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HESI EXIT EXAM STUDY GUIDE Actual Exam
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Latest Updated Version
Brand New Pass Guaranteed - A+ Graded
MEDICAL-SURGICAL NURSING (35% - Questions 1-56)
Q1: A 68-year-old male post-CABG day 2 has chest tube drainage of 150 mL/hr for 2
consecutive hours. Which action by the nurse is the priority?
• A. Document the findings and continue monitoring
• B. Notify the surgeon immediately [CORRECT]
• C. Milk the chest tube to ensure patency
• D. Clamp the chest tube to prevent excessive drainage
Correct Answer: B
Rationale: Chest tube drainage >100-150 mL/hr for 2 consecutive hours indicates postoperative
hemorrhage requiring immediate surgical evaluation; this exceeds acceptable drainage and may
indicate mediastinal bleeding requiring emergency re-exploration.
Q2: A patient with diabetic ketoacidosis has the following arterial blood gas: pH 7.25, PaCO2
30, HCO3 14, PaO2 88. Which interpretation is correct?
• A. Metabolic alkalosis with respiratory compensation
• B. Metabolic acidosis with respiratory compensation [CORRECT]
• C. Respiratory acidosis with metabolic compensation
• D. Mixed respiratory and metabolic alkalosis
Correct Answer: B
Rationale: DKA presents with metabolic acidosis (low pH, low bicarbonate) and respiratory
compensation (low PaCO2 from Kussmaul respirations); the low pH with primary decrease in
bicarbonate confirms metabolic acidosis with appropriate hyperventilation compensatory
response.
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Q3: A 55-year-old female with acute pancreatitis develops tachycardia, hypotension, and
abdominal distension. Which finding indicates the most severe complication?
• A. Serum amylase 500 U/L
• B. Grey Turner's sign (flank ecchymosis) [CORRECT]
• C. Mild epigastric tenderness
• D. Blood glucose 180 mg/dL
Correct Answer: B
Rationale: Grey Turner's sign indicates retroperitoneal hemorrhage in severe necrotizing
pancreatitis, associated with high mortality; this physical finding represents blood tracking from
the retroperitoneum to subcutaneous tissues and signals critical illness requiring intensive care.
Q4: A patient receiving heparin has the following results: aPTT 90 seconds (control 30), platelet
count 80,000 (was 250,000). Which condition is present?
• A. Therapeutic anticoagulation
• B. Heparin-induced thrombocytopenia [CORRECT]
• C. Expected response to therapy
• D. Disseminated intravascular coagulation
Correct Answer: B
Rationale: Heparin-induced thrombocytopenia is characterized by platelet count decrease >50%
from baseline or absolute count <150,000 occurring 5-10 days after heparin exposure, with
thrombosis risk; immediate discontinuation of all heparin and alternative anticoagulation is
required.
Q5: Calculate the IV flow rate: 1000 mL D5W to infuse over 8 hours with tubing drip factor 15
gtt/mL.
• A. 21 gtt/min
• B. 31 gtt/min [CORRECT]
• C. 42 gtt/min
• D. 63 gtt/min
Correct Answer: B
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Rationale: Flow rate calculation: 1000 mL ÷ 8 hours = 125 mL/hr; 125 mL/hr × 15 gtt/mL ÷ 60
min/hr = 31.25 gtt/min rounded to 31 gtt/min.
Q6: A patient with heart failure has daily weights showing 3 kg gain in 2 days, JVD 6 cm, and
crackles bilaterally. Which medication adjustment is expected?
• A. Increase diuretic dose [CORRECT]
• B. Discontinue ACE inhibitor
• C. Reduce beta-blocker dose
• D. Hold all cardiac medications
Correct Answer: A
Rationale: 3 kg weight gain in 2 days with signs of volume overload (JVD, crackles) indicates
acute decompensated heart failure requiring increased diuresis to remove excess fluid and reduce
preload; this is standard management for fluid overload exacerbation.
Q7: A postoperative patient has a wound evisceration. Which immediate action by the nurse is
correct?
• A. Cover the wound with sterile saline-moistened dressing and keep patient NPO
[CORRECT]
• B. Push the protruding organs back into the abdomen
• C. Remove the sutures to relieve tension
• D. Apply dry sterile dressing and prepare for discharge
Correct Answer: A
Rationale: Wound evisceration requires immediate coverage with sterile saline-moistened
dressing to prevent tissue desiccation, NPO status for imminent surgical repair, and urgent
surgical notification; never attempt to reinsert organs or remove sutures.
