HESI RN Exit Exam V2 Actual 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 60
Recommended Time: 120 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs) with Next Generation NCLEX (NGN)
Style Items
Question Style: Scenario-Based, Applied, Clinical Judgment, and Professional
Decision-Making Questions
Difficulty Level: Rigorous and Comprehensive
==============================
SECTION 1: Medical-Surgical Nursing
Question 1
A 68-year-old client is admitted with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs are BP 88/56, HR 112, RR 24. The 12-lead ECG
shows ST-segment elevation in leads V1 through V4. Which action should the nurse take
first?
A. Administer sublingual nitroglycerin and assess pain level
B. Initiate high-flow oxygen and prepare for emergent percutaneous coronary
intervention
C. Obtain a stat troponin level and complete a full health history
D. Administer morphine sulfate intravenously and place the client in supine position
,Correct Answer: B
Rationale: The client is presenting with an anterior ST-elevation myocardial infarction
and is hypotensive, indicating cardiogenic shock. High-flow oxygen supports
oxygenation, and emergent PCI is the priority reperfusion strategy. Nitroglycerin is
contraindicated with hypotension. A full health history delays time-sensitive
intervention. Morphine may be given but is not the first priority, and supine position is
acceptable but secondary to reperfusion.
Question 2
A client with a history of heart failure presents with severe dyspnea, frothy pink sputum,
and an oxygen saturation of 84 percent on room air. Bilateral crackles are auscultated.
Which intervention should the nurse implement first?
A. Administer furosemide intravenously as prescribed
B. Place the client in a high-Fowler position with legs dependent
C. Obtain a stat chest x-ray and arterial blood gas
D. Insert an indwelling urinary catheter to monitor output
Correct Answer: B
Rationale: Positioning in high-Fowler with legs dependent reduces venous return and
pulmonary congestion immediately, improving oxygenation before pharmacologic
interventions. Furosemide is important but positioning is faster and noninvasive.
,Diagnostic tests should not delay immediate interventions. Urinary catheterization is
appropriate later but not the first action.
Question 3
A client with chronic obstructive pulmonary disease is admitted with acute
exacerbation. The client is lethargic, has a respiratory rate of 8 breaths per minute, and
an oxygen saturation of 78 percent on 2 liters nasal cannula. Which intervention is the
priority?
A. Increase the oxygen flow rate to 6 liters per minute
B. Prepare for emergent noninvasive positive pressure ventilation
C. Administer a nebulized bronchodilator and encourage coughing
D. Obtain a stat arterial blood gas before changing any interventions
Correct Answer: B
Rationale: The client has acute respiratory failure with bradypnea and severe
hypoxemia. Noninvasive positive pressure ventilation is indicated to improve ventilation
and oxygenation while avoiding intubation if possible. High-flow oxygen in COPD must
be titrated carefully to avoid suppressing the hypoxic drive, but the immediate threat is
respiratory failure requiring ventilatory support. Bronchodilators are adjunctive. ABG
should not delay intervention in acute failure.
, Question 4
A 54-year-old client is admitted with community-acquired pneumonia. Eight hours after
admission, the client becomes confused, has a temperature of 102.8 degrees
Fahrenheit, heart rate of 128, respiratory rate of 32, and blood pressure of 82/48. Which
action should the nurse take first?
A. Initiate sepsis protocol, obtain blood cultures, and begin broad-spectrum antibiotics
within one hour
B. Administer acetaminophen to reduce the fever and improve comfort
C. Obtain a sputum culture and wait for results before starting antibiotics
D. Insert a central line and begin fluid resuscitation with albumin
Correct Answer: A
Rationale: The client meets criteria for sepsis with hypotension and organ dysfunction.
The Surviving Sepsis Campaign requires blood cultures, lactate measurement, and
broad-spectrum antibiotics within one hour. Antipyretics do not treat sepsis. Waiting for
sputum culture results delays life-saving antibiotics. Fluid resuscitation is important but
should follow sepsis protocol initiation with crystalloids, not albumin first.
Question 5
A client with cirrhosis presents with asterixis, confusion, and a blood ammonia level of
128 mcg per dL. Which intervention should the nurse include in the plan of care?
