ELSEVIER HESI
HESI 799 RN Exit Exam
Complete Study Guide
All Practice Questions with Detailed Rationales
Topic Focus: Medical-Surgical, Pediatrics, Maternity, Mental Health,
Pharmacology, Leadership & Critical Care
Edition 1 · August 2026 · All Questions Complete
Table of Contents
1. Instructions for Use 2
2. Medical-Surgical Nursing (Questions 1–50) 2
3. Pharmacology & Medication Administration (Questions 51–80) 5
4. Pediatrics & Maternity (Questions 81–120) 7
,5. Mental Health & Psychiatric Nursing (Questions 121–150) 9
6. Leadership, Delegation & Ethics (Questions 151–180) 11
7. Critical Care & Emergency (Questions 181–210) 13
HESI 799 RN Exit Exam Page 1
,HESI 799 RN EXIT EXAM STUDY GUIDE MEDICAL-SURGICAL — Q1–50
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is. All questions are derived directly from the source material and verified for
accuracy.
Category: Medical-Surgical Nursing — Questions 1–50
1 During the admission assessment, the nurse auscultates heart sounds for a client
with no history of cardiovascular disease. Where should the nurse listen when
assessing the client's point of maximal impulse (PMI)?
A 4th-5th intercostal space midclavicular
B 2nd intercostal space right sternal border
C 3rd intercostal space left sternal border
D 5th intercostal space anterior axillary
Why A is correct: The point of maximal impulse (PMI) is normally located at the 4th-5th
intercostal space at the midclavicular line. This is where the apical pulse is best heard.
B — This is the aortic area.
C — This is the pulmonic area.
D — This is not the standard PMI location.
, 2 A client with atrial fibrillation receives a new prescription for dabigatran. What
instruction should the nurse include in this client's teaching plan?
A Keep an antidote available in the event of hemorrhage
B Continue obtaining scheduled laboratory bleeding tests
C Eliminate spinach and other green vegetables in the diet
D Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Why D is correct: Dabigatran, a direct reversible thrombin inhibitor, is prescribed to reduce
the risk of stroke in clients with atrial fibrillation. The risk of bleeding and GI events can be
significant, and concomitant use of NSAIDs and other anticoagulants should be avoided.
A — There is no specific antidote readily available.
B — Routine lab monitoring is not required for dabigatran.
C — This is for warfarin, not dabigatran.
3 The nurse is making a home visit to a male client who is in the moderate stage of
Alzheimer's disease. The client's wife is exhausted and tells the nurse that the family
plans to take turns caring for the client in their home, each keeping him for two
weeks at a time. How should the nurse respond?
A Advise the client's spouse to consider inpatient hospice care as an alternative
B Suggest that each rotation last one week, rather than two, to prevent caregiver
fatigue
C Use active listening to allow the client and spouse to express their feelings about the
plan
D Suggest enrolling the client in adult daycare instead of rotating among family
Why D is correct: Suggesting a viable alternative, such as adult daycare, provides an option
to allow the spouse respite with the least disruption to routines and environment.
A — Hospice is for end-of-life care.
B — One-week rotations may be just as disruptive.
C — Active listening is important but does not offer a solution.
HESI 799 RN Exit Exam
Complete Study Guide
All Practice Questions with Detailed Rationales
Topic Focus: Medical-Surgical, Pediatrics, Maternity, Mental Health,
Pharmacology, Leadership & Critical Care
Edition 1 · August 2026 · All Questions Complete
Table of Contents
1. Instructions for Use 2
2. Medical-Surgical Nursing (Questions 1–50) 2
3. Pharmacology & Medication Administration (Questions 51–80) 5
4. Pediatrics & Maternity (Questions 81–120) 7
,5. Mental Health & Psychiatric Nursing (Questions 121–150) 9
6. Leadership, Delegation & Ethics (Questions 151–180) 11
7. Critical Care & Emergency (Questions 181–210) 13
HESI 799 RN Exit Exam Page 1
,HESI 799 RN EXIT EXAM STUDY GUIDE MEDICAL-SURGICAL — Q1–50
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is. All questions are derived directly from the source material and verified for
accuracy.
Category: Medical-Surgical Nursing — Questions 1–50
1 During the admission assessment, the nurse auscultates heart sounds for a client
with no history of cardiovascular disease. Where should the nurse listen when
assessing the client's point of maximal impulse (PMI)?
A 4th-5th intercostal space midclavicular
B 2nd intercostal space right sternal border
C 3rd intercostal space left sternal border
D 5th intercostal space anterior axillary
Why A is correct: The point of maximal impulse (PMI) is normally located at the 4th-5th
intercostal space at the midclavicular line. This is where the apical pulse is best heard.
B — This is the aortic area.
C — This is the pulmonic area.
D — This is not the standard PMI location.
, 2 A client with atrial fibrillation receives a new prescription for dabigatran. What
instruction should the nurse include in this client's teaching plan?
A Keep an antidote available in the event of hemorrhage
B Continue obtaining scheduled laboratory bleeding tests
C Eliminate spinach and other green vegetables in the diet
D Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Why D is correct: Dabigatran, a direct reversible thrombin inhibitor, is prescribed to reduce
the risk of stroke in clients with atrial fibrillation. The risk of bleeding and GI events can be
significant, and concomitant use of NSAIDs and other anticoagulants should be avoided.
A — There is no specific antidote readily available.
B — Routine lab monitoring is not required for dabigatran.
C — This is for warfarin, not dabigatran.
3 The nurse is making a home visit to a male client who is in the moderate stage of
Alzheimer's disease. The client's wife is exhausted and tells the nurse that the family
plans to take turns caring for the client in their home, each keeping him for two
weeks at a time. How should the nurse respond?
A Advise the client's spouse to consider inpatient hospice care as an alternative
B Suggest that each rotation last one week, rather than two, to prevent caregiver
fatigue
C Use active listening to allow the client and spouse to express their feelings about the
plan
D Suggest enrolling the client in adult daycare instead of rotating among family
Why D is correct: Suggesting a viable alternative, such as adult daycare, provides an option
to allow the spouse respite with the least disruption to routines and environment.
A — Hospice is for end-of-life care.
B — One-week rotations may be just as disruptive.
C — Active listening is important but does not offer a solution.
