EXIT HESI COMPREHENSIVE B EVOLVE
PRACTICE QUESTIONS AND ANSWERS
LATEST 2025/2026 UPDATED
This comprehensive HESI Exit Exam Version B study guide features a high-
density collection of realistic multiple-choice practice questions paired with
highlighted correct answers and comprehensive rationales. Designed
specifically to mimic the actual Evolve testing framework, it breaks down
complex clinical judgments across high-yield nursing topics including critical
lab values, pharmacology, prioritization, and advanced disease management.
It serves as an essential, high-utility tool for nursing students aiming to
maximize their study efficiency and pass their exit boards on the first attempt.
1. Cardiovascular System: Coronary Artery Disease
A patient is admitted to the emergency department with
severe, crushing chest pain radiating to the left arm.
The electrocardiogram (ECG) shows ST-segment
elevation in leads V1 through V4. Which intervention
should the nurse implement first?
A. Administer morphine sulfate 2 mg IV push
B. Obtain a stat 12-lead ECG repeat
C. Administer oxygen via nasal cannula at 2 L/min
D. Administer chewable aspirin 325 mg
Answer: D. Administer chewable aspirin 325 mg
,Rationale: In an acute myocardial infarction
(STEMI), chewable aspirin is the highest priority
first action because it inhibits platelet aggregation
and prevents further clot propagation. While
morphine helps pain and oxygen treats hypoxia,
antiplatelet therapy directly addresses the
underlying coronary thrombus. Repeat ECGs
should not delay initial life-saving medication
administration.
2. Pharmacology: Digoxin Toxicity
A patient with heart failure is taking digoxin 0.25 mg
daily. The patient reports anorexia, nausea, and seeing
yellow-green halos around lights. Which laboratory
result requires immediate notification to the healthcare
provider?
A. Serum digoxin level of 1.2 ng/mL
B. Serum potassium level of 3.1 mEq/L
C. Serum sodium level of 136 mEq/L
D. Serum BUN level of 22 mg/dL
Answer: B. Serum potassium level of 3.1 mEq/L
,Rationale: Hypokalemia (potassium < 3.5 mEq/L)
sensitizes the myocardium to digoxin, greatly
increasing the risk of life-threatening digitalis-
induced arrhythmias. Visual changes and
gastrointestinal upset are classic signs of toxicity.
Even if the digoxin level is within a normal
therapeutic range (0.5–2.0 ng/mL), low potassium
levels magnify its toxic effects.
3. Fluid and Electrolytes: Acid-Base Balance
An arterial blood gas (ABG) analysis reveals the
following results: pH 7.30, PaCO2 51 mm Hg, HCO3 24
mEq/L. How should the nurse interpret these findings?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: C. Uncompensated respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. The
PaCO2 is elevated above the normal range (35–45
mm Hg), which aligns with the acidotic pH
, (respiratory origin). Because the HCO3 value is
completely within normal limits (22–26 mEq/L), the
kidneys have not yet begun to compensate for the
respiratory failure.
4. Maternal-Newborn: Postpartum Hemorrhage
A nurse evaluates a postpartum client 2 hours after a
vaginal delivery. The nurse notes that the fundus is
boggy, displaced to the right, and located two fingers
above the umbilicus. What is the priority nursing action?
A. Perform deep fundal massage
B. Administer oxytocin intramuscularly
C. Assist the client to the bathroom to void
D. Assess the client’s blood pressure and pulse
Answer: C. Assist the client to the bathroom to void
Rationale: A fundus that is boggy and displaced to
the right indicates uterine atony caused by a
distended urinary bladder. Emptying the bladder
allows the uterus to contract effectively. If the
fundus remains boggy after voiding, fundal
PRACTICE QUESTIONS AND ANSWERS
LATEST 2025/2026 UPDATED
This comprehensive HESI Exit Exam Version B study guide features a high-
density collection of realistic multiple-choice practice questions paired with
highlighted correct answers and comprehensive rationales. Designed
specifically to mimic the actual Evolve testing framework, it breaks down
complex clinical judgments across high-yield nursing topics including critical
lab values, pharmacology, prioritization, and advanced disease management.
It serves as an essential, high-utility tool for nursing students aiming to
maximize their study efficiency and pass their exit boards on the first attempt.
1. Cardiovascular System: Coronary Artery Disease
A patient is admitted to the emergency department with
severe, crushing chest pain radiating to the left arm.
The electrocardiogram (ECG) shows ST-segment
elevation in leads V1 through V4. Which intervention
should the nurse implement first?
A. Administer morphine sulfate 2 mg IV push
B. Obtain a stat 12-lead ECG repeat
C. Administer oxygen via nasal cannula at 2 L/min
D. Administer chewable aspirin 325 mg
Answer: D. Administer chewable aspirin 325 mg
,Rationale: In an acute myocardial infarction
(STEMI), chewable aspirin is the highest priority
first action because it inhibits platelet aggregation
and prevents further clot propagation. While
morphine helps pain and oxygen treats hypoxia,
antiplatelet therapy directly addresses the
underlying coronary thrombus. Repeat ECGs
should not delay initial life-saving medication
administration.
2. Pharmacology: Digoxin Toxicity
A patient with heart failure is taking digoxin 0.25 mg
daily. The patient reports anorexia, nausea, and seeing
yellow-green halos around lights. Which laboratory
result requires immediate notification to the healthcare
provider?
A. Serum digoxin level of 1.2 ng/mL
B. Serum potassium level of 3.1 mEq/L
C. Serum sodium level of 136 mEq/L
D. Serum BUN level of 22 mg/dL
Answer: B. Serum potassium level of 3.1 mEq/L
,Rationale: Hypokalemia (potassium < 3.5 mEq/L)
sensitizes the myocardium to digoxin, greatly
increasing the risk of life-threatening digitalis-
induced arrhythmias. Visual changes and
gastrointestinal upset are classic signs of toxicity.
Even if the digoxin level is within a normal
therapeutic range (0.5–2.0 ng/mL), low potassium
levels magnify its toxic effects.
3. Fluid and Electrolytes: Acid-Base Balance
An arterial blood gas (ABG) analysis reveals the
following results: pH 7.30, PaCO2 51 mm Hg, HCO3 24
mEq/L. How should the nurse interpret these findings?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Uncompensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Answer: C. Uncompensated respiratory acidosis
Rationale: A pH below 7.35 indicates acidosis. The
PaCO2 is elevated above the normal range (35–45
mm Hg), which aligns with the acidotic pH
, (respiratory origin). Because the HCO3 value is
completely within normal limits (22–26 mEq/L), the
kidneys have not yet begun to compensate for the
respiratory failure.
4. Maternal-Newborn: Postpartum Hemorrhage
A nurse evaluates a postpartum client 2 hours after a
vaginal delivery. The nurse notes that the fundus is
boggy, displaced to the right, and located two fingers
above the umbilicus. What is the priority nursing action?
A. Perform deep fundal massage
B. Administer oxytocin intramuscularly
C. Assist the client to the bathroom to void
D. Assess the client’s blood pressure and pulse
Answer: C. Assist the client to the bathroom to void
Rationale: A fundus that is boggy and displaced to
the right indicates uterine atony caused by a
distended urinary bladder. Emptying the bladder
allows the uterus to contract effectively. If the
fundus remains boggy after voiding, fundal
