HESI Practice Exam 2026–2027
Comprehensive Nursing Practice Examination
QUESTION 1
A client with heart failure is prescribed furosemide 40 mg IV push. Which laboratory value
should the nurse monitor most closely?
Answer: Serum potassium levels
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to significant potassium wasting. Hypokalemia can
precipitate cardiac dysrhythmias, especially in patients with heart failure who may also be
taking digoxin. Serum potassium should be monitored before and after administration, with
normal range being 3.5-5.0 mEq/L. Other electrolytes such as sodium, magnesium, and
calcium may also be affected but potassium presents the most immediate life-threatening
risk.
QUESTION 2
A postoperative patient reports sudden chest pain and shortness of breath. The nurse notes
tachycardia, tachypnea, and oxygen saturation of 88% on room air. What is the priority
nursing action?
Answer: Apply high-flow oxygen and notify the healthcare provider immediately
Rationale: This clinical presentation is highly suggestive of a pulmonary embolism (PE), a
life-threatening complication of surgery. The priority is to maintain oxygenation and
perfusion while preparing for immediate medical intervention. High-flow oxygen should be
administered via non-rebreather mask at 15 L/min to maximize oxygen delivery. The
healthcare provider must be notified stat for further orders, which may include a V/Q scan,
CT angiography, and initiation of anticoagulation therapy. Placing the patient in a high
Fowler's position facilitates breathing, but oxygenation takes precedence over positioning.
QUESTION 3
,A client with type 1 diabetes mellitus is experiencing hypoglycemia with a blood glucose of
52 mg/dL. The client is alert and able to swallow. Which intervention should the nurse
implement first?
Answer: Administer 15 grams of rapid-acting carbohydrate (4 oz orange juice or 3 glucose
tablets)
Rationale: The "Rule of 15" is the standard of care for treating hypoglycemia in an alert
patient. Rapid-acting carbohydrates such as glucose tablets (4 grams each), fruit juice (4
oz), regular soda (4 oz), or honey (1 tablespoon) are preferred because they are quickly
absorbed and raise blood glucose within 15 minutes. After administration, the nurse should
recheck blood glucose in 15 minutes and repeat the treatment if still below 70 mg/dL.
Glucagon is reserved for unconscious patients or those unable to swallow. A complex
carbohydrate with protein is given only after blood glucose returns to normal to prevent
subsequent hypoglycemia.
QUESTION 4
The nurse is caring for a patient with cirrhosis who develops confusion, asterixis, and
elevated ammonia levels. Which dietary modification is most appropriate?
Answer: Restrict protein intake while ensuring adequate caloric intake from carbohydrates
and fats
Rationale: Hepatic encephalopathy results from the liver's inability to metabolize ammonia,
a byproduct of protein metabolism. In acute encephalopathy, protein restriction (20-40
g/day) is indicated to reduce ammonia production. However, protein should not be
completely eliminated because chronic protein deficiency worsens muscle wasting and can
increase ammonia levels through endogenous protein catabolism. In chronic management,
vegetable protein sources are preferred over animal proteins as they have fewer aromatic
amino acids and produce less ammonia. Lactulose and rifaximin are pharmacological
treatments that help reduce ammonia absorption and production.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing: pH 7.32, PaCO2 58 mmHg, HCO3 34 mEq/L. The nurse interprets these
findings as:
,Answer: Partially compensated respiratory acidosis
Rationale: The primary disturbance is respiratory acidosis as evidenced by elevated PaCO2
(>45 mmHg) and decreased pH (<7.35). The elevated bicarbonate (HCO3 >26 mEq/L)
indicates metabolic compensation by the kidneys, which have attempted to retain
bicarbonate to buffer the acidosis. Because the pH remains below 7.35, compensation is
partial rather than complete. This pattern is typical in chronic COPD patients with CO2
retention who have developed renal compensation over time. Oxygen therapy should be
administered cautiously (2 L/min via nasal cannula) to avoid suppressing the hypoxic drive
that these patients often rely on for respiration.
QUESTION 6
The nurse is preparing to administer digoxin to a patient with atrial fibrillation. Which finding
would indicate the need to hold the medication and notify the healthcare provider?
Answer: Apical pulse 48 beats/min with an irregular rhythm
Rationale: Digoxin has a narrow therapeutic index and exerts its effects by inhibiting the
Na+/K+ ATPase pump, leading to increased intracellular calcium and enhanced myocardial
contractility. It also slows conduction through the AV node. The therapeutic range for
digoxin is 0.8-2.0 ng/mL. A heart rate below 60 beats/min is a contraindication for
administration, as digoxin may further decrease the heart rate, potentially causing
symptomatic bradycardia or heart block. Toxicity manifests as nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias, particularly premature
ventricular contractions. The nurse should also check digoxin levels if the patient has signs
of toxicity.
QUESTION 7
A client with acute pancreatitis reports severe abdominal pain that radiates to the back.
Which position should the nurse encourage to provide comfort?
