HESI COMPREHENSIVE EXIT EXAM PRACTICE
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS AND
ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A client with acute pancreatitis is NPO and receiving IV fluids.
Which laboratory finding is the best indicator of nutritional
improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a
level of 22 mg/dL indicates adequate protein synthesis. Amylase and
lipase reflect pancreatic inflammation, not nutrition. Blood glucose
indicates glucose control.
2. A nurse is reviewing a telemetry strip. The PR interval
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
,Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
3. A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value requires immediate notification before
administering the dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias. The
provider should be notified before giving the dose. Other values are
within normal limits.
4. A nurse is teaching a client with a new colostomy about stoma
care. Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
, 5. A client is receiving a continuous heparin infusion. The aPTT is 105
seconds (therapeutic 60–80 seconds). The client has no active
bleeding. What is the nurse’s best action?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
titration nomogram. Protamine is for severe hemorrhage. Vitamin K
reverses warfarin. Continuing the rate increases bleeding risk.
6. A postpartum client who delivered a 9-pound infant 2 hours ago
has a boggy uterus displaced to the right, heavy lochia rubra, and
perineal pad saturation in 15 minutes. What is the priority nursing
intervention?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder
distention. Empty the bladder first, then massage the fundus.
Methylergonovine may be given if massage fails. Trendelenburg and ice
are not priorities.
7. A nurse is caring for a client 24 hours after a femoral-popliteal
bypass graft. The client reports severe pain in the affected leg, and
, the foot is pale, cool, and mottled with absent pedal pulses. What
should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the surgeon immediately of suspected graft occlusion
C) Document findings and reassess in 30 minutes
D) Apply warm compresses to the foot
Correct Answer: B
Sudden severe pain, pallor, pulselessness, and coolness indicate acute
arterial occlusion, a surgical emergency. Elevation reduces arterial flow.
Delay risks limb loss. Warm compresses do not restore perfusion.
8. A client with major depressive disorder suddenly becomes more
energetic, gives away possessions, and states, “I have a plan to
end my pain.” What is the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs
of imminent suicide; continuous observation is the immediate priority. A
no-suicide contract does not replace supervision. Group therapy and
anxiolytics do not address acute risk.
9. A client with COPD is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes respirations have decreased to 8 breaths
per minute and the client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | PRACTICE QUESTIONS AND
ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A client with acute pancreatitis is NPO and receiving IV fluids.
Which laboratory finding is the best indicator of nutritional
improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a
level of 22 mg/dL indicates adequate protein synthesis. Amylase and
lipase reflect pancreatic inflammation, not nutrition. Blood glucose
indicates glucose control.
2. A nurse is reviewing a telemetry strip. The PR interval
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
,Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
3. A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value requires immediate notification before
administering the dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias. The
provider should be notified before giving the dose. Other values are
within normal limits.
4. A nurse is teaching a client with a new colostomy about stoma
care. Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
, 5. A client is receiving a continuous heparin infusion. The aPTT is 105
seconds (therapeutic 60–80 seconds). The client has no active
bleeding. What is the nurse’s best action?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
titration nomogram. Protamine is for severe hemorrhage. Vitamin K
reverses warfarin. Continuing the rate increases bleeding risk.
6. A postpartum client who delivered a 9-pound infant 2 hours ago
has a boggy uterus displaced to the right, heavy lochia rubra, and
perineal pad saturation in 15 minutes. What is the priority nursing
intervention?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder
distention. Empty the bladder first, then massage the fundus.
Methylergonovine may be given if massage fails. Trendelenburg and ice
are not priorities.
7. A nurse is caring for a client 24 hours after a femoral-popliteal
bypass graft. The client reports severe pain in the affected leg, and
, the foot is pale, cool, and mottled with absent pedal pulses. What
should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the surgeon immediately of suspected graft occlusion
C) Document findings and reassess in 30 minutes
D) Apply warm compresses to the foot
Correct Answer: B
Sudden severe pain, pallor, pulselessness, and coolness indicate acute
arterial occlusion, a surgical emergency. Elevation reduces arterial flow.
Delay risks limb loss. Warm compresses do not restore perfusion.
8. A client with major depressive disorder suddenly becomes more
energetic, gives away possessions, and states, “I have a plan to
end my pain.” What is the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs
of imminent suicide; continuous observation is the immediate priority. A
no-suicide contract does not replace supervision. Group therapy and
anxiolytics do not address acute risk.
9. A client with COPD is receiving oxygen at 2 L/min via nasal
cannula. The nurse notes respirations have decreased to 8 breaths
per minute and the client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
