HESI EXIT RN EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains
Fundamentals of Nursing and Health Assessment
Pharmacology and Medication Administration
Medical-Surgical Nursing and Care of the Adult
Maternal and Newborn Health Nursing
Pediatric Nursing and Child Health
Mental Health and Psychiatric Nursing
Community Health and Population-Focused Care
Leadership, Management, and Professional Ethics
Safety, Quality Improvement, and Evidence-Based Practice
Introduction
The HESI Exit RN Examination is designed to assess the comprehensive knowledge
and clinical judgment required for safe, entry-level professional nursing practice. It
evaluates mastery of core nursing domains, including patient-centered care,
pharmacological interventions, and legal and ethical responsibilities. The exam
utilizes multiple-choice and scenario-based questions to test critical thinking and
real-world clinical decision-making. Emphasis is placed on applying theoretical
foundations to practical patient situations, ensuring candidates are prepared to
deliver high-quality, evidence-based care in diverse healthcare environments.
SECTION ONE: QUESTIONS 1–50
,1. A nurse is assessing a client who is experiencing severe diarrhea and vomiting
for the past three days. Which acid-base imbalance should the nurse anticipate?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
🟢 Correct Answer: C. Metabolic acidosis
🔴 Explanation: Prolonged vomiting causes loss of hydrochloric acid (metabolic
alkalosis), but severe diarrhea causes a loss of bicarbonate, leading to metabolic
acidosis. The combination of both can be complex, but diarrhea's bicarbonate loss
is the primary driver for metabolic acidosis in this scenario.
2. A client is prescribed digoxin. Which assessment finding indicates a potential
toxic effect of the medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 110/70 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Nausea and visual disturbances
🟢 Correct Answer: D. Nausea and visual disturbances
🔴 Explanation: Early signs of digoxin toxicity include anorexia, nausea, vomiting,
and visual disturbances such as blurred or yellow-tinged vision. Bradycardia can
also be a sign, but nausea and visual changes are classic early indicators.
3. A nurse is caring for a client with a new colostomy. Which stoma appearance
should the nurse report to the healthcare provider immediately?
A. Pink and moist
B. Dark red and dry
,C. Slightly edematous
D. Small amount of bleeding
🟢 Correct Answer: B. Dark red and dry
🔴 Explanation: A healthy stoma should be pink to red and moist. A dark red, dry,
or dusky stoma indicates inadequate blood supply (ischemia) and must be
reported immediately to prevent necrosis.
4. A client with a diagnosis of major depressive disorder is started on sertraline.
The nurse should instruct the client to report which of the following adverse
effects immediately?
A. Increased appetite
B. Drowsiness
C. Suicidal thoughts
D. Dry mouth
🟢 Correct Answer: C. Suicidal thoughts
🔴 Explanation: Antidepressants, particularly SSRIs, can increase the risk of suicidal
ideation, especially in the initial weeks of therapy. The nurse must instruct the client
and family to report any worsening depression or suicidal thoughts immediately.
5. A nurse is preparing to administer a blood transfusion. Which action is the
priority before initiating the transfusion?
A. Verify the client's identity and blood product with another nurse.
B. Obtain the client's vital signs.
C. Explain the procedure to the client.
D. Pre-medicate the client with diphenhydramine.
🟢 Correct Answer: A. Verify the client's identity and blood product with another
nurse.
, 🔴 Explanation: The priority action before a blood transfusion is a two-nurse
verification of the client's identity, blood type, and unit number to prevent a
potentially fatal hemolytic transfusion reaction. Vital signs are also crucial but
verification is the primary safety check.
6. A nurse is assessing a client with heart failure. Which finding indicates a
worsening of the condition?
A. Weight loss of 2 kg in one week
B. Blood pressure of 100/60 mm Hg
C. Crackles in the lung bases
D. Heart rate of 80 beats per minute
🟢 Correct Answer: C. Crackles in the lung bases
🔴 Explanation: Crackles in the lung bases indicate fluid accumulation in the lungs
(pulmonary edema), a sign of worsening heart failure. Weight gain, not loss, is also
a sign of fluid retention.
7. A client is admitted with a diagnosis of pancreatitis. Which laboratory value
should the nurse monitor most closely?
A. Serum calcium
B. Serum amylase
C. Serum potassium
D. Serum sodium
🟢 Correct Answer: B. Serum amylase
🔴 Explanation: Serum amylase and lipase are the primary laboratory markers for
diagnosing and monitoring acute pancreatitis. Amylase levels typically rise within
24 hours of onset.
8. A nurse is teaching a client about a low-purine diet for gout. Which food
should the client avoid?
