HESI RN Exit Exam V2 Actual 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 55
Recommended Time: 110 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs) with Next Generation NCLEX (NGN)
Style Items
Question Style: Scenario-Based, Applied, Clinical Judgment,
Difficulty Level: Rigorous and Comprehensive
==============================
SECTION 1: Medical-Surgical Nursing
Question 1
A 72-year-old client is admitted with community-acquired pneumonia. The client has a
history of chronic obstructive pulmonary disease and is receiving oxygen at 2 liters per
nasal cannula. The nurse notes the client is becoming increasingly somnolent and the
respiratory rate has decreased from 24 to 10 breaths per minute. Which action should
the nurse take first?
A. Increase the oxygen flow rate to 4 liters per minute
B. Prepare for immediate endotracheal intubation
C. Stimulate the client and notify the healthcare provider
D. Obtain an arterial blood gas sample
,Correct Answer: C
Rationale: The client with COPD is at risk for carbon dioxide narcosis due to decreased
respiratory drive, especially with supplemental oxygen. The nurse should first stimulate
the client to increase respiratory effort and notify the provider immediately. Increasing
oxygen without assessment could worsen CO2 retention. Intubation may be necessary
but requires a provider order. ABGs are important but do not take precedence over
addressing the immediate change in mental status and respiratory rate.
Question 2
A nurse is caring for a client with a newly placed tracheostomy. The nurse notes the
client is anxious, restless, and has an oxygen saturation of 88%. The nurse auscultates
breath sounds and notes absent sounds over the left lung. Which action should the
nurse take first?
A. Suction the tracheostomy tube
B. Deflate the tracheostomy cuff and reinflate
C. Call the rapid response team
D. Check the tracheostomy tube for proper placement and patency
Correct Answer: D
Rationale: Absent breath sounds on one side in a client with a new tracheostomy may
indicate the tube has been displaced into the right mainstem bronchus or has become
obstructed. The nurse must first assess tube placement and patency before taking
,further action. Suctioning is appropriate if secretions are suspected but assessment
comes first. Calling the rapid response team may be necessary if the tube is displaced,
but assessment precedes escalation. Cuff manipulation is not indicated without first
identifying the cause.
Question 3
A client with acute pancreatitis is receiving total parenteral nutrition. The nurse notes
the client has a temperature of 38.6 degrees C, chills, and glucose of 240 mg/dL. The
TPN solution appears cloudy. Which action should the nurse take first?
A. Obtain a blood culture and urine culture
B. Stop the TPN infusion immediately and change the tubing
C. Administer an antipyretic and continue monitoring
D. Increase the regular insulin per sliding scale
Correct Answer: B
Rationale: Cloudy TPN solution indicates contamination, and the client's fever and chills
suggest catheter-related bloodstream infection. The nurse must stop the infusion
immediately to prevent further introduction of pathogens and change the tubing. Blood
cultures should be obtained after stopping the infusion. Administering antipyretics or
insulin does not address the source of infection. TPN is a high-risk medium for bacterial
and fungal growth.
, Question 4
A nurse is caring for a client with a bowel obstruction who has a nasogastric tube
connected to low intermittent suction. The client reports increasing abdominal pain and
distention. The nurse notes the NG tube is draining only 50 mL in 4 hours. Which action
should the nurse take first?
A. Irrigate the nasogastric tube with 30 mL of normal saline
B. Assess the tube for kinks, clamping, or displacement
C. Increase the suction pressure to high continuous suction
D. Administer the prescribed analgesic for abdominal pain
Correct Answer: B
Rationale: Decreased output from an NG tube with increasing abdominal distention
suggests the tube is not functioning properly. The nurse must first assess the system
for mechanical issues such as kinks, clamps, or displacement before irrigating or
adjusting suction. Irrigating without assessing placement risks forcing fluid into the
lungs if the tube is displaced. Increasing suction without assessment could cause
mucosal damage. Pain medication may mask worsening symptoms.
Question 5
A client with a history of atrial fibrillation is taking warfarin 5 mg daily. The INR is 6.2.
The client reports black tarry stools and epistaxis. Which intervention should the nurse
prioritize?
