HESI RN EXIT EXAM (V1–V10)COMPREHENSIVE PRACTICE EXAMINATION BUNDLE
,Section Contents Questions
Table of Contents HESI RN Exit Exam (V1–V10) —
HESI RN Exit Exam V1 Original Comprehensive Practice Exam 1–100
HESI RN Exit Exam V2 Comprehensive Practice Exam 101–200
HESI RN Exit Exam V3 Comprehensive Practice Exam 201–300
HESI RN Exit Exam V4 Comprehensive Practice Exam 301–400
HESI RN Exit Exam V5 Comprehensive Practice Exam 401–500
HESI RN Exit Exam V6 Comprehensive Practice Exam 501–600
HESI RN Exit Exam V7 Comprehensive Practice Exam 601–700
HESI RN Exit Exam V8 Comprehensive Practice Exam 701–800
HESI RN Exit Exam V9 Comprehensive Practice Exam 801–900
HESI RN Exit Exam V10 Comprehensive Practice Exam 901–1000
Comprehensive Answer Key & Detailed explanations, Clinical Pearls, and HESI High-
Throughout
Rationales Yield Tips
Exam Features
• 10 Complete HESI RN Exit Exams
• 1,000 Original HESI-Style Questions
• Detailed Rationales
• Why the Other Options Are Incorrect
• Clinical Pearls
• HESI High-Yield Tips
• Priority, Delegation & Management of Care
• Pharmacology
• Adult Medical-Surgical Nursing
• Critical Care
• Emergency Nursing
• Maternal-Newborn Nursing
, • Pediatric Nursing
• Mental Health Nursing
• Leadership & Management
• Infection Prevention & Control
• NGN Clinical Judgment–Style Questions
• Randomized A–D Answer Distribution
• NCLEX/HESI-Level Critical Thinking
HESI RN Exit Exam V1
Question 1
A nurse is caring for four clients on a medical-surgical unit. Which client should the nurse assess first?
A. A client with heart failure who reports fatigue after walking to the bathroom.
B. A client who is 2 hours postoperative following a thyroidectomy and reports increasing neck tightness and
difficulty swallowing.
C. A client with type 2 diabetes whose pre-breakfast blood glucose is 242 mg/dL.
D. A client receiving oral antibiotics for cellulitis who reports pain rated 6/10.
Correct Answer: B. A client who is 2 hours postoperative following a thyroidectomy and reports
increasing neck tightness and difficulty swallowing.
Rationale
Difficulty swallowing accompanied by neck tightness shortly after a thyroidectomy is a classic warning sign of a
postoperative hematoma. Blood accumulating beneath the incision can rapidly compress the trachea, leading
to airway obstruction within minutes. Immediate assessment of the airway, notification of the surgeon, and
preparation for emergency intervention are essential. Airway compromise always takes precedence over pain
management, chronic disease symptoms, or isolated laboratory abnormalities.
Why the Other Options Are Less Appropriate
A. Fatigue after ambulation is a common finding in clients with chronic heart failure and does not suggest
immediate clinical deterioration.
C. A blood glucose level of 242 mg/dL requires treatment but is unlikely to cause immediate life-threatening
complications compared with an obstructed airway.
D. Pain control is important; however, it is not the priority when another client is exhibiting signs of possible
airway compromise.
Clinical Pearl
,Following thyroid surgery, frequently inspect the neck for swelling and monitor for hoarseness, dysphagia,
stridor, or respiratory distress.
HESI High-Yield Tip
When answering priority questions, always determine which client is at greatest risk for loss of airway,
breathing, or circulation.
Question 2
Before administering morning medications, which prescription should the nurse question?
A. Potassium chloride 20 mEq IV push for a client with a serum potassium level of 2.8 mEq/L.
B. Cefazolin 2 g IV to be administered 30 minutes before surgery.
C. Acetaminophen 650 mg orally every 6 hours as needed for fever.
D. Enoxaparin 40 mg subcutaneously once daily following hip replacement surgery.
Correct Answer: A. Potassium chloride 20 mEq IV push for a client with a serum potassium level of 2.8
mEq/L.
