HESI Exit Exam 2026/2027 Actual Exam EXAM with
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Medical-Surgical Nursing and Critical Care
2. Pharmacology and Parenteral Therapies
3. Mental Health and Psychiatric Nursing
4. Maternal-Newborn and Women's Health Nursing
5. Pediatric Nursing and Growth & Development
6. Community Health, Leadership, and Management
1. A 68-year-old male with a history of heart failure is admitted with acute dyspnea, bilateral
crackles, and pitting pedal edema. The healthcare provider prescribes furosemide 40 mg IV push.
Which laboratory value should the nurse monitor most closely prior to and following the
administration of this medication?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
CORRECT ANSWER : B
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to significant renal excretion of potassium and the risk of
hypokalemia. Serum sodium, glucose, and calcium are less acutely volatile with loop diuretic
therapy compared to potassium.
,2. A nurse is caring for a client diagnosed with major depressive disorder who has been prescribed
sertraline for two weeks. Which clinical observation requires the most immediate nursing
intervention and reporting?
A. The client reports mild nausea and dry mouth upon taking the morning dose.
B. The client exhibits increased energy, improved mood, and verbalizes active suicidal ideation
with a specific plan.
C. The client is sleeping eight hours per night, an improvement from baseline insomnia.
D. The client expresses feelings of ambivalence regarding ongoing outpatient psychotherapy.
CORRECT ANSWER : B
Rationale: As selective serotonin reuptake inhibitors (SSRIs) like sertraline begin taking
therapeutic effect over 2 to 4 weeks, an increase in energy often precedes improvement in
depressed mood, putting the client at peak risk for executing suicide. Mild nausea and dry mouth
are expected, manageable side effects.
3. A primigravida client at 38 weeks of gestation is admitted to the labor and delivery unit in active
labor. Suddenly, she complains of a tearing sensation in her abdomen, followed by loss of fetal
station on vaginal examination and fetal heart rate decelerations dropping to 70 beats per minute.
Which action should the nurse take first?
A. Administer oxygen via non-rebreather mask at 10 L/min.
B. Prepare the client for immediate emergency cesarean delivery.
C. Increase the rate of the primary intravenous fluid infusion.
D. Position the client in a knee-chest position.
CORRECT ANSWER : B
Rationale: A sudden tearing abdominal sensation, loss of fetal station, and abrupt fetal distress
strongly indicate uterine rupture, which is a life-threatening obstetric emergency requiring
immediate surgical intervention via emergency cesarean delivery. While oxygen and IV fluids
are supportive, surgical delivery must be prioritized.
4. A 4-year-old child is brought to the pediatric emergency department with a 2-day history of high
fever, drooling, severe dysphagia, and inspiratory stridor. The child is sitting forward with the
chin thrust out in a tripod position. Which nursing action is strictly contraindicated?
A. Establishing continuous pulse oximetry monitoring.
, B. Inspecting the oropharynx using a tongue depressor to visualize the epiglottis.
C. Administering humidified oxygen via a blow-by method.
D. Notifying the anesthesia provider and pediatric otolaryngologist immediately.
CORRECT ANSWER : B
Rationale: Inspecting the oropharynx with a tongue depressor in a child suspected of acute
epiglottitis can trigger sudden, catastrophic laryngospasm and complete airway obstruction. The
airway must be managed in a controlled environment by personnel equipped for emergency
intubation.
5. A community health nurse is conducting an educational seminar on hypertension management
for older adults. Which lifestyle modification should the nurse emphasize as having the most
immediate and profound impact on lowering blood pressure?
A. Restricting dietary sodium intake to less than 2,000 mg daily
B. Engaging in regular aerobic exercise such as brisk walking for 30 minutes most days
C. Achieving and maintaining a healthy body weight (BMI 18.5 to 24.9)
D. Moderating alcohol consumption to no more than one drink per day for women and two for
men
CORRECT ANSWER : B
Rationale: While all lifestyle modifications are crucial, regular aerobic exercise provides an
immediate and potent reduction in systolic blood pressure by improving vascular compliance
and decreasing systemic vascular resistance. Dietary sodium restriction and weight loss also
contribute significantly over a longer duration.
6. A client with type 1 diabetes mellitus is found unresponsive in bed. The blood glucose
fingerstick reads 38 mg/dL. The client has an IV line infusing normal saline and is unable to
swallow safely. Which intervention should the nurse implement first?
