HESI CAT Exam 2025/2026 – Actual
Exam Questions with Correct Detailed
Answers and Rationales (Graded A+,
Newest Version)
1 Child with autism, nonverbal. Best first interaction? Parallel play next to the child
Rationales: Parallel play is non-threatening and allows gradual engagement.
2 24-week pregnant woman with nasal stuffiness and nosebleeds. Cause? Increased estrogen
causing nasal mucosa swelling Rationales: Estrogen-induced vasodilation → pregnancy
rhinitis.
3 GCS 3 in ED. How to describe the coma? Deep coma with severe brain injury Rationales:
GCS 3–8 = severe; 3 is the lowest possible score.
4 Earliest sign of increasing ICP? Change in level of consciousness Rationales: LOC is the most
sensitive and earliest indicator.
5 Half-strength tube feeding at 50 mL/hr. Full-strength needed for 8 hours? 200 mL Rationales:
50 mL half-strength = 25 mL full-strength per hour × 8 hr = 200 mL.
6 Long-term alcoholic keeps drinking mainly to? Avoid withdrawal symptoms Rationales:
Physical dependence → tolerance and withdrawal drive use.
7 New BP medicine unsafe in asthma? Non-selective beta-blocker Rationales: Blocks β2
receptors → bronchoconstriction.
8 Client on clonidine feels drowsy. Most important question? Did you miss any doses?
Rationales: Abrupt stop → rebound hypertension → sedation/confusion.
9 Kidney stone client passed stones yesterday. Still strain urine? Yes, until provider stops the
order Rationales: Order remains in effect; more stones may pass.
10 Before thoracentesis, most important action? Confirm recent chest x-ray done Rationales:
X-ray confirms fluid location and side.
, 11 Pulseless VT. After starting CPR, next step? Defibrillate Rationales: ACLS: shockable
rhythm → immediate defibrillation.
12 Best site for Lovenox injection? Abdomen, 2 inches from umbilicus Rationales: Deep
subcutaneous fat → consistent absorption.
13 Active genital herpes at delivery. Delivery method? Cesarean section Rationales: ACOG
guideline to prevent neonatal HSV.
14 Catatonic schizophrenia client (mute, motionless). Priority? 1:1 observation for safety
Rationales: Risk of dehydration, pressure ulcers, DVT.
15 Client on valproate worried about weight gain. Referral? Dietitian Rationales: Valproate
commonly causes weight gain; nutrition counseling helps.
16 Post-op urine output 20 mL/hr, dark. First action? Notify provider Rationales: Oliguria <30
mL/hr indicates possible hypovolemia or AKI.
17 Classic digoxin toxicity signs? Nausea, yellow vision, bradycardia Rationales: GI, visual,
and cardiac effects are hallmark.
18 Myasthenic crisis worsening. Priority? Intubate if respiratory failure Rationales: Weak
respiratory muscles → airway protection first.
19 Normal saline is what type of fluid? Isotonic crystalloid Rationales: 0.9% NaCl = 308
mOsm/L, same as plasma.
20 Cushing’s syndrome classic appearance? Moon face, buffalo hump, thin extremities
Rationales: Cortisol → central fat redistribution, muscle wasting.
21 Addisonian crisis treatment order? IV hydrocortisone first, then fluids Rationales: Replace
cortisol immediately; then volume.
22 Best sign of fluid overload in heart failure? Crackles in lungs Rationales: Pulmonary edema
from left-sided backup.
23 Warfarin INR 8, no bleeding. Action? Hold warfarin + vitamin K 5–10 mg PO Rationales:
Standard reversal for supratherapeutic INR without bleed.
24 First ECG change in hypokalemia? Flat T waves + prominent U waves Rationales: K⁺ <3.5
→ repolarization abnormalities.
25 COPD patient on home oxygen. Target SpO₂? 88–92% Rationales: GOLD guideline prevents
hypoxic drive suppression.
Exam Questions with Correct Detailed
Answers and Rationales (Graded A+,
Newest Version)
1 Child with autism, nonverbal. Best first interaction? Parallel play next to the child
Rationales: Parallel play is non-threatening and allows gradual engagement.
2 24-week pregnant woman with nasal stuffiness and nosebleeds. Cause? Increased estrogen
causing nasal mucosa swelling Rationales: Estrogen-induced vasodilation → pregnancy
rhinitis.
3 GCS 3 in ED. How to describe the coma? Deep coma with severe brain injury Rationales:
GCS 3–8 = severe; 3 is the lowest possible score.
4 Earliest sign of increasing ICP? Change in level of consciousness Rationales: LOC is the most
sensitive and earliest indicator.
5 Half-strength tube feeding at 50 mL/hr. Full-strength needed for 8 hours? 200 mL Rationales:
50 mL half-strength = 25 mL full-strength per hour × 8 hr = 200 mL.
6 Long-term alcoholic keeps drinking mainly to? Avoid withdrawal symptoms Rationales:
Physical dependence → tolerance and withdrawal drive use.
7 New BP medicine unsafe in asthma? Non-selective beta-blocker Rationales: Blocks β2
receptors → bronchoconstriction.
8 Client on clonidine feels drowsy. Most important question? Did you miss any doses?
Rationales: Abrupt stop → rebound hypertension → sedation/confusion.
9 Kidney stone client passed stones yesterday. Still strain urine? Yes, until provider stops the
order Rationales: Order remains in effect; more stones may pass.
10 Before thoracentesis, most important action? Confirm recent chest x-ray done Rationales:
X-ray confirms fluid location and side.
, 11 Pulseless VT. After starting CPR, next step? Defibrillate Rationales: ACLS: shockable
rhythm → immediate defibrillation.
12 Best site for Lovenox injection? Abdomen, 2 inches from umbilicus Rationales: Deep
subcutaneous fat → consistent absorption.
13 Active genital herpes at delivery. Delivery method? Cesarean section Rationales: ACOG
guideline to prevent neonatal HSV.
14 Catatonic schizophrenia client (mute, motionless). Priority? 1:1 observation for safety
Rationales: Risk of dehydration, pressure ulcers, DVT.
15 Client on valproate worried about weight gain. Referral? Dietitian Rationales: Valproate
commonly causes weight gain; nutrition counseling helps.
16 Post-op urine output 20 mL/hr, dark. First action? Notify provider Rationales: Oliguria <30
mL/hr indicates possible hypovolemia or AKI.
17 Classic digoxin toxicity signs? Nausea, yellow vision, bradycardia Rationales: GI, visual,
and cardiac effects are hallmark.
18 Myasthenic crisis worsening. Priority? Intubate if respiratory failure Rationales: Weak
respiratory muscles → airway protection first.
19 Normal saline is what type of fluid? Isotonic crystalloid Rationales: 0.9% NaCl = 308
mOsm/L, same as plasma.
20 Cushing’s syndrome classic appearance? Moon face, buffalo hump, thin extremities
Rationales: Cortisol → central fat redistribution, muscle wasting.
21 Addisonian crisis treatment order? IV hydrocortisone first, then fluids Rationales: Replace
cortisol immediately; then volume.
22 Best sign of fluid overload in heart failure? Crackles in lungs Rationales: Pulmonary edema
from left-sided backup.
23 Warfarin INR 8, no bleeding. Action? Hold warfarin + vitamin K 5–10 mg PO Rationales:
Standard reversal for supratherapeutic INR without bleed.
24 First ECG change in hypokalemia? Flat T waves + prominent U waves Rationales: K⁺ <3.5
→ repolarization abnormalities.
25 COPD patient on home oxygen. Target SpO₂? 88–92% Rationales: GOLD guideline prevents
hypoxic drive suppression.