Q8: A patient with COPD has ABG: pH 7.32, PaCO2 58, PaO2 65, HCO3 30 on room air.
Which oxygen delivery device is most appropriate?
• A. Non-rebreather mask at 15 L/min
• B. Nasal cannula 2-3 L/min [CORRECT]
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• C. Simple mask at 10 L/min
• D. High-flow nasal cannula at 40 L/min
Correct Answer: B
Rationale: COPD patients with chronic hypercapnia (elevated PaCO2) require low-flow oxygen
(1-3 L/min) to maintain PaO2 60-65 mmHg (SpO2 88-92%); higher oxygen concentrations
suppress hypoxic respiratory drive causing CO2 retention and respiratory acidosis worsening.
Q9: A patient is receiving dopamine 5 mcg/kg/min. Which assessment finding indicates
therapeutic effect?
• A. Heart rate decrease from 110 to 85 bpm
• B. Urine output increase from 20 to 50 mL/hr [CORRECT]
• C. Blood pressure decrease from 140/90 to 110/70
• D. Respiratory rate decrease from 28 to 16
Correct Answer: B
Rationale: Dopamine at 2-5 mcg/kg/min stimulates dopaminergic receptors causing renal and
mesenteric vasodilation, increasing renal perfusion and urine output; this "renal dose" effect is
used to improve perfusion to vital organs in shock states.
Q10: A patient with acute kidney injury has potassium 6.8 mEq/L with peaked T waves on ECG.
Which medication is administered first?
• A. Insulin and glucose
• B. IV calcium gluconate [CORRECT]
• C. Sodium polystyrene sulfonate
• D. Hemodialysis
Correct Answer: B
Rationale: IV calcium gluconate is administered first in severe hyperkalemia with ECG changes
to stabilize cardiac membranes and prevent life-threatening arrhythmias; it works within minutes
while other interventions (insulin/glucose, kayexalate, dialysis) take longer to lower potassium.
HESI EXIT EXAM STUDY GUIDE Actual Exam
2026/2027 Complete Questions and Verified Answers
with Detailed Rationales Latest Updated Version
Brand New Pass Guaranteed - A+ Graded
MEDICAL-SURGICAL NURSING (35% - Questions 1-56)
Q1: A 68-year-old male post-CABG day 2 has chest tube drainage of 150 mL/hr for 2
consecutive hours. Which action by the nurse is the priority?
• A. Document the findings and continue monitoring
• B. Notify the surgeon immediately [CORRECT]
• C. Milk the chest tube to ensure patency
• D. Clamp the chest tube to prevent excessive drainage
Correct Answer: B
Rationale: Chest tube drainage >100-150 mL/hr for 2 consecutive hours indicates postoperative
hemorrhage requiring immediate surgical evaluation; this exceeds acceptable drainage and may
indicate mediastinal bleeding requiring emergency re-exploration.
Q2: A patient with diabetic ketoacidosis has the following arterial blood gas: pH 7.25, PaCO2
30, HCO3 14, PaO2 88. Which interpretation is correct?
• A. Metabolic alkalosis with respiratory compensation
• B. Metabolic acidosis with respiratory compensation [CORRECT]
• C. Respiratory acidosis with metabolic compensation
• D. Mixed respiratory and metabolic alkalosis
Correct Answer: B
Rationale: DKA presents with metabolic acidosis (low pH, low bicarbonate) and respiratory
compensation (low PaCO2 from Kussmaul respirations); the low pH with primary decrease in
bicarbonate confirms metabolic acidosis with appropriate hyperventilation compensatory
response.
,2
Q3: A 55-year-old female with acute pancreatitis develops tachycardia, hypotension, and
abdominal distension. Which finding indicates the most severe complication?
• A. Serum amylase 500 U/L
• B. Grey Turner's sign (flank ecchymosis) [CORRECT]
• C. Mild epigastric tenderness
• D. Blood glucose 180 mg/dL
Correct Answer: B
Rationale: Grey Turner's sign indicates retroperitoneal hemorrhage in severe necrotizing
pancreatitis, associated with high mortality; this physical finding represents blood tracking from
the retroperitoneum to subcutaneous tissues and signals critical illness requiring intensive care.
