HESI EXIT EXAM RN TEST BANK 2026/2027 | Updated Edition
with 100% Correct Answers | NCLEX-RN Aligned |
Comprehensive Nursing Review | Pass Guaranteed - A+
Graded
CLIENT NEEDS CATEGORY: SAFE AND EFFECTIVE CARE ENVIRONMENT
Management of Care (36 Questions)
Q1: The nurse receives shift report on four clients. Which client should the nurse assess
first?
A. A 45-year-old client with pneumonia who has a temperature of 100.4°F (38°C) and is
receiving IV antibiotics
B. A 62-year-old client 2 days post-MI who reports chest pain rated 3/10
C. A 28-year-old client admitted for dehydration with stable vital signs and IV fluids at
125 mL/hr
D. A 55-year-old client with COPD who has an SpO2 of 86% on 2 L/min nasal cannula
Correct Answer: D [CORRECT]
Rationale: The nurse must apply the ABC (Airway, Breathing, Circulation) priority
framework. An SpO2 of 86% represents severe hypoxemia (normal >94%) and indicates
acute respiratory compromise requiring immediate intervention. While the post-MI client
with chest pain (B) requires prompt assessment, the ABCs take precedence over pain.
The pneumonia client (A) has a low-grade fever expected with infection, and the
,dehydrated client (C) has stable vital signs. NCLEX Strategy: When prioritizing, always
identify the unstable client with life-threatening physiological changes first. Hypoxemia
can rapidly progress to respiratory arrest.
Q2: The charge nurse on a medical-surgical unit has the following staff: one RN with 2
years experience, one RN who just completed orientation last week, one LPN/LVN with
5 years experience, and two unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate to the LPN/LVN?
A. Perform the initial admission assessment on a client with chest pain
B. Administer IV push furosemide to a client with fluid overload
C. Administer a scheduled subcutaneous heparin injection to a stable client
D. Evaluate the effectiveness of pain medication administered 1 hour ago
Correct Answer: C [CORRECT]
Rationale: Delegation principles require matching task complexity to scope of practice.
LPN/LVNs can administer medications via routes they've been trained for, including
subcutaneous injections, in stable clients with predictable outcomes. Why others are
incorrect: Initial assessments (A) require RN-level clinical judgment and data analysis.
IV push medications (B) are outside LPN/LVN scope in most states. Evaluation of
interventions (D) requires RN assessment skills to determine if outcomes were met. The
LPN/LVN can collect data, but the RN must evaluate and make clinical decisions.
Q3: A nurse is caring for a client who is 1 day postoperative following abdominal
surgery. The client reports sudden severe abdominal pain, and the nurse notes a heart
,rate of 118 bpm, blood pressure of 88/52 mmHg, and a rigid, distended abdomen. What
is the priority nursing action?
A. Document the findings and notify the surgeon in 30 minutes
B. Administer the prescribed PRN morphine for pain
C. Position the client in high-Fowler's position
D. Notify the surgeon immediately and prepare for possible emergency surgery
Correct Answer: D [CORRECT]
Rationale: These findings indicate acute abdomen with probable peritonitis and
hemorrhagic shock (tachycardia + hypotension = shock). The rigid, board-like abdomen
suggests peritoneal irritation, possibly from anastomotic leak or internal bleeding. This
is a life-threatening emergency requiring immediate surgical intervention. Why others
are incorrect: Waiting to notify (A) could result in death. Morphine (B) would mask
symptoms and is contraindicated with undiagnosed acute abdomen. High-Fowler's (C)
is inappropriate for a client in shock (should be supine with legs elevated). Clinical
Judgment: Recognize cues (rigid abdomen, shock symptoms) → Analyze (surgical
emergency) → Take action (immediate notification).
Q4: [SELECT ALL THAT APPLY] The nurse is preparing discharge instructions for a client
with a new diagnosis of heart failure. Which statements by the client indicate
understanding of the disease management? (Select all that apply)
A. "I should weigh myself daily and call my doctor if I gain 3 pounds in one week"
B. "I can eat as many fresh fruits and vegetables as I want"
C. "I should take my furosemide in the morning to avoid nighttime urination"
, D. "I need to limit my sodium intake to less than 2 grams per day"
E. "I should report increased shortness of breath or swelling immediately"
F. "It's okay to stop taking my medications once I feel better"
Correct Answers: A [CORRECT], C [CORRECT], D [CORRECT], E [CORRECT]
Rationale: Heart failure self-management education is critical to prevent readmission.
Daily weights detect fluid retention early (A). Morning diuretic timing prevents nocturia
(C). Sodium restriction reduces fluid retention (D). Reporting symptom changes enables
early intervention (E). Why incorrect: While fruits/vegetables are healthy, some (canned,
frozen) contain sodium and portions must be monitored (B). Never stop heart failure
medications abruptly (F) - this causes rebound symptoms and decompensation.
Teaching Strategy: Focus on daily monitoring, medication adherence, dietary
modifications, and when to seek help.
Q5: A nursing student asks the preceptor about the purpose of a root cause analysis
(RCA) following a medication error. What is the best explanation by the preceptor?
