A Review of 4 Different HESI Exit Past Exams with Real Exam
Questions Correct Answers/ Updated Review of 4 Previous
HESI EXIT Exams - Questions and Correct Answers - 133
Questions
Section 1: General (Questions 1-133)
1 A client presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis following a prolonged
international flight. Initial arterial blood gas (ABG) analysis reveals respiratory alkalosis. Which of the
following nursing interventions is the most immediate priority?
A) Administer intravenous unfractionated heparin per protocol.
B) Prepare for emergent intubation and mechanical ventilation.
C) Initiate continuous pulse oximetry and apply supplemental oxygen.
D) Obtain a 12-lead electrocardiogram (ECG) to assess for cardiac ischemia.
Answer: C
Rationale: The most immediate priority for a client presenting with symptoms highly suggestive of pulmonary
embolism (dyspnea, pleuritic chest pain, hemoptysis) is to address oxygenation. Respiratory alkalosis indicates
hyperventilation in response to hypoxia. Supplemental oxygen and continuous pulse oximetry directly support gas
exchange and monitor oxygenation status, which are critical for stabilizing the client before definitive treatment.
2 A client with chronic kidney disease (CKD) undergoing hemodialysis develops severe muscle cramps and
paresthesias during treatment. The nurse notes peaked T waves on the cardiac monitor. Which of the following
electrolyte imbalances is most likely contributing to these manifestations?
A) Hypocalcemia
B) Hypermagnesemia
C) Hyperkalemia
D) Hyponatremia
Answer: C
Rationale: Peaked T waves on ECG, severe muscle cramps, and paresthesias are classic signs of hyperkalemia, a
common complication in CKD clients, especially during or after dialysis. This occurs due to impaired renal
excretion of potassium. While other electrolyte imbalances can occur, the constellation of symptoms and ECG
changes points most directly to hyperkalemia.
3 A client diagnosed with acute pancreatitis is experiencing severe abdominal pain, nausea, and vomiting. The
nurse observes diminished bowel sounds and abdominal distension. Which dietary modification is most
appropriate for this client?
A) Clear liquid diet progressing to soft foods as tolerated.
B) Low-fat, high-protein diet to promote pancreatic healing.
C) NPO (nil per os) with nasogastric suction and intravenous hydration.
D) Small, frequent meals high in carbohydrates and moderate protein.
Answer: C
Rationale: In acute pancreatitis, the primary goal is to rest the pancreas to prevent further auto-digestion. Placing the
client NPO with nasogastric suction reduces pancreatic stimulation and secretion of digestive enzymes, alleviating
pain and inflammation. Intravenous hydration maintains fluid and electrolyte balance. Other dietary options would
,stimulate the pancreas and exacerbate the condition.
4 A client undergoing chemotherapy for leukemia develops a fever of 38.8°C (101.8°F), chills, and a sore throat.
The absolute neutrophil count (ANC) is 450 cells/mm³. Which of the following nursing actions is the highest
priority?
A) Administer prescribed antipyretics and monitor temperature.
B) Obtain blood cultures from two different sites and administer broad-spectrum antibiotics.
C) Initiate reverse isolation precautions and restrict visitors.
D) Prepare to administer granulocyte colony-stimulating factor (G-CSF).
Answer: B
Rationale: A client with an ANC below 500 cells/mm³ and a fever is experiencing febrile neutropenia, a
life-threatening emergency. The highest priority is to obtain blood cultures promptly to identify the causative
organism and then initiate broad-spectrum antibiotics without delay. Delaying antibiotics significantly increases
mortality risk. While other actions are important, they are secondary to infection management.
5 A client is admitted with suspected septic shock. Which of the following hemodynamic parameters is the most
critical to monitor for initial response to fluid resuscitation and vasopressor therapy?
