EXIT HESI Comprehensive B
Evolve: 150 Q&A with Rationales
2027/2028
EXIT HESI COMPREHENSIVE B — FULL PRACTICE EXAM
Domain 1: Medical-Surgical Nursing (Questions 1–40)
Question 1: The nurse is caring for a client with a cerebrovascular accident (CVA) who is
receiving enteral tube feedings. Which task performed by the UAP requires immediate
intervention by the nurse?
A) Suctions oral secretions from mouth
B) Positions head of bed flat when changing sheets
C) Takes temperature using the axillary method
D) Keeps head of bed elevated at 30 degrees
Answer: B
Rationale: Positioning the head of the bed flat when enteral feedings are in progress puts
the client at risk for aspiration (B). The others are all acceptable tasks performed by the
UAP. The head of bed should remain elevated at least 30 degrees during and for 30–60
minutes after enteral feeding to prevent aspiration pneumonia.
Question 2: When caring for a postsurgical client who has undergone multiple blood
transfusions, which serum laboratory finding is of most concern to the nurse?
A) Sodium level, 137 mEq/L
B) Potassium level, 5.5 mEq/L
,C) Blood urea nitrogen (BUN) level, 18 mg/dL
D) Calcium level, 10 mEq/L
Answer: B
Rationale: Multiple blood transfusions are a risk factor for hyperkalemia because stored
blood releases potassium into the plasma. A serum potassium level higher than 5.0 mEq/L
indicates hyperkalemia, which can cause life-threatening cardiac dysrhythmias. The other
values are within normal limits.
Question 3: The nurse is caring for a client with heart failure who develops respiratory
distress and coughs up pink frothy sputum. Which action should the nurse take first?
A) Draw arterial blood gases
B) Notify the primary health care provider
C) Position in a high Fowler's position with the legs down
D) Obtain a chest X-ray
Answer: C
Rationale: Pink frothy sputum indicates pulmonary edema. Positioning the patient in a
high Fowler's position with dangling feet decreases venous return to the left ventricle
(preload), reducing pulmonary congestion. This is the priority intervention before notifying
the provider or obtaining diagnostic tests.
Question 4: The nurse is caring for a client with deep vein thrombosis who is on a
continuous IV heparin infusion. The activated partial prothrombin time (aPTT) is 120
seconds. Which action should the nurse take?
A) Increase the rate of the heparin infusion using a nomogram
B) Decrease the heparin infusion rate and give vitamin K IM
C) Stop the infusion and notify the primary health care provider
D) Continue the infusion at the current rate and recheck aPTT in 6 hours
Answer: C
Rationale: A therapeutic aPTT is typically 1.5–2.5 times the control value (approximately
45–70 seconds). An aPTT of 120 seconds indicates a high risk of bleeding. The infusion
should be stopped immediately, and the provider notified. Vitamin K is the antidote for
warfarin, not heparin; protamine sulfate is the antidote for heparin.
Question 5: The nurse is caring for a client with an ischemic stroke who has a
prescription for tissue plasminogen activator (t-PA) IV. Which action(s) should the nurse
expect to implement? (Select all that apply.)
,A) Administer aspirin with tissue plasminogen activator (t-PA)
B) Complete the National Institute of Health Stroke Scale (NIHSS)
C) Assess the client for signs of bleeding during and after the infusion
D) Start t-PA within 6 hours after the onset of stroke symptoms
E) Initiate multidisciplinary consult for potential rehabilitation
Answer: B, C, E
Rationale: Neurologic assessment, including the NIHSS, is indicated for the client receiving
t-PA. This includes close monitoring for bleeding during and after the infusion; if bleeding
or other signs of neurologic impairment occur, the infusion should be stopped (B, C, and
E). Aspirin is contraindicated with t-PA because it increases the risk for bleeding (A). The
administration of t-PA within 6 hours of symptoms is concurrent with a diagnosis of a
myocardial infarction and within 4.5 hours of symptoms is concurrent for a stroke (D).
Question 6: A 68-year-old male with a history of chronic obstructive pulmonary disease
(COPD) is admitted with acute respiratory distress. The arterial blood gas (ABG) results
show: pH 7.28, PaCO₂ 58 mmHg, HCO₃⁻ 26 mEq/L, and PaO₂ 55 mmHg. Which
underlying pathophysiology and immediate nursing intervention are most appropriate
for this patient?
A) Metabolic acidosis caused by renal failure; administer continuous intravenous sodium
bicarbonate.
B) Respiratory alkalosis caused by acute hyperventilation; instruct the patient to breathe
into a paper bag.
C) Respiratory acidosis caused by alveolar hypoventilation; apply low-flow supplemental
oxygen and prepare for non-invasive positive pressure ventilation (BiPAP).
D) Metabolic alkalosis caused by persistent vomiting; initiate aggressive isotonic
crystalloid fluid resuscitation.
Answer: C
Rationale: The patient's ABG values indicate uncompensated respiratory acidosis (low pH,
high PaCO₂, and normal HCO₃⁻) along with hypoxemia (low PaO₂). In chronic COPD,
retention of carbon dioxide occurs due to alveolar hypoventilation and air trapping.
