HESI RN Exit Exam 2026 Practice Questions and Answers
with Rationales – Complete Nursing Review
1. Heart Failure
A client with heart failure suddenly develops severe dyspnea, crackles throughout both
lung fields, and an oxygen saturation of 82%. Which action should the nurse take first?
A. Obtain the client’s daily weight
B. Place the client in high-Fowler’s position
C. Restrict the client’s oral fluids
D. Review the client’s sodium intake
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning promotes maximum lung expansion and decreases
venous return, which can improve breathing in acute pulmonary congestion. The client’s
severe hypoxemia makes respiratory support the priority.
2. Digoxin Toxicity
A client taking digoxin reports nausea and seeing yellow-green halos around lights.
What should the nurse do?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Give the medication with food
D. Encourage increased sodium intake
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, vomiting, anorexia, and visual disturbances such as yellow-green
halos are associated with digoxin toxicity. The medication should be withheld and the
client evaluated.
3. Blood Transfusion Reaction
A client receiving packed RBCs suddenly develops chills and severe low back pain.
What is the nurse’s priority action?
A. Slow the transfusion
B. Stop the transfusion
,C. Administer acetaminophen
D. Recheck the client’s temperature in 30 minutes
Answer: B. Stop the transfusion
Rationale: Sudden chills and back pain may indicate an acute hemolytic transfusion
reaction. The transfusion must be stopped immediately, and the IV should generally be
maintained with compatible normal saline using appropriate tubing per facility protocol.
4. Pulmonary Embolism
A postoperative client suddenly develops chest pain, severe shortness of breath,
tachycardia, and oxygen saturation of 86%. Which complication should the nurse
suspect?
A. Atelectasis
B. Pulmonary embolism
C. Urinary retention
D. Wound infection
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
concerning for pulmonary embolism, a potentially life-threatening postoperative
complication.
5. Delegation
Which task is appropriate for an experienced UAP to perform?
A. Assess a newly admitted client
B. Teach incentive-spirometer use
C. Obtain vital signs on a stable client
D. Evaluate response to medication
Answer: C. Obtain vital signs on a stable client
Rationale: Routine vital-sign collection for a stable client can be delegated. Assessment,
teaching, and evaluation require nursing judgment and remain the RN’s responsibility.
6. Severe Hypoglycemia
A client with type 1 diabetes is unconscious, diaphoretic, and has a blood glucose level
of 38 mg/dL. IV access is unavailable. Which medication should the nurse anticipate?
,A. Regular insulin
B. Glucagon
C. Metformin
D. Potassium chloride
Answer: B. Glucagon
Rationale: Glucagon raises blood glucose and can be administered during severe
hypoglycemia when the client cannot safely take oral glucose and IV access is
unavailable.
7. Warfarin
Which finding should a client taking warfarin report immediately?
A. Increased appetite
B. Black, tarry stools
C. Mild thirst
D. Clear urine
Answer: B. Black, tarry stools
Rationale: Black, tarry stools can indicate gastrointestinal bleeding. Warfarin increases
the risk of serious bleeding, so this finding requires prompt evaluation.
8. COPD
Which intervention is most appropriate for a client with COPD receiving oxygen?
A. Administer the highest possible oxygen concentration
B. Administer prescribed oxygen and monitor respiratory status
C. Discontinue oxygen when dyspnea occurs
D. Encourage rapid breathing
Answer: B. Administer prescribed oxygen and monitor respiratory status
Rationale: Oxygen should be administered as prescribed, with careful monitoring of
oxygenation and respiratory status. Excessive oxygen administration without
appropriate monitoring can be harmful in some clients with chronic respiratory disease.
9. Meningitis
, A client is admitted with suspected bacterial meningitis. Which precaution should the
nurse initiate?
A. Droplet
B. Airborne
C. Protective environment
D. No additional precautions
Answer: A. Droplet
Rationale: Suspected bacterial meningitis requires droplet precautions initially because
organisms can spread through respiratory secretions.
10. Opioid Toxicity
A client receiving IV morphine is difficult to arouse and has a respiratory rate of 7/min.
Which medication should the nurse anticipate?
A. Naloxone
B. Furosemide
C. Flumazenil
D. Protamine
Answer: A. Naloxone
Rationale: Naloxone is an opioid antagonist that reverses opioid-induced respiratory
depression. The client’s markedly decreased respiratory rate is an emergency.
11. Stroke
A client suddenly develops facial drooping, right-sided weakness, and difficulty
speaking. What should the nurse do first?
A. Give the client oral fluids
B. Determine when the symptoms began
C. Allow the client to rest
D. Administer aspirin immediately
Answer: B. Determine when the symptoms began
with Rationales – Complete Nursing Review
1. Heart Failure
A client with heart failure suddenly develops severe dyspnea, crackles throughout both
lung fields, and an oxygen saturation of 82%. Which action should the nurse take first?
