HESI RN Exit Exam Actual Exam 2026/2027 |
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A nurse is caring for a 68-year-old client admitted with acute decompensated heart
failure. The client's vital signs are: BP 88/62, HR 118, RR 26, and SpO2 89%.
Auscultation reveals bilateral crackles and a new S3 gallop. The nurse notes a 4 kg
weight gain since yesterday. Which action should the nurse take FIRST?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow oxygen therapy via non-rebreather mask
C. Place the client in a high-Fowler's position with legs elevated
D. Initiate dopamine infusion per sepsis protocol
Correct Answer: B
Rationale: The client is in acute cardiogenic shock with hypoxemia (SpO2 89%) and
pulmonary edema (crackles, S3). The priority is oxygenation per the ABCs. Option A is
important but secondary to stabilizing oxygenation. Option C is incorrect because leg
elevation would worsen venous return and pulmonary congestion. Option D is
inappropriate as the shock is cardiogenic, not septic; fluids would worsen the condition.
Q2: A client with atrial fibrillation on warfarin therapy presents to the ED with a
nosebleed that has persisted for 20 minutes. The nurse notes an INR of 6.8. Which
intervention is the priority?
A. Apply firm pressure to the nares for 10 minutes
B. Administer vitamin K 10 mg IV per standing order
C. Prepare for immediate transfusion of fresh frozen plasma
D. Hold the next scheduled warfarin dose
,Correct Answer: B
Rationale: An INR of 6.8 represents life-threatening bleeding risk. Vitamin K is the
antidote for warfarin and must be given IV for rapid reversal. Option A is ineffective for
this severity. Option C is not first-line; vitamin K addresses the underlying coagulopathy.
Option D is insufficient alone given the active bleeding and critically elevated INR.
Q3: A nurse is monitoring a client 6 hours post-MI who is receiving alteplase infusion.
The client's BP suddenly increases from 130/80 to 198/110, and the nurse notes new
left-sided weakness. Which action is MOST appropriate?
A. Slow the alteplase infusion rate
B. Administer IV labetalol per hypertensive emergency protocol
C. Immediately stop the alteplase and notify the provider
D. Perform a 12-lead EKG to assess for re-infarction
Correct Answer: C
Rationale: New neurological deficits during thrombolytic therapy indicate intracranial
hemorrhage, the most catastrophic complication. The infusion must be stopped
immediately. Option A is unsafe; any thrombolytic increases bleeding risk. Option B is
secondary to stopping the alteplase. Option D is irrelevant to the neurological
emergency.
Q4: A client with sickle cell anemia is admitted with a vaso-occlusive crisis. The client
receives morphine 4 mg IV. Thirty minutes later, the client is drowsy with a respiratory
rate of 8/min and SpO2 91%. Which intervention is the priority?
A. Administer naloxone 0.4 mg IV per PRN order
B. Increase oxygen flow rate to maintain SpO2 >94%
C. Stimulate the client verbally and physically
D. Obtain a stat arterial blood gas
Correct Answer: A
Rationale: Respiratory depression (RR <10) is a life-threatening opioid side effect.
Naloxone is the opioid antagonist and must be administered immediately per standing
, orders. Option B is supportive but does not address the respiratory depression. Option C
is insufficient. Option D delays treatment of the primary problem.
Q5: A client with DVT is started on a heparin infusion. The aPTT result is 92 seconds
(control 30 seconds, therapeutic range 60-80 seconds). Which action should the nurse
take?
A. Continue the infusion as prescribed
B. Reduce the infusion rate by 50% and recheck aPTT in 6 hours
C. Stop the infusion and notify the provider immediately
D. Prepare to administer protamine sulfate
Correct Answer: B
Rationale: An aPTT of 92 seconds is supratherapeutic and increases bleeding risk. The
standard protocol is to reduce the rate by 50% for mild elevations and recheck. Option A
is unsafe. Option C is excessive; this level doesn't require complete discontinuation.
Option D is for severe heparin overdose (aPTT >150 seconds or active bleeding).
Q6: A nurse is assessing a client with severe anemia (Hgb 6.8 g/dL). Which finding
requires IMMEDIATE intervention?
A. Fatigue and pale conjunctiva
B. Syncopal episodes and dyspnea at rest
C. Pica and brittle nails
D. Mild tachycardia (HR 102)
Correct Answer: B
Rationale: Syncope and dyspnea at rest indicate inadequate tissue perfusion and
oxygenation from critically low hemoglobin, requiring immediate transfusion evaluation.
Options A, C, and D are expected findings but not emergent. The priority is addressing
life-threatening hypoxia and potential hemodynamic collapse.
Q7: A client in septic shock has received 3 liters of crystalloid but remains hypotensive
(MAP 55 mmHg). The provider orders norepinephrine infusion. Before initiating, which
assessment is MOST critical?