Hypoxemia drives their respiratory effort, so high concentrations of oxygen could suppress
their hypoxic drive. Administering low-flow oxygen or utilizing BiPAP helps improve
ventilation, clear excess CO₂, and safely increase oxygenation.
Question 7: A 45-year-old female is 12 hours postoperative following a total
thyroidectomy for Graves' disease. During the clinical assessment, the nurse notes that
the patient complains of tingling around her mouth and fingers and exhibits a positive
Chvostek's sign. Which laboratory parameter must the nurse evaluate immediately?
, A) Serum potassium level
B) Serum calcium level
C) Serum sodium level
D) Serum magnesium level
Answer: B
Rationale: A total thyroidectomy carries a high risk of accidental damage to or removal of
the parathyroid glands. This complication leads to a sudden drop in parathyroid hormone
(PTH) secretion, causing acute hypocalcemia. Clinical manifestations of hypocalcemia
include perioral numbness, tingling of the extremities, hyperreflexia, and positive signs like
Chvostek's (facial twitching when tapping the facial nerve). This is a medical emergency
that requires prompt intravenous administration of calcium gluconate to prevent tetany
and laryngospasm.
Question 8: The nurse is preparing to administer an initial dose of intravenous
vancomycin to a 34-year-old patient with MRSA bacteremia. To prevent the
development of vancomycin flushing syndrome (formerly termed "red man syndrome"),
which administration protocol should the nurse enforce?
A) Administer the medication via rapid intravenous push over 2 to 3 minutes.
B) Infuse the medication slowly over a minimum of 60 to 90 minutes using an infusion
pump.
C) Mix the medication with a continuous infusion of heparin to maintain line patency.
D) Keep the patient in a strict Trendelenburg position throughout the duration of the
infusion.
Answer: B
Rationale: Vancomycin flushing syndrome is caused by rapid infusion of vancomycin,
which triggers histamine release. To prevent this reaction, the medication should be
infused slowly over at least 60 minutes. Rapid IV push (A) would increase the risk. Heparin
(C) is not mixed with vancomycin. Trendelenburg position (D) is not required and is not
related to prevention of this syndrome.
Question 9: The nurse is assessing a client at 20 weeks' gestation. Which measurement
should be compared with the client's current weight to obtain the most accurate data
about her weight gain during pregnancy?
A) Usual prepregnant weight
B) Weight at the first prenatal visit
C) Weight during previous pregnancy
D) Recommended pattern of weight gain
Evolve: 150 Q&A with Rationales
2027/2028
EXIT HESI COMPREHENSIVE B — FULL PRACTICE EXAM
Domain 1: Medical-Surgical Nursing (Questions 1–40)
Question 1: The nurse is caring for a client with a cerebrovascular accident (CVA) who is
receiving enteral tube feedings. Which task performed by the UAP requires immediate
intervention by the nurse?
A) Suctions oral secretions from mouth
B) Positions head of bed flat when changing sheets
C) Takes temperature using the axillary method
D) Keeps head of bed elevated at 30 degrees
Answer: B
Rationale: Positioning the head of the bed flat when enteral feedings are in progress puts
the client at risk for aspiration (B). The others are all acceptable tasks performed by the
UAP. The head of bed should remain elevated at least 30 degrees during and for 30–60
minutes after enteral feeding to prevent aspiration pneumonia.
Question 2: When caring for a postsurgical client who has undergone multiple blood
transfusions, which serum laboratory finding is of most concern to the nurse?
A) Sodium level, 137 mEq/L
B) Potassium level, 5.5 mEq/L
,C) Blood urea nitrogen (BUN) level, 18 mg/dL
D) Calcium level, 10 mEq/L
Answer: B
Rationale: Multiple blood transfusions are a risk factor for hyperkalemia because stored
blood releases potassium into the plasma. A serum potassium level higher than 5.0 mEq/L
indicates hyperkalemia, which can cause life-threatening cardiac dysrhythmias. The other
values are within normal limits.
Question 3: The nurse is caring for a client with heart failure who develops respiratory
distress and coughs up pink frothy sputum. Which action should the nurse take first?
A) Draw arterial blood gases
B) Notify the primary health care provider
C) Position in a high Fowler's position with the legs down
D) Obtain a chest X-ray
Answer: C
Rationale: Pink frothy sputum indicates pulmonary edema. Positioning the patient in a
high Fowler's position with dangling feet decreases venous return to the left ventricle
(preload), reducing pulmonary congestion. This is the priority intervention before notifying
the provider or obtaining diagnostic tests.
Question 4: The nurse is caring for a client with deep vein thrombosis who is on a
continuous IV heparin infusion. The activated partial prothrombin time (aPTT) is 120
seconds. Which action should the nurse take?
