HESI RN EXIT Exam 2025/2026 –
Actual Clinical Questions with
Verified Answers & Rationales
FUNDAMENTALS & PRIORITIZATION (1–15)
1. The nurse receives report on four clients. Which client should the nurse assess first?
A. 45-year-old with type 2 diabetes, glucose 180 mg/dL
B. 62-year-old post-op day 1 appendectomy, pain 4/10
C. 28-year-old with asthma, peak flow 85% personal best
D. 78-year-old with pneumonia, oxygen saturation 88% on 2 L NC
D. 78-year-old with pneumonia, oxygen saturation 88% on 2 L NC
Rationale: Airway/breathing takes priority (ABC). Hypoxemia <90% is life-threatening and
requires immediate intervention.
2. The charge nurse must delegate vital signs to the UAP. Which task is appropriate to
delegate?
A. Initial vital signs on a client admitted with chest pain
B. Blood pressure on a stable post-op client
C. Apical pulse on a client with new-onset atrial fibrillation
D. Temperature on a client with suspected sepsis
B. Blood pressure on a stable post-op client
Rationale: UAP can perform routine, stable vital signs. Unstable or new cardiac rhythms require
RN assessment.
3. A client with a Foley catheter reports burning on urination. The priority nursing action is:
A. Obtain a urine culture
B. Increase fluid intake to 3 L/day
C. Administer phenazopyridine (Pyridium)
D. Assess the catheter site for redness and drainage
D. Assess the catheter site for redness and drainage
Rationale: Assessment is the first step in the nursing process. Signs of CAUTI must be
identified before interventions.
4. The nurse is preparing to administer medications. Which medication should be held and the
provider notified?
,A. Metoprolol to a client with HR 58 bpm
B. Lisinopril to a client with BP 118/76 mmHg
C. Furosemide to a client with K⁺ 4.2 mEq/L
D. Atorvastatin to a client with ALT 45 U/L
A. Metoprolol to a client with HR 58 bpm
Rationale: Beta-blockers are held for HR <60 bpm to prevent bradycardia and hypotension.
5. A client with dementia attempts to climb out of bed. The most appropriate initial action is:
A. Apply soft wrist restraints
B. Administer PRN haloperidol
C. Lower the bed and place a mat on the floor
D. Assign a 1:1 sitter
C. Lower the bed and place a mat on the floor
Rationale: Least restrictive intervention first. Fall prevention via environmental modification is
priority.
6. The nurse is triaging clients in the ED. Which client should be seen first?
A. 32-year-old with migraine, pain 8/10
B. 55-year-old with chest pain, diaphoretic, BP 90/60
C. 19-year-old with ankle sprain, swelling
D. 68-year-old with UTI, burning on urination
B. 55-year-old with chest pain, diaphoretic, BP 90/60
Rationale: Signs of acute coronary syndrome with hypotension = immediate life threat.
7. A client with a PEG tube has diarrhea after tube feeding. The priority intervention is:
A. Slow the feeding rate
B. Change to a different formula
C. Administer loperamide
D. Check residual volume
D. Check residual volume
Rationale: High residual (>250 mL) indicates delayed gastric emptying, a common cause of
diarrhea in tube-fed clients.
8. The nurse is discharging a client with heart failure. Which statement indicates need for
further teaching?
A. “I will weigh myself daily and report gain of 2 lbs in 1 day.”
B. “I can eat canned soup as long as it’s low-sodium.”
C. “I will take my furosemide in the morning.”
D. “I will restrict fluids to 2 L per day.”
B. “I can eat canned soup as long as it’s low-sodium.”
,Rationale: Most canned soups are high in sodium (>500 mg/serving), even “low-sodium”
versions. Client needs education on label reading.
9. A client with COPD is prescribed home oxygen at 2 L/min. The nurse should teach the client
to:
A. Use oxygen only during exertion
B. Keep oxygen tank away from open flames
C. Clean nasal cannula with alcohol weekly
D. Increase flow to 4 L/min if short of breath
B. Keep oxygen tank away from open flames
Rationale: Oxygen supports combustion; fire safety is critical. Flow rates must not be adjusted
without provider order.
10. The nurse is caring for a client with a stage II pressure injury. The best dressing is:
A. Dry gauze
B. Hydrocolloid
C. Alginate
D. Transparent film
B. Hydrocolloid
Rationale: Stage II (partial-thickness) requires moist wound healing; hydrocolloid promotes
autolysis and protects.
