1
HESI RN EXIT EXAM 2026–2027 | 200 NCLEX-STYLE PRACTICE QUESTIONS
WITH 100% CORRECT ANSWERS & DETAILED RATIONALES
1. A 28-year-old postpartum client, 12 hours after a spontaneous vaginal delivery, reports
increasing pelvic pressure and a large amount of lochia with bright red bleeding. Her
fundus is boggy and approximately two fingerbreadths above the umbilicus and deviated
slightly to the right. She is pale and diaphoretic. Which initial action should the nurse
take?
A. Insert an indwelling urinary catheter and measure urine output.
B. Perform fundal massage and assess for uterine atony.
C. Start a peripheral IV and prepare for blood transfusion.
D. Administer oxytocin 10 units IM per standing orders.
B. Perform fundal massage and assess for uterine atony.
Rationale: The immediate priority for a boggy, displaced fundus with heavy lochia is to perform
uterine fundal massage to stimulate contraction and expel retained clots. The uterus being
displaced to the right often indicates a full bladder, so assessing/emptying the bladder is
important—but fundal massage is the fastest intervention to reduce hemorrhage. IV access and
transfusion may be needed if bleeding persists, and oxytocin is indicated, but fundal massage
should be initiated immediately while preparations continue.
, 2
2. A client with heart failure is prescribed furosemide 40 mg IV for worsening pulmonary
edema. The nurse notes the client’s potassium is 3.0 mEq/L and reports the client is also taking
digoxin. Which action should the nurse take first?
A. Administer furosemide and schedule potassium supplementation later.
B. Hold furosemide and notify the provider about the low potassium level.
C. Give furosemide and draw serum magnesium and calcium levels.
D. Give furosemide and monitor for signs of digoxin toxicity.
B. Hold furosemide and notify the provider about the low potassium level.
Rationale: A potassium of 3.0 mEq/L is hypokalemia and increases the risk of digoxin toxicity
and life-threatening arrhythmias. Before administering a diuretic that will further lower
potassium, the nurse should notify the provider and withhold the med until potassium is
corrected. Monitoring for toxicity and replacing electrolytes will follow, but immediate
administration without correction is unsafe.
3. A 45-year-old client with type 1 diabetes prepares to start continuous subcutaneous
insulin infusion (insulin pump). The nurse is teaching pump management including
troubleshooting. Which instruction is most important for the nurse to emphasize to prevent
diabetic ketoacidosis?
, 3
A. Change the insulin infusion set and site every 48–72 hours.
B. Check blood glucose every 4 hours and keep extra insulin vials available.
C. Use bolus dosing for all snacks and refrain from basal rate adjustments.
D. If the pump malfunctions, administer the usual long-acting insulin and call provider.
B. Check blood glucose every 4 hours and keep extra insulin vials available.
Rationale: If the pump fails or infusion set dislodges, insulin delivery stops quickly and DKA can
develop within hours. Frequent glucose checks and having backup insulin (vials/syringes or
pens) are critical so client can restore insulin delivery promptly. Changing sets every 48–72
hours is correct but secondary. Boluses and basal adjustments are part of pump use but do not
immediately prevent DKA if pump fails. Long-acting insulin alone may not suffice for immediate
basal needs without provider direction.
4. A postoperative client 8 hours after abdominal surgery has a respiratory rate of 10
breaths/min, oxygen saturation 89% on room air, and decreased breath sounds at the bases. The
client reports moderate incisional pain rated 6/10. Which nursing action best addresses the
immediate respiratory concern while balancing pain control?
A. Encourage incentive spirometry every hour and provide opioid PRN for pain.
B. Call rapid response for possible postoperative respiratory failure.
C. Apply 2 L nasal cannula oxygen and provide nonpharmacologic pain measures.
D. Reposition the client and administer a prescribed non-opioid analgesic, then reassess.
, 4
D. Reposition the client and administer a prescribed non-opioid analgesic, then reassess.
Rationale: The client has evidence of hypoventilation and hypoxia likely from pain-limited deep
breathing. Repositioning and giving non-opioid analgesia (e.g., acetaminophen or NSAID if
ordered) can improve ability to breathe deeply and use incentive spirometry. Incentive
spirometry plus analgesia is important, but giving an opioid PRN without first attempting non-
opioid measures may worsen respiratory depression. Oxygen may be used but addressing
hypoventilation cause (pain) is priority. Rapid response is premature unless status worsens.
5. A client with newly diagnosed rheumatoid arthritis is prescribed methotrexate 15 mg
weekly. The nurse provides teaching about adverse effects and monitoring. Which statement by
the client indicates the need for further teaching?
A. "I should expect to have periodic blood tests to check my liver and blood counts."
B. "I should avoid alcohol while taking this medication to reduce liver damage."
C. "If I become pregnant I can continue methotrexate with close monitoring."
D. "I may experience nausea and mouth sores; I will report severe symptoms."
C. "If I become pregnant I can continue methotrexate with close monitoring."
Rationale: Methotrexate is teratogenic and contraindicated in pregnancy; clients must use
effective contraception and stop the drug before conception. Periodic labs for liver function and
blood counts, avoiding alcohol, and reporting mucositis or severe side effects are correct. The
client’s statement about continuing in pregnancy is inaccurate and requires correction.
