PN HESI EXIT EXAM 300 ACTUAL TESTBANK QUESTIONS
AND CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
The HESI PN Exit Exam is a standardized, comprehensive assessment used
by practical nursing programs to evaluate a student's readiness for the
NCLEX-PN. It consists of 130 items, with 100 scored questions covering core
nursing content across all client needs categories, including safe and effective
care, health promotion, psychosocial integrity, and physiological integrity.
The exam incorporates Next Generation NCLEX (NGN) style questions, such
as case studies and bow-tie items, to test clinical judgment. A scoring system
provides a predictive probability of passing the NCLEX-PN, with scores
above 850 typically indicating a high likelihood of success on the first attempt.
1. A client with congestive heart failure is prescribed furosemide. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
through the kidneys, leading to hypokalemia. Hypokalemia can precipitate cardiac
dysrhythmias, especially in clients taking digitalis. While sodium, calcium, and
magnesium may be affected, potassium is the most critical and commonly
monitored parameter.
2. A client is receiving a blood transfusion and reports chills and low back pain.
What is the nurse’s priority action?
A. Slow the infusion rate
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Notify the healthcare provider
Answer: C. Stop the transfusion immediately
Rationale: Chills and low back pain are classic signs of an acute hemolytic
transfusion reaction, which can be fatal. The priority is to stop the transfusion to
prevent further hemolysis, then maintain IV access with normal saline, notify the
,provider, and monitor vital signs. Slowing the infusion or giving acetaminophen
does not address the life-threatening reaction.
3. A postoperative client has a prescription for morphine sulfate 4 mg IV every 4
hours PRN for severe pain. The nurse notes a respiratory rate of 10 breaths per
minute. What should the nurse do first?
A. Administer the morphine as prescribed
B. Hold the morphine and reassess in 30 minutes
C. Hold the morphine and notify the healthcare provider
D. Administer naloxone immediately
Answer: C. Hold the morphine and notify the healthcare provider
Rationale: A respiratory rate of 10 is below the normal range and indicates
respiratory depression, a known adverse effect of morphine. The nurse should hold
the dose and notify the provider for further orders. Naloxone is reserved for severe
overdose with apnea or unresponsiveness, not for mild bradypnea.
4. A client with diabetes mellitus type 2 has a fasting blood glucose of 180 mg/dL.
The healthcare provider prescribes metformin. Which statement by the client
indicates a need for further teaching?
A. I will take this medication with meals to reduce stomach upset.
B. I should avoid drinking alcohol while taking this drug.
C. I can stop my diet because this medicine controls my sugar.
D. I need to watch for signs of lactic acidosis.
Answer: C. I can stop my diet because this medicine controls my sugar.
Rationale: Metformin is an adjunct to diet and exercise, not a replacement. Clients
must continue dietary management. Taking metformin with meals reduces GI
distress, alcohol increases lactic acidosis risk, and signs of lactic acidosis include
muscle pain and malaise, all of which are correct statements.
5. A nurse is caring for a client with a nasogastric tube attached to low intermittent
suction. Which electrolyte imbalance is most likely to occur?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Nasogastric suction removes gastric fluids that contain potassium,
chloride, and hydrogen ions. Prolonged suction leads to hypokalemic,
hypochloremic metabolic alkalosis. The other options are not typically associated
with NG suction losses.
,6. A client on warfarin has an international normalized ratio (INR) of 4.5. The
nurse should anticipate which intervention?
A. Increasing the warfarin dose
B. Administering vitamin K
C. Administering protamine sulfate
D. Continuing the current dose
Answer: B. Administering vitamin K
Rationale: The therapeutic INR for most conditions is 2.0 to 3.0. An INR of 4.5
indicates excessive anticoagulation and a high bleeding risk. Vitamin K is the
antidote for warfarin. Protamine sulfate is for heparin overdose.
7. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The nurse should apply oxygen at which rate?
A. 2 L/min via nasal cannula
B. 6 L/min via nasal cannula
C. 10 L/min via face mask
D. 15 L/min via non-rebreather mask
Answer: A. 2 L/min via nasal cannula
Rationale: Clients with COPD often have chronic hypercapnia and rely on hypoxic
drive for respiration. High-flow oxygen can suppress this drive and cause
respiratory failure. Low-flow oxygen at 1-2 L/min is standard to maintain
saturation between 88-92% without depressing ventilation.
8. A postpartum client who is Rh-negative gives birth to an Rh-positive infant.
Which medication should the nurse anticipate administering?
A. Oxytocin
B. Rho(D) immune globulin
C. Methylergonovine
D. Misoprostol
Answer: B. Rho(D) immune globulin
Rationale: Rho(D) immune globulin (RhoGAM) is given to Rh-negative mothers
who deliver Rh-positive infants to prevent maternal sensitization and hemolytic
disease of the newborn in subsequent pregnancies. It should be given within 72
hours of delivery.