Rationales | Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
EXAM INFORMATION
Total Questions: 60
Recommended Time: 120 Minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs) with Next Generation NCLEX (NGN)
Style Items
Question Style: Scenario-Based, Applied, Clinical Judgment, and Professional
Decision-Making Questions
Difficulty Level: Rigorous and Comprehensive
==============================
SECTION 1: Medical-Surgical Nursing
Question 1
A 68-year-old client is admitted with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. Vital signs are BP 88/56, HR 112, RR 24. The 12-lead ECG
shows ST-segment elevation in leads V1 through V4. Which action should the nurse take
first?
A. Administer sublingual nitroglycerin and assess pain level
B. Initiate high-flow oxygen and prepare for emergent percutaneous coronary
intervention
C. Obtain a stat troponin level and complete a full health history
D. Administer morphine sulfate intravenously and place the client in supine position
,Correct Answer: B
Rationale: The client is presenting with an anterior ST-elevation myocardial infarction
and is hypotensive, indicating cardiogenic shock. High-flow oxygen supports
oxygenation, and emergent PCI is the priority reperfusion strategy. Nitroglycerin is
contraindicated with hypotension. A full health history delays time-sensitive
intervention. Morphine may be given but is not the first priority, and supine position is
acceptable but secondary to reperfusion.
Question 2
A client with a history of heart failure presents with severe dyspnea, frothy pink sputum,
and an oxygen saturation of 84 percent on room air. Bilateral crackles are auscultated.
Which intervention should the nurse implement first?
A. Administer furosemide intravenously as prescribed
B. Place the client in a high-Fowler position with legs dependent
C. Obtain a stat chest x-ray and arterial blood gas
D. Insert an indwelling urinary catheter to monitor output
Correct Answer: B
Rationale: Positioning in high-Fowler with legs dependent reduces venous return and
pulmonary congestion immediately, improving oxygenation before pharmacologic
interventions. Furosemide is important but positioning is faster and noninvasive.
,Diagnostic tests should not delay immediate interventions. Urinary catheterization is
appropriate later but not the first action.
Question 3
A client with chronic obstructive pulmonary disease is admitted with acute
exacerbation. The client is lethargic, has a respiratory rate of 8 breaths per minute, and
an oxygen saturation of 78 percent on 2 liters nasal cannula. Which intervention is the
priority?
A. Increase the oxygen flow rate to 6 liters per minute
B. Prepare for emergent noninvasive positive pressure ventilation
C. Administer a nebulized bronchodilator and encourage coughing
D. Obtain a stat arterial blood gas before changing any interventions
Correct Answer: B
Rationale: The client has acute respiratory failure with bradypnea and severe
hypoxemia. Noninvasive positive pressure ventilation is indicated to improve ventilation
and oxygenation while avoiding intubation if possible. High-flow oxygen in COPD must
be titrated carefully to avoid suppressing the hypoxic drive, but the immediate threat is
respiratory failure requiring ventilatory support. Bronchodilators are adjunctive. ABG
should not delay intervention in acute failure.
, Question 4
A 54-year-old client is admitted with community-acquired pneumonia. Eight hours after
admission, the client becomes confused, has a temperature of 102.8 degrees
Fahrenheit, heart rate of 128, respiratory rate of 32, and blood pressure of 82/48. Which
action should the nurse take first?
A. Initiate sepsis protocol, obtain blood cultures, and begin broad-spectrum antibiotics
within one hour
B. Administer acetaminophen to reduce the fever and improve comfort
C. Obtain a sputum culture and wait for results before starting antibiotics
D. Insert a central line and begin fluid resuscitation with albumin
Correct Answer: A
Rationale: The client meets criteria for sepsis with hypotension and organ dysfunction.
The Surviving Sepsis Campaign requires blood cultures, lactate measurement, and
broad-spectrum antibiotics within one hour. Antipyretics do not treat sepsis. Waiting for
sputum culture results delays life-saving antibiotics. Fluid resuscitation is important but
should follow sepsis protocol initiation with crystalloids, not albumin first.
Question 5
A client with cirrhosis presents with asterixis, confusion, and a blood ammonia level of
128 mcg per dL. Which intervention should the nurse include in the plan of care?
