HESI RN Exit Exam 2025 – Complete
Actual Questions with Correct
Answers and Expert Rationales
Question 1
Scenario: A client with heart failure is admitted with dyspnea and bilateral crackles. The nurse
notes a heart rate of 110 bpm and oxygen saturation of 88%.
Question: What is the nurse’s priority action?
A) Administer a beta-blocker as prescribed.
B) Administer supplemental oxygen.
C) Elevate the head of the bed to 90 degrees.
D) Obtain a 12-lead ECG.
Answer: B) Administer supplemental oxygen.
Rationale: The client’s oxygen saturation of 88% indicates hypoxemia, a critical condition
requiring immediate intervention to improve oxygenation. Administering supplemental oxygen is
the priority to stabilize the client. A beta-blocker (A) may be indicated later, elevating the bed
(C) is secondary, and an ECG (D) is diagnostic but not the immediate priority.
Question 2
Scenario: A client with type 1 diabetes reports nausea and shakiness. The blood glucose level is
50 mg/dL.
Question: What is the nurse’s first action?
A) Administer insulin as prescribed.
B) Provide 15 grams of a fast-acting carbohydrate.
C) Check the client’s hemoglobin A1c.
D) Encourage the client to rest.
Answer: B) Provide 15 grams of a fast-acting carbohydrate.
Rationale: A blood glucose of 50 mg/dL indicates hypoglycemia, requiring immediate
administration of 15 grams of a fast-acting carbohydrate (e.g., juice or glucose gel) to raise blood
sugar. Insulin (A) would worsen hypoglycemia, A1c (C) is a long-term measure, and rest (D)
does not address the issue.
,Question 3
Scenario: A client with schizophrenia is pacing and shouting, “They’re watching me!” The
nurse observes clenched fists and rapid speech.
Question: What is the nurse’s priority action?
A) Administer an antipsychotic medication.
B) Assess the client’s level of agitation and safety risk.
C) Place the client in seclusion.
D) Instruct the client to calm down.
Answer: B) Assess the client’s level of agitation and safety risk.
Rationale: Assessing agitation and safety is the priority to determine the risk of harm to self or
others, guiding further interventions. Administering medication (A) or seclusion (C) requires
assessment first, and instructing to calm down (D) may escalate agitation.
Question 4
Scenario: A postoperative client reports severe pain at the surgical site. The nurse notes a
prescription for morphine 2 mg IV every 4 hours PRN.
Question: What should the nurse do first?
A) Administer the morphine immediately.
B) Assess the client’s pain level and vital signs.
C) Notify the healthcare provider.
D) Apply a warm compress to the site.
Answer: B) Assess the client’s pain level and vital signs.
Rationale: Assessing pain and vital signs is essential to determine the severity and ensure safe
administration of morphine. Administering without assessment (A) is unsafe, notifying the
provider (C) is premature, and a warm compress (D) is not indicated.
Question 5
Scenario: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client’s respiratory rate is 28 breaths/min, and oxygen saturation is
90%.
,Question: What should the nurse do next?
A) Increase the oxygen to 4 L/min.
B) Position the client in a semi-Fowler’s position.
C) Administer a bronchodilator.
D) Encourage deep breathing exercises.
Answer: B) Position the client in a semi-Fowler’s position.
Rationale: A semi-Fowler’s position optimizes lung expansion and improves breathing in
COPD. Increasing oxygen (A) requires a prescription, a bronchodilator (C) may be indicated
later, and deep breathing (D) is less effective in acute distress.
Question 6
Scenario: A nurse is caring for a client receiving a blood transfusion. The client reports itching
and hives after 15 minutes.
Question: What is the nurse’s first action?
A) Slow the transfusion rate.
B) Stop the transfusion immediately.
C) Administer an antihistamine.
D) Check the client’s temperature.
Answer: B) Stop the transfusion immediately.
Rationale: Itching and hives suggest an allergic reaction, requiring immediate cessation of the
transfusion to prevent further complications. Slowing the rate (A) is insufficient, an
antihistamine (C) is secondary, and checking temperature (D) is not the priority.
