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HESI Fundamentals Exam Questions &
Answers 2026 – 500 Verified Q&A with
Rationales for Nursing Students – Evolve
HESI Review, Pharmacology, Med-Surg,
& Critical Thinking
Ace your HESI Fundamentals exam with this
comprehensive Q&A set of 500 practice questions, all
formatted in a clear, un-bolded question style with
answers in italic bold and detailed rationales in italic.
This resource covers the Evolve platform's core
competencies: Safety, Infection Control, Medication
Administration, Nursing Process (ADPIE), Basic Care,
Fluid/Electrolytes, and Pharmacology. Each question
mirrors real HESI/Nursing school exams, helping you
build critical thinking and clinical judgment. Instant
download – start practicing today!
,2|Page
Question 1:
A nurse is preparing to administer an intramuscular injection to an adult client in the
ventrogluteal site. Which action is correct for locating this site?
A. Place the heel of the hand on the greater trochanter and the index finger on the
anterior superior iliac spine
B. Place the heel of the hand on the iliac crest and the index finger on the posterior
superior iliac spine
C. Use the midpoint between the greater trochanter and the iliac crest
D. Use the center of the gluteal muscle mass
Answer: A. Place the heel of the hand on the greater trochanter and the index
finger on the anterior superior iliac spine
Rationale: The ventrogluteal site is located by placing the heel of the hand on the
greater trochanter, the index finger on the anterior superior iliac spine, and the middle
finger extending toward the iliac crest. The injection is given in the V-shaped area
between the fingers. This site is preferred because it avoids major nerves and blood
vessels.
Question 2:
A client with a history of heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A. Heart rate of 68 beats/min
B. Serum digoxin level of 1.8 ng/mL
C. Nausea, vomiting, and visual disturbances
D. Serum potassium level of 4.2 mEq/L
Answer: C. Nausea, vomiting, and visual disturbances
Rationale: Nausea, vomiting, anorexia, and visual disturbances (yellow/green halos)
are classic signs of digoxin toxicity. A digoxin level of 1.8 ng/mL is within the
therapeutic range (0.8–2.0 ng/mL). A heart rate of 68 and potassium of 4.2 are normal.
Question 3:
A nurse is caring for a client with a nasogastric tube attached to low intermittent
suction. Which electrolyte imbalance is the client at greatest risk for?
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A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: NG suction removes gastric fluids rich in potassium and hydrogen ions,
leading to hypokalemia and metabolic alkalosis. Hyperkalemia, hypercalcemia, and
hypermagnesemia are not associated with NG suction.
Question 4:
A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the
nurse monitor to evaluate the effectiveness of this medication?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B. INR
Rationale: Warfarin therapy is monitored by the International Normalized Ratio (INR),
with a therapeutic goal of 2–3 for most indications. aPTT monitors heparin; platelet
count monitors for thrombocytopenia; bleeding time is not routinely used.
Question 5:
A nurse is assessing a client who is 1 day post-operative following a thyroidectomy.
Which finding requires immediate intervention?
A. Hoarseness
B. Pain at the incision site
C. Stridor
D. Serosanguineous drainage on the dressing
Answer: C. Stridor
Rationale: Stridor is a high-pitched inspiratory sound indicating airway obstruction,
which can occur from laryngeal edema or tracheal compression. This is a medical
emergency. Hoarseness and mild incisional pain are expected; serosanguineous
drainage is normal in the first 24 hours.
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Question 6:
A client is receiving a blood transfusion. Fifteen minutes after the start, the client
reports chills, low back pain, and feels flushed. Which action should the nurse take
first?
A. Slow the infusion rate
B. Administer diphenhydramine
C. Stop the transfusion immediately
D. Notify the healthcare provider
Answer: C. Stop the transfusion immediately
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction
(chills, back pain, flushing). The priority action is to stop the transfusion immediately to
prevent further reaction. Next, disconnect the tubing, flush with normal saline, notify
the provider, and send the blood bag to the blood bank.
Question 7:
A nurse is teaching a client about self-administration of insulin. Which instruction is
correct for mixing NPH and regular insulin in the same syringe?
A. Draw the NPH insulin first, then the regular insulin
B. Draw the regular insulin first, then the NPH insulin
C. Draw both insulins simultaneously
D. There is no specific order
Answer: B. Draw the regular insulin first, then the NPH insulin
Rationale: "Clear before cloudy" is the rule. Regular insulin (clear) should be drawn first
to prevent contamination of the regular insulin with NPH (cloudy) insulin.
Contaminating regular insulin can alter its onset of action.
Question 8:
A client with a history of COPD has an oxygen saturation of 88% on room air. The
nurse applies supplemental oxygen via nasal cannula. Which flow rate is most
appropriate to start?
