Page 1 of 61
HESI RN READINESS EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
HESI RN Readiness Exam — 250 Practice Questions
10-Point Summary of HESI RN Readiness Exam Coverage
Safe and Effective Care Environment: Management of care, delegation, supervision, client
rights, informed consent, incident reporting, safety protocols, and emergency response.
Health Promotion and Maintenance: Anticipatory guidance, disease prevention,
immunizations, growth and development, prenatal care, and lifestyle modifications.
Psychosocial Integrity: Therapeutic communication, coping mechanisms, grief and loss,
crisis intervention, psychiatric disorders, and substance abuse.
Pharmacological Therapies: Medication administration, side effects, adverse reactions,
interactions, contraindications, and client teaching for major drug classes.
Reduction of Risk Potential: Monitoring for complications, interpreting diagnostic tests,
preventing injury, and recognizing early signs of deterioration.
Physiological Adaptation: Managing acute and chronic conditions (cardiac, respiratory,
endocrine, renal, neurological), and responding to changes in client status.
Basic Care and Comfort: Mobility, nutrition, hydration, elimination, comfort measures, and
assistance with ADLs.
Maternal and Newborn Health: Antepartum, intrapartum, and postpartum care, newborn
assessment, and common complications.
Pediatric Nursing: Common childhood illnesses, developmental milestones, safety, and
management of pediatric emergencies.
Clinical Judgment & NGN: Questions testing the six cognitive skills of the NCSBN
Clinical Judgment Measurement Model.
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1-25)
, Page 2 of 61
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
C. A client with heart failure who has crackles in the lung bases and is short of breath.
D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
Answer: C. Rationale: Prioritize Hypotheses: The client with heart failure who has crackles
and is short of breath is experiencing acute respiratory distress, which could indicate
pulmonary edema—a life-threatening emergency. This client should be assessed first. The
potassium level of 5.2 mEq/L (D) is elevated but not critical (critical is >6.5). The blood
glucose of 180 (A) is elevated but not immediately life-threatening. The fever (B) is
concerning but not the priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
A. Administering a scheduled dose of oral metoprolol.
B. Assessing a client's surgical wound for signs of infection.
C. Assisting a client with a bed bath and providing oral care.
D. Interpreting a client's telemetry rhythm strip.
Answer: C. Rationale: Generate Solutions: Assisting with a bed bath and providing oral
care are tasks within the scope of UAP. Administration of medications (A), wound
assessment (B), and rhythm interpretation (D) require the knowledge and judgment of a
licensed nurse and cannot be delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
A. Tremors and diaphoresis.
B. Nausea and vomiting.
C. Seizure activity and autonomic hyperactivity.
D. Insomnia and anxiety.
Answer: C. Rationale: Prioritize Hypotheses: Alcohol withdrawal can lead to seizures and
autonomic hyperactivity (tachycardia, hypertension, hyperthermia), which are life-
threatening. Monitoring for these signs is the highest priority. While tremors (A), nausea (B),
and insomnia (D) are common withdrawal symptoms, they are not as immediately life-
threatening as seizures.
, Page 3 of 61
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Elevate the head of the bed to a high-Fowler's position.
C. Notify the healthcare provider immediately.
D. Assess the client's vital signs and oxygen saturation.
Answer: C. Rationale: Take Actions: Sudden shortness of breath and chest pain are classic
symptoms of a pulmonary embolism (PE), a life-threatening complication. The nurse should
notify the healthcare provider immediately while simultaneously initiating other
interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
A. An Ambu bag and a suction catheter.
B. An obturator and a spare tracheostomy tube.
C. A sterile tracheostomy dressing and cleaning supplies.
D. A pulse oximeter and an oxygen saturation monitor.
Answer: B. Rationale: Generate Solutions: An obturator and a spare tracheostomy tube of
the same size (or one size smaller) must be kept at the bedside at all times to allow for
immediate replacement if the tube is accidentally dislodged—a life-threatening airway
emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
A. The client's serum potassium level increases to 4.5 mEq/L.
B. The client's urine output increases to 1,500 mL per 24 hours.
C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
D. The client's heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Evaluate Outcomes: Furosemide is a loop diuretic that reduces fluid
volume, which subsequently decreases blood pressure and reduces the workload on the heart.
