2025/26 HESI RN Exit Exam Versions 1 - 7 Multiple
Choice Questions & Answers (Verified Answers),
100% Guaranteed Pass ||Complete A+ Guide - PDF
with rationale
1. A client with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (6.8 mEq/L)
and metabolic acidosis. The provider orders intravenous sodium bicarbonate, calcium gluconate,
and regular insulin with dextrose 50%. Which nursing action is most critical prior to
administering these medications?
A. Verify the client's serum potassium level has been rechecked within the last hour.
B. Assess the client's IV site for patency and signs of infiltration.
C. Obtain a 12-lead electrocardiogram (ECG) and monitor for cardiac dysrhythmias.
D. Review the client's most recent serum calcium level to avoid hypocalcemia.
Answer: C
Rationale: In severe hyperkalemia, life-threatening cardiac dysrhythmias are the priority. An ECG
provides immediate information about potassium's effect on the heart (e.g., peaked T waves, widened
QRS). While assessing IV site and rechecking labs are important, they do not address the immediate risk
of cardiac arrest. Calcium gluconate is given to stabilize the myocardium, but ECG monitoring is
essential to guide therapy and detect deterioration.
2. A nurse is caring for a client with a traumatic brain injury (TBI) who has an intracranial
pressure (ICP) monitor reading of 22 mm Hg (normal 5-15 mm Hg). Which intervention should
the nurse question?
A. Administering 100 mL of 3% hypertonic saline intravenously over 30 minutes.
B. Elevating the head of the bed to 30 degrees and maintaining head midline.
C. Suctioning the endotracheal tube every 2 hours with pre-oxygenation.
D. Administering fentanyl 50 mcg IV push for pain management.
Answer: C
Rationale: Routine suctioning without clinical indication can increase ICP due to coughing and vagal
stimulation. Suctioning should be performed only when needed and with pre-oxygenation and limited
passes. Hypertonic saline and head elevation are appropriate for ICP reduction. Fentanyl is used
cautiously but can be given for pain as long as it does not cause hypotension or respiratory depression.
3. A client receiving a continuous infusion of heparin for deep vein thrombosis has an activated
partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse
notes coffee-ground emesis and a decrease in blood pressure. Which action should the nurse take
first?
Page 1
,A. Administer vitamin K intramuscularly.
B. Stop the heparin infusion immediately.
C. Increase the rate of intravenous fluids.
D. Prepare to administer protamine sulfate.
Answer: B
Rationale: The first action is to stop the heparin infusion to prevent further bleeding. Protamine sulfate is
the reversal agent but should be prepared after stopping the infusion. Vitamin K reverses warfarin, not
heparin. IV fluids may be needed but are not the priority over stopping the anticoagulant.
4. A nurse is assessing a client with suspected acute respiratory distress syndrome (ARDS). Which
finding is most indicative of the condition?
A. PaO2 of 80 mm Hg on 40% oxygen via face mask.
B. Bilateral infiltrates on chest X-ray with a normal pulmonary artery wedge pressure (PAWP).
C. Elevated brain natriuretic peptide (BNP) level of 800 pg/mL.
D. Decreased breath sounds and dullness to percussion on the right side.
Answer: B
Rationale: ARDS is characterized by bilateral pulmonary infiltrates (non-cardiogenic pulmonary edema)
with a PAWP 18 mm Hg, indicating that the edema is not due to left heart failure. A PaO2 of 80 mm Hg
on 40% oxygen is relatively good and not typical of ARDS. Elevated BNP suggests heart failure.
Decreased breath sounds and dullness suggest pleural effusion.
5. A nurse is providing discharge teaching to a client who had a kidney transplant. Which
statement by the client indicates a need for further instruction?
A. I will take my immunosuppressant medications at the same time every day.
B. I should avoid large crowds and people who are sick for the next few months.
C. If I have a fever, I will take acetaminophen and call the clinic if it persists.
D. I will monitor my urine output and weigh myself daily.
Answer: C
Rationale: Fever is a sign of infection or rejection; the client should notify the transplant team
immediately rather than self-treating with acetaminophen. Immunosuppressed clients require prompt
evaluation of fever. The other statements reflect correct understanding of medication adherence,
infection avoidance, and self-monitoring.
6. A nurse is caring for a client with diabetic ketoacidosis (DKA) who has an initial blood glucose
of 650 mg/dL. The provider orders an insulin infusion at 0.1 units/kg/hour. Which laboratory value
requires the most immediate intervention?
A. Serum potassium 3.2 mEq/L.
B. Serum bicarbonate 12 mEq/L.
C. Blood glucose 350 mg/dL after 2 hours.
D. Arterial pH 7.25.
Answer: A
Rationale: Hypokalemia (K+ 3.2 mEq/L) is life-threatening because insulin therapy drives potassium into
cells, potentially causing cardiac dysrhythmias. Potassium replacement is urgently needed before or
Page 2
,alongside insulin. Bicarbonate 12 mEq/L and pH 7.25 are expected in DKA and will correct with insulin
and fluids. Glucose dropping to 350 mg/dL is appropriate.
