HESI RN Exit Exam 2026 NGN Nursing Questions &
Rationales Verified Solutions
Practice Exam – Version 1
1. A nurse is assessing a client with heart failure who reports increased shortness of breath when lying
flat. Which finding should the nurse prioritize?
A. Oxygen saturation of 94% on room air
B. Bibasilar crackles on auscultation
C. Heart rate of 88 beats per minute
D. Peripheral edema of 1+
Correct Answer: B
Rationale: Bibasilar crackles indicate fluid accumulation in the lungs, a sign of
worsening heart failure and pulmonary congestion. This is the priority finding
because it directly reflects impaired gas exchange and requires immediate
intervention. While oxygen saturation of 94% is slightly low, it is not critically
abnormal. A heart rate of 88 and 1+ edema are expected findings in heart failure
and are not immediately life-threatening.
2. A nurse is caring for a client who is 2 hours post-operative following a total hip arthroplasty. Which
action should the nurse take first?
A. Administer pain medication as prescribed
B. Assess the surgical dressing for drainage
C. Place a pillow between the client's legs
D. Encourage the client to perform ankle pumps
Correct Answer: B
Rationale: Assessing the surgical dressing for drainage is the priority because it
evaluates for postoperative hemorrhage or infection, which can be life-
threatening. While pain management, positioning, and circulation exercises are
important, assessment of the surgical site takes precedence in the immediate
postoperative period to detect complications early.
,3. A nurse is reviewing laboratory results for a client receiving warfarin. Which finding should the
nurse report to the provider immediately?
A. INR of 2.5
B. Hemoglobin of 12 g/dL
C. INR of 6.0
D. Platelet count of 200,000/mm³
Correct Answer: C
Rationale: An INR of 6.0 is critically elevated and places the client at high risk for
hemorrhage. The therapeutic range for warfarin is typically 2.0–3.0. The nurse
should withhold the next dose and notify the provider immediately. An INR of 2.5
is within therapeutic range, hemoglobin of 12 g/dL is normal, and a platelet count
of 200,000/mm³ is within normal limits.
4. A nurse is teaching a client about newly prescribed metformin. Which statement by the client
indicates understanding?
A. "I should take this medication on an empty stomach."
B. "I need to monitor my blood sugar regularly."
C. "I can skip meals if I feel nauseous."
D. "This medication can cause weight gain."
Correct Answer: B
Rationale: Clients taking metformin should monitor blood glucose regularly to
evaluate medication effectiveness and detect hypoglycemia or hyperglycemia.
Metformin should be taken with meals to reduce gastrointestinal upset, not on an
empty stomach. Skipping meals while taking metformin can increase the risk of
hypoglycemia. Metformin is associated with weight loss or weight neutrality, not
weight gain.
5. A nurse is caring for a client with a new colostomy. Which finding indicates a need for immediate
intervention?
A. Stoma is pink and moist
B. Stoma is dusky and dark
C. Small amount of bleeding at the stoma site
D. Output is liquid immediately after surgery
Correct Answer: B
,Rationale: A dusky or dark stoma indicates inadequate blood supply and possible
necrosis, which requires immediate intervention. A healthy stoma should be pink
and moist. Small amounts of bleeding are normal in the immediate postoperative
period. Liquid output is expected initially after colostomy surgery.
6. A nurse is assessing a client with suspected appendicitis. Which finding should the nurse expect?
A. Pain relieved by lying still
B. Rebound tenderness in the right lower quadrant
C. Diffuse abdominal pain relieved by vomiting
D. Pain in the left upper quadrant
Correct Answer: B
Rationale: Rebound tenderness in the right lower quadrant (McBurney's point) is a
classic sign of appendicitis. Pain typically worsens with movement, not relieved by
lying still. Appendicitis pain is usually localized to the right lower quadrant, not the
left upper quadrant. While vomiting may occur, it does not typically relieve the
pain.
7. A nurse is preparing to administer digoxin to a client. Which assessment finding should cause the
nurse to withhold the medication?
