HESI V2 Exit Exam Actual 2026/2027
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview
This actual examination reflects the comprehensive nursing knowledge required for success on the HESI
V2 Exit Exam. It is designed to evaluate the student's ability to apply clinical judgment, prioritize patient
care, and demonstrate competency across all major nursing content areas. Questions are structured to
assess recall of nursing concepts, application of clinical reasoning to patient scenarios, and analysis of
complex patient presentations. This authentic question bank represents the real exams used in the
course and serves as a comprehensive resource for students demonstrating readiness for the HESI Exit
Exam and NCLEX-RN.
SECTION I: Medical-Surgical Nursing (20 Questions)
Q1. A patient with heart failure is receiving furosemide 40 mg IV daily. The nurse notes a potassium level
of 2.8 mEq/L. Which action should the nurse take first?
A. Hold the next dose of furosemide and notify the provider [CORRECT]
B. Administer the furosemide as scheduled
C. Increase the patient's fluid intake
D. Obtain a repeat potassium level in 24 hours
The best answer is A. A potassium of 2.8 mEq/L is critically low and places the patient at risk for life-
threatening cardiac arrhythmias; furosemide is a potassium-wasting diuretic that will worsen the
hypokalemia, so the dose must be held and the provider notified immediately for potassium
replacement orders. This aligns with HESI/NCLEX standards for patient safety and medication
management, where addressing life-threatening electrolyte imbalances takes priority over routine
medication administration.
Correct Answer: A
,Q2. A patient post-op day 2 after abdominal surgery reports sudden onset of dyspnea, tachycardia, and
pleuritic chest pain. Vital signs: HR 118, RR 28, BP 92/58, SpO2 88% on room air. The nurse recognizes
these findings as most consistent with:
A. Atelectasis
B. Pulmonary embolism [CORRECT]
C. Pneumonia
D. Hypovolemic shock
This choice is correct because the sudden onset of dyspnea, pleuritic chest pain, tachycardia,
hypotension, and hypoxemia in a postoperative patient is the classic presentation of pulmonary
embolism, a potentially fatal complication of immobility and surgery. This aligns with HESI/NCLEX
standards for recognizing postoperative complications, where pulmonary embolism requires immediate
intervention including oxygen, anticoagulation, and notification of the rapid response team.
Correct Answer: B
Q3. A patient with type 2 diabetes has a fasting blood glucose of 248 mg/dL. The nurse is preparing to
administer regular insulin per sliding scale. Before administering insulin, the nurse should:
A. Administer the insulin immediately
B. Verify the blood glucose with the patient's glucometer and confirm the insulin dose [CORRECT]
C. Wait one hour and recheck the glucose
D. Give the patient orange juice first
The best answer is B. The nurse must verify the blood glucose reading and confirm the correct insulin
dose according to the sliding scale protocol before administration; this is a critical safety check that
prevents insulin errors, which can cause severe hypoglycemia or hyperglycemia. This aligns with
HESI/NCLEX standards for medication administration safety, where the six rights of medication
administration and independent double-checks for high-alert medications like insulin are non-
negotiable.
Correct Answer: B
Q4. A patient with cirrhosis develops increasing abdominal girth, dyspnea, and decreased urine output.
The nurse notes a serum albumin of 2.1 g/dL and total bilirubin of 8.4 mg/dL. Which nursing
intervention is the priority?
A. Administer a laxative
B. Monitor intake and output, measure abdominal girth daily, and assess respiratory status [CORRECT]
,C. Encourage a high-sodium diet
D. Restrict all protein intake
This choice is correct because this patient has worsening ascites from portal hypertension and
hypoalbuminemia, which can compromise respiratory function and indicates deteriorating liver
function; careful monitoring of fluid status, abdominal girth, and respiratory status is essential while
awaiting provider orders for diuretics, paracentesis, or albumin replacement. This aligns with
HESI/NCLEX standards for prioritizing care in patients with decompensated cirrhosis, where respiratory
compromise from ascites is a life-threatening concern.
Correct Answer: B
Q5. A patient with a newly placed tracheostomy develops subcutaneous emphysema around the neck
and chest. The nurse's priority action is to:
A. Suction the tracheostomy tube
B. Assess tube placement and notify the provider immediately, as this may indicate tracheal perforation
or dislodgement [CORRECT]
C. Apply a tight dressing around the stoma
D. Administer oxygen via nasal cannula
The best answer is B. Subcutaneous emphysema after tracheostomy placement is a serious finding that
may indicate tracheal perforation, tube dislodgement into the pretracheal space, or cuff leak;
immediate assessment of tube position, cuff integrity, and breath sounds is essential, with provider
notification for further evaluation and possible tube replacement. This aligns with HESI/NCLEX standards
for airway management, where any sign of tracheostomy complication requires immediate assessment
and intervention to maintain the airway.
