HESI EXIT RN EXAMINATION – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
CORE DOMAINS
1. Management of Care and Prioritization
2. Safety and Infection Prevention
3. Pharmacology and Medication Administration
4. Adult Medical-Surgical Nursing
5. Maternal-Newborn Nursing
6. Pediatric Nursing
7. Mental Health Nursing
8. Health Assessment and Clinical Judgment
9. Physiological Adaptation and Complication Recognition
10. Health Promotion and Patient Education
INTRODUCTION
The HESI Exit RN Examination evaluates a nursing student's ability to apply knowledge,
prioritize patient needs, recognize clinical changes, and make safe professional decisions.
Success requires more than memorizing disease facts or medication names; candidates must
connect assessment findings with appropriate nursing interventions and anticipate potential
complications. This practice test emphasizes clinical judgment through a balanced combination
of foundational questions and realistic patient scenarios. The rationales reinforce the reasoning
behind each answer so that learners can identify knowledge gaps and strengthen decision-making
skills. Working through varied questions can help candidates develop the prioritization, safety,
assessment, and application skills expected of an entry-level registered nurse.
SECTION ONE
QUESTIONS 1–50
1. A nurse receives report on four clients. Which client should the nurse assess first?
A. A client with chronic osteoarthritis reporting pain of 6/10
B. A client with pneumonia whose temperature is 38.1°C (100.6°F)
C. A client with heart failure who has new-onset severe dyspnea and pink, frothy sputum
D. A client with diabetes whose premeal blood glucose is 186 mg/dL
Rationale: New severe dyspnea with pink, frothy sputum suggests acute pulmonary edema, a
potentially life-threatening complication of heart failure. Immediate respiratory assessment and
intervention take priority over the other findings.
, 2. A client is prescribed digoxin. Which assessment finding requires the nurse to withhold
the medication and notify the provider?
A. Blood pressure of 128/74 mm Hg
B. Apical pulse of 54 beats/min
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Rationale: Digoxin can slow the heart rate, and significant bradycardia increases the risk of
adverse effects. The medication should be withheld when the apical pulse is below the prescribed
safe range, commonly less than 60 beats/min in adults.
3. A client with chronic obstructive pulmonary disease is receiving oxygen. Which finding
indicates that the intervention is producing the desired effect?
A. Respiratory rate increases from 18 to 30/min
B. The client becomes increasingly drowsy
C. Oxygen saturation increases from 84% to 91%
D. The client develops a productive cough
Rationale: An improvement in oxygen saturation indicates improved oxygenation. The other
findings either indicate deterioration or do not directly demonstrate that oxygen therapy is
achieving its intended effect.
4. A nurse is teaching a client who has been prescribed warfarin. Which statement indicates
correct understanding?
A. "I should stop eating foods that contain vitamin K."
B. "I can take aspirin whenever I develop a headache."
C. "I should double my next dose if I forget one."
D. "I will report unusual bleeding or black, tarry stools."
Rationale: Warfarin increases bleeding risk, so unusual bleeding and gastrointestinal bleeding
signs require prompt reporting. Clients should maintain consistent vitamin K intake rather than
eliminating vitamin K-containing foods.
, 5. A postoperative client suddenly becomes restless and reports difficulty breathing. The
oxygen saturation is 86% on room air. What should the nurse do first?
A. Administer the prescribed opioid analgesic
B. Encourage the client to drink fluids
C. Apply oxygen and assess the client's respiratory status
D. Document the finding and reassess in 30 minutes
Rationale: Hypoxemia is an immediate threat to life. Oxygen should be applied while the nurse
rapidly assesses airway, breathing, circulation, and the possible cause of the respiratory change.
6. Which laboratory result is most concerning for a client receiving heparin therapy?
A. Hemoglobin 13.8 g/dL
B. Platelet count 78,000/mm³
C. Sodium 139 mEq/L
D. Potassium 4.1 mEq/L
Rationale: A markedly decreased platelet count during heparin therapy may indicate heparin-
induced thrombocytopenia, a serious immune-mediated complication associated with thrombosis
and bleeding risk.
