HESI RN Specialty Exam Review Exam Prep – Real Practice Questions,
Answers & Detailed Rationales (Updated 2026) | Medical-
Surgical Nursing, Pediatrics & Maternal Health, Pharmacology & Dosage
Calculations, Mental Health & Psychiatric Nursing, Critical Care &
Emergency Concepts, NCLEX-Style Clinical Judgment, Patient Safety,
Priority Interventions & HESI RN Specialty Success
Question 1: A nurse is preparing to insert an indwelling urinary catheter for a
female client. Which action by the nurse demonstrates proper sterile technique
during this procedure?
A. Placing the sterile drape on the client's thighs after donning sterile gloves
B. Cleansing the urinary meatus with a single downward stroke using a new antiseptic
swab for each stroke
C. Holding the catheter 2 inches from the tip while advancing it into the urethra
D. Inflating the balloon with 10 mL of sterile water before confirming urine return
CORRECT ANSWER: B. Cleansing the urinary meatus with a single downward stroke
using a new antiseptic swab for each stroke
Rationale: Proper perineal cleansing for female catheterization requires using a new
antiseptic swab for each stroke and cleansing from front to back (urethra toward anus)
to prevent introducing fecal bacteria into the urinary tract. Option A is incorrect because
the sterile drape should be placed before donning sterile gloves to maintain sterility.
Option C is incorrect because the catheter should be held 1-2 inches from the tip, but
the critical error is advancing without confirming placement. Option D is incorrect
because the balloon should only be inflated after urine return is confirmed to ensure the
catheter is in the bladder, preventing urethral trauma.
Question 2: A client with heart failure is prescribed furosemide 40 mg IV push. The
nurse knows that which assessment finding requires immediate intervention
before administering this medication?
A. Blood pressure 110/70 mm Hg
B. Serum potassium level 3.2 mEq/L
C. Urine output 40 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium level 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, and a serum
potassium level of 3.2 mEq/L indicates hypokalemia (normal range 3.5-5.0 mEq/L).
Administering furosemide without addressing hypokalemia could worsen electrolyte
imbalance, leading to cardiac arrhythmias. Option A is within normal limits for a heart
failure client on diuretics. Option C represents adequate urine output. Option D is
expected in heart failure and indicates the need for diuretic therapy, not a
contraindication.
,Question 3: During a newborn assessment, the nurse notes that the infant's hips
produce a clicking sound when abducted. Which action should the nurse take first?
A. Document the finding as a normal variant in newborns
B. Apply a Pavlik harness immediately
C. Notify the pediatric provider for further evaluation
D. Teach the parents about developmental dysplasia of the hip
CORRECT ANSWER: C. Notify the pediatric provider for further evaluation
Rationale: A clicking or clunking sound during hip abduction in a newborn may indicate
developmental dysplasia of the hip (DDH), which requires prompt orthopedic
evaluation. Early detection and intervention improve outcomes. Option A is incorrect
because while some hip instability can be normal, a distinct click warrants evaluation.
Option B is incorrect because application of a Pavlik harness requires a provider's order
after diagnosis. Option D is important but should occur after the provider has evaluated
the infant.
Question 4: A client diagnosed with schizophrenia is prescribed clozapine. Which
laboratory value requires the nurse to hold the medication and notify the provider?
A. White blood cell count 2,800/mm³
B. Hemoglobin 13 g/dL
C. Platelet count 250,000/mm³
D. Fasting glucose 95 mg/dL
CORRECT ANSWER: A. White blood cell count 2,800/mm³
Rationale: Clozapine carries a black box warning for agranulocytosis, a life-threatening
drop in white blood cells. A WBC count below 3,000/mm³ or absolute neutrophil count
below 1,500/mm³ requires immediate discontinuation and provider notification. Option
B is within normal limits for hemoglobin. Option C is a normal platelet count. Option D
is a normal fasting glucose level, though clozapine can cause hyperglycemia, this value
does not require holding the dose.
Question 5: The nurse is caring for a client with a chest tube connected to a water-
seal drainage system. Which observation indicates that the system is functioning
properly?
A. Continuous bubbling in the water-seal chamber
B. Tidaling in the water-seal chamber that corresponds with respiration
C. Drainage of 200 mL of bright red blood in the first hour
D. The suction control chamber has no bubbling
CORRECT ANSWER: B. Tidaling in the water-seal chamber that corresponds with
respiration
Rationale: Tidaling (fluctuation of fluid level) in the water-seal chamber with inspiration
and expiration indicates that the chest tube is patent and the system is functioning
,correctly. Option A is incorrect because continuous bubbling in the water-seal chamber
indicates an air leak. Option C may indicate hemorrhage and requires provider
notification. Option D is incorrect because gentle continuous bubbling in the suction
control chamber is expected when suction is applied.
