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HESI RN Comprehensive Exit Exam
2025–2026: 300 Practice Questions
with Verified Answers & Rationales”
Question 1 – Pharmacology
A nurse is administering digoxin to an elderly client diagnosed with heart failure. Prior to
administration, the nurse notes the client’s heart rate is 54 beats per minute, and the client
complains of nausea and blurred vision. The client’s latest potassium level is 3.2 mEq/L.
The healthcare provider has ordered digoxin 0.125 mg PO daily. The nurse understands that
the client may be experiencing signs of digoxin toxicity. Based on this information, what
should be the nurse’s priority action?
, A. Administer the medication and monitor for further symptoms
B. Notify the healthcare provider and withhold the dose
C. Encourage the client to drink fluids and monitor potassium
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D. Recheck the heart rate in 30 minutes before deciding
✅ Correct Answer: B. Notify the healthcare provider and withhold the dose
Rationale: Digoxin toxicity is more likely when potassium levels are low. The client's
bradycardia, nausea, and visual disturbances are classic signs of toxicity. Withholding the
dose and contacting the provider is critical. Administering the drug (A) could worsen
toxicity. Encouraging fluids (C) is not a priority intervention in this case. Rechecking vitals
(D) delays necessary action.
🧠 Question 2 – Mental Health
A 22-year-old female client diagnosed with schizophrenia is admitted for acute psychotic
symptoms, including auditory hallucinations instructing her to harm herself. She reports she
has “heard the voices” more frequently over the last 3 days and feels “exhausted trying to
ignore them.” The nurse notes the client appears anxious, avoids eye contact, and responds
to unseen stimuli. What is the most therapeutic response by the nurse during the initial
interaction?
A. “I don’t hear anything. Are you sure you’re not imagining it?”
B. “You're safe here, and I will stay with you. Let’s talk about what you're feeling.”
C. “You need to stop listening to those voices—they aren’t real.”
D. “Do the voices tell you to do bad things? Why do you listen?”
, ✅ Correct Answer: B. “You're safe here, and I will stay with you. Let’s talk about
what you're feeling.”
Page | 3 Rationale: This response offers emotional safety and establishes trust while acknowledging
the client’s distress. It avoids reinforcing the hallucinations without directly denying them.
Options A and C are dismissive and could worsen anxiety. Option D could escalate the
client’s fear or resistance.
🩺 Question 3 – Med-Surg
A postoperative client who underwent abdominal surgery 2 days ago reports increased
abdominal pain, chills, and a temperature of 38.9°C (102°F). On assessment, the nurse
notes the client’s surgical dressing is dry, but the abdomen is distended, firm, and tender to
palpation. Bowel sounds are absent in all quadrants. The client’s heart rate is 112 bpm, and
blood pressure is 100/64 mmHg. What complication is the nurse most concerned about?
A. Bowel obstruction due to paralytic ileus
B. Peritonitis resulting from surgical site infection
C. Normal postoperative inflammation
D. Urinary tract infection causing referred pain
✅ Correct Answer: B. Peritonitis resulting from surgical site infection
Rationale: Fever, abdominal distention, pain, and absent bowel sounds suggest peritonitis
— a medical emergency. While paralytic ileus (A) is a consideration, the presence of
systemic infection signs points to peritonitis. Normal inflammation (C) wouldn’t include
, high fever and distention. UTI (D) wouldn’t cause abdominal firmness and absent bowel
sounds.
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👶 Question 4 – Maternity
A nurse is caring for a laboring woman at 40 weeks’ gestation who has been on an oxytocin
infusion for 6 hours. The client is experiencing contractions every 90 seconds, lasting 90
seconds each. The fetal heart rate (FHR) shows late decelerations with minimal variability.
The client is diaphoretic, restless, and complains of chest tightness. The nurse immediately
stops the oxytocin. What is the nurse’s next priority action?
A. Place the client in the supine position and increase IV fluids
B. Administer naloxone to reverse possible opioid toxicity
C. Reposition the client to her side and apply oxygen
D. Call the provider to prepare for emergency cesarean delivery
✅ Correct Answer: C. Reposition the client to her side and apply oxygen
Rationale: These signs indicate uterine hyperstimulation and possible fetal distress. The
nurse’s next action after stopping oxytocin is to improve fetal oxygenation by repositioning
and providing oxygen. Supine position (A) worsens uterine perfusion. Naloxone (B) is
inappropriate without opioid use. Calling the provider (D) is important but not the
immediate next step.
