HESI-Style Comprehensive Nursing Exit
Examination
This examination tests core clinical competencies across Medical-Surgical Nursing,
Pharmacology, Pediatrics, Maternal-Newborn Care, Psychiatric Mental Health,
Leadership, Delegation, and Safety.
Question 1
A client with chronic kidney disease (CKD) reports severe muscle weakness and cardiac
palpitations. The ECG monitor reveals tall, peaked T waves. Which intervention should the
nurse implement first?
● A. Administer oral sodium polystyrene sulfonate.
● B. Prepare the client for immediate hemodialysis.
● C. Administer IV calcium gluconate.
● D. Obtain a 12-lead electrocardiogram.
Correct Answer: C
Rationale: Calcium gluconate immediately stabilizes the myocardial cell membrane to
prevent lethal arrhythmias caused by hyperkalemia. While sodium polystyrene sulfonate
and dialysis remove potassium from the body, they take longer to act and do not provide
urgent cardiac membrane protection.
Question 2
A nurse receives change-of-shift report on four clients. Which client should the nurse
assess first?
● A. A client 2 hours post-thyroidectomy reporting voice hoarseness and a feeling of
throat tightness.
● B. A client with pneumonia who has an oxygen saturation of 93% on 2 L/min nasal
cannula.
, ● C. A client with diabetes mellitus who has a bedtime blood glucose reading of 145
mg/dL.
● D. A client post-cholecystectomy requesting pain medication 4 out of 10.
Correct Answer: A
Rationale: Throat tightness and hoarseness after a thyroidectomy indicate potential
airway compromise from laryngeal nerve damage or a expanding neck hematoma. The
other clients are stable and exhibit expected findings that do not take priority over airway
compromise.
Question 3
A primary health care provider prescribes levothyroxine 100 mcg PO daily for a client with
hypothyroidism. Which instruction is most critical for the nurse to include in the discharge
teaching?
● A. Take the medication with a high-fiber breakfast every morning.
● B. Stop taking the medication once symptoms subside.
● C. Take the medication right before bedtime with a glass of milk.
● D. Take the medication in the morning on an empty stomach with a full glass of
water.
Correct Answer: D
Rationale: Levothyroxine is absorbed best when taken on an empty stomach first thing in
the morning with plain water, at least 30 to 60 minutes before breakfast. Taking it with
food or calcium-containing beverages like milk significantly impairs gastrointestinal
absorption.
Question 4
A client receiving a continuous infusion of heparin for deep vein thrombosis (DVT) has an
activated partial thromboplastin time (aPTT) of 110 seconds (control: 30–40 seconds).
What action should the nurse perform first?
● A. Increase the infusion rate by 2 mL/hr.
● B. Stop the continuous heparin infusion.
, ● C. Prepare to administer protamine sulfate immediately.
● D. Notify the primary healthcare provider.
Correct Answer: B
Rationale: An aPTT of 110 seconds is significantly above the therapeutic target (typically
1.5–2.5 times baseline) and places the client at high risk for major hemorrhage, requiring
an immediate stop of the infusion. Protamine sulfate is the antidote, but pausing the
infusion is the fastest initial safety step before administering reversing agents or notifying
the provider.
Question 5
A postpartum client who delivered vaginally 4 hours ago experiences heavy vaginal
bleeding with large clots. On palpation, the nurse notes the fundus is soft, boggy, and
displaced to the right above the umbilicus. What is the priority nursing action?
● A. Administer intramuscular oxytocin.
● B. Assist the client to void or perform urinary catheterization.
● C. Perform vigorous fundal massage continuously for 15 minutes.
● D. Place the client in the Trendelenburg position.
Correct Answer: B
Rationale: A boggy fundus displaced to the right is the classic sign of uterine atony
secondary to a full urinary bladder. Emptying the bladder allows the uterus to contract
properly; oxytocin or massage alone will not resolve atony caused by bladder
displacement.
Question 6
An infant diagnosed with tetralogy of Fallot becomes suddenly cyanotic and hyperpneic
during a heel-stick procedure. What immediate position should the nurse place the infant
in?
● A. High Fowlers position.
● B. Trendelenburg position.
● C. Right lateral side-lying position.
, ● D. Knee-chest position.
Correct Answer: D
Rationale: Placing the infant in a knee-chest position increases systemic vascular
resistance, which decreases the right-to-left shunt and improves pulmonary blood flow
during a hypercyanotic ("tet") spell. Other positions do not alter systemic vascular
resistance sufficiently to relieve the acute cardiac hypoxia.
Question 7
A client diagnosed with major depressive disorder has been taking phenelzine, a
monoamine oxidase inhibitor (MAOI), for 3 weeks. Which menu selection by the client
indicates a correct understanding of dietary restrictions?
● A. Grilled chicken breast with steamed broccoli and white rice.
● B. Pepperoni pizza with extra cheese and draft beer.
● C. Aged cheddar cheese sandwich on sourdough bread with avocado.
● D. Smoked salmon on a bagel with cream cheese and fava beans.
Correct Answer: A
Rationale: Monoamine oxidase inhibitors interact with tyramine-containing foods (aged
cheeses, cured meats, fermented products, draft beer) to cause a severe hypertensive
crisis; plain chicken, broccoli, and rice are low in tyramine. Options B, C, and D contain
high levels of tyramine and must be strictly avoided.
Question 8
The nurse manager is making staff assignments for the medical-surgical unit. Which task
is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
● A. Assessing a newly admitted client's skin integrity and pressure injury risk.
● B. Instructing a client with COPD on how to use a incentive spirometer.
● C. Assisting a stable post-operative client with ambulation in the hallway.
● D. Evaluating a client's response to an antiemetic medication.
