HESI Compass Comprehensive Exit Exam
2026/2027 | Practice Test Bank, Verified
Answers & Rationales | Nursing Exit Exam
Prep
HESI COMPASS COMPREHENSIVE EXIT EXAM 2026/2027 | PRACTICE TEST BANK
DOCUMENT OVERVIEW:
• This practice test bank contains verified questions with detailed rationales
designed to simulate the actual HESI Compass Nursing Exit Exam, covering all major
clinical domains and nursing competencies across medical-surgical, pediatric,
maternal, psychiatric, and critical care nursing.
• Study this material by completing 20-25 questions daily, reviewing rationales
carefully for both correct and incorrect options, and identifying weak content areas
to focus your remaining exam preparation efforts.
QUESTION 1
A 68-year-old client with chronic obstructive pulmonary disease (COPD) is
admitted to the unit. Which nursing action is the priority when caring for this
client?
A) Administer oxygen at high flow rates to increase SpO2 immediately
B) Position the client in high Fowler's position and assess respiratory status
C) Encourage the client to cough and deep breathe every 2 hours
D) Obtain a complete health history before providing any interventions
E) Insert a peripheral IV line for medication administration
✓ CORRECT ANSWER: B) Position the client in high Fowler's position and assess
respiratory status
,RATIONALE: In COPD clients, positioning in high Fowler's position (or semi-
Fowler's) facilitates diaphragmatic excursion and optimizes respiratory mechanics.
Assessment of respiratory status (including SpO2, respiratory rate, breath sounds,
and use of accessory muscles) is the priority nursing action to establish baseline
data and guide subsequent interventions. While high-flow oxygen is
contraindicated in COPD patients (as they may have CO2 retention and hypoxic
drive), low-flow oxygen (1-3 L/min) may be appropriate based on assessment
findings. Deep breathing and coughing are important but secondary to initial
assessment and positioning.
QUESTION 2
A 45-year-old client is receiving vancomycin for a methicillin-resistant
Staphylococcus aureus (MRSA) infection. Which adverse effect requires
immediate nursing intervention?
A) Mild tinnitus and dizziness during infusion
B) Red man syndrome appearing as flushing on the neck and chest
C) Sudden onset of severe headache and neck rigidity
D) Temporary increase in blood urea nitrogen (BUN) levels
E) Mild nausea and decreased appetite
✓ CORRECT ANSWER: C) Sudden onset of severe headache and neck rigidity
RATIONALE: Severe headache and neck rigidity suggest vancomycin-induced
meningitis or a serious CNS adverse effect requiring immediate physician
notification and possible discontinuation of the drug. While red man syndrome
(option B) is a common adverse effect of vancomycin that can be managed with
premedication and slower infusion rates, it is not immediately dangerous. Tinnitus
and dizziness may indicate ototoxicity but are less immediately life-threatening
than meningeal symptoms. Mild nausea and increased BUN are expected mild
,effects that require monitoring but not immediate intervention. The presentation of
headache with neck rigidity is a medical emergency.
QUESTION 3
A 3-year-old child is hospitalized with acute gastroenteritis and moderate
dehydration. Which assessment finding indicates worsening dehydration?
A) Fontanel is flat and skin turgor is normal
B) Capillary refill time is greater than 2 seconds
C) Urine output is 1.5 mL/kg/hour
D) Mucous membranes are slightly dry with minimal tears
E) Heart rate is within the normal range for age
✓ CORRECT ANSWER: B) Capillary refill time is greater than 2 seconds
RATIONALE: A capillary refill time greater than 2 seconds (normal is less than 2
seconds in children) indicates poor peripheral perfusion and inadequate circulating
volume, signifying significant dehydration that requires immediate intervention. A
flat fontanel indicates adequate hydration; normal skin turgor indicates good
hydration status. Urine output of 1.5 mL/kg/hour is appropriate and reflects
adequate renal perfusion. Slightly dry mucous membranes with minimal tears are
consistent with mild to moderate dehydration, not worsening dehydration. A
normal heart rate does not indicate worsening dehydration—tachycardia is an early
compensatory response to hypovolemia.
QUESTION 4
A 32-year-old primigravida at 38 weeks gestation is admitted in active labor.
She has Group B Streptococcus (GBS) positive status. What is the most
appropriate nursing action?
, A) Inform the client that she will need a cesarean delivery to prevent fetal infection
B) Ensure intravenous penicillin G administration every 4 hours during labor
C) Prepare for early cord clamping to prevent neonatal transmission
D) Notify the pediatric team for neonatal prophylactic antibiotics after delivery
E) Restrict oral intake and position for potential emergency surgery
✓ CORRECT ANSWER: B) Ensure intravenous penicillin G administration every
4 hours during labor
RATIONALE: The standard of care for GBS-positive mothers in labor is intravenous
penicillin G 5 million units initially, then 2.5 million units every 4 hours until delivery.
This antibiotic regimen significantly reduces the risk of neonatal GBS infection.
Cesarean delivery is not indicated solely for GBS colonization unless other obstetric
indications exist. Early cord clamping does not prevent GBS transmission. While the
pediatric team should be informed and neonates born to untreated GBS-positive
mothers may require observation and possible antibiotics, maternal antibiotic
therapy during labor is the primary intervention. Routine NPO status and
emergency positioning are not specifically indicated for GBS colonization.
QUESTION 5
A 55-year-old client with major depressive disorder is started on sertraline.
Which client teaching is most important for the nurse to provide?
