NURS 499: HESI RN Exit Exam Questions And Answers with Detailed Rationales
Course Code: NURS 499
Course Name: Comprehensive Nursing Concepts and HESI RN Exit Exam Prep
Academic Year: 2026/2027
,Question 1
A 62-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increased shortness of
breath, a productive cough, and a respiratory rate of 28 breaths/minute. The arterial
blood gas (ABG) results reveal a pH of 7.31, PaCO2 of 54 mmHg, HCO3 of 26
mEq/L, and PaO2 of 58 mmHg. Which oxygen delivery method should the nurse
prioritize to safely manage this patient's hypoxemia?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% (4 L/min)
C. Simple face mask at 6 L/min
D. Nasal cannula at 6 L/min
CORRECT ANSWER: B. Venturi mask at 28% (4 L/min)
RATIONALE: The patient is experiencing respiratory acidosis secondary to
acute hypercapnic respiratory failure from a COPD exacerbation. In patients with
chronic hypercapnia, the respiratory drive is often driven by hypoxemia (low
oxygen levels) rather than high carbon dioxide levels. Providing high
concentrations of oxygen (such as with a non-rebreather mask) can obliterate this
hypoxic drive, causing severe respiratory depression. A Venturi mask is the
preferred delivery device because it provides a precise, fixed concentration of
oxygen, allowing safe correction of severe hypoxemia without suppressing the
respiratory center. Nasal cannulas at high flow rates or simple face masks do not
guarantee precise oxygen percentages and can lead to unintended high
concentrations or room-air mixing.
Question 2
The nurse is reviewing the lab values of a pregnant client at 34 weeks gestation
who is admitted with severe preeclampsia. The lab report indicates a platelet count
of 72,000/mm³, alanine aminotransferase (ALT) of 115 U/L, and aspartate
aminotransferase (AST) of 130 U/L. The nurse should immediately screen the
patient for which life-threatening complication?
A. Disseminated intravascular coagulation (DIC) only
B. HELLP syndrome
C. Acute kidney injury (AKI)
D. Placenta previa
, CORRECT ANSWER: B. HELLP syndrome
RATIONALE: The triad of hemolysis, elevated liver enzymes, and low
platelets defines HELLP syndrome, a severe manifestation or complication of
preeclampsia. This client displays elevated liver enzymes (ALT/AST) and
significant thrombocytopenia (platelets < 100,000/mm³). Rapid identification is
vital because HELLP syndrome increases the risk of liver hematoma, severe
hemorrhage, placenta abruptio, and maternal death. While DIC can develop
secondary to HELLP, the specific findings point directly to the diagnostic criteria
of HELLP syndrome. Placenta previa involves an abnormally implanted placenta
and presents with painless vaginal bleeding, not liver or platelet dysfunction.
Question 3
An 8-month-old infant is brought to the pediatric clinic for a well-child checkup.
The nurse assesses the infant's growth and developmental milestones to ensure
proper neurological and musculoskeletal maturation.
Based on the milestone expectations for an 8-month-old infant, which assessment
finding requires immediate referral to a specialist?
A. Inability to pull to a standing position
B. Presence of an asymmetric Moro reflex
C. Absence of a crude palmar grasp
D. Negative Babinski sign
, CORRECT ANSWER: B. Presence of an asymmetric Moro reflex
RATIONALE: The Moro reflex (startle reflex) should fully disappear by 3 to 4
months of age as the infant's central nervous system matures. The presence of a
Moro reflex at 8 months is abnormal and highly indicative of underlying
neurological damage or cerebral palsy. Furthermore, an asymmetric Moro reflex at
any age points toward a localized focal defect, such as a fractured clavicle or
brachial plexus injury. Pulling to a standing position is an expected skill closer to 9
to 10 months, so its absence at 8 months is not concerning. The Babinski reflex
remains normally positive (fanning of toes) up to 1 to 2 years of age.
Question 4
A nurse is preparing to administer an intravenous bolus of furosemide 40 mg to a
patient admitted with acute decompensated heart failure and severe bilateral
pulmonary edema. To minimize the risk of drug-induced ototoxicity, the nurse
must execute which administration technique?
A. Dilute the medication in 100 mL of 5% Dextrose in Water and infuse over 1
hour
B. Inject the medication slowly over a minimum of 2 to 4 minutes
C. Administer the drug as a rapid IV push over 5 to 10 seconds
D. Flush the line with heparin immediately before and after administration
CORRECT ANSWER: B. Inject the medication slowly over a minimum of 2
to 4 minutes
RATIONALE: High-dose or rapidly administered loop diuretics like
furosemide can cause transient or permanent ototoxicity (tinnitus, hearing loss),
especially in patients with renal impairment. To safely deliver an IV bolus of
furosemide, it should be administered slowly, not exceeding a rate of 20 mg per
minute. For a 40 mg dose, this means a minimum of 2 minutes. Rapid IV pushing
increases peak serum levels too quickly, damaging the hair cells within the
cochlea. Furosemide boluses are designed for direct IV push, so diluting it into a 1-
hour secondary infusion is unnecessary and delays urgent diuresis for pulmonary
edema.
