HESI Exit Exam | HESI RN Exit Examination Study
Guide & Exam Prep 2026/2027 | Elsevier HESI RN
Comprehensive Exit Review, NCLEX-RN Readiness,
Adult Medical-Surgical Nursing, Fundamentals,
Pharmacology, Maternal-Newborn, Pediatrics,
Mental Health, Leadership & Management,
Community Health, Prioritization, Delegation,
Patient Safety, NGN Clinical Judgment, Practice
Questions, Answers & Detailed Rationales
Question 1: A client who is 24-hours post-operative following an abdominal
hysterectomy reports sudden, sharp pain in the right calf. Which action should
the nurse take first?
A. Administer the prescribed PRN analgesic.
B. Massage the affected calf to promote circulation.
C. Apply a warm compress to the area.
D. Instruct the client to remain in bed and notify the healthcare provider.
CORRECT ANSWER: D. Instruct the client to remain in bed and notify the
healthcare provider.
Rationale: Sudden, sharp calf pain in a post-operative client is a classic sign of a deep
vein thrombosis (DVT). The nurse's priority is to prevent the dislodgement of a potential
thrombus by keeping the client on bed rest and immediately notifying the healthcare
provider. Massaging the area (B) or applying heat (C) could dislodge the clot, leading to
a pulmonary embolism. Administering an analgesic (A) would mask the symptom
without addressing the underlying, life-threatening issue.
Question 2: When teaching a client with newly diagnosed type 1 diabetes
mellitus about insulin administration, which statement indicates a need for
further teaching?
A. "I will rotate my injection sites within the same anatomical region."
B. "I can store my current bottle of insulin at room temperature."
C. "I should draw up the NPH insulin before the regular insulin."
D. "I need to check my blood glucose level before administering insulin."
CORRECT ANSWER: C. "I should draw up the NPH insulin before the regular
insulin."
Rationale: The correct technique for mixing insulins is to draw up the clear
(regular/short-acting) insulin first, followed by the cloudy (NPH/intermediate-acting)
insulin. This prevents contamination of the regular insulin vial with the longer-acting
NPH. The other statements are correct: rotating sites (A) prevents lipohypertrophy,
insulin can be stored at room temperature for up to 28 days (B), and checking blood
glucose before administration (D) is a standard safety measure.
,Question 3: A client with heart failure is prescribed furosemide and digoxin.
The nurse identifies that a potassium level of 3.0 mEq/L increases the client's
risk for which complication?
A. Digitalis toxicity
B. Hyperkalemia
C. Pulmonary edema
D. Anaphylactic shock
CORRECT ANSWER: A. Digitalis toxicity
Rationale: Hypokalemia (normal potassium is 3.5-5.0 mEq/L) increases the risk of
digoxin toxicity because digoxin and potassium compete for the same binding sites on
the sodium-potassium ATPase pump. Low potassium potentiates the effects of digoxin,
leading to toxicity. Furosemide is a loop diuretic that can cause hypokalemia.
Question 4: The nurse is assessing a client who has undergone a
thyroidectomy 6 hours ago. Which assessment finding requires immediate
intervention?
A. Hoarseness of the voice
B. Pain rated 5 on a 0-10 scale at the incision site
C. Tingling sensations around the mouth and fingertips
D. Swallowing difficulty
CORRECT ANSWER: C. Tingling sensations around the mouth and fingertips
Rationale: Tingling around the mouth and fingertips are early signs of hypocalcemia,
which can occur if the parathyroid glands are accidentally removed or damaged during
a thyroidectomy. This can rapidly progress to life-threatening laryngospasm and
seizures. This requires immediate intervention with IV calcium. Hoarseness (A), pain (B),
and difficulty swallowing (D) are expected post-operative findings that should be
monitored but do not require immediate, life-saving intervention at this stage.
Question 5: A client is admitted with a diagnosis of acute pancreatitis. Which
laboratory value is most consistent with this diagnosis?
A. Decreased serum glucose
B. Elevated serum lipase
C. Decreased serum amylase
D. Elevated serum bilirubin
CORRECT ANSWER: B. Elevated serum lipase
Rationale: In acute pancreatitis, pancreatic enzymes are released into the bloodstream.
Serum lipase is more specific and remains elevated longer than serum amylase, making
it the preferred diagnostic indicator. Amylase is also elevated (not decreased, C), glucose
is often increased due to impaired insulin production (not decreased, A), and bilirubin
may be elevated if the cause is a gallstone, but lipase is the most direct indicator of
pancreatic inflammation.
