1
HESI RN Exit Exam 2025 –
160 Verified Questions with
Detailed Rationales | A+
Grade | Latest NGN Update
Medical-Surgical Nursing (40 Questions)
1. A client with heart failure reports sudden shortness of breath and a productive cough with
pink-tinged sputum. What is the nurse’s priority action?
A) Administer a bronchodilator
B) Elevate the head of the bed
C) Notify the provider
D) Increase IV fluid rate
Answer: B. Elevate the head of the bed
Rationale: Pink-tinged sputum and shortness of breath indicate pulmonary edema, a
heart failure complication. Elevating the head of the bed improves breathing per ABC
(airway, breathing, circulation) principles.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
88%. What should the nurse do first?
A) Increase oxygen flow to 5 L/min
B) Encourage deep breathing exercises
C) Administer a rescue inhaler
D) Assess respiratory status
Answer: D. Assess respiratory status
Rationale: An oxygen saturation of 88% is low for COPD but may be baseline.
Assessing respiratory status determines the need for intervention per NCLEX-RN
standards.
3. A client post-stroke exhibits dysphagia. Which intervention is most appropriate?
A) Offer thin liquids
B) Place the client in a supine position
C) Consult a speech therapist
D) Encourage rapid eating
Answer: C. Consult a speech therapist
Rationale: Dysphagia increases aspiration risk. A speech therapist can assess swallowing
and recommend safe feeding strategies.
, 2
4. A client with diabetes mellitus has a blood glucose of 450 mg/dL. Which finding
suggests diabetic ketoacidosis (DKA)?
A) Bradycardia
B) Kussmaul respirations
C) Hypertension
D) Increased appetite
Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations (rapid, deep breathing) compensate for metabolic
acidosis in DKA, per RN-level endocrine management.
5. A client with acute kidney injury (AKI) has a potassium level of 6.2 mEq/L. What is the
nurse’s priority action?
A) Administer a loop diuretic
B) Prepare for an ECG
C) Encourage potassium-rich foods
D) Monitor urine output
Answer: B. Prepare for an ECG
Rationale: Hyperkalemia (potassium >5.0 mEq/L) risks cardiac arrhythmias. An ECG
assesses for life-threatening changes, per ABC principles.
6. A client with a gastrointestinal bleed has a hemoglobin of 7 g/dL. What is the priority
intervention?
A) Administer IV fluids
B) Prepare for a blood transfusion
C) Monitor vital signs every 4 hours
D) Provide dietary education
Answer: B. Prepare for a blood transfusion
Rationale: A hemoglobin of 7 g/dL indicates severe anemia, requiring a blood
transfusion to restore oxygen-carrying capacity, per RN standards.
7. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the
nurse monitor?
A) Platelet count
B) INR
C) Creatinine
D) Blood glucose
Answer: B. INR
Rationale: Warfarin requires INR monitoring (target 2.0–3.0) to assess anticoagulation
efficacy and bleeding risk.
8. A client with pneumonia develops a fever of 102°F. What should the nurse do first?
A) Administer an antipyretic
B) Obtain blood cultures
C) Encourage fluid intake
D) Apply a cooling blanket
Answer: B. Obtain blood cultures
Rationale: Fever may indicate sepsis. Obtaining blood cultures before antibiotics
identifies the causative organism, per RN infection control standards.
9. A client post-myocardial infarction reports chest pain. What is the nurse’s first action?
A) Administer aspirin
, 3
B) Notify the provider
C) Administer nitroglycerin
D) Perform an ECG
Answer: D. Perform an ECG
Rationale: Chest pain post-MI may indicate ischemia. An ECG assesses for acute
changes, guiding treatment per ABC principles.
10. A client with a seizure disorder has a tonic-clonic seizure. What is the priority action?
A) Administer lorazepam IV
B) Restrain the client’s limbs
C) Ensure airway patency
D) Insert an oral airway
Answer: C. Ensure airway patency
Rationale: Airway patency is the priority during a seizure to prevent hypoxia, per ABC
principles. Restraints and oral airways risk injury.
11. A client with heart failure is prescribed furosemide. Which finding indicates
effectiveness?
A) Increased edema
B) Decreased urine output
C) Weight loss
D) Elevated blood pressure
Answer: C. Weight loss
Rationale: Furosemide reduces fluid overload in heart failure, evidenced by weight loss
from diuresis.
12. A client with COPD reports increased dyspnea. Which position should the nurse
recommend?
A) Supine
B) Prone
C) Tripod
D) Lateral
Answer: C. Tripod
Rationale: The tripod position (leaning forward) maximizes lung expansion, improving
breathing in COPD.