A) Central Venous Pressure (CVP)
B) Pulmonary Artery Wedge Pressure (PAWP)
C) Mean Arterial Pressure (MAP)
D) Cardiac Output (CO)
Answer: C
Rationale: In septic shock, the primary goal of fluid resuscitation and vasopressor therapy is to restore adequate
tissue perfusion. Mean Arterial Pressure (MAP) is the most critical hemodynamic parameter to monitor as it
directly reflects organ perfusion pressure. Maintaining a MAP greater than 65 mmHg is a key target in septic shock
guidelines. While CVP, PAWP, and CO provide valuable information, MAP is the immediate indicator of perfusion
adequacy.
6 A client with a history of peptic ulcer disease reports dark, tarry stools for several days. On assessment, the
client is pale, dizzy, and has a heart rate of 110 bpm with a blood pressure of 90/60 mmHg. Which laboratory
result is most indicative of the client's current physiological state?
A) Elevated white blood cell count (WBC)
B) Decreased hemoglobin and hematocrit
C) Elevated serum amylase and lipase
D) Increased blood urea nitrogen (BUN) to creatinine ratio
Answer: B
Rationale: Dark, tarry stools (melena), pallor, dizziness, and tachycardia with hypotension are classic signs of upper
gastrointestinal bleeding. Decreased hemoglobin and hematocrit directly reflect the loss of blood volume and red
blood cells, confirming the anemic state caused by the bleeding. An elevated BUN/creatinine ratio can also occur
due to digestion of blood proteins, but the most direct indicator of blood loss is the H&H.
7 A client with Type 1 Diabetes Mellitus presents to the emergency department with Kussmaul respirations, fruity
breath odor, and severe dehydration. Blood glucose is 680 mg/dL, and arterial pH is 7.18. Which intravenous
fluid is most appropriate for initial rapid rehydration?
A) Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS)
B) 0.9% Sodium Chloride (Normal Saline)
C) Lactated Ringer's solution
,D) Dextrose 5% in Water (D5W)
Answer: B
Rationale: The client is in Diabetic Ketoacidosis (DKA) with severe dehydration. Initial fluid resuscitation in DKA
requires isotonic saline (0.9% Normal Saline) to rapidly expand intravascular volume and restore renal perfusion.
This helps lower blood glucose and correct acidosis. D5W would worsen hyperglycemia, and D5 1/2 NS or
Lactated Ringer's are not the primary initial fluids for rapid volume expansion in severe DKA.
8 A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following
laboratory findings would the nurse anticipate?
A) Serum sodium 148 mEq/L, urine osmolality 100 mOsm/kg
B) Serum sodium 120 mEq/L, urine specific gravity 1.030
C) Serum potassium 3.0 mEq/L, urine output 3000 mL/24h
D) Serum osmolality 300 mOsm/kg, urine sodium 10 mEq/L
Answer: B
Rationale: SIADH is characterized by excessive secretion of ADH, leading to water retention, hyponatremia, and
concentrated urine. Therefore, a serum sodium of 120 mEq/L (hyponatremia) and a high urine specific gravity
(e.g., 1.030) indicating concentrated urine are classic findings. The body retains water, diluting the serum and
concentrating the urine. Other options reflect different fluid/electrolyte imbalances or normal ranges.
9 A client with a history of atrial fibrillation on warfarin therapy is admitted with signs of an acute ischemic
stroke. Which of the following is the most critical contraindication to administering tissue plasminogen
activator (tPA)?
A) Current systolic blood pressure of 160 mmHg.
B) Onset of stroke symptoms 3 hours prior to presentation.
C) International Normalized Ratio (INR) of 2.5.
D) Minor neurological deficit with spontaneous improvement.
Answer: C
Rationale: An INR of 2.5, while within the therapeutic range for atrial fibrillation, is a critical contraindication for
tPA administration in an acute ischemic stroke. For tPA, the INR must be less than or equal to 1.7 to minimize the
risk of hemorrhagic transformation. A systolic BP of 160 mmHg is manageable and not an absolute
contraindication if it can be lowered. Symptom onset within 3 hours is within the therapeutic window, and minor
deficits are not a contraindication if disabling.