,Question 6: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse assesses the client
and notes a respiratory rate of 10 breaths/min and somnolence. Which action
should the nurse take first?
A. Increase the oxygen to 4 L/min.
B. Encourage the client to take deep breaths.
C. Prepare for intubation.
D. Check the client's oxygen saturation level.
CORRECT ANSWER: D. Check the client's oxygen saturation level.
Rationale: The priority action is to assess the client's current oxygenation status. The
client's decreased respiratory rate and somnolence could indicate carbon dioxide (CO2)
narcosis, a complication of oxygen therapy in COPD clients who are chronic CO2
retainers. The nurse must first check the SpO2 to gather objective data before making
any changes to the oxygen therapy (A) or implementing other interventions (B, C).
Question 7: The nurse is preparing to administer a blood transfusion to a
client. Which intravenous (IV) solution is the only appropriate solution to use
as a primary infusion with packed red blood cells?
A. 0.9% sodium chloride
B. 0.45% sodium chloride
C. Dextrose 5% in water (D5W)
D. Lactated Ringer's solution
CORRECT ANSWER: A. 0.9% sodium chloride
Rationale: Normal saline (0.9% sodium chloride) is the only solution that is isotonic and
compatible with blood products. D5W (C) can cause hemolysis due to the dextrose, and
lactated Ringer's (D) contains calcium, which can cause clotting in the tubing if mixed
with citrated blood. Hypotonic solutions like 0.45% sodium chloride (B) can cause red
blood cells to swell and lyse.
Question 8: The healthcare provider prescribes a 24-hour urine collection for a
client. Which action by the nurse is most important to ensure accurate results?
A. Keep the urine container on ice during the collection period.
B. Ask the client to void and discard the first morning urine.
C. Instruct the client to increase fluid intake during the collection.
D. Start the collection with the first voided urine of the morning.
CORRECT ANSWER: B. Ask the client to void and discard the first morning
urine.
Rationale: For a 24-hour urine collection, the collection period begins after the client
voids and discards the first morning specimen. This ensures that the collection starts
with an empty bladder and represents all urine produced over the next 24 hours. The
collection is then completed 24 hours later with the final void. While keeping the
, container on ice or in a refrigerator (A) is important for many tests, starting and ending
the collection correctly (B) is the most critical step for accuracy. The first morning urine
is discarded, not included.
Question 9: A 70-year-old client is admitted with confusion and a temperature
of 103°F (39.4°C). The client's skin is warm and flushed. The nurse suspects
the client is experiencing which type of hyperthermia?
A. Heat exhaustion
B. Heat stroke
C. Heat cramps
D. Malignant hyperthermia
CORRECT ANSWER: B. Heat stroke
Rationale: Classic signs of heat stroke include a core body temperature above 104°F
(40°C), hot and dry skin (though it can sometimes be moist), confusion, and other
central nervous system dysfunction. The client's age (older adult), high fever, and
confusion point to heat stroke, which is a medical emergency. Heat exhaustion (A)
typically presents with diaphoresis, weakness, and a lower fever. Heat cramps (C)
involve muscle spasms without confusion or high fever. Malignant hyperthermia (D) is a
reaction to anesthesia.
Question 10: The nurse is caring for a client with a chest tube connected to a
closed-chest drainage system. Which observation indicates that the chest tube
system is functioning correctly?
A. Continuous bubbling in the water-seal chamber.
B. Tidaling in the water-seal chamber with respirations.
C. Vigorous bubbling in the suction control chamber.
D. The fluid level in the water-seal chamber is decreasing.
CORRECT ANSWER: B. Tidaling in the water-seal chamber with respirations.
Rationale: Tidaling (fluctuation of the fluid level in the water-seal chamber) is a normal
and expected finding in a functional chest tube system, reflecting the negative
intrapleural pressure changes during inspiration and expiration. Continuous bubbling in
the water-seal chamber (A) suggests an air leak, not normal function. The suction
control chamber should have gentle, not vigorous, bubbling (C). The fluid level in the
water-seal chamber should remain relatively constant, not decrease (D).
Question 11: The nurse is assessing a client's surgical wound on the third post-
operative day. The wound edges are well-approximated, but there is a small
amount of serosanguineous drainage. Which action should the nurse take?