A. Administer 50 mL of 50 percent dextrose solution (D50W) via IV push.
B. Inject glucagon 1 mg intramuscularly into the lateral thigh.
C. Provide 4 ounces of orange juice mixed with two packets of sugar via oral syringe.
D. Recheck the blood glucose level in 15 minutes to confirm hypoglycemia.
CORRECT ANSWER : A
, Rationale: For an unconscious, hypoglycemic client with established IV access, the fastest and
most effective treatment is IV administration of 50 percent dextrose (D50W) to rapidly raise
cerebral blood glucose. Oral administration is unsafe due to aspiration risk, and IV dextrose
works faster than IM glucagon.
7. A nurse is assessing a client admitted with acute pancreatitis. Which clinical finding is most
consistent with this diagnosis?
A. Right upper quadrant pain radiating to the right scapula after a fatty meal
B. Severe, constant epigastric pain radiating straight through to the back, aggravated by lying
supine
C. Intermittent cramping lower abdominal pain relieved by defecation
D. Left lower quadrant tenderness accompanied by alternating diarrhea and constipation
CORRECT ANSWER : B
Rationale: Acute pancreatitis classically presents with severe, boring, constant epigastric pain
that frequently radiates straight to the back and worsens in the supine position. RUQ pain
radiating to the scapula indicates cholecystitis, while LLQ tenderness points toward
diverticulitis.
8. A client is receiving intravenous heparin infusion for the treatment of a deep vein thrombosis.
The baseline activated partial thromboplastin time (aPTT) is 30 seconds. Which therapeutic
aPTT value indicates that the heparin dosage is within the desired therapeutic range?
A. 30 to 45 seconds
B. 46 to 70 seconds
C. 90 to 110 seconds
D. Greater than 120 seconds
CORRECT ANSWER : B
Rationale: Therapeutic anticoagulation with unfractionated heparin aims for an activated
partial thromboplastin time (aPTT) of 1.5 to 2.5 times the normal control value. With a baseline
of 30 seconds, a therapeutic range of 46 to 70 seconds effectively prevents clot propagation
without excessive bleeding risk.
9. A 2-month-old infant is brought to the clinic for routine immunizations. The parent expresses
concern that the infant is experiencing fussiness and a low-grade fever following the previous set
of vaccines. Which response by the nurse is most appropriate?
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Medical-Surgical Nursing and Critical Care
2. Pharmacology and Parenteral Therapies
3. Mental Health and Psychiatric Nursing
4. Maternal-Newborn and Women's Health Nursing
5. Pediatric Nursing and Growth & Development
6. Community Health, Leadership, and Management
1. A 68-year-old male with a history of heart failure is admitted with acute dyspnea, bilateral
crackles, and pitting pedal edema. The healthcare provider prescribes furosemide 40 mg IV push.
Which laboratory value should the nurse monitor most closely prior to and following the
administration of this medication?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
CORRECT ANSWER : B
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to significant renal excretion of potassium and the risk of
hypokalemia. Serum sodium, glucose, and calcium are less acutely volatile with loop diuretic
therapy compared to potassium.
,2. A nurse is caring for a client diagnosed with major depressive disorder who has been prescribed
sertraline for two weeks. Which clinical observation requires the most immediate nursing
intervention and reporting?
A. The client reports mild nausea and dry mouth upon taking the morning dose.
B. The client exhibits increased energy, improved mood, and verbalizes active suicidal ideation
with a specific plan.
C. The client is sleeping eight hours per night, an improvement from baseline insomnia.
D. The client expresses feelings of ambivalence regarding ongoing outpatient psychotherapy.
CORRECT ANSWER : B
Rationale: As selective serotonin reuptake inhibitors (SSRIs) like sertraline begin taking
therapeutic effect over 2 to 4 weeks, an increase in energy often precedes improvement in
depressed mood, putting the client at peak risk for executing suicide. Mild nausea and dry mouth
are expected, manageable side effects.
3. A primigravida client at 38 weeks of gestation is admitted to the labor and delivery unit in active
labor. Suddenly, she complains of a tearing sensation in her abdomen, followed by loss of fetal
station on vaginal examination and fetal heart rate decelerations dropping to 70 beats per minute.
Which action should the nurse take first?
