HESI RN Exit Exam
Question Bank — Sets 1 through 10
Original NGN-Style Questions
Next Generation NCLEX• Answers & Rationales Included After Every Question
, EXAM 1 — Medical-Surgical Nursing I (Cardiac &
Respiratory)
1. A nurse is caring for a client who is 2 hours post-cardiac catheterization via the right femoral
artery. Which finding requires immediate action?
A. Heart rate 88 bpm
B. Bruising at the insertion site
C. Absent pedal pulse in the right foot
D. Client reports mild soreness at the site
✓ Answer: C
Rationale: An absent pedal pulse after femoral artery catheterization suggests arterial occlusion or
thrombus formation, which threatens limb perfusion and requires immediate notification of the
provider. Mild soreness and bruising are expected findings; a heart rate of 88 is within normal limits.
2. The nurse is reviewing morning labs for a client with heart failure who is taking digoxin. Which
result should be reported to the provider before administering the next dose?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Digoxin level 1.5 ng/mL
D. Creatinine 0.9 mg/dL
✓ Answer: A
Rationale: Hypokalemia (normal 3.5–5.0 mEq/L) increases myocardial sensitivity to digoxin and
raises the risk of digoxin toxicity and dysrhythmias, so it must be corrected and reported before the
dose is given. The digoxin level, sodium, and creatinine are within normal/therapeutic ranges.
3. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 89%
on room air. The provider prescribes supplemental oxygen. Which method and rate is most
appropriate to start with?
A. Non-rebreather mask at 10–15 L/min
B. Nasal cannula at 1–2 L/min
C. Venturi mask at 12 L/min
D. Simple face mask at 8 L/min
✓ Answer: B
Rationale: Clients with COPD rely on a hypoxic drive to stimulate respiration because of chronic
CO2 retention; low-flow oxygen (1–2 L/min via nasal cannula) prevents suppressing that drive while
still improving oxygenation. High-flow devices risk worsening hypercapnia and respiratory
depression.
,4. NGN Extended Multiple Response: A nurse is assessing a client suspected of having left-sided
heart failure. Select all findings the nurse would expect. (Select all that apply.)
■ Crackles in the lung bases
■ Jugular vein distention
■ Dyspnea on exertion
■ Peripheral edema
■ Orthopnea
■ Hepatomegaly
✓ Answer: Crackles in the lung bases; Dyspnea on exertion; Orthopnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation, producing
pulmonary congestion manifested as crackles, dyspnea, and orthopnea. Jugular vein distention,
peripheral edema, and hepatomegaly result from systemic venous congestion and are findings of
right-sided heart failure.
5. A client develops chest pain, diaphoresis, and shortness of breath. An ECG shows ST-segment
elevation. Which action is the nurse's priority?
A. Obtain a 12-lead ECG in 30 minutes to compare
B. Administer sublingual nitroglycerin and notify the provider immediately
C. Ask the client to ambulate to assess tolerance
D. Document findings and reassess in 1 hour
✓ Answer: B
Rationale: ST-segment elevation with chest pain indicates an acute myocardial infarction (STEMI);
the priority is to relieve ischemia and initiate rapid treatment (time is myocardium), so nitroglycerin is
given and the provider/rapid response team is notified immediately. Delaying care or having the client
exert themselves is unsafe.
6. The nurse is teaching a client newly diagnosed with hypertension about lifestyle modification.
Which statement indicates a need for further teaching?
A. "I will try to limit my sodium intake to less than 2,300 mg per day."
B. "I can stop my medication once my blood pressure is normal."
C. "I should aim for at least 150 minutes of moderate exercise weekly."
D. "I will limit alcohol to no more than one drink per day."
✓ Answer: B
Rationale: Hypertension medications control, but do not cure, hypertension; stopping medication
when blood pressure normalizes will cause it to rise again and increases the risk of complications.
The other statements reflect correct understanding of DASH-diet, exercise, and alcohol
recommendations.
, 7. A client with atrial fibrillation is started on warfarin. Which lab value does the nurse monitor to
evaluate therapeutic effect?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
D. D-dimer
✓ Answer: B
Rationale: Warfarin therapy is monitored using the INR, with a therapeutic goal typically between
2.0–3.0 for most indications including atrial fibrillation. PTT monitors heparin therapy, not warfarin.
8. A client is admitted with an exacerbation of asthma. Which assessment finding is most
concerning and suggests worsening respiratory status?
A. Loud expiratory wheezing
B. Respiratory rate of 28/min with wheezing
C. Diminished breath sounds with minimal wheezing
D. Use of accessory muscles
✓ Answer: C
Rationale: Diminished or absent breath sounds during an asthma exacerbation indicate severely
reduced air movement ("silent chest") and impending respiratory failure — a critical warning sign, not
improvement. Loud wheezing and accessory muscle use indicate increased work of breathing but
ongoing air movement.
9. A client returns from surgery with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. What is the priority nursing action?
A. Clamp the chest tube immediately
B. Check the system for an air leak
C. Increase the suction pressure
D. Document as an expected finding
✓ Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak somewhere in the
system (not the lung, which produces intermittent bubbling); the nurse should assess connections
and tubing to locate and correct the leak. Clamping the tube is contraindicated as it can cause a
tension pneumothorax.