A. Apply a dry sterile dressing.
B. Notify the healthcare provider immediately.
C. Culture the drainage.
D. Apply an antibiotic ointment.
Guide & Exam Prep 2026/2027 | Elsevier HESI RN
Comprehensive Exit Review, NCLEX-RN Readiness,
Adult Medical-Surgical Nursing, Fundamentals,
Pharmacology, Maternal-Newborn, Pediatrics,
Mental Health, Leadership & Management,
Community Health, Prioritization, Delegation,
Patient Safety, NGN Clinical Judgment, Practice
Questions, Answers & Detailed Rationales
Question 1: A client who is 24-hours post-operative following an abdominal
hysterectomy reports sudden, sharp pain in the right calf. Which action should
the nurse take first?
A. Administer the prescribed PRN analgesic.
B. Massage the affected calf to promote circulation.
C. Apply a warm compress to the area.
D. Instruct the client to remain in bed and notify the healthcare provider.
CORRECT ANSWER: D. Instruct the client to remain in bed and notify the
healthcare provider.
Rationale: Sudden, sharp calf pain in a post-operative client is a classic sign of a deep
vein thrombosis (DVT). The nurse's priority is to prevent the dislodgement of a potential
thrombus by keeping the client on bed rest and immediately notifying the healthcare
provider. Massaging the area (B) or applying heat (C) could dislodge the clot, leading to
a pulmonary embolism. Administering an analgesic (A) would mask the symptom
without addressing the underlying, life-threatening issue.
Question 2: When teaching a client with newly diagnosed type 1 diabetes
mellitus about insulin administration, which statement indicates a need for
further teaching?
A. "I will rotate my injection sites within the same anatomical region."
B. "I can store my current bottle of insulin at room temperature."
C. "I should draw up the NPH insulin before the regular insulin."
D. "I need to check my blood glucose level before administering insulin."
CORRECT ANSWER: C. "I should draw up the NPH insulin before the regular
insulin."
Rationale: The correct technique for mixing insulins is to draw up the clear
(regular/short-acting) insulin first, followed by the cloudy (NPH/intermediate-acting)
insulin. This prevents contamination of the regular insulin vial with the longer-acting
NPH. The other statements are correct: rotating sites (A) prevents lipohypertrophy,
insulin can be stored at room temperature for up to 28 days (B), and checking blood
glucose before administration (D) is a standard safety measure.
,Question 3: A client with heart failure is prescribed furosemide and digoxin.
The nurse identifies that a potassium level of 3.0 mEq/L increases the client's
risk for which complication?
A. Digitalis toxicity
B. Hyperkalemia
C. Pulmonary edema
D. Anaphylactic shock
CORRECT ANSWER: A. Digitalis toxicity
Rationale: Hypokalemia (normal potassium is 3.5-5.0 mEq/L) increases the risk of
digoxin toxicity because digoxin and potassium compete for the same binding sites on
the sodium-potassium ATPase pump. Low potassium potentiates the effects of digoxin,
leading to toxicity. Furosemide is a loop diuretic that can cause hypokalemia.
Question 4: The nurse is assessing a client who has undergone a
thyroidectomy 6 hours ago. Which assessment finding requires immediate
intervention?
A. Hoarseness of the voice
B. Pain rated 5 on a 0-10 scale at the incision site
C. Tingling sensations around the mouth and fingertips
D. Swallowing difficulty
CORRECT ANSWER: C. Tingling sensations around the mouth and fingertips
Rationale: Tingling around the mouth and fingertips are early signs of hypocalcemia,
which can occur if the parathyroid glands are accidentally removed or damaged during
a thyroidectomy. This can rapidly progress to life-threatening laryngospasm and
seizures. This requires immediate intervention with IV calcium. Hoarseness (A), pain (B),
and difficulty swallowing (D) are expected post-operative findings that should be
monitored but do not require immediate, life-saving intervention at this stage.
Question 5: A client is admitted with a diagnosis of acute pancreatitis. Which
laboratory value is most consistent with this diagnosis?
A. Decreased serum glucose
B. Elevated serum lipase
C. Decreased serum amylase
D. Elevated serum bilirubin
CORRECT ANSWER: B. Elevated serum lipase
Rationale: In acute pancreatitis, pancreatic enzymes are released into the bloodstream.
Serum lipase is more specific and remains elevated longer than serum amylase, making
it the preferred diagnostic indicator. Amylase is also elevated (not decreased, C), glucose
is often increased due to impaired insulin production (not decreased, A), and bilirubin
may be elevated if the cause is a gallstone, but lipase is the most direct indicator of
pancreatic inflammation.