HESI RN Comprehensive Exit Exam
2025–2026: 300 Practice Questions
with Verified Answers & Rationales”
Question 1 – Pharmacology
A nurse is administering digoxin to an elderly client diagnosed with heart failure. Prior to
administration, the nurse notes the client’s heart rate is 54 beats per minute, and the client
complains of nausea and blurred vision. The client’s latest potassium level is 3.2 mEq/L.
The healthcare provider has ordered digoxin 0.125 mg PO daily. The nurse understands that
the client may be experiencing signs of digoxin toxicity. Based on this information, what
should be the nurse’s priority action?
, A. Administer the medication and monitor for further symptoms
B. Notify the healthcare provider and withhold the dose
C. Encourage the client to drink fluids and monitor potassium
Page | 2
D. Recheck the heart rate in 30 minutes before deciding
✅ Correct Answer: B. Notify the healthcare provider and withhold the dose
Rationale: Digoxin toxicity is more likely when potassium levels are low. The client's
bradycardia, nausea, and visual disturbances are classic signs of toxicity. Withholding the
dose and contacting the provider is critical. Administering the drug (A) could worsen
toxicity. Encouraging fluids (C) is not a priority intervention in this case. Rechecking vitals
(D) delays necessary action.
🧠 Question 2 – Mental Health
A 22-year-old female client diagnosed with schizophrenia is admitted for acute psychotic
symptoms, including auditory hallucinations instructing her to harm herself. She reports she
has “heard the voices” more frequently over the last 3 days and feels “exhausted trying to
ignore them.” The nurse notes the client appears anxious, avoids eye contact, and responds
to unseen stimuli. What is the most therapeutic response by the nurse during the initial
interaction?
A. “I don’t hear anything. Are you sure you’re not imagining it?”
B. “You're safe here, and I will stay with you. Let’s talk about what you're feeling.”
C. “You need to stop listening to those voices—they aren’t real.”
D. “Do the voices tell you to do bad things? Why do you listen?”
, ✅ Correct Answer: B. “You're safe here, and I will stay with you. Let’s talk about
what you're feeling.”
Page | 3 Rationale: This response offers emotional safety and establishes trust while acknowledging
the client’s distress. It avoids reinforcing the hallucinations without directly denying them.
Options A and C are dismissive and could worsen anxiety. Option D could escalate the
client’s fear or resistance.
🩺 Question 3 – Med-Surg
A postoperative client who underwent abdominal surgery 2 days ago reports increased
abdominal pain, chills, and a temperature of 38.9°C (102°F). On assessment, the nurse
notes the client’s surgical dressing is dry, but the abdomen is distended, firm, and tender to
palpation. Bowel sounds are absent in all quadrants. The client’s heart rate is 112 bpm, and
blood pressure is 100/64 mmHg. What complication is the nurse most concerned about?
A. Bowel obstruction due to paralytic ileus
B. Peritonitis resulting from surgical site infection
C. Normal postoperative inflammation
D. Urinary tract infection causing referred pain
✅ Correct Answer: B. Peritonitis resulting from surgical site infection
Rationale: Fever, abdominal distention, pain, and absent bowel sounds suggest peritonitis
— a medical emergency. While paralytic ileus (A) is a consideration, the presence of
systemic infection signs points to peritonitis. Normal inflammation (C) wouldn’t include
, high fever and distention. UTI (D) wouldn’t cause abdominal firmness and absent bowel
sounds.
Page | 4
👶 Question 4 – Maternity
A nurse is caring for a laboring woman at 40 weeks’ gestation who has been on an oxytocin
infusion for 6 hours. The client is experiencing contractions every 90 seconds, lasting 90
seconds each. The fetal heart rate (FHR) shows late decelerations with minimal variability.
The client is diaphoretic, restless, and complains of chest tightness. The nurse immediately
stops the oxytocin. What is the nurse’s next priority action?
A. Place the client in the supine position and increase IV fluids
B. Administer naloxone to reverse possible opioid toxicity
C. Reposition the client to her side and apply oxygen
D. Call the provider to prepare for emergency cesarean delivery
✅ Correct Answer: C. Reposition the client to her side and apply oxygen
Rationale: These signs indicate uterine hyperstimulation and possible fetal distress. The
nurse’s next action after stopping oxytocin is to improve fetal oxygenation by repositioning
and providing oxygen. Supine position (A) worsens uterine perfusion. Naloxone (B) is
inappropriate without opioid use. Calling the provider (D) is important but not the
immediate next step.
