2026 HESI RN Exit Exam (LATEST EDITION)
Comprehensive Practice Examination |
Complete Questions & Verified Answers |
100% Correct | Grade A – Elsevier
1. A client with heart failure has crackles in bilateral lung bases, JVD, and an S3 gallop. Which
medication should the nurse prepare to administer first?
A) Metoprolol
B) Furosemide IV
C) Digoxin
D) Spironolactone
Answer: B
Rationale: IV furosemide rapidly reduces preload and pulmonary congestion in acute heart failure.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen delivery device is safest?
A) Non-rebreather at 15 L/min
B) Nasal cannula at 1-2 L/min
C) Simple face mask at 6 L/min
D) Venturi mask at 40%
Answer: B
Rationale: Low-flow oxygen prevents CO2 retention in COPD clients.
3. A client with diabetes has a blood glucose of 45 mg/dL and is conscious. What should the nurse
administer first?
A) Insulin
B) 15 g of oral carbohydrate
C) Glucagon IM
,D) D50W IV
Answer: B
Rationale: Conscious hypoglycemia is treated with oral fast-acting carbohydrate.
4. A client is receiving IV heparin. The aPTT is 110 seconds. What should the nurse do?
A) Increase the infusion rate
B) Hold the infusion and notify the provider
C) Administer vitamin K
D) Continue the infusion
Answer: B
Rationale: aPTT >100 seconds indicates supratherapeutic anticoagulation.
5. A client with preeclampsia is receiving magnesium sulfate. Which finding indicates toxicity?
A) DTRs 2+
B) Respiratory rate 10 breaths/min
C) Urine output 50 mL/hr
D) Magnesium level 5 mg/dL
Answer: B
Rationale: Respiratory depression indicates magnesium toxicity; antidote is calcium gluconate.
6. A postpartum client has a boggy fundus. What should the nurse do first?
A) Administer oxytocin
B) Massage the fundus
C) Notify the provider
D) Increase IV fluids
Answer: B
Rationale: Fundal massage stimulates uterine contraction to control bleeding.
2
,7. A newborn has an Apgar score of 4 at 1 minute. What should the nurse do first?
A) Begin chest compressions
B) Dry and stimulate the infant
C) Administer epinephrine
D) Intubate
Answer: B
Rationale: Initial steps for moderate depression include drying, warming, and stimulation.
8. A client with schizophrenia has command hallucinations to harm self. What is the priority
action?
A) Ask what the voices are saying
B) Implement suicide precautions
C) Administer PRN antipsychotic
D) Document the finding
Answer: B
Rationale: Command hallucinations to self-harm require immediate safety interventions.
9. A client on lithium has a level of 1.8 mEq/L. Which finding does the nurse expect?
A) Fine hand tremor
B) Coarse tremor and vomiting
C) Polyuria
D) Weight gain
Answer: B
Rationale: Lithium level 1.5-2.0 mEq/L indicates moderate toxicity.
10. A client with an NG tube is receiving medications. Which action is correct?
A) Mix all medications together
3
, B) Flush with water before and after each medication
C) Administer with food
D) Crush enteric-coated tablets
Answer: B
Rationale: Flushing prevents clogging and ensures delivery.
11. A client has a new colostomy with a purple stoma. What should the nurse do?
A) Document as normal
B) Notify the surgeon immediately
C) Apply a warm compress
D) Reassure the client
Answer: B
Rationale: Purple/black stoma indicates ischemia or necrosis.
12. A client is post-op day 1 and reports calf pain and swelling. What is the priority action?
A) Massage the calf
B) Assess for DVT and notify the provider
C) Apply warm compress
D) Elevate the leg
Answer: B
Rationale: Unilateral calf pain and swelling suggest DVT; massage is contraindicated.
