2025/2026 HESI RN Exit Exam (V1 – V7) — 250
HESI-STYLE Questions & Answers
1. A postoperative client becomes restless and has an oxygen saturation of 88%. Which
action should the RN take first?
Apply oxygen as prescribed.
Assess airway patency and breathing.
Call the healthcare provider.
Offer oral fluids.
Rationale: Airway and breathing assessment take priority before other interventions.
2. A nurse receives a client from PACU who is difficult to arouse. Which assessment is
the priority?
Pain rating
Airway patency
Urine output
Surgical dressing
Rationale: A reduced level of consciousness can compromise the airway; assess airway first.
Real clinical photograph: nurse and patient (public-domain NCI image).
3. Which intervention is most appropriate for a client at high risk for falls?
Keep the bed in the highest position.
Place the call light within reach and keep the bed low.
Encourage the client to walk independently.
Keep all four side rails raised routinely.
Rationale: A low bed and accessible call light reduce fall risk without creating an entrapment hazard.
4. A client with dysphagia is eating lunch. Which action best reduces aspiration risk?
Place the client flat after each bite.
Offer thin liquids rapidly.
Keep the client upright during and after the meal.
Encourage talking while chewing.
Rationale: Upright positioning during and after meals helps protect the airway.
5. Which task is appropriate for the RN to delegate to trained UAP?
Initial assessment of chest pain
Original HESI-style practice content — not leaked or secure exam items. Page 1
, Teaching insulin injection
Routine vital signs on a stable client
Evaluating a new pressure injury
Rationale: Routine, predictable data collection on a stable client can be delegated; assessment and teaching remain with
the RN.
6. A medication order is difficult to read. What is the best nursing action?
Guess the intended medication.
Ask another nurse to interpret it.
Clarify the order with the prescriber before administration.
Administer the smallest possible dose.
Rationale: An unclear order must be clarified before the medication is given.
7. Which finding requires immediate intervention after a central venous catheter
dressing change?
Dry, intact dressing
Mild tenderness at the site
New shortness of breath and chest pain
Client asking for water
Rationale: Sudden respiratory symptoms after central access can indicate pneumothorax and require urgent
assessment.
8. A client receiving a blood transfusion develops chills and low back pain. What should
the nurse do first?
Slow the transfusion.
Stop the transfusion.
Give acetaminophen.
Flush the line with blood tubing contents.
Rationale: Chills and back pain can signal an acute hemolytic reaction; stop the transfusion immediately.
9. Which client should the nurse assess first?
Client with chronic arthritis reporting pain 5/10
Client with new stridor after extubation
Client waiting for discharge instructions
Client requesting a blanket
Rationale: Stridor indicates upper-airway obstruction and is an immediate threat to life.
10. A client with a seizure begins convulsing in bed. Which action is appropriate?
Restrain the extremities.
Insert an oral airway.
Turn the client to the side and protect the head.
Give oral medication.
Rationale: Side-lying positioning and protection from injury are appropriate during a seizure.
11. Which action by a nurse is most important when caring for a client on contact
precautions?
Wear a fit-tested N95 respirator for every entry.
Use gown and gloves according to facility policy.
Keep the door closed at all times.
Original HESI-style practice content — not leaked or secure exam items. Page 2
, Place the client in a negative-pressure room.
Rationale: Contact precautions generally require gown and gloves; negative pressure is used for airborne precautions.
12. A nurse notes a reddened area over a client’s sacrum that does not blanch. How
should this be documented?
Stage 1 pressure injury
Stage 2 pressure injury
Stage 3 pressure injury
Deep tissue pressure injury
Rationale: Nonblanchable erythema of intact skin is consistent with a stage 1 pressure injury.
13. Which action is safest when transferring a weak client from bed to chair?
Pull the client by the arms.
Lock the wheels and use a gait belt as indicated.
Ask the client to hold the nurse’s neck.
Move the chair after the client stands.
Rationale: Locking equipment and using appropriate transfer assistance reduce injury risk.
14. A client reports dizziness when standing. Which nursing action is appropriate?
Have the client stand quickly.
Assist the client back to a safe position and assess blood pressure.
Encourage walking to improve circulation.
Restrict all fluids.
Rationale: The client should be protected from a fall and assessed for orthostatic hypotension or another cause.
15. Which item should be removed from the room of a client at risk for self-harm?
Plastic drinking cup
Prescribed medication
Sharps and other potential weapons
Call light
Rationale: Removing potentially dangerous objects is a core environmental safety measure.
16. A nurse enters a room and finds a client on the floor. What is the priority action?
Move the client back to bed immediately.
Assess for injury before moving the client.
Complete an incident report first.