10 A patient presents with sudden onset of severe, tearing chest pain radiating to the back, accompanied by
hypotension and pulselessness in one arm. Initial ECG shows non-specific ST-T wave changes. Which
diagnostic intervention takes immediate priority to confirm the suspected diagnosis and guide definitive
management?
A) Cardiac troponin I levels and serial ECGs
B) Emergent peripheral angiography of the affected limb
C) Transthoracic echocardiography to assess left ventricular function
D) Computed Tomography Angiography (CTA) of the chest and abdomen
Answer: D
Rationale: The clinical presentation is highly suggestive of acute aortic dissection. CTA of the chest and abdomen is
the most rapid and definitive diagnostic modality to confirm aortic dissection, delineate its extent, and identify
complications, which is crucial for immediate surgical planning. Other options are less specific or would delay
critical diagnosis.
, 11 In a patient diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), which laboratory
finding, in conjunction with clinical hyponatremia, is most indicative of the underlying pathophysiology and
guides the initial management strategy?
A) Elevated serum osmolality and decreased urine sodium
B) Decreased serum osmolality and elevated urine sodium
C) Normal serum osmolality and dilute urine
D) Elevated serum potassium and metabolic acidosis
Answer: B
Rationale: SIADH is characterized by excessive ADH secretion, leading to water retention and dilutional
hyponatremia. This results in decreased serum osmolality. The kidneys attempt to excrete water, but due to ADH,
they reabsorb water, concentrating the urine and leading to inappropriately high urine sodium despite
hyponatremia. This combination is pathognomonic for SIADH.
12 A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute exacerbation.
Arterial blood gas (ABG) results show pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, and HCO3 30 mEq/L.
Which immediate intervention is most appropriate to stabilize this patient?
A) Administer high-flow oxygen via a non-rebreather mask
B) Initiate continuous positive airway pressure (CPAP) ventilation
C) Administer sodium bicarbonate intravenously
D) Prepare for emergent endotracheal intubation
Answer: B
Rationale: The ABG indicates acute-on-chronic respiratory acidosis with hypoxemia. Non-invasive positive
pressure ventilation (such as CPAP or BiPAP) is the preferred initial intervention for acute exacerbations of COPD
with respiratory acidosis, as it improves ventilation, reduces work of breathing, and avoids intubation when
possible. High-flow oxygen can worsen hypercapnia, bicarbonate is generally not indicated, and intubation is a last
resort.
13 A patient is admitted with suspected septic shock. Which combination of hemodynamic parameters, if present,
would most strongly support the diagnosis and necessitate immediate initiation of broad-spectrum antibiotics
and fluid resuscitation?
A) Mean Arterial Pressure (MAP) > 65 mmHg, Lactate > 2 mmol/L, Central Venous Pressure (CVP) 10 cmH2O
B) MAP < 65 mmHg despite fluid resuscitation, Lactate > 2 mmol/L, requiring vasopressors
C) Systemic Vascular Resistance (SVR) elevated, Cardiac Output (CO) decreased, fever
D) MAP 70 mmHg, WBC count 15,000/mm3, heart rate 110 bpm
Answer: B
Rationale: Septic shock is defined by persistent hypotension requiring vasopressors to maintain MAP "e 65 mmHg,
and a serum lactate level > 2 mmol/L (18 mg/dL), despite adequate fluid resuscitation. Option B directly reflects
this diagnostic criteria and indicates severe tissue hypoperfusion requiring urgent intervention. Other options do not
fully capture the shock state.
14 A patient with a history of atrial fibrillation on warfarin therapy presents with acute onset of severe headache,
confusion, and right-sided weakness. A STAT head CT scan is ordered. Which finding on the CT scan would
necessitate immediate reversal of anticoagulation and neurosurgical consultation?
