HESI EXIT EXAM COMPREHENSIVE
REVIEW (NIGHTINGALE COLLEGE)
2026/2027 QUESTIONS AND CORRECT
DETAILED ANSWERS
1. A client is admitted with Hyperkalemia (Potassium level of 6.3 mEq/L). Which
electrocardiogram (ECG) change is most critical for the nurse to monitor for?
A. Prominent U-waves
B. Prolonged PR interval
C. ST-segment depression
D. Tall, peaked T-waves
Answer: D
Conceptual Explanation: Hyperkalemia causes peaked T-waves as the cardiac cell
repolarization is accelerated. Prominent U-waves are seen in hypokalemia.
2. A nurse is caring for a client with Magnesium Sulfate infusion for preeclampsia. Assessment
reveals absent deep tendon reflexes (DTRs) and a respiratory rate of 10 breaths/min. Which
action should the nurse take first?
A. Decrease the infusion rate by half
B. Administer Calcium Gluconate IV push
,C. Notify the healthcare provider immediately
D. Stop the Magnesium Sulfate infusion
Answer: D
Conceptual Explanation: Safety first: The client is showing signs of Magnesium toxicity
(respiratory depression and absent DTRs). The immediate nursing priority is to stop the
medication before administering the antidote.
3. A client with Addison’s disease is being discharged. Which instruction is most vital
regarding medication management during periods of high stress or illness?
A. Decrease the dose of fludrocortisone
B. Switch to oral hypoglycemic agents
C. Skip a dose if nausea occurs
D. Increase the dose of glucocorticoids
Answer: D
Conceptual Explanation: Clients with adrenal insufficiency (Addison’s) cannot produce
extra cortisol during stress. They must increase their steroid dosage to prevent an
Addisonian crisis.
4. Which arterial blood gas (ABG) result would the nurse expect to find in a client who has
been vomiting for 24 hours?
A. pH 7.30, PaCO2 50, HCO3 26
, B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 48, HCO3 22
Answer: B
Conceptual Explanation: Vomiting causes loss of gastric acid (HCl), leading to Metabolic
Alkalosis. This is characterized by high pH (>7.45) and high Bicarbonate (>26).
5. A client is receiving a Heparin infusion for a Deep Vein Thrombosis (DVT). The current aPTT
is 110 seconds (Control: 30 seconds). What is the nurse’s priority action?
A. Increase the infusion rate per protocol
B. Stop the infusion and prepare Protamine Sulfate
C. Continue the infusion and recheck in 4 hours
D. Document the findings as therapeutic
Answer: B
Conceptual Explanation: Normal therapeutic aPTT is 1.5 to 2.5 times the control (approx
45-75s). 110 seconds is dangerously high, requiring cessation of the drug and potentially
the antidote, Protamine Sulfate.
6. A client with Chronic Renal Failure is prescribed Epoetin Alfa. The nurse should identify
that the medication is effective if which of the following occurs?
A. Hematocrit and Hemoglobin increase
REVIEW (NIGHTINGALE COLLEGE)
2026/2027 QUESTIONS AND CORRECT
DETAILED ANSWERS
1. A client is admitted with Hyperkalemia (Potassium level of 6.3 mEq/L). Which
electrocardiogram (ECG) change is most critical for the nurse to monitor for?
A. Prominent U-waves
B. Prolonged PR interval
C. ST-segment depression
D. Tall, peaked T-waves
Answer: D
Conceptual Explanation: Hyperkalemia causes peaked T-waves as the cardiac cell
repolarization is accelerated. Prominent U-waves are seen in hypokalemia.
2. A nurse is caring for a client with Magnesium Sulfate infusion for preeclampsia. Assessment
reveals absent deep tendon reflexes (DTRs) and a respiratory rate of 10 breaths/min. Which
action should the nurse take first?
A. Decrease the infusion rate by half
B. Administer Calcium Gluconate IV push
,C. Notify the healthcare provider immediately
D. Stop the Magnesium Sulfate infusion
Answer: D
Conceptual Explanation: Safety first: The client is showing signs of Magnesium toxicity
(respiratory depression and absent DTRs). The immediate nursing priority is to stop the
medication before administering the antidote.
3. A client with Addison’s disease is being discharged. Which instruction is most vital
regarding medication management during periods of high stress or illness?
A. Decrease the dose of fludrocortisone
B. Switch to oral hypoglycemic agents
C. Skip a dose if nausea occurs
D. Increase the dose of glucocorticoids
Answer: D
Conceptual Explanation: Clients with adrenal insufficiency (Addison’s) cannot produce
extra cortisol during stress. They must increase their steroid dosage to prevent an
Addisonian crisis.
4. Which arterial blood gas (ABG) result would the nurse expect to find in a client who has
been vomiting for 24 hours?
A. pH 7.30, PaCO2 50, HCO3 26
, B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 48, HCO3 22
Answer: B
Conceptual Explanation: Vomiting causes loss of gastric acid (HCl), leading to Metabolic
Alkalosis. This is characterized by high pH (>7.45) and high Bicarbonate (>26).
5. A client is receiving a Heparin infusion for a Deep Vein Thrombosis (DVT). The current aPTT
is 110 seconds (Control: 30 seconds). What is the nurse’s priority action?
A. Increase the infusion rate per protocol
B. Stop the infusion and prepare Protamine Sulfate
C. Continue the infusion and recheck in 4 hours
D. Document the findings as therapeutic
Answer: B
Conceptual Explanation: Normal therapeutic aPTT is 1.5 to 2.5 times the control (approx
45-75s). 110 seconds is dangerously high, requiring cessation of the drug and potentially
the antidote, Protamine Sulfate.
6. A client with Chronic Renal Failure is prescribed Epoetin Alfa. The nurse should identify
that the medication is effective if which of the following occurs?
A. Hematocrit and Hemoglobin increase
