HESI PN EXIT EXAM 2026 [REAL] | 110 Questions & Answers
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Graded
Section 1: Medical-Surgical Nursing (35 Questions)
Q1: A client with heart failure is prescribed furosemide (Lasix) 40 mg IV daily. Which
finding indicates the medication is achieving the desired therapeutic effect?
A. Weight gain of 2 kg over 24 hours
B. Decreased ankle edema and reduced dyspnea
C. Increased serum potassium level from 3.5 to 5.2 mEq/L
D. Decreased urine output from 2,000 mL to 1,200 mL per day
Correct Answer: B
Rationale: Furosemide is a loop diuretic used in heart failure to reduce fluid overload.
Therapeutic effectiveness is demonstrated by reduced symptoms of fluid overload:
decreased peripheral edema (ankle edema reduction), decreased pulmonary congestion
(reduced dyspnea), and diuresis with weight loss (not gain). Option A indicates
worsening fluid retention. Option C indicates hyperkalemia (furosemide causes
hypokalemia, not hyperkalemia—this finding would be unexpected and concerning).
Option D indicates reduced diuresis, suggesting inadequate response. HESI Strategy:
Always correlate medication effects with intended physiological outcomes—diuretics
should reduce fluid overload manifestations.
,Q2: A client is admitted with deep vein thrombosis (DVT) of the left leg and is prescribed
heparin infusion. Which laboratory value requires immediate follow-up?
A. Activated partial thromboplastin time (aPTT) of 90 seconds (therapeutic range 60-80
seconds)
B. Platelet count of 250,000/mm³ (normal range 150,000-400,000/mm³)
C. International normalized ratio (INR) of 1.0 (normal range 0.8-1.2)
D. Hemoglobin of 14 g/dL (normal range 12-16 g/dL for females, 14-18 g/dL for males)
Correct Answer: A
Rationale: Heparin therapy is monitored using aPTT with a therapeutic range typically
1.5-2.5 times control (usually 60-80 seconds). An aPTT of 90 seconds is
supratherapeutic, indicating excessive anticoagulation with increased bleeding risk. The
nurse must immediately notify the provider to adjust the infusion rate. Option B is within
normal limits. Option C is expected (INR used for warfarin monitoring, not heparin; value
is normal). Option D is normal. HESI Priority: Supratherapeutic aPTT with heparin
requires immediate intervention to prevent hemorrhage—this is a safety priority.
Q3: Select ALL that apply regarding appropriate nursing interventions for a client with
chronic obstructive pulmonary disease (COPD) experiencing dyspnea. (Select All That
Apply)
A. Position the client in high-Fowler's position with arms supported on over-bed table
B. Administer oxygen at 6 L/min via nasal cannula
C. Encourage pursed-lip breathing and diaphragmatic breathing techniques
,D. Administer prescribed bronchodilator via metered-dose inhaler (MDI) with spacer
Correct Answers: A, C, D
Rationale: COPD management focuses on positioning to maximize chest expansion
(high-Fowler's with arm support reduces respiratory muscle fatigue) (A), breathing
retraining (pursed-lip prolongs exhalation, prevents airway collapse; diaphragmatic
breathing improves efficiency) (C), and bronchodilator administration to reduce
bronchospasm (D). Option B is incorrect—COPD clients are typically maintained on
low-flow oxygen (1-3 L/min) to prevent suppression of hypoxic respiratory drive; 6 L/min
is excessive and dangerous. HESI Safety: Never administer high-flow oxygen to COPD
clients without specific orders—risk of CO₂ retention and respiratory arrest.
Q4: A client with type 1 diabetes mellitus presents with blood glucose of 420 mg/dL,
fruity breath odor, Kussmaul respirations, and lethargy. Which is the priority nursing
intervention?
A. Administer regular insulin per sliding scale
B. Start IV infusion of 0.9% sodium chloride
C. Check urine for ketones
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale: This client exhibits classic signs of diabetic ketoacidosis (DKA):
hyperglycemia (>250 mg/dL), fruity breath (acetone), Kussmaul respirations
(compensatory for metabolic acidosis), and altered mental status. The priority
intervention is fluid resuscitation with 0.9% sodium chloride to restore intravascular
, volume, correct dehydration (often 3-5 liters deficit), and reduce blood glucose through
dilution. While insulin (A) is essential, fluid resuscitation must begin first to prevent
cardiovascular collapse. Option C confirms diagnosis but doesn't treat the
life-threatening condition. Option D monitors for complications but isn't priority. HESI
ABCs: In DKA, fluid replacement is the first priority—insulin administration without
adequate fluid volume can worsen hypotension and shock.
Q5: A client is 24 hours post-op following abdominal surgery and reports severe
incisional pain rated 8/10. The nurse notes a heart rate of 118 bpm, blood pressure of
148/92 mmHg, and shallow respirations at 22/min. Which action should the nurse take
first?
A. Instruct the client to use the incentive spirometer
B. Administer the prescribed PRN opioid analgesic
C. Assess the surgical incision for signs of complications
D. Encourage the client to ambulate in the hallway
Correct Answer: B
Rationale: The client exhibits physiological indicators of severe pain (elevated HR, BP,
respiratory rate, and reported 8/10 pain). The priority is pain management using the
prescribed PRN analgesic to break the pain cycle, which will subsequently allow
effective deep breathing, coughing, and mobilization. While incision assessment (C) is
important, the vital sign changes and subjective report clearly indicate pain as the
cause. Pain relief enables other interventions (A, D) to be effective. HESI Prioritization:
Treat the identified problem (severe pain) before proceeding with preventive or
| Complete Exit Exam Prep | Verified | Pass Guaranteed - A+
Graded
Section 1: Medical-Surgical Nursing (35 Questions)
Q1: A client with heart failure is prescribed furosemide (Lasix) 40 mg IV daily. Which
finding indicates the medication is achieving the desired therapeutic effect?
