HESI RN Exit Exam Prep: Verified Questions,
Case Studies & NCLEX-RN Readiness with
Actual Complete 250+ Questions and Correct
Answers with Detailed Rationales Already
Graded A+ |2026/2027 Updated
Pass your 2026 HESI RN Exit Exam with this comprehensive prep guide. Features verified
questions across V1–V10, updated with Next Generation NCLEX (NGN) bowtie, trend,
and case study items. Each question includes a detailed rationale to build clinical
judgment and critical thinking skills. Ideal for students needing an 850+ score to predict
NCLEX-RN success. Covers Med-Surg, Peds, Maternity, Pharm, and Mental Health.
Download now for the ultimate exam day advantage!
,1. A client with a head injury has a respiratory rate of 10 breaths/min and a sluggish pupil
response. Which action is the priority?
A. Administer a PRN sedative for agitation.
B. Increase the head of the bed to 30 degrees.
C. Document the findings as expected for a head injury.
D. Perform a neurological assessment every 4 hours.
B. Increase the head of the bed to 30 degrees.
Rationale: Elevating the head of the bed promotes venous drainage and helps decrease
intracranial pressure (ICP), which is the priority in a head injury showing signs of decline
(bradypnea and sluggish pupils).
2. A nurse is preparing to administer digoxin to a client with heart failure. Which laboratory
value should the nurse review before administration?
A. Sodium level
B. Potassium level
C. Blood urea nitrogen (BUN)
D. Creatinine level
B. Potassium level.
Rationale: Hypokalemia increases the risk of digoxin toxicity. The nurse must check
potassium levels to ensure they are within the normal range before administration.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client’s oxygen saturation is 89%. What is the nurse's best
action?
A. Increase the oxygen flow rate to 4 L/min.
B. Encourage the client to perform pursed-lip breathing.
C. Change the nasal cannula to a non-rebreather mask.
D. Notify the healthcare provider immediately.
B. Encourage the client to perform pursed-lip breathing.
Rationale: An O2 sat of 88–92% is often normal/targeted for COPD. Pursed-lip breathing
helps keep airways open longer and releases trapped air. Increasing O2 too much can
suppress the hypoxic drive.
4. A nurse is teaching a client about the side effects of levothyroxine. Which symptom
should the client report immediately?
A. Weight gain of 1 pound in a week
B. Mild fatigue in the evening
C. Palpitations and chest pain
D. Dry, scaly skin
, C. Palpitations and chest pain.
Rationale: These are signs of hyperthyroidism or excessive dosing, which can lead to
cardiac stress. Weight gain or fatigue would indicate the dose is too low.
5. A client 2 hours postpartum has a fundus that is boggy and displaced to the right. What
is the nurse's first intervention?
A. Perform fundal massage.
B. Administer oxytocin as prescribed.
C. Assist the client to the bathroom to void.
D. Notify the healthcare provider.
C. Assist the client to the bathroom to void.
Rationale: A fundus displaced to the right usually indicates a full bladder, which prevents
the uterus from contracting. Emptying the bladder is the first step.
6. Which PPE should a nurse wear when entering a room for a client with active pulmonary
tuberculosis?
A. Surgical mask and gloves
B. N95 respirator and gown
C. N95 respirator only
D. Face shield and surgical mask
C. N95 respirator only.
Rationale: Airborne precautions for TB require an N95 respirator. Gowns and gloves are
only needed if there is a risk of contact with bodily fluids.
7. A nurse is caring for a client with a femur fracture who suddenly becomes restless and
develops petechiae on the chest. What should the nurse suspect?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Compartment syndrome
D. Hypovolemic shock
B. Fat embolism syndrome.
Rationale: Petechiae on the chest and restlessness following a long-bone fracture are
hallmark signs of a fat embolism, whereas pulmonary embolism typically lacks the
petechial rash.
8. A client is receiving a blood transfusion and begins to complain of low back pain and
chills. What is the nurse's priority action?
A. Slow the transfusion rate.
B. Stop the transfusion and disconnect the tubing.
C. Administer diphenhydramine.
, D. Re-check the client's identification band.
B. Stop the transfusion and disconnect the tubing.
Rationale: Low back pain and chills are signs of a hemolytic reaction. The transfusion
must be stopped immediately, and the line flushed with normal saline using new tubing.
9. A nurse is assessing a child with suspected epiglottitis. Which action is contraindicated?
A. Placing the child in a tripod position.
B. Assessing for a "barking" cough.
C. Visualizing the throat with a tongue blade.
D. Providing humidified oxygen.
C. Visualizing the throat with a tongue blade.
Rationale: This can cause a laryngospasm and total airway obstruction in a child with
epiglottitis.
10. A client with type 1 diabetes is found unconscious and clammy. What should the nurse
do first?
A. Administer 15g of oral glucose gel.
B. Administer glucagon IM or SQ.
C. Check the client’s blood glucose level.
D. Call the rapid response team.
B. Administer glucagon IM or SQ.
Rationale: If a client is unconscious, oral glucose is a choking hazard. Glucagon is the
priority for emergency treatment of severe hypoglycemia.
11. A nurse is reviewing lab results for a client on heparin. Which result requires immediate
notification of the provider?
A. aPTT of 65 seconds (Control: 30)
B. Platelet count of 90,000/mm³
C. INR of 1.2
D. Hemoglobin of 13 g/dL
B. Platelet count of 90,000/mm³.
Rationale: This indicates heparin-induced thrombocytopenia (HIT), a serious
complication that requires stopping the heparin immediately.
12. A client is scheduled for an MRI. Which finding in the client's history is a
contraindication?
