1
RN HESI EXIT ACTUAL EXAM
2026/2027 | Version 1 (V1) | Verified
Questions & Answers with Screenshots |
Graded A | Pass Guaranteed
1. [SCREENSHOT: 12-lead ECG strip shows sinus rhythm at 86 bpm with PR interval
0.32 s and QRS 0.10 s.]
Q1: The nurse should first:
A. Prepare for transcutaneous pacing
B. Hold the scheduled metoprolol dose [CORRECT]
C. Obtain a magnesium level
D. Begin high-flow O₂
Correct Answer: B
Rationale: From the screenshot, first-degree AV block (PR >0.20 s) is present. Beta-
blockers (metoprolol) further prolong conduction and are withheld until provider review.
Key Point: Always correlate PR interval with scheduled rate-slowing drugs.
2. A 6-hour-postpartum client says, “I’m bleeding through my pad every hour.” Which
action is most important?
A. Perform fundal massage and reassess [CORRECT]
B. Offer a sitz bath
C. Increase oral fluids
D. Insert a Foley catheter
Correct Answer: A
Rationale: Uterine atony is the leading cause of early postpartum hemorrhage; fundal
massage is the immediate nursing action.
Key Point: Saturating a pad in <15 min or >1 per hour is reportable.
3. [SCREENSHOT: Pediatric growth chart: 18-month-old boy, weight 8.5 kg (10th
percentile), length 76 cm (<5th percentile).]
Q3: The priority nursing intervention is:
A. Schedule speech screening
B. Assess caloric intake with 24-h recall [CORRECT]
C. Teach bicycle safety
,2
D. Order lead screening
Correct Answer: B
Rationale: From the screenshot, both weight and length fall below expected curves;
inadequate nutrition is the most modifiable factor.
Key Point: Failure-to-thrive work-up starts with feeding history.
4. The nurse delegates to an experienced AP which task on a Med-Surg floor?
A. Obtain Accu-Chek glucose before lunch [CORRECT]
B. Assess peripheral pulses post-cast application
C. Teach insulin injection technique
D. Evaluate chest-tube bubbling
Correct Answer: A
Rationale: Glucose meter checks are standardized, unmodified, and do not require
nursing judgment—within AP scope.
Key Point: Right task + right circumstance = five rights of delegation.
5. A client on lithium 600 mg BID reports mild diarrhea and a 3-kg weight gain since last
visit. Latest lithium level is 1.3 mEq/L (normal 0.6–1.2). The nurse should:
A. Encourage increased fiber
B. Suggest dividing daily sodium evenly [CORRECT]
C. Hold next dose and call provider
D. Reassure that level is acceptable
Correct Answer: B
Rationale: Slightly elevated level with early toxicity signs; consistent sodium intake
prevents further fluctuation.
Key Point: Lithium reabsorbs with Na⁺; fluctuating intake raises level.
6. Which statement by a client with borderline personality disorder demonstrates
improvement in coping?
A. “I smashed the mirror when she cancelled.”
B. “I called my therapist before I cut myself.”
C. “I used my ice cube technique instead of self-injury.” [CORRECT]
D. “I told staff they’re all against me.”
Correct Answer: C
Rationale: Substitution of self-soothing for self-mutilation shows DBT skill acquisition.
Key Point: Ice cube holding gives sensory stimulation without harm.
7. [SCREENSHOT: Morning lab table: Na 128 mEq/L, K 3.0 mEq/L, Cl 92 mEq/L,
CO₂ 28 mEq/L.]
Q7: The nurse should question which PRN order?
A. Furosemide 40 mg IV [CORRECT]
B. Acetaminophen 650 mg PO
,3
C. Ondansetron 4 mg IV
D. Docusate sodium 100 mg PO
Correct Answer: A
Rationale: From the screenshot, existing hyponatremia and hypokalemia would worsen
with loop diuretic.
Key Point: Review electrolytes before high-ceiling diuretics.
8. A client with COPD receives BiPAP 12/5 cm H₂O. Which finding warrants immediate
intervention?
A. Arterial pH 7.48 [CORRECT]
B. Heart rate 94
C. SpO₂ 93 %
D. Respiratory rate 18
Correct Answer: A
Rationale: Alkalosis may signal excessive ventilation, risking respiratory arrest in COPD
patients.
Key Point: Target pH 7.35–7.45; alkalosis depresses hypoxic drive.
9. The mother of a 3-year-old asks how to prevent future ear infections. The best response
is:
A. “Give prophylactic amoxicillin every winter.”
B. “Avoid second-hand smoke exposure.” [CORRECT]
C. “Keep him indoors during cold weather.”
D. “Lay him flat for bottle feeds.”
Correct Answer: B
Rationale: Smoke irritates Eustachian tube mucosa; cessation reduces incidence by ~40
%.
Key Point: Environmental modifiable risk factor education.
