2026/2027
2026/2027 HESI RN Exit Exam V4
All-Inclusive Certification Study
Guide: Extensive Practice Questions,
Complete Test Bank Review, Detailed
Knowledge Assessment, and Final
Exam Prep Manual
1. A healthcare provider prescribes 0.9% sodium chloride 1,000 mL to infuse
intravenously over 4 hours using tubing calibrated to deliver 10 gtt/mL. At what
rate should the nurse regulate the infusion?
A. 35 gtt/min
B. 38 gtt/min
C. 42 gtt/min
D. 50 gtt/min
Correct Answer: C. 42 gtt/min
Rationale: 1,000 × 10 ÷ 240 = 41.7 gtt/min, which rounds to 42 gtt/min.
2. Following coronary artery stent placement, a client receives prasugrel
therapy. Which assessment finding is most important for the nurse to monitor
to detect an adverse effect of this medication?
A. Observe urine color
B. Measure body temperature
C. Assess skin turgor
D. Evaluate pedal edema
Correct Answer: A. Observe urine color
Rationale: Prasugrel increases the risk for bleeding, and hematuria may be an early sign
of internal bleeding.
3. A client falls in the bathroom after being left unattended by an unlicensed
assistive personnel. Which documentation entry is most appropriate for
inclusion in the client’s health record?
A. The UAP left the client to assist another client.
B. The last time the client was assisted to the bathroom.
,2026/2027
C. The unit was understaffed when the client fell.
D. The client fell and sustained a fracture of the left hip.
Correct Answer: D. The client fell and sustained a fracture of the left hip.
Rationale: Documentation should be objective, factual, and free of blame or speculation.
4. A client has a positive tuberculin skin test. Which subjective symptom most
strongly supports a diagnosis of pulmonary tuberculosis?
A. Barking cough and vomiting
B. Productive cough with night sweats
C. Dry cough and chest tightness
D. Chronic cough and fatty stools
Correct Answer: B. Productive cough with night sweats
Rationale: Classic manifestations of pulmonary tuberculosis include a persistent
productive cough and night sweats.
5. A client with type 1 diabetes develops deep, rapid respirations and
increasing lethargy. Which assessment should the nurse obtain immediately?
A. Temperature
B. Breath sounds
C. Blood glucose level
D. White blood cell count
Correct Answer: C. Blood glucose level
Rationale: These findings suggest diabetic ketoacidosis, and confirming blood glucose is
the highest priority.
6. A client four hours post-total abdominal hysterectomy has saturated a
perineal pad every hour and decreasing urine output. Which nursing
intervention has the highest priority?
A. Evaluate skin turgor
B. Assess for weakness or dizziness
C. Change the perineal pad
D. Measure urinary output
Correct Answer: B. Assess for weakness or dizziness
Rationale: Heavy bleeding and decreasing urine output suggest possible postoperative
hemorrhage and hypovolemia.
,2026/2027
7. A terminally ill father requests discontinuation of curative treatment and
transfer to a palliative care unit. Which nursing action best facilitates continuity
of care?
A. Reassure the client that visits from his child are permitted.
B. Provide written information regarding end-of-life care.
C. Obtain a comprehensive handoff report from the transferring nurse.
D. Place a label on the chart indicating no heroic measures.
Correct Answer: C. Obtain a comprehensive handoff report from the transferring nurse.
Rationale: Continuity of care depends heavily on accurate transfer communication.
8. A client with heart failure and pulmonary edema presents with pink frothy
sputum, edema, and an irregular heart rhythm. After positioning the client and
initiating telemetry, which intervention should the nurse implement next?
A. Obtain a sputum specimen
B. Document edema severity
C. Measure hourly urine output
D. Administer prescribed IV diuretics
Correct Answer: D. Administer prescribed IV diuretics
Rationale: Pulmonary edema is a medical emergency, and IV diuretics rapidly reduce
intravascular volume and pulmonary congestion.
9. A client with suspected myxedema coma is being assessed. In what
sequence should the nurse prioritize the assessment?