Question 5
Course Code: NURS 499
Course Name: Comprehensive Nursing Concepts and HESI RN Exit Exam Prep
Academic Year: 2026/2027
,Question 1
A 62-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) presents to the emergency department with increased shortness of
breath, a productive cough, and a respiratory rate of 28 breaths/minute. The arterial
blood gas (ABG) results reveal a pH of 7.31, PaCO2 of 54 mmHg, HCO3 of 26
mEq/L, and PaO2 of 58 mmHg. Which oxygen delivery method should the nurse
prioritize to safely manage this patient's hypoxemia?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% (4 L/min)
C. Simple face mask at 6 L/min
D. Nasal cannula at 6 L/min
CORRECT ANSWER: B. Venturi mask at 28% (4 L/min)
RATIONALE: The patient is experiencing respiratory acidosis secondary to
acute hypercapnic respiratory failure from a COPD exacerbation. In patients with
chronic hypercapnia, the respiratory drive is often driven by hypoxemia (low
oxygen levels) rather than high carbon dioxide levels. Providing high
concentrations of oxygen (such as with a non-rebreather mask) can obliterate this
hypoxic drive, causing severe respiratory depression. A Venturi mask is the
preferred delivery device because it provides a precise, fixed concentration of
oxygen, allowing safe correction of severe hypoxemia without suppressing the
respiratory center. Nasal cannulas at high flow rates or simple face masks do not
guarantee precise oxygen percentages and can lead to unintended high
concentrations or room-air mixing.
Question 2
The nurse is reviewing the lab values of a pregnant client at 34 weeks gestation
who is admitted with severe preeclampsia. The lab report indicates a platelet count
of 72,000/mm³, alanine aminotransferase (ALT) of 115 U/L, and aspartate
aminotransferase (AST) of 130 U/L. The nurse should immediately screen the
patient for which life-threatening complication?
A. Disseminated intravascular coagulation (DIC) only
B. HELLP syndrome
C. Acute kidney injury (AKI)
D. Placenta previa
, CORRECT ANSWER: B. HELLP syndrome
RATIONALE: The triad of hemolysis, elevated liver enzymes, and low
platelets defines HELLP syndrome, a severe manifestation or complication of
preeclampsia. This client displays elevated liver enzymes (ALT/AST) and
significant thrombocytopenia (platelets < 100,000/mm³). Rapid identification is
vital because HELLP syndrome increases the risk of liver hematoma, severe
hemorrhage, placenta abruptio, and maternal death. While DIC can develop
secondary to HELLP, the specific findings point directly to the diagnostic criteria
of HELLP syndrome. Placenta previa involves an abnormally implanted placenta
and presents with painless vaginal bleeding, not liver or platelet dysfunction.
Question 3
An 8-month-old infant is brought to the pediatric clinic for a well-child checkup.
The nurse assesses the infant's growth and developmental milestones to ensure
proper neurological and musculoskeletal maturation.
Based on the milestone expectations for an 8-month-old infant, which assessment
finding requires immediate referral to a specialist?
A. Inability to pull to a standing position
B. Presence of an asymmetric Moro reflex
C. Absence of a crude palmar grasp
D. Negative Babinski sign
, CORRECT ANSWER: B. Presence of an asymmetric Moro reflex
RATIONALE: The Moro reflex (startle reflex) should fully disappear by 3 to 4
months of age as the infant's central nervous system matures. The presence of a
Moro reflex at 8 months is abnormal and highly indicative of underlying
neurological damage or cerebral palsy. Furthermore, an asymmetric Moro reflex at
any age points toward a localized focal defect, such as a fractured clavicle or
brachial plexus injury. Pulling to a standing position is an expected skill closer to 9
to 10 months, so its absence at 8 months is not concerning. The Babinski reflex
remains normally positive (fanning of toes) up to 1 to 2 years of age.
Question 4
A nurse is preparing to administer an intravenous bolus of furosemide 40 mg to a
patient admitted with acute decompensated heart failure and severe bilateral
pulmonary edema. To minimize the risk of drug-induced ototoxicity, the nurse
must execute which administration technique?
A. Dilute the medication in 100 mL of 5% Dextrose in Water and infuse over 1
hour
B. Inject the medication slowly over a minimum of 2 to 4 minutes
C. Administer the drug as a rapid IV push over 5 to 10 seconds
D. Flush the line with heparin immediately before and after administration
CORRECT ANSWER: B. Inject the medication slowly over a minimum of 2
to 4 minutes
RATIONALE: High-dose or rapidly administered loop diuretics like
furosemide can cause transient or permanent ototoxicity (tinnitus, hearing loss),
especially in patients with renal impairment. To safely deliver an IV bolus of
furosemide, it should be administered slowly, not exceeding a rate of 20 mg per
minute. For a 40 mg dose, this means a minimum of 2 minutes. Rapid IV pushing
increases peak serum levels too quickly, damaging the hair cells within the
cochlea. Furosemide boluses are designed for direct IV push, so diluting it into a 1-
hour secondary infusion is unnecessary and delays urgent diuresis for pulmonary
edema.
Question 5