A. Heart rate of 58 beats per minute
B. Heart rate of 72 beats per minute
C. Blood pressure of 120/80 mm Hg
D. Respiratory rate of 18 breaths per minute
Correct Answer: A
Rationale: Digoxin should be withheld if the heart rate is below 60 beats per
minute in adults, as bradycardia is a sign of digoxin toxicity. The nurse should hold
the medication and notify the provider. A heart rate of 72, blood pressure of
120/80, and respiratory rate of 18 are all within normal limits and do not require
withholding the medication.
8. A nurse is caring for a client with a tracheostomy. Which action should the nurse take to prevent
complications?
, A. Suction the tracheostomy every 2 hours routinely
B. Perform sterile technique when suctioning
C. Instill normal saline before suctioning
D. Change the tracheostomy ties daily
Correct Answer: B
Rationale: Sterile technique should be used when suctioning a tracheostomy to
prevent introducing microorganisms into the lower respiratory tract. Routine
suctioning every 2 hours is not recommended; suctioning should be performed as
needed based on assessment findings. Instilling normal saline before suctioning is
no longer recommended as it can increase the risk of infection. Tracheostomy ties
should be changed when soiled or loose, not necessarily daily.
9. A nurse is assessing a client with increased intracranial pressure (ICP). Which finding is an early sign
of increased ICP?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Decerebrate posturing
D. Cushing's triad
Correct Answer: A
Rationale: A decreased level of consciousness is often the earliest sign of increased
intracranial pressure. Fixed and dilated pupils, decerebrate posturing, and
Cushing's triad (bradycardia, hypertension, irregular respirations) are late signs of
increased ICP and indicate severe neurological compromise.
10. A nurse is caring for a client receiving heparin infusion. Which laboratory value should the nurse
monitor?
A. PT (prothrombin time)
B. aPTT (activated partial thromboplastin time)
C. INR (international normalized ratio)
D. Bleeding time
Correct Answer: B
Rationale: aPTT is used to monitor heparin therapy. The therapeutic range is
typically 1.5–2.5 times the control value. PT and INR are used to monitor warfarin
therapy. Bleeding time is not used to monitor heparin therapy.
Rationales Verified Solutions
Practice Exam – Version 1
1. A nurse is assessing a client with heart failure who reports increased shortness of breath when lying
flat. Which finding should the nurse prioritize?
A. Oxygen saturation of 94% on room air
B. Bibasilar crackles on auscultation
C. Heart rate of 88 beats per minute
D. Peripheral edema of 1+
Correct Answer: B
Rationale: Bibasilar crackles indicate fluid accumulation in the lungs, a sign of
worsening heart failure and pulmonary congestion. This is the priority finding
because it directly reflects impaired gas exchange and requires immediate
intervention. While oxygen saturation of 94% is slightly low, it is not critically
abnormal. A heart rate of 88 and 1+ edema are expected findings in heart failure
and are not immediately life-threatening.
2. A nurse is caring for a client who is 2 hours post-operative following a total hip arthroplasty. Which
action should the nurse take first?
A. Administer pain medication as prescribed
B. Assess the surgical dressing for drainage
C. Place a pillow between the client's legs
D. Encourage the client to perform ankle pumps
Correct Answer: B
Rationale: Assessing the surgical dressing for drainage is the priority because it
evaluates for postoperative hemorrhage or infection, which can be life-
threatening. While pain management, positioning, and circulation exercises are
important, assessment of the surgical site takes precedence in the immediate
postoperative period to detect complications early.
,3. A nurse is reviewing laboratory results for a client receiving warfarin. Which finding should the
nurse report to the provider immediately?
A. INR of 2.5
B. Hemoglobin of 12 g/dL
C. INR of 6.0
D. Platelet count of 200,000/mm³
Correct Answer: C
Rationale: An INR of 6.0 is critically elevated and places the client at high risk for
hemorrhage. The therapeutic range for warfarin is typically 2.0–3.0. The nurse
should withhold the next dose and notify the provider immediately. An INR of 2.5
is within therapeutic range, hemoglobin of 12 g/dL is normal, and a platelet count
of 200,000/mm³ is within normal limits.