Question 6: A client with type 1 diabetes mellitus is experiencing symptoms of
hypoglycemia. Which action should the nurse instruct the client to take first?
A. Administer 1 mg glucagon intramuscularly
B. Consume 15 grams of fast-acting carbohydrate
C. Recheck blood glucose in 15 minutes
D. Eat a snack containing protein and complex carbohydrates
CORRECT ANSWER: B. Consume 15 grams of fast-acting carbohydrate
Rationale: The first-line treatment for conscious clients with hypoglycemia is the "15-15
rule": consume 15 grams of fast-acting carbohydrate (e.g., 4 oz fruit juice, glucose
tablets) and recheck blood glucose in 15 minutes. Option A is reserved for unconscious
clients or those unable to swallow. Option C occurs after administering carbohydrate.
Option D is appropriate after blood glucose stabilizes to prevent recurrence but is not
the initial action.
Question 7: The nurse is assessing a client who is 2 hours postpartum. Which
finding requires immediate intervention?
A. Fundus firm at the umbilicus
B. Lochia rubra moderate in amount
C. Perineal pad saturated with blood in 15 minutes
D. Temperature 99.8°F (37.7°C)
CORRECT ANSWER: C. Perineal pad saturated with blood in 15 minutes
Rationale: Saturating a perineal pad with blood in 15 minutes or less indicates excessive
postpartum bleeding (hemorrhage), which is a medical emergency requiring immediate
intervention to prevent hypovolemic shock. Option A is an expected finding; the fundus
should be firm and at the umbilicus immediately postpartum. Option B describes
normal lochia in the immediate postpartum period. Option D is a mild temperature
elevation that can occur due to dehydration but is not immediately concerning.
Question 8: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen via nasal cannula at 2 L/min. The nurse understands that
increasing the oxygen flow rate could cause which complication?
A. Oxygen toxicity
B. Absorption atelectasis
C. Suppression of the hypoxic drive
D. Carbon monoxide poisoning
CORRECT ANSWER: C. Suppression of the hypoxic drive
, Rationale: Clients with chronic COPD may rely on hypoxic drive (low oxygen levels)
rather than hypercapnic drive (high CO2 levels) to stimulate breathing. Administering
high concentrations of oxygen can suppress this hypoxic drive, leading to respiratory
depression and CO2 retention. Option A is more common with prolonged high-flow
oxygen (>50%) but is not the primary concern in COPD. Option B occurs with high FiO2
but is less specific to COPD. Option D is unrelated to oxygen therapy.
Question 9: The nurse is preparing to administer digoxin 0.125 mg orally to a client
with heart failure. Which assessment finding should prompt the nurse to hold the
dose?
A. Apical pulse 58 beats per minute
B. Blood pressure 138/86 mm Hg
C. Serum sodium 138 mEq/L
D. Potassium level 4.0 mEq/L
CORRECT ANSWER: A. Apical pulse 58 beats per minute
Rationale: Digoxin should be held if the apical pulse is below 60 beats per minute in
adults due to the risk of bradycardia and heart block. The nurse must assess the apical
pulse for a full minute before administration. Option B is within acceptable limits for a
heart failure client. Options C and D are within normal electrolyte ranges; hypokalemia
increases digoxin toxicity risk, but 4.0 mEq/L is normal.
Question 10: A client is scheduled for a colonoscopy. Which instruction should the
nurse include in the pre-procedure teaching?
A. "You may take your morning medications with a small sip of water."
B. "You will need to arrange for someone to drive you home after the procedure."
C. "You can resume your regular diet immediately after the procedure."
D. "You should expect to pass bright red blood for 24 hours post-procedure."
CORRECT ANSWER: B. "You will need to arrange for someone to drive you home
after the procedure."
Rationale: Sedation is typically used during colonoscopy, impairing judgment and
reflexes for several hours; therefore, clients must have a responsible adult to drive them
home. Option A may be incorrect depending on facility policy and medication type (e.g.,
anticoagulants often held). Option C is incorrect; clients start with clear liquids and
advance diet as tolerated. Option D is incorrect; while minor bleeding can occur, bright
red blood for 24 hours is not expected and should be reported.
Question 11: The nurse is caring for a client with a traumatic brain injury. Which
assessment finding indicates increasing intracranial pressure?
