HESI RN Exit Exam 2025 – Complete
Actual Questions with Correct
Answers and Expert Rationales
Question 1
Scenario: A client with a history of myocardial infarction reports chest pain radiating to the jaw
and nausea.
Question: What is the nurse’s priority action?
A) Encourage deep breathing exercises.
B) Administer nitroglycerin sublingually if prescribed.
C) Apply a warm compress to the chest.
D) Administer an antacid immediately.
Answer: B) Administer nitroglycerin sublingually if prescribed.
Rationale: Chest pain radiating to the jaw with nausea suggests angina or myocardial infarction,
requiring nitroglycerin to relieve pain and improve coronary blood flow. Deep breathing (A) or a
warm compress (C) is inappropriate, and an antacid (D) does not address cardiac pain.
Question 2
Scenario: A client with type 2 diabetes has a blood glucose level of 300 mg/dL and reports
increased thirst.
Question: What is the nurse’s first action?
A) Administer a fast-acting carbohydrate.
B) Notify the healthcare provider.
C) Encourage fluid restriction.
D) Monitor the client for 24 hours.
Answer: B) Notify the healthcare provider.
Rationale: A blood glucose of 300 mg/dL with thirst indicates hyperglycemia, requiring
provider notification for insulin or other interventions. Carbohydrates (A) worsen
hyperglycemia, fluid restriction (C) is inappropriate, and monitoring (D) delays treatment.
,Question 3
Scenario: A client with bipolar disorder is admitted in a manic state, talking rapidly and refusing
to sit.
Question: What is the nurse’s priority action?
A) Administer a PRN sedative.
B) Assess the client’s safety risk.
C) Place the client in restraints.
D) Encourage group therapy participation.
Answer: B) Assess the client’s safety risk.
Rationale: Manic behavior increases safety risks, so assessment is the priority to determine
interventions. Sedatives (A) or restraints (C) require assessment first, and group therapy (D) is
inappropriate during acute mania.
Question 4
Scenario: A postoperative client has a prescription for hydromorphone 1 mg IV every 4 hours
PRN for pain. The client reports pain at 8/10.
Question: What should the nurse do first?
A) Administer the hydromorphone immediately.
B) Assess the client’s vital signs and pain characteristics.
C) Notify the provider for a dose increase.
D) Apply a cold pack to the surgical site.
Answer: B) Assess the client’s vital signs and pain characteristics.
Rationale: Assessing vital signs and pain ensures safe opioid administration and rules out
complications. Administering without assessment (A) is unsafe, notifying the provider (C) is
premature, and a cold pack (D) is not indicated.
Question 5
Scenario: A client with chronic obstructive pulmonary disease (COPD) reports increased
dyspnea and has an oxygen saturation of 86%.
Question: What is the nurse’s priority action?
A) Increase oxygen to 4 L/min.
B) Notify the healthcare provider.
,C) Administer a PRN diuretic.
D) Encourage pursed-lip breathing.
Answer: B) Notify the healthcare provider.
Rationale: An oxygen saturation of 86% indicates severe hypoxemia, requiring provider
notification for possible oxygen adjustment or treatment. Increasing oxygen (A) or administering
diuretics (C) requires a prescription, and pursed-lip breathing (D) is secondary.
Question 6
Scenario: A client receiving a blood transfusion develops a fever of 100.4°F (38°C) and chills.
Question: What is the nurse’s first action?
A) Administer acetaminophen.
B) Stop the transfusion and notify the provider.
C) Slow the transfusion rate.
D) Monitor the client’s temperature.
Answer: B) Stop the transfusion and notify the provider.
Rationale: Fever and chills suggest a transfusion reaction, requiring immediate cessation and
provider notification. Acetaminophen (A) or slowing the rate (C) is insufficient, and monitoring
(D) delays intervention.
Question 7
Scenario: A client with hypertension is prescribed losartan and reports dizziness when standing.
Question: What should the nurse assess for?
A) Hyperglycemia.
B) Orthostatic hypotension.
C) Hyperkalemia.
D) Respiratory distress.
Answer: B) Orthostatic hypotension.
Rationale: Dizziness when standing suggests orthostatic hypotension, a side effect of
antihypertensives like losartan. Hyperglycemia (A), hyperkalemia (C), or respiratory distress (D)
are not directly related.
Question 8
, Scenario: A client with atrial fibrillation is prescribed digoxin. The nurse notes an apical pulse
of 56 bpm.
Question: What should the nurse do?
A) Administer the digoxin 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 toxicity risk. Administering
(A) or half the dose (D) is unsafe, and blood pressure (C) is not the priority.
Question 9
Scenario: A client with a history of deep vein thrombosis has an INR of 4.2 while on warfarin.
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 high-vitamin K diet.
D) Monitor for bruising only.
Answer: B) Notify the provider of the elevated INR.
Rationale: An INR of 4.2 is above the therapeutic range (2.0–3.0), increasing bleeding risk,
requiring provider notification. Administering the dose (A) is unsafe, vitamin K (C) needs a
prescription, and monitoring (D) is insufficient.
Question 10
Scenario: A client with bacterial meningitis reports a severe headache and photophobia.
Question: What is the nurse’s priority action?
A) Administer an analgesic immediately.
B) Assess neurological status.
C) Dim the room lights only.
D) Encourage fluid intake.
Answer: B) Assess neurological status.
