HESI RN Fundamentals Exit Exam: 100 Actual
Questions with Rationales & Verified Answers – 7th
Edition by Sandra L. Upchurch, Linda Anne Silvestri,
and Angela Elizabeth Silvestri
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results show pH 7.25, PaCO2 65 mm Hg, HCO3- 26
mEq/L. The nurse notes that the patient is somnolent and has a respiratory rate of 8 breaths per
minute. Which intervention should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Prepare for noninvasive positive pressure ventilation (NIPPV)
C. Administer intravenous sodium bicarbonate
D. Increase the IV fluid rate to 150 mL/hour
Answer: B
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2) with acute
hypoventilation. NIPPV is the first-line intervention to improve ventilation and correct acidosis without
intubation. High-flow oxygen may worsen hypercapnia in COPD. Sodium bicarbonate is not indicated
because acidosis is respiratory, not metabolic. IV fluids do not address the underlying hypoventilation.
2. A patient with a history of type 2 diabetes mellitus is admitted with a wound infection. The nurse
notes that the patient's blood glucose level is 320 mg/dL. The patient is receiving insulin glargine 30
units subcutaneously at bedtime and insulin aspart 6 units subcutaneously before meals. Which
action should the nurse take?
A. Administer an additional 6 units of insulin aspart now
B. Hold the next dose of insulin glargine until blood glucose is < 200 mg/dL
C. Increase the insulin glargine dose to 40 units tonight
D. Administer the insulin aspart as scheduled and monitor blood glucose
Answer: D
Rationale: Insulin aspart is a rapid-acting insulin given before meals to cover postprandial glucose. The
nurse should administer the scheduled dose and monitor. Additional insulin aspart without a sliding
scale could cause hypoglycemia. Insulin glargine is a long-acting basal insulin; holding or increasing it
without evaluation is inappropriate. The elevated glucose likely requires a correction dose per sliding
scale, but the scheduled dose is given first.
Page 1
,3. A patient is receiving a continuous intravenous infusion of heparin for deep vein thrombosis.
The current aPTT is 120 seconds (therapeutic range 60-80 seconds). The nurse reviews the
prescription: 'Adjust heparin infusion per aPTT protocol: if aPTT > 100 seconds, stop infusion for
1 hour and restart at 50% of previous rate.' Which action should the nurse take?
A. Stop the infusion for 1 hour, then restart at the same rate
B. Stop the infusion for 1 hour, then restart at 50% of the previous rate
C. Decrease the infusion rate by 50% without stopping
D. Continue the infusion at the current rate and recheck aPTT in 6 hours
Answer: B
Rationale: The aPTT is supratherapeutic, indicating increased bleeding risk. The protocol specifies
stopping the infusion for 1 hour and restarting at 50% of the previous rate. Option A restarts at the same
rate, which would not reduce the dose. Option C does not include the required stop. Option D continues
the infusion, risking bleeding.
4. A patient with a history of heart failure is admitted with dyspnea and peripheral edema. The
nurse administers furosemide 40 mg intravenously. One hour later, the patient's urine output is 50
mL. The nurse reviews the medical record: serum creatinine 2.8 mg/dL, BUN 45 mg/dL, and
potassium 3.2 mEq/L. Which action should the nurse take first?
A. Administer another dose of furosemide 40 mg IV
B. Administer potassium chloride 20 mEq IV
C. Notify the healthcare provider of the low urine output and electrolyte values
D. Increase the IV fluid rate to promote urine output
Answer: C
Rationale: The patient has acute kidney injury (elevated creatinine and BUN) with hypokalemia and poor
response to furosemide. Administering more furosemide could worsen kidney function. Potassium
replacement is needed but should be done cautiously with renal impairment; the provider should be
notified first to adjust orders. Increasing IV fluids could cause fluid overload in heart failure.
5. A patient with a diagnosis of sepsis is receiving norepinephrine via central line. The nurse
notices that the infusion site is erythematous and the patient complains of pain at the insertion site.
Which action should the nurse take?
A. Apply a warm compress to the site and continue the infusion
B. Stop the infusion and remove the central line immediately
C. Assess for infiltration and notify the healthcare provider
D. Decrease the norepinephrine infusion rate and document findings
Answer: C
Rationale: Norepinephrine is a vasopressor that can cause tissue necrosis if extravasation occurs.
Erythema and pain suggest possible infiltration. The nurse should stop the infusion, assess for
infiltration (e.g., swelling, coolness), and notify the provider for further management. Warm compresses
are not indicated; vasopressor extravasation may require phentolamine. Removing the line without
assessment is premature.
