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HESI RN Exit Practice ACTUAL EXAM 2026/2027 |
Comprehensive Integrated Exam with Verified
Questions and Answers | Predicts NCLEX-RN
Readiness | Pass Guaranteed - A+ Graded
Question 1 (Adult Medical-Surgical - Cardiovascular)
A 68-year-old client with a history of heart failure presents to the emergency department with
severe dyspnea, frothy pink sputum, and a blood pressure of 202/118 mmHg. Which action
should the nurse take first?
A. Insert an indwelling urinary catheter to monitor output
B. Apply oxygen via non-rebreather mask and place client in high-Fowler's position
C. Prepare for immediate synchronized cardioversion
D. Administer furosemide 80 mg IV push
Question 2 (Management of Care - Prioritization)
The nurse is caring for four clients on a medical-surgical unit. Which client requires immediate
assessment?
A. A client 24 hours post-operative appendectomy with a temperature of 101.2°F (38.4°C)
B. A client with COPD who reports increased shortness of breath after walking to the bathroom
C. A client with a new onset of confusion and oxygen saturation of 88% on room air
D. A client scheduled for discharge who needs medication instructions
Question 3 (Pharmacology - Cardiovascular)
A client with atrial fibrillation is prescribed rivaroxaban 20 mg daily. Which client statement
indicates a need for further teaching regarding this medication?
A. "I will report any unusual bleeding or bruising immediately."
B. "I should take this medication with my evening meal every day."
C. "I can stop taking this medication once my heart rhythm returns to normal."
D. "I will use a soft toothbrush and electric razor to prevent cuts."
Question 4 (Pediatric Nursing - Growth & Development)
,2
A nurse is assessing a 4-year-old child during a well-child visit. Which finding requires further
evaluation?
A. The child insists on wearing the same superhero shirt every day
B. The child cannot skip or hop on one foot
C. The child has an imaginary friend who joins us for dinner
D. The child becomes distressed when separated from parents
Question 5 (Adult Medical-Surgical - Endocrine)
A client with Type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The nurse notes a
blood glucose of 485 mg/dL, potassium of 5.8 mEq/L, and pH of 7.28. Which intervention is the
priority?
A. Begin an infusion of regular insulin at 0.1 units/kg/hour after initiating IV fluids
B. Administer potassium chloride immediately to correct hyperkalemia
C. Give sodium bicarbonate IV to correct the acidosis
D. Start 5% dextrose in water (D5W) when blood glucose reaches 200 mg/dL
Question 6 (Maternity - Intrapartum)
A client in active labor at 38 weeks gestation has a prolonged deceleration on the fetal monitor.
The fetal heart rate drops from 145 bpm to 90 bpm and remains there for 3 minutes after the
contraction ends. What is the nurse's priority action?
A. Continue monitoring as this is a normal physiological response
B. Perform a vaginal examination to check for rapid cervical dilation
C. Turn the client to her left side and apply supplemental oxygen
D. Prepare for immediate forceps-assisted delivery
Question 7 (Psychiatric - Therapeutic Communication)
A client with major depressive disorder states, "I'm completely worthless and everyone would be
better off without me." What is the nurse's best response?
A. "You have family who love you; you shouldn't think that way."
B. "Tell me more about why you feel worthless right now."
C. "Let's focus on your positive qualities instead."
D. "Have you been taking your antidepressant medication regularly?"
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Question 8 (Adult Medical-Surgical - Respiratory)
A client with COVID-19 pneumonia is receiving high-flow nasal cannula oxygen at 40 L/min
and 60% FiO2. The arterial blood gas results show: pH 7.32, PaCO2 52 mmHg, PaO2 58 mmHg,
HCO3 26 mEq/L. Which action should the nurse take?
A. Increase the FiO2 to 80% per protocol
B. Prepare the client for mechanical ventilation
C. Encourage the client to perform pursed-lip breathing
D. Administer albuterol nebulizer treatment
Question 9 (Fundamentals - Select All That Apply)
The nurse is preparing a client with a new ileostomy for discharge. Which statements by the
client indicate understanding of ostomy care? (Select all that apply.)
A. "I should use skin barrier paste to prevent leakage around the stoma."
B. "My stoma should appear pink to cherry red and moist."
C. "I can eat popcorn and raw celery as part of a healthy diet."
D. "I will empty the pouch when it is one-third full of gas or stool."
E. "A decrease in stoma size to 2 cm is expected after 6 weeks."
F. "I should report any skin breakdown or persistent leakage immediately."
Question 10 (Adult Medical-Surgical - Renal)
A client with chronic kidney disease (CKD) stage 4 is prescribed sodium polystyrene sulfonate
(Kayexalate) 15 g orally. The nurse should monitor for which adverse effect?