1. Observe breathing patterns
2. Assess blood pressure
3. Measure body temperature
4. Palpate for pedal edema
A. 3 → 2 → 1 → 4
B. 1 → 2 → 3 → 4
C. 2 → 1 → 4 → 3
D. 4 → 3 → 2 → 1
Correct Answer: A. 3 → 2 → 1 → 4
Rationale: Myxedema coma is characterized by hypothermia, hypoventilation, and
cardiovascular collapse. Temperature is prioritized first.
, 2026/2027
10. A client with type 2 diabetes reports weakness and palpitations. Which
finding may indicate an emerging metabolic emergency?
A. Potassium 3.5 mEq/L
B. Fingertip numbness
C. Sodium 135 mEq/L
D. Cervical stiffness
Correct Answer: B. Fingertip numbness
Rationale: Weakness and palpitations with numbness may indicate metabolic or
electrolyte instability and require prompt evaluation.
Question 11
An older adult with sudden confusion after a fall is admitted. What is the priority
SBAR communication to the healthcare provider?
A. Current medication list
B. Presence of healthcare power of attorney
C. Increasing confusion after fall
D. Fall as reason for admission
Correct Answer: C. Increasing confusion after fall
Rationale:
SBAR communication prioritizes the most acute clinical change. Sudden confusion
after a fall may indicate intracranial injury, hemorrhage, or metabolic disturbance, all
of which require urgent evaluation.
While the fall is the initiating event, and medications and legal status are important
contextual data, the acute neurological decline is the most critical information to
escalate immediately. Effective SBAR communication ensures timely diagnosis and
intervention in potentially life-threatening conditions.
Question 12
A client with severe burns has weight gain of 2 kg in 24 hours and elevated central
venous pressure. Which intervention is most appropriate?
A. Auscultate for irregular heart rate
B. Review arterial blood gases
C. Measure ankle circumference
D. Document abdominal girth
Correct Answer: A. Auscultate for irregular heart rate
Rationale:
2026/2027 HESI RN Exit Exam V4
All-Inclusive Certification Study
Guide: Extensive Practice Questions,
Complete Test Bank Review, Detailed
Knowledge Assessment, and Final
Exam Prep Manual
1. A healthcare provider prescribes 0.9% sodium chloride 1,000 mL to infuse
intravenously over 4 hours using tubing calibrated to deliver 10 gtt/mL. At what
rate should the nurse regulate the infusion?
A. 35 gtt/min
B. 38 gtt/min
C. 42 gtt/min
D. 50 gtt/min
Correct Answer: C. 42 gtt/min
Rationale: 1,000 × 10 ÷ 240 = 41.7 gtt/min, which rounds to 42 gtt/min.
2. Following coronary artery stent placement, a client receives prasugrel
therapy. Which assessment finding is most important for the nurse to monitor
to detect an adverse effect of this medication?
A. Observe urine color
B. Measure body temperature
C. Assess skin turgor
D. Evaluate pedal edema
Correct Answer: A. Observe urine color
Rationale: Prasugrel increases the risk for bleeding, and hematuria may be an early sign
of internal bleeding.
3. A client falls in the bathroom after being left unattended by an unlicensed
assistive personnel. Which documentation entry is most appropriate for
inclusion in the client’s health record?
A. The UAP left the client to assist another client.
B. The last time the client was assisted to the bathroom.
,2026/2027
C. The unit was understaffed when the client fell.
D. The client fell and sustained a fracture of the left hip.
Correct Answer: D. The client fell and sustained a fracture of the left hip.
Rationale: Documentation should be objective, factual, and free of blame or speculation.
4. A client has a positive tuberculin skin test. Which subjective symptom most
strongly supports a diagnosis of pulmonary tuberculosis?
A. Barking cough and vomiting
B. Productive cough with night sweats
C. Dry cough and chest tightness
D. Chronic cough and fatty stools
Correct Answer: B. Productive cough with night sweats
Rationale: Classic manifestations of pulmonary tuberculosis include a persistent
productive cough and night sweats.
