HESI Compass Comprehensive Exit Exam Actual
2026 Questions and Verified Answers 350
Practice Questions and Correct Answers with
Detailed Rationales 2026|2027|Pass Guaranteed!!!
Introduction
The HESI Compass Comprehensive Exit Exam is a standardized, NCLEX-RN
readiness assessment designed to evaluate whether nursing students nearing
graduation are prepared for licensure and safe entry-level practice. The exam
emphasizes clinical judgment, prioritization, safety, and evidence-based decision-
making across all core nursing domains.
The following question bank is organized into subject-specific sections. Each
question follows a single-best-answer format with four options (A, B, C, D), a
correct answer, and a detailed rationale. Questions are numbered sequentially and
are designed to avoid duplication.
Section 1: Pharmacology (Questions 1–50)
1. A client with heart failure is prescribed furosemide IV. Which assessment
finding requires immediate intervention?
A. Serum potassium 3.0 mEq/L
B. Urine output 40 mL/hr.
C. Blood pressure 118/72 mm Hg
D. Serum sodium 138 mEq/L
Answer: A
,Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 3.0 mEq/L indicates hypokalemia, which increases the risk of cardiac
dysrhythmias, especially in clients with heart failure. Urine output of 40 mL/hr. is
adequate. The blood pressure and sodium level are within normal limits.
2. A nurse notes a physician's order for a medication dose that exceeds the
normal range. The physician is unavailable. Which action should the nurse
take?
A. Administer the medication as ordered and document the discrepancy
B. Withhold the medication until the physician rounds in the morning
C. Ask the answering service to contact the on-call physician
D. Ask the pharmacist to adjust the dose based on clinical judgment
Answer: C
Rationale: Any questionable or unsafe medication order must be clarified before
administration. The nurse should follow the chain of command and contact the on-
call physician through the answering service. Administering a potentially unsafe
dose violates patient safety. Withholding until morning may delay necessary
treatment. A pharmacist cannot independently change a prescribed dose.
3. A client is prescribed digoxin. Which assessment finding should the nurse
report immediately?
A. Heart rate 58 beats/min
B. Serum potassium 3.2 mEq/L
C. Blood pressure 110/70 mm Hg
D. Serum digoxin level 0.8 ng/mL
Answer: B
Rationale: Hypokalemia increases the risk of digoxin toxicity because potassium
and digoxin compete for binding sites on the sodium-potassium ATPase pump. A
serum potassium of 3.2 mEq/L is below normal and places the client at risk. A
heart rate of 58 beats/min is within the acceptable range for digoxin therapy but
,should be monitored. The blood pressure and digoxin level are within normal
limits.
4. A client receiving heparin has an aPTT of 95 seconds. Which action should
the nurse take?
A. Administer the next dose as scheduled
B. Hold the heparin infusion and notify the healthcare provider
C. Increase the heparin infusion rate
D. Administer vitamin K
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the control value (approximately 60–80 seconds). An aPTT of 95
seconds indicates excessive anticoagulation and risk of bleeding. The nurse should
hold the infusion and notify the provider. Vitamin K is the antidote for warfarin,
not heparin. Protamine sulfate is the antidote for heparin.
5. A client with type 2 diabetes is prescribed metformin. Which laboratory
value should the nurse monitor most closely?
A. Serum creatinine
B. Serum potassium
C. Serum calcium
D. Serum sodium
Answer: A
Rationale: Metformin is contraindicated in clients with renal impairment because it
can accumulate and cause lactic acidosis. Serum creatinine should be monitored
closely to assess renal function. Potassium, calcium, and sodium are not directly
affected by metformin.
, 6. A client is receiving vancomycin IV. Which adverse effect should the nurse
monitor for during infusion?
A. Hypotension
B. Flushing of the face and neck
C. Bradycardia
D. Hypertension
Answer: B
Rationale: Vancomycin can cause "red man syndrome," characterized by flushing
of the face, neck, and upper torso due to rapid infusion. The infusion rate should be
slowed. Hypotension, bradycardia, and hypertension are not typical adverse effects
of vancomycin infusion.
7. A client with a history of peptic ulcer disease is prescribed prednisone.
Which instruction should the nurse include in teaching?
A. Take the medication on an empty stomach
B. Take the medication with food or milk
C. Avoid dairy products while taking this medication
D. Take the medication at bedtime
Answer: B
Rationale: Prednisone can irritate the gastric mucosa and increase the risk of peptic
ulcer formation. Taking it with food or milk reduces gastric irritation. It should not
be taken on an empty stomach. Dairy products do not interfere with prednisone.
Taking it at bedtime may cause insomnia.
8. A client is prescribed levothyroxine. Which instruction should the nurse
provide?
A. Take the medication at bedtime
B. Take the medication with breakfast
C. Take the medication on an empty stomach 30 to 60 minutes before breakfast
D. Take the medication with calcium supplements
2026 Questions and Verified Answers 350
Practice Questions and Correct Answers with
Detailed Rationales 2026|2027|Pass Guaranteed!!!
