[HESI EXIT REAL EXAM] – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
*Core Domains*
*- Medical-Surgical Nursing*
*- Pediatric Nursing*
*- Maternity and Newborn Nursing*
*- Psychiatric and Mental Health Nursing*
*- Pharmacology and Pathophysiology*
*- Leadership and Management*
*- Community and Public Health*
*- Fundamental Nursing Skills*
*Introduction*
*The HESI Exit Exam is a comprehensive assessment designed to evaluate the
readiness of nursing students for licensure. This examination assesses the application of
clinical knowledge, critical thinking, and decision-making skills across all core nursing
specialties. The structure consists of multiple-choice and scenario-based questions that
mimic the complexity of the NCLEX-RN. By focusing on real-world clinical application,
evidence-based practice, and safe nursing care, this assessment ensures that candidates can
effectively manage patient outcomes, prioritize care in high-pressure situations, and
maintain adherence to professional, legal, and ethical standards required in the healthcare
environment.*
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client with heart failure who suddenly develops dyspnea and
pink frothy sputum. Which action should the nurse take first? A. Administer a PRN
dose of morphine. B. Obtain a chest X-ray. C. Elevate the head of the bed to a high-
Fowler's position. D. Notify the healthcare provider.
C. Elevate the head of the bed to a high-Fowler's position. Explanation: The client is
exhibiting signs of acute pulmonary edema. The immediate priority is to improve
oxygenation and reduce venous return by placing the client in an upright position.
2. A client diagnosed with type 1 diabetes mellitus is found unconscious and
unresponsive. Which action is the priority? A. Administer subcutaneous insulin. B.
, Check the client's blood glucose level. C. Assess for a patent airway. D. Administer
intramuscular glucagon.
C. Assess for a patent airway. Explanation: The ABCs (Airway, Breathing, Circulation)
always take priority. Ensuring a patent airway is the first step in managing an unresponsive
patient.
3. A nurse is reviewing discharge instructions for a client with hypertension. Which
dietary change should the nurse emphasize? A. Increasing intake of potassium-rich
foods. B. Restricting sodium intake to 2,000 mg per day. C. Incorporating high-fat
dairy products. D. Eliminating all forms of carbohydrates.
B. Restricting sodium intake to 2,000 mg per day. Explanation: Sodium restriction is a
primary non-pharmacological intervention for managing hypertension, as excessive sodium
leads to fluid retention and increased blood pressure.
4. A psychiatric client diagnosed with schizophrenia is experiencing auditory
hallucinations. Which response by the nurse is therapeutic? A. "I hear what you are
hearing, and it is not real." B. "Why are you listening to those voices?" C. "I
understand that you are hearing voices, but I do not hear them." D. "You need to
ignore the voices so we can focus on our conversation."
C. I understand that you are hearing voices, but I do not hear them. Explanation: This
response acknowledges the client’s reality without validating the hallucination, establishing
trust while maintaining professional boundaries.
5. A nurse is assessing a newborn and notes a bluish discoloration of the hands and
feet. Which action is appropriate? A. Immediately notify the neonatal intensive care
unit. B. Administer oxygen via a nasal cannula. C. Document the finding as
acrocyanosis and monitor. D. Check the infant’s blood glucose levels.
C. Document the finding as acrocyanosis and monitor. Explanation: Acrocyanosis is a
normal finding in newborns due to immature peripheral circulation and usually resolves
shortly after birth.
6. A client is receiving an IV infusion of vancomycin. The client develops a red rash on
the face and neck. What should the nurse do first? A. Increase the infusion rate. B.
Stop the infusion. C. Administer diphenhydramine. D. Document the reaction as an
allergy.
B. Stop the infusion. Explanation: The client is likely experiencing "Red Man
Syndrome," a reaction to a rapid infusion of vancomycin. The infusion must be stopped
immediately to prevent further reaction.
7. Which finding in a client with a chest tube should be reported to the provider
immediately? A. Continuous bubbling in the water-seal chamber. B. 100 mL of
, serosanguinous drainage in the collection chamber. C. Fluctuations in the water-seal
chamber with respiration. D. Minimal drainage from the site.
A. Continuous bubbling in the water-seal chamber. Explanation: Continuous bubbling
in the water-seal chamber indicates an air leak in the system, which requires immediate
intervention.
