HESI 799 RN Exit Exam Part 2 of 2 Comprehensive
EXAM 2026-2027 LATEST UPDATED VERSION 120
QUESTIONS
1. A nurse is assessing a client's pain. Which of the following is a subjective
indicator of pain?
• A) Heart rate of 110 bpm
• B) Client's statement of "I feel a sharp pain in my side"
• C) Grimacing and guarding of the abdomen
• D) Blood pressure of 150/90 mmHg
• Rationale: Subjective data is information that the client reports, such as
their feelings or perceptions. The client's verbal statement about their pain
is the most reliable and primary subjective indicator. Objective data like vital
signs and physical cues (grimacing, guarding) are important but are
considered observable indicators.
2. The nurse is preparing to administer a medication via a nasogastric (NG) tube.
What is the priority action before administering the medication?
• A) Flush the tube with 30 mL of air.
• B) Check for residual volume and verify tube placement.
• C) Crush all medications together and mix with water.
• D) Position the client in a supine position.
• Rationale: The priority is client safety. Verifying tube placement is
crucial to prevent administering medication into the lungs. Checking for
residual volume helps determine if the client is absorbing feeds and if the
medication should be held. Flushing with air is not a standard verification
, method. Medications should be crushed and administered separately, and
the client should be in a semi-Fowler's position to prevent aspiration.
3. A client is on strict bed rest. Which intervention is most important for
preventing the complication of deep vein thrombosis (DVT)?
• A) Encouraging a high-fiber diet.
• B) Performing range-of-motion exercises.
• C) Providing a back massage.
• D) Maintaining a dark, quiet environment.
• Rationale: DVT is a major risk for immobilized clients. Leg exercises,
such as ankle pumps and range-of-motion (ROM) exercises, promote
venous return and prevent stasis of blood in the deep veins. A high-fiber
diet prevents constipation, not DVT. A back massage promotes comfort, and
a quiet environment promotes rest, but neither directly prevents DVT.
4. A nurse is caring for a client with a new colostomy. Which of the following
statements by the client indicates a need for further teaching?
• A) "I should avoid eating foods that cause gas, like beans."
• B) "I will need to change my entire pouching system every day."
• C) "I can use a skin barrier wipe to protect the skin around my stoma."
• D) "I should empty the pouch when it is one-third to one-half full."
• Rationale: The pouching system typically needs to be changed every 3
to 7 days, not daily. Daily changes can irritate the skin. Emptying the pouch
when it's 1/3 to 1/2 full, using skin barrier products, and avoiding gas-
forming foods are all correct parts of ostomy care.
5. The nurse is assessing a client for dehydration. Which of the following findings
would the nurse expect?
• A) Bounding pulse
, • B) Hypertension
• C) Poor skin turgor
• D) Moist mucous membranes
• Rationale: Poor skin turgor (tenting) is a classic sign of dehydration due
to a decrease in interstitial fluid. Other signs include dry mucous
membranes, tachycardia, and hypotension. A bounding pulse and
hypertension are more indicative of fluid volume excess.
6. What is the primary purpose of a surgical aseptic technique?
• A) To reduce the number of microorganisms on a surface.
• B) To eliminate all microorganisms, including spores, from an object.
• C) To protect the nurse from injury.
• D) To prevent the spread of infection from one client to another.
• Rationale: Surgical asepsis, or sterile technique, aims to eliminate all
microorganisms, including pathogens and spores, from an area or object. It
is used for procedures that invade sterile body areas, such as surgery or
catheter insertion. Medical asepsis (clean technique) is used to reduce the
number of microorganisms.
7. A nurse is teaching a client about a low-sodium diet. Which food should the
client be instructed to avoid?
• A) Fresh fruit
• B) Canned soup
• C) Fresh chicken breast
• D) Steamed broccoli
• Rationale: Canned soups are notoriously high in sodium as it is used as
a preservative and flavor enhancer. Fresh fruits, vegetables, and
unprocessed meats are naturally low in sodium.
, 8. When transferring a client from a bed to a chair, which action by the nurse is
correct?
• A) Place the chair at a 45-degree angle to the bed.
• B) Lock the wheels of both the bed and the chair.
• C) Have the client place their arms around the nurse's neck.
• D) Stand on the client's weak side.
• Rationale: Locking the wheels on the bed and chair is a critical safety
measure to prevent movement during the transfer. The chair should be
placed parallel or at a slight angle to the bed. The client should push up on
the mattress or chair arms, not pull on the nurse's neck. The nurse should
stand on the client's strong side to provide maximum support.
9. A client's arterial blood gas (ABG) results are: pH 7.30, PaCO2 50 mmHg, HCO3
24 mEq/L. The nurse interprets these results as:
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic acidosis
• D) Metabolic alkalosis
• Rationale: The pH is low (acidotic) and the PaCO2 is high (acidotic). This
indicates a respiratory problem. The HCO3 is normal, so there is no
metabolic compensation. Therefore, the results indicate uncompensated
respiratory acidosis.
10. The nurse is preparing to give an intramuscular (IM) injection to an adult
client in the deltoid site. What is the maximum volume of medication that can
be administered in this site?
