HESI RN EXIT EXAMINATION PRACTICE TEST –
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM | PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW | 100% CORRECT ANSWERS |
VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing students
preparing for the HESI RN Exit Exam and the NCLEX-RN®. It integrates Next
Generation NCLEX (NGN) clinical judgment concepts and reflects the breadth and
depth of the HESI exit assessment, including medical-surgical nursing,
pharmacology, maternal-newborn and pediatric nursing, psychiatric-mental health
nursing, critical care, and professional issues. The 100 advanced-level questions
challenge your ability to analyze complex clinical scenarios, prioritize care,
delegate appropriately, and make sound evidence-based decisions. Each item
reflects the rigor of the HESI exit exam, emphasizing the nursing process, patient
safety, and clinical reasoning. Detailed rationales accompany every answer,
explaining why the correct choice is optimal and why alternatives fall short. Use
this practice test to evaluate your readiness, identify knowledge gaps, and build
the confidence and competence essential for success on the HESI RN Exit
Examination and the NCLEX-RN.
Table of Contents
1. Medical-Surgical Nursing and Emergency Care
2. Pharmacology and Medication Safety
3. Maternal-Newborn and Women’s Health
4. Pediatric Nursing
5. Psychiatric-Mental Health Nursing
6. Critical Care and Hemodynamics
7. Fundamentals, Safety, and Infection Control
8. Prioritization, Delegation, and Leadership
9. Community Health and Discharge Planning
10. Professional, Legal, and Ethical Issues
, 1. The nurse is caring for a client 12 hours after a total thyroidectomy. The
client reports numbness and tingling around the mouth and muscle cramps.
The nurse should first:
A) Administer the prescribed oral calcium supplement.
B) Assess for Chvostek’s and Trousseau’s signs.
C) Check the client’s serum calcium level.
D) Notify the health care provider.
Correct Answer: B
Tingling around the mouth and muscle cramps suggest hypocalcemia due to
inadvertent removal of or damage to the parathyroid glands during
thyroidectomy. The nurse should first assess for Chvostek’s and Trousseau’s signs
to confirm latent tetany. Checking calcium (C) and notifying the provider (D) are
appropriate after focused assessment. Administering calcium (A) may be needed
but assessment precedes intervention.
2. A client with left-sided heart failure is admitted with worsening dyspnea.
The nurse auscultates crackles in all lung fields and notes an SpO₂ of 87% on
room air. Which action should the nurse take first?
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain an arterial blood gas.
D) Apply a 100% non-rebreather mask.
Correct Answer: B
Positioning the client in high Fowler’s position reduces venous return and
pulmonary congestion, improving ventilation and oxygenation. This low-risk,
high-priority action can be done immediately. Oxygen (D) and diuretics (A) are also
important but positioning should be done first to maximize ventilation. ABG (C) is
not the first action.
3. A client is receiving packed red blood cells. Fifteen minutes after the
transfusion starts, the client develops chills, fever, and flank pain. What
should the nurse do first?
A) Slow the transfusion and administer the prescribed antipyretic.
, B) Stop the transfusion and maintain the IV line with normal saline.
C) Notify the health care provider and blood bank.
D) Obtain a urine specimen to evaluate for hemolysis.
Correct Answer: B
Chills, fever, and flank pain are signs of an acute hemolytic transfusion reaction.
The priority is to stop the transfusion immediately and keep the IV line open with
normal saline to maintain vascular access and prevent further complications.
Notifying the provider and blood bank (C) and obtaining specimens (D) occur after
stopping the infusion. Slowing the rate (A) is not appropriate for a suspected
hemolytic reaction.
4. A client with cirrhosis is admitted with increasing ascites and a serum
albumin of 2.0 g/dL. The nurse anticipates an order for:
A) Furosemide
B) Spironolactone
C) Fresh frozen plasma
D) Albumin infusion
Correct Answer: D
Hypoalbuminemia decreases oncotic pressure and contributes to ascites. Albumin
infusion may be ordered to increase oncotic pressure and mobilize fluid.
