January Semester 2026 | HESI RN Comprehensive Exit Exam |
Latest 2025–2026 Updated Practice Questions, Detailed
Rationales, NCLEX-Style Scenarios, Final Nursing Program Exit
Assessment Study Guide
1. Which of the following is the priority nursing intervention for a patient
experiencing acute chest pain?
• A) Administer morphine as prescribed
• B) Obtain an electrocardiogram (ECG)
• C) Provide oxygen therapy
• D) Initiate IV access
Correct Option: B) Obtain an electrocardiogram (ECG)
Rationale: Obtaining an ECG is a priority to assess for cardiac ischemia, which is
critical in a patient with acute chest pain.
2. A nurse is caring for a patient receiving digoxin. Which of the following findings
should alert the nurse to the possibility of digoxin toxicity?
• A) Heart rate of 60 beats per minute
• B) Serum potassium level of 4.2 mEq/L
• C) Serum digoxin level of 2.0 ng/mL
• D) Blood pressure of 120/80 mmHg
Correct Option: C) Serum digoxin level of 2.0 ng/mL
Rationale: A serum digoxin level of 2.0 ng/mL is above the therapeutic range and
indicates toxicity potential.
3. The nurse is preparing to administer a medication via the intramuscular route.
Which of the following sites is most appropriate?
• A) Abdomen
• B) Dorsogluteal site
• C) Vastus lateralis
• D) Subscapular area
Correct Option: C) Vastus lateralis
Rationale: The vastus lateralis is a preferred site for intramuscular injections, especially
in infants and small children, due to its size and muscle mass.
,4. A patient is being discharged after a stroke. What is the most appropriate
teaching point for this patient?
• A) "You may resume normal activities immediately."
• B) "Avoid any physical activity for the next year."
• C) "Monitor for any signs of another stroke."
• D) "It is important to increase your sodium intake."
Correct Option: C) "Monitor for any signs of another stroke."
Rationale: Education about recognizing signs of another stroke is crucial for patient
safety and prompt intervention.
5. Which laboratory finding would the nurse expect in a patient with renal failure?
• A) Decreased serum creatinine
• B) Elevated blood urea nitrogen (BUN)
• C) Hypokalemia
• D) Decreased phosphorus levels
Correct Option: B) Elevated blood urea nitrogen (BUN)
Rationale: In renal failure, the kidney's ability to excrete waste is impaired, leading to
elevated levels of BUN.
6. A nurse is caring for a patient who is receiving chemotherapy. Which of the
following is the most appropriate nursing intervention?
• A) Encourage a high-fiber diet
• B) Monitor for signs of infection
• C) Administer antiemetics before meals
• D) Restrict fluid intake
Correct Option: B) Monitor for signs of infection
Rationale: Chemotherapy can cause neutropenia, increasing the risk of infection; thus,
monitoring for signs of infection is critical.
7. A patient with a history of hypertension presents with a blood pressure of
180/110 mmHg. Which class of medication should the nurse expect to be initiated?
, • A) Beta blockers
• B) Calcium channel blockers
• C) ACE inhibitors
• D) Diuretics
Correct Option: C) ACE inhibitors
Rationale: ACE inhibitors are often first-line treatments for managing hypertension,
particularly in patients with certain comorbidities.
8. In planning care for a patient with heart failure, which instruction would be most
important for the nurse to include?
• A) "You can eat as much salt as you want."
• B) "Weigh yourself daily and report any weight gain."
• C) "Increase your fluid intake for hydration."
• D) "Exercise vigorously to improve heart function."
Correct Option: B) "Weigh yourself daily and report any weight gain."
Rationale: Daily weights help monitor fluid status, which is critical in managing heart
failure.
9. A nurse is assessing a patient with diabetes who presents with a blood glucose
level of 450 mg/dL. Which of the following findings would the nurse expect?
• A) Bradycardia
• B) Polyuria
• C) Hypotension
• D) Hypoglycemia
Correct Option: B) Polyuria
Rationale: High blood glucose levels can cause osmotic diuresis, leading to increased
urine output (polyuria).
10. When administering a blood transfusion, the nurse should monitor for which of
the following complications?
• A) Bradycardia
, • B) Hemolytic reaction
• C) Hypertension
• D) Hyperglycemia
Correct Option: B) Hemolytic reaction
Rationale: Hemolytic reactions are serious and can occur if there is a mismatch
between donor and recipient blood types.
11. A nurse is providing discharge instructions for a patient with asthma. Which
statement indicates a need for further teaching?
• A) "I will avoid known triggers for my asthma."
• B) "I can use my rescue inhaler as needed."
• C) "I should take my daily controller medication only when I have symptoms."
• D) "I will keep my asthma action plan handy."
Correct Option: C) "I should take my daily controller medication only when I have
symptoms."
Rationale: Daily controller medications should be taken consistently, not just when
symptoms occur.
12. Which of the following is the first step in the nursing process?
• A) Diagnosis
• B) Planning
• C) Assessment
• D) Evaluation
Correct Option: C) Assessment
Rationale: Assessment is the first step in the nursing process and involves gathering
information about the patient's health status.
13. A nurse is caring for a patient with chronic obstructive pulmonary disease
(COPD). Which assessment finding would indicate a need for further intervention?