• A) 0.5 mL
• B) 1 mL
EXAM 2026-2027 LATEST UPDATED VERSION 120
QUESTIONS
1. A nurse is assessing a client's pain. Which of the following is a subjective
indicator of pain?
• A) Heart rate of 110 bpm
• B) Client's statement of "I feel a sharp pain in my side"
• C) Grimacing and guarding of the abdomen
• D) Blood pressure of 150/90 mmHg
• Rationale: Subjective data is information that the client reports, such as
their feelings or perceptions. The client's verbal statement about their pain
is the most reliable and primary subjective indicator. Objective data like vital
signs and physical cues (grimacing, guarding) are important but are
considered observable indicators.
2. The nurse is preparing to administer a medication via a nasogastric (NG) tube.
What is the priority action before administering the medication?
• A) Flush the tube with 30 mL of air.
• B) Check for residual volume and verify tube placement.
• C) Crush all medications together and mix with water.
• D) Position the client in a supine position.
• Rationale: The priority is client safety. Verifying tube placement is
crucial to prevent administering medication into the lungs. Checking for
residual volume helps determine if the client is absorbing feeds and if the
medication should be held. Flushing with air is not a standard verification
, method. Medications should be crushed and administered separately, and
the client should be in a semi-Fowler's position to prevent aspiration.
3. A client is on strict bed rest. Which intervention is most important for
preventing the complication of deep vein thrombosis (DVT)?
• A) Encouraging a high-fiber diet.
• B) Performing range-of-motion exercises.
• C) Providing a back massage.
• D) Maintaining a dark, quiet environment.
• Rationale: DVT is a major risk for immobilized clients. Leg exercises,
such as ankle pumps and range-of-motion (ROM) exercises, promote
venous return and prevent stasis of blood in the deep veins. A high-fiber
diet prevents constipation, not DVT. A back massage promotes comfort, and
a quiet environment promotes rest, but neither directly prevents DVT.
4. A nurse is caring for a client with a new colostomy. Which of the following
statements by the client indicates a need for further teaching?
• A) "I should avoid eating foods that cause gas, like beans."
• B) "I will need to change my entire pouching system every day."
• C) "I can use a skin barrier wipe to protect the skin around my stoma."
• D) "I should empty the pouch when it is one-third to one-half full."
• Rationale: The pouching system typically needs to be changed every 3
to 7 days, not daily. Daily changes can irritate the skin. Emptying the pouch
when it's 1/3 to 1/2 full, using skin barrier products, and avoiding gas-
forming foods are all correct parts of ostomy care.
5. The nurse is assessing a client for dehydration. Which of the following findings
would the nurse expect?
• A) Bounding pulse
, • B) Hypertension
• C) Poor skin turgor
• D) Moist mucous membranes
• Rationale: Poor skin turgor (tenting) is a classic sign of dehydration due
to a decrease in interstitial fluid. Other signs include dry mucous
membranes, tachycardia, and hypotension. A bounding pulse and
hypertension are more indicative of fluid volume excess.
6. What is the primary purpose of a surgical aseptic technique?
• A) To reduce the number of microorganisms on a surface.
• B) To eliminate all microorganisms, including spores, from an object.
• C) To protect the nurse from injury.
• D) To prevent the spread of infection from one client to another.
• Rationale: Surgical asepsis, or sterile technique, aims to eliminate all
microorganisms, including pathogens and spores, from an area or object. It
is used for procedures that invade sterile body areas, such as surgery or
catheter insertion. Medical asepsis (clean technique) is used to reduce the
number of microorganisms.
7. A nurse is teaching a client about a low-sodium diet. Which food should the
client be instructed to avoid?
• A) Fresh fruit
• B) Canned soup
• C) Fresh chicken breast
• D) Steamed broccoli
• Rationale: Canned soups are notoriously high in sodium as it is used as
a preservative and flavor enhancer. Fresh fruits, vegetables, and
unprocessed meats are naturally low in sodium.
, 8. When transferring a client from a bed to a chair, which action by the nurse is
correct?
• A) Place the chair at a 45-degree angle to the bed.
• B) Lock the wheels of both the bed and the chair.
• C) Have the client place their arms around the nurse's neck.
• D) Stand on the client's weak side.
• Rationale: Locking the wheels on the bed and chair is a critical safety
measure to prevent movement during the transfer. The chair should be
placed parallel or at a slight angle to the bed. The client should push up on
the mattress or chair arms, not pull on the nurse's neck. The nurse should
stand on the client's strong side to provide maximum support.
9. A client's arterial blood gas (ABG) results are: pH 7.30, PaCO2 50 mmHg, HCO3
24 mEq/L. The nurse interprets these results as:
• A) Respiratory acidosis
• B) Respiratory alkalosis
• C) Metabolic acidosis
• D) Metabolic alkalosis
• Rationale: The pH is low (acidotic) and the PaCO2 is high (acidotic). This
indicates a respiratory problem. The HCO3 is normal, so there is no
metabolic compensation. Therefore, the results indicate uncompensated
respiratory acidosis.
10. The nurse is preparing to give an intramuscular (IM) injection to an adult
client in the deltoid site. What is the maximum volume of medication that can
be administered in this site?
• A) 0.5 mL
• B) 1 mL
