2025/26 HESI RN Exit Exam -
Comprehensive Practice Test
This test contains 85 questions covering Versions 1-7.
Instructions: Choose the single best answer for each question. Correct answers are
highlighted in bold with a rationale provided.
Medical-Surgical Nursing
1. A client with a history of heart failure is admitted with dyspnea, orthopnea, and
3+ pitting edema. Vital signs: BP 168/94, HR 110, RR 28, SpO₂ 90% on room air.
Which action should the nurse take first?
A. Administer furosemide 40 mg IV
B. Apply oxygen via nasal cannula at 2 L/min
C. Place the client in high-Fowler’s position
D. Obtain a 12-lead ECG
* Rationale: High-Fowler's position is a non-invasive, immediate intervention that reduces
venous return (preload), improves lung expansion, and facilitates oxygenation while other
interventions are prepared.
2. A client with acute pancreatitis is admitted with severe abdominal pain and an
elevated serum amylase. Which additional information is the client most likely to
report?
A. Drinks alcohol until intoxicated at least twice weekly
B. Abdominal pain decreases when lying supine
C. Pain lasts an hour and leaves the abdomen tender
D. Right upper quadrant pain refers to the right scapula
* Rationale: Alcohol abuse is a leading cause of pancreatitis. The pain of pancreatitis is
typically severe, piercing, and often radiates to the back, not relieved by lying supine.
3. A client is one-hour post-cardiac catheterization with a stent placed in the right
coronary artery. The nurse administers prasugrel, a platelet inhibitor. To monitor
for adverse effects, which assessment is most important?
A. Monitoring for signs of myocardial ischemia
B. Monitoring for bleeding at the access site and gums
C. Assessing for an increased heart rate
,D. Checking for deep vein thrombosis
* Rationale: Prasugrel is an antiplatelet medication that inhibits platelet aggregation,
significantly increasing the risk of bleeding. Monitoring for bleeding is the priority.
4. The nurse is assessing a client with a long history of COPD who is on 2 L/min of
oxygen. Which finding requires immediate intervention?
A. Oxygen saturation of 90%
B. Respiratory rate of 22 breaths/min
C. Increasing drowsiness and confusion
D. Mild expiratory wheezing
* Rationale: In COPD clients with chronic hypercapnia, the hypoxic drive is their primary
stimulus to breathe. Over-oxygenation can lead to decreased respiratory drive, resulting in
increasing drowsiness, confusion, and respiratory acidosis, which is a medical emergency.
5. A client with a new colostomy is being discharged. Which statement by the
client indicates a need for further teaching?
A. "I will empty the pouch when it is one-third to one-half full."
B. "I will use a skin barrier to protect the area around my stoma."
C. "I should expect my stoma to be dark purple in color."
D. "I can cut the pouch opening to fit the size of my stoma."
* Rationale: A healthy stoma should be pink and moist, like the inside of the mouth. A
dark purple or black stoma indicates compromised circulation and necrosis, which must be
reported immediately.
6. A client with a chest tube to water-seal drainage asks to go for a walk. Which
action should the nurse take?
A. Clamp the chest tube during the walk.
B. Disconnect the drainage system from suction.
C. Keep the drainage system below the level of the chest.
D. Place the drainage system on the client's lap while in the wheelchair.
* Rationale: The drainage system must always be kept below the insertion site to prevent
fluid from re-entering the pleural space. Clamping can lead to a tension pneumothorax.
7. The nurse is providing discharge teaching to a client who had a below-the-knee
amputation (BKA). Which recommendations should the nurse include? (Select all
that apply)
A. Avoid range of motion exercises of the residual limb
B. Use a residual limb shrinker
C. Apply alcohol to the stump after bathing
D. Inspect skin for redness and breakdown
E. Wash the stump with mild soap and water and dry thoroughly
, * Rationale: A shrinker helps shape the limb. Daily washing and inspection for skin
breakdown are crucial for hygiene and preventing complications. ROM exercises are
encouraged.
8. A client with a pituitary tumor develops syndrome of inappropriate antidiuretic
hormone (SIADH). Which finding would the nurse expect?
A. Decreased serum sodium
B. Increased urine output
C. Increased serum osmolality
D. Decreased blood pressure
* Rationale: SIADH causes water retention, leading to dilutional hyponatremia (decreased
serum sodium). Urine output decreases, and serum osmolality decreases.
9. The nurse is assessing a client who has just returned from a thyroidectomy. The
client reports tingling in the fingers and around the mouth. What is the nurse's
priority action?
A. Administer prescribed pain medication.
B. Assess for Chvostek's sign.
C. Encourage the client to take deep breaths.
D. Notify the charge nurse.
* Rationale: Tingling (paresthesia) is an early sign of hypocalcemia due to accidental
parathyroid removal during surgery. Assessing for Chvostek's sign (facial muscle twitching)
or Trousseau's sign confirms latent tetany.
10. A client with liver cirrhosis and jaundice reports severe pruritus. Which nursing
intervention is most appropriate?
A. Encourage hot baths to open skin pores.
B. Apply powder to keep the skin dry.
C. Encourage the client to use cool water for bathing and apply lotion.
D. Administer an antihistamine as the first-line treatment.
* Rationale: Cool water soothes itching, and lotion helps with dry skin. Hot water worsens
pruritus.
Pharmacology
11. A client with DKA has an initial potassium level of 5.8 mEq/L. Which finding is
most concerning to the nurse?
