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HESI RN COMPASS EXIT EXAM V1 ACTUAL
EXAM PREP 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. The nurse receives shift report on four clients. Which client should be
assessed FIRST?
A) Client with pneumonia, oxygen saturation 89% on room air,
respirations 24
B) Client with heart failure, 2+ pitting edema, weight gain of 1 kg in 24
hours
C) Client with diabetes, blood glucose 210 mg/dL, requesting lunch
D) Client post-appendectomy day 2, reports pain 4/10
Correct Answer: A
Rationale: Oxygen saturation of 89% indicates hypoxemia, a problem
with Breathing (ABCs). This is an immediate priority over stable edema,
hyperglycemia, or controlled pain.
2. An RN on a medical-surgical unit is delegating tasks to an LPN and a
UAP. Which assignment is most appropriate for the LPN?
A) Bathe a client with a stroke who is continent
B) Administer a scheduled subcutaneous insulin injection to a stable
client with diabetes
C) Ambulate a client post–total knee replacement day 2
D) Feed a client with dementia who needs encouragement
Rationale: LPNs can administer subcutaneous medications to stable
clients. Bathing, ambulating, and feeding are appropriate for UAPs
under RN supervision.
3. A client with a chest tube accidentally pulls the tubing from the
insertion site. The nurse’s FIRST action is to:
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A) Clamp the chest tube near the client’s bed
B) Apply an occlusive dressing taped on three sides
C) Reinsert the chest tube using sterile technique
D) Notify the provider immediately
Rationale: An open pneumothorax is imminent. An occlusive dressing
taped on three sides allows air to escape but prevents tension
pneumothorax. Clamping is contraindicated and reinsertion is not
within nursing scope.
4. A postpartum client with a history of deep vein thrombosis suddenly
reports shortness of breath and chest pain. The nurse’s priority action is
to:
A) Administer oxygen via nasal cannula
B) Place the client in a high-Fowler’s position and call a rapid
response
C) Check the client’s vital signs
D) Give aspirin 324 mg orally
Rationale: Suspected pulmonary embolism is a medical emergency.
High-Fowler’s and calling for help come before any other intervention.
Oxygen and vitals are important but not the first step in a
decompensating client.
5. The nurse is teaching a client with newly diagnosed hypertension
about lifestyle modifications. Which statement by the client indicates a
need for further teaching?
A) “I will limit my sodium intake to less than 2,300 mg per day.”
B) “I should aim for at least 150 minutes of moderate exercise weekly.”
C) “I can stop my medication once my blood pressure is normal for
a week.”
D) “I will limit alcohol to no more than one drink per day for women.”
Rationale: Antihypertensive medications are typically lifelong; stopping
them can cause rebound hypertension. The other statements are
accurate.
6. The nurse is caring for a client receiving warfarin for atrial
fibrillation. Which laboratory value requires immediate notification of
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the provider?
A) INR 2.5
B) Platelets 180,000/mm³
C) Hemoglobin 12 g/dL
D) INR 4.8
Rationale: Therapeutic INR for atrial fibrillation is 2.0–3.0. INR 4.8
significantly increases bleeding risk; the provider may need to hold the
dose or order vitamin K.
7. A client with major depressive disorder is started on phenelzine, a
monoamine oxidase inhibitor (MAOI). Which statement by the client
indicates understanding of dietary restrictions?
A) “I can still drink my morning coffee as long as it’s decaf.”
B) “I need to avoid aged cheeses, smoked meats, and red wine.”
C) “I must never eat chocolate again.”
D) “I can eat pizza as long as I take the medication after the meal.”
Rationale: MAOIs require avoidance of tyramine-rich foods (aged
cheeses, cured meats, fermented products) to prevent hypertensive crisis.
Coffee and chocolate are allowed in moderation; pizza with aged cheese
is problematic.
8. The nurse assesses a client 6 hours after a total hip arthroplasty. The
client’s oxygen saturation is 88% on room air, and they report sudden
onset of dyspnea. The nurse suspects:
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Anesthesia reaction
Rationale: Postoperative, especially orthopedic surgery, plus sudden
dyspnea and hypoxia is highly suspicious for venous thromboembolism.
Atelectasis is more gradual.
9. A primigravida at 38 weeks gestation presents with a blood pressure
of 160/100 mm Hg, 3+ proteinuria, and a headache. The nurse should
prepare for which intervention first?