A. Hypoglycemia
B. Fecal impaction
C. Metabolic alkalosis
D. Hypernatremia
Question 11 (Pediatric Nursing - Respiratory)
A 6-month-old infant is admitted with bronchiolitis and moderate respiratory distress. Which
intervention should the nurse implement first?
A. Administer albuterol via nebulizer
B. Perform nasal suctioning with a bulb syringe
, 4
C. Initiate high-flow nasal cannula therapy
D. Obtain a chest x-ray
Question 12 (Management of Care - Delegation)
Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) in
a postoperative unit?
A. Assessing pain level 1 hour after administration of opioids
B. Teaching the client about signs of wound infection
C. Assisting a client to ambulate to the bathroom for the first time after surgery
D. Evaluating the effectiveness of antiemetic medication
Question 13 (Adult Medical-Surgical - Gastrointestinal)
A client with cirrhosis presents with asterixis, confusion, and a blood ammonia level of 142
mcg/dL. Which dietary modification should the nurse implement?
A. Increase protein intake to 1.5 g/kg/day to prevent muscle wasting
B. Restrict protein intake and provide lactulose to promote ammonia excretion
C. Encourage a high-fiber diet to prevent constipation
D. Provide sodium chloride supplements to manage hyponatremia
Question 14 (Psychiatric - Crisis Intervention)
A client is brought to the emergency department after a sexual assault. The client is crying
uncontrollably and repeatedly states, "I can't believe this happened to me." What is the priority
nursing intervention?
A. Encourage the client to take a shower to feel clean
B. Provide a quiet, private space and remain present without demanding conversation
C. Ask detailed questions about the sequence of events for the police report
D. Administer prophylactic antibiotics immediately
Question 15 (Maternity - Antepartum)
A pregnant client at 28 weeks gestation reports a severe headache, visual disturbances, and
epigastric pain. Her blood pressure is 162/104 mmHg. Which finding is most concerning?
A. Proteinuria of 2+ on urine dipstick
B. Patellar deep tendon reflexes graded 3+ with clonus
HESI RN Exit Practice ACTUAL EXAM 2026/2027 |
Comprehensive Integrated Exam with Verified
Questions and Answers | Predicts NCLEX-RN
Readiness | Pass Guaranteed - A+ Graded
Question 1 (Adult Medical-Surgical - Cardiovascular)
A 68-year-old client with a history of heart failure presents to the emergency department with
severe dyspnea, frothy pink sputum, and a blood pressure of 202/118 mmHg. Which action
should the nurse take first?
A. Insert an indwelling urinary catheter to monitor output
B. Apply oxygen via non-rebreather mask and place client in high-Fowler's position
C. Prepare for immediate synchronized cardioversion
D. Administer furosemide 80 mg IV push
Question 2 (Management of Care - Prioritization)
The nurse is caring for four clients on a medical-surgical unit. Which client requires immediate
assessment?
A. A client 24 hours post-operative appendectomy with a temperature of 101.2°F (38.4°C)
B. A client with COPD who reports increased shortness of breath after walking to the bathroom
C. A client with a new onset of confusion and oxygen saturation of 88% on room air
D. A client scheduled for discharge who needs medication instructions
Question 3 (Pharmacology - Cardiovascular)
A client with atrial fibrillation is prescribed rivaroxaban 20 mg daily. Which client statement
indicates a need for further teaching regarding this medication?
A. "I will report any unusual bleeding or bruising immediately."
B. "I should take this medication with my evening meal every day."
C. "I can stop taking this medication once my heart rhythm returns to normal."
D. "I will use a soft toothbrush and electric razor to prevent cuts."
Question 4 (Pediatric Nursing - Growth & Development)
,2
A nurse is assessing a 4-year-old child during a well-child visit. Which finding requires further
evaluation?
A. The child insists on wearing the same superhero shirt every day
B. The child cannot skip or hop on one foot
C. The child has an imaginary friend who joins us for dinner
D. The child becomes distressed when separated from parents
Question 5 (Adult Medical-Surgical - Endocrine)
A client with Type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The nurse notes a
blood glucose of 485 mg/dL, potassium of 5.8 mEq/L, and pH of 7.28. Which intervention is the
priority?