7. A nurse is caring for a client with suspected bacterial meningitis. Which action is most
appropriate?
A. Place the client in a negative-pressure room
B. Encourage frequent visitors to provide emotional support
C. Initiate appropriate droplet precautions
D. Keep the room completely dark at all times
Rationale: Bacterial meningitis caused by organisms such as Neisseria meningitidis requires
droplet precautions because respiratory secretions can transmit the infection. Standard
precautions alone are insufficient during the appropriate period of communicability.
8. A client with diabetes is awake, confused, diaphoretic, and has a blood glucose level of
48 mg/dL. Which intervention should the nurse perform?
, A. Administer the scheduled long-acting insulin
B. Restrict oral intake until the glucose is rechecked
C. Administer glucagon only after contacting the provider
D. Give a rapid-acting source of oral carbohydrate
Rationale: An alert client who can safely swallow and has symptomatic hypoglycemia should
receive approximately 15 g of rapid-acting carbohydrate, followed by reassessment of blood
glucose.
9. A nurse is assessing a client with a suspected stroke. Which finding requires immediate
action?
A. Mild headache
B. History of hypertension
C. Sudden inability to speak clearly
D. Blood pressure of 148/88 mm Hg
Rationale: Sudden speech impairment is a classic sign of acute stroke. Rapid recognition and
evaluation are essential because time-sensitive interventions may reduce neurological injury.
10. A client with a new tracheostomy becomes anxious and begins making ineffective
attempts to breathe. The nurse hears gurgling sounds from the tracheostomy. What is the
priority action?
A. Offer the client oral fluids
B. Place the client flat
C. Assess and suction the airway as indicated
D. Remove the tracheostomy tube immediately
Rationale: Gurgling suggests retained secretions obstructing the airway. Airway patency is the
immediate priority, and suctioning may remove secretions and improve ventilation.
11. Which finding should the nurse expect in a client experiencing hypokalemia?
A. Peaked T waves
B. Hyperactive bowel sounds
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
CORE DOMAINS
1. Management of Care and Prioritization
2. Safety and Infection Prevention
3. Pharmacology and Medication Administration
4. Adult Medical-Surgical Nursing
5. Maternal-Newborn Nursing
6. Pediatric Nursing
7. Mental Health Nursing
8. Health Assessment and Clinical Judgment
9. Physiological Adaptation and Complication Recognition
10. Health Promotion and Patient Education
INTRODUCTION
The HESI Exit RN Examination evaluates a nursing student's ability to apply knowledge,
prioritize patient needs, recognize clinical changes, and make safe professional decisions.
Success requires more than memorizing disease facts or medication names; candidates must
connect assessment findings with appropriate nursing interventions and anticipate potential
complications. This practice test emphasizes clinical judgment through a balanced combination
of foundational questions and realistic patient scenarios. The rationales reinforce the reasoning
behind each answer so that learners can identify knowledge gaps and strengthen decision-making
skills. Working through varied questions can help candidates develop the prioritization, safety,
assessment, and application skills expected of an entry-level registered nurse.
SECTION ONE
QUESTIONS 1–50
1. A nurse receives report on four clients. Which client should the nurse assess first?
A. A client with chronic osteoarthritis reporting pain of 6/10
B. A client with pneumonia whose temperature is 38.1°C (100.6°F)
C. A client with heart failure who has new-onset severe dyspnea and pink, frothy sputum
D. A client with diabetes whose premeal blood glucose is 186 mg/dL
Rationale: New severe dyspnea with pink, frothy sputum suggests acute pulmonary edema, a
potentially life-threatening complication of heart failure. Immediate respiratory assessment and
intervention take priority over the other findings.
, 2. A client is prescribed digoxin. Which assessment finding requires the nurse to withhold
the medication and notify the provider?
A. Blood pressure of 128/74 mm Hg
B. Apical pulse of 54 beats/min
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Rationale: Digoxin can slow the heart rate, and significant bradycardia increases the risk of
adverse effects. The medication should be withheld when the apical pulse is below the prescribed
safe range, commonly less than 60 beats/min in adults.
