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HESI MILESTONE 2 NEWEST EXAM 2026 |
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALE |
RATED A+ | NEW AND REVISED
1. A patient with chronic heart failure presents with shortness of
breath and lower extremity edema. Which nursing assessment
finding is most concerning?
A. Bilateral ankle swelling
B. Mild fatigue with activity
C. Jugular vein distention with crackles in lungs
D. Mild weight gain over one week
Rationale: Jugular vein distention and pulmonary crackles indicate
worsening fluid overload, which is a sign of acute decompensation
requiring prompt intervention.
2. A nurse administers a new medication and the patient develops
urticaria and difficulty breathing. What is the first nursing action?
A. Document the reaction and continue monitoring
B. Stop the medication and call for emergency support
C. Notify the physician after the shift
D. Administer the next scheduled dose as prescribed
Rationale: Immediate intervention is required for a suspected
anaphylactic reaction to prevent airway compromise.
3. A client with type 1 diabetes asks about adjusting insulin during
illness. Which response is most appropriate?
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A. “Skip insulin if you are not eating.”
B. “Double your insulin dose until you feel better.”
C. “Continue your usual insulin schedule and monitor blood
glucose frequently.”
D. “Stop insulin and focus on fluids.”
Rationale: Illness can increase glucose levels; patients should
continue insulin and closely monitor glucose to prevent hyperglycemia
and ketoacidosis.
4. A patient on digoxin presents with nausea, vomiting, and a heart
rate of 48 bpm. What is the priority action?
A. Give the next scheduled dose
B. Encourage oral fluids
C. Hold the digoxin and notify the physician
D. Document findings only
Rationale: Bradycardia and gastrointestinal symptoms are classic
signs of digoxin toxicity; the medication should be held, and the
provider notified.
5. A nurse is planning care for a patient with a newly diagnosed
pulmonary embolism. Which intervention should be prioritized?
A. Encourage ambulation every 2 hours
B. Administer prescribed anticoagulants
C. Provide a high-carbohydrate diet
D. Teach relaxation techniques
Rationale: Anticoagulation is critical to prevent clot extension and
further embolic events.
6. A patient with chronic kidney disease is scheduled for dialysis.
The patient reports dizziness and fatigue before treatment. Which
action is most appropriate?
A. Proceed with dialysis as scheduled
B. Encourage oral intake and proceed
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C. Assess vital signs and notify the dialysis team
D. Administer antiemetics before dialysis
Rationale: Pre-dialysis hypotension or instability can increase risk for
adverse events; assessment and communication are essential.
7. A nurse is caring for a patient with COPD who has O2 saturation
of 88% on 2 L/min nasal cannula. What is the first action?
A. Increase O2 to 6 L/min
B. Place the patient in Trendelenburg position
C. Elevate the head of the bed and encourage pursed-lip
breathing
D. Call rapid response
Rationale: COPD patients are sensitive to oxygen; interventions that
improve ventilation without high-flow O2 are preferred first.
8. A nurse observes a new graduate preparing to administer a blood
transfusion. Which action requires intervention?
A. Verifying the patient’s identity with two nurses
B. Checking the blood type compatibility
C. Infusing blood using only a 25-gauge needle
D. Monitoring the patient for reaction during transfusion
Rationale: Blood should be administered through at least an 18–20
gauge IV to prevent hemolysis and ensure flow rate.
9. Which nursing intervention is priority for a patient with acute
pancreatitis?
A. Administer antibiotics as prescribed
B. Encourage high-protein diet
C. Manage pain and maintain NPO status
D. Encourage ambulation
Rationale: Acute pancreatitis requires bowel rest (NPO) and pain
management; infection is not primary initially.
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10. A patient with a chest tube reports sudden shortness of breath
and the drainage system is bubbling continuously. What is the
nurse’s best action?
A. Clamp the chest tube immediately
B. Assess the system for an air leak and notify the provider
C. Encourage deep breathing and coughing
D. Remove the chest tube
Rationale: Continuous bubbling may indicate an air leak; immediate
assessment is required without clamping, which can cause tension
pneumothorax.
11. A patient with hypertension is prescribed a new ACE
inhibitor. Which side effect should the nurse teach the patient to
report immediately?
A. Mild fatigue
B. Swelling of the lips or tongue
C. Occasional headache
D. Slight dizziness
Rationale: Angioedema is a life-threatening side effect of ACE
inhibitors and requires immediate attention.
12. A nurse is caring for a patient with suspected sepsis. Which
finding is most concerning?
A. Mild fever of 100°F
B. Heart rate 90 bpm
C. Blood pressure 82/50 mmHg
D. Slightly elevated WBC
Rationale: Hypotension indicates septic shock and requires urgent
intervention to prevent organ failure.
13. A patient with Parkinson’s disease is experiencing difficulty
swallowing. Which intervention is most appropriate?