11. A client with diabetes is scheduled for surgery at 0700. The nurse should:
A. Hold all oral agents and give sliding scale insulin
B. Administer metformin at 0600
C. Give half dose of long-acting insulin
D. Hold NPH insulin only
A. Hold all oral agents and give sliding scale insulin
Rationale: All oral agents are held on day of surgery due to NPO status and risk of lactic
acidosis (metformin) or hypoglycemia.
12. The nurse is administering blood. Thirty minutes into transfusion, the client reports chills and
flank subdued pain. The first action is:
A. Slow the infusion
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain urine specimen
B. Stop the transfusion
Rationale: Signs of acute hemolytic reaction (fever, chills, flank pain) require immediate
cessation of transfusion.
13. A client with C. diff is in contact isolation. The most important infection control measure is:
, A. Hand hygiene with soap and water
B. Wearing a mask
C. Using alcohol-based hand rub
D. Double gloving
A. Hand hygiene with soap and water
Rationale: Alcohol does not kill C. diff spores; soap and water mechanically remove spores.
14. The nurse is preparing to insert a nasogastric tube. The client suddenly becomes
unresponsive. The priority action is:
A. Call the rapid response team
B. Check pulse and breathing
C. Lower the head of the bed
D. Suction the oropharynx
B. Check pulse and breathing
Rationale: ABC priority; assess airway and breathing before any other action.
15. A client with a history of falls is prescribed lorazepam. The nurse should:
A. Administer as ordered
B. Request a non-benzodiazepine alternative
C. Give with food
D. Monitor respiratory rate q4h
B. Request a non-benzodiazepine alternative
Rationale: Beers Criteria: benzodiazepines increase fall risk in older adults; safer alternatives
should be considered.
CARDIOVASCULAR SYSTEM (16–35)
16. A client with heart failure reports sudden weight gain of 5 lbs in 3 days. The nurse should:
A. Increase furosemide dose
B. Restrict fluids to 1.5 L/day
C. Assess for jugular vein distention
D. Administer potassium supplement
C. Assess for jugular vein distention
Rationale: Weight gain may indicate fluid retention; JVD confirms volume overload.
17. A client post-MI is prescribed metoprolol. The nurse should hold the dose if:
A. BP 110/70 mmHg
B. HR 55 bpm
C. Respiratory rate 18
D. Temperature 98.6°F
Actual Clinical Questions with
Verified Answers & Rationales
FUNDAMENTALS & PRIORITIZATION (1–15)
1. The nurse receives report on four clients. Which client should the nurse assess first?
A. 45-year-old with type 2 diabetes, glucose 180 mg/dL
B. 62-year-old post-op day 1 appendectomy, pain 4/10
C. 28-year-old with asthma, peak flow 85% personal best
D. 78-year-old with pneumonia, oxygen saturation 88% on 2 L NC
D. 78-year-old with pneumonia, oxygen saturation 88% on 2 L NC
Rationale: Airway/breathing takes priority (ABC). Hypoxemia <90% is life-threatening and
requires immediate intervention.
2. The charge nurse must delegate vital signs to the UAP. Which task is appropriate to
delegate?
A. Initial vital signs on a client admitted with chest pain
B. Blood pressure on a stable post-op client
C. Apical pulse on a client with new-onset atrial fibrillation
D. Temperature on a client with suspected sepsis
B. Blood pressure on a stable post-op client
Rationale: UAP can perform routine, stable vital signs. Unstable or new cardiac rhythms require
RN assessment.
3. A client with a Foley catheter reports burning on urination. The priority nursing action is:
A. Obtain a urine culture
B. Increase fluid intake to 3 L/day
C. Administer phenazopyridine (Pyridium)
D. Assess the catheter site for redness and drainage
D. Assess the catheter site for redness and drainage
Rationale: Assessment is the first step in the nursing process. Signs of CAUTI must be
identified before interventions.
4. The nurse is preparing to administer medications. Which medication should be held and the
provider notified?
,A. Metoprolol to a client with HR 58 bpm
B. Lisinopril to a client with BP 118/76 mmHg
C. Furosemide to a client with K⁺ 4.2 mEq/L
D. Atorvastatin to a client with ALT 45 U/L
A. Metoprolol to a client with HR 58 bpm
Rationale: Beta-blockers are held for HR <60 bpm to prevent bradycardia and hypotension.
5. A client with dementia attempts to climb out of bed. The most appropriate initial action is:
A. Apply soft wrist restraints
B. Administer PRN haloperidol
C. Lower the bed and place a mat on the floor
D. Assign a 1:1 sitter
C. Lower the bed and place a mat on the floor
Rationale: Least restrictive intervention first. Fall prevention via environmental modification is
priority.