Ask the client why they fell.
Rationale: The nurse should assess for injury and stabilize the client before moving them.
17. Which statement by a nurse demonstrates therapeutic communication?
“You should not feel that way.”
“Why did you do that?”
“Tell me more about what concerns you.”
“Everything will be fine.”
Rationale: Open-ended, nonjudgmental communication encourages expression and assessment.
18. Which intervention best promotes sleep for a hospitalized client?
Cluster care and reduce nighttime interruptions when possible.
Keep the television on for background noise.
Original HESI-style practice content — not leaked or secure exam items. Page 3
, Offer caffeinated drinks at bedtime.
Wake the client every hour for routine conversation.
Rationale: Clustering care can reduce interruptions and support restorative sleep.
19. A client refuses a prescribed treatment after receiving information about risks and
benefits. What should the nurse do?
Force the treatment because it is ordered.
Respect the refusal and document the discussion.
Ask the family to consent instead.
Hide the treatment in food.
Rationale: A competent client has the right to refuse treatment; the nurse documents informed refusal and notification
as appropriate.
20. Which action is most important when using a newly inserted feeding tube for the
first time?
Start the feeding immediately.
Verify tube placement according to policy before use.
Place the client flat.
Add medication to the formula.
Rationale: Tube placement must be verified before initial use to reduce aspiration risk.
21. A client is prescribed digoxin. The apical pulse is 54/min. What should the nurse do?
Give the dose.
Hold the dose and notify the prescriber.
Double the dose tomorrow.
Give the dose with an antacid.
Rationale: Bradycardia can be an adverse effect of digoxin; the dose is commonly held below the ordered parameter.
22. Which laboratory value is most important to monitor for a client receiving warfarin?
aPTT
INR
Troponin
Serum amylase
Rationale: INR is used to monitor warfarin therapy.
23. A client receiving heparin has an unexpectedly low platelet count. Which
complication should the nurse suspect?
HIT
Hyperkalemia
Pancreatitis
Aplastic anemia
Rationale: A significant platelet drop during heparin therapy raises concern for heparin-induced thrombocytopenia.
24. A client taking furosemide is at greatest risk for which electrolyte imbalance?
Hyperkalemia
Hypokalemia
Hypermagnesemia
Hypernatremia
Rationale: Loop diuretics can cause potassium loss.
Original HESI-style practice content — not leaked or secure exam items. Page 4
HESI-STYLE Questions & Answers
1. A postoperative client becomes restless and has an oxygen saturation of 88%. Which
action should the RN take first?
Apply oxygen as prescribed.
Assess airway patency and breathing.
Call the healthcare provider.
Offer oral fluids.
Rationale: Airway and breathing assessment take priority before other interventions.
2. A nurse receives a client from PACU who is difficult to arouse. Which assessment is
the priority?
Pain rating
Airway patency
Urine output
Surgical dressing
Rationale: A reduced level of consciousness can compromise the airway; assess airway first.
Real clinical photograph: nurse and patient (public-domain NCI image).
3. Which intervention is most appropriate for a client at high risk for falls?
Keep the bed in the highest position.
Place the call light within reach and keep the bed low.
Encourage the client to walk independently.
Keep all four side rails raised routinely.
Rationale: A low bed and accessible call light reduce fall risk without creating an entrapment hazard.
4. A client with dysphagia is eating lunch. Which action best reduces aspiration risk?
Place the client flat after each bite.
Offer thin liquids rapidly.
Keep the client upright during and after the meal.
Encourage talking while chewing.
Rationale: Upright positioning during and after meals helps protect the airway.
5. Which task is appropriate for the RN to delegate to trained UAP?
Initial assessment of chest pain
Original HESI-style practice content — not leaked or secure exam items. Page 1
, Teaching insulin injection
Routine vital signs on a stable client
Evaluating a new pressure injury
Rationale: Routine, predictable data collection on a stable client can be delegated; assessment and teaching remain with
the RN.
6. A medication order is difficult to read. What is the best nursing action?
Guess the intended medication.
Ask another nurse to interpret it.
Clarify the order with the prescriber before administration.
Administer the smallest possible dose.
Rationale: An unclear order must be clarified before the medication is given.
7. Which finding requires immediate intervention after a central venous catheter
dressing change?
Dry, intact dressing
Mild tenderness at the site
New shortness of breath and chest pain
Client asking for water
Rationale: Sudden respiratory symptoms after central access can indicate pneumothorax and require urgent
assessment.
8. A client receiving a blood transfusion develops chills and low back pain. What should
the nurse do first?
Slow the transfusion.
Stop the transfusion.
Give acetaminophen.
Flush the line with blood tubing contents.