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains
Fundamentals of Nursing and Health Assessment
Pharmacology and Medication Administration
Medical-Surgical Nursing and Care of the Adult
Maternal and Newborn Health Nursing
Pediatric Nursing and Child Health
Mental Health and Psychiatric Nursing
Community Health and Population-Focused Care
Leadership, Management, and Professional Ethics
Safety, Quality Improvement, and Evidence-Based Practice
Introduction
The HESI Exit RN Examination is designed to assess the comprehensive knowledge
and clinical judgment required for safe, entry-level professional nursing practice. It
evaluates mastery of core nursing domains, including patient-centered care,
pharmacological interventions, and legal and ethical responsibilities. The exam
utilizes multiple-choice and scenario-based questions to test critical thinking and
real-world clinical decision-making. Emphasis is placed on applying theoretical
foundations to practical patient situations, ensuring candidates are prepared to
deliver high-quality, evidence-based care in diverse healthcare environments.
SECTION ONE: QUESTIONS 1–50
,1. A nurse is assessing a client who is experiencing severe diarrhea and vomiting
for the past three days. Which acid-base imbalance should the nurse anticipate?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
🟢 Correct Answer: C. Metabolic acidosis
🔴 Explanation: Prolonged vomiting causes loss of hydrochloric acid (metabolic
alkalosis), but severe diarrhea causes a loss of bicarbonate, leading to metabolic
acidosis. The combination of both can be complex, but diarrhea's bicarbonate loss
is the primary driver for metabolic acidosis in this scenario.
2. A client is prescribed digoxin. Which assessment finding indicates a potential
toxic effect of the medication?
A. Heart rate of 58 beats per minute
B. Blood pressure of 110/70 mm Hg
C. Serum potassium level of 4.0 mEq/L
D. Nausea and visual disturbances
🟢 Correct Answer: D. Nausea and visual disturbances
🔴 Explanation: Early signs of digoxin toxicity include anorexia, nausea, vomiting,
and visual disturbances such as blurred or yellow-tinged vision. Bradycardia can
also be a sign, but nausea and visual changes are classic early indicators.
3. A nurse is caring for a client with a new colostomy. Which stoma appearance
should the nurse report to the healthcare provider immediately?
A. Pink and moist
B. Dark red and dry
,C. Slightly edematous
D. Small amount of bleeding
🟢 Correct Answer: B. Dark red and dry
🔴 Explanation: A healthy stoma should be pink to red and moist. A dark red, dry,
or dusky stoma indicates inadequate blood supply (ischemia) and must be
reported immediately to prevent necrosis.
4. A client with a diagnosis of major depressive disorder is started on sertraline.
The nurse should instruct the client to report which of the following adverse
effects immediately?
A. Increased appetite
B. Drowsiness
C. Suicidal thoughts
D. Dry mouth
🟢 Correct Answer: C. Suicidal thoughts
🔴 Explanation: Antidepressants, particularly SSRIs, can increase the risk of suicidal
ideation, especially in the initial weeks of therapy. The nurse must instruct the client
and family to report any worsening depression or suicidal thoughts immediately.
5. A nurse is preparing to administer a blood transfusion. Which action is the
priority before initiating the transfusion?
A. Verify the client's identity and blood product with another nurse.
B. Obtain the client's vital signs.
C. Explain the procedure to the client.
D. Pre-medicate the client with diphenhydramine.
🟢 Correct Answer: A. Verify the client's identity and blood product with another
nurse.
, 🔴 Explanation: The priority action before a blood transfusion is a two-nurse
verification of the client's identity, blood type, and unit number to prevent a
potentially fatal hemolytic transfusion reaction. Vital signs are also crucial but
verification is the primary safety check.
6. A nurse is assessing a client with heart failure. Which finding indicates a
worsening of the condition?
A. Weight loss of 2 kg in one week
B. Blood pressure of 100/60 mm Hg
C. Crackles in the lung bases
D. Heart rate of 80 beats per minute
🟢 Correct Answer: C. Crackles in the lung bases
🔴 Explanation: Crackles in the lung bases indicate fluid accumulation in the lungs
(pulmonary edema), a sign of worsening heart failure. Weight gain, not loss, is also
a sign of fluid retention.
7. A client is admitted with a diagnosis of pancreatitis. Which laboratory value
should the nurse monitor most closely?
A. Serum calcium
B. Serum amylase
C. Serum potassium
D. Serum sodium
🟢 Correct Answer: B. Serum amylase
🔴 Explanation: Serum amylase and lipase are the primary laboratory markers for
diagnosing and monitoring acute pancreatitis. Amylase levels typically rise within
24 hours of onset.
8. A nurse is teaching a client about a low-purine diet for gout. Which food
should the client avoid?