7. A client with major depressive disorder is started on phenelzine, a monoamine oxidase inhibitor
(MAOI). Which snack choice by the client indicates understanding of dietary restrictions?
A. Aged cheddar cheese with crackers.
B. Salami and Swiss cheese sandwich.
C. Fresh fruit salad with yogurt.
D. Pepperoni pizza.
Answer: C
Rationale: MAOIs require avoidance of tyramine-rich foods to prevent hypertensive crisis. Aged cheese,
cured meats (salami, pepperoni), and fermented foods are high in tyramine. Fresh fruit and yogurt (low
tyramine) are safe choices.
8. A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone (SIADH).
Which finding is most consistent with this condition?
A. Serum sodium 152 mEq/L and urine osmolality 100 mOsm/kg.
B. Serum sodium 120 mEq/L and urine osmolality 600 mOsm/kg.
C. Serum sodium 135 mEq/L and urine specific gravity 1.005.
D. Serum sodium 145 mEq/L and urine sodium 10 mEq/L.
Answer: B
Rationale: SIADH causes hyponatremia (low serum sodium) due to water retention, and inappropriately
concentrated urine (high urine osmolality >300 mOsm/kg). Option B shows hyponatremia (120 mEq/L)
with high urine osmolality (600 mOsm/kg), consistent with SIADH. Option A shows hypernatremia and
dilute urine, seen in diabetes insipidus. Option C shows normal sodium and dilute urine. Option D
shows high-normal sodium and low urine sodium, suggesting volume depletion.
9. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site.
B. Replace the drainage system immediately.
C. Assess the chest tube system for an air leak.
D. Increase the suction pressure to eliminate the bubbling.
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system. The nurse
should assess for the source of the leak (e.g., loose connections, dislodged tube). Clamping is dangerous
and can cause tension pneumothorax. Replacing the system is not the first step. Increasing suction may
worsen the leak or cause damage.
10. A nurse is preparing to administer a blood transfusion to a client with a history of multiple
transfusions. Which action is most important to prevent a transfusion reaction?
A. Pre-medicate with diphenhydramine and acetaminophen.
Page 3
, B. Use a leukocyte-reduced blood product.
C. Administer the blood through a 22-gauge IV catheter.
D. Obtain a baseline set of vital signs.
Answer: B
Rationale: Leukocyte-reduced blood products decrease the risk of febrile non-hemolytic transfusion
reactions, which are common in multiply transfused clients. Pre-medication may help but is not as
effective as leukoreduction. Baseline vitals are important but do not prevent reactions. A 22-gauge
catheter is acceptable but not the most important preventive measure.
11. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. Arterial blood gas results show pH 7.25, PaCO2 60 mm Hg, PaO2 50 mm Hg,
HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Administer oxygen via nasal cannula at 2 L/min.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous methylprednisolone.
Answer: A
Rationale: The ABG shows uncompensated respiratory acidosis with hypoxemia. For COPD patients with
acute hypercapnic respiratory failure, NIPPV is first-line to reduce work of breathing and improve gas
exchange, avoiding intubation if possible. Oxygen at low flow is needed but not the priority; intubation
is reserved for NIPPV failure or severe distress; steroids are adjunctive.
12. A nurse is assessing a client receiving a blood transfusion. Which finding indicates the need to
stop the transfusion immediately?
A. Temperature increase from 37.0°C to 37.5°C (98.6°F to 99.5°F).
B. Heart rate increase from 80 to 95 beats per minute.
C. Development of urticaria and wheezing.
D. Blood pressure decrease from 120/80 to 110/70 mm Hg.
Answer: C
Rationale: Urticaria and wheezing indicate an acute allergic or anaphylactic transfusion reaction,
requiring immediate cessation. A mild temperature increase may be a non-hemolytic febrile reaction, but
it does not mandate stopping if mild; heart rate and blood pressure changes are non-specific and could
be due to volume or anxiety.
13. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment finding
indicates the medication is effective?
A. Increase in urine output to 200 mL over 2 hours.
B. Decrease in peripheral edema by 1+.
C. Decrease in pulmonary artery wedge pressure (PAWP) to 8 mm Hg.
D. Increase in serum potassium level from 3.5 to 4.2 mEq/L.
Answer: C
Rationale: Furosemide reduces preload by promoting diuresis, leading to decreased PAWP (normal 4-12
mm Hg), indicating reduced left ventricular filling pressure. Increased urine output and decreased
Page 4
Choice Questions & Answers (Verified Answers),
100% Guaranteed Pass ||Complete A+ Guide - PDF
with rationale
1. A client with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia (6.8 mEq/L)
and metabolic acidosis. The provider orders intravenous sodium bicarbonate, calcium gluconate,
and regular insulin with dextrose 50%. Which nursing action is most critical prior to
administering these medications?