8. A nurse is caring for a client with a spinal cord injury at the T4 level. The client
reports a pounding headache and profuse sweating. What is the priority assessment?
A. Check the blood pressure. B. Assess the level of consciousness. C. Inspect the skin
for pressure ulcers. D. Review the medication administration record.
A. Check the blood pressure. Explanation: Symptoms indicate autonomic dysreflexia,
a medical emergency characterized by severe hypertension triggered by a noxious stimulus
below the level of the injury.
9. Which precaution should the nurse implement for a client with suspected
meningitis? A. Airborne precautions. B. Droplet precautions. C. Contact precautions.
D. Standard precautions only.
B. Droplet precautions. Explanation: Meningitis caused by Neisseria meningitidis is
spread via respiratory droplets; therefore, droplet precautions are required for 24 hours
after the initiation of antibiotic therapy.
10. A nurse is teaching a client about the use of an incentive spirometer. Which
instruction is correct? A. Exhale forcefully into the device. B. Seal lips tightly around
the mouthpiece and inhale slowly. C. Use the device once a day. D. Sit in a supine
position while using the device.
B. Seal lips tightly around the mouthpiece and inhale slowly. Explanation: Proper use
of an incentive spirometer requires slow, sustained inhalation to expand the alveoli and
prevent atelectasis.
11. A client with liver cirrhosis exhibits signs of hepatic encephalopathy, including
confusion and asterixis. Which medication does the nurse expect to administer? A.
Lactulose. B. Furosemide. C. Spironolactone. D. Acetaminophen.
A. Lactulose. Explanation: Lactulose is used to reduce ammonia levels in the blood,
which is the causative factor for hepatic encephalopathy in liver failure.
12. A nurse is caring for a client who is terminally ill. The family expresses frustration
regarding the client's care. What is the most appropriate action by the nurse? A. Ask
the family to leave the room. B. Use active listening to allow the family to express
their feelings. C. Explain the facility's policies on end-of-life care. D. Refer the family
to the facility chaplain.
, B. Use active listening to allow the family to express their feelings. Explanation:
Therapeutic communication involves allowing the family to vent their emotions, which is an
important aspect of providing compassionate end-of-life care.
13. A client with deep vein thrombosis (DVT) is prescribed heparin therapy. The nurse
should prioritize monitoring for: A. Increased blood pressure. B. Signs of bleeding. C.
Increased peripheral pulses. D. Urinary output.
B. Signs of bleeding. Explanation: Heparin is an anticoagulant that increases the risk
of hemorrhage; therefore, monitoring for signs of bleeding is the safety priority.
14. A nurse is preparing to administer digoxin to a client. Which assessment finding
requires holding the dose? A. Potassium level of 4.5 mEq/L. B. Apical heart rate of 52
beats per minute. C. Blood pressure of 130/80 mmHg. D. Client reports seeing yellow
halos.
B. Apical heart rate of 52 beats per minute. Explanation: Digoxin should generally be
held if the heart rate is below 60 beats per minute in an adult, as it has negative
chronotropic effects.
15. A client is prescribed phenytoin for seizure control. What is a key side effect the
nurse should teach the client to monitor for? A. Gingival hyperplasia. B.
Photosensitivity. C. Weight gain. D. Increased hair growth.
A. Gingival hyperplasia. Explanation: Gingival hyperplasia (overgrowth of gum tissue)
is a common side effect of phenytoin, necessitating excellent oral hygiene and regular dental
checkups.
16. A nurse is reviewing a care plan for a client with anorexia nervosa. Which
intervention is most appropriate? A. Allow the client to choose all meal times. B.
Provide small, frequent meals and supervise during eating. C. Focus on physical
appearance in daily conversations. D. Encourage heavy exercise to stimulate appetite.
B. Provide small, frequent meals and supervise during eating. Explanation:
Supervision during and after meals is necessary to prevent the disposal of food or self-
induced vomiting in clients with eating disorders.
17. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which flow rate is typically recommended to avoid suppressing the hypoxic
drive? A. 1–3 L/min via nasal cannula. B. 6–8 L/min via simple face mask. C. 10–12
L/min via non-rebreather mask. D. 15 L/min via high-flow system.
A. 1–3 L/min via nasal cannula. Explanation: Clients with COPD often rely on a
hypoxic drive to breathe. Low-flow oxygen is essential to provide oxygenation without
suppressing the respiratory drive.