A. Administer oxygen via non-rebreather mask at 10 L/min.
B. Prepare the client for immediate emergency cesarean delivery.
C. Increase the rate of the primary intravenous fluid infusion.
D. Position the client in a knee-chest position.
CORRECT ANSWER : B
Rationale: A sudden tearing abdominal sensation, loss of fetal station, and abrupt fetal distress
strongly indicate uterine rupture, which is a life-threatening obstetric emergency requiring
immediate surgical intervention via emergency cesarean delivery. While oxygen and IV fluids
are supportive, surgical delivery must be prioritized.
4. A 4-year-old child is brought to the pediatric emergency department with a 2-day history of high
fever, drooling, severe dysphagia, and inspiratory stridor. The child is sitting forward with the
chin thrust out in a tripod position. Which nursing action is strictly contraindicated?
A. Establishing continuous pulse oximetry monitoring.
, B. Inspecting the oropharynx using a tongue depressor to visualize the epiglottis.
C. Administering humidified oxygen via a blow-by method.
D. Notifying the anesthesia provider and pediatric otolaryngologist immediately.
CORRECT ANSWER : B
Rationale: Inspecting the oropharynx with a tongue depressor in a child suspected of acute
epiglottitis can trigger sudden, catastrophic laryngospasm and complete airway obstruction. The
airway must be managed in a controlled environment by personnel equipped for emergency
intubation.
5. A community health nurse is conducting an educational seminar on hypertension management
for older adults. Which lifestyle modification should the nurse emphasize as having the most
immediate and profound impact on lowering blood pressure?
A. Restricting dietary sodium intake to less than 2,000 mg daily
B. Engaging in regular aerobic exercise such as brisk walking for 30 minutes most days
C. Achieving and maintaining a healthy body weight (BMI 18.5 to 24.9)
D. Moderating alcohol consumption to no more than one drink per day for women and two for
men
CORRECT ANSWER : B
Rationale: While all lifestyle modifications are crucial, regular aerobic exercise provides an
immediate and potent reduction in systolic blood pressure by improving vascular compliance
and decreasing systemic vascular resistance. Dietary sodium restriction and weight loss also
contribute significantly over a longer duration.
6. A client with type 1 diabetes mellitus is found unresponsive in bed. The blood glucose
fingerstick reads 38 mg/dL. The client has an IV line infusing normal saline and is unable to
swallow safely. Which intervention should the nurse implement first?
A. Administer 50 mL of 50 percent dextrose solution (D50W) via IV push.
B. Inject glucagon 1 mg intramuscularly into the lateral thigh.
C. Provide 4 ounces of orange juice mixed with two packets of sugar via oral syringe.
D. Recheck the blood glucose level in 15 minutes to confirm hypoglycemia.
CORRECT ANSWER : A
, Rationale: For an unconscious, hypoglycemic client with established IV access, the fastest and
most effective treatment is IV administration of 50 percent dextrose (D50W) to rapidly raise
cerebral blood glucose. Oral administration is unsafe due to aspiration risk, and IV dextrose
works faster than IM glucagon.
7. A nurse is assessing a client admitted with acute pancreatitis. Which clinical finding is most
consistent with this diagnosis?
A. Right upper quadrant pain radiating to the right scapula after a fatty meal
B. Severe, constant epigastric pain radiating straight through to the back, aggravated by lying
supine
C. Intermittent cramping lower abdominal pain relieved by defecation
D. Left lower quadrant tenderness accompanied by alternating diarrhea and constipation
CORRECT ANSWER : B
Rationale: Acute pancreatitis classically presents with severe, boring, constant epigastric pain
that frequently radiates straight to the back and worsens in the supine position. RUQ pain
radiating to the scapula indicates cholecystitis, while LLQ tenderness points toward
diverticulitis.
8. A client is receiving intravenous heparin infusion for the treatment of a deep vein thrombosis.
The baseline activated partial thromboplastin time (aPTT) is 30 seconds. Which therapeutic
aPTT value indicates that the heparin dosage is within the desired therapeutic range?
A. 30 to 45 seconds
B. 46 to 70 seconds
C. 90 to 110 seconds
D. Greater than 120 seconds
CORRECT ANSWER : B
Rationale: Therapeutic anticoagulation with unfractionated heparin aims for an activated
partial thromboplastin time (aPTT) of 1.5 to 2.5 times the normal control value. With a baseline
of 30 seconds, a therapeutic range of 46 to 70 seconds effectively prevents clot propagation
without excessive bleeding risk.
9. A 2-month-old infant is brought to the clinic for routine immunizations. The parent expresses
concern that the infant is experiencing fussiness and a low-grade fever following the previous set
of vaccines. Which response by the nurse is most appropriate?
