2026/2027 RN HESI Exit Exam Version 1 V1 All Questions &
Answers with Detailed Rationales | Complete Exam-Style
Questions | Graded A+ Pass Guaranteed
Total Questions: 80
SECTION 1: Medical-Surgical Nursing
1. The nurse is caring for a patient post-operative day 1 following a bowel resection.
Which assessment finding requires immediate intervention?
A. Scant serosanguineous drainage on the surgical dressing
B. Absent bowel sounds in all four quadrants
C. Rigid abdomen with rebound tenderness
D. Pain rated 6/10 at the incision site
Correct Answer: C. Rigid abdomen with rebound tenderness
Rationale: A rigid abdomen with rebound tenderness indicates peritonitis, a surgical
emergency requiring immediate provider notification. A is incorrect because scant
serosanguineous drainage is expected in the first 24-48 hours post-op. B is incorrect
because absent bowel sounds are expected immediately post-abdominal surgery due to
paralytic ileus; they should return within 2-3 days. D is incorrect because post-operative
pain of 6/10 requires intervention but is not an emergency finding.
2. A patient with chronic obstructive pulmonary disease (COPD) is admitted with an
exacerbation. The patient's arterial blood gas shows pH 7.32, PaCO₂ 58 mmHg,
and PaO₂ 52 mmHg on room air. Which oxygen delivery method is most
appropriate?
A. 4 L/min nasal cannula
B. 2 L/min nasal cannula
C. 10 L/min non-rebreather mask
D. 40% Venturi mask
,Correct Answer: B. 2 L/min nasal cannula
Rationale: Patients with COPD are chronic CO₂ retainers whose respiratory drive
depends on hypoxemia. Oxygen should be titrated to maintain SpO₂ 88-92% (PaO₂ 55-60
mmHg). Starting at 2 L/min prevents CO₂ narcosis. A is incorrect because 4 L/min may
suppress the hypoxic drive. C is incorrect because high-flow oxygen can cause
respiratory depression and acidosis in CO₂ retainers. D is incorrect because while
Venturi masks deliver precise FiO₂, the initial approach in COPD is low-flow oxygen
titration.
3. A patient with heart failure is instructed to weigh daily. The patient calls the clinic
and reports a 4-pound weight gain in 2 days. What is the nurse's best response?
A. "This is normal fluctuation; continue your current medications."
B. "Increase your furosemide by 20 mg today and call back tomorrow."
C. "This may indicate fluid retention; contact your provider for further instructions."
D. "Restrict your fluids to 1 liter per day until the weight returns to baseline."
Correct Answer: C. "This may indicate fluid retention; contact your provider for further
instructions."
Rationale: A weight gain of 2-3 pounds in 1 day or 5 pounds in 1 week indicates fluid
retention and requires provider evaluation for possible diuretic adjustment. A is
incorrect because a 4-pound gain in 2 days is clinically significant. B is incorrect
because nurses cannot independently adjust diuretic doses without a provider order. D
is incorrect because fluid restriction changes require provider orders and are not
initiated by the nurse independently.
4. A patient is admitted with diabetic ketoacidosis (DKA). The patient's blood
glucose is 520 mg/dL, pH is 7.25, and potassium is 3.2 mEq/L. Which
intervention should the nurse implement first?
A. Begin an insulin infusion at 0.1 units/kg/hour
B. Administer IV potassium chloride 40 mEq
C. Initiate an IV infusion of 0.9% sodium chloride at 1 L/hour
D. Obtain arterial blood gases
,Correct Answer: C. Initiate an IV infusion of 0.9% sodium chloride at 1 L/hour
Rationale: The priority in DKA is fluid resuscitation with isotonic saline to restore
intravascular volume and improve perfusion. Fluid resuscitation precedes insulin
administration. A is incorrect because insulin should not be started until fluid
resuscitation is underway and potassium is addressed; insulin drives potassium
intracellularly and can precipitate fatal arrhythmias if K⁺ is low. B is incorrect because
while potassium will need replacement, the first priority is fluid resuscitation. D is
incorrect because ABGs may already be available; if not, they can be drawn while fluids
are initiated.
5. A patient arrives at the emergency department with sudden onset of right-sided
weakness and aphasia. The symptoms began 2 hours ago. Which action should
the nurse take first?
