PN HESI EXIT EXAM
2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS) | A+ GRADE BRAND NEW
Exam Subject: Practical Nursing (PN) Exit Exam & Medical-Surgical Foundations
Target Audience: Nursing Students preparing for HESI PN & NCLEX-PN Licensing Exams
Structure: 215 Comprehensive Practice Questions with Detailed Physiological Rationales
ISCHEMIC HEART DISEASE & CORONARY ARTERY DISEASE
Question 1: A client is scheduled for a dipyridamole thallium scan to evaluate myocardial
perfusion. The nurse should check to make sure that the client has avoided which of the
following substances for at least 4 to 24 hours prior to the procedure?
A. Caffeine
B. Fatty meals
C. Excess sugar
D. Milk products
ANSWER ■: A — Caffeine
Explanation: Dipyridamole thallium scans require the avoidance of caffeine and other methylxanthines
because they can interfere with the pharmacological effects of dipyridamole, which dilates the coronary arteries.
Fatty meals, excess sugar, and milk products do not directly interfere with the thallium imaging process or the
action of dipyridamole.
Question 2: The nurse in an ambulatory clinic is interviewing a client who is complaining of
flu-like symptoms. The client suddenly reports experiencing chest pain. Which of the
following questions should the nurse ask first to best help discriminate pain caused by a
non-cardiac problem?
A. "Can you describe the chest pain to me?"
B. "Have you ever had this specific chest pain before?"
C. "Does the pain get worse when you breathe in?"
D. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"
ANSWER ■: C — "Does the pain get worse when you breathe in?"
Explanation: Pain that worsens upon inspiration is highly indicative of a pleuritic or musculoskeletal source,
which helps differentiate it from classic cardiac ischemic pain (which is typically dull, crushing, constant, and
unaffected by breathing). Asking the client to describe, rate, or recall prior pain are helpful general pain
assessment questions but are less specific in ruling out a cardiac origin.
Verified Solutions & Complete Explanations Page 1 Adult Medical-Surgical & General PN Foundations
,PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 3: A hospitalized client with a history of chronic stable angina pectoris is ambulating
in the corridor and suddenly complains of severe substernal chest pain. Which action should
the nurse take first?
A. Check the client's vital signs immediately.
B. Assist the client to sit or lie down.
C. Administer one sublingual nitroglycerin tablet.
D. Apply nasal cannula oxygen at a rate of 2 L/min.
ANSWER ■: B — Assist the client to sit or lie down.
Explanation: The immediate priority when a client experiences chest pain during activity is to reduce
myocardial oxygen demand by stopping the activity and assisting the client to sit or lie down. Once the client is
resting, the nurse can check vital signs, administer nitroglycerin, and apply oxygen as prescribed.
Question 4: The nurse is collecting data from a client with known coronary artery disease
(CAD) who was admitted to the hospital 2 days ago. The nurse notes bilateral 2+ pitting edema
in the lower extremities. Based on this finding, which action should the nurse implement first?
A. Review the client's intake and output records for the last 2 days.
B. Prescribe daily weights starting on the following morning.
C. Change the timing of the diuretic administration from morning to evening.
D. Request a strict sodium restriction of 1 g/day from the health care provider.
ANSWER ■: A — Review the client's intake and output records for the last 2 days.
Explanation: Reviewing the client's intake and output (I&O) records for the past 2 days is the first step in
determining the fluid balance trend and identifying if fluid retention is occurring. Prescribing daily weights is an
intervention (and typically requires a provider order or is standard protocol, but data analysis comes first).
Diuretics should not be shifted to the evening because they cause nocturia. Restricting sodium is a
collaborative intervention that follows assessment.
Question 5: A client with coronary artery disease (CAD) has selected guided imagery to help
cope with psychological stress. Which statement by the client indicates an accurate
understanding of this stress-reduction measure?
A. "This will help only if I play soft music at the same time."
B. "This will work for me only if I am alone in a completely quiet area."
C. "I need to do this only when I lie down in case I fall asleep."
D. "The best thing about this is that I can use it anywhere, anytime."
ANSWER ■: D — "The best thing about this is that I can use it anywhere, anytime."
Explanation: Guided imagery is a highly effective, portable stress-reduction technique that can be practiced
anywhere and at any time once learned. It does not strictly require music, isolation, or a recumbent position to
be therapeutically beneficial.
Verified Solutions & Complete Explanations Page 2 Adult Medical-Surgical & General PN Foundations
,PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 6: An emergency department client who complains of chest pain for 2 days is
reluctant to take a nitroglycerin sublingual tablet offered by the nurse. The client states, "I
don't need that—my dad takes that for his heart. There's nothing wrong with my heart." Which
defense mechanism is this client demonstrating?