A. Verify the client's serum potassium level has been rechecked within the last hour.
B. Assess the client's IV site for patency and signs of infiltration.
C. Obtain a 12-lead electrocardiogram (ECG) and monitor for cardiac dysrhythmias.
D. Review the client's most recent serum calcium level to avoid hypocalcemia.
Answer: C
Rationale: In severe hyperkalemia, life-threatening cardiac dysrhythmias are the priority. An ECG
provides immediate information about potassium's effect on the heart (e.g., peaked T waves, widened
QRS). While assessing IV site and rechecking labs are important, they do not address the immediate risk
of cardiac arrest. Calcium gluconate is given to stabilize the myocardium, but ECG monitoring is
essential to guide therapy and detect deterioration.
2. A nurse is caring for a client with a traumatic brain injury (TBI) who has an intracranial
pressure (ICP) monitor reading of 22 mm Hg (normal 5-15 mm Hg). Which intervention should
the nurse question?
A. Administering 100 mL of 3% hypertonic saline intravenously over 30 minutes.
B. Elevating the head of the bed to 30 degrees and maintaining head midline.
C. Suctioning the endotracheal tube every 2 hours with pre-oxygenation.
D. Administering fentanyl 50 mcg IV push for pain management.
Answer: C
Rationale: Routine suctioning without clinical indication can increase ICP due to coughing and vagal
stimulation. Suctioning should be performed only when needed and with pre-oxygenation and limited
passes. Hypertonic saline and head elevation are appropriate for ICP reduction. Fentanyl is used
cautiously but can be given for pain as long as it does not cause hypotension or respiratory depression.
3. A client receiving a continuous infusion of heparin for deep vein thrombosis has an activated
partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse
notes coffee-ground emesis and a decrease in blood pressure. Which action should the nurse take
first?
Page 1
,A. Administer vitamin K intramuscularly.
B. Stop the heparin infusion immediately.
C. Increase the rate of intravenous fluids.
D. Prepare to administer protamine sulfate.
Answer: B
Rationale: The first action is to stop the heparin infusion to prevent further bleeding. Protamine sulfate is
the reversal agent but should be prepared after stopping the infusion. Vitamin K reverses warfarin, not
heparin. IV fluids may be needed but are not the priority over stopping the anticoagulant.
4. A nurse is assessing a client with suspected acute respiratory distress syndrome (ARDS). Which
finding is most indicative of the condition?
A. PaO2 of 80 mm Hg on 40% oxygen via face mask.
B. Bilateral infiltrates on chest X-ray with a normal pulmonary artery wedge pressure (PAWP).
C. Elevated brain natriuretic peptide (BNP) level of 800 pg/mL.
D. Decreased breath sounds and dullness to percussion on the right side.
Answer: B
Rationale: ARDS is characterized by bilateral pulmonary infiltrates (non-cardiogenic pulmonary edema)
with a PAWP 18 mm Hg, indicating that the edema is not due to left heart failure. A PaO2 of 80 mm Hg
on 40% oxygen is relatively good and not typical of ARDS. Elevated BNP suggests heart failure.
Decreased breath sounds and dullness suggest pleural effusion.
5. A nurse is providing discharge teaching to a client who had a kidney transplant. Which
statement by the client indicates a need for further instruction?
A. I will take my immunosuppressant medications at the same time every day.
B. I should avoid large crowds and people who are sick for the next few months.
C. If I have a fever, I will take acetaminophen and call the clinic if it persists.
D. I will monitor my urine output and weigh myself daily.
Answer: C
Rationale: Fever is a sign of infection or rejection; the client should notify the transplant team
immediately rather than self-treating with acetaminophen. Immunosuppressed clients require prompt
evaluation of fever. The other statements reflect correct understanding of medication adherence,
infection avoidance, and self-monitoring.
6. A nurse is caring for a client with diabetic ketoacidosis (DKA) who has an initial blood glucose
of 650 mg/dL. The provider orders an insulin infusion at 0.1 units/kg/hour. Which laboratory value
requires the most immediate intervention?
A. Serum potassium 3.2 mEq/L.
B. Serum bicarbonate 12 mEq/L.
C. Blood glucose 350 mg/dL after 2 hours.
D. Arterial pH 7.25.
Answer: A
Rationale: Hypokalemia (K+ 3.2 mEq/L) is life-threatening because insulin therapy drives potassium into
cells, potentially causing cardiac dysrhythmias. Potassium replacement is urgently needed before or
Page 2
,alongside insulin. Bicarbonate 12 mEq/L and pH 7.25 are expected in DKA and will correct with insulin
and fluids. Glucose dropping to 350 mg/dL is appropriate.
