HESI RN EXIT NGN V8 QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. What instruction best reflects safe practice for Opioid analgesics?
A. “Only I will push the PCA button when I am awake and need pain medication.”
B. “I will avoid alcohol and other sedating drugs unless the prescriber says they are safe.”
C. “I will carry a rapid source of glucose and know how to treat a low blood sugar.”
D. “I will report black stools, unusual bruising, severe headache, or other signs of bleeding.”
Correct Answer: B. “I will avoid alcohol and other sedating drugs unless the prescriber says they are safe.”
Explanation: This statement reflects appropriate teaching for Opioid analgesics. Opioids can relieve severe pain
but may depress ventilation and consciousness; monitoring must focus on respiratory status and sedation as well
as pain.
2. Which situation most clearly raises concern for patient abandonment?
A. A nurse refuses an assignment before accepting it and follows the staffing escalation process.
B. A nurse accepts an assignment and then leaves without arranging appropriate transfer of care.
C. A nurse takes an approved meal break after handing off responsibility.
D. A nurse requests help with a heavy transfer.
Correct Answer: B. A nurse accepts an assignment and then leaves without arranging appropriate transfer of
care.
Explanation: Abandonment involves terminating an established nurse-patient relationship without reasonable
notice or arrangements for continued care. Specific legal definitions vary by jurisdiction.
3. A monochorionic twin pregnancy shows one fetus with oligohydramnios and growth restriction and the
other with polyhydramnios and signs of volume overload. Which complication is suggested?
A. Shoulder dystocia.
B. Normal dichorionic development.
C. Postpartum endometritis.
D. Twin-to-twin transfusion syndrome.
Correct Answer: D. Twin-to-twin transfusion syndrome.
Explanation: Shared placental vascular connections in monochorionic twins can cause imbalanced blood flow,
producing donor and recipient complications.
4. Which postpartum client should generally not receive methylergonovine?
A. A client with severe hypertension or preeclampsia.
B. A normotensive client with uterine atony.
C. A client who is Rh-negative.
D. A client with an intact perineum.
Correct Answer: A. A client with severe hypertension or preeclampsia.
Explanation: Methylergonovine causes vasoconstriction and can raise blood pressure, so it is avoided in
significant hypertension or preeclampsia.
5. Which postoperative intervention supports prevention of venous thromboembolism after total knee
arthroplasty?
A. Use prescribed anticoagulation or mechanical prophylaxis and mobilize as directed.
B. Keep the knee completely immobile for weeks without orders.
C. Massage the calf if it becomes painful and swollen.
D. Discontinue prophylaxis because the surgery involved a joint rather than the abdomen.
Correct Answer: A. Use prescribed anticoagulation or mechanical prophylaxis and mobilize as directed.
Explanation: Major orthopedic surgery carries substantial VTE risk. Pharmacologic and/or mechanical
prophylaxis plus early mobilization are commonly used.
6. Which nursing action best supports client autonomy?
A. Choose all treatments for the client to prevent mistakes.
B. Provide understandable information and respect an informed client's decision even when it differs from the
nurse's preference.
C. Withhold alternatives that may confuse the client.
D. Pressure the client to follow the nurse's personal values.
Correct Answer: B. Provide understandable information and respect an informed client's decision even when it
differs from the nurse's preference.
,Explanation: Autonomy is the client's right to make informed choices about care. The nurse supports
decision-making without coercion.
7. Which principle is appropriate when using oral suction for pooled secretions?
A. Insert rigid suction deeply into the throat of an awake client without warning.
B. Use maximum suction pressure continuously.
C. Ignore gagging and distress.
D. Use gentle suction while protecting oral tissues and monitoring the client's tolerance.
Correct Answer: D. Use gentle suction while protecting oral tissues and monitoring the client's tolerance.
Explanation: Oral suction should remove secretions without causing mucosal trauma or unnecessary stimulation.
Client tolerance and airway status are monitored.
8. A hospitalized client with a mechanical heart valve taking warfarin reports visible blood in the urine.
Which action is most appropriate?
A. Double the next warfarin dose.
B. Assess the bleeding and notify the prescribing team promptly for anticoagulation evaluation.
C. Ignore the finding because hematuria is expected.
D. Start aspirin without discussing it with the prescriber.
Correct Answer: B. Assess the bleeding and notify the prescribing team promptly for anticoagulation evaluation.
Explanation: Visible bleeding in an anticoagulated client requires assessment and prompt review of
anticoagulant effect and contributing factors. It should not be treated as an expected finding.
9. During nursing care, a client denies pain, but the nurse notes guarding and facial grimacing. What
should the nurse do next?