,Question 6: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse assesses the client
and notes a respiratory rate of 10 breaths/min and somnolence. Which action
should the nurse take first?
A. Increase the oxygen to 4 L/min.
B. Encourage the client to take deep breaths.
C. Prepare for intubation.
D. Check the client's oxygen saturation level.
CORRECT ANSWER: D. Check the client's oxygen saturation level.
Rationale: The priority action is to assess the client's current oxygenation status. The
client's decreased respiratory rate and somnolence could indicate carbon dioxide (CO2)
narcosis, a complication of oxygen therapy in COPD clients who are chronic CO2
retainers. The nurse must first check the SpO2 to gather objective data before making
any changes to the oxygen therapy (A) or implementing other interventions (B, C).
Question 7: The nurse is preparing to administer a blood transfusion to a
client. Which intravenous (IV) solution is the only appropriate solution to use
as a primary infusion with packed red blood cells?
A. 0.9% sodium chloride
B. 0.45% sodium chloride
C. Dextrose 5% in water (D5W)
D. Lactated Ringer's solution
CORRECT ANSWER: A. 0.9% sodium chloride
Rationale: Normal saline (0.9% sodium chloride) is the only solution that is isotonic and
compatible with blood products. D5W (C) can cause hemolysis due to the dextrose, and
lactated Ringer's (D) contains calcium, which can cause clotting in the tubing if mixed
with citrated blood. Hypotonic solutions like 0.45% sodium chloride (B) can cause red
blood cells to swell and lyse.
Question 8: The healthcare provider prescribes a 24-hour urine collection for a
client. Which action by the nurse is most important to ensure accurate results?
A. Keep the urine container on ice during the collection period.
B. Ask the client to void and discard the first morning urine.
C. Instruct the client to increase fluid intake during the collection.
D. Start the collection with the first voided urine of the morning.
CORRECT ANSWER: B. Ask the client to void and discard the first morning
urine.
Rationale: For a 24-hour urine collection, the collection period begins after the client
voids and discards the first morning specimen. This ensures that the collection starts
with an empty bladder and represents all urine produced over the next 24 hours. The
collection is then completed 24 hours later with the final void. While keeping the
, container on ice or in a refrigerator (A) is important for many tests, starting and ending
the collection correctly (B) is the most critical step for accuracy. The first morning urine
is discarded, not included.
Question 9: A 70-year-old client is admitted with confusion and a temperature
of 103°F (39.4°C). The client's skin is warm and flushed. The nurse suspects
the client is experiencing which type of hyperthermia?
A. Heat exhaustion
B. Heat stroke
C. Heat cramps
D. Malignant hyperthermia
CORRECT ANSWER: B. Heat stroke
Rationale: Classic signs of heat stroke include a core body temperature above 104°F
(40°C), hot and dry skin (though it can sometimes be moist), confusion, and other
central nervous system dysfunction. The client's age (older adult), high fever, and
confusion point to heat stroke, which is a medical emergency. Heat exhaustion (A)
typically presents with diaphoresis, weakness, and a lower fever. Heat cramps (C)
involve muscle spasms without confusion or high fever. Malignant hyperthermia (D) is a
reaction to anesthesia.
Question 10: The nurse is caring for a client with a chest tube connected to a
closed-chest drainage system. Which observation indicates that the chest tube
system is functioning correctly?
A. Continuous bubbling in the water-seal chamber.
B. Tidaling in the water-seal chamber with respirations.
C. Vigorous bubbling in the suction control chamber.
D. The fluid level in the water-seal chamber is decreasing.
CORRECT ANSWER: B. Tidaling in the water-seal chamber with respirations.
Rationale: Tidaling (fluctuation of the fluid level in the water-seal chamber) is a normal
and expected finding in a functional chest tube system, reflecting the negative
intrapleural pressure changes during inspiration and expiration. Continuous bubbling in
the water-seal chamber (A) suggests an air leak, not normal function. The suction
control chamber should have gentle, not vigorous, bubbling (C). The fluid level in the
water-seal chamber should remain relatively constant, not decrease (D).
Question 11: The nurse is assessing a client's surgical wound on the third post-
operative day. The wound edges are well-approximated, but there is a small
amount of serosanguineous drainage. Which action should the nurse take?
A. Apply a dry sterile dressing.
B. Notify the healthcare provider immediately.
C. Culture the drainage.
D. Apply an antibiotic ointment.