A) Evidence of chronic lacunar infarcts
B) Acute ischemic stroke in the left middle cerebral artery territory
C) Subarachnoid hemorrhage with midline shift
D) Cerebral edema without clear hemorrhage
Questions Correct Answers/ Updated Review of 4 Previous
HESI EXIT Exams - Questions and Correct Answers - 133
Questions
Section 1: General (Questions 1-133)
1 A client presents with sudden onset dyspnea, pleuritic chest pain, and hemoptysis following a prolonged
international flight. Initial arterial blood gas (ABG) analysis reveals respiratory alkalosis. Which of the
following nursing interventions is the most immediate priority?
A) Administer intravenous unfractionated heparin per protocol.
B) Prepare for emergent intubation and mechanical ventilation.
C) Initiate continuous pulse oximetry and apply supplemental oxygen.
D) Obtain a 12-lead electrocardiogram (ECG) to assess for cardiac ischemia.
Answer: C
Rationale: The most immediate priority for a client presenting with symptoms highly suggestive of pulmonary
embolism (dyspnea, pleuritic chest pain, hemoptysis) is to address oxygenation. Respiratory alkalosis indicates
hyperventilation in response to hypoxia. Supplemental oxygen and continuous pulse oximetry directly support gas
exchange and monitor oxygenation status, which are critical for stabilizing the client before definitive treatment.
2 A client with chronic kidney disease (CKD) undergoing hemodialysis develops severe muscle cramps and
paresthesias during treatment. The nurse notes peaked T waves on the cardiac monitor. Which of the following
electrolyte imbalances is most likely contributing to these manifestations?
A) Hypocalcemia
B) Hypermagnesemia
C) Hyperkalemia
D) Hyponatremia
Answer: C
Rationale: Peaked T waves on ECG, severe muscle cramps, and paresthesias are classic signs of hyperkalemia, a
common complication in CKD clients, especially during or after dialysis. This occurs due to impaired renal
excretion of potassium. While other electrolyte imbalances can occur, the constellation of symptoms and ECG
changes points most directly to hyperkalemia.
3 A client diagnosed with acute pancreatitis is experiencing severe abdominal pain, nausea, and vomiting. The
nurse observes diminished bowel sounds and abdominal distension. Which dietary modification is most
appropriate for this client?
A) Clear liquid diet progressing to soft foods as tolerated.
B) Low-fat, high-protein diet to promote pancreatic healing.
C) NPO (nil per os) with nasogastric suction and intravenous hydration.
D) Small, frequent meals high in carbohydrates and moderate protein.
Answer: C
Rationale: In acute pancreatitis, the primary goal is to rest the pancreas to prevent further auto-digestion. Placing the
client NPO with nasogastric suction reduces pancreatic stimulation and secretion of digestive enzymes, alleviating
pain and inflammation. Intravenous hydration maintains fluid and electrolyte balance. Other dietary options would
,stimulate the pancreas and exacerbate the condition.
4 A client undergoing chemotherapy for leukemia develops a fever of 38.8°C (101.8°F), chills, and a sore throat.
The absolute neutrophil count (ANC) is 450 cells/mm³. Which of the following nursing actions is the highest
priority?
A) Administer prescribed antipyretics and monitor temperature.
B) Obtain blood cultures from two different sites and administer broad-spectrum antibiotics.
C) Initiate reverse isolation precautions and restrict visitors.
D) Prepare to administer granulocyte colony-stimulating factor (G-CSF).
Answer: B
Rationale: A client with an ANC below 500 cells/mm³ and a fever is experiencing febrile neutropenia, a
life-threatening emergency. The highest priority is to obtain blood cultures promptly to identify the causative
organism and then initiate broad-spectrum antibiotics without delay. Delaying antibiotics significantly increases
mortality risk. While other actions are important, they are secondary to infection management.
5 A client is admitted with suspected septic shock. Which of the following hemodynamic parameters is the most
critical to monitor for initial response to fluid resuscitation and vasopressor therapy?
