HESI Midpoint V1 Style Exam 2026 – 180 Questions
with Answers & Rationale
1. A nurse is assessing a client with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the
nurse take first?
A. Administer oxygen via non-rebreather mask.
B. Place the client in high Fowler’s position.
C. Notify the healthcare provider.
D. Check pulse oximetry.
✅ Correct Answer: B
Rationale: High Fowler’s position reduces venous return and promotes lung
expansion, improving oxygenation. This is the priority before applying
oxygen or calling the provider.
2. A client is prescribed digoxin 0.25 mg PO daily. The available tablets are
0.125 mg each. How many tablets should the nurse administer?
A. 0.5 tablet
B. 1 tablet
C. 2 tablets
D. 3 tablets
✅ Correct Answer: C (2 tablets)
*Rationale: 0.25 mg / 0.125 mg per tablet = 2 tablets.*
3. A nurse is teaching a client with type 2 diabetes about metformin. Which
statement indicates understanding?
A. “I should take this medication when I feel my blood sugar is high.”
B. “I will notify my doctor if I have muscle pain or tiredness.”
,C. “Metformin can cause weight gain and increased appetite.”
D. “I should take metformin only on days I eat a heavy meal.”
✅ Correct Answer: B
Rationale: Muscle pain/tiredness may indicate lactic acidosis, a rare but
serious metformin side effect requiring provider notification.
4. A client post-MI is receiving heparin infusion. Which lab value requires
immediate action?
A. aPTT 65 seconds
B. Platelets 80,000/mm³
C. Hemoglobin 13 g/dL
D. INR 1.2
✅ Correct Answer: B
*Rationale: Platelets <100,000 or >50% drop from baseline suggests heparin-
induced thrombocytopenia (HIT), a medical emergency.*
5. A nurse is caring for a client with an indwelling urinary catheter. Which
action best prevents infection?
A. Empty the drainage bag every 24 hours.
B. Keep the drainage bag on the client’s lap during transport.
C. Ensure the tubing is free of kinks and below bladder level.
D. Vigorously clean the meatus with antiseptic twice daily.
✅ Correct Answer: C
Rationale: Maintaining unobstructed urine flow prevents stasis and
infection. Routine vigorous cleaning is not recommended and can irritate.
6. A toddler is prescribed amoxicillin 40 mg/kg/day divided every 8 hours.
The child weighs 22 lbs (10 kg). What is the single dose?
,A. 133 mg
B. 200 mg
C. 400 mg
D. 1333 mg
✅ Correct Answer: A (133 mg)
*Rationale: 40 mg/kg/day × 10 kg = 400 mg/day ÷ 3 doses = 133 mg/dose.*
7. A nurse is preparing to insert a nasogastric tube. In which position should
the client be placed?
A. Supine with head flat
B. Left lateral with neck extended
C. High Fowler’s with head tilted forward
D. Trendelenburg
✅ Correct Answer: C
Rationale: High Fowler’s with head tilted forward closes the trachea and
opens the esophagus, facilitating passage into the stomach.
8. A client with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG change is expected?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged QT interval
✅ Correct Answer: C
Rationale: Hyperkalemia causes tall, peaked T waves. Flat T waves and U
waves occur with hypokalemia.
9. A nurse is educating a pregnant client about group B streptococcus (GBS)
screening. When is this test typically performed?
, A. 10–14 weeks gestation
B. 24–28 weeks gestation
C. 35–37 weeks gestation
D. At the onset of labor
✅ Correct Answer: C
Rationale: GBS screening is done at 35–37 weeks to guide intrapartum
antibiotic prophylaxis.
10. A client on a mechanical ventilator has an endotracheal tube cuff
pressure of 38 cm H₂O. What is the priority action?
A. Document the finding as normal.
B. Add more air to the cuff.
C. Deflate the cuff to 20–30 cm H₂O.
D. Suction the airway immediately.
✅ Correct Answer: C
Rationale: Normal cuff pressure is 20–30 cm H₂O. >30 increases risk of
tracheal necrosis.
11. A nurse is assessing a client’s IV site and notes warmth, redness, and a
palpable cord along the vein. What is the most likely complication?
A. Infiltration
B. Phlebitis
C. Extravasation
D. Air embolism
✅ Correct Answer: B
Rationale: Redness, warmth, and a palpable venous cord indicate phlebitis
(vein inflammation).
12. A client is receiving furosemide 40 mg IV push. Which finding indicates a
therapeutic effect?
with Answers & Rationale
1. A nurse is assessing a client with heart failure who reports sudden onset of
dyspnea and coughing up pink, frothy sputum. Which action should the
nurse take first?