A. Document that the client is exaggerating symptoms.
B. Administer a sedative without further assessment.
C. Ignore the nonverbal behavior because only vital signs matter.
D. Explore the discrepancy with additional assessment rather than assuming either finding is wrong.
Correct Answer: D. Explore the discrepancy with additional assessment rather than assuming either finding is
wrong.
Explanation: Conflicting cues should be validated through further assessment. Nonverbal findings may add
important information but should not be interpreted without the client's context.
10. Before a client stands from a wheelchair, what should the nurse do?
A. Leave the brakes unlocked so the chair can move with the client.
B. Keep the footrests directly under the client's feet.
C. Place the wheelchair far from the bed.
D. Lock the wheelchair brakes and move the footrests out of the way.
Correct Answer: D. Lock the wheelchair brakes and move the footrests out of the way.
Explanation: Locked brakes and cleared footrests reduce the risk of falls during transfer. The chair should be
positioned close to the transfer surface.
11. Which symptom is common with hypernatremia caused by water deficit?
A. Intense thirst with signs of dehydration.
B. No thirst and severe fluid overload in every case.
C. Only jaundice.
D. Isolated hearing loss.
Correct Answer: A. Intense thirst with signs of dehydration.
Explanation: Hypernatremia from water loss commonly stimulates thirst and may accompany dry mucosa,
weakness, or neurologic changes.
12. Which assessment pattern is most consistent with increasing dependent edema? Three-day assessment
Day Weight Ankle edema 1
70. 2 kg Trace 2
71. 0 kg 1+ 3
72. 1 kg 2+
A. Decreasing weight and dry mucous membranes.
B. Improved skin elasticity with no swelling.
C. Progressive ankle swelling with deeper pitting by evening and increasing daily weight.
, D. Stable ankles with unchanged weight.
Correct Answer: C. Progressive ankle swelling with deeper pitting by evening and increasing daily weight.
Explanation: Increasing pitting edema and weight gain suggest fluid accumulation and warrant further
assessment of the cause.
13. Which response protects client privacy when using the electronic health record?
A. Share the password with coworkers.
B. Leave the chart open in a public hallway.
C. Log out or secure the workstation when leaving it unattended.
D. Photograph the screen with a personal phone.
Correct Answer: C. Log out or secure the workstation when leaving it unattended.
Explanation: Securing unattended workstations reduces unauthorized access to protected health information.
14. During pediatric care, a child uses a rescue inhaler most days and wakes with cough several nights each
week. Which conclusion is most appropriate? Two-week asthma history Measure Finding Rescue inhaler
Most days Night cough 4 nights/week Sports symptoms Frequent
A. Asthma control is inadequate and the long-term management plan needs reassessment.
B. Frequent rescue use proves excellent control.
C. Night symptoms are unrelated to asthma.
D. Controller therapy should be stopped.
Correct Answer: A. Asthma control is inadequate and the long-term management plan needs reassessment.
Explanation: Frequent symptoms and rescue-medication use indicate poor control and increased exacerbation
risk.
15. A parent reports that a toddler may have swallowed an unknown household cleaner but is awake and
breathing normally. What should the nurse advise first?
A. Induce vomiting with syrup of ipecac.
B. Contact Poison Control immediately and follow its instructions.
C. Give milk regardless of the substance.
D. Wait for symptoms before seeking help.
Correct Answer: B. Contact Poison Control immediately and follow its instructions.
Explanation: Poison Control provides substance-specific guidance. Routine induction of vomiting and
indiscriminate dilution are not recommended.
16. During pediatric care, a child with moderate croup receives nebulized epinephrine. Why is continued
observation important afterward?
A. The medication permanently suppresses the gag reflex.
B. Airway symptoms can recur as the medication effect wears off.
C. It always causes delayed bacterial meningitis.
D. The child must remain NPO for 24 hours.
Correct Answer: B. Airway symptoms can recur as the medication effect wears off.
Explanation: Nebulized epinephrine provides temporary reduction in airway edema, so recurrence of stridor or
distress after the effect fades must be monitored.
17. Which new finding is the strongest cue that a previously stable client may be deteriorating?
A. The client asks for a different television channel.
B. The client prefers tea instead of coffee.
C. Respiratory rate increases from 18/min to 30/min and the client becomes restless.
D. The client requests an extra blanket while vital signs remain unchanged.
Correct Answer: C. Respiratory rate increases from 18/min to 30/min and the client becomes restless.
Explanation: Tachypnea with restlessness may be an early sign of physiologic compromise and requires prompt
assessment. Preference changes are not comparable deterioration cues.
18. Which medication should be readily available when magnesium sulfate is administered for severe
preeclampsia?
A. Methylergonovine.
B. Rho(D) immune globulin.
C. Rubella vaccine.
D. Calcium gluconate.
Correct Answer: D. Calcium gluconate.