A) Increase the rate of the heparin infusion using a nomogram
B) Decrease the heparin infusion rate and give vitamin K IM
C) Stop the infusion and notify the primary health care provider
D) Continue the infusion at the current rate and recheck aPTT in 6 hours
Answer: C
Rationale: A therapeutic aPTT is typically 1.5–2.5 times the control value (approximately
45–70 seconds). An aPTT of 120 seconds indicates a high risk of bleeding. The infusion
should be stopped immediately, and the provider notified. Vitamin K is the antidote for
warfarin, not heparin; protamine sulfate is the antidote for heparin.
Question 5: The nurse is caring for a client with an ischemic stroke who has a
prescription for tissue plasminogen activator (t-PA) IV. Which action(s) should the nurse
expect to implement? (Select all that apply.)
,A) Administer aspirin with tissue plasminogen activator (t-PA)
B) Complete the National Institute of Health Stroke Scale (NIHSS)
C) Assess the client for signs of bleeding during and after the infusion
D) Start t-PA within 6 hours after the onset of stroke symptoms
E) Initiate multidisciplinary consult for potential rehabilitation
Answer: B, C, E
Rationale: Neurologic assessment, including the NIHSS, is indicated for the client receiving
t-PA. This includes close monitoring for bleeding during and after the infusion; if bleeding
or other signs of neurologic impairment occur, the infusion should be stopped (B, C, and
E). Aspirin is contraindicated with t-PA because it increases the risk for bleeding (A). The
administration of t-PA within 6 hours of symptoms is concurrent with a diagnosis of a
myocardial infarction and within 4.5 hours of symptoms is concurrent for a stroke (D).
Question 6: A 68-year-old male with a history of chronic obstructive pulmonary disease
(COPD) is admitted with acute respiratory distress. The arterial blood gas (ABG) results
show: pH 7.28, PaCO₂ 58 mmHg, HCO₃⁻ 26 mEq/L, and PaO₂ 55 mmHg. Which
underlying pathophysiology and immediate nursing intervention are most appropriate
for this patient?
A) Metabolic acidosis caused by renal failure; administer continuous intravenous sodium
bicarbonate.
B) Respiratory alkalosis caused by acute hyperventilation; instruct the patient to breathe
into a paper bag.
C) Respiratory acidosis caused by alveolar hypoventilation; apply low-flow supplemental
oxygen and prepare for non-invasive positive pressure ventilation (BiPAP).
D) Metabolic alkalosis caused by persistent vomiting; initiate aggressive isotonic
crystalloid fluid resuscitation.
Answer: C
Rationale: The patient's ABG values indicate uncompensated respiratory acidosis (low pH,
high PaCO₂, and normal HCO₃⁻) along with hypoxemia (low PaO₂). In chronic COPD,
retention of carbon dioxide occurs due to alveolar hypoventilation and air trapping.
Hypoxemia drives their respiratory effort, so high concentrations of oxygen could suppress
their hypoxic drive. Administering low-flow oxygen or utilizing BiPAP helps improve
ventilation, clear excess CO₂, and safely increase oxygenation.
Question 7: A 45-year-old female is 12 hours postoperative following a total
thyroidectomy for Graves' disease. During the clinical assessment, the nurse notes that
the patient complains of tingling around her mouth and fingers and exhibits a positive
Chvostek's sign. Which laboratory parameter must the nurse evaluate immediately?
, A) Serum potassium level
B) Serum calcium level
C) Serum sodium level
D) Serum magnesium level
Answer: B
Rationale: A total thyroidectomy carries a high risk of accidental damage to or removal of
the parathyroid glands. This complication leads to a sudden drop in parathyroid hormone
(PTH) secretion, causing acute hypocalcemia. Clinical manifestations of hypocalcemia
include perioral numbness, tingling of the extremities, hyperreflexia, and positive signs like
Chvostek's (facial twitching when tapping the facial nerve). This is a medical emergency
that requires prompt intravenous administration of calcium gluconate to prevent tetany
and laryngospasm.
Question 8: The nurse is preparing to administer an initial dose of intravenous
vancomycin to a 34-year-old patient with MRSA bacteremia. To prevent the
development of vancomycin flushing syndrome (formerly termed "red man syndrome"),
which administration protocol should the nurse enforce?
A) Administer the medication via rapid intravenous push over 2 to 3 minutes.
B) Infuse the medication slowly over a minimum of 60 to 90 minutes using an infusion
pump.
C) Mix the medication with a continuous infusion of heparin to maintain line patency.
D) Keep the patient in a strict Trendelenburg position throughout the duration of the
infusion.
Answer: B
Rationale: Vancomycin flushing syndrome is caused by rapid infusion of vancomycin,
which triggers histamine release. To prevent this reaction, the medication should be
infused slowly over at least 60 minutes. Rapid IV push (A) would increase the risk. Heparin
(C) is not mixed with vancomycin. Trendelenburg position (D) is not required and is not
related to prevention of this syndrome.
Question 9: The nurse is assessing a client at 20 weeks' gestation. Which measurement
should be compared with the client's current weight to obtain the most accurate data
about her weight gain during pregnancy?
A) Usual prepregnant weight
B) Weight at the first prenatal visit
C) Weight during previous pregnancy
D) Recommended pattern of weight gain