Rationales | Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 55
Recommended Time: 110 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs) with Next Generation NCLEX (NGN)
Style Items
Question Style: Scenario-Based, Applied, Clinical Judgment,
Difficulty Level: Rigorous and Comprehensive
==============================
SECTION 1: Medical-Surgical Nursing
Question 1
A 72-year-old client is admitted with community-acquired pneumonia. The client has a
history of chronic obstructive pulmonary disease and is receiving oxygen at 2 liters per
nasal cannula. The nurse notes the client is becoming increasingly somnolent and the
respiratory rate has decreased from 24 to 10 breaths per minute. Which action should
the nurse take first?
A. Increase the oxygen flow rate to 4 liters per minute
B. Prepare for immediate endotracheal intubation
C. Stimulate the client and notify the healthcare provider
D. Obtain an arterial blood gas sample
,Correct Answer: C
Rationale: The client with COPD is at risk for carbon dioxide narcosis due to decreased
respiratory drive, especially with supplemental oxygen. The nurse should first stimulate
the client to increase respiratory effort and notify the provider immediately. Increasing
oxygen without assessment could worsen CO2 retention. Intubation may be necessary
but requires a provider order. ABGs are important but do not take precedence over
addressing the immediate change in mental status and respiratory rate.
Question 2
A nurse is caring for a client with a newly placed tracheostomy. The nurse notes the
client is anxious, restless, and has an oxygen saturation of 88%. The nurse auscultates
breath sounds and notes absent sounds over the left lung. Which action should the
nurse take first?
A. Suction the tracheostomy tube
B. Deflate the tracheostomy cuff and reinflate
C. Call the rapid response team
D. Check the tracheostomy tube for proper placement and patency
Correct Answer: D
Rationale: Absent breath sounds on one side in a client with a new tracheostomy may
indicate the tube has been displaced into the right mainstem bronchus or has become
obstructed. The nurse must first assess tube placement and patency before taking
,further action. Suctioning is appropriate if secretions are suspected but assessment
comes first. Calling the rapid response team may be necessary if the tube is displaced,
but assessment precedes escalation. Cuff manipulation is not indicated without first
identifying the cause.
Question 3
A client with acute pancreatitis is receiving total parenteral nutrition. The nurse notes
the client has a temperature of 38.6 degrees C, chills, and glucose of 240 mg/dL. The
TPN solution appears cloudy. Which action should the nurse take first?
A. Obtain a blood culture and urine culture
B. Stop the TPN infusion immediately and change the tubing
C. Administer an antipyretic and continue monitoring
D. Increase the regular insulin per sliding scale
Correct Answer: B
Rationale: Cloudy TPN solution indicates contamination, and the client's fever and chills
suggest catheter-related bloodstream infection. The nurse must stop the infusion
immediately to prevent further introduction of pathogens and change the tubing. Blood
cultures should be obtained after stopping the infusion. Administering antipyretics or
insulin does not address the source of infection. TPN is a high-risk medium for bacterial
and fungal growth.
, Question 4
A nurse is caring for a client with a bowel obstruction who has a nasogastric tube
connected to low intermittent suction. The client reports increasing abdominal pain and
distention. The nurse notes the NG tube is draining only 50 mL in 4 hours. Which action
should the nurse take first?
A. Irrigate the nasogastric tube with 30 mL of normal saline
B. Assess the tube for kinks, clamping, or displacement
C. Increase the suction pressure to high continuous suction
D. Administer the prescribed analgesic for abdominal pain
Correct Answer: B
Rationale: Decreased output from an NG tube with increasing abdominal distention
suggests the tube is not functioning properly. The nurse must first assess the system
for mechanical issues such as kinks, clamps, or displacement before irrigating or
adjusting suction. Irrigating without assessing placement risks forcing fluid into the
lungs if the tube is displaced. Increasing suction without assessment could cause
mucosal damage. Pain medication may mask worsening symptoms.
Question 5
A client with a history of atrial fibrillation is taking warfarin 5 mg daily. The INR is 6.2.
The client reports black tarry stools and epistaxis. Which intervention should the nurse
prioritize?
