HESI RN 2026 EXIT EXAM ACTUAL EXAM AND CORRECT ANSWERS |
GRADED A+
Question 1.
NGN: Nurses Notes, saturation is low. Noted cyanosis in the clients lips. Healthcare provider made aware.
1310: pain rating on a pain scale of 0 to 10. Temperature elevation noted. The client is anxious and using
accessory muscles to breathe. Alerted the surgeon about the client status. New orders noted. What does
the nurse need to document at 1330? SATA
A) Urine output.
B) Respiratory rate.
C) Blood pressure.
D) Pain.
E) Temperature.
F) Flow rate of oxygen.
G) Oxygen saturation.
CORRECT ANSWERS: B) Respiratory rate, C) Blood pressure, D) Pain, E) Temperature, G) Oxygen
saturation.
Question 2.
NGN: Match the activity with the most appropriate person to do the activity.
- Provide mouth care.
- Document changes in respiratory status.
- Set up the oxygen administration system.
- Change the gauze under the nasal cannula.
CORRECT ANSWERS: Provide mouth care - UAP. Document changes in respiratory status - RN/RT. Set
up the oxygen administration system - RN/RT. Change the gauze under the nasal cannula - UAP.
Question 3.
A client experiencing an acute dystonic reaction presents with a laryngeal spasm. Which treatment should the
nurse prepare?
A) IV administration of benztropine.
B) IV administration of isotonic crystalloid fluid.
C) PO administration of lorazepam.
D) PO administration of divalproex.
CORRECT ANSWER: A) IV administration of benztropine.
Question 4.
A client with heart failure becomes short of breath, anxious, and has audible wheezing with pink frothy sputum.
The nurse sits the client upright and provides oxygen per nasal cannula. The nurse receives a prescription to
administer a one-time dose of morphine sulfate IV. Which action should the nurse take?
,A) Administer the dose of morphine sulfate as prescribed.
B) Consult with the charge nurse regarding the morphine prescription.
C) Review the need for the prescription with the healthcare provider.
D) Withhold the morphine until the clients dyspnea resolves.
CORRECT ANSWER: A) Administer the dose of morphine sulfate as prescribed.
Question 5.
A client with acute asthma exacerbation is manifesting inspiratory and expiratory wheezes and a decreased
forced expiratory volume. Which prescribed drug class should the nurse administer first to the client?
A) Inhaled short acting beta two agonists.
B) Inhaled corticosteroids.
C) Anti-cholinergics.
D) Leukotriene modifiers.
CORRECT ANSWER: B) Inhaled corticosteroids.
Question 6.
The nurse enters a clients room to administer oral medications and finds an unlicensed assistive personnel
providing personal care to the client, whose condition has obviously deteriorated. The client is lying in a supine
position and is weak, pale, and diaphoretic. Which is the priority nursing action?
A) Determine why the UAP did not notify the nurse of the change in the clients condition.
B) Advised the UAP to stop providing care so the nurse can assess the clients condition.
C) Explain to the UAP that changes in a clients condition should be reported immediately.
D) Ask for UAP to position the client so the oral medications can be administered.
CORRECT ANSWER: B) Advised the UAP to stop providing care so the nurse can assess the clients
condition.
Question 7.
The client who was admitted yesterday with severe dehydration is reporting pain where a 24-gauge IV catheter
with 0.9% sodium chloride is infusing at a rate of 150 mL per hour. Which intervention should the nurse
implement first?
A) Discontinue the 24 gauge IV.
B) Establish a second IV site.
C) Stop the 0.9% sodium chloride infusion.
D) Assess the IV for blood return.
CORRECT ANSWER: C) Stop the 0.9% sodium chloride infusion.
Question 8.
Which client should the nurse assess frequently because of the risk for overflow incontinence?
,A) A client with hematuria and decreasing hemoglobin and hematocrit levels.
B) A client who has been fasting, with increased serum creatinine levels.
C) A client who is confused and frequently forgets to go to the bathroom.
D) A client who has a history of frequent urinary tract infections.
CORRECT ANSWER: C) A client who is confused and frequently forgets to go to the bathroom.
Question 9.
After a spider bite on the lower extremity, a client is admitted for treatment of an infection that is spreading up
the leg. Which admission assessment findings should the nurse report to the healthcare provider? SATA.
A) Location of the initial IV site.
B) Swollen lymph nodes in the groin.
C) Red blood cell count.
D) White blood cell count.
E) Core body temperature.
CORRECT ANSWERS: B) Swollen lymph nodes in the groin, D) White blood cell count, E) Core body
temperature.
Question 10.
A client develops urticaria on the trunk and neck shortly after a secondary infusion of penicillin is initiated. In
which order should the nurse implement these interventions?