WITH ANSWERS AND EXPLANATIONS
1. What instruction best reflects safe practice for Opioid analgesics?
A. “Only I will push the PCA button when I am awake and need pain medication.”
B. “I will avoid alcohol and other sedating drugs unless the prescriber says they are safe.”
C. “I will carry a rapid source of glucose and know how to treat a low blood sugar.”
D. “I will report black stools, unusual bruising, severe headache, or other signs of bleeding.”
Correct Answer: B. “I will avoid alcohol and other sedating drugs unless the prescriber says they are safe.”
Explanation: This statement reflects appropriate teaching for Opioid analgesics. Opioids can relieve severe pain
but may depress ventilation and consciousness; monitoring must focus on respiratory status and sedation as well
as pain.
2. Which situation most clearly raises concern for patient abandonment?
A. A nurse refuses an assignment before accepting it and follows the staffing escalation process.
B. A nurse accepts an assignment and then leaves without arranging appropriate transfer of care.
C. A nurse takes an approved meal break after handing off responsibility.
D. A nurse requests help with a heavy transfer.
Correct Answer: B. A nurse accepts an assignment and then leaves without arranging appropriate transfer of
care.
Explanation: Abandonment involves terminating an established nurse-patient relationship without reasonable
notice or arrangements for continued care. Specific legal definitions vary by jurisdiction.
3. A monochorionic twin pregnancy shows one fetus with oligohydramnios and growth restriction and the
other with polyhydramnios and signs of volume overload. Which complication is suggested?
A. Shoulder dystocia.
B. Normal dichorionic development.
C. Postpartum endometritis.
D. Twin-to-twin transfusion syndrome.
Correct Answer: D. Twin-to-twin transfusion syndrome.
Explanation: Shared placental vascular connections in monochorionic twins can cause imbalanced blood flow,
producing donor and recipient complications.
4. Which postpartum client should generally not receive methylergonovine?
A. A client with severe hypertension or preeclampsia.
B. A normotensive client with uterine atony.
C. A client who is Rh-negative.
D. A client with an intact perineum.
Correct Answer: A. A client with severe hypertension or preeclampsia.
Explanation: Methylergonovine causes vasoconstriction and can raise blood pressure, so it is avoided in
significant hypertension or preeclampsia.
5. Which postoperative intervention supports prevention of venous thromboembolism after total knee
arthroplasty?
A. Use prescribed anticoagulation or mechanical prophylaxis and mobilize as directed.
B. Keep the knee completely immobile for weeks without orders.
C. Massage the calf if it becomes painful and swollen.
D. Discontinue prophylaxis because the surgery involved a joint rather than the abdomen.
Correct Answer: A. Use prescribed anticoagulation or mechanical prophylaxis and mobilize as directed.
Explanation: Major orthopedic surgery carries substantial VTE risk. Pharmacologic and/or mechanical
prophylaxis plus early mobilization are commonly used.
6. Which nursing action best supports client autonomy?
A. Choose all treatments for the client to prevent mistakes.
B. Provide understandable information and respect an informed client's decision even when it differs from the
nurse's preference.
C. Withhold alternatives that may confuse the client.
D. Pressure the client to follow the nurse's personal values.
Correct Answer: B. Provide understandable information and respect an informed client's decision even when it
differs from the nurse's preference.
,Explanation: Autonomy is the client's right to make informed choices about care. The nurse supports
decision-making without coercion.
7. Which principle is appropriate when using oral suction for pooled secretions?
A. Insert rigid suction deeply into the throat of an awake client without warning.
B. Use maximum suction pressure continuously.
C. Ignore gagging and distress.
D. Use gentle suction while protecting oral tissues and monitoring the client's tolerance.
Correct Answer: D. Use gentle suction while protecting oral tissues and monitoring the client's tolerance.
Explanation: Oral suction should remove secretions without causing mucosal trauma or unnecessary stimulation.
Client tolerance and airway status are monitored.
8. A hospitalized client with a mechanical heart valve taking warfarin reports visible blood in the urine.
Which action is most appropriate?
A. Double the next warfarin dose.
B. Assess the bleeding and notify the prescribing team promptly for anticoagulation evaluation.
C. Ignore the finding because hematuria is expected.
D. Start aspirin without discussing it with the prescriber.
Correct Answer: B. Assess the bleeding and notify the prescribing team promptly for anticoagulation evaluation.
Explanation: Visible bleeding in an anticoagulated client requires assessment and prompt review of
anticoagulant effect and contributing factors. It should not be treated as an expected finding.
9. During nursing care, a client denies pain, but the nurse notes guarding and facial grimacing. What
should the nurse do next?