A. Allergy to shellfish
B. History of claustrophobia
C. Presence of a cardiac pacemaker
D. Recent use of contrast dye
Case Studies & NCLEX-RN Readiness with
Actual Complete 250+ Questions and Correct
Answers with Detailed Rationales Already
Graded A+ |2026/2027 Updated
Pass your 2026 HESI RN Exit Exam with this comprehensive prep guide. Features verified
questions across V1–V10, updated with Next Generation NCLEX (NGN) bowtie, trend,
and case study items. Each question includes a detailed rationale to build clinical
judgment and critical thinking skills. Ideal for students needing an 850+ score to predict
NCLEX-RN success. Covers Med-Surg, Peds, Maternity, Pharm, and Mental Health.
Download now for the ultimate exam day advantage!
,1. A client with a head injury has a respiratory rate of 10 breaths/min and a sluggish pupil
response. Which action is the priority?
A. Administer a PRN sedative for agitation.
B. Increase the head of the bed to 30 degrees.
C. Document the findings as expected for a head injury.
D. Perform a neurological assessment every 4 hours.
B. Increase the head of the bed to 30 degrees.
Rationale: Elevating the head of the bed promotes venous drainage and helps decrease
intracranial pressure (ICP), which is the priority in a head injury showing signs of decline
(bradypnea and sluggish pupils).
2. A nurse is preparing to administer digoxin to a client with heart failure. Which laboratory
value should the nurse review before administration?
A. Sodium level
B. Potassium level
C. Blood urea nitrogen (BUN)
D. Creatinine level
B. Potassium level.
Rationale: Hypokalemia increases the risk of digoxin toxicity. The nurse must check
potassium levels to ensure they are within the normal range before administration.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client’s oxygen saturation is 89%. What is the nurse's best
action?
A. Increase the oxygen flow rate to 4 L/min.
B. Encourage the client to perform pursed-lip breathing.
C. Change the nasal cannula to a non-rebreather mask.
D. Notify the healthcare provider immediately.
B. Encourage the client to perform pursed-lip breathing.
Rationale: An O2 sat of 88–92% is often normal/targeted for COPD. Pursed-lip breathing
helps keep airways open longer and releases trapped air. Increasing O2 too much can
suppress the hypoxic drive.
4. A nurse is teaching a client about the side effects of levothyroxine. Which symptom
should the client report immediately?
A. Weight gain of 1 pound in a week
B. Mild fatigue in the evening
C. Palpitations and chest pain
D. Dry, scaly skin
, C. Palpitations and chest pain.
Rationale: These are signs of hyperthyroidism or excessive dosing, which can lead to
cardiac stress. Weight gain or fatigue would indicate the dose is too low.
5. A client 2 hours postpartum has a fundus that is boggy and displaced to the right. What
is the nurse's first intervention?
A. Perform fundal massage.
B. Administer oxytocin as prescribed.
C. Assist the client to the bathroom to void.
D. Notify the healthcare provider.
C. Assist the client to the bathroom to void.
Rationale: A fundus displaced to the right usually indicates a full bladder, which prevents
the uterus from contracting. Emptying the bladder is the first step.
6. Which PPE should a nurse wear when entering a room for a client with active pulmonary
tuberculosis?
A. Surgical mask and gloves
B. N95 respirator and gown
C. N95 respirator only
D. Face shield and surgical mask
C. N95 respirator only.
Rationale: Airborne precautions for TB require an N95 respirator. Gowns and gloves are
only needed if there is a risk of contact with bodily fluids.
7. A nurse is caring for a client with a femur fracture who suddenly becomes restless and
develops petechiae on the chest. What should the nurse suspect?
A. Pulmonary embolism
B. Fat embolism syndrome
C. Compartment syndrome
D. Hypovolemic shock
B. Fat embolism syndrome.
Rationale: Petechiae on the chest and restlessness following a long-bone fracture are
hallmark signs of a fat embolism, whereas pulmonary embolism typically lacks the
petechial rash.
8. A client is receiving a blood transfusion and begins to complain of low back pain and
chills. What is the nurse's priority action?
A. Slow the transfusion rate.
B. Stop the transfusion and disconnect the tubing.
C. Administer diphenhydramine.
, D. Re-check the client's identification band.
B. Stop the transfusion and disconnect the tubing.
Rationale: Low back pain and chills are signs of a hemolytic reaction. The transfusion
must be stopped immediately, and the line flushed with normal saline using new tubing.
9. A nurse is assessing a child with suspected epiglottitis. Which action is contraindicated?
A. Placing the child in a tripod position.
B. Assessing for a "barking" cough.
C. Visualizing the throat with a tongue blade.
D. Providing humidified oxygen.
C. Visualizing the throat with a tongue blade.
Rationale: This can cause a laryngospasm and total airway obstruction in a child with
epiglottitis.
10. A client with type 1 diabetes is found unconscious and clammy. What should the nurse
do first?
A. Administer 15g of oral glucose gel.
B. Administer glucagon IM or SQ.
C. Check the client’s blood glucose level.
D. Call the rapid response team.
B. Administer glucagon IM or SQ.
Rationale: If a client is unconscious, oral glucose is a choking hazard. Glucagon is the
priority for emergency treatment of severe hypoglycemia.
11. A nurse is reviewing lab results for a client on heparin. Which result requires immediate
notification of the provider?
A. aPTT of 65 seconds (Control: 30)
B. Platelet count of 90,000/mm³
C. INR of 1.2
D. Hemoglobin of 13 g/dL
B. Platelet count of 90,000/mm³.
Rationale: This indicates heparin-induced thrombocytopenia (HIT), a serious
complication that requires stopping the heparin immediately.
12. A client is scheduled for an MRI. Which finding in the client's history is a
contraindication?
A. Allergy to shellfish
B. History of claustrophobia
C. Presence of a cardiac pacemaker
D. Recent use of contrast dye
