ORIGINAL HESI RN Exit Exam
HESI RN EXIT EXAM V2 2026 – COMPREHENSIVE
NURSING PRACTICE QUESTIONS
Comprehensive High-Acuity Nursing Practice: Prioritization, Pathophysiology, and
Safe Care Delivery Across the Lifespan practice exam tests your clinical judgment
and prioritization skills across high-acuity medical-surgical, pediatric, and
emergency nursing scenarios. It closely mirrors the NCLEX-RN® and HESI Exit Exam
formats to prepare you for safe, effective practice in diverse healthcare settings.
1. Sexual Assault & Forensic Evidence
A female client presents to the emergency department stating she was sexually assaulted.
Which action should the nurse prioritize first?
A. Obtain a detailed history of the assault.
B. Ask the client if she has showered, changed clothes, or douched since the incident.
C. Prepare the client for a pelvic examination.
D. Notify the police department immediately.
Correct Answer: B. Ask the client if she has showered, changed clothes, or douched since the
incident.
Rationale: Preserving forensic evidence is a critical priority in sexual assault cases. The nurse
must first determine if the client has performed any actions that could destroy DNA evidence
(such as bathing, douching, or changing clothes). While emotional support and physical safety
are paramount, assessing the preservation of evidence guides the next steps. Option A is
incorrect because obtaining a detailed history can wait until the client is stabilized and evidence
is collected. Option C is incorrect because a pelvic exam is for evidence collection, but the nurse
must first assess if evidence is still present. Option D is incorrect because reporting to the police
is the client's choice (unless mandatory reporting laws apply for minors or vulnerable adults),
and it is not the first clinical action.
1
,ORIGINAL HESI RN Exit Exam
2. Pediatric Increased Intracranial Pressure (ICP)
The nurse is assessing a 3-year-old child admitted with bacterial meningitis. Which assessment
finding is the earliest indicator that the child is experiencing increased intracranial pressure
(ICP)?
A. Decreased level of consciousness.
B. Sluggish and unequal pupillary responses.
C. Increased head circumference.
D. Bradycardia and hypertension.
Correct Answer: A. Decreased level of consciousness.
Rationale: A change in the level of consciousness (LOC) is often the earliest and most sensitive
indicator of increased ICP. Option B (unequal pupils) and Option D (bradycardia and
hypertension, known as Cushing's triad) are late signs of increased ICP and indicate brainstem
herniation. Option C (increased head circumference) is a sign of increased ICP in infants whose
fontanels are still open, but it is not a typical early sign in a 3-year-old whose fontanels have
closed.
3. Acute Pancreatitis
A client is admitted with acute pancreatitis. Which laboratory value is the most specific and
reliable indicator of this condition?
A. Serum amylase.
B. Serum lipase.
C. Serum glucose.
D. White blood cell count.
Correct Answer: B. Serum lipase.
Rationale: Serum lipase is considered the most specific and reliable diagnostic indicator for
acute pancreatitis. It rises within 4 to 8 hours, peaks at 24 hours, and remains elevated for 8 to
14 days. Option A (amylase) also rises but is less specific (can be elevated in other conditions
like renal failure or cholecystitis) and returns to normal faster. Options C and D may be elevated
in pancreatitis but are not specific to the diagnosis.
2
,ORIGINAL HESI RN Exit Exam
4. Sickle Cell Anemia (SCA) Discharge Teaching
A child newly diagnosed with sickle cell anemia (SCA) is being discharged. Which instruction is
the priority for the nurse to include in the discharge teaching?
A. Avoid crowds and individuals with known infections.
B. Restrict fluids to prevent fluid overload.
C. Administer iron supplements daily.
D. Limit physical activity to prevent fatigue.
Correct Answer: A. Avoid crowds and individuals with known infections.
Rationale: Children with SCA are functionally asplenic, making them highly susceptible to life-
threatening infections (e.g., pneumococcal sepsis). Infection prevention is a top priority. Option
B is incorrect; hydration is crucial for SCA to prevent sickling. Option C is incorrect; iron
supplements are not routinely given unless there is a confirmed iron deficiency, as iron overload
is a risk. Option D is incorrect; while rest is important during a crisis, regular, moderate activity
should be encouraged when the child is well.