Rationale: Headache and photophobia may indicate worsening meningitis or increased
Actual Questions with Correct
Answers and Expert Rationales
Question 1
Scenario: A client with a history of myocardial infarction reports chest pain radiating to the jaw
and nausea.
Question: What is the nurse’s priority action?
A) Encourage deep breathing exercises.
B) Administer nitroglycerin sublingually if prescribed.
C) Apply a warm compress to the chest.
D) Administer an antacid immediately.
Answer: B) Administer nitroglycerin sublingually if prescribed.
Rationale: Chest pain radiating to the jaw with nausea suggests angina or myocardial infarction,
requiring nitroglycerin to relieve pain and improve coronary blood flow. Deep breathing (A) or a
warm compress (C) is inappropriate, and an antacid (D) does not address cardiac pain.
Question 2
Scenario: A client with type 2 diabetes has a blood glucose level of 300 mg/dL and reports
increased thirst.
Question: What is the nurse’s first action?
A) Administer a fast-acting carbohydrate.
B) Notify the healthcare provider.
C) Encourage fluid restriction.
D) Monitor the client for 24 hours.
Answer: B) Notify the healthcare provider.
Rationale: A blood glucose of 300 mg/dL with thirst indicates hyperglycemia, requiring
provider notification for insulin or other interventions. Carbohydrates (A) worsen
hyperglycemia, fluid restriction (C) is inappropriate, and monitoring (D) delays treatment.
,Question 3
Scenario: A client with bipolar disorder is admitted in a manic state, talking rapidly and refusing
to sit.
Question: What is the nurse’s priority action?
A) Administer a PRN sedative.
B) Assess the client’s safety risk.
C) Place the client in restraints.
D) Encourage group therapy participation.
Answer: B) Assess the client’s safety risk.
Rationale: Manic behavior increases safety risks, so assessment is the priority to determine
interventions. Sedatives (A) or restraints (C) require assessment first, and group therapy (D) is
inappropriate during acute mania.
Question 4
Scenario: A postoperative client has a prescription for hydromorphone 1 mg IV every 4 hours
PRN for pain. The client reports pain at 8/10.
Question: What should the nurse do first?
A) Administer the hydromorphone immediately.
B) Assess the client’s vital signs and pain characteristics.
C) Notify the provider for a dose increase.
D) Apply a cold pack to the surgical site.
Answer: B) Assess the client’s vital signs and pain characteristics.
Rationale: Assessing vital signs and pain ensures safe opioid administration and rules out
complications. Administering without assessment (A) is unsafe, notifying the provider (C) is
premature, and a cold pack (D) is not indicated.
Question 5
Scenario: A client with chronic obstructive pulmonary disease (COPD) reports increased
dyspnea and has an oxygen saturation of 86%.
Question: What is the nurse’s priority action?
A) Increase oxygen to 4 L/min.
B) Notify the healthcare provider.
,C) Administer a PRN diuretic.
D) Encourage pursed-lip breathing.
Answer: B) Notify the healthcare provider.
Rationale: An oxygen saturation of 86% indicates severe hypoxemia, requiring provider
notification for possible oxygen adjustment or treatment. Increasing oxygen (A) or administering
diuretics (C) requires a prescription, and pursed-lip breathing (D) is secondary.
Question 6
Scenario: A client receiving a blood transfusion develops a fever of 100.4°F (38°C) and chills.
Question: What is the nurse’s first action?
A) Administer acetaminophen.
B) Stop the transfusion and notify the provider.
C) Slow the transfusion rate.
D) Monitor the client’s temperature.
Answer: B) Stop the transfusion and notify the provider.
Rationale: Fever and chills suggest a transfusion reaction, requiring immediate cessation and
provider notification. Acetaminophen (A) or slowing the rate (C) is insufficient, and monitoring
(D) delays intervention.
Question 7
Scenario: A client with hypertension is prescribed losartan and reports dizziness when standing.
Question: What should the nurse assess for?
A) Hyperglycemia.
B) Orthostatic hypotension.
C) Hyperkalemia.
D) Respiratory distress.
Answer: B) Orthostatic hypotension.
Rationale: Dizziness when standing suggests orthostatic hypotension, a side effect of
antihypertensives like losartan. Hyperglycemia (A), hyperkalemia (C), or respiratory distress (D)
are not directly related.
Question 8
, Scenario: A client with atrial fibrillation is prescribed digoxin. The nurse notes an apical pulse
of 56 bpm.
Question: What should the nurse do?
A) Administer the digoxin 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 toxicity risk. Administering
(A) or half the dose (D) is unsafe, and blood pressure (C) is not the priority.
Question 9
Scenario: A client with a history of deep vein thrombosis has an INR of 4.2 while on warfarin.
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 high-vitamin K diet.
D) Monitor for bruising only.
Answer: B) Notify the provider of the elevated INR.
Rationale: An INR of 4.2 is above the therapeutic range (2.0–3.0), increasing bleeding risk,
requiring provider notification. Administering the dose (A) is unsafe, vitamin K (C) needs a
prescription, and monitoring (D) is insufficient.
Question 10
Scenario: A client with bacterial meningitis reports a severe headache and photophobia.
Question: What is the nurse’s priority action?
A) Administer an analgesic immediately.
B) Assess neurological status.
C) Dim the room lights only.
D) Encourage fluid intake.
Answer: B) Assess neurological status.
Rationale: Headache and photophobia may indicate worsening meningitis or increased