6. The nurse is triaging clients in the ED. Which client should be seen first?
A. 32-year-old with migraine, pain 8/10
B. 55-year-old with chest pain, diaphoretic, BP 90/60
C. 19-year-old with ankle sprain, swelling
D. 68-year-old with UTI, burning on urination
B. 55-year-old with chest pain, diaphoretic, BP 90/60
Rationale: Signs of acute coronary syndrome with hypotension = immediate life threat.
7. A client with a PEG tube has diarrhea after tube feeding. The priority intervention is:
A. Slow the feeding rate
B. Change to a different formula
C. Administer loperamide
D. Check residual volume
D. Check residual volume
Rationale: High residual (>250 mL) indicates delayed gastric emptying, a common cause of
diarrhea in tube-fed clients.
8. The nurse is discharging a client with heart failure. Which statement indicates need for
further teaching?
A. “I will weigh myself daily and report gain of 2 lbs in 1 day.”
B. “I can eat canned soup as long as it’s low-sodium.”
C. “I will take my furosemide in the morning.”
D. “I will restrict fluids to 2 L per day.”
B. “I can eat canned soup as long as it’s low-sodium.”
,Rationale: Most canned soups are high in sodium (>500 mg/serving), even “low-sodium”
versions. Client needs education on label reading.
9. A client with COPD is prescribed home oxygen at 2 L/min. The nurse should teach the client
to:
A. Use oxygen only during exertion
B. Keep oxygen tank away from open flames
C. Clean nasal cannula with alcohol weekly
D. Increase flow to 4 L/min if short of breath
B. Keep oxygen tank away from open flames
Rationale: Oxygen supports combustion; fire safety is critical. Flow rates must not be adjusted
without provider order.
10. The nurse is caring for a client with a stage II pressure injury. The best dressing is:
A. Dry gauze
B. Hydrocolloid
C. Alginate
D. Transparent film
B. Hydrocolloid
Rationale: Stage II (partial-thickness) requires moist wound healing; hydrocolloid promotes
autolysis and protects.
11. A client with diabetes is scheduled for surgery at 0700. The nurse should:
A. Hold all oral agents and give sliding scale insulin
B. Administer metformin at 0600
C. Give half dose of long-acting insulin
D. Hold NPH insulin only
A. Hold all oral agents and give sliding scale insulin
Rationale: All oral agents are held on day of surgery due to NPO status and risk of lactic
acidosis (metformin) or hypoglycemia.
12. The nurse is administering blood. Thirty minutes into transfusion, the client reports chills and
flank subdued pain. The first action is:
A. Slow the infusion
B. Stop the transfusion
C. Administer acetaminophen
D. Obtain urine specimen
B. Stop the transfusion
Rationale: Signs of acute hemolytic reaction (fever, chills, flank pain) require immediate
cessation of transfusion.
13. A client with C. diff is in contact isolation. The most important infection control measure is:
, A. Hand hygiene with soap and water
B. Wearing a mask
C. Using alcohol-based hand rub
D. Double gloving
A. Hand hygiene with soap and water
Rationale: Alcohol does not kill C. diff spores; soap and water mechanically remove spores.
14. The nurse is preparing to insert a nasogastric tube. The client suddenly becomes
unresponsive. The priority action is:
A. Call the rapid response team
B. Check pulse and breathing
C. Lower the head of the bed
D. Suction the oropharynx
B. Check pulse and breathing
Rationale: ABC priority; assess airway and breathing before any other action.
15. A client with a history of falls is prescribed lorazepam. The nurse should:
A. Administer as ordered
B. Request a non-benzodiazepine alternative
C. Give with food
D. Monitor respiratory rate q4h
B. Request a non-benzodiazepine alternative
Rationale: Beers Criteria: benzodiazepines increase fall risk in older adults; safer alternatives
should be considered.
CARDIOVASCULAR SYSTEM (16–35)
16. A client with heart failure reports sudden weight gain of 5 lbs in 3 days. The nurse should:
A. Increase furosemide dose
B. Restrict fluids to 1.5 L/day
C. Assess for jugular vein distention
D. Administer potassium supplement
C. Assess for jugular vein distention
Rationale: Weight gain may indicate fluid retention; JVD confirms volume overload.
17. A client post-MI is prescribed metoprolol. The nurse should hold the dose if:
A. BP 110/70 mmHg
B. HR 55 bpm
C. Respiratory rate 18
D. Temperature 98.6°F