A. Begin an infusion of regular insulin at 0.1 units/kg/hour after initiating IV fluids
B. Administer potassium chloride immediately to correct hyperkalemia
C. Give sodium bicarbonate IV to correct the acidosis
D. Start 5% dextrose in water (D5W) when blood glucose reaches 200 mg/dL
Question 6 (Maternity - Intrapartum)
A client in active labor at 38 weeks gestation has a prolonged deceleration on the fetal monitor.
The fetal heart rate drops from 145 bpm to 90 bpm and remains there for 3 minutes after the
contraction ends. What is the nurse's priority action?
A. Continue monitoring as this is a normal physiological response
B. Perform a vaginal examination to check for rapid cervical dilation
C. Turn the client to her left side and apply supplemental oxygen
D. Prepare for immediate forceps-assisted delivery
Question 7 (Psychiatric - Therapeutic Communication)
A client with major depressive disorder states, "I'm completely worthless and everyone would be
better off without me." What is the nurse's best response?
A. "You have family who love you; you shouldn't think that way."
B. "Tell me more about why you feel worthless right now."
C. "Let's focus on your positive qualities instead."
D. "Have you been taking your antidepressant medication regularly?"
,3
Question 8 (Adult Medical-Surgical - Respiratory)
A client with COVID-19 pneumonia is receiving high-flow nasal cannula oxygen at 40 L/min
and 60% FiO2. The arterial blood gas results show: pH 7.32, PaCO2 52 mmHg, PaO2 58 mmHg,
HCO3 26 mEq/L. Which action should the nurse take?
A. Increase the FiO2 to 80% per protocol
B. Prepare the client for mechanical ventilation
C. Encourage the client to perform pursed-lip breathing
D. Administer albuterol nebulizer treatment
Question 9 (Fundamentals - Select All That Apply)
The nurse is preparing a client with a new ileostomy for discharge. Which statements by the
client indicate understanding of ostomy care? (Select all that apply.)
A. "I should use skin barrier paste to prevent leakage around the stoma."
B. "My stoma should appear pink to cherry red and moist."
C. "I can eat popcorn and raw celery as part of a healthy diet."
D. "I will empty the pouch when it is one-third full of gas or stool."
E. "A decrease in stoma size to 2 cm is expected after 6 weeks."
F. "I should report any skin breakdown or persistent leakage immediately."
Question 10 (Adult Medical-Surgical - Renal)
A client with chronic kidney disease (CKD) stage 4 is prescribed sodium polystyrene sulfonate
(Kayexalate) 15 g orally. The nurse should monitor for which adverse effect?
A. Hypoglycemia
B. Fecal impaction
C. Metabolic alkalosis
D. Hypernatremia
Question 11 (Pediatric Nursing - Respiratory)
A 6-month-old infant is admitted with bronchiolitis and moderate respiratory distress. Which
intervention should the nurse implement first?
A. Administer albuterol via nebulizer
B. Perform nasal suctioning with a bulb syringe
, 4
C. Initiate high-flow nasal cannula therapy
D. Obtain a chest x-ray
Question 12 (Management of Care - Delegation)
Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP) in
a postoperative unit?
A. Assessing pain level 1 hour after administration of opioids
B. Teaching the client about signs of wound infection
C. Assisting a client to ambulate to the bathroom for the first time after surgery
D. Evaluating the effectiveness of antiemetic medication
Question 13 (Adult Medical-Surgical - Gastrointestinal)
A client with cirrhosis presents with asterixis, confusion, and a blood ammonia level of 142
mcg/dL. Which dietary modification should the nurse implement?
A. Increase protein intake to 1.5 g/kg/day to prevent muscle wasting
B. Restrict protein intake and provide lactulose to promote ammonia excretion
C. Encourage a high-fiber diet to prevent constipation
D. Provide sodium chloride supplements to manage hyponatremia
Question 14 (Psychiatric - Crisis Intervention)
A client is brought to the emergency department after a sexual assault. The client is crying
uncontrollably and repeatedly states, "I can't believe this happened to me." What is the priority
nursing intervention?
A. Encourage the client to take a shower to feel clean
B. Provide a quiet, private space and remain present without demanding conversation
C. Ask detailed questions about the sequence of events for the police report
D. Administer prophylactic antibiotics immediately
Question 15 (Maternity - Antepartum)
A pregnant client at 28 weeks gestation reports a severe headache, visual disturbances, and
epigastric pain. Her blood pressure is 162/104 mmHg. Which finding is most concerning?
A. Proteinuria of 2+ on urine dipstick
B. Patellar deep tendon reflexes graded 3+ with clonus