Q4: A patient receiving heparin has the following results: aPTT 90 seconds (control 30), platelet
count 80,000 (was 250,000). Which condition is present?
• A. Therapeutic anticoagulation
• B. Heparin-induced thrombocytopenia [CORRECT]
• C. Expected response to therapy
• D. Disseminated intravascular coagulation
Correct Answer: B
Rationale: Heparin-induced thrombocytopenia is characterized by platelet count decrease >50%
from baseline or absolute count <150,000 occurring 5-10 days after heparin exposure, with
thrombosis risk; immediate discontinuation of all heparin and alternative anticoagulation is
required.
Q5: Calculate the IV flow rate: 1000 mL D5W to infuse over 8 hours with tubing drip factor 15
gtt/mL.
• A. 21 gtt/min
• B. 31 gtt/min [CORRECT]
• C. 42 gtt/min
• D. 63 gtt/min
Correct Answer: B
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Rationale: Flow rate calculation: 1000 mL ÷ 8 hours = 125 mL/hr; 125 mL/hr × 15 gtt/mL ÷ 60
min/hr = 31.25 gtt/min rounded to 31 gtt/min.
Q6: A patient with heart failure has daily weights showing 3 kg gain in 2 days, JVD 6 cm, and
crackles bilaterally. Which medication adjustment is expected?
• A. Increase diuretic dose [CORRECT]
• B. Discontinue ACE inhibitor
• C. Reduce beta-blocker dose
• D. Hold all cardiac medications
Correct Answer: A
Rationale: 3 kg weight gain in 2 days with signs of volume overload (JVD, crackles) indicates
acute decompensated heart failure requiring increased diuresis to remove excess fluid and reduce
preload; this is standard management for fluid overload exacerbation.
Q7: A postoperative patient has a wound evisceration. Which immediate action by the nurse is
correct?
• A. Cover the wound with sterile saline-moistened dressing and keep patient NPO
[CORRECT]
• B. Push the protruding organs back into the abdomen
• C. Remove the sutures to relieve tension
• D. Apply dry sterile dressing and prepare for discharge
Correct Answer: A
Rationale: Wound evisceration requires immediate coverage with sterile saline-moistened
dressing to prevent tissue desiccation, NPO status for imminent surgical repair, and urgent
surgical notification; never attempt to reinsert organs or remove sutures.
Q8: A patient with COPD has ABG: pH 7.32, PaCO2 58, PaO2 65, HCO3 30 on room air.
Which oxygen delivery device is most appropriate?
• A. Non-rebreather mask at 15 L/min
• B. Nasal cannula 2-3 L/min [CORRECT]
, 4
• C. Simple mask at 10 L/min
• D. High-flow nasal cannula at 40 L/min
Correct Answer: B
Rationale: COPD patients with chronic hypercapnia (elevated PaCO2) require low-flow oxygen
(1-3 L/min) to maintain PaO2 60-65 mmHg (SpO2 88-92%); higher oxygen concentrations
suppress hypoxic respiratory drive causing CO2 retention and respiratory acidosis worsening.
Q9: A patient is receiving dopamine 5 mcg/kg/min. Which assessment finding indicates
therapeutic effect?
• A. Heart rate decrease from 110 to 85 bpm
• B. Urine output increase from 20 to 50 mL/hr [CORRECT]
• C. Blood pressure decrease from 140/90 to 110/70
• D. Respiratory rate decrease from 28 to 16
Correct Answer: B
Rationale: Dopamine at 2-5 mcg/kg/min stimulates dopaminergic receptors causing renal and
mesenteric vasodilation, increasing renal perfusion and urine output; this "renal dose" effect is
used to improve perfusion to vital organs in shock states.
Q10: A patient with acute kidney injury has potassium 6.8 mEq/L with peaked T waves on ECG.
Which medication is administered first?
• A. Insulin and glucose
• B. IV calcium gluconate [CORRECT]
• C. Sodium polystyrene sulfonate
• D. Hemodialysis
Correct Answer: B
Rationale: IV calcium gluconate is administered first in severe hyperkalemia with ECG changes
to stabilize cardiac membranes and prevent life-threatening arrhythmias; it works within minutes
while other interventions (insulin/glucose, kayexalate, dialysis) take longer to lower potassium.