A) Central Venous Pressure (CVP)
B) Pulmonary Artery Wedge Pressure (PAWP)
C) Mean Arterial Pressure (MAP)
D) Cardiac Output (CO)
Answer: C
Rationale: In septic shock, the primary goal of fluid resuscitation and vasopressor therapy is to restore adequate
tissue perfusion. Mean Arterial Pressure (MAP) is the most critical hemodynamic parameter to monitor as it
directly reflects organ perfusion pressure. Maintaining a MAP greater than 65 mmHg is a key target in septic shock
guidelines. While CVP, PAWP, and CO provide valuable information, MAP is the immediate indicator of perfusion
adequacy.
6 A client with a history of peptic ulcer disease reports dark, tarry stools for several days. On assessment, the
client is pale, dizzy, and has a heart rate of 110 bpm with a blood pressure of 90/60 mmHg. Which laboratory
result is most indicative of the client's current physiological state?
A) Elevated white blood cell count (WBC)
B) Decreased hemoglobin and hematocrit
C) Elevated serum amylase and lipase
D) Increased blood urea nitrogen (BUN) to creatinine ratio
Answer: B
Rationale: Dark, tarry stools (melena), pallor, dizziness, and tachycardia with hypotension are classic signs of upper
gastrointestinal bleeding. Decreased hemoglobin and hematocrit directly reflect the loss of blood volume and red
blood cells, confirming the anemic state caused by the bleeding. An elevated BUN/creatinine ratio can also occur
due to digestion of blood proteins, but the most direct indicator of blood loss is the H&H.
7 A client with Type 1 Diabetes Mellitus presents to the emergency department with Kussmaul respirations, fruity
breath odor, and severe dehydration. Blood glucose is 680 mg/dL, and arterial pH is 7.18. Which intravenous
fluid is most appropriate for initial rapid rehydration?
A) Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS)
B) 0.9% Sodium Chloride (Normal Saline)
C) Lactated Ringer's solution
,D) Dextrose 5% in Water (D5W)
Answer: B
Rationale: The client is in Diabetic Ketoacidosis (DKA) with severe dehydration. Initial fluid resuscitation in DKA
requires isotonic saline (0.9% Normal Saline) to rapidly expand intravascular volume and restore renal perfusion.
This helps lower blood glucose and correct acidosis. D5W would worsen hyperglycemia, and D5 1/2 NS or
Lactated Ringer's are not the primary initial fluids for rapid volume expansion in severe DKA.
8 A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following
laboratory findings would the nurse anticipate?
A) Serum sodium 148 mEq/L, urine osmolality 100 mOsm/kg
B) Serum sodium 120 mEq/L, urine specific gravity 1.030
C) Serum potassium 3.0 mEq/L, urine output 3000 mL/24h
D) Serum osmolality 300 mOsm/kg, urine sodium 10 mEq/L
Answer: B
Rationale: SIADH is characterized by excessive secretion of ADH, leading to water retention, hyponatremia, and
concentrated urine. Therefore, a serum sodium of 120 mEq/L (hyponatremia) and a high urine specific gravity
(e.g., 1.030) indicating concentrated urine are classic findings. The body retains water, diluting the serum and
concentrating the urine. Other options reflect different fluid/electrolyte imbalances or normal ranges.
9 A client with a history of atrial fibrillation on warfarin therapy is admitted with signs of an acute ischemic
stroke. Which of the following is the most critical contraindication to administering tissue plasminogen
activator (tPA)?
A) Current systolic blood pressure of 160 mmHg.
B) Onset of stroke symptoms 3 hours prior to presentation.
C) International Normalized Ratio (INR) of 2.5.
D) Minor neurological deficit with spontaneous improvement.
Answer: C
Rationale: An INR of 2.5, while within the therapeutic range for atrial fibrillation, is a critical contraindication for
tPA administration in an acute ischemic stroke. For tPA, the INR must be less than or equal to 1.7 to minimize the
risk of hemorrhagic transformation. A systolic BP of 160 mmHg is manageable and not an absolute
contraindication if it can be lowered. Symptom onset within 3 hours is within the therapeutic window, and minor
deficits are not a contraindication if disabling.