10. [SCREENSHOT: Medication administration record excerpt: 0800—Warfarin 5 mg
PO; 1400—Enoxaparin 40 mg SC; 2200—Aspirin 81 mg PO.]
Q10: The nurse should clarify which combination with the pharmacist?
A. Warfarin + Enoxaparin overlap [CORRECT]
B. Warfarin + Aspirin
C. Enoxaparin timing
D. Aspirin dose
Correct Answer: A
Rationale: From the screenshot, simultaneous anticoagulants raise bleeding risk unless
bridge therapy is intended.
Key Point: Verify therapeutic intent for double coverage.
, 4
11. When teaching a client with newly diagnosed open-angle glaucoma, the nurse explains
that the drug of choice is:
A. Atropine drops
B. Prostaglandin analog drops [CORRECT]
C. Oral acetazolamide only
D. Steroid drops
Correct Answer: B
Rationale: Prostaglandins (e.g., latanoprost) increase uveoscleral outflow and are first-
line in 2026 AAO guidelines.
Key Point: Darkening of iris/lashes is expected side effect.
12. A 28-week-gestation client in preterm labor receives nifedipine 10 mg PO. Which finding
requires immediate notification of the provider?
A. BP 88/50 mmHg [CORRECT]
B. Fetal HR 140
C. Glucose 98 mg/dL
D. Respiratory rate 22
Correct Answer: A
Rationale: Nifedipine is a potent vasodilator; systolic <90 mmHg risks maternal
hypoperfusion and fetal hypoxia.
Key Point: Expecting ↓BP but not below 90 systolic.
13. Which order for a client with SIADH should the nurse question?
A. Restrict fluids to 1 L/day
B. Infuse 0.45 % NaCl 125 mL/h [CORRECT]
C. Daily weights
D. Monitor urine osmolality
Correct Answer: B
Rationale: Hypotonic solution would worsen hyponatremia; isotonic (0.9 %) or
hypertonic (3 %) indicated.
Key Point: SIADH = water excess, not sodium loss.
14. [SCREENSHOT: Chest-tube drainage system: column 1 (air-leak chamber) shows
gentle bubbling on expiration; column 2 (water-seal) fluctuates 4 cm with
respiration; drainage 80 mL serosanguineous.]
Q14: The nurse’s appropriate action is:
A. Document and continue to monitor [CORRECT]
B. Clamp tube immediately
C. Add 20 mL sterile water to suction port
D. Milk tubing toward chamber
Correct Answer: A
Rationale: From the screenshot, gentle bubbling with expiration is expected with new
RN HESI EXIT ACTUAL EXAM
2026/2027 | Version 1 (V1) | Verified
Questions & Answers with Screenshots |
Graded A | Pass Guaranteed
1. [SCREENSHOT: 12-lead ECG strip shows sinus rhythm at 86 bpm with PR interval
0.32 s and QRS 0.10 s.]
Q1: The nurse should first:
A. Prepare for transcutaneous pacing
B. Hold the scheduled metoprolol dose [CORRECT]
C. Obtain a magnesium level
D. Begin high-flow O₂
Correct Answer: B
Rationale: From the screenshot, first-degree AV block (PR >0.20 s) is present. Beta-
blockers (metoprolol) further prolong conduction and are withheld until provider review.
Key Point: Always correlate PR interval with scheduled rate-slowing drugs.
2. A 6-hour-postpartum client says, “I’m bleeding through my pad every hour.” Which
action is most important?
A. Perform fundal massage and reassess [CORRECT]
B. Offer a sitz bath
C. Increase oral fluids
D. Insert a Foley catheter
Correct Answer: A
Rationale: Uterine atony is the leading cause of early postpartum hemorrhage; fundal
massage is the immediate nursing action.
Key Point: Saturating a pad in <15 min or >1 per hour is reportable.
3. [SCREENSHOT: Pediatric growth chart: 18-month-old boy, weight 8.5 kg (10th
percentile), length 76 cm (<5th percentile).]
Q3: The priority nursing intervention is:
A. Schedule speech screening
B. Assess caloric intake with 24-h recall [CORRECT]
C. Teach bicycle safety
,2
D. Order lead screening
Correct Answer: B
Rationale: From the screenshot, both weight and length fall below expected curves;
inadequate nutrition is the most modifiable factor.
Key Point: Failure-to-thrive work-up starts with feeding history.
4. The nurse delegates to an experienced AP which task on a Med-Surg floor?
A. Obtain Accu-Chek glucose before lunch [CORRECT]
B. Assess peripheral pulses post-cast application
C. Teach insulin injection technique
D. Evaluate chest-tube bubbling
Correct Answer: A
Rationale: Glucose meter checks are standardized, unmodified, and do not require
nursing judgment—within AP scope.
Key Point: Right task + right circumstance = five rights of delegation.