4. A nurse is teaching a client about newly prescribed metformin. Which statement by the client
indicates understanding?
A. "I should take this medication on an empty stomach."
B. "I need to monitor my blood sugar regularly."
C. "I can skip meals if I feel nauseous."
D. "This medication can cause weight gain."
Correct Answer: B
Rationale: Clients taking metformin should monitor blood glucose regularly to
evaluate medication effectiveness and detect hypoglycemia or hyperglycemia.
Metformin should be taken with meals to reduce gastrointestinal upset, not on an
empty stomach. Skipping meals while taking metformin can increase the risk of
hypoglycemia. Metformin is associated with weight loss or weight neutrality, not
weight gain.
5. A nurse is caring for a client with a new colostomy. Which finding indicates a need for immediate
intervention?
A. Stoma is pink and moist
B. Stoma is dusky and dark
C. Small amount of bleeding at the stoma site
D. Output is liquid immediately after surgery
Correct Answer: B
,Rationale: A dusky or dark stoma indicates inadequate blood supply and possible
necrosis, which requires immediate intervention. A healthy stoma should be pink
and moist. Small amounts of bleeding are normal in the immediate postoperative
period. Liquid output is expected initially after colostomy surgery.
6. A nurse is assessing a client with suspected appendicitis. Which finding should the nurse expect?
A. Pain relieved by lying still
B. Rebound tenderness in the right lower quadrant
C. Diffuse abdominal pain relieved by vomiting
D. Pain in the left upper quadrant
Correct Answer: B
Rationale: Rebound tenderness in the right lower quadrant (McBurney's point) is a
classic sign of appendicitis. Pain typically worsens with movement, not relieved by
lying still. Appendicitis pain is usually localized to the right lower quadrant, not the
left upper quadrant. While vomiting may occur, it does not typically relieve the
pain.
7. A nurse is preparing to administer digoxin to a client. Which assessment finding should cause the
nurse to withhold the medication?
A. Heart rate of 58 beats per minute
B. Heart rate of 72 beats per minute
C. Blood pressure of 120/80 mm Hg
D. Respiratory rate of 18 breaths per minute
Correct Answer: A
Rationale: Digoxin should be withheld if the heart rate is below 60 beats per
minute in adults, as bradycardia is a sign of digoxin toxicity. The nurse should hold
the medication and notify the provider. A heart rate of 72, blood pressure of
120/80, and respiratory rate of 18 are all within normal limits and do not require
withholding the medication.
8. A nurse is caring for a client with a tracheostomy. Which action should the nurse take to prevent
complications?
, A. Suction the tracheostomy every 2 hours routinely
B. Perform sterile technique when suctioning
C. Instill normal saline before suctioning
D. Change the tracheostomy ties daily
Correct Answer: B
Rationale: Sterile technique should be used when suctioning a tracheostomy to
prevent introducing microorganisms into the lower respiratory tract. Routine
suctioning every 2 hours is not recommended; suctioning should be performed as
needed based on assessment findings. Instilling normal saline before suctioning is
no longer recommended as it can increase the risk of infection. Tracheostomy ties
should be changed when soiled or loose, not necessarily daily.
9. A nurse is assessing a client with increased intracranial pressure (ICP). Which finding is an early sign
of increased ICP?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Decerebrate posturing
D. Cushing's triad
Correct Answer: A
Rationale: A decreased level of consciousness is often the earliest sign of increased
intracranial pressure. Fixed and dilated pupils, decerebrate posturing, and
Cushing's triad (bradycardia, hypertension, irregular respirations) are late signs of
increased ICP and indicate severe neurological compromise.
10. A nurse is caring for a client receiving heparin infusion. Which laboratory value should the nurse
monitor?
A. PT (prothrombin time)
B. aPTT (activated partial thromboplastin time)
C. INR (international normalized ratio)
D. Bleeding time
Correct Answer: B
Rationale: aPTT is used to monitor heparin therapy. The therapeutic range is
typically 1.5–2.5 times the control value. PT and INR are used to monitor warfarin
therapy. Bleeding time is not used to monitor heparin therapy.