A. "It determines which staff member was responsible for the error so they can be
disciplined"
B. "It identifies system failures and process weaknesses to prevent future errors"
C. "It establishes legal liability for the hospital in case of litigation"
D. "It calculates the financial cost of the error to the institution"
Correct Answer: B [CORRECT]
with 100% Correct Answers | NCLEX-RN Aligned |
Comprehensive Nursing Review | Pass Guaranteed - A+
Graded
CLIENT NEEDS CATEGORY: SAFE AND EFFECTIVE CARE ENVIRONMENT
Management of Care (36 Questions)
Q1: The nurse receives shift report on four clients. Which client should the nurse assess
first?
A. A 45-year-old client with pneumonia who has a temperature of 100.4°F (38°C) and is
receiving IV antibiotics
B. A 62-year-old client 2 days post-MI who reports chest pain rated 3/10
C. A 28-year-old client admitted for dehydration with stable vital signs and IV fluids at
125 mL/hr
D. A 55-year-old client with COPD who has an SpO2 of 86% on 2 L/min nasal cannula
Correct Answer: D [CORRECT]
Rationale: The nurse must apply the ABC (Airway, Breathing, Circulation) priority
framework. An SpO2 of 86% represents severe hypoxemia (normal >94%) and indicates
acute respiratory compromise requiring immediate intervention. While the post-MI client
with chest pain (B) requires prompt assessment, the ABCs take precedence over pain.
The pneumonia client (A) has a low-grade fever expected with infection, and the
,dehydrated client (C) has stable vital signs. NCLEX Strategy: When prioritizing, always
identify the unstable client with life-threatening physiological changes first. Hypoxemia
can rapidly progress to respiratory arrest.
Q2: The charge nurse on a medical-surgical unit has the following staff: one RN with 2
years experience, one RN who just completed orientation last week, one LPN/LVN with
5 years experience, and two unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate to the LPN/LVN?
A. Perform the initial admission assessment on a client with chest pain
B. Administer IV push furosemide to a client with fluid overload
C. Administer a scheduled subcutaneous heparin injection to a stable client
D. Evaluate the effectiveness of pain medication administered 1 hour ago
Correct Answer: C [CORRECT]
Rationale: Delegation principles require matching task complexity to scope of practice.
LPN/LVNs can administer medications via routes they've been trained for, including
subcutaneous injections, in stable clients with predictable outcomes. Why others are
incorrect: Initial assessments (A) require RN-level clinical judgment and data analysis.
IV push medications (B) are outside LPN/LVN scope in most states. Evaluation of
interventions (D) requires RN assessment skills to determine if outcomes were met. The
LPN/LVN can collect data, but the RN must evaluate and make clinical decisions.
Q3: A nurse is caring for a client who is 1 day postoperative following abdominal
surgery. The client reports sudden severe abdominal pain, and the nurse notes a heart
,rate of 118 bpm, blood pressure of 88/52 mmHg, and a rigid, distended abdomen. What
is the priority nursing action?
A. Document the findings and notify the surgeon in 30 minutes
B. Administer the prescribed PRN morphine for pain
C. Position the client in high-Fowler's position
D. Notify the surgeon immediately and prepare for possible emergency surgery
Correct Answer: D [CORRECT]
Rationale: These findings indicate acute abdomen with probable peritonitis and
hemorrhagic shock (tachycardia + hypotension = shock). The rigid, board-like abdomen
suggests peritoneal irritation, possibly from anastomotic leak or internal bleeding. This
is a life-threatening emergency requiring immediate surgical intervention. Why others
are incorrect: Waiting to notify (A) could result in death. Morphine (B) would mask
symptoms and is contraindicated with undiagnosed acute abdomen. High-Fowler's (C)
is inappropriate for a client in shock (should be supine with legs elevated). Clinical
Judgment: Recognize cues (rigid abdomen, shock symptoms) → Analyze (surgical
emergency) → Take action (immediate notification).
Q4: [SELECT ALL THAT APPLY] The nurse is preparing discharge instructions for a client
with a new diagnosis of heart failure. Which statements by the client indicate
understanding of the disease management? (Select all that apply)
A. "I should weigh myself daily and call my doctor if I gain 3 pounds in one week"
B. "I can eat as many fresh fruits and vegetables as I want"
C. "I should take my furosemide in the morning to avoid nighttime urination"
, D. "I need to limit my sodium intake to less than 2 grams per day"
E. "I should report increased shortness of breath or swelling immediately"
F. "It's okay to stop taking my medications once I feel better"
Correct Answers: A [CORRECT], C [CORRECT], D [CORRECT], E [CORRECT]
Rationale: Heart failure self-management education is critical to prevent readmission.
Daily weights detect fluid retention early (A). Morning diuretic timing prevents nocturia
(C). Sodium restriction reduces fluid retention (D). Reporting symptom changes enables
early intervention (E). Why incorrect: While fruits/vegetables are healthy, some (canned,
frozen) contain sodium and portions must be monitored (B). Never stop heart failure
medications abruptly (F) - this causes rebound symptoms and decompensation.
Teaching Strategy: Focus on daily monitoring, medication adherence, dietary
modifications, and when to seek help.
Q5: A nursing student asks the preceptor about the purpose of a root cause analysis
(RCA) following a medication error. What is the best explanation by the preceptor?
A. "It determines which staff member was responsible for the error so they can be
disciplined"
B. "It identifies system failures and process weaknesses to prevent future errors"
C. "It establishes legal liability for the hospital in case of litigation"
D. "It calculates the financial cost of the error to the institution"
Correct Answer: B [CORRECT]