A) The medication will improve symptoms immediately within 24 hours
B) Therapeutic effects may take 2-4 weeks, and the client should continue taking
the medication as prescribed
C) The client should not take this medication with food or milk products
D) Suicidal ideation will completely disappear within 1 week of starting treatment
E) The medication should be discontinued if side effects such as nausea occur
2026/2027 | Practice Test Bank, Verified
Answers & Rationales | Nursing Exit Exam
Prep
HESI COMPASS COMPREHENSIVE EXIT EXAM 2026/2027 | PRACTICE TEST BANK
DOCUMENT OVERVIEW:
• This practice test bank contains verified questions with detailed rationales
designed to simulate the actual HESI Compass Nursing Exit Exam, covering all major
clinical domains and nursing competencies across medical-surgical, pediatric,
maternal, psychiatric, and critical care nursing.
• Study this material by completing 20-25 questions daily, reviewing rationales
carefully for both correct and incorrect options, and identifying weak content areas
to focus your remaining exam preparation efforts.
QUESTION 1
A 68-year-old client with chronic obstructive pulmonary disease (COPD) is
admitted to the unit. Which nursing action is the priority when caring for this
client?
A) Administer oxygen at high flow rates to increase SpO2 immediately
B) Position the client in high Fowler's position and assess respiratory status
C) Encourage the client to cough and deep breathe every 2 hours
D) Obtain a complete health history before providing any interventions
E) Insert a peripheral IV line for medication administration
✓ CORRECT ANSWER: B) Position the client in high Fowler's position and assess
respiratory status
,RATIONALE: In COPD clients, positioning in high Fowler's position (or semi-
Fowler's) facilitates diaphragmatic excursion and optimizes respiratory mechanics.
Assessment of respiratory status (including SpO2, respiratory rate, breath sounds,
and use of accessory muscles) is the priority nursing action to establish baseline
data and guide subsequent interventions. While high-flow oxygen is
contraindicated in COPD patients (as they may have CO2 retention and hypoxic
drive), low-flow oxygen (1-3 L/min) may be appropriate based on assessment
findings. Deep breathing and coughing are important but secondary to initial
assessment and positioning.
QUESTION 2
A 45-year-old client is receiving vancomycin for a methicillin-resistant
Staphylococcus aureus (MRSA) infection. Which adverse effect requires
immediate nursing intervention?
A) Mild tinnitus and dizziness during infusion
B) Red man syndrome appearing as flushing on the neck and chest
C) Sudden onset of severe headache and neck rigidity
D) Temporary increase in blood urea nitrogen (BUN) levels
E) Mild nausea and decreased appetite
✓ CORRECT ANSWER: C) Sudden onset of severe headache and neck rigidity
RATIONALE: Severe headache and neck rigidity suggest vancomycin-induced
meningitis or a serious CNS adverse effect requiring immediate physician
notification and possible discontinuation of the drug. While red man syndrome
(option B) is a common adverse effect of vancomycin that can be managed with
premedication and slower infusion rates, it is not immediately dangerous. Tinnitus
and dizziness may indicate ototoxicity but are less immediately life-threatening
than meningeal symptoms. Mild nausea and increased BUN are expected mild
,effects that require monitoring but not immediate intervention. The presentation of
headache with neck rigidity is a medical emergency.
QUESTION 3
A 3-year-old child is hospitalized with acute gastroenteritis and moderate
dehydration. Which assessment finding indicates worsening dehydration?
A) Fontanel is flat and skin turgor is normal
B) Capillary refill time is greater than 2 seconds
C) Urine output is 1.5 mL/kg/hour
D) Mucous membranes are slightly dry with minimal tears
E) Heart rate is within the normal range for age
✓ CORRECT ANSWER: B) Capillary refill time is greater than 2 seconds
RATIONALE: A capillary refill time greater than 2 seconds (normal is less than 2
seconds in children) indicates poor peripheral perfusion and inadequate circulating
volume, signifying significant dehydration that requires immediate intervention. A
flat fontanel indicates adequate hydration; normal skin turgor indicates good
hydration status. Urine output of 1.5 mL/kg/hour is appropriate and reflects
adequate renal perfusion. Slightly dry mucous membranes with minimal tears are
consistent with mild to moderate dehydration, not worsening dehydration. A
normal heart rate does not indicate worsening dehydration—tachycardia is an early
compensatory response to hypovolemia.
QUESTION 4
A 32-year-old primigravida at 38 weeks gestation is admitted in active labor.
She has Group B Streptococcus (GBS) positive status. What is the most
appropriate nursing action?
, A) Inform the client that she will need a cesarean delivery to prevent fetal infection
B) Ensure intravenous penicillin G administration every 4 hours during labor
C) Prepare for early cord clamping to prevent neonatal transmission
D) Notify the pediatric team for neonatal prophylactic antibiotics after delivery
E) Restrict oral intake and position for potential emergency surgery
✓ CORRECT ANSWER: B) Ensure intravenous penicillin G administration every
4 hours during labor
RATIONALE: The standard of care for GBS-positive mothers in labor is intravenous
penicillin G 5 million units initially, then 2.5 million units every 4 hours until delivery.
This antibiotic regimen significantly reduces the risk of neonatal GBS infection.
Cesarean delivery is not indicated solely for GBS colonization unless other obstetric
indications exist. Early cord clamping does not prevent GBS transmission. While the
pediatric team should be informed and neonates born to untreated GBS-positive
mothers may require observation and possible antibiotics, maternal antibiotic
therapy during labor is the primary intervention. Routine NPO status and
emergency positioning are not specifically indicated for GBS colonization.
QUESTION 5
A 55-year-old client with major depressive disorder is started on sertraline.
Which client teaching is most important for the nurse to provide?
A) The medication will improve symptoms immediately within 24 hours
B) Therapeutic effects may take 2-4 weeks, and the client should continue taking
the medication as prescribed
C) The client should not take this medication with food or milk products
D) Suicidal ideation will completely disappear within 1 week of starting treatment
E) The medication should be discontinued if side effects such as nausea occur