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
*Core Domains*
*- Medical-Surgical Nursing*
*- Pediatric Nursing*
*- Maternity and Newborn Nursing*
*- Psychiatric and Mental Health Nursing*
*- Pharmacology and Pathophysiology*
*- Leadership and Management*
*- Community and Public Health*
*- Fundamental Nursing Skills*
*Introduction*
*The HESI Exit Exam is a comprehensive assessment designed to evaluate the
readiness of nursing students for licensure. This examination assesses the application of
clinical knowledge, critical thinking, and decision-making skills across all core nursing
specialties. The structure consists of multiple-choice and scenario-based questions that
mimic the complexity of the NCLEX-RN. By focusing on real-world clinical application,
evidence-based practice, and safe nursing care, this assessment ensures that candidates can
effectively manage patient outcomes, prioritize care in high-pressure situations, and
maintain adherence to professional, legal, and ethical standards required in the healthcare
environment.*
SECTION ONE: QUESTIONS 1–100
1. A nurse is caring for a client with heart failure who suddenly develops dyspnea and
pink frothy sputum. Which action should the nurse take first? A. Administer a PRN
dose of morphine. B. Obtain a chest X-ray. C. Elevate the head of the bed to a high-
Fowler's position. D. Notify the healthcare provider.
C. Elevate the head of the bed to a high-Fowler's position. Explanation: The client is
exhibiting signs of acute pulmonary edema. The immediate priority is to improve
oxygenation and reduce venous return by placing the client in an upright position.
2. A client diagnosed with type 1 diabetes mellitus is found unconscious and
unresponsive. Which action is the priority? A. Administer subcutaneous insulin. B.
, Check the client's blood glucose level. C. Assess for a patent airway. D. Administer
intramuscular glucagon.
C. Assess for a patent airway. Explanation: The ABCs (Airway, Breathing, Circulation)
always take priority. Ensuring a patent airway is the first step in managing an unresponsive
patient.
3. A nurse is reviewing discharge instructions for a client with hypertension. Which
dietary change should the nurse emphasize? A. Increasing intake of potassium-rich
foods. B. Restricting sodium intake to 2,000 mg per day. C. Incorporating high-fat
dairy products. D. Eliminating all forms of carbohydrates.
B. Restricting sodium intake to 2,000 mg per day. Explanation: Sodium restriction is a
primary non-pharmacological intervention for managing hypertension, as excessive sodium
leads to fluid retention and increased blood pressure.
4. A psychiatric client diagnosed with schizophrenia is experiencing auditory
hallucinations. Which response by the nurse is therapeutic? A. "I hear what you are
hearing, and it is not real." B. "Why are you listening to those voices?" C. "I
understand that you are hearing voices, but I do not hear them." D. "You need to
ignore the voices so we can focus on our conversation."
C. I understand that you are hearing voices, but I do not hear them. Explanation: This
response acknowledges the client’s reality without validating the hallucination, establishing
trust while maintaining professional boundaries.
5. A nurse is assessing a newborn and notes a bluish discoloration of the hands and
feet. Which action is appropriate? A. Immediately notify the neonatal intensive care
unit. B. Administer oxygen via a nasal cannula. C. Document the finding as
acrocyanosis and monitor. D. Check the infant’s blood glucose levels.
C. Document the finding as acrocyanosis and monitor. Explanation: Acrocyanosis is a
normal finding in newborns due to immature peripheral circulation and usually resolves
shortly after birth.
6. A client is receiving an IV infusion of vancomycin. The client develops a red rash on
the face and neck. What should the nurse do first? A. Increase the infusion rate. B.
Stop the infusion. C. Administer diphenhydramine. D. Document the reaction as an
allergy.
B. Stop the infusion. Explanation: The client is likely experiencing "Red Man
Syndrome," a reaction to a rapid infusion of vancomycin. The infusion must be stopped
immediately to prevent further reaction.
7. Which finding in a client with a chest tube should be reported to the provider
immediately? A. Continuous bubbling in the water-seal chamber. B. 100 mL of
, serosanguinous drainage in the collection chamber. C. Fluctuations in the water-seal
chamber with respiration. D. Minimal drainage from the site.
A. Continuous bubbling in the water-seal chamber. Explanation: Continuous bubbling
in the water-seal chamber indicates an air leak in the system, which requires immediate
intervention.