13. A client with a brain injury has an intracranial pressure (ICP) of 22 mmHg. What is the
priority action?
A) Administer a sedative
B) Elevate the head of the bed
C) Increase IV fluids
D) Encourage coughing
Answer: B. Elevate the head of the bed
Rationale: Elevating the head of the bed (30–45 degrees) reduces ICP by promoting
venous drainage, per RN neuro standards.
14. A client with type 1 diabetes reports nausea and abdominal pain. What should the nurse
assess first?
A) Blood glucose level
B) Blood pressure
C) Bowel sounds
, 4
D) Pain level
Answer: A. Blood glucose level
Rationale: Nausea and abdominal pain may indicate DKA or hypoglycemia. Checking
blood glucose guides intervention.
15. A client with chronic kidney disease (CKD) reports muscle cramps. Which laboratory
value should the nurse review?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Answer: C. Calcium
Rationale: Hypocalcemia, common in CKD, causes muscle cramps due to impaired renal
calcium regulation.
16. A client with a peptic ulcer reports sudden severe abdominal pain. What should the nurse
suspect?
A) Gastritis
B) Perforation
C) Reflux
D) Obstruction
Answer: B. Perforation
Rationale: Sudden severe pain suggests perforation, a surgical emergency, requiring
immediate assessment.
17. A client with heart failure has crackles in the lungs. What is the priority intervention?
A) Administer oxygen
B) Restrict fluids
C) Encourage ambulation
D) Monitor blood pressure
Answer: A. Administer oxygen
Rationale: Crackles indicate pulmonary edema. Oxygen improves oxygenation, per ABC
principles.
18. A client with a spinal cord injury reports a headache and blurred vision. What should the
nurse assess first?
A) Blood pressure
B) Pain level
C) Bowel sounds
D) Temperature
Answer: A. Blood pressure
Rationale: Headache and blurred vision suggest autonomic dysreflexia, a hypertensive
emergency in spinal cord injury, requiring immediate BP assessment.
19. A client with hypothyroidism reports fatigue and weight gain. Which laboratory value
should the nurse monitor?
A) TSH
B) Hemoglobin
C) Creatinine
D) Potassium
Answer: A. TSH
HESI RN Exit Exam 2025 –
160 Verified Questions with
Detailed Rationales | A+
Grade | Latest NGN Update
Medical-Surgical Nursing (40 Questions)
1. A client with heart failure reports sudden shortness of breath and a productive cough with
pink-tinged sputum. What is the nurse’s priority action?
A) Administer a bronchodilator
B) Elevate the head of the bed
C) Notify the provider
D) Increase IV fluid rate
Answer: B. Elevate the head of the bed
Rationale: Pink-tinged sputum and shortness of breath indicate pulmonary edema, a
heart failure complication. Elevating the head of the bed improves breathing per ABC
(airway, breathing, circulation) principles.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of
88%. What should the nurse do first?
A) Increase oxygen flow to 5 L/min
B) Encourage deep breathing exercises
C) Administer a rescue inhaler
D) Assess respiratory status
Answer: D. Assess respiratory status
Rationale: An oxygen saturation of 88% is low for COPD but may be baseline.
Assessing respiratory status determines the need for intervention per NCLEX-RN
standards.
3. A client post-stroke exhibits dysphagia. Which intervention is most appropriate?
A) Offer thin liquids
B) Place the client in a supine position
C) Consult a speech therapist
D) Encourage rapid eating
Answer: C. Consult a speech therapist
Rationale: Dysphagia increases aspiration risk. A speech therapist can assess swallowing
and recommend safe feeding strategies.
, 2
4. A client with diabetes mellitus has a blood glucose of 450 mg/dL. Which finding
suggests diabetic ketoacidosis (DKA)?
A) Bradycardia
B) Kussmaul respirations
C) Hypertension
D) Increased appetite
Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations (rapid, deep breathing) compensate for metabolic
acidosis in DKA, per RN-level endocrine management.
5. A client with acute kidney injury (AKI) has a potassium level of 6.2 mEq/L. What is the
nurse’s priority action?
A) Administer a loop diuretic
B) Prepare for an ECG
C) Encourage potassium-rich foods
D) Monitor urine output
Answer: B. Prepare for an ECG
Rationale: Hyperkalemia (potassium >5.0 mEq/L) risks cardiac arrhythmias. An ECG
assesses for life-threatening changes, per ABC principles.