Correct Answer: B
Q6. A patient with a stroke has left-sided hemiparesis and dysphagia. The nurse is preparing to
administer oral medications. Which action is most appropriate?
A. Crush all medications and mix with water
B. Verify that a swallowing evaluation has been completed and follow the recommended consistency
and positioning [CORRECT]
C. Place the patient supine for medication administration
D. Administer medications with a straw
This choice is correct because patients with dysphagia require a formal swallowing evaluation before
any oral intake, and medications must be administered according to the prescribed consistency (thin
, liquid, nectar-thick, honey-thick, or pudding) with the patient upright at 90 degrees to prevent
aspiration. This aligns with HESI/NCLEX standards for stroke care, where aspiration prevention is a
critical nursing responsibility, and crushing certain medications or using straws can increase aspiration
risk.
Correct Answer: B
Q7. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The patient becomes drowsy
and the respiratory rate drops from 24 to 10 breaths per minute. The nurse should:
A. Increase the oxygen flow to 6 L/min
B. Decrease the oxygen flow and notify the provider, as the patient may be experiencing CO2 narcosis
[CORRECT]
C. Administer a sedative
D. Place the patient in a supine position
The best answer is B. Patients with COPD who are chronic CO2 retainers depend on hypoxic drive to
stimulate breathing; excessive oxygen administration can suppress this drive, causing CO2 narcosis with
respiratory depression, confusion, and acidosis. This aligns with HESI/NCLEX standards for respiratory
nursing care, where oxygen titration in COPD patients must balance hypoxemia correction against the
risk of CO2 retention, and any change in mental status or respiratory pattern warrants immediate
reassessment.
Correct Answer: B
Q8. A patient with a total hip replacement is post-op day 1. Which position should the nurse avoid?
A. Supine with a pillow under the knee
B. Side-lying with a pillow between the legs
C. Sitting in a chair with hips flexed less than 90 degrees
D. Hip flexion beyond 90 degrees, adduction past midline, and internal rotation [CORRECT]
This choice is correct because posterior hip precautions after total hip arthroplasty prohibit hip flexion
greater than 90 degrees, adduction past the body's midline, and internal rotation to prevent posterior
dislocation of the prosthetic femoral head from the acetabular component. This aligns with HESI/NCLEX
standards for orthopedic nursing, where understanding and enforcing hip precautions is essential for
preventing dislocation, which is a serious complication requiring closed reduction or revision surgery.
Correct Answer: D
100% Verified | Detailed Rationales –
Pass Guaranteed – A+ Graded
Content Area Overview
This actual examination reflects the comprehensive nursing knowledge required for success on the HESI
V2 Exit Exam. It is designed to evaluate the student's ability to apply clinical judgment, prioritize patient
care, and demonstrate competency across all major nursing content areas. Questions are structured to
assess recall of nursing concepts, application of clinical reasoning to patient scenarios, and analysis of
complex patient presentations. This authentic question bank represents the real exams used in the
course and serves as a comprehensive resource for students demonstrating readiness for the HESI Exit
Exam and NCLEX-RN.
SECTION I: Medical-Surgical Nursing (20 Questions)
Q1. A patient with heart failure is receiving furosemide 40 mg IV daily. The nurse notes a potassium level
of 2.8 mEq/L. Which action should the nurse take first?
A. Hold the next dose of furosemide and notify the provider [CORRECT]
B. Administer the furosemide as scheduled
C. Increase the patient's fluid intake
D. Obtain a repeat potassium level in 24 hours
The best answer is A. A potassium of 2.8 mEq/L is critically low and places the patient at risk for life-
threatening cardiac arrhythmias; furosemide is a potassium-wasting diuretic that will worsen the
hypokalemia, so the dose must be held and the provider notified immediately for potassium
replacement orders. This aligns with HESI/NCLEX standards for patient safety and medication
management, where addressing life-threatening electrolyte imbalances takes priority over routine
medication administration.
Correct Answer: A
,Q2. A patient post-op day 2 after abdominal surgery reports sudden onset of dyspnea, tachycardia, and
pleuritic chest pain. Vital signs: HR 118, RR 28, BP 92/58, SpO2 88% on room air. The nurse recognizes
these findings as most consistent with:
A. Atelectasis
B. Pulmonary embolism [CORRECT]
C. Pneumonia
D. Hypovolemic shock
This choice is correct because the sudden onset of dyspnea, pleuritic chest pain, tachycardia,
hypotension, and hypoxemia in a postoperative patient is the classic presentation of pulmonary
embolism, a potentially fatal complication of immobility and surgery. This aligns with HESI/NCLEX
standards for recognizing postoperative complications, where pulmonary embolism requires immediate
intervention including oxygen, anticoagulation, and notification of the rapid response team.