3. A client with chronic obstructive pulmonary disease is receiving oxygen. Which finding
indicates that the intervention is producing the desired effect?
A. Respiratory rate increases from 18 to 30/min
B. The client becomes increasingly drowsy
C. Oxygen saturation increases from 84% to 91%
D. The client develops a productive cough
Rationale: An improvement in oxygen saturation indicates improved oxygenation. The other
findings either indicate deterioration or do not directly demonstrate that oxygen therapy is
achieving its intended effect.
4. A nurse is teaching a client who has been prescribed warfarin. Which statement indicates
correct understanding?
A. "I should stop eating foods that contain vitamin K."
B. "I can take aspirin whenever I develop a headache."
C. "I should double my next dose if I forget one."
D. "I will report unusual bleeding or black, tarry stools."
Rationale: Warfarin increases bleeding risk, so unusual bleeding and gastrointestinal bleeding
signs require prompt reporting. Clients should maintain consistent vitamin K intake rather than
eliminating vitamin K-containing foods.
, 5. A postoperative client suddenly becomes restless and reports difficulty breathing. The
oxygen saturation is 86% on room air. What should the nurse do first?
A. Administer the prescribed opioid analgesic
B. Encourage the client to drink fluids
C. Apply oxygen and assess the client's respiratory status
D. Document the finding and reassess in 30 minutes
Rationale: Hypoxemia is an immediate threat to life. Oxygen should be applied while the nurse
rapidly assesses airway, breathing, circulation, and the possible cause of the respiratory change.
6. Which laboratory result is most concerning for a client receiving heparin therapy?
A. Hemoglobin 13.8 g/dL
B. Platelet count 78,000/mm³
C. Sodium 139 mEq/L
D. Potassium 4.1 mEq/L
Rationale: A markedly decreased platelet count during heparin therapy may indicate heparin-
induced thrombocytopenia, a serious immune-mediated complication associated with thrombosis
and bleeding risk.
7. A nurse is caring for a client with suspected bacterial meningitis. Which action is most
appropriate?
A. Place the client in a negative-pressure room
B. Encourage frequent visitors to provide emotional support
C. Initiate appropriate droplet precautions
D. Keep the room completely dark at all times
Rationale: Bacterial meningitis caused by organisms such as Neisseria meningitidis requires
droplet precautions because respiratory secretions can transmit the infection. Standard
precautions alone are insufficient during the appropriate period of communicability.
8. A client with diabetes is awake, confused, diaphoretic, and has a blood glucose level of
48 mg/dL. Which intervention should the nurse perform?
, A. Administer the scheduled long-acting insulin
B. Restrict oral intake until the glucose is rechecked
C. Administer glucagon only after contacting the provider
D. Give a rapid-acting source of oral carbohydrate
Rationale: An alert client who can safely swallow and has symptomatic hypoglycemia should
receive approximately 15 g of rapid-acting carbohydrate, followed by reassessment of blood
glucose.
9. A nurse is assessing a client with a suspected stroke. Which finding requires immediate
action?
A. Mild headache
B. History of hypertension
C. Sudden inability to speak clearly
D. Blood pressure of 148/88 mm Hg
Rationale: Sudden speech impairment is a classic sign of acute stroke. Rapid recognition and
evaluation are essential because time-sensitive interventions may reduce neurological injury.
10. A client with a new tracheostomy becomes anxious and begins making ineffective
attempts to breathe. The nurse hears gurgling sounds from the tracheostomy. What is the
priority action?
A. Offer the client oral fluids
B. Place the client flat
C. Assess and suction the airway as indicated
D. Remove the tracheostomy tube immediately
Rationale: Gurgling suggests retained secretions obstructing the airway. Airway patency is the
immediate priority, and suctioning may remove secretions and improve ventilation.
11. Which finding should the nurse expect in a client experiencing hypokalemia?
A. Peaked T waves
B. Hyperactive bowel sounds