9. A client with peptic ulcer disease reports burning epigastric pain that improves
after eating. The nurse suspects which type of ulcer?
A. Duodenal ulcer
B. Gastric ulcer
, C. Stress ulcer
D. Esophageal ulcer
Answer: A. Duodenal ulcer
Rationale: Duodenal ulcers typically cause pain that occurs 2-3 hours after meals
and is relieved by food or antacids because food buffers gastric acid. Gastric ulcers
often worsen with eating. Stress ulcers are related to critical illness, and esophageal
ulcers are associated with reflux.
10. A nurse is preparing to administer an intramuscular injection to a thin older
adult. Which needle size is most appropriate?
A. 18 gauge, 1.5 inches
B. 21 gauge, 1 inch
C. 25 gauge, 5/8 inch
D. 22 gauge, 1.5 inches
Answer: C. 25 gauge, 5/8 inch
Rationale: Thin older adults have reduced muscle mass, so a shorter needle (5/8
inch) with a smaller gauge (25) is appropriate to ensure intramuscular delivery
without hitting bone. Longer needles increase the risk of periosteal injury.
11. A client with severe preeclampsia is receiving magnesium sulfate. Which
finding indicates magnesium toxicity?
A. Deep tendon reflexes 2+
B. Respiratory rate 14 breaths/min
C. Urinary output of 100 mL in 4 hours
D. Serum magnesium level of 6 mEq/L
Answer: C. Urinary output of 100 mL in 4 hours
Rationale: Magnesium toxicity is associated with loss of deep tendon reflexes (not
2+), respiratory depression (below 12), and oliguria (less than 30 mL/hr or 120 mL
in 4 hours). A serum level of 6 mEq/L is within therapeutic range (4-7 mEq/L).
Oliguria indicates reduced excretion, leading to accumulation.
12. A client is prescribed digoxin. Which finding would indicate digoxin toxicity?
A. Heart rate of 68 beats per minute
B. Serum digoxin level of 1.2 ng/mL
C. Yellow-green halos around lights
D. Blood pressure of 120/80 mmHg
Answer: C. Yellow-green halos around lights
Rationale: Visual disturbances such as yellow-green halos, blurred vision, and
photophobia are classic signs of digoxin toxicity. A normal heart rate and
AND CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
The HESI PN Exit Exam is a standardized, comprehensive assessment used
by practical nursing programs to evaluate a student's readiness for the
NCLEX-PN. It consists of 130 items, with 100 scored questions covering core
nursing content across all client needs categories, including safe and effective
care, health promotion, psychosocial integrity, and physiological integrity.
The exam incorporates Next Generation NCLEX (NGN) style questions, such
as case studies and bow-tie items, to test clinical judgment. A scoring system
provides a predictive probability of passing the NCLEX-PN, with scores
above 850 typically indicating a high likelihood of success on the first attempt.
1. A client with congestive heart failure is prescribed furosemide. Which
laboratory value should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium loss
through the kidneys, leading to hypokalemia. Hypokalemia can precipitate cardiac
dysrhythmias, especially in clients taking digitalis. While sodium, calcium, and
magnesium may be affected, potassium is the most critical and commonly
monitored parameter.
2. A client is receiving a blood transfusion and reports chills and low back pain.
What is the nurse’s priority action?
A. Slow the infusion rate
B. Administer acetaminophen
C. Stop the transfusion immediately
D. Notify the healthcare provider
Answer: C. Stop the transfusion immediately
Rationale: Chills and low back pain are classic signs of an acute hemolytic
transfusion reaction, which can be fatal. The priority is to stop the transfusion to
prevent further hemolysis, then maintain IV access with normal saline, notify the
,provider, and monitor vital signs. Slowing the infusion or giving acetaminophen
does not address the life-threatening reaction.
3. A postoperative client has a prescription for morphine sulfate 4 mg IV every 4
hours PRN for severe pain. The nurse notes a respiratory rate of 10 breaths per
minute. What should the nurse do first?
A. Administer the morphine as prescribed
B. Hold the morphine and reassess in 30 minutes
C. Hold the morphine and notify the healthcare provider
D. Administer naloxone immediately
Answer: C. Hold the morphine and notify the healthcare provider
Rationale: A respiratory rate of 10 is below the normal range and indicates
respiratory depression, a known adverse effect of morphine. The nurse should hold
the dose and notify the provider for further orders. Naloxone is reserved for severe
overdose with apnea or unresponsiveness, not for mild bradypnea.
4. A client with diabetes mellitus type 2 has a fasting blood glucose of 180 mg/dL.
The healthcare provider prescribes metformin. Which statement by the client
indicates a need for further teaching?