8. A nurse is caring for a client with a spinal cord injury at the T4 level. The client
reports a pounding headache and profuse sweating. What is the priority assessment?
A. Check the blood pressure. B. Assess the level of consciousness. C. Inspect the skin
for pressure ulcers. D. Review the medication administration record.
A. Check the blood pressure. Explanation: Symptoms indicate autonomic dysreflexia,
a medical emergency characterized by severe hypertension triggered by a noxious stimulus
below the level of the injury.
9. Which precaution should the nurse implement for a client with suspected
meningitis? A. Airborne precautions. B. Droplet precautions. C. Contact precautions.
D. Standard precautions only.
B. Droplet precautions. Explanation: Meningitis caused by Neisseria meningitidis is
spread via respiratory droplets; therefore, droplet precautions are required for 24 hours
after the initiation of antibiotic therapy.
10. A nurse is teaching a client about the use of an incentive spirometer. Which
instruction is correct? A. Exhale forcefully into the device. B. Seal lips tightly around
the mouthpiece and inhale slowly. C. Use the device once a day. D. Sit in a supine
position while using the device.
B. Seal lips tightly around the mouthpiece and inhale slowly. Explanation: Proper use
of an incentive spirometer requires slow, sustained inhalation to expand the alveoli and
prevent atelectasis.
11. A client with liver cirrhosis exhibits signs of hepatic encephalopathy, including
confusion and asterixis. Which medication does the nurse expect to administer? A.
Lactulose. B. Furosemide. C. Spironolactone. D. Acetaminophen.
A. Lactulose. Explanation: Lactulose is used to reduce ammonia levels in the blood,
which is the causative factor for hepatic encephalopathy in liver failure.
12. A nurse is caring for a client who is terminally ill. The family expresses frustration
regarding the client's care. What is the most appropriate action by the nurse? A. Ask
the family to leave the room. B. Use active listening to allow the family to express
their feelings. C. Explain the facility's policies on end-of-life care. D. Refer the family
to the facility chaplain.
, B. Use active listening to allow the family to express their feelings. Explanation:
Therapeutic communication involves allowing the family to vent their emotions, which is an
important aspect of providing compassionate end-of-life care.
13. A client with deep vein thrombosis (DVT) is prescribed heparin therapy. The nurse
should prioritize monitoring for: A. Increased blood pressure. B. Signs of bleeding. C.
Increased peripheral pulses. D. Urinary output.
B. Signs of bleeding. Explanation: Heparin is an anticoagulant that increases the risk
of hemorrhage; therefore, monitoring for signs of bleeding is the safety priority.
14. A nurse is preparing to administer digoxin to a client. Which assessment finding
requires holding the dose? A. Potassium level of 4.5 mEq/L. B. Apical heart rate of 52
beats per minute. C. Blood pressure of 130/80 mmHg. D. Client reports seeing yellow
halos.
B. Apical heart rate of 52 beats per minute. Explanation: Digoxin should generally be
held if the heart rate is below 60 beats per minute in an adult, as it has negative
chronotropic effects.
15. A client is prescribed phenytoin for seizure control. What is a key side effect the
nurse should teach the client to monitor for? A. Gingival hyperplasia. B.
Photosensitivity. C. Weight gain. D. Increased hair growth.
A. Gingival hyperplasia. Explanation: Gingival hyperplasia (overgrowth of gum tissue)
is a common side effect of phenytoin, necessitating excellent oral hygiene and regular dental
checkups.
16. A nurse is reviewing a care plan for a client with anorexia nervosa. Which
intervention is most appropriate? A. Allow the client to choose all meal times. B.
Provide small, frequent meals and supervise during eating. C. Focus on physical
appearance in daily conversations. D. Encourage heavy exercise to stimulate appetite.
B. Provide small, frequent meals and supervise during eating. Explanation:
Supervision during and after meals is necessary to prevent the disposal of food or self-
induced vomiting in clients with eating disorders.
17. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
therapy. Which flow rate is typically recommended to avoid suppressing the hypoxic
drive? A. 1–3 L/min via nasal cannula. B. 6–8 L/min via simple face mask. C. 10–12
L/min via non-rebreather mask. D. 15 L/min via high-flow system.
A. 1–3 L/min via nasal cannula. Explanation: Clients with COPD often rely on a
hypoxic drive to breathe. Low-flow oxygen is essential to provide oxygenation without
suppressing the respiratory drive.