Answer: Fetal position with knees drawn up to the chest or sitting upright leaning forward
Rationale: The pain of acute pancreatitis is caused by inflammation, edema, and
autodigestion of the pancreas. The fetal position reduces tension on the abdominal muscles
and decreases intra-abdominal pressure, which can reduce pancreatic stimulation. Sitting
upright and leaning forward also decreases pressure on the retroperitoneal structures and
, may provide relief. The patient should be positioned to maximize comfort while maintaining
safety. NPO status, pain management (usually with opioids), and pancreatic rest are the
mainstays of acute pancreatitis treatment. Lipase and amylase levels are typically elevated
with values 2-3 times above normal.
QUESTION 8
The nurse is assessing a patient who has returned from a cardiac catheterization via the
femoral approach. Which finding requires immediate intervention?
Answer: Pulsatile mass in the right groin with a bruit upon auscultation
Rationale: A pulsatile mass with a bruit suggests the development of a pseudoaneurysm or
arteriovenous (AV) fistula at the catheterization site. This occurs when the arterial puncture
does not seal properly, allowing blood to leak into surrounding tissue and form a pulsating
hematoma. Pseudoaneurysms are serious complications that may require ultrasound-
guided compression, thrombin injection, or surgical repair. The groin site should be
monitored for hematoma, bleeding, or changes in distal pulses. While a small hematoma or
bruising is expected, a pulsatile mass with a bruit requires immediate notification of the
provider. Other signs of complication include cold, pale extremities, diminished pulses, and
neurovascular compromise distal to the site.
QUESTION 9
A patient with end-stage renal disease (ESRD) receiving hemodialysis has a potassium
level of 6.2 mEq/L. Which assessment finding is most concerning?
Answer: Peaked T waves on telemetry monitoring
Rationale: Hyperkalemia (potassium >5.0 mEq/L) can be life-threatening due to its effects
on cardiac conduction. Peaked T waves are the earliest ECG change associated with
hyperkalemia. As potassium levels rise further, PR interval prolongation, QRS widening,
and eventually sinusoidal waves and ventricular fibrillation may occur. Immediate
interventions for severe hyperkalemia include calcium gluconate (to stabilize cardiac
membranes), insulin with glucose (to shift potassium intracellularly), albuterol nebulization,
and sodium bicarbonate. Hemodialysis is the definitive treatment for ESRD patients. This
patient should be dialyzed emergently. Restlessness, nausea, and diarrhea are also
symptoms but cardiac changes present the greatest risk of sudden death.
Comprehensive Nursing Practice Examination
QUESTION 1
A client with heart failure is prescribed furosemide 40 mg IV push. Which laboratory value
should the nurse monitor most closely?
Answer: Serum potassium levels
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to significant potassium wasting. Hypokalemia can
precipitate cardiac dysrhythmias, especially in patients with heart failure who may also be
taking digoxin. Serum potassium should be monitored before and after administration, with
normal range being 3.5-5.0 mEq/L. Other electrolytes such as sodium, magnesium, and
calcium may also be affected but potassium presents the most immediate life-threatening
risk.
QUESTION 2
A postoperative patient reports sudden chest pain and shortness of breath. The nurse notes
tachycardia, tachypnea, and oxygen saturation of 88% on room air. What is the priority
nursing action?
Answer: Apply high-flow oxygen and notify the healthcare provider immediately
Rationale: This clinical presentation is highly suggestive of a pulmonary embolism (PE), a
life-threatening complication of surgery. The priority is to maintain oxygenation and
perfusion while preparing for immediate medical intervention. High-flow oxygen should be
administered via non-rebreather mask at 15 L/min to maximize oxygen delivery. The
healthcare provider must be notified stat for further orders, which may include a V/Q scan,
CT angiography, and initiation of anticoagulation therapy. Placing the patient in a high
Fowler's position facilitates breathing, but oxygenation takes precedence over positioning.
QUESTION 3
,A client with type 1 diabetes mellitus is experiencing hypoglycemia with a blood glucose of
52 mg/dL. The client is alert and able to swallow. Which intervention should the nurse
implement first?
Answer: Administer 15 grams of rapid-acting carbohydrate (4 oz orange juice or 3 glucose
tablets)
Rationale: The "Rule of 15" is the standard of care for treating hypoglycemia in an alert
patient. Rapid-acting carbohydrates such as glucose tablets (4 grams each), fruit juice (4
oz), regular soda (4 oz), or honey (1 tablespoon) are preferred because they are quickly
absorbed and raise blood glucose within 15 minutes. After administration, the nurse should
recheck blood glucose in 15 minutes and repeat the treatment if still below 70 mg/dL.
Glucagon is reserved for unconscious patients or those unable to swallow. A complex
carbohydrate with protein is given only after blood glucose returns to normal to prevent
subsequent hypoglycemia.
QUESTION 4
The nurse is caring for a patient with cirrhosis who develops confusion, asterixis, and
elevated ammonia levels. Which dietary modification is most appropriate?