A. Pupils equal and reactive to light
B. Glasgow Coma Scale score decreasing from 14 to 10
C. Blood pressure 118/76 mm Hg
D. Respiratory rate 16 breaths per minute
Answers & Detailed Rationales (Updated 2026) | Medical-
Surgical Nursing, Pediatrics & Maternal Health, Pharmacology & Dosage
Calculations, Mental Health & Psychiatric Nursing, Critical Care &
Emergency Concepts, NCLEX-Style Clinical Judgment, Patient Safety,
Priority Interventions & HESI RN Specialty Success
Question 1: A nurse is preparing to insert an indwelling urinary catheter for a
female client. Which action by the nurse demonstrates proper sterile technique
during this procedure?
A. Placing the sterile drape on the client's thighs after donning sterile gloves
B. Cleansing the urinary meatus with a single downward stroke using a new antiseptic
swab for each stroke
C. Holding the catheter 2 inches from the tip while advancing it into the urethra
D. Inflating the balloon with 10 mL of sterile water before confirming urine return
CORRECT ANSWER: B. Cleansing the urinary meatus with a single downward stroke
using a new antiseptic swab for each stroke
Rationale: Proper perineal cleansing for female catheterization requires using a new
antiseptic swab for each stroke and cleansing from front to back (urethra toward anus)
to prevent introducing fecal bacteria into the urinary tract. Option A is incorrect because
the sterile drape should be placed before donning sterile gloves to maintain sterility.
Option C is incorrect because the catheter should be held 1-2 inches from the tip, but
the critical error is advancing without confirming placement. Option D is incorrect
because the balloon should only be inflated after urine return is confirmed to ensure the
catheter is in the bladder, preventing urethral trauma.
Question 2: A client with heart failure is prescribed furosemide 40 mg IV push. The
nurse knows that which assessment finding requires immediate intervention
before administering this medication?
A. Blood pressure 110/70 mm Hg
B. Serum potassium level 3.2 mEq/L
C. Urine output 40 mL/hr
D. Weight gain of 1 kg in 24 hours
CORRECT ANSWER: B. Serum potassium level 3.2 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium excretion, and a serum
potassium level of 3.2 mEq/L indicates hypokalemia (normal range 3.5-5.0 mEq/L).
Administering furosemide without addressing hypokalemia could worsen electrolyte
imbalance, leading to cardiac arrhythmias. Option A is within normal limits for a heart
failure client on diuretics. Option C represents adequate urine output. Option D is
expected in heart failure and indicates the need for diuretic therapy, not a
contraindication.
,Question 3: During a newborn assessment, the nurse notes that the infant's hips
produce a clicking sound when abducted. Which action should the nurse take first?
A. Document the finding as a normal variant in newborns
B. Apply a Pavlik harness immediately
C. Notify the pediatric provider for further evaluation
D. Teach the parents about developmental dysplasia of the hip
CORRECT ANSWER: C. Notify the pediatric provider for further evaluation
Rationale: A clicking or clunking sound during hip abduction in a newborn may indicate
developmental dysplasia of the hip (DDH), which requires prompt orthopedic
evaluation. Early detection and intervention improve outcomes. Option A is incorrect
because while some hip instability can be normal, a distinct click warrants evaluation.
Option B is incorrect because application of a Pavlik harness requires a provider's order
after diagnosis. Option D is important but should occur after the provider has evaluated
the infant.
Question 4: A client diagnosed with schizophrenia is prescribed clozapine. Which
laboratory value requires the nurse to hold the medication and notify the provider?
A. White blood cell count 2,800/mm³
B. Hemoglobin 13 g/dL
C. Platelet count 250,000/mm³
D. Fasting glucose 95 mg/dL
CORRECT ANSWER: A. White blood cell count 2,800/mm³
Rationale: Clozapine carries a black box warning for agranulocytosis, a life-threatening
drop in white blood cells. A WBC count below 3,000/mm³ or absolute neutrophil count
below 1,500/mm³ requires immediate discontinuation and provider notification. Option
B is within normal limits for hemoglobin. Option C is a normal platelet count. Option D
is a normal fasting glucose level, though clozapine can cause hyperglycemia, this value
does not require holding the dose.
Question 5: The nurse is caring for a client with a chest tube connected to a water-
seal drainage system. Which observation indicates that the system is functioning
properly?
A. Continuous bubbling in the water-seal chamber
B. Tidaling in the water-seal chamber that corresponds with respiration
C. Drainage of 200 mL of bright red blood in the first hour
D. The suction control chamber has no bubbling
CORRECT ANSWER: B. Tidaling in the water-seal chamber that corresponds with
respiration
Rationale: Tidaling (fluctuation of fluid level) in the water-seal chamber with inspiration
and expiration indicates that the chest tube is patent and the system is functioning
,correctly. Option A is incorrect because continuous bubbling in the water-seal chamber
indicates an air leak. Option C may indicate hemorrhage and requires provider
notification. Option D is incorrect because gentle continuous bubbling in the suction
control chamber is expected when suction is applied.
