HESI RN EXIT EXAM FINAL REVIEW 2026 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The nurse notes the patient's respiratory rate has decreased from 22 to 8 breaths/min and the patient is difficult
to arouse. What is the nurse's priority action?
A. Increase the oxygen flow rate to 4 L/min
B. Assess the patient's oxygen saturation
C. Decrease the oxygen flow rate to 1 L/min
D. Notify the healthcare provider immediately
🟢 Correct Answer:
D. Notify the healthcare provider immediately
🔴 RATIONALE:
A sudden drop in respiratory rate and decreased level of consciousness in a COPD patient receiving
supplemental oxygen indicates carbon dioxide narcosis, a life-threatening emergency caused by loss of hypoxic
drive. The nurse should notify the healthcare provider immediately and prepare to support ventilation. While
decreasing oxygen may be appropriate, notifying the provider is the priority.
,Question 2
The nurse is caring for a patient with heart failure who is receiving intravenous furosemide. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Decreased blood pressure
B. Increased urine output and decreased dyspnea
C. Decreased heart rate
D. Increased peripheral edema
🟢 Correct Answer:
B. Increased urine output and decreased dyspnea
🔴 RATIONALE:
Furosemide is a loop diuretic used to reduce fluid volume overload. The desired therapeutic effects include
increased urine output, decreased edema, and relief of shortness of breath. Increased edema or decreased urine
output indicates the medication is not effective. While decreased blood pressure and heart rate may occur,
increased urine output is the most direct indicator.
Question 3
A patient with acute kidney injury has a serum potassium level of 6.9 mEq/L. Which intervention should the
nurse implement first?
A. Administer oral sodium polystyrene sulfonate
B. Prepare the patient for emergent hemodialysis
C. Administer intravenous calcium gluconate
D. Administer intravenous insulin and dextrose
,🟢 Correct Answer:
C. Administer intravenous calcium gluconate
🔴 RATIONALE:
Hyperkalemia of 6.9 mEq/L is a life-threatening emergency due to the risk of cardiac arrhythmias. The first
priority is to stabilize the cardiac membrane by administering IV calcium gluconate. While insulin and dextrose,
sodium polystyrene, and hemodialysis are all treatments for hyperkalemia, cardiac membrane stabilization is the
immediate priority.
Question 4
A patient with a spinal cord injury at T5 is experiencing a severe headache, profuse diaphoresis, and a blood
pressure of 215/110 mmHg. What is the nurse's priority action?
A. Administer a prescribed antihypertensive medication
B. Place the patient in a supine position
C. Assess for a distended bladder or fecal impaction
D. Notify the healthcare provider
🟢 Correct Answer:
C. Assess for a distended bladder or fecal impaction
🔴 RATIONALE:
The patient is experiencing autonomic dysreflexia, a medical emergency triggered by a noxious stimulus below
the level of injury. The most common triggers are a distended bladder or fecal impaction. The nurse should
, immediately assess for and remove the triggering stimulus. Sitting the patient upright is also important to help
lower blood pressure.
Question 5
The nurse is preparing to administer a blood transfusion to a patient. Which IV solution should be used to
prime the blood administration tubing?
A. 5% dextrose in water
B. 0.9% normal saline
C. Lactated Ringer's solution
D. 0.45% normal saline
🟢 Correct Answer:
B. 0.9% normal saline
🔴 RATIONALE:
Only 0.9% normal saline should be used to prime blood administration tubing. Dextrose solutions can cause
hemolysis of red blood cells, and lactated Ringer's contains calcium, which can cause clotting in the tubing.
Normal saline maintains isotonicity and is compatible with blood products.
Question 6
A patient with cirrhosis of the liver is exhibiting signs of hepatic encephalopathy. Which medication should the
nurse anticipate administering?
SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via nasal cannula.
The nurse notes the patient's respiratory rate has decreased from 22 to 8 breaths/min and the patient is difficult
to arouse. What is the nurse's priority action?
A. Increase the oxygen flow rate to 4 L/min
B. Assess the patient's oxygen saturation
C. Decrease the oxygen flow rate to 1 L/min
D. Notify the healthcare provider immediately
🟢 Correct Answer:
D. Notify the healthcare provider immediately
🔴 RATIONALE:
A sudden drop in respiratory rate and decreased level of consciousness in a COPD patient receiving
supplemental oxygen indicates carbon dioxide narcosis, a life-threatening emergency caused by loss of hypoxic
drive. The nurse should notify the healthcare provider immediately and prepare to support ventilation. While
decreasing oxygen may be appropriate, notifying the provider is the priority.
,Question 2
The nurse is caring for a patient with heart failure who is receiving intravenous furosemide. Which assessment
finding indicates the medication is having the desired therapeutic effect?
A. Decreased blood pressure
B. Increased urine output and decreased dyspnea
C. Decreased heart rate
D. Increased peripheral edema
🟢 Correct Answer:
B. Increased urine output and decreased dyspnea
🔴 RATIONALE:
Furosemide is a loop diuretic used to reduce fluid volume overload. The desired therapeutic effects include
increased urine output, decreased edema, and relief of shortness of breath. Increased edema or decreased urine
output indicates the medication is not effective. While decreased blood pressure and heart rate may occur,
increased urine output is the most direct indicator.
Question 3
A patient with acute kidney injury has a serum potassium level of 6.9 mEq/L. Which intervention should the
nurse implement first?
A. Administer oral sodium polystyrene sulfonate
B. Prepare the patient for emergent hemodialysis
C. Administer intravenous calcium gluconate
D. Administer intravenous insulin and dextrose
,🟢 Correct Answer:
C. Administer intravenous calcium gluconate
🔴 RATIONALE:
Hyperkalemia of 6.9 mEq/L is a life-threatening emergency due to the risk of cardiac arrhythmias. The first
priority is to stabilize the cardiac membrane by administering IV calcium gluconate. While insulin and dextrose,
sodium polystyrene, and hemodialysis are all treatments for hyperkalemia, cardiac membrane stabilization is the
immediate priority.
Question 4
A patient with a spinal cord injury at T5 is experiencing a severe headache, profuse diaphoresis, and a blood
pressure of 215/110 mmHg. What is the nurse's priority action?
A. Administer a prescribed antihypertensive medication
B. Place the patient in a supine position
C. Assess for a distended bladder or fecal impaction
D. Notify the healthcare provider
🟢 Correct Answer:
C. Assess for a distended bladder or fecal impaction
🔴 RATIONALE:
The patient is experiencing autonomic dysreflexia, a medical emergency triggered by a noxious stimulus below
the level of injury. The most common triggers are a distended bladder or fecal impaction. The nurse should
, immediately assess for and remove the triggering stimulus. Sitting the patient upright is also important to help
lower blood pressure.
Question 5
The nurse is preparing to administer a blood transfusion to a patient. Which IV solution should be used to
prime the blood administration tubing?
A. 5% dextrose in water
B. 0.9% normal saline
C. Lactated Ringer's solution
D. 0.45% normal saline
🟢 Correct Answer:
B. 0.9% normal saline
🔴 RATIONALE:
Only 0.9% normal saline should be used to prime blood administration tubing. Dextrose solutions can cause
hemolysis of red blood cells, and lactated Ringer's contains calcium, which can cause clotting in the tubing.
Normal saline maintains isotonicity and is compatible with blood products.
Question 6
A patient with cirrhosis of the liver is exhibiting signs of hepatic encephalopathy. Which medication should the
nurse anticipate administering?