Answer: Restrict protein intake while ensuring adequate caloric intake from carbohydrates
and fats
Rationale: Hepatic encephalopathy results from the liver's inability to metabolize ammonia,
a byproduct of protein metabolism. In acute encephalopathy, protein restriction (20-40
g/day) is indicated to reduce ammonia production. However, protein should not be
completely eliminated because chronic protein deficiency worsens muscle wasting and can
increase ammonia levels through endogenous protein catabolism. In chronic management,
vegetable protein sources are preferred over animal proteins as they have fewer aromatic
amino acids and produce less ammonia. Lactulose and rifaximin are pharmacological
treatments that help reduce ammonia absorption and production.
QUESTION 5
A patient with chronic obstructive pulmonary disease (COPD) has an arterial blood gas
(ABG) showing: pH 7.32, PaCO2 58 mmHg, HCO3 34 mEq/L. The nurse interprets these
findings as:
,Answer: Partially compensated respiratory acidosis
Rationale: The primary disturbance is respiratory acidosis as evidenced by elevated PaCO2
(>45 mmHg) and decreased pH (<7.35). The elevated bicarbonate (HCO3 >26 mEq/L)
indicates metabolic compensation by the kidneys, which have attempted to retain
bicarbonate to buffer the acidosis. Because the pH remains below 7.35, compensation is
partial rather than complete. This pattern is typical in chronic COPD patients with CO2
retention who have developed renal compensation over time. Oxygen therapy should be
administered cautiously (2 L/min via nasal cannula) to avoid suppressing the hypoxic drive
that these patients often rely on for respiration.
QUESTION 6
The nurse is preparing to administer digoxin to a patient with atrial fibrillation. Which finding
would indicate the need to hold the medication and notify the healthcare provider?
Answer: Apical pulse 48 beats/min with an irregular rhythm
Rationale: Digoxin has a narrow therapeutic index and exerts its effects by inhibiting the
Na+/K+ ATPase pump, leading to increased intracellular calcium and enhanced myocardial
contractility. It also slows conduction through the AV node. The therapeutic range for
digoxin is 0.8-2.0 ng/mL. A heart rate below 60 beats/min is a contraindication for
administration, as digoxin may further decrease the heart rate, potentially causing
symptomatic bradycardia or heart block. Toxicity manifests as nausea, vomiting, visual
disturbances (yellow-green halos), and cardiac dysrhythmias, particularly premature
ventricular contractions. The nurse should also check digoxin levels if the patient has signs
of toxicity.
QUESTION 7
A client with acute pancreatitis reports severe abdominal pain that radiates to the back.
Which position should the nurse encourage to provide comfort?
Answer: Fetal position with knees drawn up to the chest or sitting upright leaning forward
Rationale: The pain of acute pancreatitis is caused by inflammation, edema, and
autodigestion of the pancreas. The fetal position reduces tension on the abdominal muscles
and decreases intra-abdominal pressure, which can reduce pancreatic stimulation. Sitting
upright and leaning forward also decreases pressure on the retroperitoneal structures and
, may provide relief. The patient should be positioned to maximize comfort while maintaining
safety. NPO status, pain management (usually with opioids), and pancreatic rest are the
mainstays of acute pancreatitis treatment. Lipase and amylase levels are typically elevated
with values 2-3 times above normal.
QUESTION 8
The nurse is assessing a patient who has returned from a cardiac catheterization via the
femoral approach. Which finding requires immediate intervention?
Answer: Pulsatile mass in the right groin with a bruit upon auscultation
Rationale: A pulsatile mass with a bruit suggests the development of a pseudoaneurysm or
arteriovenous (AV) fistula at the catheterization site. This occurs when the arterial puncture
does not seal properly, allowing blood to leak into surrounding tissue and form a pulsating
hematoma. Pseudoaneurysms are serious complications that may require ultrasound-
guided compression, thrombin injection, or surgical repair. The groin site should be
monitored for hematoma, bleeding, or changes in distal pulses. While a small hematoma or
bruising is expected, a pulsatile mass with a bruit requires immediate notification of the
provider. Other signs of complication include cold, pale extremities, diminished pulses, and
neurovascular compromise distal to the site.
QUESTION 9
A patient with end-stage renal disease (ESRD) receiving hemodialysis has a potassium
level of 6.2 mEq/L. Which assessment finding is most concerning?
Answer: Peaked T waves on telemetry monitoring
Rationale: Hyperkalemia (potassium >5.0 mEq/L) can be life-threatening due to its effects
on cardiac conduction. Peaked T waves are the earliest ECG change associated with
hyperkalemia. As potassium levels rise further, PR interval prolongation, QRS widening,
and eventually sinusoidal waves and ventricular fibrillation may occur. Immediate
interventions for severe hyperkalemia include calcium gluconate (to stabilize cardiac
membranes), insulin with glucose (to shift potassium intracellularly), albuterol nebulization,
and sodium bicarbonate. Hemodialysis is the definitive treatment for ESRD patients. This
patient should be dialyzed emergently. Restlessness, nausea, and diarrhea are also
symptoms but cardiac changes present the greatest risk of sudden death.