A. Anger
B. Denial
C. Phobic behavior
D. Obsessive-compulsive behavior
ANSWER ■: B — Denial
Explanation: The client's statement is a classic example of denial, where they refuse to acknowledge a
potentially life-threatening health problem despite symptoms. Denial is a common defense mechanism in the
early stages of cardiac illness. The statement does not represent anger, phobia, or obsessive-compulsive traits.
Question 7: The nurse has completed nutritional counseling with an overweight client about
weight reduction to modify the risk for coronary artery disease (CAD). The nurse should
determine that the teaching is successful if the client identifies which weight loss goal as safe
and realistic?
A. One half pound per day
B. Two pounds per week
C. Four pounds per week
D. Six pounds per week
ANSWER ■: B — Two pounds per week
Explanation: A safe, sustainable, and medically sound weight loss goal is 1 to 2 pounds per week. Rapid
weight loss beyond this range can lead to electrolyte imbalances, muscle wasting, and nutritional deficiencies,
and is rarely maintained long-term.
Question 8: The nurse monitors the laboratory data of a client at risk for coronary artery
disease. A fasting blood glucose reading of 200 mg/dL is recorded on the chart. How should
the nurse analyze this result?
A. It is normal, indicating adequate glucose control with no cardiac risk.
B. It is elevated, but would not present a significant risk for coronary artery disease.
C. It is elevated, signaling the presence of diabetes mellitus, which is a major risk factor for coronary artery
disease.
D. It is decreased, indicating a decreased risk of coronary artery disease.
ANSWER ■: C — It is elevated, signaling the presence of diabetes mellitus, which is a major risk factor
for coronary artery disease.
Explanation: A fasting blood glucose of 200 mg/dL is significantly elevated (normal is <100 mg/dL) and
indicates diabetes mellitus if confirmed on a repeat test. Diabetes is an independent, major cardiovascular risk
factor that accelerates atherosclerosis. Thus, options A, B, and D are incorrect.
Verified Solutions & Complete Explanations Page 3 Adult Medical-Surgical & General PN Foundations
, PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 9: The nurse has completed counseling about smoking cessation with a client with
coronary artery disease (CAD). The nurse determines that the client has understood the
material best if the client makes which of the following statements?
A. "A smoker has twice the risk of having a heart attack as a nonsmoker."
B. "I may try just cutting down first, because the major damage has already been done."
C. "I don't think I want to quit because none of the effects are reversible anyway."
D. "I'm never going to start again because I can cut my risk of cardiovascular disease to zero within a year."
ANSWER ■: A — "A smoker has twice the risk of having a heart attack as a nonsmoker."
Explanation: Nicotine in tobacco smoke causes vasoconstriction and increases carbon monoxide levels,
doubling a smoker's risk of myocardial infarction compared to a nonsmoker. This is an accurate risk
assessment. Cardiovascular risk decreases substantially after quitting, but it does not reach zero within a single
year; instead, it matches a nonsmoker's risk after 3 to 4 years.
Question 10: A client with a history of angina pectoris tells the nurse that chest pain usually
occurs after going up two flights of stairs or after walking four blocks. The nurse should
interpret that the client is experiencing which type of angina?
A. Stable angina
B. Variant angina
C. Unstable angina
D. Intractable angina
ANSWER ■: A — Stable angina
Explanation: Stable angina is characterized by chest pain that is predictable in onset, duration, and severity,
and is precipitated by a known level of physical exertion or stress. Variant (Prinzmetal's) angina occurs at rest,
often in cyclic morning patterns. Unstable angina is unpredictable, increases in frequency, and occurs at rest or
with minimal exertion. Intractable angina is chronic, severe, and unresponsive to standard medical therapies.
Question 11: The nurse is teaching a client with angina pectoris about disease management
and lifestyle changes necessary to control disease progression. Which statement by the client
indicates a need for further teaching?
A. "I will avoid using table salt with my meals."
B. "It is best to exercise once a week for an hour."
C. "I will take nitroglycerin whenever chest discomfort begins."
D. "I will use muscle relaxation to cope with stressful situations."
ANSWER ■: B — "It is best to exercise once a week for an hour."
Explanation: Exercising once a week for an hour is unsafe and ineffective for cardiovascular conditioning.
Clients with stable CAD should engage in moderate aerobic exercise (like walking) for 30 minutes on most days
of the week (5 or more days). Avoiding salt, taking nitroglycerin at the onset of pain, and utilizing stress
management are correct and safe behaviors.