Question Bank — Sets 1 through 10
Original NGN-Style Questions
Next Generation NCLEX• Answers & Rationales Included After Every Question
, EXAM 1 — Medical-Surgical Nursing I (Cardiac &
Respiratory)
1. A nurse is caring for a client who is 2 hours post-cardiac catheterization via the right femoral
artery. Which finding requires immediate action?
A. Heart rate 88 bpm
B. Bruising at the insertion site
C. Absent pedal pulse in the right foot
D. Client reports mild soreness at the site
✓ Answer: C
Rationale: An absent pedal pulse after femoral artery catheterization suggests arterial occlusion or
thrombus formation, which threatens limb perfusion and requires immediate notification of the
provider. Mild soreness and bruising are expected findings; a heart rate of 88 is within normal limits.
2. The nurse is reviewing morning labs for a client with heart failure who is taking digoxin. Which
result should be reported to the provider before administering the next dose?
A. Potassium 3.0 mEq/L
B. Sodium 138 mEq/L
C. Digoxin level 1.5 ng/mL
D. Creatinine 0.9 mg/dL
✓ Answer: A
Rationale: Hypokalemia (normal 3.5–5.0 mEq/L) increases myocardial sensitivity to digoxin and
raises the risk of digoxin toxicity and dysrhythmias, so it must be corrected and reported before the
dose is given. The digoxin level, sodium, and creatinine are within normal/therapeutic ranges.
3. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 89%
on room air. The provider prescribes supplemental oxygen. Which method and rate is most
appropriate to start with?
A. Non-rebreather mask at 10–15 L/min
B. Nasal cannula at 1–2 L/min
C. Venturi mask at 12 L/min
D. Simple face mask at 8 L/min
✓ Answer: B
Rationale: Clients with COPD rely on a hypoxic drive to stimulate respiration because of chronic
CO2 retention; low-flow oxygen (1–2 L/min via nasal cannula) prevents suppressing that drive while
still improving oxygenation. High-flow devices risk worsening hypercapnia and respiratory
depression.
,4. NGN Extended Multiple Response: A nurse is assessing a client suspected of having left-sided
heart failure. Select all findings the nurse would expect. (Select all that apply.)
■ Crackles in the lung bases
■ Jugular vein distention
■ Dyspnea on exertion
■ Peripheral edema
■ Orthopnea
■ Hepatomegaly
✓ Answer: Crackles in the lung bases; Dyspnea on exertion; Orthopnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation, producing
pulmonary congestion manifested as crackles, dyspnea, and orthopnea. Jugular vein distention,
peripheral edema, and hepatomegaly result from systemic venous congestion and are findings of
right-sided heart failure.
5. A client develops chest pain, diaphoresis, and shortness of breath. An ECG shows ST-segment
elevation. Which action is the nurse's priority?
A. Obtain a 12-lead ECG in 30 minutes to compare
B. Administer sublingual nitroglycerin and notify the provider immediately
C. Ask the client to ambulate to assess tolerance
D. Document findings and reassess in 1 hour
✓ Answer: B
Rationale: ST-segment elevation with chest pain indicates an acute myocardial infarction (STEMI);
the priority is to relieve ischemia and initiate rapid treatment (time is myocardium), so nitroglycerin is
given and the provider/rapid response team is notified immediately. Delaying care or having the client
exert themselves is unsafe.
6. The nurse is teaching a client newly diagnosed with hypertension about lifestyle modification.
Which statement indicates a need for further teaching?
A. "I will try to limit my sodium intake to less than 2,300 mg per day."
B. "I can stop my medication once my blood pressure is normal."
C. "I should aim for at least 150 minutes of moderate exercise weekly."
D. "I will limit alcohol to no more than one drink per day."
✓ Answer: B
Rationale: Hypertension medications control, but do not cure, hypertension; stopping medication
when blood pressure normalizes will cause it to rise again and increases the risk of complications.
The other statements reflect correct understanding of DASH-diet, exercise, and alcohol
recommendations.
, 7. A client with atrial fibrillation is started on warfarin. Which lab value does the nurse monitor to
evaluate therapeutic effect?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
D. D-dimer
✓ Answer: B
Rationale: Warfarin therapy is monitored using the INR, with a therapeutic goal typically between
2.0–3.0 for most indications including atrial fibrillation. PTT monitors heparin therapy, not warfarin.
8. A client is admitted with an exacerbation of asthma. Which assessment finding is most
concerning and suggests worsening respiratory status?
A. Loud expiratory wheezing
B. Respiratory rate of 28/min with wheezing
C. Diminished breath sounds with minimal wheezing
D. Use of accessory muscles
✓ Answer: C
Rationale: Diminished or absent breath sounds during an asthma exacerbation indicate severely
reduced air movement ("silent chest") and impending respiratory failure — a critical warning sign, not
improvement. Loud wheezing and accessory muscle use indicate increased work of breathing but
ongoing air movement.
9. A client returns from surgery with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. What is the priority nursing action?
A. Clamp the chest tube immediately
B. Check the system for an air leak
C. Increase the suction pressure
D. Document as an expected finding
✓ Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak somewhere in the
system (not the lung, which produces intermittent bubbling); the nurse should assess connections
and tubing to locate and correct the leak. Clamping the tube is contraindicated as it can cause a
tension pneumothorax.