Spironolactone (B) is also used for ascites due to secondary hyperaldosteronism,
but albumin directly addresses the low albumin level. Furosemide (A) may be used
after albumin administration. Fresh frozen plasma (C) is not the primary treatment
for hypoalbuminemia.
5. A client with a fractured femur is in Buck’s traction. The nurse should:
A) Remove the traction weights when repositioning the client.
B) Ensure that the weights hang freely and do not touch the floor.
C) Place a pillow under the knee to maintain flexion.
D) Release the traction when the client is bathing.
Correct Answer: B
For traction to be effective, the weights must hang freely and not rest on the floor
, or bed. Traction should be continuous; removing weights (A) or releasing traction
(D) interrupts treatment. Placing a pillow under the knee (C) can cause
contractures and interfere with the line of pull.
6. A client with diabetic ketoacidosis (DKA) is receiving regular insulin IV and
normal saline. Which laboratory value should the nurse monitor most
closely during initial treatment?
A) Serum calcium
B) Serum potassium
C) Serum albumin
D) Serum bilirubin
Correct Answer: B
During DKA treatment, insulin and fluid administration shift potassium into cells,
causing serum potassium to drop rapidly. Hypokalemia can cause life-threatening
cardiac arrhythmias. Potassium levels must be monitored frequently and
potassium added to IV fluids as needed. The other electrolytes are less critical
during initial DKA management.
7. A client with a suspected pulmonary embolism suddenly develops severe
dyspnea, tachypnea, and a loud systolic murmur at the left sternal border.
The nurse suspects:
A) Myocardial infarction
B) Cardiac tamponade
C) Acute right ventricular failure
D) Papillary muscle rupture
Correct Answer: C
A pulmonary embolism increases pulmonary vascular resistance, leading to right
ventricular strain and failure. A new murmur (tricuspid regurgitation) can be heard
due to right ventricular dilation. Myocardial infarction (A) presents with chest pain
and ECG changes. Cardiac tamponade (B) presents with muffled heart sounds and
hypotension. Papillary muscle rupture (D) is a complication of MI.
STUDY GUIDE | LATEST UPDATE 2026/2027 | ACTUAL
EXAM | PRACTICE QUESTIONS AND ANSWERS |
EXAM REVIEW | 100% CORRECT ANSWERS |
VERIFIED SOLUTIONS
This comprehensive practice examination is designed for nursing students
preparing for the HESI RN Exit Exam and the NCLEX-RN®. It integrates Next
Generation NCLEX (NGN) clinical judgment concepts and reflects the breadth and
depth of the HESI exit assessment, including medical-surgical nursing,
pharmacology, maternal-newborn and pediatric nursing, psychiatric-mental health
nursing, critical care, and professional issues. The 100 advanced-level questions
challenge your ability to analyze complex clinical scenarios, prioritize care,
delegate appropriately, and make sound evidence-based decisions. Each item
reflects the rigor of the HESI exit exam, emphasizing the nursing process, patient
safety, and clinical reasoning. Detailed rationales accompany every answer,
explaining why the correct choice is optimal and why alternatives fall short. Use
this practice test to evaluate your readiness, identify knowledge gaps, and build
the confidence and competence essential for success on the HESI RN Exit
Examination and the NCLEX-RN.
Table of Contents
1. Medical-Surgical Nursing and Emergency Care
2. Pharmacology and Medication Safety
3. Maternal-Newborn and Women’s Health
4. Pediatric Nursing
5. Psychiatric-Mental Health Nursing
6. Critical Care and Hemodynamics
7. Fundamentals, Safety, and Infection Control
8. Prioritization, Delegation, and Leadership
9. Community Health and Discharge Planning
10. Professional, Legal, and Ethical Issues
, 1. The nurse is caring for a client 12 hours after a total thyroidectomy. The
client reports numbness and tingling around the mouth and muscle cramps.
The nurse should first:
A) Administer the prescribed oral calcium supplement.
B) Assess for Chvostek’s and Trousseau’s signs.
C) Check the client’s serum calcium level.
D) Notify the health care provider.
Correct Answer: B
Tingling around the mouth and muscle cramps suggest hypocalcemia due to
inadvertent removal of or damage to the parathyroid glands during
thyroidectomy. The nurse should first assess for Chvostek’s and Trousseau’s signs
to confirm latent tetany. Checking calcium (C) and notifying the provider (D) are
appropriate after focused assessment. Administering calcium (A) may be needed
but assessment precedes intervention.
