HESI RN EXIT EXAMS V1, V2, V3, V4, V5, V6 - 89 Questions
and Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing - Comprehensive Exit Exam
Description This exam integrates advanced nursing concepts across medical-surgical,
maternal-child, mental health, pharmacology, and leadership domains. It aligns
with NCLEX-RN test plan competencies and requires synthesis of evidence-based
practice, patient safety, and clinical judgment at the level of a graduating senior
nursing student.
Expected Grade A+
Total Questions 89
Duration 4 hours
Learning Outcomes 1. Apply clinical reasoning to prioritize nursing interventions in complex,
multi-system scenarios.
2. Interpret diagnostic data and laboratory values to guide clinical decisions.
3. Evaluate pharmacological therapies for adverse effects and patient education
needs.
4. Demonstrate leadership in delegation, conflict resolution, and ethical
decision-making.
5. Integrate evidence-based practice to improve patient outcomes across diverse
healthcare settings.
Accreditation This examination meets the rigor and standards of top-tier US nursing programs
accredited by CCNE and ACEN, reflecting the complexity of the NCLEX-RN and
HESI Exit Exam blueprint.
Page 1
,1. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
on volume-controlled ventilation. The patient's plateau pressure is 32 cm H2O,
PEEP is 10 cm H2O, and FiO2 is 0.6. Arterial blood gas shows pH 7.25, PaCO2 50
mm Hg, PaO2 60 mm Hg. Which intervention should the nurse anticipate?
A. Increase PEEP to 15 cm H2O and perform recruitment maneuvers
B. Increase FiO2 to 1.0 and administer sodium bicarbonate
C. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
D. Switch to pressure-controlled ventilation and reduce PEEP to 5 cm H2O
Answer: C. Decrease tidal volume to 4 mL/kg ideal body weight and increase
respiratory rate
The patient has ARDS with plateau pressure >30 cm H2O, indicating risk of
volutrauma. Low tidal volume ventilation (4-6 mL/kg) is the standard of care to prevent
further lung injury. Permissive hypercapnia is accepted; the pH >7.20 does not require
bicarbonate. Increasing PEEP may improve oxygenation but does not address the high
plateau pressure.
2. A patient with septic shock is receiving norepinephrine at 20 mcg/min and
vasopressin at 0.04 units/min. Mean arterial pressure (MAP) remains 58 mm Hg.
Which hemodynamic parameter should the nurse evaluate to guide further
intervention?
A. Central venous pressure (CVP)
B. Cardiac index (CI)
C. Stroke volume variation (SVV)
D. Pulmonary artery occlusion pressure (PAOP)
Answer: B. Cardiac index (CI)
In septic shock refractory to vasopressors, assessing cardiac output/index helps
determine if low MAP is due to low cardiac output or low systemic vascular resistance.
If CI is low, inotropes (e.g., dobutamine) may be added. CVP and PAOP assess preload
but are less helpful after initial resuscitation. SVV is used for fluid responsiveness, but
with ongoing vasopressors, cardiac function is key.
Page 2
,3. A nurse is preparing to administer intravenous immune globulin (IVIG) to a
patient with chronic inflammatory demyelinating polyneuropathy. Which
pre-administration assessment is most critical?
A. Serum immunoglobulin A (IgA) level
B. Complete blood count with differential
C. Liver function tests including albumin
D. Erythrocyte sedimentation rate (ESR)
Answer: A. Serum immunoglobulin A (IgA) level
IVIG can cause anaphylaxis in patients with IgA deficiency due to anti-IgA antibodies.
Checking IgA level is essential before administration. CBC, LFTs, and ESR are not
specific contraindications. If IgA is low, consider IgA-depleted IVIG or alternative
therapy.
4. A nurse is assessing a patient with suspected acute coronary syndrome (ACS). The
ECG shows ST-segment elevation in leads II, III, and aVF. Which artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
ST elevation in the inferior leads (II, III, aVF) indicates occlusion of the right coronary
artery in about 80% of cases. The left anterior descending artery supplies the anterior
wall; left circumflex supplies the lateral wall; left main occlusion causes widespread
ischemia often with cardiogenic shock.
Page 3
, 5. A patient with schizophrenia has been nonadherent to antipsychotic medication.
The nurse observes the patient staring at the ceiling, tilting the head back, and
exhibiting jerky eye movements. What is the nurse's priority action?
A. Administer diphenhydramine 50 mg intramuscularly
B. Place the patient in a quiet room with reduced stimuli
C. Assess for suicidal ideation and implement one-to-one observation
D. Administer haloperidol 5 mg intramuscularly for agitation
Answer: A. Administer diphenhydramine 50 mg intramuscularly
The symptoms describe oculogyric crisis, an acute dystonic reaction to antipsychotics.
Diphenhydramine or benztropine is the treatment. Reducing stimuli may help but does
not address the dystonia. Haloperidol would worsen the reaction. Suicidal assessment is
not indicated for this acute extrapyramidal symptom.
6. A nurse is caring for a patient with a pulmonary embolism who is receiving a
heparin infusion. The aPTT is 45 seconds (control 30 seconds). Which of the
following should the nurse do?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Administer a heparin bolus of 5000 units
C. Continue the current infusion rate
D. Stop the infusion for 1 hour and recheck aPTT
Answer: C. Continue the current infusion rate
The therapeutic aPTT range for heparin is typically 1.5-2.5 times the control (45-75
seconds). An aPTT of 45 seconds is at the lower end of therapeutic but within range. No
adjustment is needed. Increasing the rate or giving a bolus could cause bleeding.