Question 7
Scenario: A client with hypertension started lisinopril and reports a persistent dry cough.
Question: What is the best nursing action?
A) Encourage increased fluid intake.
B) Notify the healthcare provider for an alternative medication.
C) Administer an over-the-counter cough suppressant.
D) Continue monitoring the cough.
Answer: B) Notify the healthcare provider for an alternative medication.
Rationale: A dry cough is a common side effect of ACE inhibitors like lisinopril, often requiring
a switch to another medication (e.g., ARB). Fluid intake (A) or suppressants (C) do not address
the cause, and monitoring (D) delays intervention.
, Question 8
Scenario: A nurse is preparing to administer digoxin 0.125 mg to a client with heart failure. The
client’s pulse is 58 bpm.
Question: What should the nurse do?
A) Administer the dose as prescribed.
B) Withhold the dose and notify the provider.
C) Check the client’s blood pressure.
D) Administer half the dose.
Answer: B) Withhold the dose and notify the provider.
Rationale: Digoxin is withheld if the pulse is below 60 bpm due to the risk of toxicity.
Administering the dose (A) or half (D) is unsafe, and checking blood pressure (C) is not relevant
to the pulse finding.
Question 9
Scenario: A client with a history of deep vein thrombosis is prescribed warfarin. The latest INR
is 3.8.
Question: What is the nurse’s best action?
A) Administer the next dose as scheduled.
B) Notify the provider of the elevated INR.
C) Encourage a diet high in vitamin K.
D) Monitor for signs of bleeding only.
Answer: B) Notify the provider of the elevated INR.
Rationale: An INR of 3.8 is above the therapeutic range (2.0–3.0) for DVT, indicating a risk of
bleeding. The provider should be notified to adjust the dose. Administering the dose (A) is
unsafe, vitamin K (C) requires a prescription, and monitoring alone (D) is insufficient.
Question 10
Scenario: A nurse is caring for a client with bacterial meningitis. Which assessment finding
indicates increased intracranial pressure (ICP)?
Question:
A) Tachycardia and tachypnea.
Actual Questions with Correct
Answers and Expert Rationales
Question 1
Scenario: A client with heart failure is admitted with dyspnea and bilateral crackles. The nurse
notes a heart rate of 110 bpm and oxygen saturation of 88%.
Question: What is the nurse’s priority action?
A) Administer a beta-blocker as prescribed.
B) Administer supplemental oxygen.
C) Elevate the head of the bed to 90 degrees.
D) Obtain a 12-lead ECG.
Answer: B) Administer supplemental oxygen.
Rationale: The client’s oxygen saturation of 88% indicates hypoxemia, a critical condition
requiring immediate intervention to improve oxygenation. Administering supplemental oxygen is
the priority to stabilize the client. A beta-blocker (A) may be indicated later, elevating the bed
(C) is secondary, and an ECG (D) is diagnostic but not the immediate priority.
Question 2
Scenario: A client with type 1 diabetes reports nausea and shakiness. The blood glucose level is
50 mg/dL.
Question: What is the nurse’s first action?
A) Administer insulin as prescribed.
B) Provide 15 grams of a fast-acting carbohydrate.
C) Check the client’s hemoglobin A1c.
D) Encourage the client to rest.
Answer: B) Provide 15 grams of a fast-acting carbohydrate.
Rationale: A blood glucose of 50 mg/dL indicates hypoglycemia, requiring immediate
administration of 15 grams of a fast-acting carbohydrate (e.g., juice or glucose gel) to raise blood
sugar. Insulin (A) would worsen hypoglycemia, A1c (C) is a long-term measure, and rest (D)
does not address the issue.
,Question 3
Scenario: A client with schizophrenia is pacing and shouting, “They’re watching me!” The
nurse observes clenched fists and rapid speech.
Question: What is the nurse’s priority action?
A) Administer an antipsychotic medication.
B) Assess the client’s level of agitation and safety risk.
C) Place the client in seclusion.
D) Instruct the client to calm down.
Answer: B) Assess the client’s level of agitation and safety risk.