A. Document that the client is exaggerating symptoms.
B. Administer a sedative without further assessment.
C. Ignore the nonverbal behavior because only vital signs matter.
D. Explore the discrepancy with additional assessment rather than assuming either finding is wrong.
Correct Answer: D. Explore the discrepancy with additional assessment rather than assuming either finding is
wrong.
Explanation: Conflicting cues should be validated through further assessment. Nonverbal findings may add
important information but should not be interpreted without the client's context.
10. Before a client stands from a wheelchair, what should the nurse do?
A. Leave the brakes unlocked so the chair can move with the client.
B. Keep the footrests directly under the client's feet.
C. Place the wheelchair far from the bed.
D. Lock the wheelchair brakes and move the footrests out of the way.
Correct Answer: D. Lock the wheelchair brakes and move the footrests out of the way.
Explanation: Locked brakes and cleared footrests reduce the risk of falls during transfer. The chair should be
positioned close to the transfer surface.
11. Which symptom is common with hypernatremia caused by water deficit?
A. Intense thirst with signs of dehydration.
B. No thirst and severe fluid overload in every case.
C. Only jaundice.
D. Isolated hearing loss.
Correct Answer: A. Intense thirst with signs of dehydration.
Explanation: Hypernatremia from water loss commonly stimulates thirst and may accompany dry mucosa,
weakness, or neurologic changes.
12. Which assessment pattern is most consistent with increasing dependent edema? Three-day assessment
Day Weight Ankle edema 1
70. 2 kg Trace 2
71. 0 kg 1+ 3
72. 1 kg 2+
A. Decreasing weight and dry mucous membranes.
B. Improved skin elasticity with no swelling.
C. Progressive ankle swelling with deeper pitting by evening and increasing daily weight.
, D. Stable ankles with unchanged weight.
Correct Answer: C. Progressive ankle swelling with deeper pitting by evening and increasing daily weight.
Explanation: Increasing pitting edema and weight gain suggest fluid accumulation and warrant further
assessment of the cause.
13. Which response protects client privacy when using the electronic health record?
A. Share the password with coworkers.
B. Leave the chart open in a public hallway.
C. Log out or secure the workstation when leaving it unattended.
D. Photograph the screen with a personal phone.
Correct Answer: C. Log out or secure the workstation when leaving it unattended.
Explanation: Securing unattended workstations reduces unauthorized access to protected health information.
14. During pediatric care, a child uses a rescue inhaler most days and wakes with cough several nights each
week. Which conclusion is most appropriate? Two-week asthma history Measure Finding Rescue inhaler
Most days Night cough 4 nights/week Sports symptoms Frequent
A. Asthma control is inadequate and the long-term management plan needs reassessment.
B. Frequent rescue use proves excellent control.
C. Night symptoms are unrelated to asthma.
D. Controller therapy should be stopped.
Correct Answer: A. Asthma control is inadequate and the long-term management plan needs reassessment.
Explanation: Frequent symptoms and rescue-medication use indicate poor control and increased exacerbation
risk.
15. A parent reports that a toddler may have swallowed an unknown household cleaner but is awake and
breathing normally. What should the nurse advise first?
A. Induce vomiting with syrup of ipecac.
B. Contact Poison Control immediately and follow its instructions.
C. Give milk regardless of the substance.
D. Wait for symptoms before seeking help.
Correct Answer: B. Contact Poison Control immediately and follow its instructions.
Explanation: Poison Control provides substance-specific guidance. Routine induction of vomiting and
indiscriminate dilution are not recommended.
16. During pediatric care, a child with moderate croup receives nebulized epinephrine. Why is continued
observation important afterward?
A. The medication permanently suppresses the gag reflex.
B. Airway symptoms can recur as the medication effect wears off.
C. It always causes delayed bacterial meningitis.
D. The child must remain NPO for 24 hours.
Correct Answer: B. Airway symptoms can recur as the medication effect wears off.
Explanation: Nebulized epinephrine provides temporary reduction in airway edema, so recurrence of stridor or
distress after the effect fades must be monitored.
17. Which new finding is the strongest cue that a previously stable client may be deteriorating?
A. The client asks for a different television channel.
B. The client prefers tea instead of coffee.
C. Respiratory rate increases from 18/min to 30/min and the client becomes restless.
D. The client requests an extra blanket while vital signs remain unchanged.
Correct Answer: C. Respiratory rate increases from 18/min to 30/min and the client becomes restless.
Explanation: Tachypnea with restlessness may be an early sign of physiologic compromise and requires prompt
assessment. Preference changes are not comparable deterioration cues.
18. Which medication should be readily available when magnesium sulfate is administered for severe
preeclampsia?
A. Methylergonovine.
B. Rho(D) immune globulin.
C. Rubella vaccine.
D. Calcium gluconate.
Correct Answer: D. Calcium gluconate.