Question 6: A client with type 1 diabetes mellitus is experiencing symptoms of
hypoglycemia. Which action should the nurse instruct the client to take first?
A. Administer 1 mg glucagon intramuscularly
B. Consume 15 grams of fast-acting carbohydrate
C. Recheck blood glucose in 15 minutes
D. Eat a snack containing protein and complex carbohydrates
CORRECT ANSWER: B. Consume 15 grams of fast-acting carbohydrate
Rationale: The first-line treatment for conscious clients with hypoglycemia is the "15-15
rule": consume 15 grams of fast-acting carbohydrate (e.g., 4 oz fruit juice, glucose
tablets) and recheck blood glucose in 15 minutes. Option A is reserved for unconscious
clients or those unable to swallow. Option C occurs after administering carbohydrate.
Option D is appropriate after blood glucose stabilizes to prevent recurrence but is not
the initial action.
Question 7: The nurse is assessing a client who is 2 hours postpartum. Which
finding requires immediate intervention?
A. Fundus firm at the umbilicus
B. Lochia rubra moderate in amount
C. Perineal pad saturated with blood in 15 minutes
D. Temperature 99.8°F (37.7°C)
CORRECT ANSWER: C. Perineal pad saturated with blood in 15 minutes
Rationale: Saturating a perineal pad with blood in 15 minutes or less indicates excessive
postpartum bleeding (hemorrhage), which is a medical emergency requiring immediate
intervention to prevent hypovolemic shock. Option A is an expected finding; the fundus
should be firm and at the umbilicus immediately postpartum. Option B describes
normal lochia in the immediate postpartum period. Option D is a mild temperature
elevation that can occur due to dehydration but is not immediately concerning.
Question 8: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen via nasal cannula at 2 L/min. The nurse understands that
increasing the oxygen flow rate could cause which complication?
A. Oxygen toxicity
B. Absorption atelectasis
C. Suppression of the hypoxic drive
D. Carbon monoxide poisoning
CORRECT ANSWER: C. Suppression of the hypoxic drive
, Rationale: Clients with chronic COPD may rely on hypoxic drive (low oxygen levels)
rather than hypercapnic drive (high CO2 levels) to stimulate breathing. Administering
high concentrations of oxygen can suppress this hypoxic drive, leading to respiratory
depression and CO2 retention. Option A is more common with prolonged high-flow
oxygen (>50%) but is not the primary concern in COPD. Option B occurs with high FiO2
but is less specific to COPD. Option D is unrelated to oxygen therapy.
Question 9: The nurse is preparing to administer digoxin 0.125 mg orally to a client
with heart failure. Which assessment finding should prompt the nurse to hold the
dose?
A. Apical pulse 58 beats per minute
B. Blood pressure 138/86 mm Hg
C. Serum sodium 138 mEq/L
D. Potassium level 4.0 mEq/L
CORRECT ANSWER: A. Apical pulse 58 beats per minute
Rationale: Digoxin should be held if the apical pulse is below 60 beats per minute in
adults due to the risk of bradycardia and heart block. The nurse must assess the apical
pulse for a full minute before administration. Option B is within acceptable limits for a
heart failure client. Options C and D are within normal electrolyte ranges; hypokalemia
increases digoxin toxicity risk, but 4.0 mEq/L is normal.
Question 10: A client is scheduled for a colonoscopy. Which instruction should the
nurse include in the pre-procedure teaching?
A. "You may take your morning medications with a small sip of water."
B. "You will need to arrange for someone to drive you home after the procedure."
C. "You can resume your regular diet immediately after the procedure."
D. "You should expect to pass bright red blood for 24 hours post-procedure."
CORRECT ANSWER: B. "You will need to arrange for someone to drive you home
after the procedure."
Rationale: Sedation is typically used during colonoscopy, impairing judgment and
reflexes for several hours; therefore, clients must have a responsible adult to drive them
home. Option A may be incorrect depending on facility policy and medication type (e.g.,
anticoagulants often held). Option C is incorrect; clients start with clear liquids and
advance diet as tolerated. Option D is incorrect; while minor bleeding can occur, bright
red blood for 24 hours is not expected and should be reported.
Question 11: The nurse is caring for a client with a traumatic brain injury. Which
assessment finding indicates increasing intracranial pressure?
A. Pupils equal and reactive to light
B. Glasgow Coma Scale score decreasing from 14 to 10
C. Blood pressure 118/76 mm Hg
D. Respiratory rate 16 breaths per minute