A decrease in blood pressure indicates a positive therapeutic response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
, Page 4 of 61
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Evaluate Outcomes: Warfarin is an anticoagulant. Ibuprofen (an
NSAID) increases the risk of bleeding and should be avoided. Clients should use
acetaminophen for pain instead. Regular INR monitoring (A) is required. Vitamin K-rich
foods (B) can interfere with warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
A. Continue to monitor the client's vital signs.
B. Notify the healthcare provider immediately.
C. Administer a bolus of magnesium sulfate.
D. Document the finding as a normal response.
Answer: B. Rationale: Take Actions: Absent DTRs is a sign of magnesium toxicity. The
antidote is calcium gluconate. The nurse must notify the healthcare provider immediately so
that the magnesium sulfate can be discontinued and calcium gluconate can be administered.
9. The nurse is caring for a client who is receiving a blood transfusion. The client
complains of chills and lower back pain. What is the nurse's priority action?
A. Slow the rate of the transfusion.
B. Stop the transfusion and hang normal saline.
C. Administer an antihistamine.
D. Document the findings.
Answer: B. Rationale: Take Actions: Chills and lower back pain are classic signs of a
hemolytic transfusion reaction. The priority is to stop the transfusion immediately to prevent
further reaction, maintain IV access with normal saline, and notify the provider.
10. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: Generate Solutions: The standard protocol is to hold digoxin and
notify the healthcare provider if the apical pulse is below 60 beats per minute (or per facility
policy). Bradycardia can be a sign of digoxin toxicity.
HESI RN READINESS EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
HESI RN Readiness Exam — 250 Practice Questions
10-Point Summary of HESI RN Readiness Exam Coverage
Safe and Effective Care Environment: Management of care, delegation, supervision, client
rights, informed consent, incident reporting, safety protocols, and emergency response.
Health Promotion and Maintenance: Anticipatory guidance, disease prevention,
immunizations, growth and development, prenatal care, and lifestyle modifications.
Psychosocial Integrity: Therapeutic communication, coping mechanisms, grief and loss,
crisis intervention, psychiatric disorders, and substance abuse.
Pharmacological Therapies: Medication administration, side effects, adverse reactions,
interactions, contraindications, and client teaching for major drug classes.
Reduction of Risk Potential: Monitoring for complications, interpreting diagnostic tests,
preventing injury, and recognizing early signs of deterioration.
Physiological Adaptation: Managing acute and chronic conditions (cardiac, respiratory,
endocrine, renal, neurological), and responding to changes in client status.
Basic Care and Comfort: Mobility, nutrition, hydration, elimination, comfort measures, and
assistance with ADLs.
Maternal and Newborn Health: Antepartum, intrapartum, and postpartum care, newborn
assessment, and common complications.
Pediatric Nursing: Common childhood illnesses, developmental milestones, safety, and
management of pediatric emergencies.
Clinical Judgment & NGN: Questions testing the six cognitive skills of the NCSBN
Clinical Judgment Measurement Model.
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT (Questions 1-25)
, Page 2 of 61
1. The nurse is caring for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A. A client with diabetes mellitus who has a blood glucose of 180 mg/dL.
B. A client with pneumonia who has a temperature of 101.2°F (38.4°C).
C. A client with heart failure who has crackles in the lung bases and is short of breath.
D. A client with chronic kidney disease who has a potassium level of 5.2 mEq/L.
Answer: C. Rationale: Prioritize Hypotheses: The client with heart failure who has crackles
and is short of breath is experiencing acute respiratory distress, which could indicate
pulmonary edema—a life-threatening emergency. This client should be assessed first. The
potassium level of 5.2 mEq/L (D) is elevated but not critical (critical is >6.5). The blood
glucose of 180 (A) is elevated but not immediately life-threatening. The fever (B) is
concerning but not the priority.
2. The nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
appropriate for the nurse to delegate to the UAP?
A. Administering a scheduled dose of oral metoprolol.
B. Assessing a client's surgical wound for signs of infection.
C. Assisting a client with a bed bath and providing oral care.
D. Interpreting a client's telemetry rhythm strip.
Answer: C. Rationale: Generate Solutions: Assisting with a bed bath and providing oral
care are tasks within the scope of UAP. Administration of medications (A), wound
assessment (B), and rhythm interpretation (D) require the knowledge and judgment of a
licensed nurse and cannot be delegated.
3. A client with a history of alcohol use disorder is admitted with signs of alcohol
withdrawal. Which assessment finding is the priority for the nurse to monitor?