A. Obtain the client’s daily weight
B. Place the client in high-Fowler’s position
C. Restrict the client’s oral fluids
D. Review the client’s sodium intake
Answer: B. Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning promotes maximum lung expansion and decreases
venous return, which can improve breathing in acute pulmonary congestion. The client’s
severe hypoxemia makes respiratory support the priority.
2. Digoxin Toxicity
A client taking digoxin reports nausea and seeing yellow-green halos around lights.
What should the nurse do?
A. Administer the next dose
B. Hold the medication and notify the provider
C. Give the medication with food
D. Encourage increased sodium intake
Answer: B. Hold the medication and notify the provider
Rationale: Nausea, vomiting, anorexia, and visual disturbances such as yellow-green
halos are associated with digoxin toxicity. The medication should be withheld and the
client evaluated.
3. Blood Transfusion Reaction
A client receiving packed RBCs suddenly develops chills and severe low back pain.
What is the nurse’s priority action?
A. Slow the transfusion
B. Stop the transfusion
,C. Administer acetaminophen
D. Recheck the client’s temperature in 30 minutes
Answer: B. Stop the transfusion
Rationale: Sudden chills and back pain may indicate an acute hemolytic transfusion
reaction. The transfusion must be stopped immediately, and the IV should generally be
maintained with compatible normal saline using appropriate tubing per facility protocol.
4. Pulmonary Embolism
A postoperative client suddenly develops chest pain, severe shortness of breath,
tachycardia, and oxygen saturation of 86%. Which complication should the nurse
suspect?
A. Atelectasis
B. Pulmonary embolism
C. Urinary retention
D. Wound infection
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
concerning for pulmonary embolism, a potentially life-threatening postoperative
complication.
5. Delegation
Which task is appropriate for an experienced UAP to perform?
A. Assess a newly admitted client
B. Teach incentive-spirometer use
C. Obtain vital signs on a stable client
D. Evaluate response to medication
Answer: C. Obtain vital signs on a stable client
Rationale: Routine vital-sign collection for a stable client can be delegated. Assessment,
teaching, and evaluation require nursing judgment and remain the RN’s responsibility.
6. Severe Hypoglycemia
A client with type 1 diabetes is unconscious, diaphoretic, and has a blood glucose level
of 38 mg/dL. IV access is unavailable. Which medication should the nurse anticipate?
,A. Regular insulin
B. Glucagon
C. Metformin
D. Potassium chloride
Answer: B. Glucagon
Rationale: Glucagon raises blood glucose and can be administered during severe
hypoglycemia when the client cannot safely take oral glucose and IV access is
unavailable.
7. Warfarin
Which finding should a client taking warfarin report immediately?
A. Increased appetite
B. Black, tarry stools
C. Mild thirst
D. Clear urine
Answer: B. Black, tarry stools
Rationale: Black, tarry stools can indicate gastrointestinal bleeding. Warfarin increases
the risk of serious bleeding, so this finding requires prompt evaluation.
8. COPD
Which intervention is most appropriate for a client with COPD receiving oxygen?
A. Administer the highest possible oxygen concentration
B. Administer prescribed oxygen and monitor respiratory status
C. Discontinue oxygen when dyspnea occurs
D. Encourage rapid breathing
Answer: B. Administer prescribed oxygen and monitor respiratory status
Rationale: Oxygen should be administered as prescribed, with careful monitoring of
oxygenation and respiratory status. Excessive oxygen administration without
appropriate monitoring can be harmful in some clients with chronic respiratory disease.
9. Meningitis
, A client is admitted with suspected bacterial meningitis. Which precaution should the
nurse initiate?
A. Droplet
B. Airborne
C. Protective environment
D. No additional precautions
Answer: A. Droplet
Rationale: Suspected bacterial meningitis requires droplet precautions initially because
organisms can spread through respiratory secretions.
10. Opioid Toxicity
A client receiving IV morphine is difficult to arouse and has a respiratory rate of 7/min.
Which medication should the nurse anticipate?
A. Naloxone
B. Furosemide
C. Flumazenil
D. Protamine
Answer: A. Naloxone
Rationale: Naloxone is an opioid antagonist that reverses opioid-induced respiratory
depression. The client’s markedly decreased respiratory rate is an emergency.
11. Stroke
A client suddenly develops facial drooping, right-sided weakness, and difficulty
speaking. What should the nurse do first?
A. Give the client oral fluids
B. Determine when the symptoms began
C. Allow the client to rest
D. Administer aspirin immediately
Answer: B. Determine when the symptoms began
