HESI RN EXIT Exam
2025/2026 – 160 Verified
Questions with Faculty-Level
Rationales
1. A nurse is assessing a client with suspected myocardial infarction. Which
finding requires immediate action?
A. Blood pressure 140/90 mmHg
B. Chest pain radiating to the left arm
C. Heart rate 88 bpm
D. Oxygen saturation 95%
Rationale: Chest pain radiating to the left arm is a classic symptom of myocardial infarction,
indicating myocardial ischemia (AHA 2025). Immediate action (e.g., ECG, oxygen,
nitroglycerin) is critical to restore perfusion and prevent necrosis. Other findings are less urgent
but require monitoring.
2. A nurse is teaching a client with type 1 diabetes about insulin administration.
Which instruction is priority?
A. Store insulin at room temperature
B. Rotate injection sites
C. Shake vial before drawing dose
D. Inject at a 30-degree angle
Rationale: Rotating injection sites prevents lipodystrophy, ensuring consistent insulin absorption
(ADA 2025). Shaking vials can denature insulin, and a 90-degree angle is standard for
subcutaneous injections. Storage is important but secondary to absorption consistency.
3. A nurse is caring for a pediatric client with asthma. Which medication should
be administered first during an acute attack?
,A. Prednisone
B. Albuterol
C. Montelukast
D. Ipratropium
Rationale: Albuterol, a short-acting beta-2 agonist, rapidly relieves bronchospasm in acute
asthma (ATS 2025). It opens airways within minutes, prioritizing airway patency. Prednisone
and montelukast are for long-term control, and ipratropium is adjunctive.
4. A nurse is assessing a postpartum client 24 hours after delivery. Which finding
indicates a complication?
A. Lochia rubra
B. Fundus firm at umbilicus
C. Temperature 100.8°F (38.2°C)
D. Mild perineal discomfort
Rationale: A temperature >100.4°F post-delivery suggests infection (e.g., endometritis) (ACOG
2025). Lochia rubra, firm fundus, and mild discomfort are normal at 24 hours. Immediate
reporting and antibiotics may be needed to prevent sepsis.
5. A nurse is planning care for a client with schizophrenia. Which intervention
promotes medication adherence?
A. Administer IV antipsychotics
B. Teach about side effects
C. Restrict family visits
D. Schedule weekly blood draws
Rationale: Educating about side effects (e.g., extrapyramidal symptoms) empowers clients to
manage antipsychotics, improving adherence (APA 2025). IV administration is rare, family
support aids recovery, and blood draws are specific to certain medications (e.g., clozapine).
6. A nurse is administering IV vancomycin for MRSA. What is the minimum
infusion time to prevent adverse effects?
A. 30 minutes
B. 60 minutes
C. 15 minutes
D. 2 hours
,Rationale: Vancomycin requires ≥60-minute infusion to prevent red man syndrome (histamine-
mediated flushing) (IDSA 2025). Dosage safety includes monitoring trough levels (10–20
mcg/mL); patient teaching addresses reporting rash or hearing loss.
7. A nurse is caring for a client with heart failure. Which dietary restriction is
priority?
A. Low-fat
B. Low-sodium
C. High-protein
D. Low-fiber
Rationale: Low-sodium (<1,500 mg/day) reduces fluid retention in heart failure, preventing
exacerbations (AHA 2025). Nutrition therapy emphasizes potassium-rich foods; teaching
includes label reading to avoid hidden sodium.
8. A nurse is assessing a client with suspected appendicitis. Which finding is most
concerning?
A. Nausea and vomiting
B. Low-grade fever
C. Rebound tenderness
D. Right lower quadrant pain
Rationale: Rebound tenderness (Rovsing’s sign) indicates peritoneal irritation, suggestive of
appendicitis requiring urgent surgical evaluation (ACS 2025). Other symptoms are common but
less specific; immediate reporting prevents rupture.
9. A nurse is teaching a client with COPD about pursed-lip breathing. What is
the primary purpose?
A. Increase CO2 retention
B. Prolong exhalation
C. Reduce oxygen use
D. Clear mucus
Rationale: Pursed-lip breathing prolongs exhalation, reducing air trapping and improving
oxygenation in COPD (ATS 2025). Teaching focuses on technique to manage dyspnea,
enhancing quality of life.
, 10. A nurse is caring for a neonate with jaundice. Which intervention is most
appropriate?
A. Increase formula feedings
B. Initiate phototherapy
C. Administer vitamin K
D. Apply warm compresses
Rationale: Phototherapy converts unconjugated bilirubin to water-soluble isomers for excretion,
preventing kernicterus in neonatal jaundice (AAP 2025). Feedings support hydration, but
phototherapy is the primary treatment.
11. A nurse is administering morphine for postoperative pain. Which side effect
requires immediate intervention?
A. Nausea
B. Respiratory rate 10/min
C. Constipation
D. Sedation
Rationale: Morphine’s opioid agonism can depress respiration (<12/min is critical) (APS 2025).
Dosage safety limits initial doses (2–4 mg IV); teaching includes naloxone use for overdose and
avoiding alcohol.
12. A nurse is planning care for a client with a new colostomy. Which dietary
instruction is priority?
A. High-fiber diet
B. Chew food thoroughly
C. Avoid dairy products
D. Limit fluid intake
Rationale: Thorough chewing prevents stoma blockages, ensuring proper digestion in colostomy
clients (WOCN 2025). Dietary planning transitions to high-fiber later; teaching addresses
hydration and stoma care.