Document reaction of the drug.
Contact the healthcare provider.
Assess vital signs.
Stop the infusion.
Initiate an adverse event report.
CORRECT ORDER: 1) Stop the infusion. 2) Assess vital signs. 3) Contact the healthcare provider. 4)
Initiate an adverse event report. 5) Document reaction to drug.
Question 11.
What nursing intervention is particularly indicated for the second stage of labor?
A) Assessing the fetal heart rate and patterns for signs of fetal distress.
B) Monitoring effects of oxytocin administration to help achieve cervical dilation.
C) Providing pain medication to increase the clients tolerance of labor pains.
D) Assisting the client to push effectively so that expulsion of the fetus can be achieved.
CORRECT ANSWER: D) Assisting the client to push effectively so that expulsion of the fetus can be
achieved.
Question 12.
, A client receives a prescription for acetaminophen 1000 mg PO every eight hours PRN for pain. The bottle is
labeled acetaminophen for oral suspension USP 500 mg per 15 mL. How many tablespoons should the nurse
administer with each dose? (Enter numerical value only.)
Note: 15 mL per tablespoon.
CORRECT ANSWER: 2 tablespoons.
Question 13.
The nurse is administering multiple prescribed vaccines to a toddler. Which strategy should the nurse prioritize
to reduce the duration of pain?
A) Supine positioning.
B) Verbal reassurance.
C) Simultaneous injections.
D) Physical soothing.
CORRECT ANSWER: C) Simultaneous injections.
Question 14.
NGN: Dean 30, admit to the medical floor, vital signs every four hours, regular diet, out of bed with assist.
Complete diagram with one condition, two actions, and two parameters.
Condition: ___________
Actions: ___________
CORRECT ANSWER: Condition: Malnutrition. Actions: Assess the client for a nutrition history,
encourage the client to drink.
Question 15.
When assessing a multigravida on the first postpartum day, the nurse finds a moderate amount of lochia rubra,
with the uterus firm, and three fingerbreadths above the umbilicus. Which action should the nurse implement
first?
A) Check for a distended bladder.
B) Review the hemoglobin to determine hemorrhage.
C) Increase IV infusion rate.
D) Massage the uterus to decrease atony.
CORRECT ANSWER: A) Check for a distended bladder.
Question 16.
A client who is receiving zidovudine reports the appearance of pinpoint, red, brown spots on the skin. Which
result should the nurse report to the healthcare provider?
GRADED A+
Question 1.
NGN: Nurses Notes, saturation is low. Noted cyanosis in the clients lips. Healthcare provider made aware.
1310: pain rating on a pain scale of 0 to 10. Temperature elevation noted. The client is anxious and using
accessory muscles to breathe. Alerted the surgeon about the client status. New orders noted. What does
the nurse need to document at 1330? SATA
A) Urine output.
B) Respiratory rate.
C) Blood pressure.
D) Pain.
E) Temperature.
F) Flow rate of oxygen.
G) Oxygen saturation.
CORRECT ANSWERS: B) Respiratory rate, C) Blood pressure, D) Pain, E) Temperature, G) Oxygen
saturation.
Question 2.
NGN: Match the activity with the most appropriate person to do the activity.
- Provide mouth care.
- Document changes in respiratory status.
- Set up the oxygen administration system.
- Change the gauze under the nasal cannula.
CORRECT ANSWERS: Provide mouth care - UAP. Document changes in respiratory status - RN/RT. Set
up the oxygen administration system - RN/RT. Change the gauze under the nasal cannula - UAP.
Question 3.
A client experiencing an acute dystonic reaction presents with a laryngeal spasm. Which treatment should the
nurse prepare?
A) IV administration of benztropine.
B) IV administration of isotonic crystalloid fluid.
C) PO administration of lorazepam.
D) PO administration of divalproex.
CORRECT ANSWER: A) IV administration of benztropine.
Question 4.
A client with heart failure becomes short of breath, anxious, and has audible wheezing with pink frothy sputum.
The nurse sits the client upright and provides oxygen per nasal cannula. The nurse receives a prescription to
administer a one-time dose of morphine sulfate IV. Which action should the nurse take?
,A) Administer the dose of morphine sulfate as prescribed.
B) Consult with the charge nurse regarding the morphine prescription.
C) Review the need for the prescription with the healthcare provider.
D) Withhold the morphine until the clients dyspnea resolves.
CORRECT ANSWER: A) Administer the dose of morphine sulfate as prescribed.
Question 5.
A client with acute asthma exacerbation is manifesting inspiratory and expiratory wheezes and a decreased
forced expiratory volume. Which prescribed drug class should the nurse administer first to the client?
A) Inhaled short acting beta two agonists.
B) Inhaled corticosteroids.
