HESI RN Exit Comprehensive Practice Questions &
Answers 2026/2027 | ACTUAL-Style Practice
Exam, Nursing Test Bank, Medical-Surgical
Nursing, Pharmacology, Maternal-Newborn,
Pediatrics, Mental Health, Fundamentals,
Prioritization, Delegation, Patient Safety, and
Detailed Rationales
Question 1: A nurse is assessing a client who is 2 hours postpartum and
notes a boggy uterus displaced to the right, two fingers above the
umbilicus. Which action should the nurse implement first?
A. Administer methylergonovine intramuscularly
B. Assist the client to void
C. Perform continuous fundal massage
D. Notify the healthcare provider
CORRECT ANSWER: B. Assist the client to void
Rationale: A boggy uterus that is displaced to the right indicates bladder
distension pushing the uterus out of position and preventing effective
contraction. Emptying the bladder allows the uterus to return to midline
and firm up. Fundal massage is appropriate for a midline boggy uterus, but
displacement must be corrected first. Uterotonics and provider notification
follow if the uterus remains boggy after bladder emptying.
Question 2: A nurse is caring for a client receiving oxytocin for labor
induction. Late decelerations appear on the fetal monitor. Which
action should the nurse take first?
A. Increase the oxytocin infusion rate
B. Position the client supine with a wedge
C. Discontinue the oxytocin infusion
D. Administer oxygen at 2 L/min via nasal cannula
CORRECT ANSWER: C. Discontinue the oxytocin infusion
Rationale: Late decelerations indicate uteroplacental insufficiency and
fetal hypoxia. The priority is to stop oxytocin immediately to halt uterine
contractions and restore placental blood flow. The client should be turned
to a lateral position, not supine. Oxygen should be administered at 8–10
L/min via non-rebreather mask.
,Question 3: A client taking warfarin asks about dietary restrictions.
Which instruction should the nurse include?
A. "Avoid all dairy products."
B. "Limit citrus fruits."
C. "Maintain consistent intake of leafy green vegetables."
D. "Avoid lean meats completely."
CORRECT ANSWER: C. Maintain consistent intake of leafy green
vegetables.
Rationale: Vitamin K antagonizes warfarin's anticoagulant effect. Clients
should maintain consistent daily intake of vitamin K–rich foods rather than
eliminating them. Sudden changes in intake can destabilize INR. Dairy,
citrus, and lean meats do not significantly interact with warfarin.
Question 4: A nurse is assessing a client with a new colostomy. Which
finding indicates a need for immediate intervention?
A. Stoma is beefy red and moist
B. Stoma is pale and dusky
C. Output is liquid during the first week
D. Slight edema around the stoma
CORRECT ANSWER: B. Stoma is pale and dusky
Rationale: A healthy stoma is beefy red and moist, indicating adequate
blood flow. A pale or dusky stoma suggests ischemia and requires
immediate notification of the provider. Liquid output and mild edema are
expected during the early postoperative period.
Question 5: A client with COPD has an oxygen saturation of 88% on
room air. Which oxygen delivery method is most appropriate?
A. Nasal cannula at 2 L/min
B. Non-rebreather mask at 10 L/min
C. Simple face mask at 8 L/min
D. Venturi mask at 100%
CORRECT ANSWER: A. Nasal cannula at 2 L/min
Rationale: For COPD clients with CO₂ retention, oxygen should be titrated
to maintain SpO₂ of 88–92%. A nasal cannula at 2 L/min provides
,controlled low-flow oxygen and reduces the risk of suppressing the hypoxic
drive. High-flow oxygen can worsen hypercapnia in these clients.
Question 6: A client with a chest tube has continuous bubbling in the
water seal chamber. Which action should the nurse take?
A. Clamp the chest tube immediately
B. Document as a normal finding
C. Notify the healthcare provider
D. Increase suction pressure
CORRECT ANSWER: C. Notify the healthcare provider
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak in the system, which requires immediate investigation and provider
notification. Intermittent bubbling during exhalation or coughing can be
normal. Clamping the tube without provider direction can cause tension
pneumothorax.
Question 7: A client with acute pancreatitis reports severe abdominal
pain radiating to the back. Which laboratory finding is most consistent
with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated liver enzymes
C. Decreased serum calcium
D. Elevated BUN
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: Acute pancreatitis causes leakage of pancreatic enzymes into
the bloodstream, resulting in elevated amylase and lipase. While
hypocalcemia can occur in severe cases, it is not the primary diagnostic
finding. Liver enzymes and BUN are less specific to pancreatic
inflammation.