Rationale
Potassium chloride is classified as a high-alert medication and must never be administered by IV push. Rapid
intravenous administration can trigger fatal ventricular dysrhythmias and cardiac arrest. Potassium should
always be diluted and infused using an infusion pump at the recommended rate while the client is closely
monitored.
Why the Other Options Are Less Appropriate
B. Administering prophylactic antibiotics before surgery is recommended to reduce the risk of surgical site
infections.
C. Acetaminophen is an appropriate medication for fever management when prescribed within the
recommended dosage.
D. Enoxaparin is routinely prescribed to reduce the risk of postoperative venous thromboembolism.
Clinical Pearl
High-alert medications such as potassium chloride, insulin, and heparin require extra verification before
administration.
HESI High-Yield Tip
If an answer choice includes IV potassium push, it should immediately raise concern because potassium is
never administered by direct IV push.
Question 3
Twenty minutes after a blood transfusion begins, a client suddenly develops chills, shortness of breath, and
severe lower back pain. Which nursing action is the priority?
,A. Reduce the infusion rate and reassess the client in 15 minutes.
B. Stop the transfusion immediately and maintain IV access with normal saline using new tubing.
C. Administer prescribed acetaminophen and continue monitoring the client.
D. Notify the healthcare provider after completing the transfusion.
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline using
new tubing.
Rationale
The client's symptoms strongly indicate an acute hemolytic transfusion reaction, one of the most serious
complications of blood administration. The priority is to stop the transfusion immediately to prevent further
exposure to incompatible blood while maintaining intravenous access for emergency medications and
supportive care. Rapid intervention significantly reduces the risk of shock, kidney injury, and death.
Why the Other Options Are Less Appropriate
A. Slowing the infusion still allows incompatible blood to enter the circulation.
C. Antipyretics do not treat the underlying hemolytic reaction.
D. Delaying intervention until the transfusion is complete places the client at serious risk.
Clinical Pearl
Most severe transfusion reactions occur within the first 15–30 minutes after the infusion begins.
HESI High-Yield Tip
Remember the sequence: Stop the transfusion → Maintain IV access → Notify the provider and blood bank
→ Continue close monitoring.
Question 4
Which client assignment is most appropriate for a newly licensed registered nurse?
A. A client receiving continuous insulin and potassium infusions for diabetic ketoacidosis.
B. A client one day after laparoscopic cholecystectomy who is preparing for discharge.
C. A client with septic shock receiving vasopressor therapy.
D. A client requiring hourly neurological assessments after receiving thrombolytic therapy.
Correct Answer: B. A client one day after laparoscopic cholecystectomy who is preparing for discharge.
Rationale
Newly licensed nurses should care for clients with stable and predictable conditions. A client recovering from
uncomplicated laparoscopic surgery who is preparing for discharge has predictable care needs and is
appropriate for a novice RN. Clients requiring continuous medication titration, intensive monitoring, or
frequent neurological assessments should be assigned to experienced nurses.
Why the Other Options Are Less Appropriate
,A. Continuous insulin and electrolyte management requires advanced assessment and clinical judgment.
C. Septic shock is unstable and demands experienced nursing management.
D. Frequent neurological assessments following thrombolytic therapy require rapid recognition of subtle
changes.
Clinical Pearl
Safe assignments are based on client stability, predictability, and the nurse's level of experience.
HESI High-Yield Tip
Remember: Stable clients go to novice nurses; unstable or unpredictable clients go to experienced nurses.
Question 5
A nurse is caring for a client admitted with acute exacerbation of chronic obstructive pulmonary disease
(COPD). Which assessment finding requires the nurse's immediate intervention?
A. Productive cough with thick yellow sputum.
B. Oxygen saturation decreases from 94% to 86% despite oxygen at 2 L/min via nasal cannula.
C. Respiratory rate of 24 breaths/minute.
D. Reports fatigue after using the bedside commode.
Correct Answer: B. Oxygen saturation decreases from 94% to 86% despite oxygen at 2 L/min via nasal
cannula.
Rationale
A significant decline in oxygen saturation despite supplemental oxygen indicates worsening hypoxemia and
possible respiratory failure. Immediate assessment of airway patency, breath sounds, work of breathing, and
oxygen delivery is essential. The nurse should intervene promptly to improve oxygenation and notify the
healthcare provider if the client's condition does not improve. Preventing respiratory arrest is the highest
priority.
Why the Other Options Are Less Appropriate
A. Thick sputum is common during COPD exacerbations and requires treatment but is not the most urgent
finding.
C. A respiratory rate of 24 breaths/minute represents mild tachypnea and should be monitored, but severe
hypoxemia requires immediate action.
D. Fatigue with activity is expected during an acute COPD exacerbation and is less urgent than impaired
oxygenation.
Clinical Pearl
Clients with COPD often deteriorate gradually; worsening oxygen saturation accompanied by increased work of
breathing is an early indicator of impending respiratory failure.
, HESI High-Yield Tip
Prioritize oxygenation whenever oxygen saturation falls below the prescribed target range despite current
therapy.
Question 6
The nurse receives report on four hospitalized clients. Which client should the nurse assess first?
A. A client with bacterial pneumonia whose temperature is 38.3°C (100.9°F).
B. A client receiving intravenous heparin whose activated partial thromboplastin time (aPTT) is 84 seconds
within the prescribed therapeutic range.
C. A client one day after abdominal surgery who suddenly reports severe shortness of breath and sharp chest
pain.
D. A client with chronic kidney disease awaiting scheduled hemodialysis later in the day.
Correct Answer: C. A client one day after abdominal surgery who suddenly reports severe shortness of
breath and sharp chest pain.
Rationale
A postoperative client who suddenly develops dyspnea and pleuritic chest pain should be suspected of having
a pulmonary embolism until proven otherwise. Pulmonary embolism can rapidly progress to respiratory
collapse and cardiovascular instability, requiring immediate assessment and emergency intervention. Early
recognition greatly improves outcomes.
Why the Other Options Are Less Appropriate
A. Fever is expected with pneumonia and should be managed but is not the highest priority.
B. The aPTT is therapeutic, indicating the heparin infusion is appropriately managed.
D. Scheduled dialysis is important but does not represent an acute emergency.
Clinical Pearl
Major surgery and prolonged immobility significantly increase the risk of venous thromboembolism.
HESI High-Yield Tip
Sudden chest pain and dyspnea in a postoperative client should immediately raise suspicion for pulmonary
embolism.
Question 7
A nurse reviews laboratory results before administering morning medications. Which finding requires
immediate notification of the healthcare provider?
A. Sodium 134 mEq/L.
B. Hemoglobin 11.2 g/dL.
,C. Potassium 6.3 mEq/L.
D. White blood cell count 11,000/mm³.
Correct Answer: C. Potassium 6.3 mEq/L.
Rationale
A potassium level of 6.3 mEq/L represents significant hyperkalemia, placing the client at high risk for life-
threatening cardiac dysrhythmias. Immediate intervention, ECG monitoring, and treatment are necessary to
prevent cardiac arrest.
Why the Other Options Are Less Appropriate
A. Mild hyponatremia should be monitored but is not immediately life-threatening.
B. Mild anemia is not an emergency unless accompanied by severe symptoms or active bleeding.
D. A slightly elevated white blood cell count may reflect infection or inflammation and requires evaluation but
is less urgent than severe hyperkalemia.
Clinical Pearl
Hyperkalemia can rapidly affect cardiac conduction even before obvious symptoms develop.
HESI High-Yield Tip
Potassium abnormalities are frequently tested because of their direct impact on cardiac function.
Question 8
A client with type 1 diabetes tells the nurse, "I feel shaky, sweaty, and dizzy." The client is alert and able to
swallow. What is the nurse's priority action?
A. Administer the scheduled dose of long-acting insulin.
B. Check the client's capillary blood glucose level immediately.
C. Encourage the client to rest for 30 minutes.
D. Notify the healthcare provider before performing any intervention.
Correct Answer: B. Check the client's capillary blood glucose level immediately.
Rationale
The client's symptoms strongly suggest hypoglycemia. The nurse should immediately verify the blood glucose
level to guide prompt treatment. If hypoglycemia is confirmed and the client can safely swallow, fast-acting
carbohydrates should be administered according to protocol. Rapid assessment prevents progression to
seizures or loss of consciousness.
Why the Other Options Are Less Appropriate
A. Administering insulin before assessing glucose could worsen hypoglycemia.
C. Rest alone does not correct potentially dangerous hypoglycemia.
,D. Immediate assessment should not be delayed while waiting to contact the healthcare provider.
Clinical Pearl
Early recognition and treatment of hypoglycemia can prevent serious neurological complications.
HESI High-Yield Tip
When hypoglycemia is suspected and the client is stable, verify the blood glucose level promptly and treat
according to facility protocol.
Question 9
Following administration of an ACE inhibitor, a client develops facial swelling, difficulty swallowing, and a
muffled voice. Which action should the nurse perform first?
A. Stop the medication and activate emergency response measures.
B. Reassure the client that these symptoms usually resolve.
C. Offer cool fluids to relieve throat discomfort.
D. Place the client in Trendelenburg position.
Correct Answer: A. Stop the medication and activate emergency response measures.
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors because airway obstruction can
develop rapidly.
Why the Other Options Are Incorrect
B. Delaying treatment may result in complete airway obstruction.
C. Fluids do not relieve airway edema.
D. Trendelenburg positioning does not improve airway patency.
Clinical Pearl: Angioedema may occur even after prolonged ACE inhibitor therapy.
HESI High-Yield Tip: Airway protection is the highest priority whenever angioedema is suspected.
Question 10
During change-of-shift report, the nurse learns that one client has become increasingly difficult to arouse after
receiving intravenous opioids. Which assessment finding indicates the need for immediate intervention?
A. Respiratory rate of 8 breaths/minute
B. Pain score decreased from 9/10 to 4/10
C. Blood pressure of 138/84 mm Hg
D. Oxygen saturation of 95% on room air
Correct Answer: A. Respiratory rate of 8 breaths/minute
, Rationale: A respiratory rate below 10 breaths/minute after opioid administration suggests significant
respiratory depression and requires immediate intervention, including withholding additional opioids,
stimulating the client, administering oxygen, and preparing naloxone if indicated.
Why the Other Options Are Incorrect
B. Improved pain control is an expected therapeutic effect.
C. This blood pressure is within an acceptable range.
D. Although oxygen saturation is currently adequate, severe hypoventilation requires prompt treatment before
oxygenation deteriorates.
Clinical Pearl: Respiratory rate is the most sensitive indicator of opioid-induced respiratory depression.
HESI High-Yield Tip: After opioid administration, always assess respiratory status before evaluating pain
relief
Question 11
A client with chronic heart failure suddenly reports severe shortness of breath while lying flat. Upon entering
the room, the nurse notes pink frothy sputum and diffuse crackles throughout both lung fields. Which
intervention should the nurse perform first?
A. Place the client in High-Fowler's position and administer oxygen.
B. Encourage the client to cough deeply every hour.
C. Increase the intravenous infusion rate.
D. Prepare the client for a chest x-ray.
Correct Answer: A. Place the client in High-Fowler's position and administer oxygen.
Rationale: Pink frothy sputum, orthopnea, and diffuse crackles indicate acute pulmonary edema.
Immediate improvement of oxygenation and reduction of pulmonary congestion are the highest priorities.
Why the Other Options Are Incorrect
B. Coughing does not immediately improve oxygenation.
C. Increasing IV fluids may worsen pulmonary edema.
D. Diagnostic testing should never delay emergency treatment.
Clinical Pearl: Acute pulmonary edema is a life-threatening emergency requiring rapid airway and
breathing support.
HESI High-Yield Tip: Pink frothy sputum = think pulmonary edema until proven otherwise.
Question 12
,Section Contents Questions
Table of Contents HESI RN Exit Exam (V1–V10) —
HESI RN Exit Exam V1 Original Comprehensive Practice Exam 1–100
HESI RN Exit Exam V2 Comprehensive Practice Exam 101–200
HESI RN Exit Exam V3 Comprehensive Practice Exam 201–300
HESI RN Exit Exam V4 Comprehensive Practice Exam 301–400
HESI RN Exit Exam V5 Comprehensive Practice Exam 401–500
HESI RN Exit Exam V6 Comprehensive Practice Exam 501–600
HESI RN Exit Exam V7 Comprehensive Practice Exam 601–700
HESI RN Exit Exam V8 Comprehensive Practice Exam 701–800
HESI RN Exit Exam V9 Comprehensive Practice Exam 801–900
HESI RN Exit Exam V10 Comprehensive Practice Exam 901–1000
Comprehensive Answer Key & Detailed explanations, Clinical Pearls, and HESI High-
Throughout
Rationales Yield Tips
Exam Features
• 10 Complete HESI RN Exit Exams
• 1,000 Original HESI-Style Questions
• Detailed Rationales
• Why the Other Options Are Incorrect
• Clinical Pearls
• HESI High-Yield Tips
• Priority, Delegation & Management of Care
• Pharmacology
• Adult Medical-Surgical Nursing
• Critical Care
• Emergency Nursing
• Maternal-Newborn Nursing
, • Pediatric Nursing
• Mental Health Nursing
• Leadership & Management
• Infection Prevention & Control
• NGN Clinical Judgment–Style Questions
• Randomized A–D Answer Distribution
• NCLEX/HESI-Level Critical Thinking
HESI RN Exit Exam V1
Question 1
A nurse is caring for four clients on a medical-surgical unit. Which client should the nurse assess first?
A. A client with heart failure who reports fatigue after walking to the bathroom.
B. A client who is 2 hours postoperative following a thyroidectomy and reports increasing neck tightness and
difficulty swallowing.
C. A client with type 2 diabetes whose pre-breakfast blood glucose is 242 mg/dL.
D. A client receiving oral antibiotics for cellulitis who reports pain rated 6/10.
Correct Answer: B. A client who is 2 hours postoperative following a thyroidectomy and reports
increasing neck tightness and difficulty swallowing.
Rationale
Difficulty swallowing accompanied by neck tightness shortly after a thyroidectomy is a classic warning sign of a
postoperative hematoma. Blood accumulating beneath the incision can rapidly compress the trachea, leading
to airway obstruction within minutes. Immediate assessment of the airway, notification of the surgeon, and
preparation for emergency intervention are essential. Airway compromise always takes precedence over pain
management, chronic disease symptoms, or isolated laboratory abnormalities.
Why the Other Options Are Less Appropriate
A. Fatigue after ambulation is a common finding in clients with chronic heart failure and does not suggest
immediate clinical deterioration.
C. A blood glucose level of 242 mg/dL requires treatment but is unlikely to cause immediate life-threatening
complications compared with an obstructed airway.
D. Pain control is important; however, it is not the priority when another client is exhibiting signs of possible
airway compromise.
Clinical Pearl
,Following thyroid surgery, frequently inspect the neck for swelling and monitor for hoarseness, dysphagia,
stridor, or respiratory distress.
HESI High-Yield Tip
When answering priority questions, always determine which client is at greatest risk for loss of airway,
breathing, or circulation.
Question 2
Before administering morning medications, which prescription should the nurse question?
A. Potassium chloride 20 mEq IV push for a client with a serum potassium level of 2.8 mEq/L.
B. Cefazolin 2 g IV to be administered 30 minutes before surgery.
C. Acetaminophen 650 mg orally every 6 hours as needed for fever.
D. Enoxaparin 40 mg subcutaneously once daily following hip replacement surgery.
Correct Answer: A. Potassium chloride 20 mEq IV push for a client with a serum potassium level of 2.8
mEq/L.
Rationale
Potassium chloride is classified as a high-alert medication and must never be administered by IV push. Rapid
intravenous administration can trigger fatal ventricular dysrhythmias and cardiac arrest. Potassium should
always be diluted and infused using an infusion pump at the recommended rate while the client is closely
monitored.
Why the Other Options Are Less Appropriate
B. Administering prophylactic antibiotics before surgery is recommended to reduce the risk of surgical site
infections.
C. Acetaminophen is an appropriate medication for fever management when prescribed within the
recommended dosage.
D. Enoxaparin is routinely prescribed to reduce the risk of postoperative venous thromboembolism.
Clinical Pearl
High-alert medications such as potassium chloride, insulin, and heparin require extra verification before
administration.
HESI High-Yield Tip
If an answer choice includes IV potassium push, it should immediately raise concern because potassium is
never administered by direct IV push.
Question 3
Twenty minutes after a blood transfusion begins, a client suddenly develops chills, shortness of breath, and
severe lower back pain. Which nursing action is the priority?
,A. Reduce the infusion rate and reassess the client in 15 minutes.
B. Stop the transfusion immediately and maintain IV access with normal saline using new tubing.
C. Administer prescribed acetaminophen and continue monitoring the client.
D. Notify the healthcare provider after completing the transfusion.
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline using
new tubing.
Rationale
The client's symptoms strongly indicate an acute hemolytic transfusion reaction, one of the most serious
complications of blood administration. The priority is to stop the transfusion immediately to prevent further
exposure to incompatible blood while maintaining intravenous access for emergency medications and
supportive care. Rapid intervention significantly reduces the risk of shock, kidney injury, and death.
Why the Other Options Are Less Appropriate
A. Slowing the infusion still allows incompatible blood to enter the circulation.
C. Antipyretics do not treat the underlying hemolytic reaction.
D. Delaying intervention until the transfusion is complete places the client at serious risk.
Clinical Pearl
Most severe transfusion reactions occur within the first 15–30 minutes after the infusion begins.
HESI High-Yield Tip
Remember the sequence: Stop the transfusion → Maintain IV access → Notify the provider and blood bank
→ Continue close monitoring.
Question 4
Which client assignment is most appropriate for a newly licensed registered nurse?
A. A client receiving continuous insulin and potassium infusions for diabetic ketoacidosis.
B. A client one day after laparoscopic cholecystectomy who is preparing for discharge.
C. A client with septic shock receiving vasopressor therapy.
D. A client requiring hourly neurological assessments after receiving thrombolytic therapy.
Correct Answer: B. A client one day after laparoscopic cholecystectomy who is preparing for discharge.
Rationale
Newly licensed nurses should care for clients with stable and predictable conditions. A client recovering from
uncomplicated laparoscopic surgery who is preparing for discharge has predictable care needs and is
appropriate for a novice RN. Clients requiring continuous medication titration, intensive monitoring, or
frequent neurological assessments should be assigned to experienced nurses.
Why the Other Options Are Less Appropriate
,A. Continuous insulin and electrolyte management requires advanced assessment and clinical judgment.
C. Septic shock is unstable and demands experienced nursing management.
D. Frequent neurological assessments following thrombolytic therapy require rapid recognition of subtle
changes.
Clinical Pearl
Safe assignments are based on client stability, predictability, and the nurse's level of experience.
HESI High-Yield Tip
Remember: Stable clients go to novice nurses; unstable or unpredictable clients go to experienced nurses.
Question 5
A nurse is caring for a client admitted with acute exacerbation of chronic obstructive pulmonary disease
(COPD). Which assessment finding requires the nurse's immediate intervention?
A. Productive cough with thick yellow sputum.
B. Oxygen saturation decreases from 94% to 86% despite oxygen at 2 L/min via nasal cannula.
C. Respiratory rate of 24 breaths/minute.
D. Reports fatigue after using the bedside commode.
Correct Answer: B. Oxygen saturation decreases from 94% to 86% despite oxygen at 2 L/min via nasal
cannula.
Rationale
A significant decline in oxygen saturation despite supplemental oxygen indicates worsening hypoxemia and
possible respiratory failure. Immediate assessment of airway patency, breath sounds, work of breathing, and
oxygen delivery is essential. The nurse should intervene promptly to improve oxygenation and notify the
healthcare provider if the client's condition does not improve. Preventing respiratory arrest is the highest
priority.
Why the Other Options Are Less Appropriate
A. Thick sputum is common during COPD exacerbations and requires treatment but is not the most urgent
finding.
C. A respiratory rate of 24 breaths/minute represents mild tachypnea and should be monitored, but severe
hypoxemia requires immediate action.
D. Fatigue with activity is expected during an acute COPD exacerbation and is less urgent than impaired
oxygenation.
Clinical Pearl
Clients with COPD often deteriorate gradually; worsening oxygen saturation accompanied by increased work of
breathing is an early indicator of impending respiratory failure.
, HESI High-Yield Tip
Prioritize oxygenation whenever oxygen saturation falls below the prescribed target range despite current
therapy.
Question 6
The nurse receives report on four hospitalized clients. Which client should the nurse assess first?
A. A client with bacterial pneumonia whose temperature is 38.3°C (100.9°F).
B. A client receiving intravenous heparin whose activated partial thromboplastin time (aPTT) is 84 seconds
within the prescribed therapeutic range.
C. A client one day after abdominal surgery who suddenly reports severe shortness of breath and sharp chest
pain.
D. A client with chronic kidney disease awaiting scheduled hemodialysis later in the day.
Correct Answer: C. A client one day after abdominal surgery who suddenly reports severe shortness of
breath and sharp chest pain.
Rationale
A postoperative client who suddenly develops dyspnea and pleuritic chest pain should be suspected of having
a pulmonary embolism until proven otherwise. Pulmonary embolism can rapidly progress to respiratory
collapse and cardiovascular instability, requiring immediate assessment and emergency intervention. Early
recognition greatly improves outcomes.
Why the Other Options Are Less Appropriate
A. Fever is expected with pneumonia and should be managed but is not the highest priority.
B. The aPTT is therapeutic, indicating the heparin infusion is appropriately managed.
D. Scheduled dialysis is important but does not represent an acute emergency.
Clinical Pearl
Major surgery and prolonged immobility significantly increase the risk of venous thromboembolism.
HESI High-Yield Tip
Sudden chest pain and dyspnea in a postoperative client should immediately raise suspicion for pulmonary
embolism.
Question 7
A nurse reviews laboratory results before administering morning medications. Which finding requires
immediate notification of the healthcare provider?
A. Sodium 134 mEq/L.
B. Hemoglobin 11.2 g/dL.
,C. Potassium 6.3 mEq/L.
D. White blood cell count 11,000/mm³.
Correct Answer: C. Potassium 6.3 mEq/L.
Rationale
A potassium level of 6.3 mEq/L represents significant hyperkalemia, placing the client at high risk for life-
threatening cardiac dysrhythmias. Immediate intervention, ECG monitoring, and treatment are necessary to
prevent cardiac arrest.
Why the Other Options Are Less Appropriate
A. Mild hyponatremia should be monitored but is not immediately life-threatening.
B. Mild anemia is not an emergency unless accompanied by severe symptoms or active bleeding.
D. A slightly elevated white blood cell count may reflect infection or inflammation and requires evaluation but
is less urgent than severe hyperkalemia.
Clinical Pearl
Hyperkalemia can rapidly affect cardiac conduction even before obvious symptoms develop.
HESI High-Yield Tip
Potassium abnormalities are frequently tested because of their direct impact on cardiac function.
Question 8
A client with type 1 diabetes tells the nurse, "I feel shaky, sweaty, and dizzy." The client is alert and able to
swallow. What is the nurse's priority action?
A. Administer the scheduled dose of long-acting insulin.
B. Check the client's capillary blood glucose level immediately.
C. Encourage the client to rest for 30 minutes.
D. Notify the healthcare provider before performing any intervention.
Correct Answer: B. Check the client's capillary blood glucose level immediately.