5. Carotid Bruit Auscultation
To auscultate for a carotid bruit, where should the nurse place the stethoscope?
A. Over the trachea.
B. At the angle of the jaw.
C. At the base of the neck.
D. Over the thyroid gland.
Correct Answer: B. At the angle of the jaw.
Rationale: The carotid artery bifurcates at the angle of the jaw. This is the most common site for
atherosclerotic plaque development and where a bruit (turbulent blood flow) is best heard. The
nurse should ask the client to hold their breath briefly while auscultating to eliminate breath
sounds.
3
, ORIGINAL HESI RN Exit Exam
6. Prioritization in Acute Care (Bowel Obstruction)
The nurse receives report on four clients. Which client should the nurse assess first?
A. A client with a large bowel obstruction experiencing abdominal distention.
B. A client with a paralytic ileus and absent bowel sounds.
C. A client with a small bowel obstruction and a nasogastric tube draining greenish fluid.
D. A client with a bowel obstruction who is experiencing abdominal rigidity and guarding.
Correct Answer: D. A client with a bowel obstruction who is experiencing abdominal rigidity
and guarding.
Rationale: Abdominal rigidity and guarding are classic signs of peritonitis, which occurs when a
bowel obstruction leads to ischemia, necrosis, and perforation. This is a life-threatening
emergency requiring immediate surgical intervention. Options A, B, and C represent expected
findings for their respective conditions and are not immediately life-threatening compared to a
potential perforation.
7. Acid-Base Imbalance
A teenager presents to the emergency department with palpitations, anxiety, and
hyperventilation after vaping at a party. The nurse anticipates the client will develop which acid-
base imbalance?
A. Respiratory acidosis.
B. Respiratory alkalosis.
C. Metabolic acidosis.
D. Metabolic alkalosis.
Correct Answer: B. Respiratory alkalosis.
Rationale: Hyperventilation causes excessive exhalation of carbon dioxide (CO2). A decrease in
arterial CO2 (hypocapnia) leads to an increase in blood pH, resulting in respiratory alkalosis.
Option A is caused by hypoventilation (retaining CO2). Options C and D are metabolic in nature
and are not directly caused by hyperventilation.
4
HESI RN EXIT EXAM V2 2026 – COMPREHENSIVE
NURSING PRACTICE QUESTIONS
Comprehensive High-Acuity Nursing Practice: Prioritization, Pathophysiology, and
Safe Care Delivery Across the Lifespan practice exam tests your clinical judgment
and prioritization skills across high-acuity medical-surgical, pediatric, and
emergency nursing scenarios. It closely mirrors the NCLEX-RN® and HESI Exit Exam
formats to prepare you for safe, effective practice in diverse healthcare settings.
1. Sexual Assault & Forensic Evidence
A female client presents to the emergency department stating she was sexually assaulted.
Which action should the nurse prioritize first?
A. Obtain a detailed history of the assault.
B. Ask the client if she has showered, changed clothes, or douched since the incident.
C. Prepare the client for a pelvic examination.
D. Notify the police department immediately.
Correct Answer: B. Ask the client if she has showered, changed clothes, or douched since the
incident.
Rationale: Preserving forensic evidence is a critical priority in sexual assault cases. The nurse
must first determine if the client has performed any actions that could destroy DNA evidence
(such as bathing, douching, or changing clothes). While emotional support and physical safety
are paramount, assessing the preservation of evidence guides the next steps. Option A is
incorrect because obtaining a detailed history can wait until the client is stabilized and evidence
is collected. Option C is incorrect because a pelvic exam is for evidence collection, but the nurse
must first assess if evidence is still present. Option D is incorrect because reporting to the police
is the client's choice (unless mandatory reporting laws apply for minors or vulnerable adults),
and it is not the first clinical action.
1
,ORIGINAL HESI RN Exit Exam
2. Pediatric Increased Intracranial Pressure (ICP)
The nurse is assessing a 3-year-old child admitted with bacterial meningitis. Which assessment
finding is the earliest indicator that the child is experiencing increased intracranial pressure
(ICP)?
A. Decreased level of consciousness.
B. Sluggish and unequal pupillary responses.
C. Increased head circumference.
D. Bradycardia and hypertension.
Correct Answer: A. Decreased level of consciousness.