A. Serum glucose 420 mg/dL
B. Bicarbonate 14 mEq/L
C. The high potassium level itself
Comprehensive Practice Test
This test contains 85 questions covering Versions 1-7.
Instructions: Choose the single best answer for each question. Correct answers are
highlighted in bold with a rationale provided.
Medical-Surgical Nursing
1. A client with a history of heart failure is admitted with dyspnea, orthopnea, and
3+ pitting edema. Vital signs: BP 168/94, HR 110, RR 28, SpO₂ 90% on room air.
Which action should the nurse take first?
A. Administer furosemide 40 mg IV
B. Apply oxygen via nasal cannula at 2 L/min
C. Place the client in high-Fowler’s position
D. Obtain a 12-lead ECG
* Rationale: High-Fowler's position is a non-invasive, immediate intervention that reduces
venous return (preload), improves lung expansion, and facilitates oxygenation while other
interventions are prepared.
2. A client with acute pancreatitis is admitted with severe abdominal pain and an
elevated serum amylase. Which additional information is the client most likely to
report?
A. Drinks alcohol until intoxicated at least twice weekly
B. Abdominal pain decreases when lying supine
C. Pain lasts an hour and leaves the abdomen tender
D. Right upper quadrant pain refers to the right scapula
* Rationale: Alcohol abuse is a leading cause of pancreatitis. The pain of pancreatitis is
typically severe, piercing, and often radiates to the back, not relieved by lying supine.
3. A client is one-hour post-cardiac catheterization with a stent placed in the right
coronary artery. The nurse administers prasugrel, a platelet inhibitor. To monitor
for adverse effects, which assessment is most important?
A. Monitoring for signs of myocardial ischemia
B. Monitoring for bleeding at the access site and gums
C. Assessing for an increased heart rate
,D. Checking for deep vein thrombosis
* Rationale: Prasugrel is an antiplatelet medication that inhibits platelet aggregation,
significantly increasing the risk of bleeding. Monitoring for bleeding is the priority.
4. The nurse is assessing a client with a long history of COPD who is on 2 L/min of
oxygen. Which finding requires immediate intervention?
A. Oxygen saturation of 90%
B. Respiratory rate of 22 breaths/min
C. Increasing drowsiness and confusion
D. Mild expiratory wheezing
* Rationale: In COPD clients with chronic hypercapnia, the hypoxic drive is their primary
stimulus to breathe. Over-oxygenation can lead to decreased respiratory drive, resulting in
increasing drowsiness, confusion, and respiratory acidosis, which is a medical emergency.
5. A client with a new colostomy is being discharged. Which statement by the
client indicates a need for further teaching?
A. "I will empty the pouch when it is one-third to one-half full."
B. "I will use a skin barrier to protect the area around my stoma."
C. "I should expect my stoma to be dark purple in color."
D. "I can cut the pouch opening to fit the size of my stoma."
* Rationale: A healthy stoma should be pink and moist, like the inside of the mouth. A
dark purple or black stoma indicates compromised circulation and necrosis, which must be
reported immediately.
6. A client with a chest tube to water-seal drainage asks to go for a walk. Which
action should the nurse take?
A. Clamp the chest tube during the walk.
B. Disconnect the drainage system from suction.
C. Keep the drainage system below the level of the chest.
D. Place the drainage system on the client's lap while in the wheelchair.
* Rationale: The drainage system must always be kept below the insertion site to prevent
fluid from re-entering the pleural space. Clamping can lead to a tension pneumothorax.
7. The nurse is providing discharge teaching to a client who had a below-the-knee
amputation (BKA). Which recommendations should the nurse include? (Select all
that apply)
A. Avoid range of motion exercises of the residual limb
B. Use a residual limb shrinker
C. Apply alcohol to the stump after bathing
D. Inspect skin for redness and breakdown
E. Wash the stump with mild soap and water and dry thoroughly
, * Rationale: A shrinker helps shape the limb. Daily washing and inspection for skin
breakdown are crucial for hygiene and preventing complications. ROM exercises are
encouraged.
8. A client with a pituitary tumor develops syndrome of inappropriate antidiuretic
hormone (SIADH). Which finding would the nurse expect?
A. Decreased serum sodium
B. Increased urine output
C. Increased serum osmolality
D. Decreased blood pressure
* Rationale: SIADH causes water retention, leading to dilutional hyponatremia (decreased
serum sodium). Urine output decreases, and serum osmolality decreases.
9. The nurse is assessing a client who has just returned from a thyroidectomy. The
client reports tingling in the fingers and around the mouth. What is the nurse's
priority action?
A. Administer prescribed pain medication.
B. Assess for Chvostek's sign.
C. Encourage the client to take deep breaths.
D. Notify the charge nurse.
* Rationale: Tingling (paresthesia) is an early sign of hypocalcemia due to accidental
parathyroid removal during surgery. Assessing for Chvostek's sign (facial muscle twitching)
or Trousseau's sign confirms latent tetany.
10. A client with liver cirrhosis and jaundice reports severe pruritus. Which nursing
intervention is most appropriate?
A. Encourage hot baths to open skin pores.
B. Apply powder to keep the skin dry.
C. Encourage the client to use cool water for bathing and apply lotion.
D. Administer an antihistamine as the first-line treatment.
* Rationale: Cool water soothes itching, and lotion helps with dry skin. Hot water worsens
pruritus.
Pharmacology
11. A client with DKA has an initial potassium level of 5.8 mEq/L. Which finding is
most concerning to the nurse?
A. Serum glucose 420 mg/dL
B. Bicarbonate 14 mEq/L
C. The high potassium level itself