Examination
This examination tests core clinical competencies across Medical-Surgical Nursing,
Pharmacology, Pediatrics, Maternal-Newborn Care, Psychiatric Mental Health,
Leadership, Delegation, and Safety.
Question 1
A client with chronic kidney disease (CKD) reports severe muscle weakness and cardiac
palpitations. The ECG monitor reveals tall, peaked T waves. Which intervention should the
nurse implement first?
● A. Administer oral sodium polystyrene sulfonate.
● B. Prepare the client for immediate hemodialysis.
● C. Administer IV calcium gluconate.
● D. Obtain a 12-lead electrocardiogram.
Correct Answer: C
Rationale: Calcium gluconate immediately stabilizes the myocardial cell membrane to
prevent lethal arrhythmias caused by hyperkalemia. While sodium polystyrene sulfonate
and dialysis remove potassium from the body, they take longer to act and do not provide
urgent cardiac membrane protection.
Question 2
A nurse receives change-of-shift report on four clients. Which client should the nurse
assess first?
● A. A client 2 hours post-thyroidectomy reporting voice hoarseness and a feeling of
throat tightness.
● B. A client with pneumonia who has an oxygen saturation of 93% on 2 L/min nasal
cannula.
, ● C. A client with diabetes mellitus who has a bedtime blood glucose reading of 145
mg/dL.
● D. A client post-cholecystectomy requesting pain medication 4 out of 10.
Correct Answer: A
Rationale: Throat tightness and hoarseness after a thyroidectomy indicate potential
airway compromise from laryngeal nerve damage or a expanding neck hematoma. The
other clients are stable and exhibit expected findings that do not take priority over airway
compromise.
Question 3
A primary health care provider prescribes levothyroxine 100 mcg PO daily for a client with
hypothyroidism. Which instruction is most critical for the nurse to include in the discharge
teaching?
● A. Take the medication with a high-fiber breakfast every morning.
● B. Stop taking the medication once symptoms subside.
● C. Take the medication right before bedtime with a glass of milk.
● D. Take the medication in the morning on an empty stomach with a full glass of
water.
Correct Answer: D
Rationale: Levothyroxine is absorbed best when taken on an empty stomach first thing in
the morning with plain water, at least 30 to 60 minutes before breakfast. Taking it with
food or calcium-containing beverages like milk significantly impairs gastrointestinal
absorption.
Question 4
A client receiving a continuous infusion of heparin for deep vein thrombosis (DVT) has an
activated partial thromboplastin time (aPTT) of 110 seconds (control: 30–40 seconds).
What action should the nurse perform first?
● A. Increase the infusion rate by 2 mL/hr.
● B. Stop the continuous heparin infusion.
, ● C. Prepare to administer protamine sulfate immediately.
● D. Notify the primary healthcare provider.
Correct Answer: B
Rationale: An aPTT of 110 seconds is significantly above the therapeutic target (typically
1.5–2.5 times baseline) and places the client at high risk for major hemorrhage, requiring
an immediate stop of the infusion. Protamine sulfate is the antidote, but pausing the
infusion is the fastest initial safety step before administering reversing agents or notifying
the provider.
Question 5
A postpartum client who delivered vaginally 4 hours ago experiences heavy vaginal
bleeding with large clots. On palpation, the nurse notes the fundus is soft, boggy, and
displaced to the right above the umbilicus. What is the priority nursing action?
● A. Administer intramuscular oxytocin.
● B. Assist the client to void or perform urinary catheterization.
● C. Perform vigorous fundal massage continuously for 15 minutes.
● D. Place the client in the Trendelenburg position.
Correct Answer: B
Rationale: A boggy fundus displaced to the right is the classic sign of uterine atony
secondary to a full urinary bladder. Emptying the bladder allows the uterus to contract
properly; oxytocin or massage alone will not resolve atony caused by bladder
displacement.
Question 6
An infant diagnosed with tetralogy of Fallot becomes suddenly cyanotic and hyperpneic
during a heel-stick procedure. What immediate position should the nurse place the infant
in?
● A. High Fowlers position.
● B. Trendelenburg position.
● C. Right lateral side-lying position.
, ● D. Knee-chest position.
Correct Answer: D
Rationale: Placing the infant in a knee-chest position increases systemic vascular
resistance, which decreases the right-to-left shunt and improves pulmonary blood flow
during a hypercyanotic ("tet") spell. Other positions do not alter systemic vascular
resistance sufficiently to relieve the acute cardiac hypoxia.
Question 7
A client diagnosed with major depressive disorder has been taking phenelzine, a
monoamine oxidase inhibitor (MAOI), for 3 weeks. Which menu selection by the client
indicates a correct understanding of dietary restrictions?
● A. Grilled chicken breast with steamed broccoli and white rice.
● B. Pepperoni pizza with extra cheese and draft beer.
● C. Aged cheddar cheese sandwich on sourdough bread with avocado.
● D. Smoked salmon on a bagel with cream cheese and fava beans.
Correct Answer: A
Rationale: Monoamine oxidase inhibitors interact with tyramine-containing foods (aged
cheeses, cured meats, fermented products, draft beer) to cause a severe hypertensive
crisis; plain chicken, broccoli, and rice are low in tyramine. Options B, C, and D contain
high levels of tyramine and must be strictly avoided.
Question 8
The nurse manager is making staff assignments for the medical-surgical unit. Which task
is most appropriate to delegate to an unlicensed assistive personnel (UAP)?
● A. Assessing a newly admitted client's skin integrity and pressure injury risk.
● B. Instructing a client with COPD on how to use a incentive spirometer.
● C. Assisting a stable post-operative client with ambulation in the hallway.
● D. Evaluating a client's response to an antiemetic medication.