Rationale: A change in the level of consciousness (LOC) is often the earliest and most sensitive
indicator of increased ICP. Option B (unequal pupils) and Option D (bradycardia and
hypertension, known as Cushing's triad) are late signs of increased ICP and indicate brainstem
herniation. Option C (increased head circumference) is a sign of increased ICP in infants whose
fontanels are still open, but it is not a typical early sign in a 3-year-old whose fontanels have
closed.
3. Acute Pancreatitis
A client is admitted with acute pancreatitis. Which laboratory value is the most specific and
reliable indicator of this condition?
A. Serum amylase.
B. Serum lipase.
C. Serum glucose.
D. White blood cell count.
Correct Answer: B. Serum lipase.
Rationale: Serum lipase is considered the most specific and reliable diagnostic indicator for
acute pancreatitis. It rises within 4 to 8 hours, peaks at 24 hours, and remains elevated for 8 to
14 days. Option A (amylase) also rises but is less specific (can be elevated in other conditions
like renal failure or cholecystitis) and returns to normal faster. Options C and D may be elevated
in pancreatitis but are not specific to the diagnosis.
2
,ORIGINAL HESI RN Exit Exam
4. Sickle Cell Anemia (SCA) Discharge Teaching
A child newly diagnosed with sickle cell anemia (SCA) is being discharged. Which instruction is
the priority for the nurse to include in the discharge teaching?
A. Avoid crowds and individuals with known infections.
B. Restrict fluids to prevent fluid overload.
C. Administer iron supplements daily.
D. Limit physical activity to prevent fatigue.
Correct Answer: A. Avoid crowds and individuals with known infections.
Rationale: Children with SCA are functionally asplenic, making them highly susceptible to life-
threatening infections (e.g., pneumococcal sepsis). Infection prevention is a top priority. Option
B is incorrect; hydration is crucial for SCA to prevent sickling. Option C is incorrect; iron
supplements are not routinely given unless there is a confirmed iron deficiency, as iron overload
is a risk. Option D is incorrect; while rest is important during a crisis, regular, moderate activity
should be encouraged when the child is well.
5. Carotid Bruit Auscultation
To auscultate for a carotid bruit, where should the nurse place the stethoscope?
A. Over the trachea.
B. At the angle of the jaw.
C. At the base of the neck.
D. Over the thyroid gland.
Correct Answer: B. At the angle of the jaw.
Rationale: The carotid artery bifurcates at the angle of the jaw. This is the most common site for
atherosclerotic plaque development and where a bruit (turbulent blood flow) is best heard. The
nurse should ask the client to hold their breath briefly while auscultating to eliminate breath
sounds.
3
, ORIGINAL HESI RN Exit Exam
6. Prioritization in Acute Care (Bowel Obstruction)
The nurse receives report on four clients. Which client should the nurse assess first?
A. A client with a large bowel obstruction experiencing abdominal distention.
B. A client with a paralytic ileus and absent bowel sounds.
C. A client with a small bowel obstruction and a nasogastric tube draining greenish fluid.
D. A client with a bowel obstruction who is experiencing abdominal rigidity and guarding.
Correct Answer: D. A client with a bowel obstruction who is experiencing abdominal rigidity
and guarding.
Rationale: Abdominal rigidity and guarding are classic signs of peritonitis, which occurs when a
bowel obstruction leads to ischemia, necrosis, and perforation. This is a life-threatening
emergency requiring immediate surgical intervention. Options A, B, and C represent expected
findings for their respective conditions and are not immediately life-threatening compared to a
potential perforation.
7. Acid-Base Imbalance
A teenager presents to the emergency department with palpitations, anxiety, and
hyperventilation after vaping at a party. The nurse anticipates the client will develop which acid-
base imbalance?
A. Respiratory acidosis.
B. Respiratory alkalosis.
C. Metabolic acidosis.
D. Metabolic alkalosis.
Correct Answer: B. Respiratory alkalosis.
Rationale: Hyperventilation causes excessive exhalation of carbon dioxide (CO2). A decrease in
arterial CO2 (hypocapnia) leads to an increase in blood pH, resulting in respiratory alkalosis.
Option A is caused by hypoventilation (retaining CO2). Options C and D are metabolic in nature
and are not directly caused by hyperventilation.
4