Stopping the infusion is unnecessary.
Page 4
and Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing - Comprehensive Exit Exam
Description This exam integrates advanced nursing concepts across medical-surgical,
maternal-child, mental health, pharmacology, and leadership domains. It aligns
with NCLEX-RN test plan competencies and requires synthesis of evidence-based
practice, patient safety, and clinical judgment at the level of a graduating senior
nursing student.
Expected Grade A+
Total Questions 89
Duration 4 hours
Learning Outcomes 1. Apply clinical reasoning to prioritize nursing interventions in complex,
multi-system scenarios.
2. Interpret diagnostic data and laboratory values to guide clinical decisions.
3. Evaluate pharmacological therapies for adverse effects and patient education
needs.
4. Demonstrate leadership in delegation, conflict resolution, and ethical
decision-making.
5. Integrate evidence-based practice to improve patient outcomes across diverse
healthcare settings.
Accreditation This examination meets the rigor and standards of top-tier US nursing programs
accredited by CCNE and ACEN, reflecting the complexity of the NCLEX-RN and
HESI Exit Exam blueprint.
Page 1
,1. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
on volume-controlled ventilation. The patient's plateau pressure is 32 cm H2O,
PEEP is 10 cm H2O, and FiO2 is 0.6. Arterial blood gas shows pH 7.25, PaCO2 50
mm Hg, PaO2 60 mm Hg. Which intervention should the nurse anticipate?
A. Increase PEEP to 15 cm H2O and perform recruitment maneuvers
B. Increase FiO2 to 1.0 and administer sodium bicarbonate
C. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
D. Switch to pressure-controlled ventilation and reduce PEEP to 5 cm H2O
Answer: C. Decrease tidal volume to 4 mL/kg ideal body weight and increase
respiratory rate
The patient has ARDS with plateau pressure >30 cm H2O, indicating risk of
volutrauma. Low tidal volume ventilation (4-6 mL/kg) is the standard of care to prevent
further lung injury. Permissive hypercapnia is accepted; the pH >7.20 does not require
bicarbonate. Increasing PEEP may improve oxygenation but does not address the high
plateau pressure.
2. A patient with septic shock is receiving norepinephrine at 20 mcg/min and
vasopressin at 0.04 units/min. Mean arterial pressure (MAP) remains 58 mm Hg.
Which hemodynamic parameter should the nurse evaluate to guide further
intervention?
A. Central venous pressure (CVP)
B. Cardiac index (CI)
C. Stroke volume variation (SVV)
D. Pulmonary artery occlusion pressure (PAOP)
Answer: B. Cardiac index (CI)
In septic shock refractory to vasopressors, assessing cardiac output/index helps
determine if low MAP is due to low cardiac output or low systemic vascular resistance.
If CI is low, inotropes (e.g., dobutamine) may be added. CVP and PAOP assess preload
but are less helpful after initial resuscitation. SVV is used for fluid responsiveness, but
with ongoing vasopressors, cardiac function is key.
Page 2
,3. A nurse is preparing to administer intravenous immune globulin (IVIG) to a
patient with chronic inflammatory demyelinating polyneuropathy. Which
pre-administration assessment is most critical?
A. Serum immunoglobulin A (IgA) level
B. Complete blood count with differential
C. Liver function tests including albumin
D. Erythrocyte sedimentation rate (ESR)
Answer: A. Serum immunoglobulin A (IgA) level
IVIG can cause anaphylaxis in patients with IgA deficiency due to anti-IgA antibodies.
Checking IgA level is essential before administration. CBC, LFTs, and ESR are not
specific contraindications. If IgA is low, consider IgA-depleted IVIG or alternative
therapy.
4. A nurse is assessing a patient with suspected acute coronary syndrome (ACS). The
ECG shows ST-segment elevation in leads II, III, and aVF. Which artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
ST elevation in the inferior leads (II, III, aVF) indicates occlusion of the right coronary
artery in about 80% of cases. The left anterior descending artery supplies the anterior
wall; left circumflex supplies the lateral wall; left main occlusion causes widespread
ischemia often with cardiogenic shock.
Page 3
, 5. A patient with schizophrenia has been nonadherent to antipsychotic medication.
The nurse observes the patient staring at the ceiling, tilting the head back, and
exhibiting jerky eye movements. What is the nurse's priority action?
A. Administer diphenhydramine 50 mg intramuscularly
B. Place the patient in a quiet room with reduced stimuli
C. Assess for suicidal ideation and implement one-to-one observation
D. Administer haloperidol 5 mg intramuscularly for agitation
Answer: A. Administer diphenhydramine 50 mg intramuscularly
The symptoms describe oculogyric crisis, an acute dystonic reaction to antipsychotics.
Diphenhydramine or benztropine is the treatment. Reducing stimuli may help but does
not address the dystonia. Haloperidol would worsen the reaction. Suicidal assessment is
not indicated for this acute extrapyramidal symptom.
6. A nurse is caring for a patient with a pulmonary embolism who is receiving a
heparin infusion. The aPTT is 45 seconds (control 30 seconds). Which of the
following should the nurse do?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Administer a heparin bolus of 5000 units
C. Continue the current infusion rate
D. Stop the infusion for 1 hour and recheck aPTT
Answer: C. Continue the current infusion rate
The therapeutic aPTT range for heparin is typically 1.5-2.5 times the control (45-75
seconds). An aPTT of 45 seconds is at the lower end of therapeutic but within range. No
adjustment is needed. Increasing the rate or giving a bolus could cause bleeding.
Stopping the infusion is unnecessary.
Page 4