Rationale: Chills and back pain can signal an acute hemolytic reaction; stop the transfusion immediately.
9. Which client should the nurse assess first?
Client with chronic arthritis reporting pain 5/10
Client with new stridor after extubation
Client waiting for discharge instructions
Client requesting a blanket
Rationale: Stridor indicates upper-airway obstruction and is an immediate threat to life.
10. A client with a seizure begins convulsing in bed. Which action is appropriate?
Restrain the extremities.
Insert an oral airway.
Turn the client to the side and protect the head.
Give oral medication.
Rationale: Side-lying positioning and protection from injury are appropriate during a seizure.
11. Which action by a nurse is most important when caring for a client on contact
precautions?
Wear a fit-tested N95 respirator for every entry.
Use gown and gloves according to facility policy.
Keep the door closed at all times.
Original HESI-style practice content — not leaked or secure exam items. Page 2
, Place the client in a negative-pressure room.
Rationale: Contact precautions generally require gown and gloves; negative pressure is used for airborne precautions.
12. A nurse notes a reddened area over a client’s sacrum that does not blanch. How
should this be documented?
Stage 1 pressure injury
Stage 2 pressure injury
Stage 3 pressure injury
Deep tissue pressure injury
Rationale: Nonblanchable erythema of intact skin is consistent with a stage 1 pressure injury.
13. Which action is safest when transferring a weak client from bed to chair?
Pull the client by the arms.
Lock the wheels and use a gait belt as indicated.
Ask the client to hold the nurse’s neck.
Move the chair after the client stands.
Rationale: Locking equipment and using appropriate transfer assistance reduce injury risk.
14. A client reports dizziness when standing. Which nursing action is appropriate?
Have the client stand quickly.
Assist the client back to a safe position and assess blood pressure.
Encourage walking to improve circulation.
Restrict all fluids.
Rationale: The client should be protected from a fall and assessed for orthostatic hypotension or another cause.
15. Which item should be removed from the room of a client at risk for self-harm?
Plastic drinking cup
Prescribed medication
Sharps and other potential weapons
Call light
Rationale: Removing potentially dangerous objects is a core environmental safety measure.
16. A nurse enters a room and finds a client on the floor. What is the priority action?
Move the client back to bed immediately.
Assess for injury before moving the client.
Complete an incident report first.
Ask the client why they fell.
Rationale: The nurse should assess for injury and stabilize the client before moving them.
17. Which statement by a nurse demonstrates therapeutic communication?
“You should not feel that way.”
“Why did you do that?”
“Tell me more about what concerns you.”
“Everything will be fine.”
Rationale: Open-ended, nonjudgmental communication encourages expression and assessment.
18. Which intervention best promotes sleep for a hospitalized client?
Cluster care and reduce nighttime interruptions when possible.
Keep the television on for background noise.
Original HESI-style practice content — not leaked or secure exam items. Page 3
, Offer caffeinated drinks at bedtime.
Wake the client every hour for routine conversation.
Rationale: Clustering care can reduce interruptions and support restorative sleep.
19. A client refuses a prescribed treatment after receiving information about risks and
benefits. What should the nurse do?
Force the treatment because it is ordered.
Respect the refusal and document the discussion.
Ask the family to consent instead.
Hide the treatment in food.
Rationale: A competent client has the right to refuse treatment; the nurse documents informed refusal and notification
as appropriate.
20. Which action is most important when using a newly inserted feeding tube for the
first time?
Start the feeding immediately.
Verify tube placement according to policy before use.
Place the client flat.
Add medication to the formula.
Rationale: Tube placement must be verified before initial use to reduce aspiration risk.
21. A client is prescribed digoxin. The apical pulse is 54/min. What should the nurse do?
Give the dose.
Hold the dose and notify the prescriber.
Double the dose tomorrow.
Give the dose with an antacid.
Rationale: Bradycardia can be an adverse effect of digoxin; the dose is commonly held below the ordered parameter.
22. Which laboratory value is most important to monitor for a client receiving warfarin?
aPTT
INR
Troponin
Serum amylase
Rationale: INR is used to monitor warfarin therapy.
23. A client receiving heparin has an unexpectedly low platelet count. Which
complication should the nurse suspect?
HIT
Hyperkalemia
Pancreatitis
Aplastic anemia
Rationale: A significant platelet drop during heparin therapy raises concern for heparin-induced thrombocytopenia.
24. A client taking furosemide is at greatest risk for which electrolyte imbalance?
Hyperkalemia
Hypokalemia
Hypermagnesemia
Hypernatremia
Rationale: Loop diuretics can cause potassium loss.
Original HESI-style practice content — not leaked or secure exam items. Page 4