• A) Increased respiratory rate
• B) Use of accessory muscles
Latest 2025–2026 Updated Practice Questions, Detailed
Rationales, NCLEX-Style Scenarios, Final Nursing Program Exit
Assessment Study Guide
1. Which of the following is the priority nursing intervention for a patient
experiencing acute chest pain?
• A) Administer morphine as prescribed
• B) Obtain an electrocardiogram (ECG)
• C) Provide oxygen therapy
• D) Initiate IV access
Correct Option: B) Obtain an electrocardiogram (ECG)
Rationale: Obtaining an ECG is a priority to assess for cardiac ischemia, which is
critical in a patient with acute chest pain.
2. A nurse is caring for a patient receiving digoxin. Which of the following findings
should alert the nurse to the possibility of digoxin toxicity?
• A) Heart rate of 60 beats per minute
• B) Serum potassium level of 4.2 mEq/L
• C) Serum digoxin level of 2.0 ng/mL
• D) Blood pressure of 120/80 mmHg
Correct Option: C) Serum digoxin level of 2.0 ng/mL
Rationale: A serum digoxin level of 2.0 ng/mL is above the therapeutic range and
indicates toxicity potential.
3. The nurse is preparing to administer a medication via the intramuscular route.
Which of the following sites is most appropriate?
• A) Abdomen
• B) Dorsogluteal site
• C) Vastus lateralis
• D) Subscapular area
Correct Option: C) Vastus lateralis
Rationale: The vastus lateralis is a preferred site for intramuscular injections, especially
in infants and small children, due to its size and muscle mass.
,4. A patient is being discharged after a stroke. What is the most appropriate
teaching point for this patient?
• A) "You may resume normal activities immediately."
• B) "Avoid any physical activity for the next year."
• C) "Monitor for any signs of another stroke."
• D) "It is important to increase your sodium intake."
Correct Option: C) "Monitor for any signs of another stroke."
Rationale: Education about recognizing signs of another stroke is crucial for patient
safety and prompt intervention.
5. Which laboratory finding would the nurse expect in a patient with renal failure?
• A) Decreased serum creatinine
• B) Elevated blood urea nitrogen (BUN)
• C) Hypokalemia
• D) Decreased phosphorus levels
Correct Option: B) Elevated blood urea nitrogen (BUN)
Rationale: In renal failure, the kidney's ability to excrete waste is impaired, leading to
elevated levels of BUN.
6. A nurse is caring for a patient who is receiving chemotherapy. Which of the
following is the most appropriate nursing intervention?
• A) Encourage a high-fiber diet
• B) Monitor for signs of infection
• C) Administer antiemetics before meals
• D) Restrict fluid intake
Correct Option: B) Monitor for signs of infection
Rationale: Chemotherapy can cause neutropenia, increasing the risk of infection; thus,
monitoring for signs of infection is critical.
7. A patient with a history of hypertension presents with a blood pressure of
180/110 mmHg. Which class of medication should the nurse expect to be initiated?
, • A) Beta blockers
• B) Calcium channel blockers
• C) ACE inhibitors
• D) Diuretics
Correct Option: C) ACE inhibitors
Rationale: ACE inhibitors are often first-line treatments for managing hypertension,
particularly in patients with certain comorbidities.
8. In planning care for a patient with heart failure, which instruction would be most
important for the nurse to include?
• A) "You can eat as much salt as you want."
• B) "Weigh yourself daily and report any weight gain."
• C) "Increase your fluid intake for hydration."
• D) "Exercise vigorously to improve heart function."
Correct Option: B) "Weigh yourself daily and report any weight gain."
Rationale: Daily weights help monitor fluid status, which is critical in managing heart
failure.
9. A nurse is assessing a patient with diabetes who presents with a blood glucose
level of 450 mg/dL. Which of the following findings would the nurse expect?
• A) Bradycardia
• B) Polyuria
• C) Hypotension
• D) Hypoglycemia
Correct Option: B) Polyuria
Rationale: High blood glucose levels can cause osmotic diuresis, leading to increased
urine output (polyuria).
10. When administering a blood transfusion, the nurse should monitor for which of
the following complications?
• A) Bradycardia
, • B) Hemolytic reaction
• C) Hypertension
• D) Hyperglycemia
Correct Option: B) Hemolytic reaction
Rationale: Hemolytic reactions are serious and can occur if there is a mismatch
between donor and recipient blood types.
11. A nurse is providing discharge instructions for a patient with asthma. Which
statement indicates a need for further teaching?
• A) "I will avoid known triggers for my asthma."
• B) "I can use my rescue inhaler as needed."
• C) "I should take my daily controller medication only when I have symptoms."
• D) "I will keep my asthma action plan handy."
Correct Option: C) "I should take my daily controller medication only when I have
symptoms."
Rationale: Daily controller medications should be taken consistently, not just when
symptoms occur.
12. Which of the following is the first step in the nursing process?
• A) Diagnosis
• B) Planning
• C) Assessment
• D) Evaluation
Correct Option: C) Assessment
Rationale: Assessment is the first step in the nursing process and involves gathering
information about the patient's health status.
13. A nurse is caring for a patient with chronic obstructive pulmonary disease
(COPD). Which assessment finding would indicate a need for further intervention?
• A) Increased respiratory rate
• B) Use of accessory muscles