Question 8: A client with chronic kidney disease has a serum
potassium of 6.2 mEq/L. Which ECG change is most concerning?
A. Prolonged PR interval
B. Peaked T waves
C. ST segment depression
D. Prominent U waves
, CORRECT ANSWER: B. Peaked T waves
Rationale: Peaked, tall T waves are a classic early ECG sign of
hyperkalemia and can progress to life-threatening arrhythmias. Prolonged
PR interval and U waves are associated with hypokalemia. ST depression is
nonspecific and does not represent the hallmark hyperkalemic change.
Question 9: A nurse is caring for a client with a spinal cord injury. Which
technique is appropriate when repositioning this client?
A. Lift under the arms
B. Log-roll the client
C. Flex hips and knees
D. Raise head of bed to 90 degrees
CORRECT ANSWER: B. Log-roll the client
Rationale: Log-rolling maintains spinal alignment and prevents twisting or
flexion of the spine in clients with spinal precautions. Lifting under the
arms risks spinal movement. Flexing hips and raising the head of bed can
disrupt alignment and should be avoided.
Question 10: A client with diabetic ketoacidosis has a blood glucose of
650 mg/dL. Which intervention should the nurse implement first?
A. Administer regular insulin IV push
B. Initiate IV fluids with 0.9% normal saline
C. Administer sodium bicarbonate
D. Insert a nasogastric tube
CORRECT ANSWER: B. Initiate IV fluids with 0.9% normal saline
Rationale: The priority in DKA is fluid resuscitation to restore intravascular
volume and improve tissue perfusion. Insulin is administered after fluids
are started to prevent rapid shifts that can worsen hypotension.
Bicarbonate is reserved for severe acidosis. NG tube placement is not the
initial priority.
Question 11: A client with heart failure is receiving furosemide. Which
assessment finding indicates the medication is achieving the desired
effect?
A. Decreased jugular venous distention
B. Increased blood pressure
Answers 2026/2027 | ACTUAL-Style Practice
Exam, Nursing Test Bank, Medical-Surgical
Nursing, Pharmacology, Maternal-Newborn,
Pediatrics, Mental Health, Fundamentals,
Prioritization, Delegation, Patient Safety, and
Detailed Rationales
Question 1: A nurse is assessing a client who is 2 hours postpartum and
notes a boggy uterus displaced to the right, two fingers above the
umbilicus. Which action should the nurse implement first?
A. Administer methylergonovine intramuscularly
B. Assist the client to void
C. Perform continuous fundal massage
D. Notify the healthcare provider
CORRECT ANSWER: B. Assist the client to void
Rationale: A boggy uterus that is displaced to the right indicates bladder
distension pushing the uterus out of position and preventing effective
contraction. Emptying the bladder allows the uterus to return to midline
and firm up. Fundal massage is appropriate for a midline boggy uterus, but
displacement must be corrected first. Uterotonics and provider notification
follow if the uterus remains boggy after bladder emptying.
Question 2: A nurse is caring for a client receiving oxytocin for labor
induction. Late decelerations appear on the fetal monitor. Which
action should the nurse take first?
A. Increase the oxytocin infusion rate
B. Position the client supine with a wedge
C. Discontinue the oxytocin infusion
D. Administer oxygen at 2 L/min via nasal cannula
CORRECT ANSWER: C. Discontinue the oxytocin infusion
Rationale: Late decelerations indicate uteroplacental insufficiency and
fetal hypoxia. The priority is to stop oxytocin immediately to halt uterine
contractions and restore placental blood flow. The client should be turned
to a lateral position, not supine. Oxygen should be administered at 8–10
L/min via non-rebreather mask.
,Question 3: A client taking warfarin asks about dietary restrictions.
Which instruction should the nurse include?
A. "Avoid all dairy products."
B. "Limit citrus fruits."
C. "Maintain consistent intake of leafy green vegetables."
D. "Avoid lean meats completely."
CORRECT ANSWER: C. Maintain consistent intake of leafy green
vegetables.