13. A client with cirrhosis has asterixis and confusion. Which medication does the nurse anticipate?
A) Spironolactone
B) Lactulose
C) Furosemide
D) Octreotide
Answer: B
4
Comprehensive Practice Examination |
Complete Questions & Verified Answers |
100% Correct | Grade A – Elsevier
1. A client with heart failure has crackles in bilateral lung bases, JVD, and an S3 gallop. Which
medication should the nurse prepare to administer first?
A) Metoprolol
B) Furosemide IV
C) Digoxin
D) Spironolactone
Answer: B
Rationale: IV furosemide rapidly reduces preload and pulmonary congestion in acute heart failure.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen delivery device is safest?
A) Non-rebreather at 15 L/min
B) Nasal cannula at 1-2 L/min
C) Simple face mask at 6 L/min
D) Venturi mask at 40%
Answer: B
Rationale: Low-flow oxygen prevents CO2 retention in COPD clients.
3. A client with diabetes has a blood glucose of 45 mg/dL and is conscious. What should the nurse
administer first?
A) Insulin
B) 15 g of oral carbohydrate
C) Glucagon IM
,D) D50W IV
Answer: B
Rationale: Conscious hypoglycemia is treated with oral fast-acting carbohydrate.
4. A client is receiving IV heparin. The aPTT is 110 seconds. What should the nurse do?
A) Increase the infusion rate
B) Hold the infusion and notify the provider
C) Administer vitamin K
D) Continue the infusion
Answer: B
Rationale: aPTT >100 seconds indicates supratherapeutic anticoagulation.
5. A client with preeclampsia is receiving magnesium sulfate. Which finding indicates toxicity?
A) DTRs 2+
B) Respiratory rate 10 breaths/min
C) Urine output 50 mL/hr
D) Magnesium level 5 mg/dL
Answer: B
Rationale: Respiratory depression indicates magnesium toxicity; antidote is calcium gluconate.
6. A postpartum client has a boggy fundus. What should the nurse do first?
A) Administer oxytocin
B) Massage the fundus
C) Notify the provider
D) Increase IV fluids
Answer: B
Rationale: Fundal massage stimulates uterine contraction to control bleeding.
2
,7. A newborn has an Apgar score of 4 at 1 minute. What should the nurse do first?
A) Begin chest compressions
B) Dry and stimulate the infant
C) Administer epinephrine
D) Intubate
Answer: B
Rationale: Initial steps for moderate depression include drying, warming, and stimulation.
8. A client with schizophrenia has command hallucinations to harm self. What is the priority
action?
A) Ask what the voices are saying
B) Implement suicide precautions
C) Administer PRN antipsychotic
D) Document the finding
Answer: B
Rationale: Command hallucinations to self-harm require immediate safety interventions.
9. A client on lithium has a level of 1.8 mEq/L. Which finding does the nurse expect?
A) Fine hand tremor
B) Coarse tremor and vomiting
C) Polyuria
D) Weight gain
Answer: B
Rationale: Lithium level 1.5-2.0 mEq/L indicates moderate toxicity.
10. A client with an NG tube is receiving medications. Which action is correct?
A) Mix all medications together
3
, B) Flush with water before and after each medication
C) Administer with food
D) Crush enteric-coated tablets
Answer: B
Rationale: Flushing prevents clogging and ensures delivery.
11. A client has a new colostomy with a purple stoma. What should the nurse do?
A) Document as normal
B) Notify the surgeon immediately
C) Apply a warm compress
D) Reassure the client
Answer: B
Rationale: Purple/black stoma indicates ischemia or necrosis.
12. A client is post-op day 1 and reports calf pain and swelling. What is the priority action?
A) Massage the calf
B) Assess for DVT and notify the provider
C) Apply warm compress
D) Elevate the leg
Answer: B
Rationale: Unilateral calf pain and swelling suggest DVT; massage is contraindicated.
13. A client with cirrhosis has asterixis and confusion. Which medication does the nurse anticipate?
A) Spironolactone
B) Lactulose
C) Furosemide
D) Octreotide
Answer: B
4