Verified Solutions & Complete Explanations Page 4 Adult Medical-Surgical & General PN Foundations
2026–2027 UPDATED EXAM 100% (VERIFIED ANSWERS) | A+ GRADE BRAND NEW
Exam Subject: Practical Nursing (PN) Exit Exam & Medical-Surgical Foundations
Target Audience: Nursing Students preparing for HESI PN & NCLEX-PN Licensing Exams
Structure: 215 Comprehensive Practice Questions with Detailed Physiological Rationales
ISCHEMIC HEART DISEASE & CORONARY ARTERY DISEASE
Question 1: A client is scheduled for a dipyridamole thallium scan to evaluate myocardial
perfusion. The nurse should check to make sure that the client has avoided which of the
following substances for at least 4 to 24 hours prior to the procedure?
A. Caffeine
B. Fatty meals
C. Excess sugar
D. Milk products
ANSWER ■: A — Caffeine
Explanation: Dipyridamole thallium scans require the avoidance of caffeine and other methylxanthines
because they can interfere with the pharmacological effects of dipyridamole, which dilates the coronary arteries.
Fatty meals, excess sugar, and milk products do not directly interfere with the thallium imaging process or the
action of dipyridamole.
Question 2: The nurse in an ambulatory clinic is interviewing a client who is complaining of
flu-like symptoms. The client suddenly reports experiencing chest pain. Which of the
following questions should the nurse ask first to best help discriminate pain caused by a
non-cardiac problem?
A. "Can you describe the chest pain to me?"
B. "Have you ever had this specific chest pain before?"
C. "Does the pain get worse when you breathe in?"
D. "Can you rate the pain on a scale of 1 to 10, with 10 being the worst?"
ANSWER ■: C — "Does the pain get worse when you breathe in?"
Explanation: Pain that worsens upon inspiration is highly indicative of a pleuritic or musculoskeletal source,
which helps differentiate it from classic cardiac ischemic pain (which is typically dull, crushing, constant, and
unaffected by breathing). Asking the client to describe, rate, or recall prior pain are helpful general pain
assessment questions but are less specific in ruling out a cardiac origin.
Verified Solutions & Complete Explanations Page 1 Adult Medical-Surgical & General PN Foundations
,PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 3: A hospitalized client with a history of chronic stable angina pectoris is ambulating
in the corridor and suddenly complains of severe substernal chest pain. Which action should
the nurse take first?
A. Check the client's vital signs immediately.
B. Assist the client to sit or lie down.
C. Administer one sublingual nitroglycerin tablet.
D. Apply nasal cannula oxygen at a rate of 2 L/min.
ANSWER ■: B — Assist the client to sit or lie down.
Explanation: The immediate priority when a client experiences chest pain during activity is to reduce
myocardial oxygen demand by stopping the activity and assisting the client to sit or lie down. Once the client is
resting, the nurse can check vital signs, administer nitroglycerin, and apply oxygen as prescribed.
Question 4: The nurse is collecting data from a client with known coronary artery disease
(CAD) who was admitted to the hospital 2 days ago. The nurse notes bilateral 2+ pitting edema
in the lower extremities. Based on this finding, which action should the nurse implement first?
A. Review the client's intake and output records for the last 2 days.
B. Prescribe daily weights starting on the following morning.
C. Change the timing of the diuretic administration from morning to evening.
D. Request a strict sodium restriction of 1 g/day from the health care provider.
ANSWER ■: A — Review the client's intake and output records for the last 2 days.
Explanation: Reviewing the client's intake and output (I&O) records for the past 2 days is the first step in
determining the fluid balance trend and identifying if fluid retention is occurring. Prescribing daily weights is an
intervention (and typically requires a provider order or is standard protocol, but data analysis comes first).
Diuretics should not be shifted to the evening because they cause nocturia. Restricting sodium is a
collaborative intervention that follows assessment.
Question 5: A client with coronary artery disease (CAD) has selected guided imagery to help
cope with psychological stress. Which statement by the client indicates an accurate
understanding of this stress-reduction measure?
A. "This will help only if I play soft music at the same time."
B. "This will work for me only if I am alone in a completely quiet area."
C. "I need to do this only when I lie down in case I fall asleep."
D. "The best thing about this is that I can use it anywhere, anytime."
ANSWER ■: D — "The best thing about this is that I can use it anywhere, anytime."
Explanation: Guided imagery is a highly effective, portable stress-reduction technique that can be practiced
anywhere and at any time once learned. It does not strictly require music, isolation, or a recumbent position to
be therapeutically beneficial.
Verified Solutions & Complete Explanations Page 2 Adult Medical-Surgical & General PN Foundations
,PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 6: An emergency department client who complains of chest pain for 2 days is
reluctant to take a nitroglycerin sublingual tablet offered by the nurse. The client states, "I
don't need that—my dad takes that for his heart. There's nothing wrong with my heart." Which
defense mechanism is this client demonstrating?