HESI Fundamentals Exam Questions &
Answers 2026 – 500 Verified Q&A with
Rationales for Nursing Students – Evolve
HESI Review, Pharmacology, Med-Surg,
& Critical Thinking
Ace your HESI Fundamentals exam with this
comprehensive Q&A set of 500 practice questions, all
formatted in a clear, un-bolded question style with
answers in italic bold and detailed rationales in italic.
This resource covers the Evolve platform's core
competencies: Safety, Infection Control, Medication
Administration, Nursing Process (ADPIE), Basic Care,
Fluid/Electrolytes, and Pharmacology. Each question
mirrors real HESI/Nursing school exams, helping you
build critical thinking and clinical judgment. Instant
download – start practicing today!
,2|Page
Question 1:
A nurse is preparing to administer an intramuscular injection to an adult client in the
ventrogluteal site. Which action is correct for locating this site?
A. Place the heel of the hand on the greater trochanter and the index finger on the
anterior superior iliac spine
B. Place the heel of the hand on the iliac crest and the index finger on the posterior
superior iliac spine
C. Use the midpoint between the greater trochanter and the iliac crest
D. Use the center of the gluteal muscle mass
Answer: A. Place the heel of the hand on the greater trochanter and the index
finger on the anterior superior iliac spine
Rationale: The ventrogluteal site is located by placing the heel of the hand on the
greater trochanter, the index finger on the anterior superior iliac spine, and the middle
finger extending toward the iliac crest. The injection is given in the V-shaped area
between the fingers. This site is preferred because it avoids major nerves and blood
vessels.
Question 2:
A client with a history of heart failure is prescribed digoxin. Which finding indicates
digoxin toxicity?
A. Heart rate of 68 beats/min
B. Serum digoxin level of 1.8 ng/mL
C. Nausea, vomiting, and visual disturbances
D. Serum potassium level of 4.2 mEq/L
Answer: C. Nausea, vomiting, and visual disturbances
Rationale: Nausea, vomiting, anorexia, and visual disturbances (yellow/green halos)
are classic signs of digoxin toxicity. A digoxin level of 1.8 ng/mL is within the
therapeutic range (0.8–2.0 ng/mL). A heart rate of 68 and potassium of 4.2 are normal.
Question 3:
A nurse is caring for a client with a nasogastric tube attached to low intermittent
suction. Which electrolyte imbalance is the client at greatest risk for?
,3|Page
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: NG suction removes gastric fluids rich in potassium and hydrogen ions,
leading to hypokalemia and metabolic alkalosis. Hyperkalemia, hypercalcemia, and
hypermagnesemia are not associated with NG suction.
Question 4:
A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the
nurse monitor to evaluate the effectiveness of this medication?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Answer: B. INR
Rationale: Warfarin therapy is monitored by the International Normalized Ratio (INR),
with a therapeutic goal of 2–3 for most indications. aPTT monitors heparin; platelet
count monitors for thrombocytopenia; bleeding time is not routinely used.
Question 5:
A nurse is assessing a client who is 1 day post-operative following a thyroidectomy.
Which finding requires immediate intervention?
A. Hoarseness
B. Pain at the incision site
C. Stridor
D. Serosanguineous drainage on the dressing
Answer: C. Stridor
Rationale: Stridor is a high-pitched inspiratory sound indicating airway obstruction,
which can occur from laryngeal edema or tracheal compression. This is a medical
emergency. Hoarseness and mild incisional pain are expected; serosanguineous
drainage is normal in the first 24 hours.
, 4|Page
Question 6:
A client is receiving a blood transfusion. Fifteen minutes after the start, the client
reports chills, low back pain, and feels flushed. Which action should the nurse take
first?
A. Slow the infusion rate
B. Administer diphenhydramine
C. Stop the transfusion immediately
D. Notify the healthcare provider
Answer: C. Stop the transfusion immediately
Rationale: The client is exhibiting signs of an acute hemolytic transfusion reaction
(chills, back pain, flushing). The priority action is to stop the transfusion immediately to
prevent further reaction. Next, disconnect the tubing, flush with normal saline, notify
the provider, and send the blood bag to the blood bank.
Question 7:
A nurse is teaching a client about self-administration of insulin. Which instruction is
correct for mixing NPH and regular insulin in the same syringe?
A. Draw the NPH insulin first, then the regular insulin
B. Draw the regular insulin first, then the NPH insulin
C. Draw both insulins simultaneously
D. There is no specific order
Answer: B. Draw the regular insulin first, then the NPH insulin
Rationale: "Clear before cloudy" is the rule. Regular insulin (clear) should be drawn first
to prevent contamination of the regular insulin with NPH (cloudy) insulin.
Contaminating regular insulin can alter its onset of action.
Question 8:
A client with a history of COPD has an oxygen saturation of 88% on room air. The
nurse applies supplemental oxygen via nasal cannula. Which flow rate is most
appropriate to start?
