(Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
RN EXIT COMPREHENSIVE
PRACTICE EXAMINATION
(Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
150 Questions | 75 Multiple Choice | 75 True / False
Domains: Medical-Surgical • Pharmacology • Maternal-Newborn • Pediatrics • Mental Health • Leadership & Management
• Community Health • Fundamentals & Safety
IMPORTANT NOTICE
This is an independently authored practice examination created for study purposes. It is NOT affiliated with, endorsed by, or
produced by Elsevier, HESI, or any official HESI Exit Exam product. It should be used only as a supplementary self-
assessment tool alongside official HESI/NCLEX-RN preparation materials.
Page 1 of 27
, (Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
Instructions for Use
● This examination contains 150 total items: 75 multiple-choice questions and 75 true/false statements.
● Questions progress from easy to hard within each content domain.
● Each item includes the correct answer and an educational rationale for review.
● Cover the answer/rationale section while attempting each question for the most realistic self-assessment.
● This practice exam is a study aid and does not guarantee performance on any official examination.
Page 2 of 27
, (Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
Section 1: Multiple Choice Questions (Items 1–75)
MEDICAL-SURGICAL NURSING • Difficulty: Easy
1. A nurse is caring for a client with heart failure. Which finding requires immediate follow-up?
A. Weight gain of 3 lb (1.4 kg) in 2 days
B. Occasional ankle swelling at end of day
C. Mild fatigue after climbing two flights of stairs
D. Resting heart rate of 78 beats/min
Answer: A
Rationale: A rapid weight gain of 2-3 lb in 1-2 days indicates fluid retention and worsening heart failure and must be
reported immediately; the other findings are common and expected.
MEDICAL-SURGICAL NURSING • Difficulty: Easy
2. Which lab value should the nurse monitor most closely in a client receiving furosemide (Lasix)?
A. Potassium
B. Calcium
C. Glucose
D. Hemoglobin
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting, placing the client at risk for hypokalemia and
dysrhythmias.
MEDICAL-SURGICAL NURSING • Difficulty: Medium
3. A client with COPD has an oxygen saturation of 90% on room air. What is the priority nursing action?
A. Administer oxygen at 2 L/min via nasal cannula and reassess
B. Administer oxygen at 6 L/min via nasal cannula
C. Place the client in high Fowler's position and recheck in 4 hours
D. Withhold oxygen because the client's baseline saturation may be low
Answer: A
Rationale: Clients with COPD are at risk for suppressing their hypoxic drive to breathe with high-flow oxygen, so low-flow
supplemental oxygen (1-2 L/min) is administered cautiously with frequent reassessment.
MEDICAL-SURGICAL NURSING • Difficulty: Medium
4. A postoperative client reports sudden sharp chest pain and shortness of breath. Which action is the priority?
A. Notify the provider and prepare for possible pulmonary embolism workup
B. Reposition the client and reassess in 30 minutes
C. Administer a PRN antianxiety medication
D. Encourage the client to use the incentive spirometer
Answer: A
Rationale: Sudden chest pain and dyspnea in a postoperative client are classic signs of pulmonary embolism, a medical
emergency requiring immediate provider notification.
MEDICAL-SURGICAL NURSING • Difficulty: Hard
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and Kussmaul respirations. Which
intervention takes priority?
A. Initiate IV fluid replacement with isotonic saline
B. Administer subcutaneous regular insulin immediately
Page 3 of 27
RN EXIT COMPREHENSIVE
PRACTICE EXAMINATION
(Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
150 Questions | 75 Multiple Choice | 75 True / False
Domains: Medical-Surgical • Pharmacology • Maternal-Newborn • Pediatrics • Mental Health • Leadership & Management
• Community Health • Fundamentals & Safety
IMPORTANT NOTICE
This is an independently authored practice examination created for study purposes. It is NOT affiliated with, endorsed by, or
produced by Elsevier, HESI, or any official HESI Exit Exam product. It should be used only as a supplementary self-
assessment tool alongside official HESI/NCLEX-RN preparation materials.
Page 1 of 27
, (Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
Instructions for Use
● This examination contains 150 total items: 75 multiple-choice questions and 75 true/false statements.
● Questions progress from easy to hard within each content domain.
● Each item includes the correct answer and an educational rationale for review.
● Cover the answer/rationale section while attempting each question for the most realistic self-assessment.
● This practice exam is a study aid and does not guarantee performance on any official examination.
Page 2 of 27
, (Paper 1: RN Exit Comprehensive Practice Examination – Assessment Set A)
Section 1: Multiple Choice Questions (Items 1–75)
MEDICAL-SURGICAL NURSING • Difficulty: Easy
1. A nurse is caring for a client with heart failure. Which finding requires immediate follow-up?
A. Weight gain of 3 lb (1.4 kg) in 2 days
B. Occasional ankle swelling at end of day
C. Mild fatigue after climbing two flights of stairs
D. Resting heart rate of 78 beats/min
Answer: A
Rationale: A rapid weight gain of 2-3 lb in 1-2 days indicates fluid retention and worsening heart failure and must be
reported immediately; the other findings are common and expected.
MEDICAL-SURGICAL NURSING • Difficulty: Easy
2. Which lab value should the nurse monitor most closely in a client receiving furosemide (Lasix)?
A. Potassium
B. Calcium
C. Glucose
D. Hemoglobin
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium wasting, placing the client at risk for hypokalemia and
dysrhythmias.
MEDICAL-SURGICAL NURSING • Difficulty: Medium
3. A client with COPD has an oxygen saturation of 90% on room air. What is the priority nursing action?
A. Administer oxygen at 2 L/min via nasal cannula and reassess
B. Administer oxygen at 6 L/min via nasal cannula
C. Place the client in high Fowler's position and recheck in 4 hours
D. Withhold oxygen because the client's baseline saturation may be low
Answer: A
Rationale: Clients with COPD are at risk for suppressing their hypoxic drive to breathe with high-flow oxygen, so low-flow
supplemental oxygen (1-2 L/min) is administered cautiously with frequent reassessment.
MEDICAL-SURGICAL NURSING • Difficulty: Medium
4. A postoperative client reports sudden sharp chest pain and shortness of breath. Which action is the priority?
A. Notify the provider and prepare for possible pulmonary embolism workup
B. Reposition the client and reassess in 30 minutes
C. Administer a PRN antianxiety medication
D. Encourage the client to use the incentive spirometer
Answer: A
Rationale: Sudden chest pain and dyspnea in a postoperative client are classic signs of pulmonary embolism, a medical
emergency requiring immediate provider notification.
MEDICAL-SURGICAL NURSING • Difficulty: Hard
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL and Kussmaul respirations. Which
intervention takes priority?
A. Initiate IV fluid replacement with isotonic saline
B. Administer subcutaneous regular insulin immediately
Page 3 of 27