5. A client with type 1 diabetes develops deep, rapid respirations and
increasing lethargy. Which assessment should the nurse obtain immediately?
A. Temperature
B. Breath sounds
C. Blood glucose level
D. White blood cell count
Correct Answer: C. Blood glucose level
Rationale: These findings suggest diabetic ketoacidosis, and confirming blood glucose is
the highest priority.
6. A client four hours post-total abdominal hysterectomy has saturated a
perineal pad every hour and decreasing urine output. Which nursing
intervention has the highest priority?
A. Evaluate skin turgor
B. Assess for weakness or dizziness
C. Change the perineal pad
D. Measure urinary output
Correct Answer: B. Assess for weakness or dizziness
Rationale: Heavy bleeding and decreasing urine output suggest possible postoperative
hemorrhage and hypovolemia.
,2026/2027
7. A terminally ill father requests discontinuation of curative treatment and
transfer to a palliative care unit. Which nursing action best facilitates continuity
of care?
A. Reassure the client that visits from his child are permitted.
B. Provide written information regarding end-of-life care.
C. Obtain a comprehensive handoff report from the transferring nurse.
D. Place a label on the chart indicating no heroic measures.
Correct Answer: C. Obtain a comprehensive handoff report from the transferring nurse.
Rationale: Continuity of care depends heavily on accurate transfer communication.
8. A client with heart failure and pulmonary edema presents with pink frothy
sputum, edema, and an irregular heart rhythm. After positioning the client and
initiating telemetry, which intervention should the nurse implement next?
A. Obtain a sputum specimen
B. Document edema severity
C. Measure hourly urine output
D. Administer prescribed IV diuretics
Correct Answer: D. Administer prescribed IV diuretics
Rationale: Pulmonary edema is a medical emergency, and IV diuretics rapidly reduce
intravascular volume and pulmonary congestion.
9. A client with suspected myxedema coma is being assessed. In what
sequence should the nurse prioritize the assessment?
1. Observe breathing patterns
2. Assess blood pressure
3. Measure body temperature
4. Palpate for pedal edema
A. 3 → 2 → 1 → 4
B. 1 → 2 → 3 → 4
C. 2 → 1 → 4 → 3
D. 4 → 3 → 2 → 1
Correct Answer: A. 3 → 2 → 1 → 4
Rationale: Myxedema coma is characterized by hypothermia, hypoventilation, and
cardiovascular collapse. Temperature is prioritized first.
, 2026/2027
10. A client with type 2 diabetes reports weakness and palpitations. Which
finding may indicate an emerging metabolic emergency?
A. Potassium 3.5 mEq/L
B. Fingertip numbness
C. Sodium 135 mEq/L
D. Cervical stiffness
Correct Answer: B. Fingertip numbness
Rationale: Weakness and palpitations with numbness may indicate metabolic or
electrolyte instability and require prompt evaluation.
Question 11
An older adult with sudden confusion after a fall is admitted. What is the priority
SBAR communication to the healthcare provider?
A. Current medication list
B. Presence of healthcare power of attorney
C. Increasing confusion after fall
D. Fall as reason for admission
Correct Answer: C. Increasing confusion after fall
Rationale:
SBAR communication prioritizes the most acute clinical change. Sudden confusion
after a fall may indicate intracranial injury, hemorrhage, or metabolic disturbance, all
of which require urgent evaluation.
While the fall is the initiating event, and medications and legal status are important
contextual data, the acute neurological decline is the most critical information to
escalate immediately. Effective SBAR communication ensures timely diagnosis and
intervention in potentially life-threatening conditions.
Question 12
A client with severe burns has weight gain of 2 kg in 24 hours and elevated central
venous pressure. Which intervention is most appropriate?
A. Auscultate for irregular heart rate
B. Review arterial blood gases
C. Measure ankle circumference
D. Document abdominal girth
Correct Answer: A. Auscultate for irregular heart rate
Rationale:
