HESI Exit Comprehensive Assessment Final
Exam 2026 | Verified Practice Questions &
Answers with Detailed Rationales |
Complete RN Exit Exam Study Guide
HESI EXIT COMPREHENSIVE ASSESSMENT FINAL EXAM 2026
Verified Practice Questions & Answers with Detailed Rationales
DOCUMENT OVERVIEW
• Comprehensive Study Resource: 200 detailed practice questions mirroring the
actual HESI Exit RN exam with clinically relevant scenarios, evidence-based answers,
and comprehensive rationales to reinforce critical thinking and clinical decision-
making skills.
• Effective Study Strategy: Use this guide by reviewing each question, attempting
answers independently, then studying the rationale regardless of performance;
complete all 200 questions to identify weak areas and reinforce nursing
fundamentals across all major clinical domains.
QUESTIONS BEGIN HERE
1. A 45-year-old client with acute myocardial infarction (AMI) is admitted to
the critical care unit. Which vital sign finding would be MOST concerning
immediately after admission?
A) Heart rate of 58 beats per minute
B) Systolic blood pressure of 95 mmHg
C) Respiratory rate of 20 breaths per minute
D) Temperature of 37.2°C (98.96°F)
E) Oxygen saturation of 94% on room air
✓ CORRECT ANSWER: B) Systolic blood pressure of 95 mmHg
,Rationale: A systolic blood pressure of 95 mmHg in a client with acute MI indicates
cardiogenic shock or severe hypotension, which is a medical emergency. This level
of hypotension compromises coronary perfusion pressure and can extend the
infarction. A heart rate of 58 is bradycardic but may be acceptable; a respiratory
rate of 20 is slightly elevated but not immediately life-threatening; normal
temperature is reassuring; and 94% O2 saturation, while slightly low, is more
manageable than severe hypotension.
2. A 68-year-old female with COPD is experiencing an acute exacerbation. The
arterial blood gas (ABG) results are: pH 7.28, PaCO2 52 mmHg, HCO3- 24
mEq/L, PaO2 58 mmHg. What is the primary acid-base disturbance?
A) Respiratory acidosis with hypoxemia
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Metabolic alkalosis with respiratory depression
E) Mixed acidosis with severe hypoxemia
✓ CORRECT ANSWER: A) Respiratory acidosis with hypoxemia
Rationale: The pH is decreased (7.28, normal 7.35-7.45) indicating acidosis. The
PaCO2 is elevated (52, normal 35-45), which is the cause of the acidosis (respiratory
cause). The HCO3- is normal (24, normal 22-26), so there is no metabolic
compensation yet. Additionally, the PaO2 is significantly decreased (58, normal 80-
100), indicating hypoxemia. In COPD exacerbation, CO2 retention occurs because
the client cannot adequately expel CO2, leading to respiratory acidosis.
3. A 52-year-old male client is prescribed lisinopril for hypertension. Which
adverse effect should the nurse prioritize teaching the client to report
immediately?
A) Dry cough lasting more than a few days
,B) Slight dizziness upon standing
C) Muscle aches and fatigue
D) Swelling of the lips, tongue, or throat (angioedema)
E) Mild headache
✓ CORRECT ANSWER: D) Swelling of the lips, tongue, or throat (angioedema)
Rationale: Angioedema is a serious, potentially life-threatening adverse effect of
ACE inhibitors like lisinopril. It can occur at any time during therapy and requires
immediate medical attention as it can progress to airway obstruction. While a dry
cough is a common adverse effect of ACE inhibitors and should be reported, it is
not life-threatening. Dizziness, muscle aches, fatigue, and mild headache are
generally manageable side effects that may resolve with continued therapy.
4. A 35-year-old woman with a history of asthma presents to the emergency
department with severe shortness of breath, peak flow of 40% predicted, and
silent chest on auscultation. What is the MOST appropriate initial nursing
intervention?
A) Administer oral corticosteroids and send client home
B) Establish IV access, apply continuous pulse oximetry, and prepare for emergent
intervention
C) Have client use their rescue inhaler and reassess in 15 minutes
D) Administer oxygen only if saturation drops below 90%
E) Perform chest percussion and postural drainage
✓ CORRECT ANSWER: B) Establish IV access, apply continuous pulse oximetry,
and prepare for emergent intervention
Rationale: A peak flow at 40% predicted and a silent chest (ominous sign indicating
severely decreased airflow) indicate a life-threatening asthma exacerbation (status
asthmaticus). This client requires immediate stabilization: IV access for medication
administration, continuous pulse oximetry monitoring, and preparation for possible
, intubation. Oral corticosteroids are insufficient for this severity. The client cannot
wait 15 minutes for reassessment. Oxygen should be applied immediately (not
waiting for saturation <90%). Chest percussion is contraindicated in acute asthma.
5. A 78-year-old client with advanced Alzheimer's disease is refusing
medications and meals. The family asks the nurse what can be done. Which
response reflects the MOST appropriate ethical approach?
A) "We will need to place a feeding tube and use restraints to administer
medications."
B) "We should respect the client's autonomy while exploring reasons for refusal and
considering comfort-focused care."
C) "The client's confusion means we should make all decisions for them based on
what benefits them medically."
D) "We can administer medications in food or drinks without the client's
knowledge."
E) "The family should sign a consent form allowing us to force medications for the
client's own good."
✓ CORRECT ANSWER: B) We should respect the client's autonomy while
exploring reasons for refusal and considering comfort-focused care.
Rationale: Even in advanced dementia, clients retain rights and dignity. The ethical
approach includes: (1) exploring underlying reasons for refusal (pain, medication
side effects, depression), (2) respecting expressed preferences when possible, and
(3) considering the client's goals of care, which may shift toward comfort and
quality of life in advanced disease. Forced medication administration without
consent violates autonomy and ethical principles. Restraints should only be used as
a last resort. Deception by hiding medications in food violates informed consent.
While medical considerations matter, they must be balanced with respect for the
person.
Exam 2026 | Verified Practice Questions &
Answers with Detailed Rationales |
Complete RN Exit Exam Study Guide
HESI EXIT COMPREHENSIVE ASSESSMENT FINAL EXAM 2026
Verified Practice Questions & Answers with Detailed Rationales
DOCUMENT OVERVIEW
• Comprehensive Study Resource: 200 detailed practice questions mirroring the
actual HESI Exit RN exam with clinically relevant scenarios, evidence-based answers,
and comprehensive rationales to reinforce critical thinking and clinical decision-
making skills.
• Effective Study Strategy: Use this guide by reviewing each question, attempting
answers independently, then studying the rationale regardless of performance;
complete all 200 questions to identify weak areas and reinforce nursing
fundamentals across all major clinical domains.
QUESTIONS BEGIN HERE
1. A 45-year-old client with acute myocardial infarction (AMI) is admitted to
the critical care unit. Which vital sign finding would be MOST concerning
immediately after admission?
A) Heart rate of 58 beats per minute
B) Systolic blood pressure of 95 mmHg
C) Respiratory rate of 20 breaths per minute
D) Temperature of 37.2°C (98.96°F)
E) Oxygen saturation of 94% on room air
✓ CORRECT ANSWER: B) Systolic blood pressure of 95 mmHg
,Rationale: A systolic blood pressure of 95 mmHg in a client with acute MI indicates
cardiogenic shock or severe hypotension, which is a medical emergency. This level
of hypotension compromises coronary perfusion pressure and can extend the
infarction. A heart rate of 58 is bradycardic but may be acceptable; a respiratory
rate of 20 is slightly elevated but not immediately life-threatening; normal
temperature is reassuring; and 94% O2 saturation, while slightly low, is more
manageable than severe hypotension.
2. A 68-year-old female with COPD is experiencing an acute exacerbation. The
arterial blood gas (ABG) results are: pH 7.28, PaCO2 52 mmHg, HCO3- 24
mEq/L, PaO2 58 mmHg. What is the primary acid-base disturbance?