A. Tremors and diaphoresis.
B. Nausea and vomiting.
C. Seizure activity and autonomic hyperactivity.
D. Insomnia and anxiety.
Answer: C. Rationale: Prioritize Hypotheses: Alcohol withdrawal can lead to seizures and
autonomic hyperactivity (tachycardia, hypertension, hyperthermia), which are life-
threatening. Monitoring for these signs is the highest priority. While tremors (A), nausea (B),
and insomnia (D) are common withdrawal symptoms, they are not as immediately life-
threatening as seizures.
, Page 3 of 61
4. A client who is 2 days post-operative from a total hip replacement reports sudden
shortness of breath and chest pain. What is the nurse's priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Elevate the head of the bed to a high-Fowler's position.
C. Notify the healthcare provider immediately.
D. Assess the client's vital signs and oxygen saturation.
Answer: C. Rationale: Take Actions: Sudden shortness of breath and chest pain are classic
symptoms of a pulmonary embolism (PE), a life-threatening complication. The nurse should
notify the healthcare provider immediately while simultaneously initiating other
interventions.
5. The nurse is caring for a client with a new tracheostomy. Which piece of equipment
should be kept at the bedside at all times?
A. An Ambu bag and a suction catheter.
B. An obturator and a spare tracheostomy tube.
C. A sterile tracheostomy dressing and cleaning supplies.
D. A pulse oximeter and an oxygen saturation monitor.
Answer: B. Rationale: Generate Solutions: An obturator and a spare tracheostomy tube of
the same size (or one size smaller) must be kept at the bedside at all times to allow for
immediate replacement if the tube is accidentally dislodged—a life-threatening airway
emergency.
6. A client with heart failure is prescribed furosemide. Which finding indicates the
medication is having the desired therapeutic effect?
A. The client's serum potassium level increases to 4.5 mEq/L.
B. The client's urine output increases to 1,500 mL per 24 hours.
C. The client's blood pressure decreases from 160/90 to 130/80 mm Hg.
D. The client's heart rate decreases from 110 to 88 beats per minute.
Answer: C. Rationale: Evaluate Outcomes: Furosemide is a loop diuretic that reduces fluid
volume, which subsequently decreases blood pressure and reduces the workload on the heart.
A decrease in blood pressure indicates a positive therapeutic response.
7. The nurse is providing discharge teaching to a client who has a new prescription for
warfarin. Which statement by the client indicates a need for further teaching?
A. "I will need to have my blood drawn regularly to check my INR."
B. "I should avoid eating large amounts of green leafy vegetables."
C. "I can take ibuprofen for my headaches if I need to."
, Page 4 of 61
D. "I should report any unusual bleeding or bruising to my doctor."
Answer: C. Rationale: Evaluate Outcomes: Warfarin is an anticoagulant. Ibuprofen (an
NSAID) increases the risk of bleeding and should be avoided. Clients should use
acetaminophen for pain instead. Regular INR monitoring (A) is required. Vitamin K-rich
foods (B) can interfere with warfarin's effectiveness.
8. A client with preeclampsia is receiving magnesium sulfate. The nurse notes that the
client's deep tendon reflexes (DTRs) are absent. What is the priority nursing action?
A. Continue to monitor the client's vital signs.
B. Notify the healthcare provider immediately.
C. Administer a bolus of magnesium sulfate.
D. Document the finding as a normal response.
Answer: B. Rationale: Take Actions: Absent DTRs is a sign of magnesium toxicity. The
antidote is calcium gluconate. The nurse must notify the healthcare provider immediately so
that the magnesium sulfate can be discontinued and calcium gluconate can be administered.
9. The nurse is caring for a client who is receiving a blood transfusion. The client
complains of chills and lower back pain. What is the nurse's priority action?
A. Slow the rate of the transfusion.
B. Stop the transfusion and hang normal saline.
C. Administer an antihistamine.
D. Document the findings.
Answer: B. Rationale: Take Actions: Chills and lower back pain are classic signs of a
hemolytic transfusion reaction. The priority is to stop the transfusion immediately to prevent
further reaction, maintain IV access with normal saline, and notify the provider.
10. The nurse is preparing to administer a dose of digoxin to a client with heart failure.
The client's apical pulse is 52 beats per minute. What is the most appropriate nursing
action?
A. Administer the digoxin as ordered.
B. Hold the digoxin and notify the healthcare provider.
C. Administer the digoxin and reassess the pulse in 30 minutes.
D. Increase the client's fluid intake.
Answer: B. Rationale: Generate Solutions: The standard protocol is to hold digoxin and
notify the healthcare provider if the apical pulse is below 60 beats per minute (or per facility
policy). Bradycardia can be a sign of digoxin toxicity.
