HESI Exit RN Exam 700+ Questions, and
Rationales | Comprehensive Review Guide
PRIORITIZATION, DELEGATION, & LEADERSHIP
1. The nurse receives shift report on 4 clients. Which client should be assessed
first?
• A. Client with heart failure and crackles in mid-lung fields
• B. Client with diabetes mellitus, blood glucose 180 mg/dL
• C. Client with a tracheostomy and oxygen saturation of 86%
• D. Client with appendicitis, temperature of 100.4°F (38°C)
Correct Answer: C
Rationale: Oxygen saturation of 86% indicates severe hypoxemia and requires
immediate intervention per the ABC (Airway, Breathing, Circulation) priority
framework .
2. A nurse is preparing to delegate tasks to an unlicensed assistive personnel
(UAP). Which task is appropriate for the nurse to delegate?
• A. Assessing a client's pain level
• B. Administering oral medications
• C. Ambulating a stable client
• D. Evaluating the effectiveness of pain medication
Correct Answer: C
Rationale: Delegation follows the "Five Rights": right task, right circumstance,
right person, right direction/communication, and right supervision. UAP can
ambulate stable clients and assist with activities of daily living. Assessment,
medication administration, and evaluation are the responsibility of the licensed
nurse .
,3. The charge nurse is making assignments for one practical nurse (PN) and three
registered nurses (RNs). Which client is best to assign to the PN?
• A. Subdural hematoma with BP changed from 150/80 to 170/60
• B. Viral meningitis with temperature changed from 101.5°F to 102°F
• C. Diabetic ketoacidosis with GCS changed from 10 to 7
• D. Myxedema with BP changed from 80/50 to 70/40
Correct Answer: B
Rationale: A PN can monitor a slight temperature increase in viral meningitis. The
more critical changes (large BP shifts, significant drop in GCS) require an RN's
advanced assessment and potential immediate intervention .
4. An older adult client is brought to the ED with sudden confusion after a fall.
Which information should the nurse provide first when reporting to the
healthcare provider using SBAR?
• A. List of all home medications
• B. History of previous falls
• C. Increasing confusion of the client
• D. Daughter's contact information
Correct Answer: C
Rationale: In SBAR communication, the "S" (Situation) should include the most
pressing current concern. The acute change in mental status is the priority finding
requiring immediate provider attention .
5. A client with a do-not-resuscitate (DNR) order goes into cardiac arrest. The
nurse should:
• A. Begin CPR immediately
• B. Verify the DNR order and comfort the family
• C. Call a code blue
, • D. Ask the family for permission to withhold CPR
Correct Answer: B
Rationale: A valid DNR order means CPR should not be initiated. The nurse should
verify the order and provide comfort care to the client and family .
6. Which client should be assigned to the most experienced nurse?
• A. Client with chest tube drainage system that is bubbling continuously
• B. Client requiring a blood transfusion
• C. Client with diabetes requiring insulin administration
• D. Client with a nasogastric tube for decompression
Correct Answer: A
Rationale: Continuous bubbling in a chest tube system indicates an air leak
requiring advanced assessment and intervention skills. Blood transfusions, insulin
administration, and NG tube care can be managed by less experienced nurses .
7. A nurse is caring for a client who has a new prescription for wrist restraints.
Which action is most important?
• A. Document the reason for restraint use
• B. Tie the restraints to the bed frame (not side rail)
• C. Remove restraints every 4 hours for range of motion
• D. Obtain a PRN order for restraints
Correct Answer: B
Rationale: Restraints must be tied to the bed frame (not side rails) to prevent
injury if the side rail is lowered. Restraints should be removed every 2 hours for
range of motion, and a PRN order is never appropriate .
MEDICAL-SURGICAL NURSING
, 8. A patient has serum potassium of 6.2 mEq/L. Which intervention is MOST
important?
• A. Administer potassium supplement
• B. Restrict potassium and monitor for arrhythmias
• C. Give sodium supplement
• D. Increase potassium intake
Correct Answer: B
Rationale: Potassium 6.2 mEq/L indicates hyperkalemia (normal 3.5–5.0) with risk
of cardiac arrhythmias. Interventions include potassium restriction,
insulin/glucose, Kayexalate, or dialysis; monitor EKG for peaked T waves .
9. A patient has sodium level of 152 mEq/L. What is the priority nursing action?
• A. Administer sodium supplement
• B. Restrict fluids and monitor neuro status
• C. Give potassium
• D. Encourage fluid intake
Correct Answer: D
Rationale: Sodium 152 mEq/L indicates hypernatremia (normal 135–145) caused
by fluid deficit. The priority is to encourage fluid intake and monitor neuro status .
10. Which lab value is most specific for myocardial injury?
• A. WBC
• B. Troponin
• C. Hemoglobin
• D. Sodium
Correct Answer: B
Rationale: Troponin is the most specific and sensitive cardiac marker for
myocardial injury. WBC may be elevated but is nonspecific .