Rationale
The client's symptoms strongly suggest hypoglycemia. The nurse should immediately verify the blood glucose
level to guide prompt treatment. If hypoglycemia is confirmed and the client can safely swallow, fast-acting
carbohydrates should be administered according to protocol. Rapid assessment prevents progression to
seizures or loss of consciousness.
Why the Other Options Are Less Appropriate
A. Administering insulin before assessing glucose could worsen hypoglycemia.
C. Rest alone does not correct potentially dangerous hypoglycemia.
,D. Immediate assessment should not be delayed while waiting to contact the healthcare provider.
Clinical Pearl
Early recognition and treatment of hypoglycemia can prevent serious neurological complications.
HESI High-Yield Tip
When hypoglycemia is suspected and the client is stable, verify the blood glucose level promptly and treat
according to facility protocol.
Question 9
Following administration of an ACE inhibitor, a client develops facial swelling, difficulty swallowing, and a
muffled voice. Which action should the nurse perform first?
A. Stop the medication and activate emergency response measures.
B. Reassure the client that these symptoms usually resolve.
C. Offer cool fluids to relieve throat discomfort.
D. Place the client in Trendelenburg position.
Correct Answer: A. Stop the medication and activate emergency response measures.
Rationale: Angioedema is a life-threatening adverse effect of ACE inhibitors because airway obstruction can
develop rapidly.
Why the Other Options Are Incorrect
B. Delaying treatment may result in complete airway obstruction.
C. Fluids do not relieve airway edema.
D. Trendelenburg positioning does not improve airway patency.
Clinical Pearl: Angioedema may occur even after prolonged ACE inhibitor therapy.
HESI High-Yield Tip: Airway protection is the highest priority whenever angioedema is suspected.
Question 10
During change-of-shift report, the nurse learns that one client has become increasingly difficult to arouse after
receiving intravenous opioids. Which assessment finding indicates the need for immediate intervention?
A. Respiratory rate of 8 breaths/minute
B. Pain score decreased from 9/10 to 4/10
C. Blood pressure of 138/84 mm Hg
D. Oxygen saturation of 95% on room air
Correct Answer: A. Respiratory rate of 8 breaths/minute
, Rationale: A respiratory rate below 10 breaths/minute after opioid administration suggests significant
respiratory depression and requires immediate intervention, including withholding additional opioids,
stimulating the client, administering oxygen, and preparing naloxone if indicated.
Why the Other Options Are Incorrect
B. Improved pain control is an expected therapeutic effect.
C. This blood pressure is within an acceptable range.
D. Although oxygen saturation is currently adequate, severe hypoventilation requires prompt treatment before
oxygenation deteriorates.
Clinical Pearl: Respiratory rate is the most sensitive indicator of opioid-induced respiratory depression.
HESI High-Yield Tip: After opioid administration, always assess respiratory status before evaluating pain
relief
Question 11
A client with chronic heart failure suddenly reports severe shortness of breath while lying flat. Upon entering
the room, the nurse notes pink frothy sputum and diffuse crackles throughout both lung fields. Which
intervention should the nurse perform first?
A. Place the client in High-Fowler's position and administer oxygen.
B. Encourage the client to cough deeply every hour.
C. Increase the intravenous infusion rate.
D. Prepare the client for a chest x-ray.
Correct Answer: A. Place the client in High-Fowler's position and administer oxygen.
Rationale: Pink frothy sputum, orthopnea, and diffuse crackles indicate acute pulmonary edema.
Immediate improvement of oxygenation and reduction of pulmonary congestion are the highest priorities.
Why the Other Options Are Incorrect
B. Coughing does not immediately improve oxygenation.
C. Increasing IV fluids may worsen pulmonary edema.
D. Diagnostic testing should never delay emergency treatment.
Clinical Pearl: Acute pulmonary edema is a life-threatening emergency requiring rapid airway and
breathing support.
HESI High-Yield Tip: Pink frothy sputum = think pulmonary edema until proven otherwise.
Question 12
