, HESI RN EXIT EXAM | NGN NURSING QUESTIONS
PROVIDED WITH ANSWERS NOT LEAVING RATIONALES<
HESI NURSING EXIT EXAM >- 2025/2026 LATEST RELEASE-
1. The nurse is caring for a client admitted with acute exacerbation of heart failure. Which
assessment finding requires the nurse’s immediate intervention?
A. Productive cough with pink, frothy sputum
B. B-type natriuretic peptide (BNP) of 600 pg/mL
C. 2+ pitting edema in the lower extremities
D. Weight gain of 2 lbs over the past 3 days
**Correct Answer: A**
**Rationale:** Pink, frothy sputum is a classic sign of acute pulmonary edema, a life-
threatening complication of heart failure requiring immediate intervention (ABCs—
Airway/Breathing). BNP of 600, 2+ pitting edema, and a 2 lb weight gain are expected findings
in a heart failure exacerbation that require monitoring and treatment, but not immediate,
emergent intervention compared to pulmonary edema.
**2. [Multiple Response] The nurse is teaching a client newly prescribed warfarin. Which
statements by the client indicate the teaching has been effective? Select all that apply.**
A. "I will use a soft-bristled toothbrush."
B. "I can take ibuprofen for headaches."
C. "I will eat a consistent amount of green leafy vegetables."
D. "I should skip my dose if my INR is too low."
E. "I will notify my provider if I notice dark, tarry stools."
**Correct Answer: A, C, E**
**Rationale:** A soft-bristled toothbrush prevents gum bleeding (A). Consistent intake of
Vitamin K (green leafy vegetables) keeps INR stable; erratic intake causes fluctuations (C).
Dark, tarry stools indicate GI bleeding and must be reported (E). Ibuprofen (NSAIDs) increases
bleeding risk and should be avoided (B). The provider adjusts doses based on INR; the client
should not independently skip doses (D).
,**3. A client with a chest tube connected to a water-seal drainage system is admitted to the unit.
Which finding requires the nurse to intervene?**
A. Gentle bubbling in the suction control chamber
B. Tidaling in the water-seal chamber
C. Continuous bubbling in the water-seal chamber
D. Drainage of 50 mL in the first 2 hours
**Correct Answer: C**
**Rationale:** Continuous bubbling in the water-seal chamber indicates an air leak in the
system (e.g., loose connection or leak at the insertion site), which requires immediate
intervention. Gentle bubbling in the suction control chamber is expected when suction is applied.
Tidaling in the water-seal chamber indicates the system is patent and functioning. 50 mL of
drainage in 2 hours is a normal, expected finding.
**4. The nurse is assessing a client receiving a continuous heparin infusion. The morning aPTT
is 120 seconds (normal 30-40 seconds). Which action should the nurse take first?**
A. Notify the healthcare provider.
B. Assess the client for signs of bleeding.
C. Turn off the heparin infusion.
D. Administer protamine sulfate.
**Correct Answer: C**
**Rationale:** Using the Nursing Process and prioritization (Safety), the first action is to stop
the medication causing the harm. An aPTT of 120 is critically high, placing the client at severe
risk for hemorrhage. The nurse must turn off the infusion immediately, then assess for bleeding,
notify the provider, and await orders for an antidote (protamine sulfate).
**5. [Cloze/Drop-down] A client with diabetic ketoacidosis (DKA) is receiving IV regular
insulin and normal saline. The nurse monitors serum potassium closely because insulin causes a
shift of potassium from the (i) _____ to the (ii) _____, increasing the risk of (iii) _____.**
i: Extracellular fluid / Intracellular fluid
, ii: Intracellular fluid / Extracellular fluid
iii: Hypokalemia / Hyperkalemia
**Correct Answer:** i: Extracellular fluid; ii: Intracellular fluid; iii: Hypokalemia
**Rationale:** Insulin drives potassium *into* the cells (from extracellular to intracellular
fluid) alongside glucose. In DKA, total body potassium is already depleted (due to osmotic
diuresis), and as insulin is administered, serum potassium levels drop rapidly, posing a high risk
for life-threatening hypokalemia.
**6. A client is admitted with a suspected thoracic spinal cord injury at the T6 level. Which
assessment is the priority during the acute phase?**
A. Monitoring for neurogenic shock
B. Assessing for sensory deficits
C. Evaluating reflex bowel function
D. Monitoring for autonomic dysreflexia
**Correct Answer: A**
**Rationale:** In the acute phase immediately following a spinal cord injury above T6,
neurogenic shock (characterized by hypotension, bradycardia, and hypothermia) is a life-
threatening priority due to the loss of sympathetic nervous system tone. Autonomic dysreflexia
occurs later, typically after spinal shock has resolved, often triggered by noxious stimuli below
the injury.
**7. The charge nurse is making client assignments. Which client should be assigned to the most
experienced RN?**
A. A client 2 days post-appendectomy requiring discharge teaching.
B. A client with pneumonia requiring IV antibiotics and nebulizers.
C. A client with new-onset atrial fibrillation with a rapid ventricular response.
D. A client with chronic kidney disease scheduled for dialysis this afternoon.
**Correct Answer: C**
PROVIDED WITH ANSWERS NOT LEAVING RATIONALES<
HESI NURSING EXIT EXAM >- 2025/2026 LATEST RELEASE-
1. The nurse is caring for a client admitted with acute exacerbation of heart failure. Which
assessment finding requires the nurse’s immediate intervention?