Page 2
,6. A patient with a history of liver cirrhosis is admitted with hematemesis. The nurse inserts a
nasogastric tube and aspirates bright red blood. Vital signs: BP 90/60 mm Hg, HR 110 bpm, RR
22/min. Which intervention should the nurse implement first?
A. Administer intravenous pantoprazole
B. Prepare for emergency upper endoscopy
C. Initiate a blood transfusion of packed red blood cells
D. Administer intravenous octreotide
Answer: C
Rationale: The patient is hemodynamically unstable with hypotension and tachycardia from active
bleeding. The priority is to restore circulating volume with blood transfusion. Pantoprazole and
octreotide are important adjuncts but do not address immediate hypovolemia. Endoscopy is definitive
but not the first step in unstable patients.
7. A patient is prescribed a continuous feeding via nasogastric tube at 50 mL/hour. The nurse
checks the gastric residual and obtains 200 mL. Which action should the nurse take?
A. Discard the residual and continue the feeding at the same rate
B. Hold the feeding and recheck residual in 1 hour
C. Return the residual and continue the feeding at 50 mL/hour
D. Decrease the feeding rate to 25 mL/hour and recheck residual in 4 hours
Answer: C
Rationale: Current guidelines recommend returning gastric residuals to the stomach to avoid electrolyte
and fluid losses. A residual of 200 mL is less than 250 mL (common threshold for holding), so the
feeding can continue. Holding or decreasing the rate is not necessary. Discarding residual is outdated
practice.
8. A patient with a history of opioid use disorder is admitted for surgery. The nurse is planning
pain management postoperatively. Which intervention is most appropriate?
A. Administer opioids only as needed and at the lowest effective dose
B. Use a multimodal approach including non-opioid analgesics and regional anesthesia
C. Avoid opioids entirely to prevent relapse
D. Administer opioids on a fixed schedule to prevent withdrawal
Answer: B
Rationale: Multimodal analgesia reduces opioid requirements and addresses pain through different
mechanisms, minimizing risk of relapse. Avoiding opioids entirely may lead to undertreated pain. Fixed
scheduling without regard to pain level is not recommended. As-needed dosing may be insufficient. The
best approach combines non-opioid adjuncts with opioids if needed, with careful monitoring.
9. A patient with a diagnosis of acute pancreatitis is receiving nothing by mouth (NPO). The nurse
notes that the patient's serum calcium is 7.2 mg/dL (normal 8.5-10.5 mg/dL). Which assessment
finding is most concerning?
A. Positive Trousseau's sign
B. Nausea and vomiting
Page 3
, C. Abdominal pain rated 6/10
D. Serum amylase 400 U/L
Answer: A
Rationale: Hypocalcemia can occur in acute pancreatitis due to saponification. A positive Trousseau's
sign indicates neuromuscular irritability and risk of tetany, which is a medical emergency. Nausea, pain,
and elevated amylase are expected findings in pancreatitis but not immediately life-threatening like
tetany.
10. A patient is prescribed a one-time dose of gentamicin 120 mg intravenously. The nurse reviews
the patient's medication administration record and notes that the patient received gentamicin 80
mg intravenously 8 hours ago. Which action should the nurse take?
A. Administer the 120 mg dose as prescribed
B. Hold the dose and notify the healthcare provider
C. Administer a reduced dose of 40 mg
D. Administer the dose and monitor renal function
Answer: B
Rationale: Gentamicin is an aminoglycoside with a dosing interval typically every 24 hours or longer
depending on renal function. Administering another dose 8 hours after the previous one could lead to
toxic levels, especially if the patient has impaired renal function. The nurse should hold the dose and
verify the prescription with the provider. Reducing the dose without an order is unsafe.
11. A nurse is providing discharge teaching to a client who has a new prescription for warfarin.
Which laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT)
D. Platelet count
Answer: B
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. The INR is the
standardized measure of PT and is used to monitor warfarin therapy. aPTT monitors heparin, PT alone
is not standardized, and platelet count assesses thrombocytopenia.