C) Anti-cholinergics.
D) Leukotriene modifiers.
CORRECT ANSWER: B) Inhaled corticosteroids.
Question 6.
The nurse enters a clients room to administer oral medications and finds an unlicensed assistive personnel
providing personal care to the client, whose condition has obviously deteriorated. The client is lying in a supine
position and is weak, pale, and diaphoretic. Which is the priority nursing action?
A) Determine why the UAP did not notify the nurse of the change in the clients condition.
B) Advised the UAP to stop providing care so the nurse can assess the clients condition.
C) Explain to the UAP that changes in a clients condition should be reported immediately.
D) Ask for UAP to position the client so the oral medications can be administered.
CORRECT ANSWER: B) Advised the UAP to stop providing care so the nurse can assess the clients
condition.
Question 7.
The client who was admitted yesterday with severe dehydration is reporting pain where a 24-gauge IV catheter
with 0.9% sodium chloride is infusing at a rate of 150 mL per hour. Which intervention should the nurse
implement first?
A) Discontinue the 24 gauge IV.
B) Establish a second IV site.
C) Stop the 0.9% sodium chloride infusion.
D) Assess the IV for blood return.
CORRECT ANSWER: C) Stop the 0.9% sodium chloride infusion.
Question 8.
Which client should the nurse assess frequently because of the risk for overflow incontinence?
,A) A client with hematuria and decreasing hemoglobin and hematocrit levels.
B) A client who has been fasting, with increased serum creatinine levels.
C) A client who is confused and frequently forgets to go to the bathroom.
D) A client who has a history of frequent urinary tract infections.
CORRECT ANSWER: C) A client who is confused and frequently forgets to go to the bathroom.
Question 9.
After a spider bite on the lower extremity, a client is admitted for treatment of an infection that is spreading up
the leg. Which admission assessment findings should the nurse report to the healthcare provider? SATA.
A) Location of the initial IV site.
B) Swollen lymph nodes in the groin.
C) Red blood cell count.
D) White blood cell count.
E) Core body temperature.
CORRECT ANSWERS: B) Swollen lymph nodes in the groin, D) White blood cell count, E) Core body
temperature.
Question 10.
A client develops urticaria on the trunk and neck shortly after a secondary infusion of penicillin is initiated. In
which order should the nurse implement these interventions?
Document reaction of the drug.
Contact the healthcare provider.
Assess vital signs.
Stop the infusion.
Initiate an adverse event report.
CORRECT ORDER: 1) Stop the infusion. 2) Assess vital signs. 3) Contact the healthcare provider. 4)
Initiate an adverse event report. 5) Document reaction to drug.
Question 11.
What nursing intervention is particularly indicated for the second stage of labor?
A) Assessing the fetal heart rate and patterns for signs of fetal distress.
B) Monitoring effects of oxytocin administration to help achieve cervical dilation.
C) Providing pain medication to increase the clients tolerance of labor pains.
D) Assisting the client to push effectively so that expulsion of the fetus can be achieved.
CORRECT ANSWER: D) Assisting the client to push effectively so that expulsion of the fetus can be
achieved.
Question 12.
, A client receives a prescription for acetaminophen 1000 mg PO every eight hours PRN for pain. The bottle is
labeled acetaminophen for oral suspension USP 500 mg per 15 mL. How many tablespoons should the nurse
administer with each dose? (Enter numerical value only.)
Note: 15 mL per tablespoon.
CORRECT ANSWER: 2 tablespoons.
Question 13.
The nurse is administering multiple prescribed vaccines to a toddler. Which strategy should the nurse prioritize
to reduce the duration of pain?
A) Supine positioning.
B) Verbal reassurance.
C) Simultaneous injections.
D) Physical soothing.
CORRECT ANSWER: C) Simultaneous injections.
Question 14.
NGN: Dean 30, admit to the medical floor, vital signs every four hours, regular diet, out of bed with assist.
Complete diagram with one condition, two actions, and two parameters.
Condition: ___________
Actions: ___________
CORRECT ANSWER: Condition: Malnutrition. Actions: Assess the client for a nutrition history,
encourage the client to drink.
Question 15.
When assessing a multigravida on the first postpartum day, the nurse finds a moderate amount of lochia rubra,
with the uterus firm, and three fingerbreadths above the umbilicus. Which action should the nurse implement
first?
A) Check for a distended bladder.
B) Review the hemoglobin to determine hemorrhage.
C) Increase IV infusion rate.
D) Massage the uterus to decrease atony.
CORRECT ANSWER: A) Check for a distended bladder.
Question 16.
A client who is receiving zidovudine reports the appearance of pinpoint, red, brown spots on the skin. Which
result should the nurse report to the healthcare provider?