A. Prepare to administer tissue plasminogen activator (tPA)
B. Assess the patient's airway, breathing, and circulation
C. Insert a nasogastric tube for medication administration
D. Obtain a detailed history from the family
Correct Answer: B. Assess the patient's airway, breathing, and circulation
Rationale: The nursing process always begins with assessment of the ABCs. Airway
patency and respiratory status must be established before any other intervention. A is
incorrect because tPA administration requires CT confirmation of non-hemorrhagic
stroke, BP parameters, and exclusion of contraindications; it is not the first action. C is
incorrect because NG tube insertion is not an immediate priority and may be
contraindicated if the patient has impaired gag reflex without airway protection. D is
incorrect because while history is important, it is secondary to physiological
stabilization.
6. A patient with a suspected myocardial infarction reports chest pain of 8/10. Vital
signs are stable. Which medication should the nurse administer first?
A. Morphine sulfate 2 mg IV
, B. Nitroglycerin 0.4 mg sublingual
C. Aspirin 325 mg chewable
D. Metoprolol 25 mg oral
Correct Answer: C. Aspirin 325 mg chewable
Rationale: Aspirin should be administered immediately (within minutes of arrival) to
inhibit platelet aggregation and reduce mortality in acute MI, provided the patient has no
allergy. B is incorrect because while nitroglycerin relieves pain and reduces preload,
aspirin has greater mortality benefit and should be given first. A is incorrect because
morphine is given after aspirin and nitroglycerin if pain persists. D is incorrect because
beta-blockers are given within 24 hours but are not the first medication.
7. A patient admitted with an upper gastrointestinal bleed has the following vital
signs: BP 94/62 mmHg, HR 118 bpm, RR 22, SpO₂ 96% on room air. Which
intervention is the priority?
A. Insert a Salem sump nasogastric tube
B. Initiate two large-bore IV lines and begin fluid resuscitation
C. Administer oral proton pump inhibitor therapy
D. Prepare the patient for upper endoscopy
Correct Answer: B. Initiate two large-bore IV lines and begin fluid resuscitation
Rationale: The patient is hemodynamically unstable with hypotension and tachycardia
indicating hypovolemic shock. Fluid resuscitation with crystalloids and preparation for
blood products is the priority. A is incorrect because NG tube insertion is
diagnostic/therapeutic but not the priority over hemodynamic stabilization. C is
incorrect because oral medications are contraindicated in active GI bleeding. D is
incorrect because endoscopy is definitive management but must wait until the patient is
hemodynamically stabilized.
8. A patient with suspected sepsis has a lactate level of 4.2 mmol/L. Which action
should the nurse prioritize?
Answers with Detailed Rationales | Complete Exam-Style
Questions | Graded A+ Pass Guaranteed
Total Questions: 80
SECTION 1: Medical-Surgical Nursing
1. The nurse is caring for a patient post-operative day 1 following a bowel resection.
Which assessment finding requires immediate intervention?
A. Scant serosanguineous drainage on the surgical dressing
B. Absent bowel sounds in all four quadrants
C. Rigid abdomen with rebound tenderness
D. Pain rated 6/10 at the incision site
Correct Answer: C. Rigid abdomen with rebound tenderness
Rationale: A rigid abdomen with rebound tenderness indicates peritonitis, a surgical
emergency requiring immediate provider notification. A is incorrect because scant
serosanguineous drainage is expected in the first 24-48 hours post-op. B is incorrect
because absent bowel sounds are expected immediately post-abdominal surgery due to
paralytic ileus; they should return within 2-3 days. D is incorrect because post-operative
pain of 6/10 requires intervention but is not an emergency finding.
2. A patient with chronic obstructive pulmonary disease (COPD) is admitted with an
exacerbation. The patient's arterial blood gas shows pH 7.32, PaCO₂ 58 mmHg,
and PaO₂ 52 mmHg on room air. Which oxygen delivery method is most
appropriate?
A. 4 L/min nasal cannula
B. 2 L/min nasal cannula
C. 10 L/min non-rebreather mask
D. 40% Venturi mask
,Correct Answer: B. 2 L/min nasal cannula
Rationale: Patients with COPD are chronic CO₂ retainers whose respiratory drive
depends on hypoxemia. Oxygen should be titrated to maintain SpO₂ 88-92% (PaO₂ 55-60
mmHg). Starting at 2 L/min prevents CO₂ narcosis. A is incorrect because 4 L/min may
suppress the hypoxic drive. C is incorrect because high-flow oxygen can cause
respiratory depression and acidosis in CO₂ retainers. D is incorrect because while
Venturi masks deliver precise FiO₂, the initial approach in COPD is low-flow oxygen
titration.
3. A patient with heart failure is instructed to weigh daily. The patient calls the clinic
and reports a 4-pound weight gain in 2 days. What is the nurse's best response?