Rationale: Assessing agitation and safety is the priority to determine the risk of harm to self or
others, guiding further interventions. Administering medication (A) or seclusion (C) requires
assessment first, and instructing to calm down (D) may escalate agitation.
Question 4
Scenario: A postoperative client reports severe pain at the surgical site. The nurse notes a
prescription for morphine 2 mg IV every 4 hours PRN.
Question: What should the nurse do first?
A) Administer the morphine immediately.
B) Assess the client’s pain level and vital signs.
C) Notify the healthcare provider.
D) Apply a warm compress to the site.
Answer: B) Assess the client’s pain level and vital signs.
Rationale: Assessing pain and vital signs is essential to determine the severity and ensure safe
administration of morphine. Administering without assessment (A) is unsafe, notifying the
provider (C) is premature, and a warm compress (D) is not indicated.
Question 5
Scenario: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. The client’s respiratory rate is 28 breaths/min, and oxygen saturation is
90%.
,Question: What should the nurse do next?
A) Increase the oxygen to 4 L/min.
B) Position the client in a semi-Fowler’s position.
C) Administer a bronchodilator.
D) Encourage deep breathing exercises.
Answer: B) Position the client in a semi-Fowler’s position.
Rationale: A semi-Fowler’s position optimizes lung expansion and improves breathing in
COPD. Increasing oxygen (A) requires a prescription, a bronchodilator (C) may be indicated
later, and deep breathing (D) is less effective in acute distress.
Question 6
Scenario: A nurse is caring for a client receiving a blood transfusion. The client reports itching
and hives after 15 minutes.
Question: What is the nurse’s first action?
A) Slow the transfusion rate.
B) Stop the transfusion immediately.
C) Administer an antihistamine.
D) Check the client’s temperature.
Answer: B) Stop the transfusion immediately.
Rationale: Itching and hives suggest an allergic reaction, requiring immediate cessation of the
transfusion to prevent further complications. Slowing the rate (A) is insufficient, an
antihistamine (C) is secondary, and checking temperature (D) is not the priority.
Question 7
Scenario: A client with hypertension started lisinopril and reports a persistent dry cough.
Question: What is the best nursing action?
A) Encourage increased fluid intake.
B) Notify the healthcare provider for an alternative medication.
C) Administer an over-the-counter cough suppressant.
D) Continue monitoring the cough.
Answer: B) Notify the healthcare provider for an alternative medication.
Rationale: A dry cough is a common side effect of ACE inhibitors like lisinopril, often requiring
a switch to another medication (e.g., ARB). Fluid intake (A) or suppressants (C) do not address
the cause, and monitoring (D) delays intervention.
, Question 8
Scenario: A nurse is preparing to administer digoxin 0.125 mg to a client with heart failure. The
client’s pulse is 58 bpm.
Question: What should the nurse do?
A) Administer the dose as prescribed.
B) Withhold the dose and notify the provider.
C) Check the client’s blood pressure.
D) Administer half the dose.
Answer: B) Withhold the dose and notify the provider.
Rationale: Digoxin is withheld if the pulse is below 60 bpm due to the risk of toxicity.
Administering the dose (A) or half (D) is unsafe, and checking blood pressure (C) is not relevant
to the pulse finding.
Question 9
Scenario: A client with a history of deep vein thrombosis is prescribed warfarin. The latest INR
is 3.8.
Question: What is the nurse’s best action?
A) Administer the next dose as scheduled.
B) Notify the provider of the elevated INR.
C) Encourage a diet high in vitamin K.
D) Monitor for signs of bleeding only.
Answer: B) Notify the provider of the elevated INR.
Rationale: An INR of 3.8 is above the therapeutic range (2.0–3.0) for DVT, indicating a risk of
bleeding. The provider should be notified to adjust the dose. Administering the dose (A) is
unsafe, vitamin K (C) requires a prescription, and monitoring alone (D) is insufficient.
Question 10
Scenario: A nurse is caring for a client with bacterial meningitis. Which assessment finding
indicates increased intracranial pressure (ICP)?
Question:
A) Tachycardia and tachypnea.