A. Provide thin liquids only
HESI MILESTONE 2 NEWEST EXAM 2026 |
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALE |
RATED A+ | NEW AND REVISED
1. A patient with chronic heart failure presents with shortness of
breath and lower extremity edema. Which nursing assessment
finding is most concerning?
A. Bilateral ankle swelling
B. Mild fatigue with activity
C. Jugular vein distention with crackles in lungs
D. Mild weight gain over one week
Rationale: Jugular vein distention and pulmonary crackles indicate
worsening fluid overload, which is a sign of acute decompensation
requiring prompt intervention.
2. A nurse administers a new medication and the patient develops
urticaria and difficulty breathing. What is the first nursing action?
A. Document the reaction and continue monitoring
B. Stop the medication and call for emergency support
C. Notify the physician after the shift
D. Administer the next scheduled dose as prescribed
Rationale: Immediate intervention is required for a suspected
anaphylactic reaction to prevent airway compromise.
3. A client with type 1 diabetes asks about adjusting insulin during
illness. Which response is most appropriate?
,2|Page
A. “Skip insulin if you are not eating.”
B. “Double your insulin dose until you feel better.”
C. “Continue your usual insulin schedule and monitor blood
glucose frequently.”
D. “Stop insulin and focus on fluids.”
Rationale: Illness can increase glucose levels; patients should
continue insulin and closely monitor glucose to prevent hyperglycemia
and ketoacidosis.
4. A patient on digoxin presents with nausea, vomiting, and a heart
rate of 48 bpm. What is the priority action?
A. Give the next scheduled dose
B. Encourage oral fluids
C. Hold the digoxin and notify the physician
D. Document findings only
Rationale: Bradycardia and gastrointestinal symptoms are classic
signs of digoxin toxicity; the medication should be held, and the
provider notified.
5. A nurse is planning care for a patient with a newly diagnosed
pulmonary embolism. Which intervention should be prioritized?
A. Encourage ambulation every 2 hours
B. Administer prescribed anticoagulants
C. Provide a high-carbohydrate diet
D. Teach relaxation techniques
Rationale: Anticoagulation is critical to prevent clot extension and
further embolic events.
6. A patient with chronic kidney disease is scheduled for dialysis.
The patient reports dizziness and fatigue before treatment. Which
action is most appropriate?
A. Proceed with dialysis as scheduled
B. Encourage oral intake and proceed
,3|Page
C. Assess vital signs and notify the dialysis team
D. Administer antiemetics before dialysis
Rationale: Pre-dialysis hypotension or instability can increase risk for
adverse events; assessment and communication are essential.
7. A nurse is caring for a patient with COPD who has O2 saturation
of 88% on 2 L/min nasal cannula. What is the first action?
A. Increase O2 to 6 L/min
B. Place the patient in Trendelenburg position
C. Elevate the head of the bed and encourage pursed-lip
breathing
D. Call rapid response
Rationale: COPD patients are sensitive to oxygen; interventions that
improve ventilation without high-flow O2 are preferred first.
8. A nurse observes a new graduate preparing to administer a blood
transfusion. Which action requires intervention?
A. Verifying the patient’s identity with two nurses
B. Checking the blood type compatibility
C. Infusing blood using only a 25-gauge needle
D. Monitoring the patient for reaction during transfusion
Rationale: Blood should be administered through at least an 18–20
gauge IV to prevent hemolysis and ensure flow rate.
9. Which nursing intervention is priority for a patient with acute
pancreatitis?
A. Administer antibiotics as prescribed
B. Encourage high-protein diet
C. Manage pain and maintain NPO status
D. Encourage ambulation
Rationale: Acute pancreatitis requires bowel rest (NPO) and pain
management; infection is not primary initially.
, 4|Page
10. A patient with a chest tube reports sudden shortness of breath
and the drainage system is bubbling continuously. What is the
nurse’s best action?
A. Clamp the chest tube immediately
B. Assess the system for an air leak and notify the provider
C. Encourage deep breathing and coughing
D. Remove the chest tube
Rationale: Continuous bubbling may indicate an air leak; immediate
assessment is required without clamping, which can cause tension
pneumothorax.
11. A patient with hypertension is prescribed a new ACE
inhibitor. Which side effect should the nurse teach the patient to
report immediately?
A. Mild fatigue
B. Swelling of the lips or tongue
C. Occasional headache
D. Slight dizziness
Rationale: Angioedema is a life-threatening side effect of ACE
inhibitors and requires immediate attention.
12. A nurse is caring for a patient with suspected sepsis. Which
finding is most concerning?
A. Mild fever of 100°F
B. Heart rate 90 bpm
C. Blood pressure 82/50 mmHg
D. Slightly elevated WBC
Rationale: Hypotension indicates septic shock and requires urgent
intervention to prevent organ failure.
13. A patient with Parkinson’s disease is experiencing difficulty
swallowing. Which intervention is most appropriate?
A. Provide thin liquids only