10 A patient presents with sudden onset of severe, tearing chest pain radiating to the back, accompanied by
hypotension and pulselessness in one arm. Initial ECG shows non-specific ST-T wave changes. Which
diagnostic intervention takes immediate priority to confirm the suspected diagnosis and guide definitive
management?
A) Cardiac troponin I levels and serial ECGs
B) Emergent peripheral angiography of the affected limb
C) Transthoracic echocardiography to assess left ventricular function
D) Computed Tomography Angiography (CTA) of the chest and abdomen
Answer: D
Rationale: The clinical presentation is highly suggestive of acute aortic dissection. CTA of the chest and abdomen is
the most rapid and definitive diagnostic modality to confirm aortic dissection, delineate its extent, and identify
complications, which is crucial for immediate surgical planning. Other options are less specific or would delay
critical diagnosis.
, 11 In a patient diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH), which laboratory
finding, in conjunction with clinical hyponatremia, is most indicative of the underlying pathophysiology and
guides the initial management strategy?
A) Elevated serum osmolality and decreased urine sodium
B) Decreased serum osmolality and elevated urine sodium
C) Normal serum osmolality and dilute urine
D) Elevated serum potassium and metabolic acidosis
Answer: B
Rationale: SIADH is characterized by excessive ADH secretion, leading to water retention and dilutional
hyponatremia. This results in decreased serum osmolality. The kidneys attempt to excrete water, but due to ADH,
they reabsorb water, concentrating the urine and leading to inappropriately high urine sodium despite
hyponatremia. This combination is pathognomonic for SIADH.
12 A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute exacerbation.
Arterial blood gas (ABG) results show pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, and HCO3 30 mEq/L.
Which immediate intervention is most appropriate to stabilize this patient?
A) Administer high-flow oxygen via a non-rebreather mask
B) Initiate continuous positive airway pressure (CPAP) ventilation
C) Administer sodium bicarbonate intravenously
D) Prepare for emergent endotracheal intubation
Answer: B
Rationale: The ABG indicates acute-on-chronic respiratory acidosis with hypoxemia. Non-invasive positive
pressure ventilation (such as CPAP or BiPAP) is the preferred initial intervention for acute exacerbations of COPD
with respiratory acidosis, as it improves ventilation, reduces work of breathing, and avoids intubation when
possible. High-flow oxygen can worsen hypercapnia, bicarbonate is generally not indicated, and intubation is a last
resort.
13 A patient is admitted with suspected septic shock. Which combination of hemodynamic parameters, if present,
would most strongly support the diagnosis and necessitate immediate initiation of broad-spectrum antibiotics
and fluid resuscitation?
A) Mean Arterial Pressure (MAP) > 65 mmHg, Lactate > 2 mmol/L, Central Venous Pressure (CVP) 10 cmH2O
B) MAP < 65 mmHg despite fluid resuscitation, Lactate > 2 mmol/L, requiring vasopressors
C) Systemic Vascular Resistance (SVR) elevated, Cardiac Output (CO) decreased, fever
D) MAP 70 mmHg, WBC count 15,000/mm3, heart rate 110 bpm
Answer: B
Rationale: Septic shock is defined by persistent hypotension requiring vasopressors to maintain MAP "e 65 mmHg,
and a serum lactate level > 2 mmol/L (18 mg/dL), despite adequate fluid resuscitation. Option B directly reflects
this diagnostic criteria and indicates severe tissue hypoperfusion requiring urgent intervention. Other options do not
fully capture the shock state.
14 A patient with a history of atrial fibrillation on warfarin therapy presents with acute onset of severe headache,
confusion, and right-sided weakness. A STAT head CT scan is ordered. Which finding on the CT scan would
necessitate immediate reversal of anticoagulation and neurosurgical consultation?
A) Evidence of chronic lacunar infarcts
B) Acute ischemic stroke in the left middle cerebral artery territory
C) Subarachnoid hemorrhage with midline shift
D) Cerebral edema without clear hemorrhage