12. A client with chronic kidney disease is prescribed a restricted protein diet. The nurse
understands that the primary rationale for this restriction is to:
A. Reduce the workload on the liver
B. Decrease the production of nitrogenous wastes
C. Prevent hyperkalemia
D. Maintain serum albumin levels
Answer: B
Rationale: In chronic kidney disease, the kidneys cannot excrete nitrogenous wastes (urea, creatinine)
from protein metabolism. Restricting protein reduces these wastes, delaying the need for dialysis. Liver
workload is not the primary concern; hyperkalemia is managed by limiting potassium, not protein; and
Page 4
Questions with Rationales & Verified Answers – 7th
Edition by Sandra L. Upchurch, Linda Anne Silvestri,
and Angela Elizabeth Silvestri
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results show pH 7.25, PaCO2 65 mm Hg, HCO3- 26
mEq/L. The nurse notes that the patient is somnolent and has a respiratory rate of 8 breaths per
minute. Which intervention should the nurse implement first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Prepare for noninvasive positive pressure ventilation (NIPPV)
C. Administer intravenous sodium bicarbonate
D. Increase the IV fluid rate to 150 mL/hour
Answer: B
Rationale: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2) with acute
hypoventilation. NIPPV is the first-line intervention to improve ventilation and correct acidosis without
intubation. High-flow oxygen may worsen hypercapnia in COPD. Sodium bicarbonate is not indicated
because acidosis is respiratory, not metabolic. IV fluids do not address the underlying hypoventilation.
2. A patient with a history of type 2 diabetes mellitus is admitted with a wound infection. The nurse
notes that the patient's blood glucose level is 320 mg/dL. The patient is receiving insulin glargine 30
units subcutaneously at bedtime and insulin aspart 6 units subcutaneously before meals. Which
action should the nurse take?
A. Administer an additional 6 units of insulin aspart now
B. Hold the next dose of insulin glargine until blood glucose is < 200 mg/dL
C. Increase the insulin glargine dose to 40 units tonight
D. Administer the insulin aspart as scheduled and monitor blood glucose
Answer: D
Rationale: Insulin aspart is a rapid-acting insulin given before meals to cover postprandial glucose. The
nurse should administer the scheduled dose and monitor. Additional insulin aspart without a sliding
scale could cause hypoglycemia. Insulin glargine is a long-acting basal insulin; holding or increasing it
without evaluation is inappropriate. The elevated glucose likely requires a correction dose per sliding
scale, but the scheduled dose is given first.
Page 1
,3. A patient is receiving a continuous intravenous infusion of heparin for deep vein thrombosis.
The current aPTT is 120 seconds (therapeutic range 60-80 seconds). The nurse reviews the
prescription: 'Adjust heparin infusion per aPTT protocol: if aPTT > 100 seconds, stop infusion for
1 hour and restart at 50% of previous rate.' Which action should the nurse take?
A. Stop the infusion for 1 hour, then restart at the same rate
B. Stop the infusion for 1 hour, then restart at 50% of the previous rate
C. Decrease the infusion rate by 50% without stopping
D. Continue the infusion at the current rate and recheck aPTT in 6 hours
Answer: B
Rationale: The aPTT is supratherapeutic, indicating increased bleeding risk. The protocol specifies
stopping the infusion for 1 hour and restarting at 50% of the previous rate. Option A restarts at the same
rate, which would not reduce the dose. Option C does not include the required stop. Option D continues
the infusion, risking bleeding.
4. A patient with a history of heart failure is admitted with dyspnea and peripheral edema. The
nurse administers furosemide 40 mg intravenously. One hour later, the patient's urine output is 50
mL. The nurse reviews the medical record: serum creatinine 2.8 mg/dL, BUN 45 mg/dL, and
potassium 3.2 mEq/L. Which action should the nurse take first?
A. Administer another dose of furosemide 40 mg IV
B. Administer potassium chloride 20 mEq IV
C. Notify the healthcare provider of the low urine output and electrolyte values
D. Increase the IV fluid rate to promote urine output
Answer: C
Rationale: The patient has acute kidney injury (elevated creatinine and BUN) with hypokalemia and poor
response to furosemide. Administering more furosemide could worsen kidney function. Potassium
replacement is needed but should be done cautiously with renal impairment; the provider should be
notified first to adjust orders. Increasing IV fluids could cause fluid overload in heart failure.
5. A patient with a diagnosis of sepsis is receiving norepinephrine via central line. The nurse
notices that the infusion site is erythematous and the patient complains of pain at the insertion site.
Which action should the nurse take?
A. Apply a warm compress to the site and continue the infusion
B. Stop the infusion and remove the central line immediately
C. Assess for infiltration and notify the healthcare provider
D. Decrease the norepinephrine infusion rate and document findings
Answer: C
Rationale: Norepinephrine is a vasopressor that can cause tissue necrosis if extravasation occurs.
Erythema and pain suggest possible infiltration. The nurse should stop the infusion, assess for
infiltration (e.g., swelling, coolness), and notify the provider for further management. Warm compresses
are not indicated; vasopressor extravasation may require phentolamine. Removing the line without
assessment is premature.