2. A client with left-sided heart failure is admitted with worsening dyspnea.
The nurse auscultates crackles in all lung fields and notes an SpO₂ of 87% on
room air. Which action should the nurse take first?
A) Administer furosemide IV as prescribed.
B) Place the client in high Fowler’s position.
C) Obtain an arterial blood gas.
D) Apply a 100% non-rebreather mask.
Correct Answer: B
Positioning the client in high Fowler’s position reduces venous return and
pulmonary congestion, improving ventilation and oxygenation. This low-risk,
high-priority action can be done immediately. Oxygen (D) and diuretics (A) are also
important but positioning should be done first to maximize ventilation. ABG (C) is
not the first action.
3. A client is receiving packed red blood cells. Fifteen minutes after the
transfusion starts, the client develops chills, fever, and flank pain. What
should the nurse do first?
A) Slow the transfusion and administer the prescribed antipyretic.
, B) Stop the transfusion and maintain the IV line with normal saline.
C) Notify the health care provider and blood bank.
D) Obtain a urine specimen to evaluate for hemolysis.
Correct Answer: B
Chills, fever, and flank pain are signs of an acute hemolytic transfusion reaction.
The priority is to stop the transfusion immediately and keep the IV line open with
normal saline to maintain vascular access and prevent further complications.
Notifying the provider and blood bank (C) and obtaining specimens (D) occur after
stopping the infusion. Slowing the rate (A) is not appropriate for a suspected
hemolytic reaction.
4. A client with cirrhosis is admitted with increasing ascites and a serum
albumin of 2.0 g/dL. The nurse anticipates an order for:
A) Furosemide
B) Spironolactone
C) Fresh frozen plasma
D) Albumin infusion
Correct Answer: D
Hypoalbuminemia decreases oncotic pressure and contributes to ascites. Albumin
infusion may be ordered to increase oncotic pressure and mobilize fluid.
Spironolactone (B) is also used for ascites due to secondary hyperaldosteronism,
but albumin directly addresses the low albumin level. Furosemide (A) may be used
after albumin administration. Fresh frozen plasma (C) is not the primary treatment
for hypoalbuminemia.
5. A client with a fractured femur is in Buck’s traction. The nurse should:
A) Remove the traction weights when repositioning the client.
B) Ensure that the weights hang freely and do not touch the floor.
C) Place a pillow under the knee to maintain flexion.
D) Release the traction when the client is bathing.
Correct Answer: B
For traction to be effective, the weights must hang freely and not rest on the floor
, or bed. Traction should be continuous; removing weights (A) or releasing traction
(D) interrupts treatment. Placing a pillow under the knee (C) can cause
contractures and interfere with the line of pull.
6. A client with diabetic ketoacidosis (DKA) is receiving regular insulin IV and
normal saline. Which laboratory value should the nurse monitor most
closely during initial treatment?
A) Serum calcium
B) Serum potassium
C) Serum albumin
D) Serum bilirubin
Correct Answer: B
During DKA treatment, insulin and fluid administration shift potassium into cells,
causing serum potassium to drop rapidly. Hypokalemia can cause life-threatening
cardiac arrhythmias. Potassium levels must be monitored frequently and
potassium added to IV fluids as needed. The other electrolytes are less critical
during initial DKA management.
7. A client with a suspected pulmonary embolism suddenly develops severe
dyspnea, tachypnea, and a loud systolic murmur at the left sternal border.
The nurse suspects:
A) Myocardial infarction
B) Cardiac tamponade
C) Acute right ventricular failure
D) Papillary muscle rupture
Correct Answer: C
A pulmonary embolism increases pulmonary vascular resistance, leading to right
ventricular strain and failure. A new murmur (tricuspid regurgitation) can be heard
due to right ventricular dilation. Myocardial infarction (A) presents with chest pain
and ECG changes. Cardiac tamponade (B) presents with muffled heart sounds and
hypotension. Papillary muscle rupture (D) is a complication of MI.