Rationale: Vitamin K antagonizes warfarin's anticoagulant effect. Clients
should maintain consistent daily intake of vitamin K–rich foods rather than
eliminating them. Sudden changes in intake can destabilize INR. Dairy,
citrus, and lean meats do not significantly interact with warfarin.
Question 4: A nurse is assessing a client with a new colostomy. Which
finding indicates a need for immediate intervention?
A. Stoma is beefy red and moist
B. Stoma is pale and dusky
C. Output is liquid during the first week
D. Slight edema around the stoma
CORRECT ANSWER: B. Stoma is pale and dusky
Rationale: A healthy stoma is beefy red and moist, indicating adequate
blood flow. A pale or dusky stoma suggests ischemia and requires
immediate notification of the provider. Liquid output and mild edema are
expected during the early postoperative period.
Question 5: A client with COPD has an oxygen saturation of 88% on
room air. Which oxygen delivery method is most appropriate?
A. Nasal cannula at 2 L/min
B. Non-rebreather mask at 10 L/min
C. Simple face mask at 8 L/min
D. Venturi mask at 100%
CORRECT ANSWER: A. Nasal cannula at 2 L/min
Rationale: For COPD clients with CO₂ retention, oxygen should be titrated
to maintain SpO₂ of 88–92%. A nasal cannula at 2 L/min provides
,controlled low-flow oxygen and reduces the risk of suppressing the hypoxic
drive. High-flow oxygen can worsen hypercapnia in these clients.
Question 6: A client with a chest tube has continuous bubbling in the
water seal chamber. Which action should the nurse take?
A. Clamp the chest tube immediately
B. Document as a normal finding
C. Notify the healthcare provider
D. Increase suction pressure
CORRECT ANSWER: C. Notify the healthcare provider
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak in the system, which requires immediate investigation and provider
notification. Intermittent bubbling during exhalation or coughing can be
normal. Clamping the tube without provider direction can cause tension
pneumothorax.
Question 7: A client with acute pancreatitis reports severe abdominal
pain radiating to the back. Which laboratory finding is most consistent
with this diagnosis?
A. Elevated serum amylase and lipase
B. Elevated liver enzymes
C. Decreased serum calcium
D. Elevated BUN
CORRECT ANSWER: A. Elevated serum amylase and lipase
Rationale: Acute pancreatitis causes leakage of pancreatic enzymes into
the bloodstream, resulting in elevated amylase and lipase. While
hypocalcemia can occur in severe cases, it is not the primary diagnostic
finding. Liver enzymes and BUN are less specific to pancreatic
inflammation.
Question 8: A client with chronic kidney disease has a serum
potassium of 6.2 mEq/L. Which ECG change is most concerning?
A. Prolonged PR interval
B. Peaked T waves
C. ST segment depression
D. Prominent U waves
, CORRECT ANSWER: B. Peaked T waves
Rationale: Peaked, tall T waves are a classic early ECG sign of
hyperkalemia and can progress to life-threatening arrhythmias. Prolonged
PR interval and U waves are associated with hypokalemia. ST depression is
nonspecific and does not represent the hallmark hyperkalemic change.
Question 9: A nurse is caring for a client with a spinal cord injury. Which
technique is appropriate when repositioning this client?
A. Lift under the arms
B. Log-roll the client
C. Flex hips and knees
D. Raise head of bed to 90 degrees
CORRECT ANSWER: B. Log-roll the client
Rationale: Log-rolling maintains spinal alignment and prevents twisting or
flexion of the spine in clients with spinal precautions. Lifting under the
arms risks spinal movement. Flexing hips and raising the head of bed can
disrupt alignment and should be avoided.
Question 10: A client with diabetic ketoacidosis has a blood glucose of
650 mg/dL. Which intervention should the nurse implement first?
A. Administer regular insulin IV push
B. Initiate IV fluids with 0.9% normal saline
C. Administer sodium bicarbonate
D. Insert a nasogastric tube
CORRECT ANSWER: B. Initiate IV fluids with 0.9% normal saline
Rationale: The priority in DKA is fluid resuscitation to restore intravascular
volume and improve tissue perfusion. Insulin is administered after fluids
are started to prevent rapid shifts that can worsen hypotension.
Bicarbonate is reserved for severe acidosis. NG tube placement is not the
initial priority.
Question 11: A client with heart failure is receiving furosemide. Which
assessment finding indicates the medication is achieving the desired
effect?
A. Decreased jugular venous distention
B. Increased blood pressure