A. Weight gain of 2 kg over 24 hours
B. Decreased ankle edema and reduced dyspnea
C. Increased serum potassium level from 3.5 to 5.2 mEq/L
D. Decreased urine output from 2,000 mL to 1,200 mL per day
Correct Answer: B
Rationale: Furosemide is a loop diuretic used in heart failure to reduce fluid overload.
Therapeutic effectiveness is demonstrated by reduced symptoms of fluid overload:
decreased peripheral edema (ankle edema reduction), decreased pulmonary congestion
(reduced dyspnea), and diuresis with weight loss (not gain). Option A indicates
worsening fluid retention. Option C indicates hyperkalemia (furosemide causes
hypokalemia, not hyperkalemia—this finding would be unexpected and concerning).
Option D indicates reduced diuresis, suggesting inadequate response. HESI Strategy:
Always correlate medication effects with intended physiological outcomes—diuretics
should reduce fluid overload manifestations.
,Q2: A client is admitted with deep vein thrombosis (DVT) of the left leg and is prescribed
heparin infusion. Which laboratory value requires immediate follow-up?
A. Activated partial thromboplastin time (aPTT) of 90 seconds (therapeutic range 60-80
seconds)
B. Platelet count of 250,000/mm³ (normal range 150,000-400,000/mm³)
C. International normalized ratio (INR) of 1.0 (normal range 0.8-1.2)
D. Hemoglobin of 14 g/dL (normal range 12-16 g/dL for females, 14-18 g/dL for males)
Correct Answer: A
Rationale: Heparin therapy is monitored using aPTT with a therapeutic range typically
1.5-2.5 times control (usually 60-80 seconds). An aPTT of 90 seconds is
supratherapeutic, indicating excessive anticoagulation with increased bleeding risk. The
nurse must immediately notify the provider to adjust the infusion rate. Option B is within
normal limits. Option C is expected (INR used for warfarin monitoring, not heparin; value
is normal). Option D is normal. HESI Priority: Supratherapeutic aPTT with heparin
requires immediate intervention to prevent hemorrhage—this is a safety priority.
Q3: Select ALL that apply regarding appropriate nursing interventions for a client with
chronic obstructive pulmonary disease (COPD) experiencing dyspnea. (Select All That
Apply)
A. Position the client in high-Fowler's position with arms supported on over-bed table
B. Administer oxygen at 6 L/min via nasal cannula
C. Encourage pursed-lip breathing and diaphragmatic breathing techniques
,D. Administer prescribed bronchodilator via metered-dose inhaler (MDI) with spacer
Correct Answers: A, C, D
Rationale: COPD management focuses on positioning to maximize chest expansion
(high-Fowler's with arm support reduces respiratory muscle fatigue) (A), breathing
retraining (pursed-lip prolongs exhalation, prevents airway collapse; diaphragmatic
breathing improves efficiency) (C), and bronchodilator administration to reduce
bronchospasm (D). Option B is incorrect—COPD clients are typically maintained on
low-flow oxygen (1-3 L/min) to prevent suppression of hypoxic respiratory drive; 6 L/min
is excessive and dangerous. HESI Safety: Never administer high-flow oxygen to COPD
clients without specific orders—risk of CO₂ retention and respiratory arrest.
Q4: A client with type 1 diabetes mellitus presents with blood glucose of 420 mg/dL,
fruity breath odor, Kussmaul respirations, and lethargy. Which is the priority nursing
intervention?
A. Administer regular insulin per sliding scale
B. Start IV infusion of 0.9% sodium chloride
C. Check urine for ketones
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale: This client exhibits classic signs of diabetic ketoacidosis (DKA):
hyperglycemia (>250 mg/dL), fruity breath (acetone), Kussmaul respirations
(compensatory for metabolic acidosis), and altered mental status. The priority
intervention is fluid resuscitation with 0.9% sodium chloride to restore intravascular
, volume, correct dehydration (often 3-5 liters deficit), and reduce blood glucose through
dilution. While insulin (A) is essential, fluid resuscitation must begin first to prevent
cardiovascular collapse. Option C confirms diagnosis but doesn't treat the
life-threatening condition. Option D monitors for complications but isn't priority. HESI
ABCs: In DKA, fluid replacement is the first priority—insulin administration without
adequate fluid volume can worsen hypotension and shock.
Q5: A client is 24 hours post-op following abdominal surgery and reports severe
incisional pain rated 8/10. The nurse notes a heart rate of 118 bpm, blood pressure of
148/92 mmHg, and shallow respirations at 22/min. Which action should the nurse take
first?
A. Instruct the client to use the incentive spirometer
B. Administer the prescribed PRN opioid analgesic
C. Assess the surgical incision for signs of complications
D. Encourage the client to ambulate in the hallway
Correct Answer: B
Rationale: The client exhibits physiological indicators of severe pain (elevated HR, BP,
respiratory rate, and reported 8/10 pain). The priority is pain management using the
prescribed PRN analgesic to break the pain cycle, which will subsequently allow
effective deep breathing, coughing, and mobilization. While incision assessment (C) is
important, the vital sign changes and subjective report clearly indicate pain as the
cause. Pain relief enables other interventions (A, D) to be effective. HESI Prioritization:
Treat the identified problem (severe pain) before proceeding with preventive or