A. Productive cough with pink, frothy sputum
B. B-type natriuretic peptide (BNP) of 600 pg/mL
C. 2+ pitting edema in the lower extremities
D. Weight gain of 2 lbs over the past 3 days
**Correct Answer: A**
**Rationale:** Pink, frothy sputum is a classic sign of acute pulmonary edema, a life-
threatening complication of heart failure requiring immediate intervention (ABCs—
Airway/Breathing). BNP of 600, 2+ pitting edema, and a 2 lb weight gain are expected findings
in a heart failure exacerbation that require monitoring and treatment, but not immediate,
emergent intervention compared to pulmonary edema.
**2. [Multiple Response] The nurse is teaching a client newly prescribed warfarin. Which
statements by the client indicate the teaching has been effective? Select all that apply.**
A. "I will use a soft-bristled toothbrush."
B. "I can take ibuprofen for headaches."
C. "I will eat a consistent amount of green leafy vegetables."
D. "I should skip my dose if my INR is too low."
E. "I will notify my provider if I notice dark, tarry stools."
**Correct Answer: A, C, E**
**Rationale:** A soft-bristled toothbrush prevents gum bleeding (A). Consistent intake of
Vitamin K (green leafy vegetables) keeps INR stable; erratic intake causes fluctuations (C).
Dark, tarry stools indicate GI bleeding and must be reported (E). Ibuprofen (NSAIDs) increases
bleeding risk and should be avoided (B). The provider adjusts doses based on INR; the client
should not independently skip doses (D).
,**3. A client with a chest tube connected to a water-seal drainage system is admitted to the unit.
Which finding requires the nurse to intervene?**
A. Gentle bubbling in the suction control chamber
B. Tidaling in the water-seal chamber
C. Continuous bubbling in the water-seal chamber
D. Drainage of 50 mL in the first 2 hours
**Correct Answer: C**
**Rationale:** Continuous bubbling in the water-seal chamber indicates an air leak in the
system (e.g., loose connection or leak at the insertion site), which requires immediate
intervention. Gentle bubbling in the suction control chamber is expected when suction is applied.
Tidaling in the water-seal chamber indicates the system is patent and functioning. 50 mL of
drainage in 2 hours is a normal, expected finding.
**4. The nurse is assessing a client receiving a continuous heparin infusion. The morning aPTT
is 120 seconds (normal 30-40 seconds). Which action should the nurse take first?**
A. Notify the healthcare provider.
B. Assess the client for signs of bleeding.
C. Turn off the heparin infusion.
D. Administer protamine sulfate.
**Correct Answer: C**
**Rationale:** Using the Nursing Process and prioritization (Safety), the first action is to stop
the medication causing the harm. An aPTT of 120 is critically high, placing the client at severe
risk for hemorrhage. The nurse must turn off the infusion immediately, then assess for bleeding,
notify the provider, and await orders for an antidote (protamine sulfate).
**5. [Cloze/Drop-down] A client with diabetic ketoacidosis (DKA) is receiving IV regular
insulin and normal saline. The nurse monitors serum potassium closely because insulin causes a
shift of potassium from the (i) _____ to the (ii) _____, increasing the risk of (iii) _____.**
i: Extracellular fluid / Intracellular fluid
, ii: Intracellular fluid / Extracellular fluid
iii: Hypokalemia / Hyperkalemia
**Correct Answer:** i: Extracellular fluid; ii: Intracellular fluid; iii: Hypokalemia
**Rationale:** Insulin drives potassium *into* the cells (from extracellular to intracellular
fluid) alongside glucose. In DKA, total body potassium is already depleted (due to osmotic
diuresis), and as insulin is administered, serum potassium levels drop rapidly, posing a high risk
for life-threatening hypokalemia.
**6. A client is admitted with a suspected thoracic spinal cord injury at the T6 level. Which
assessment is the priority during the acute phase?**
A. Monitoring for neurogenic shock
B. Assessing for sensory deficits
C. Evaluating reflex bowel function
D. Monitoring for autonomic dysreflexia
**Correct Answer: A**
**Rationale:** In the acute phase immediately following a spinal cord injury above T6,
neurogenic shock (characterized by hypotension, bradycardia, and hypothermia) is a life-
threatening priority due to the loss of sympathetic nervous system tone. Autonomic dysreflexia
occurs later, typically after spinal shock has resolved, often triggered by noxious stimuli below
the injury.
**7. The charge nurse is making client assignments. Which client should be assigned to the most
experienced RN?**
A. A client 2 days post-appendectomy requiring discharge teaching.
B. A client with pneumonia requiring IV antibiotics and nebulizers.
C. A client with new-onset atrial fibrillation with a rapid ventricular response.
D. A client with chronic kidney disease scheduled for dialysis this afternoon.
**Correct Answer: C**