HESI RN EXIT EXAM 2026–2027 | 200 NCLEX-STYLE PRACTICE QUESTIONS
WITH 100% CORRECT ANSWERS & DETAILED RATIONALES
1. A 28-year-old postpartum client, 12 hours after a spontaneous vaginal delivery, reports
increasing pelvic pressure and a large amount of lochia with bright red bleeding. Her
fundus is boggy and approximately two fingerbreadths above the umbilicus and deviated
slightly to the right. She is pale and diaphoretic. Which initial action should the nurse
take?
A. Insert an indwelling urinary catheter and measure urine output.
B. Perform fundal massage and assess for uterine atony.
C. Start a peripheral IV and prepare for blood transfusion.
D. Administer oxytocin 10 units IM per standing orders.
B. Perform fundal massage and assess for uterine atony.
Rationale: The immediate priority for a boggy, displaced fundus with heavy lochia is to perform
uterine fundal massage to stimulate contraction and expel retained clots. The uterus being
displaced to the right often indicates a full bladder, so assessing/emptying the bladder is
important—but fundal massage is the fastest intervention to reduce hemorrhage. IV access and
transfusion may be needed if bleeding persists, and oxytocin is indicated, but fundal massage
should be initiated immediately while preparations continue.
, 2
2. A client with heart failure is prescribed furosemide 40 mg IV for worsening pulmonary
edema. The nurse notes the client’s potassium is 3.0 mEq/L and reports the client is also taking
digoxin. Which action should the nurse take first?
A. Administer furosemide and schedule potassium supplementation later.
B. Hold furosemide and notify the provider about the low potassium level.
C. Give furosemide and draw serum magnesium and calcium levels.
D. Give furosemide and monitor for signs of digoxin toxicity.
B. Hold furosemide and notify the provider about the low potassium level.
Rationale: A potassium of 3.0 mEq/L is hypokalemia and increases the risk of digoxin toxicity
and life-threatening arrhythmias. Before administering a diuretic that will further lower
potassium, the nurse should notify the provider and withhold the med until potassium is
corrected. Monitoring for toxicity and replacing electrolytes will follow, but immediate
administration without correction is unsafe.
3. A 45-year-old client with type 1 diabetes prepares to start continuous subcutaneous
insulin infusion (insulin pump). The nurse is teaching pump management including
troubleshooting. Which instruction is most important for the nurse to emphasize to prevent
diabetic ketoacidosis?
, 3
A. Change the insulin infusion set and site every 48–72 hours.
B. Check blood glucose every 4 hours and keep extra insulin vials available.
C. Use bolus dosing for all snacks and refrain from basal rate adjustments.
D. If the pump malfunctions, administer the usual long-acting insulin and call provider.
B. Check blood glucose every 4 hours and keep extra insulin vials available.
Rationale: If the pump fails or infusion set dislodges, insulin delivery stops quickly and DKA can
develop within hours. Frequent glucose checks and having backup insulin (vials/syringes or
pens) are critical so client can restore insulin delivery promptly. Changing sets every 48–72
hours is correct but secondary. Boluses and basal adjustments are part of pump use but do not
immediately prevent DKA if pump fails. Long-acting insulin alone may not suffice for immediate
basal needs without provider direction.
4. A postoperative client 8 hours after abdominal surgery has a respiratory rate of 10
breaths/min, oxygen saturation 89% on room air, and decreased breath sounds at the bases. The
client reports moderate incisional pain rated 6/10. Which nursing action best addresses the
immediate respiratory concern while balancing pain control?
A. Encourage incentive spirometry every hour and provide opioid PRN for pain.
B. Call rapid response for possible postoperative respiratory failure.
C. Apply 2 L nasal cannula oxygen and provide nonpharmacologic pain measures.
D. Reposition the client and administer a prescribed non-opioid analgesic, then reassess.
, 4
D. Reposition the client and administer a prescribed non-opioid analgesic, then reassess.
Rationale: The client has evidence of hypoventilation and hypoxia likely from pain-limited deep
breathing. Repositioning and giving non-opioid analgesia (e.g., acetaminophen or NSAID if
ordered) can improve ability to breathe deeply and use incentive spirometry. Incentive
spirometry plus analgesia is important, but giving an opioid PRN without first attempting non-
opioid measures may worsen respiratory depression. Oxygen may be used but addressing
hypoventilation cause (pain) is priority. Rapid response is premature unless status worsens.
5. A client with newly diagnosed rheumatoid arthritis is prescribed methotrexate 15 mg
weekly. The nurse provides teaching about adverse effects and monitoring. Which statement by
the client indicates the need for further teaching?
A. "I should expect to have periodic blood tests to check my liver and blood counts."
B. "I should avoid alcohol while taking this medication to reduce liver damage."
C. "If I become pregnant I can continue methotrexate with close monitoring."
D. "I may experience nausea and mouth sores; I will report severe symptoms."
C. "If I become pregnant I can continue methotrexate with close monitoring."
Rationale: Methotrexate is teratogenic and contraindicated in pregnancy; clients must use
effective contraception and stop the drug before conception. Periodic labs for liver function and
blood counts, avoiding alcohol, and reporting mucositis or severe side effects are correct. The
client’s statement about continuing in pregnancy is inaccurate and requires correction.