5. A client on lithium 600 mg BID reports mild diarrhea and a 3-kg weight gain since last
visit. Latest lithium level is 1.3 mEq/L (normal 0.6–1.2). The nurse should:
A. Encourage increased fiber
B. Suggest dividing daily sodium evenly [CORRECT]
C. Hold next dose and call provider
D. Reassure that level is acceptable
Correct Answer: B
Rationale: Slightly elevated level with early toxicity signs; consistent sodium intake
prevents further fluctuation.
Key Point: Lithium reabsorbs with Na⁺; fluctuating intake raises level.
6. Which statement by a client with borderline personality disorder demonstrates
improvement in coping?
A. “I smashed the mirror when she cancelled.”
B. “I called my therapist before I cut myself.”
C. “I used my ice cube technique instead of self-injury.” [CORRECT]
D. “I told staff they’re all against me.”
Correct Answer: C
Rationale: Substitution of self-soothing for self-mutilation shows DBT skill acquisition.
Key Point: Ice cube holding gives sensory stimulation without harm.
7. [SCREENSHOT: Morning lab table: Na 128 mEq/L, K 3.0 mEq/L, Cl 92 mEq/L,
CO₂ 28 mEq/L.]
Q7: The nurse should question which PRN order?
A. Furosemide 40 mg IV [CORRECT]
B. Acetaminophen 650 mg PO
,3
C. Ondansetron 4 mg IV
D. Docusate sodium 100 mg PO
Correct Answer: A
Rationale: From the screenshot, existing hyponatremia and hypokalemia would worsen
with loop diuretic.
Key Point: Review electrolytes before high-ceiling diuretics.
8. A client with COPD receives BiPAP 12/5 cm H₂O. Which finding warrants immediate
intervention?
A. Arterial pH 7.48 [CORRECT]
B. Heart rate 94
C. SpO₂ 93 %
D. Respiratory rate 18
Correct Answer: A
Rationale: Alkalosis may signal excessive ventilation, risking respiratory arrest in COPD
patients.
Key Point: Target pH 7.35–7.45; alkalosis depresses hypoxic drive.
9. The mother of a 3-year-old asks how to prevent future ear infections. The best response
is:
A. “Give prophylactic amoxicillin every winter.”
B. “Avoid second-hand smoke exposure.” [CORRECT]
C. “Keep him indoors during cold weather.”
D. “Lay him flat for bottle feeds.”
Correct Answer: B
Rationale: Smoke irritates Eustachian tube mucosa; cessation reduces incidence by ~40
%.
Key Point: Environmental modifiable risk factor education.
10. [SCREENSHOT: Medication administration record excerpt: 0800—Warfarin 5 mg
PO; 1400—Enoxaparin 40 mg SC; 2200—Aspirin 81 mg PO.]
Q10: The nurse should clarify which combination with the pharmacist?
A. Warfarin + Enoxaparin overlap [CORRECT]
B. Warfarin + Aspirin
C. Enoxaparin timing
D. Aspirin dose
Correct Answer: A
Rationale: From the screenshot, simultaneous anticoagulants raise bleeding risk unless
bridge therapy is intended.
Key Point: Verify therapeutic intent for double coverage.
, 4
11. When teaching a client with newly diagnosed open-angle glaucoma, the nurse explains
that the drug of choice is:
A. Atropine drops
B. Prostaglandin analog drops [CORRECT]
C. Oral acetazolamide only
D. Steroid drops
Correct Answer: B
Rationale: Prostaglandins (e.g., latanoprost) increase uveoscleral outflow and are first-
line in 2026 AAO guidelines.
Key Point: Darkening of iris/lashes is expected side effect.
12. A 28-week-gestation client in preterm labor receives nifedipine 10 mg PO. Which finding
requires immediate notification of the provider?
A. BP 88/50 mmHg [CORRECT]
B. Fetal HR 140
C. Glucose 98 mg/dL
D. Respiratory rate 22
Correct Answer: A
Rationale: Nifedipine is a potent vasodilator; systolic <90 mmHg risks maternal
hypoperfusion and fetal hypoxia.
Key Point: Expecting ↓BP but not below 90 systolic.
13. Which order for a client with SIADH should the nurse question?
A. Restrict fluids to 1 L/day
B. Infuse 0.45 % NaCl 125 mL/h [CORRECT]
C. Daily weights
D. Monitor urine osmolality
Correct Answer: B
Rationale: Hypotonic solution would worsen hyponatremia; isotonic (0.9 %) or
hypertonic (3 %) indicated.
Key Point: SIADH = water excess, not sodium loss.
14. [SCREENSHOT: Chest-tube drainage system: column 1 (air-leak chamber) shows
gentle bubbling on expiration; column 2 (water-seal) fluctuates 4 cm with
respiration; drainage 80 mL serosanguineous.]
Q14: The nurse’s appropriate action is:
A. Document and continue to monitor [CORRECT]
B. Clamp tube immediately
C. Add 20 mL sterile water to suction port
D. Milk tubing toward chamber
Correct Answer: A
Rationale: From the screenshot, gentle bubbling with expiration is expected with new