A. Administer oxygen via non-rebreather mask.
B. Place the client in high Fowler’s position.
C. Notify the healthcare provider.
D. Check pulse oximetry.
✅ Correct Answer: B
Rationale: High Fowler’s position reduces venous return and promotes lung
expansion, improving oxygenation. This is the priority before applying
oxygen or calling the provider.
2. A client is prescribed digoxin 0.25 mg PO daily. The available tablets are
0.125 mg each. How many tablets should the nurse administer?
A. 0.5 tablet
B. 1 tablet
C. 2 tablets
D. 3 tablets
✅ Correct Answer: C (2 tablets)
*Rationale: 0.25 mg / 0.125 mg per tablet = 2 tablets.*
3. A nurse is teaching a client with type 2 diabetes about metformin. Which
statement indicates understanding?
A. “I should take this medication when I feel my blood sugar is high.”
B. “I will notify my doctor if I have muscle pain or tiredness.”
,C. “Metformin can cause weight gain and increased appetite.”
D. “I should take metformin only on days I eat a heavy meal.”
✅ Correct Answer: B
Rationale: Muscle pain/tiredness may indicate lactic acidosis, a rare but
serious metformin side effect requiring provider notification.
4. A client post-MI is receiving heparin infusion. Which lab value requires
immediate action?
A. aPTT 65 seconds
B. Platelets 80,000/mm³
C. Hemoglobin 13 g/dL
D. INR 1.2
✅ Correct Answer: B
*Rationale: Platelets <100,000 or >50% drop from baseline suggests heparin-
induced thrombocytopenia (HIT), a medical emergency.*
5. A nurse is caring for a client with an indwelling urinary catheter. Which
action best prevents infection?
A. Empty the drainage bag every 24 hours.
B. Keep the drainage bag on the client’s lap during transport.
C. Ensure the tubing is free of kinks and below bladder level.
D. Vigorously clean the meatus with antiseptic twice daily.
✅ Correct Answer: C
Rationale: Maintaining unobstructed urine flow prevents stasis and
infection. Routine vigorous cleaning is not recommended and can irritate.
6. A toddler is prescribed amoxicillin 40 mg/kg/day divided every 8 hours.
The child weighs 22 lbs (10 kg). What is the single dose?
,A. 133 mg
B. 200 mg
C. 400 mg
D. 1333 mg
✅ Correct Answer: A (133 mg)
*Rationale: 40 mg/kg/day × 10 kg = 400 mg/day ÷ 3 doses = 133 mg/dose.*
7. A nurse is preparing to insert a nasogastric tube. In which position should
the client be placed?
A. Supine with head flat
B. Left lateral with neck extended
C. High Fowler’s with head tilted forward
D. Trendelenburg
✅ Correct Answer: C
Rationale: High Fowler’s with head tilted forward closes the trachea and
opens the esophagus, facilitating passage into the stomach.
8. A client with chronic kidney disease has a potassium level of 6.8 mEq/L.
Which ECG change is expected?
A. Flattened T waves
B. Prominent U waves
C. Peaked T waves
D. Prolonged QT interval
✅ Correct Answer: C
Rationale: Hyperkalemia causes tall, peaked T waves. Flat T waves and U
waves occur with hypokalemia.
9. A nurse is educating a pregnant client about group B streptococcus (GBS)
screening. When is this test typically performed?
, A. 10–14 weeks gestation
B. 24–28 weeks gestation
C. 35–37 weeks gestation
D. At the onset of labor
✅ Correct Answer: C
Rationale: GBS screening is done at 35–37 weeks to guide intrapartum
antibiotic prophylaxis.
10. A client on a mechanical ventilator has an endotracheal tube cuff
pressure of 38 cm H₂O. What is the priority action?
A. Document the finding as normal.
B. Add more air to the cuff.
C. Deflate the cuff to 20–30 cm H₂O.
D. Suction the airway immediately.
✅ Correct Answer: C
Rationale: Normal cuff pressure is 20–30 cm H₂O. >30 increases risk of
tracheal necrosis.
11. A nurse is assessing a client’s IV site and notes warmth, redness, and a
palpable cord along the vein. What is the most likely complication?
A. Infiltration
B. Phlebitis
C. Extravasation
D. Air embolism
✅ Correct Answer: B
Rationale: Redness, warmth, and a palpable venous cord indicate phlebitis
(vein inflammation).
12. A client is receiving furosemide 40 mg IV push. Which finding indicates a
therapeutic effect?