Rationales | Comprehensive Review Guide
PRIORITIZATION, DELEGATION, & LEADERSHIP
1. The nurse receives shift report on 4 clients. Which client should be assessed
first?
• A. Client with heart failure and crackles in mid-lung fields
• B. Client with diabetes mellitus, blood glucose 180 mg/dL
• C. Client with a tracheostomy and oxygen saturation of 86%
• D. Client with appendicitis, temperature of 100.4°F (38°C)
Correct Answer: C
Rationale: Oxygen saturation of 86% indicates severe hypoxemia and requires
immediate intervention per the ABC (Airway, Breathing, Circulation) priority
framework .
2. A nurse is preparing to delegate tasks to an unlicensed assistive personnel
(UAP). Which task is appropriate for the nurse to delegate?
• A. Assessing a client's pain level
• B. Administering oral medications
• C. Ambulating a stable client
• D. Evaluating the effectiveness of pain medication
Correct Answer: C
Rationale: Delegation follows the "Five Rights": right task, right circumstance,
right person, right direction/communication, and right supervision. UAP can
ambulate stable clients and assist with activities of daily living. Assessment,
medication administration, and evaluation are the responsibility of the licensed
nurse .
,3. The charge nurse is making assignments for one practical nurse (PN) and three
registered nurses (RNs). Which client is best to assign to the PN?
• A. Subdural hematoma with BP changed from 150/80 to 170/60
• B. Viral meningitis with temperature changed from 101.5°F to 102°F
• C. Diabetic ketoacidosis with GCS changed from 10 to 7
• D. Myxedema with BP changed from 80/50 to 70/40
Correct Answer: B
Rationale: A PN can monitor a slight temperature increase in viral meningitis. The
more critical changes (large BP shifts, significant drop in GCS) require an RN's
advanced assessment and potential immediate intervention .
4. An older adult client is brought to the ED with sudden confusion after a fall.
Which information should the nurse provide first when reporting to the
healthcare provider using SBAR?
• A. List of all home medications
• B. History of previous falls
• C. Increasing confusion of the client
• D. Daughter's contact information
Correct Answer: C
Rationale: In SBAR communication, the "S" (Situation) should include the most
pressing current concern. The acute change in mental status is the priority finding
requiring immediate provider attention .
5. A client with a do-not-resuscitate (DNR) order goes into cardiac arrest. The
nurse should:
• A. Begin CPR immediately
• B. Verify the DNR order and comfort the family
• C. Call a code blue
, • D. Ask the family for permission to withhold CPR
Correct Answer: B
Rationale: A valid DNR order means CPR should not be initiated. The nurse should
verify the order and provide comfort care to the client and family .
6. Which client should be assigned to the most experienced nurse?
• A. Client with chest tube drainage system that is bubbling continuously
• B. Client requiring a blood transfusion
• C. Client with diabetes requiring insulin administration
• D. Client with a nasogastric tube for decompression
Correct Answer: A
Rationale: Continuous bubbling in a chest tube system indicates an air leak
requiring advanced assessment and intervention skills. Blood transfusions, insulin
administration, and NG tube care can be managed by less experienced nurses .
7. A nurse is caring for a client who has a new prescription for wrist restraints.
Which action is most important?
• A. Document the reason for restraint use
• B. Tie the restraints to the bed frame (not side rail)
• C. Remove restraints every 4 hours for range of motion
• D. Obtain a PRN order for restraints
Correct Answer: B
Rationale: Restraints must be tied to the bed frame (not side rails) to prevent
injury if the side rail is lowered. Restraints should be removed every 2 hours for
range of motion, and a PRN order is never appropriate .
MEDICAL-SURGICAL NURSING
, 8. A patient has serum potassium of 6.2 mEq/L. Which intervention is MOST
important?
• A. Administer potassium supplement
• B. Restrict potassium and monitor for arrhythmias
• C. Give sodium supplement
• D. Increase potassium intake
Correct Answer: B
Rationale: Potassium 6.2 mEq/L indicates hyperkalemia (normal 3.5–5.0) with risk
of cardiac arrhythmias. Interventions include potassium restriction,
insulin/glucose, Kayexalate, or dialysis; monitor EKG for peaked T waves .
9. A patient has sodium level of 152 mEq/L. What is the priority nursing action?
• A. Administer sodium supplement
• B. Restrict fluids and monitor neuro status
• C. Give potassium
• D. Encourage fluid intake
Correct Answer: D
Rationale: Sodium 152 mEq/L indicates hypernatremia (normal 135–145) caused
by fluid deficit. The priority is to encourage fluid intake and monitor neuro status .
10. Which lab value is most specific for myocardial injury?
• A. WBC
• B. Troponin
• C. Hemoglobin
• D. Sodium
Correct Answer: B
Rationale: Troponin is the most specific and sensitive cardiac marker for
myocardial injury. WBC may be elevated but is nonspecific .