6. A client with a gastrointestinal bleed has a hemoglobin of 7 g/dL. What is the priority
intervention?
A) Administer IV fluids
B) Prepare for a blood transfusion
C) Monitor vital signs every 4 hours
D) Provide dietary education
Answer: B. Prepare for a blood transfusion
Rationale: A hemoglobin of 7 g/dL indicates severe anemia, requiring a blood
transfusion to restore oxygen-carrying capacity, per RN standards.
7. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the
nurse monitor?
A) Platelet count
B) INR
C) Creatinine
D) Blood glucose
Answer: B. INR
Rationale: Warfarin requires INR monitoring (target 2.0–3.0) to assess anticoagulation
efficacy and bleeding risk.
8. A client with pneumonia develops a fever of 102°F. What should the nurse do first?
A) Administer an antipyretic
B) Obtain blood cultures
C) Encourage fluid intake
D) Apply a cooling blanket
Answer: B. Obtain blood cultures
Rationale: Fever may indicate sepsis. Obtaining blood cultures before antibiotics
identifies the causative organism, per RN infection control standards.
9. A client post-myocardial infarction reports chest pain. What is the nurse’s first action?
A) Administer aspirin
, 3
B) Notify the provider
C) Administer nitroglycerin
D) Perform an ECG
Answer: D. Perform an ECG
Rationale: Chest pain post-MI may indicate ischemia. An ECG assesses for acute
changes, guiding treatment per ABC principles.
10. A client with a seizure disorder has a tonic-clonic seizure. What is the priority action?
A) Administer lorazepam IV
B) Restrain the client’s limbs
C) Ensure airway patency
D) Insert an oral airway
Answer: C. Ensure airway patency
Rationale: Airway patency is the priority during a seizure to prevent hypoxia, per ABC
principles. Restraints and oral airways risk injury.
11. A client with heart failure is prescribed furosemide. Which finding indicates
effectiveness?
A) Increased edema
B) Decreased urine output
C) Weight loss
D) Elevated blood pressure
Answer: C. Weight loss
Rationale: Furosemide reduces fluid overload in heart failure, evidenced by weight loss
from diuresis.
12. A client with COPD reports increased dyspnea. Which position should the nurse
recommend?
A) Supine
B) Prone
C) Tripod
D) Lateral
Answer: C. Tripod
Rationale: The tripod position (leaning forward) maximizes lung expansion, improving
breathing in COPD.
13. A client with a brain injury has an intracranial pressure (ICP) of 22 mmHg. What is the
priority action?
A) Administer a sedative
B) Elevate the head of the bed
C) Increase IV fluids
D) Encourage coughing
Answer: B. Elevate the head of the bed
Rationale: Elevating the head of the bed (30–45 degrees) reduces ICP by promoting
venous drainage, per RN neuro standards.
14. A client with type 1 diabetes reports nausea and abdominal pain. What should the nurse
assess first?
A) Blood glucose level
B) Blood pressure
C) Bowel sounds
, 4
D) Pain level
Answer: A. Blood glucose level
Rationale: Nausea and abdominal pain may indicate DKA or hypoglycemia. Checking
blood glucose guides intervention.
15. A client with chronic kidney disease (CKD) reports muscle cramps. Which laboratory
value should the nurse review?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Answer: C. Calcium
Rationale: Hypocalcemia, common in CKD, causes muscle cramps due to impaired renal
calcium regulation.
16. A client with a peptic ulcer reports sudden severe abdominal pain. What should the nurse
suspect?
A) Gastritis
B) Perforation
C) Reflux
D) Obstruction
Answer: B. Perforation
Rationale: Sudden severe pain suggests perforation, a surgical emergency, requiring
immediate assessment.
17. A client with heart failure has crackles in the lungs. What is the priority intervention?
A) Administer oxygen
B) Restrict fluids
C) Encourage ambulation
D) Monitor blood pressure
Answer: A. Administer oxygen
Rationale: Crackles indicate pulmonary edema. Oxygen improves oxygenation, per ABC
principles.
18. A client with a spinal cord injury reports a headache and blurred vision. What should the
nurse assess first?
A) Blood pressure
B) Pain level
C) Bowel sounds
D) Temperature
Answer: A. Blood pressure
Rationale: Headache and blurred vision suggest autonomic dysreflexia, a hypertensive
emergency in spinal cord injury, requiring immediate BP assessment.
19. A client with hypothyroidism reports fatigue and weight gain. Which laboratory value
should the nurse monitor?
A) TSH
B) Hemoglobin
C) Creatinine
D) Potassium
Answer: A. TSH