A. "This is normal fluctuation; continue your current medications."
B. "Increase your furosemide by 20 mg today and call back tomorrow."
C. "This may indicate fluid retention; contact your provider for further instructions."
D. "Restrict your fluids to 1 liter per day until the weight returns to baseline."
Correct Answer: C. "This may indicate fluid retention; contact your provider for further
instructions."
Rationale: A weight gain of 2-3 pounds in 1 day or 5 pounds in 1 week indicates fluid
retention and requires provider evaluation for possible diuretic adjustment. A is
incorrect because a 4-pound gain in 2 days is clinically significant. B is incorrect
because nurses cannot independently adjust diuretic doses without a provider order. D
is incorrect because fluid restriction changes require provider orders and are not
initiated by the nurse independently.
4. A patient is admitted with diabetic ketoacidosis (DKA). The patient's blood
glucose is 520 mg/dL, pH is 7.25, and potassium is 3.2 mEq/L. Which
intervention should the nurse implement first?
A. Begin an insulin infusion at 0.1 units/kg/hour
B. Administer IV potassium chloride 40 mEq
C. Initiate an IV infusion of 0.9% sodium chloride at 1 L/hour
D. Obtain arterial blood gases
,Correct Answer: C. Initiate an IV infusion of 0.9% sodium chloride at 1 L/hour
Rationale: The priority in DKA is fluid resuscitation with isotonic saline to restore
intravascular volume and improve perfusion. Fluid resuscitation precedes insulin
administration. A is incorrect because insulin should not be started until fluid
resuscitation is underway and potassium is addressed; insulin drives potassium
intracellularly and can precipitate fatal arrhythmias if K⁺ is low. B is incorrect because
while potassium will need replacement, the first priority is fluid resuscitation. D is
incorrect because ABGs may already be available; if not, they can be drawn while fluids
are initiated.
5. A patient arrives at the emergency department with sudden onset of right-sided
weakness and aphasia. The symptoms began 2 hours ago. Which action should
the nurse take first?
A. Prepare to administer tissue plasminogen activator (tPA)
B. Assess the patient's airway, breathing, and circulation
C. Insert a nasogastric tube for medication administration
D. Obtain a detailed history from the family
Correct Answer: B. Assess the patient's airway, breathing, and circulation
Rationale: The nursing process always begins with assessment of the ABCs. Airway
patency and respiratory status must be established before any other intervention. A is
incorrect because tPA administration requires CT confirmation of non-hemorrhagic
stroke, BP parameters, and exclusion of contraindications; it is not the first action. C is
incorrect because NG tube insertion is not an immediate priority and may be
contraindicated if the patient has impaired gag reflex without airway protection. D is
incorrect because while history is important, it is secondary to physiological
stabilization.
6. A patient with a suspected myocardial infarction reports chest pain of 8/10. Vital
signs are stable. Which medication should the nurse administer first?
A. Morphine sulfate 2 mg IV
, B. Nitroglycerin 0.4 mg sublingual
C. Aspirin 325 mg chewable
D. Metoprolol 25 mg oral
Correct Answer: C. Aspirin 325 mg chewable
Rationale: Aspirin should be administered immediately (within minutes of arrival) to
inhibit platelet aggregation and reduce mortality in acute MI, provided the patient has no
allergy. B is incorrect because while nitroglycerin relieves pain and reduces preload,
aspirin has greater mortality benefit and should be given first. A is incorrect because
morphine is given after aspirin and nitroglycerin if pain persists. D is incorrect because
beta-blockers are given within 24 hours but are not the first medication.
7. A patient admitted with an upper gastrointestinal bleed has the following vital
signs: BP 94/62 mmHg, HR 118 bpm, RR 22, SpO₂ 96% on room air. Which
intervention is the priority?
A. Insert a Salem sump nasogastric tube
B. Initiate two large-bore IV lines and begin fluid resuscitation
C. Administer oral proton pump inhibitor therapy
D. Prepare the patient for upper endoscopy
Correct Answer: B. Initiate two large-bore IV lines and begin fluid resuscitation
Rationale: The patient is hemodynamically unstable with hypotension and tachycardia
indicating hypovolemic shock. Fluid resuscitation with crystalloids and preparation for
blood products is the priority. A is incorrect because NG tube insertion is
diagnostic/therapeutic but not the priority over hemodynamic stabilization. C is
incorrect because oral medications are contraindicated in active GI bleeding. D is
incorrect because endoscopy is definitive management but must wait until the patient is
hemodynamically stabilized.
8. A patient with suspected sepsis has a lactate level of 4.2 mmol/L. Which action
should the nurse prioritize?