7. A client with major depressive disorder is started on phenelzine, a monoamine oxidase inhibitor
(MAOI). Which snack choice by the client indicates understanding of dietary restrictions?
A. Aged cheddar cheese with crackers.
B. Salami and Swiss cheese sandwich.
C. Fresh fruit salad with yogurt.
D. Pepperoni pizza.
Answer: C
Rationale: MAOIs require avoidance of tyramine-rich foods to prevent hypertensive crisis. Aged cheese,
cured meats (salami, pepperoni), and fermented foods are high in tyramine. Fresh fruit and yogurt (low
tyramine) are safe choices.
8. A nurse is assessing a client with syndrome of inappropriate antidiuretic hormone (SIADH).
Which finding is most consistent with this condition?
A. Serum sodium 152 mEq/L and urine osmolality 100 mOsm/kg.
B. Serum sodium 120 mEq/L and urine osmolality 600 mOsm/kg.
C. Serum sodium 135 mEq/L and urine specific gravity 1.005.
D. Serum sodium 145 mEq/L and urine sodium 10 mEq/L.
Answer: B
Rationale: SIADH causes hyponatremia (low serum sodium) due to water retention, and inappropriately
concentrated urine (high urine osmolality >300 mOsm/kg). Option B shows hyponatremia (120 mEq/L)
with high urine osmolality (600 mOsm/kg), consistent with SIADH. Option A shows hypernatremia and
dilute urine, seen in diabetes insipidus. Option C shows normal sodium and dilute urine. Option D
shows high-normal sodium and low urine sodium, suggesting volume depletion.
9. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. Which action should the nurse take?
A. Clamp the chest tube near the insertion site.
B. Replace the drainage system immediately.
C. Assess the chest tube system for an air leak.
D. Increase the suction pressure to eliminate the bubbling.
Answer: C
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the system. The nurse
should assess for the source of the leak (e.g., loose connections, dislodged tube). Clamping is dangerous
and can cause tension pneumothorax. Replacing the system is not the first step. Increasing suction may
worsen the leak or cause damage.
10. A nurse is preparing to administer a blood transfusion to a client with a history of multiple
transfusions. Which action is most important to prevent a transfusion reaction?
A. Pre-medicate with diphenhydramine and acetaminophen.
Page 3
, B. Use a leukocyte-reduced blood product.
C. Administer the blood through a 22-gauge IV catheter.
D. Obtain a baseline set of vital signs.
Answer: B
Rationale: Leukocyte-reduced blood products decrease the risk of febrile non-hemolytic transfusion
reactions, which are common in multiply transfused clients. Pre-medication may help but is not as
effective as leukoreduction. Baseline vitals are important but do not prevent reactions. A 22-gauge
catheter is acceptable but not the most important preventive measure.
11. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory failure. Arterial blood gas results show pH 7.25, PaCO2 60 mm Hg, PaO2 50 mm Hg,
HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Administer oxygen via nasal cannula at 2 L/min.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous methylprednisolone.
Answer: A
Rationale: The ABG shows uncompensated respiratory acidosis with hypoxemia. For COPD patients with
acute hypercapnic respiratory failure, NIPPV is first-line to reduce work of breathing and improve gas
exchange, avoiding intubation if possible. Oxygen at low flow is needed but not the priority; intubation
is reserved for NIPPV failure or severe distress; steroids are adjunctive.
12. A nurse is assessing a client receiving a blood transfusion. Which finding indicates the need to
stop the transfusion immediately?
A. Temperature increase from 37.0°C to 37.5°C (98.6°F to 99.5°F).
B. Heart rate increase from 80 to 95 beats per minute.
C. Development of urticaria and wheezing.
D. Blood pressure decrease from 120/80 to 110/70 mm Hg.
Answer: C
Rationale: Urticaria and wheezing indicate an acute allergic or anaphylactic transfusion reaction,
requiring immediate cessation. A mild temperature increase may be a non-hemolytic febrile reaction, but
it does not mandate stopping if mild; heart rate and blood pressure changes are non-specific and could
be due to volume or anxiety.
13. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment finding
indicates the medication is effective?
A. Increase in urine output to 200 mL over 2 hours.
B. Decrease in peripheral edema by 1+.
C. Decrease in pulmonary artery wedge pressure (PAWP) to 8 mm Hg.
D. Increase in serum potassium level from 3.5 to 4.2 mEq/L.
Answer: C
Rationale: Furosemide reduces preload by promoting diuresis, leading to decreased PAWP (normal 4-12
mm Hg), indicating reduced left ventricular filling pressure. Increased urine output and decreased
Page 4