Introduction
The HESI Compass Comprehensive Exit Exam is a standardized, NCLEX-RN
readiness assessment designed to evaluate whether nursing students nearing
graduation are prepared for licensure and safe entry-level practice. The exam
emphasizes clinical judgment, prioritization, safety, and evidence-based decision-
making across all core nursing domains.
The following question bank is organized into subject-specific sections. Each
question follows a single-best-answer format with four options (A, B, C, D), a
correct answer, and a detailed rationale. Questions are numbered sequentially and
are designed to avoid duplication.
Section 1: Pharmacology (Questions 1–50)
1. A client with heart failure is prescribed furosemide IV. Which assessment
finding requires immediate intervention?
A. Serum potassium 3.0 mEq/L
B. Urine output 40 mL/hr.
C. Blood pressure 118/72 mm Hg
D. Serum sodium 138 mEq/L
Answer: A
,Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 3.0 mEq/L indicates hypokalemia, which increases the risk of cardiac
dysrhythmias, especially in clients with heart failure. Urine output of 40 mL/hr. is
adequate. The blood pressure and sodium level are within normal limits.
2. A nurse notes a physician's order for a medication dose that exceeds the
normal range. The physician is unavailable. Which action should the nurse
take?
A. Administer the medication as ordered and document the discrepancy
B. Withhold the medication until the physician rounds in the morning
C. Ask the answering service to contact the on-call physician
D. Ask the pharmacist to adjust the dose based on clinical judgment
Answer: C
Rationale: Any questionable or unsafe medication order must be clarified before
administration. The nurse should follow the chain of command and contact the on-
call physician through the answering service. Administering a potentially unsafe
dose violates patient safety. Withholding until morning may delay necessary
treatment. A pharmacist cannot independently change a prescribed dose.
3. A client is prescribed digoxin. Which assessment finding should the nurse
report immediately?
A. Heart rate 58 beats/min
B. Serum potassium 3.2 mEq/L
C. Blood pressure 110/70 mm Hg
D. Serum digoxin level 0.8 ng/mL
Answer: B
Rationale: Hypokalemia increases the risk of digoxin toxicity because potassium
and digoxin compete for binding sites on the sodium-potassium ATPase pump. A
serum potassium of 3.2 mEq/L is below normal and places the client at risk. A
heart rate of 58 beats/min is within the acceptable range for digoxin therapy but
,should be monitored. The blood pressure and digoxin level are within normal
limits.
4. A client receiving heparin has an aPTT of 95 seconds. Which action should
the nurse take?
A. Administer the next dose as scheduled
B. Hold the heparin infusion and notify the healthcare provider
C. Increase the heparin infusion rate
D. Administer vitamin K
Answer: B
Rationale: The therapeutic range for aPTT during heparin therapy is typically 1.5
to 2.5 times the control value (approximately 60–80 seconds). An aPTT of 95
seconds indicates excessive anticoagulation and risk of bleeding. The nurse should
hold the infusion and notify the provider. Vitamin K is the antidote for warfarin,
not heparin. Protamine sulfate is the antidote for heparin.
5. A client with type 2 diabetes is prescribed metformin. Which laboratory
value should the nurse monitor most closely?
A. Serum creatinine
B. Serum potassium
C. Serum calcium
D. Serum sodium
Answer: A
Rationale: Metformin is contraindicated in clients with renal impairment because it
can accumulate and cause lactic acidosis. Serum creatinine should be monitored
closely to assess renal function. Potassium, calcium, and sodium are not directly
affected by metformin.
, 6. A client is receiving vancomycin IV. Which adverse effect should the nurse
monitor for during infusion?
A. Hypotension
B. Flushing of the face and neck
C. Bradycardia
D. Hypertension
Answer: B
Rationale: Vancomycin can cause "red man syndrome," characterized by flushing
of the face, neck, and upper torso due to rapid infusion. The infusion rate should be
slowed. Hypotension, bradycardia, and hypertension are not typical adverse effects
of vancomycin infusion.
7. A client with a history of peptic ulcer disease is prescribed prednisone.
Which instruction should the nurse include in teaching?
A. Take the medication on an empty stomach
B. Take the medication with food or milk
C. Avoid dairy products while taking this medication
D. Take the medication at bedtime
Answer: B
Rationale: Prednisone can irritate the gastric mucosa and increase the risk of peptic
ulcer formation. Taking it with food or milk reduces gastric irritation. It should not
be taken on an empty stomach. Dairy products do not interfere with prednisone.
Taking it at bedtime may cause insomnia.
8. A client is prescribed levothyroxine. Which instruction should the nurse
provide?
A. Take the medication at bedtime
B. Take the medication with breakfast
C. Take the medication on an empty stomach 30 to 60 minutes before breakfast
D. Take the medication with calcium supplements