A. I will take this medication with meals to reduce stomach upset.
B. I should avoid drinking alcohol while taking this drug.
C. I can stop my diet because this medicine controls my sugar.
D. I need to watch for signs of lactic acidosis.
Answer: C. I can stop my diet because this medicine controls my sugar.
Rationale: Metformin is an adjunct to diet and exercise, not a replacement. Clients
must continue dietary management. Taking metformin with meals reduces GI
distress, alcohol increases lactic acidosis risk, and signs of lactic acidosis include
muscle pain and malaise, all of which are correct statements.
5. A nurse is caring for a client with a nasogastric tube attached to low intermittent
suction. Which electrolyte imbalance is most likely to occur?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Nasogastric suction removes gastric fluids that contain potassium,
chloride, and hydrogen ions. Prolonged suction leads to hypokalemic,
hypochloremic metabolic alkalosis. The other options are not typically associated
with NG suction losses.
,6. A client on warfarin has an international normalized ratio (INR) of 4.5. The
nurse should anticipate which intervention?
A. Increasing the warfarin dose
B. Administering vitamin K
C. Administering protamine sulfate
D. Continuing the current dose
Answer: B. Administering vitamin K
Rationale: The therapeutic INR for most conditions is 2.0 to 3.0. An INR of 4.5
indicates excessive anticoagulation and a high bleeding risk. Vitamin K is the
antidote for warfarin. Protamine sulfate is for heparin overdose.
7. A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. The nurse should apply oxygen at which rate?
A. 2 L/min via nasal cannula
B. 6 L/min via nasal cannula
C. 10 L/min via face mask
D. 15 L/min via non-rebreather mask
Answer: A. 2 L/min via nasal cannula
Rationale: Clients with COPD often have chronic hypercapnia and rely on hypoxic
drive for respiration. High-flow oxygen can suppress this drive and cause
respiratory failure. Low-flow oxygen at 1-2 L/min is standard to maintain
saturation between 88-92% without depressing ventilation.
8. A postpartum client who is Rh-negative gives birth to an Rh-positive infant.
Which medication should the nurse anticipate administering?
A. Oxytocin
B. Rho(D) immune globulin
C. Methylergonovine
D. Misoprostol
Answer: B. Rho(D) immune globulin
Rationale: Rho(D) immune globulin (RhoGAM) is given to Rh-negative mothers
who deliver Rh-positive infants to prevent maternal sensitization and hemolytic
disease of the newborn in subsequent pregnancies. It should be given within 72
hours of delivery.
9. A client with peptic ulcer disease reports burning epigastric pain that improves
after eating. The nurse suspects which type of ulcer?
A. Duodenal ulcer
B. Gastric ulcer
, C. Stress ulcer
D. Esophageal ulcer
Answer: A. Duodenal ulcer
Rationale: Duodenal ulcers typically cause pain that occurs 2-3 hours after meals
and is relieved by food or antacids because food buffers gastric acid. Gastric ulcers
often worsen with eating. Stress ulcers are related to critical illness, and esophageal
ulcers are associated with reflux.
10. A nurse is preparing to administer an intramuscular injection to a thin older
adult. Which needle size is most appropriate?
A. 18 gauge, 1.5 inches
B. 21 gauge, 1 inch
C. 25 gauge, 5/8 inch
D. 22 gauge, 1.5 inches
Answer: C. 25 gauge, 5/8 inch
Rationale: Thin older adults have reduced muscle mass, so a shorter needle (5/8
inch) with a smaller gauge (25) is appropriate to ensure intramuscular delivery
without hitting bone. Longer needles increase the risk of periosteal injury.
11. A client with severe preeclampsia is receiving magnesium sulfate. Which
finding indicates magnesium toxicity?
A. Deep tendon reflexes 2+
B. Respiratory rate 14 breaths/min
C. Urinary output of 100 mL in 4 hours
D. Serum magnesium level of 6 mEq/L
Answer: C. Urinary output of 100 mL in 4 hours
Rationale: Magnesium toxicity is associated with loss of deep tendon reflexes (not
2+), respiratory depression (below 12), and oliguria (less than 30 mL/hr or 120 mL
in 4 hours). A serum level of 6 mEq/L is within therapeutic range (4-7 mEq/L).
Oliguria indicates reduced excretion, leading to accumulation.
12. A client is prescribed digoxin. Which finding would indicate digoxin toxicity?
A. Heart rate of 68 beats per minute
B. Serum digoxin level of 1.2 ng/mL
C. Yellow-green halos around lights
D. Blood pressure of 120/80 mmHg
Answer: C. Yellow-green halos around lights
Rationale: Visual disturbances such as yellow-green halos, blurred vision, and
photophobia are classic signs of digoxin toxicity. A normal heart rate and