Correct Answer: B
Q3. A patient with type 2 diabetes has a fasting blood glucose of 248 mg/dL. The nurse is preparing to
administer regular insulin per sliding scale. Before administering insulin, the nurse should:
A. Administer the insulin immediately
B. Verify the blood glucose with the patient's glucometer and confirm the insulin dose [CORRECT]
C. Wait one hour and recheck the glucose
D. Give the patient orange juice first
The best answer is B. The nurse must verify the blood glucose reading and confirm the correct insulin
dose according to the sliding scale protocol before administration; this is a critical safety check that
prevents insulin errors, which can cause severe hypoglycemia or hyperglycemia. This aligns with
HESI/NCLEX standards for medication administration safety, where the six rights of medication
administration and independent double-checks for high-alert medications like insulin are non-
negotiable.
Correct Answer: B
Q4. A patient with cirrhosis develops increasing abdominal girth, dyspnea, and decreased urine output.
The nurse notes a serum albumin of 2.1 g/dL and total bilirubin of 8.4 mg/dL. Which nursing
intervention is the priority?
A. Administer a laxative
B. Monitor intake and output, measure abdominal girth daily, and assess respiratory status [CORRECT]
,C. Encourage a high-sodium diet
D. Restrict all protein intake
This choice is correct because this patient has worsening ascites from portal hypertension and
hypoalbuminemia, which can compromise respiratory function and indicates deteriorating liver
function; careful monitoring of fluid status, abdominal girth, and respiratory status is essential while
awaiting provider orders for diuretics, paracentesis, or albumin replacement. This aligns with
HESI/NCLEX standards for prioritizing care in patients with decompensated cirrhosis, where respiratory
compromise from ascites is a life-threatening concern.
Correct Answer: B
Q5. A patient with a newly placed tracheostomy develops subcutaneous emphysema around the neck
and chest. The nurse's priority action is to:
A. Suction the tracheostomy tube
B. Assess tube placement and notify the provider immediately, as this may indicate tracheal perforation
or dislodgement [CORRECT]
C. Apply a tight dressing around the stoma
D. Administer oxygen via nasal cannula
The best answer is B. Subcutaneous emphysema after tracheostomy placement is a serious finding that
may indicate tracheal perforation, tube dislodgement into the pretracheal space, or cuff leak;
immediate assessment of tube position, cuff integrity, and breath sounds is essential, with provider
notification for further evaluation and possible tube replacement. This aligns with HESI/NCLEX standards
for airway management, where any sign of tracheostomy complication requires immediate assessment
and intervention to maintain the airway.
Correct Answer: B
Q6. A patient with a stroke has left-sided hemiparesis and dysphagia. The nurse is preparing to
administer oral medications. Which action is most appropriate?
A. Crush all medications and mix with water
B. Verify that a swallowing evaluation has been completed and follow the recommended consistency
and positioning [CORRECT]
C. Place the patient supine for medication administration
D. Administer medications with a straw
This choice is correct because patients with dysphagia require a formal swallowing evaluation before
any oral intake, and medications must be administered according to the prescribed consistency (thin
, liquid, nectar-thick, honey-thick, or pudding) with the patient upright at 90 degrees to prevent
aspiration. This aligns with HESI/NCLEX standards for stroke care, where aspiration prevention is a
critical nursing responsibility, and crushing certain medications or using straws can increase aspiration
risk.
Correct Answer: B
Q7. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. The patient becomes drowsy
and the respiratory rate drops from 24 to 10 breaths per minute. The nurse should:
A. Increase the oxygen flow to 6 L/min
B. Decrease the oxygen flow and notify the provider, as the patient may be experiencing CO2 narcosis
[CORRECT]
C. Administer a sedative
D. Place the patient in a supine position
The best answer is B. Patients with COPD who are chronic CO2 retainers depend on hypoxic drive to
stimulate breathing; excessive oxygen administration can suppress this drive, causing CO2 narcosis with
respiratory depression, confusion, and acidosis. This aligns with HESI/NCLEX standards for respiratory
nursing care, where oxygen titration in COPD patients must balance hypoxemia correction against the
risk of CO2 retention, and any change in mental status or respiratory pattern warrants immediate
reassessment.
Correct Answer: B
Q8. A patient with a total hip replacement is post-op day 1. Which position should the nurse avoid?
A. Supine with a pillow under the knee
B. Side-lying with a pillow between the legs
C. Sitting in a chair with hips flexed less than 90 degrees
D. Hip flexion beyond 90 degrees, adduction past midline, and internal rotation [CORRECT]
This choice is correct because posterior hip precautions after total hip arthroplasty prohibit hip flexion
greater than 90 degrees, adduction past the body's midline, and internal rotation to prevent posterior
dislocation of the prosthetic femoral head from the acetabular component. This aligns with HESI/NCLEX
standards for orthopedic nursing, where understanding and enforcing hip precautions is essential for
preventing dislocation, which is a serious complication requiring closed reduction or revision surgery.
Correct Answer: D