2025/2026 – 160 Verified
Questions with Faculty-Level
Rationales
1. A nurse is assessing a client with suspected myocardial infarction. Which
finding requires immediate action?
A. Blood pressure 140/90 mmHg
B. Chest pain radiating to the left arm
C. Heart rate 88 bpm
D. Oxygen saturation 95%
Rationale: Chest pain radiating to the left arm is a classic symptom of myocardial infarction,
indicating myocardial ischemia (AHA 2025). Immediate action (e.g., ECG, oxygen,
nitroglycerin) is critical to restore perfusion and prevent necrosis. Other findings are less urgent
but require monitoring.
2. A nurse is teaching a client with type 1 diabetes about insulin administration.
Which instruction is priority?
A. Store insulin at room temperature
B. Rotate injection sites
C. Shake vial before drawing dose
D. Inject at a 30-degree angle
Rationale: Rotating injection sites prevents lipodystrophy, ensuring consistent insulin absorption
(ADA 2025). Shaking vials can denature insulin, and a 90-degree angle is standard for
subcutaneous injections. Storage is important but secondary to absorption consistency.
3. A nurse is caring for a pediatric client with asthma. Which medication should
be administered first during an acute attack?
,A. Prednisone
B. Albuterol
C. Montelukast
D. Ipratropium
Rationale: Albuterol, a short-acting beta-2 agonist, rapidly relieves bronchospasm in acute
asthma (ATS 2025). It opens airways within minutes, prioritizing airway patency. Prednisone
and montelukast are for long-term control, and ipratropium is adjunctive.
4. A nurse is assessing a postpartum client 24 hours after delivery. Which finding
indicates a complication?
A. Lochia rubra
B. Fundus firm at umbilicus
C. Temperature 100.8°F (38.2°C)
D. Mild perineal discomfort
Rationale: A temperature >100.4°F post-delivery suggests infection (e.g., endometritis) (ACOG
2025). Lochia rubra, firm fundus, and mild discomfort are normal at 24 hours. Immediate
reporting and antibiotics may be needed to prevent sepsis.
5. A nurse is planning care for a client with schizophrenia. Which intervention
promotes medication adherence?
A. Administer IV antipsychotics
B. Teach about side effects
C. Restrict family visits
D. Schedule weekly blood draws
Rationale: Educating about side effects (e.g., extrapyramidal symptoms) empowers clients to
manage antipsychotics, improving adherence (APA 2025). IV administration is rare, family
support aids recovery, and blood draws are specific to certain medications (e.g., clozapine).
6. A nurse is administering IV vancomycin for MRSA. What is the minimum
infusion time to prevent adverse effects?
A. 30 minutes
B. 60 minutes
C. 15 minutes
D. 2 hours
,Rationale: Vancomycin requires ≥60-minute infusion to prevent red man syndrome (histamine-
mediated flushing) (IDSA 2025). Dosage safety includes monitoring trough levels (10–20
mcg/mL); patient teaching addresses reporting rash or hearing loss.
7. A nurse is caring for a client with heart failure. Which dietary restriction is
priority?
A. Low-fat
B. Low-sodium
C. High-protein
D. Low-fiber
Rationale: Low-sodium (<1,500 mg/day) reduces fluid retention in heart failure, preventing
exacerbations (AHA 2025). Nutrition therapy emphasizes potassium-rich foods; teaching
includes label reading to avoid hidden sodium.
8. A nurse is assessing a client with suspected appendicitis. Which finding is most
concerning?
A. Nausea and vomiting
B. Low-grade fever
C. Rebound tenderness
D. Right lower quadrant pain
Rationale: Rebound tenderness (Rovsing’s sign) indicates peritoneal irritation, suggestive of
appendicitis requiring urgent surgical evaluation (ACS 2025). Other symptoms are common but
less specific; immediate reporting prevents rupture.
9. A nurse is teaching a client with COPD about pursed-lip breathing. What is
the primary purpose?
A. Increase CO2 retention
B. Prolong exhalation
C. Reduce oxygen use
D. Clear mucus
Rationale: Pursed-lip breathing prolongs exhalation, reducing air trapping and improving
oxygenation in COPD (ATS 2025). Teaching focuses on technique to manage dyspnea,
enhancing quality of life.
, 10. A nurse is caring for a neonate with jaundice. Which intervention is most
appropriate?
A. Increase formula feedings
B. Initiate phototherapy
C. Administer vitamin K
D. Apply warm compresses
Rationale: Phototherapy converts unconjugated bilirubin to water-soluble isomers for excretion,
preventing kernicterus in neonatal jaundice (AAP 2025). Feedings support hydration, but
phototherapy is the primary treatment.
11. A nurse is administering morphine for postoperative pain. Which side effect
requires immediate intervention?
A. Nausea
B. Respiratory rate 10/min
C. Constipation
D. Sedation
Rationale: Morphine’s opioid agonism can depress respiration (<12/min is critical) (APS 2025).
Dosage safety limits initial doses (2–4 mg IV); teaching includes naloxone use for overdose and
avoiding alcohol.
12. A nurse is planning care for a client with a new colostomy. Which dietary
instruction is priority?
A. High-fiber diet
B. Chew food thoroughly
C. Avoid dairy products
D. Limit fluid intake
Rationale: Thorough chewing prevents stoma blockages, ensuring proper digestion in colostomy
clients (WOCN 2025). Dietary planning transitions to high-fiber later; teaching addresses
hydration and stoma care.