Questions with Verified Answers | 100% Correct |
Pass Guaranteed
SECTION 1: Cardiovascular & Hematological Disorders
Q1: A nurse is caring for a 68-year-old client admitted with acute decompensated heart
failure. The client's vital signs are: BP 88/62, HR 118, RR 26, and SpO2 89%.
Auscultation reveals bilateral crackles and a new S3 gallop. The nurse notes a 4 kg
weight gain since yesterday. Which action should the nurse take FIRST?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow oxygen therapy via non-rebreather mask
C. Place the client in a high-Fowler's position with legs elevated
D. Initiate dopamine infusion per sepsis protocol
Correct Answer: B
Rationale: The client is in acute cardiogenic shock with hypoxemia (SpO2 89%) and
pulmonary edema (crackles, S3). The priority is oxygenation per the ABCs. Option A is
important but secondary to stabilizing oxygenation. Option C is incorrect because leg
elevation would worsen venous return and pulmonary congestion. Option D is
inappropriate as the shock is cardiogenic, not septic; fluids would worsen the condition.
Q2: A client with atrial fibrillation on warfarin therapy presents to the ED with a
nosebleed that has persisted for 20 minutes. The nurse notes an INR of 6.8. Which
intervention is the priority?
A. Apply firm pressure to the nares for 10 minutes
B. Administer vitamin K 10 mg IV per standing order
C. Prepare for immediate transfusion of fresh frozen plasma
D. Hold the next scheduled warfarin dose
,Correct Answer: B
Rationale: An INR of 6.8 represents life-threatening bleeding risk. Vitamin K is the
antidote for warfarin and must be given IV for rapid reversal. Option A is ineffective for
this severity. Option C is not first-line; vitamin K addresses the underlying coagulopathy.
Option D is insufficient alone given the active bleeding and critically elevated INR.
Q3: A nurse is monitoring a client 6 hours post-MI who is receiving alteplase infusion.
The client's BP suddenly increases from 130/80 to 198/110, and the nurse notes new
left-sided weakness. Which action is MOST appropriate?
A. Slow the alteplase infusion rate
B. Administer IV labetalol per hypertensive emergency protocol
C. Immediately stop the alteplase and notify the provider
D. Perform a 12-lead EKG to assess for re-infarction
Correct Answer: C
Rationale: New neurological deficits during thrombolytic therapy indicate intracranial
hemorrhage, the most catastrophic complication. The infusion must be stopped
immediately. Option A is unsafe; any thrombolytic increases bleeding risk. Option B is
secondary to stopping the alteplase. Option D is irrelevant to the neurological
emergency.
Q4: A client with sickle cell anemia is admitted with a vaso-occlusive crisis. The client
receives morphine 4 mg IV. Thirty minutes later, the client is drowsy with a respiratory
rate of 8/min and SpO2 91%. Which intervention is the priority?
A. Administer naloxone 0.4 mg IV per PRN order
B. Increase oxygen flow rate to maintain SpO2 >94%
C. Stimulate the client verbally and physically
D. Obtain a stat arterial blood gas
Correct Answer: A
Rationale: Respiratory depression (RR <10) is a life-threatening opioid side effect.
Naloxone is the opioid antagonist and must be administered immediately per standing
, orders. Option B is supportive but does not address the respiratory depression. Option C
is insufficient. Option D delays treatment of the primary problem.
Q5: A client with DVT is started on a heparin infusion. The aPTT result is 92 seconds
(control 30 seconds, therapeutic range 60-80 seconds). Which action should the nurse
take?
A. Continue the infusion as prescribed
B. Reduce the infusion rate by 50% and recheck aPTT in 6 hours
C. Stop the infusion and notify the provider immediately
D. Prepare to administer protamine sulfate
Correct Answer: B
Rationale: An aPTT of 92 seconds is supratherapeutic and increases bleeding risk. The
standard protocol is to reduce the rate by 50% for mild elevations and recheck. Option A
is unsafe. Option C is excessive; this level doesn't require complete discontinuation.
Option D is for severe heparin overdose (aPTT >150 seconds or active bleeding).
Q6: A nurse is assessing a client with severe anemia (Hgb 6.8 g/dL). Which finding
requires IMMEDIATE intervention?
A. Fatigue and pale conjunctiva
B. Syncopal episodes and dyspnea at rest
C. Pica and brittle nails
D. Mild tachycardia (HR 102)
Correct Answer: B
Rationale: Syncope and dyspnea at rest indicate inadequate tissue perfusion and
oxygenation from critically low hemoglobin, requiring immediate transfusion evaluation.
Options A, C, and D are expected findings but not emergent. The priority is addressing
life-threatening hypoxia and potential hemodynamic collapse.
Q7: A client in septic shock has received 3 liters of crystalloid but remains hypotensive
(MAP 55 mmHg). The provider orders norepinephrine infusion. Before initiating, which
assessment is MOST critical?