Page 2
,6. A patient with a history of liver cirrhosis is admitted with hematemesis. The nurse inserts a
nasogastric tube and aspirates bright red blood. Vital signs: BP 90/60 mm Hg, HR 110 bpm, RR
22/min. Which intervention should the nurse implement first?
A. Administer intravenous pantoprazole
B. Prepare for emergency upper endoscopy
C. Initiate a blood transfusion of packed red blood cells
D. Administer intravenous octreotide
Answer: C
Rationale: The patient is hemodynamically unstable with hypotension and tachycardia from active
bleeding. The priority is to restore circulating volume with blood transfusion. Pantoprazole and
octreotide are important adjuncts but do not address immediate hypovolemia. Endoscopy is definitive
but not the first step in unstable patients.
7. A patient is prescribed a continuous feeding via nasogastric tube at 50 mL/hour. The nurse
checks the gastric residual and obtains 200 mL. Which action should the nurse take?
A. Discard the residual and continue the feeding at the same rate
B. Hold the feeding and recheck residual in 1 hour
C. Return the residual and continue the feeding at 50 mL/hour
D. Decrease the feeding rate to 25 mL/hour and recheck residual in 4 hours
Answer: C
Rationale: Current guidelines recommend returning gastric residuals to the stomach to avoid electrolyte
and fluid losses. A residual of 200 mL is less than 250 mL (common threshold for holding), so the
feeding can continue. Holding or decreasing the rate is not necessary. Discarding residual is outdated
practice.
8. A patient with a history of opioid use disorder is admitted for surgery. The nurse is planning
pain management postoperatively. Which intervention is most appropriate?
A. Administer opioids only as needed and at the lowest effective dose
B. Use a multimodal approach including non-opioid analgesics and regional anesthesia
C. Avoid opioids entirely to prevent relapse
D. Administer opioids on a fixed schedule to prevent withdrawal
Answer: B
Rationale: Multimodal analgesia reduces opioid requirements and addresses pain through different
mechanisms, minimizing risk of relapse. Avoiding opioids entirely may lead to undertreated pain. Fixed
scheduling without regard to pain level is not recommended. As-needed dosing may be insufficient. The
best approach combines non-opioid adjuncts with opioids if needed, with careful monitoring.
9. A patient with a diagnosis of acute pancreatitis is receiving nothing by mouth (NPO). The nurse
notes that the patient's serum calcium is 7.2 mg/dL (normal 8.5-10.5 mg/dL). Which assessment
finding is most concerning?
A. Positive Trousseau's sign
B. Nausea and vomiting
Page 3
, C. Abdominal pain rated 6/10
D. Serum amylase 400 U/L
Answer: A
Rationale: Hypocalcemia can occur in acute pancreatitis due to saponification. A positive Trousseau's
sign indicates neuromuscular irritability and risk of tetany, which is a medical emergency. Nausea, pain,
and elevated amylase are expected findings in pancreatitis but not immediately life-threatening like
tetany.
10. A patient is prescribed a one-time dose of gentamicin 120 mg intravenously. The nurse reviews
the patient's medication administration record and notes that the patient received gentamicin 80
mg intravenously 8 hours ago. Which action should the nurse take?
A. Administer the 120 mg dose as prescribed
B. Hold the dose and notify the healthcare provider
C. Administer a reduced dose of 40 mg
D. Administer the dose and monitor renal function
Answer: B
Rationale: Gentamicin is an aminoglycoside with a dosing interval typically every 24 hours or longer
depending on renal function. Administering another dose 8 hours after the previous one could lead to
toxic levels, especially if the patient has impaired renal function. The nurse should hold the dose and
verify the prescription with the provider. Reducing the dose without an order is unsafe.
11. A nurse is providing discharge teaching to a client who has a new prescription for warfarin.
Which laboratory value should the nurse monitor to evaluate the therapeutic effect of this
medication?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Prothrombin time (PT)
D. Platelet count
Answer: B
Rationale: Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. The INR is the
standardized measure of PT and is used to monitor warfarin therapy. aPTT monitors heparin, PT alone
is not standardized, and platelet count assesses thrombocytopenia.
12. A client with chronic kidney disease is prescribed a restricted protein diet. The nurse
understands that the primary rationale for this restriction is to:
A. Reduce the workload on the liver
B. Decrease the production of nitrogenous wastes
C. Prevent hyperkalemia
D. Maintain serum albumin levels
Answer: B
Rationale: In chronic kidney disease, the kidneys cannot excrete nitrogenous wastes (urea, creatinine)
from protein metabolism. Restricting protein reduces these wastes, delaying the need for dialysis. Liver
workload is not the primary concern; hyperkalemia is managed by limiting potassium, not protein; and
Page 4
