin is contraindicated with systolic BP <90 mmHg. Cardiac enzymes
can wait until the patient is stabilized.
Q2: A patient with heart failure is receiving digoxin 0.25 mg daily. Which finding requires
immediate intervention?
A. Potassium level 3.8 mEq/L
B. Apical pulse 54/min before administration
C. Patient reports yellow-green halos around lights
D. BUN 22 mg/dL
Correct Answer: C
,Rationale: Yellow-green halos are classic signs of digoxin toxicity, requiring immediate
discontinuation and possible digoxin immune Fab. A pulse <60/min warrants
withholding but isn't as urgent as toxicity symptoms. Potassium 3.8 is borderline low
but acceptable. Elevated BUN is expected in heart failure.
Q3: Four days post-MI, a patient develops sudden dyspnea and chest pain. BP drops to
80/50 mmHg, heart sounds reveal a loud holosystolic murmur at the apex radiating to
the axilla. What complication has occurred?
A. Ventricular septal rupture
B. Papillary muscle rupture with acute mitral regurgitation
C. Dressler's syndrome
D. Left ventricular aneurysm
Correct Answer: B
Rationale: Papillary muscle rupture typically occurs 3-7 days post-MI, causing acute
mitral regurgitation with a new holosystolic murmur and cardiogenic shock. Ventricular
septal rupture would have a murmur at the left sternal border. Dressler's syndrome
presents later with fever and pericarditis. LV aneurysm doesn't cause acute murmur.
Q4: A patient with DVT receiving heparin infusion has aPTT 120 seconds (control 30
seconds). What is the priority nursing action?
A. Continue infusion as ordered
B. Stop infusion and notify provider immediately
C. Decrease infusion rate by 50%
D. Draw PT/INR level
Correct Answer: B
Rationale: aPTT >3 times control (90 seconds) indicates severe over-anticoagulation
with bleeding risk. The infusion must be stopped immediately. Continuing or just
decreasing could cause hemorrhage. PT/INR isn't affected by heparin.
, Q5: A patient with iron deficiency anemia receiving ferrous sulfate reports "my stools
are black and I have constipation." What is the appropriate response?
A. Discontinue medication immediately
B. Increase fluid and fiber intake, reassure about black stools
C. Obtain stool for occult blood test
D. Switch to IV iron preparation
Correct Answer: B
Rationale: Black stools are expected with oral iron and harmless. Constipation is
common; increasing fluids/fiber helps. Discontinuing would treat the medication
incorrectly. Occult blood testing would be positive from the iron itself. IV iron isn't
indicated for this minor side effect.
Q6: Post-cardiac catheterization via right femoral artery, the nurse notes the patient's
right foot is cool and mottled with absent pedal pulse. What should the nurse do FIRST?
A. Elevate the extremity
B. Check pulse with Doppler
C. Remove the pressure dressing
D. Notify the interventional cardiologist immediately
Correct Answer: D
Rationale: These are classic signs of acute arterial occlusion, a medical emergency
requiring immediate intervention (possible thrombectomy). Elevating could worsen
ischemia. Doppler confirms but delays treatment. Removing dressing could cause
hemorrhage.
Q7: A patient with pericarditis complains of increased chest pain when lying flat and
relieved by sitting up. What type of pain is this describing?
A. Pleuritic pain
B. Pericardial friction rub pain
C. Positional pericardial pain
D. Referred cardiac pain