A. Anger
B. Denial
C. Phobic behavior
D. Obsessive-compulsive behavior
ANSWER ■: B — Denial
Explanation: The client's statement is a classic example of denial, where they refuse to acknowledge a
potentially life-threatening health problem despite symptoms. Denial is a common defense mechanism in the
early stages of cardiac illness. The statement does not represent anger, phobia, or obsessive-compulsive traits.
Question 7: The nurse has completed nutritional counseling with an overweight client about
weight reduction to modify the risk for coronary artery disease (CAD). The nurse should
determine that the teaching is successful if the client identifies which weight loss goal as safe
and realistic?
A. One half pound per day
B. Two pounds per week
C. Four pounds per week
D. Six pounds per week
ANSWER ■: B — Two pounds per week
Explanation: A safe, sustainable, and medically sound weight loss goal is 1 to 2 pounds per week. Rapid
weight loss beyond this range can lead to electrolyte imbalances, muscle wasting, and nutritional deficiencies,
and is rarely maintained long-term.
Question 8: The nurse monitors the laboratory data of a client at risk for coronary artery
disease. A fasting blood glucose reading of 200 mg/dL is recorded on the chart. How should
the nurse analyze this result?
A. It is normal, indicating adequate glucose control with no cardiac risk.
B. It is elevated, but would not present a significant risk for coronary artery disease.
C. It is elevated, signaling the presence of diabetes mellitus, which is a major risk factor for coronary artery
disease.
D. It is decreased, indicating a decreased risk of coronary artery disease.
ANSWER ■: C — It is elevated, signaling the presence of diabetes mellitus, which is a major risk factor
for coronary artery disease.
Explanation: A fasting blood glucose of 200 mg/dL is significantly elevated (normal is <100 mg/dL) and
indicates diabetes mellitus if confirmed on a repeat test. Diabetes is an independent, major cardiovascular risk
factor that accelerates atherosclerosis. Thus, options A, B, and D are incorrect.
Verified Solutions & Complete Explanations Page 3 Adult Medical-Surgical & General PN Foundations
, PN HESI EXIT EXAM — 2026-2027 A+ GRADE EXAM PREPARATION
Question 9: The nurse has completed counseling about smoking cessation with a client with
coronary artery disease (CAD). The nurse determines that the client has understood the
material best if the client makes which of the following statements?
A. "A smoker has twice the risk of having a heart attack as a nonsmoker."
B. "I may try just cutting down first, because the major damage has already been done."
C. "I don't think I want to quit because none of the effects are reversible anyway."
D. "I'm never going to start again because I can cut my risk of cardiovascular disease to zero within a year."
ANSWER ■: A — "A smoker has twice the risk of having a heart attack as a nonsmoker."
Explanation: Nicotine in tobacco smoke causes vasoconstriction and increases carbon monoxide levels,
doubling a smoker's risk of myocardial infarction compared to a nonsmoker. This is an accurate risk
assessment. Cardiovascular risk decreases substantially after quitting, but it does not reach zero within a single
year; instead, it matches a nonsmoker's risk after 3 to 4 years.
Question 10: A client with a history of angina pectoris tells the nurse that chest pain usually
occurs after going up two flights of stairs or after walking four blocks. The nurse should
interpret that the client is experiencing which type of angina?
A. Stable angina
B. Variant angina
C. Unstable angina
D. Intractable angina
ANSWER ■: A — Stable angina
Explanation: Stable angina is characterized by chest pain that is predictable in onset, duration, and severity,
and is precipitated by a known level of physical exertion or stress. Variant (Prinzmetal's) angina occurs at rest,
often in cyclic morning patterns. Unstable angina is unpredictable, increases in frequency, and occurs at rest or
with minimal exertion. Intractable angina is chronic, severe, and unresponsive to standard medical therapies.
Question 11: The nurse is teaching a client with angina pectoris about disease management
and lifestyle changes necessary to control disease progression. Which statement by the client
indicates a need for further teaching?
A. "I will avoid using table salt with my meals."
B. "It is best to exercise once a week for an hour."
C. "I will take nitroglycerin whenever chest discomfort begins."
D. "I will use muscle relaxation to cope with stressful situations."
ANSWER ■: B — "It is best to exercise once a week for an hour."
Explanation: Exercising once a week for an hour is unsafe and ineffective for cardiovascular conditioning.
Clients with stable CAD should engage in moderate aerobic exercise (like walking) for 30 minutes on most days
of the week (5 or more days). Avoiding salt, taking nitroglycerin at the onset of pain, and utilizing stress
management are correct and safe behaviors.
Verified Solutions & Complete Explanations Page 4 Adult Medical-Surgical & General PN Foundations