A) Respiratory acidosis with hypoxemia
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Metabolic alkalosis with respiratory depression
E) Mixed acidosis with severe hypoxemia
✓ CORRECT ANSWER: A) Respiratory acidosis with hypoxemia
Rationale: The pH is decreased (7.28, normal 7.35-7.45) indicating acidosis. The
PaCO2 is elevated (52, normal 35-45), which is the cause of the acidosis (respiratory
cause). The HCO3- is normal (24, normal 22-26), so there is no metabolic
compensation yet. Additionally, the PaO2 is significantly decreased (58, normal 80-
100), indicating hypoxemia. In COPD exacerbation, CO2 retention occurs because
the client cannot adequately expel CO2, leading to respiratory acidosis.
3. A 52-year-old male client is prescribed lisinopril for hypertension. Which
adverse effect should the nurse prioritize teaching the client to report
immediately?
A) Dry cough lasting more than a few days
,B) Slight dizziness upon standing
C) Muscle aches and fatigue
D) Swelling of the lips, tongue, or throat (angioedema)
E) Mild headache
✓ CORRECT ANSWER: D) Swelling of the lips, tongue, or throat (angioedema)
Rationale: Angioedema is a serious, potentially life-threatening adverse effect of
ACE inhibitors like lisinopril. It can occur at any time during therapy and requires
immediate medical attention as it can progress to airway obstruction. While a dry
cough is a common adverse effect of ACE inhibitors and should be reported, it is
not life-threatening. Dizziness, muscle aches, fatigue, and mild headache are
generally manageable side effects that may resolve with continued therapy.
4. A 35-year-old woman with a history of asthma presents to the emergency
department with severe shortness of breath, peak flow of 40% predicted, and
silent chest on auscultation. What is the MOST appropriate initial nursing
intervention?
A) Administer oral corticosteroids and send client home
B) Establish IV access, apply continuous pulse oximetry, and prepare for emergent
intervention
C) Have client use their rescue inhaler and reassess in 15 minutes
D) Administer oxygen only if saturation drops below 90%
E) Perform chest percussion and postural drainage
✓ CORRECT ANSWER: B) Establish IV access, apply continuous pulse oximetry,
and prepare for emergent intervention
Rationale: A peak flow at 40% predicted and a silent chest (ominous sign indicating
severely decreased airflow) indicate a life-threatening asthma exacerbation (status
asthmaticus). This client requires immediate stabilization: IV access for medication
administration, continuous pulse oximetry monitoring, and preparation for possible
, intubation. Oral corticosteroids are insufficient for this severity. The client cannot
wait 15 minutes for reassessment. Oxygen should be applied immediately (not
waiting for saturation <90%). Chest percussion is contraindicated in acute asthma.
5. A 78-year-old client with advanced Alzheimer's disease is refusing
medications and meals. The family asks the nurse what can be done. Which
response reflects the MOST appropriate ethical approach?
A) "We will need to place a feeding tube and use restraints to administer
medications."
B) "We should respect the client's autonomy while exploring reasons for refusal and
considering comfort-focused care."
C) "The client's confusion means we should make all decisions for them based on
what benefits them medically."
D) "We can administer medications in food or drinks without the client's
knowledge."
E) "The family should sign a consent form allowing us to force medications for the
client's own good."
✓ CORRECT ANSWER: B) We should respect the client's autonomy while
exploring reasons for refusal and considering comfort-focused care.
Rationale: Even in advanced dementia, clients retain rights and dignity. The ethical
approach includes: (1) exploring underlying reasons for refusal (pain, medication
side effects, depression), (2) respecting expressed preferences when possible, and
(3) considering the client's goals of care, which may shift toward comfort and
quality of life in advanced disease. Forced medication administration without
consent violates autonomy and ethical principles. Restraints should only be used as
a last resort. Deception by hiding medications in food violates informed consent.
While medical considerations matter, they must be balanced with respect for the
person.