A) Administer oral labetalol
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B) Initiate intravenous magnesium sulfate
C) Encourage oral hydration
D) Apply fetal heart rate monitor
Rationale: Severe preeclampsia (severe hypertension + proteinuria +
headache) requires seizure prophylaxis with IV magnesium sulfate.
Fetal monitoring is important but not first after identifying severe
features.
10. The charge nurse is making assignments for a surgical unit. Which
client should be assigned to the most experienced RN?
A) Client with a urinary tract infection requiring oral antibiotics
B) Client 2 hours post-thyroidectomy with stridor
C) Client scheduled for discharge teaching on wound care
D) Client with a fractured hip awaiting surgery
Rationale: Stridor after thyroidectomy indicates airway compromise
from laryngeal edema or hematoma – a life-threatening emergency
needing expert assessment and intervention.
11. The nurse administers digoxin to a client with heart failure. Which
finding requires withholding the medication and notifying the provider?
A) Heart rate 68 beats/min
B) Serum potassium 4.0 mEq/L
C) Apical pulse 52 beats/min with nausea and yellow vision
D) Blood pressure 130/80 mm Hg
*Rationale: Digoxin toxicity presents with bradycardia, nausea, and
visual disturbances (yellow/green halos). A pulse <60 in adults typically
warrants holding digoxin.*
12. A client with end-stage renal disease (ESRD) on hemodialysis
reports muscle cramps and tingling around the mouth. The nurse notes a
positive Chvostek’s sign. Which electrolyte imbalance is most likely?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypermagnesemia
Rationale: Hypocalcemia causes neuromuscular irritability – muscle
HESI RN COMPASS EXIT EXAM V1 ACTUAL
EXAM PREP 2026 ALL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. The nurse receives shift report on four clients. Which client should be
assessed FIRST?
A) Client with pneumonia, oxygen saturation 89% on room air,
respirations 24
B) Client with heart failure, 2+ pitting edema, weight gain of 1 kg in 24
hours
C) Client with diabetes, blood glucose 210 mg/dL, requesting lunch
D) Client post-appendectomy day 2, reports pain 4/10
Correct Answer: A
Rationale: Oxygen saturation of 89% indicates hypoxemia, a problem
with Breathing (ABCs). This is an immediate priority over stable edema,
hyperglycemia, or controlled pain.
2. An RN on a medical-surgical unit is delegating tasks to an LPN and a
UAP. Which assignment is most appropriate for the LPN?
A) Bathe a client with a stroke who is continent
B) Administer a scheduled subcutaneous insulin injection to a stable
client with diabetes
C) Ambulate a client post–total knee replacement day 2
D) Feed a client with dementia who needs encouragement
Rationale: LPNs can administer subcutaneous medications to stable
clients. Bathing, ambulating, and feeding are appropriate for UAPs
under RN supervision.
3. A client with a chest tube accidentally pulls the tubing from the
insertion site. The nurse’s FIRST action is to:
,2|Page
A) Clamp the chest tube near the client’s bed
B) Apply an occlusive dressing taped on three sides
C) Reinsert the chest tube using sterile technique
D) Notify the provider immediately
Rationale: An open pneumothorax is imminent. An occlusive dressing
taped on three sides allows air to escape but prevents tension
pneumothorax. Clamping is contraindicated and reinsertion is not
within nursing scope.
4. A postpartum client with a history of deep vein thrombosis suddenly
reports shortness of breath and chest pain. The nurse’s priority action is
to:
A) Administer oxygen via nasal cannula
B) Place the client in a high-Fowler’s position and call a rapid
response
C) Check the client’s vital signs
D) Give aspirin 324 mg orally
Rationale: Suspected pulmonary embolism is a medical emergency.
High-Fowler’s and calling for help come before any other intervention.
Oxygen and vitals are important but not the first step in a
decompensating client.
5. The nurse is teaching a client with newly diagnosed hypertension
about lifestyle modifications. Which statement by the client indicates a
need for further teaching?
A) “I will limit my sodium intake to less than 2,300 mg per day.”
B) “I should aim for at least 150 minutes of moderate exercise weekly.”
C) “I can stop my medication once my blood pressure is normal for
a week.”
D) “I will limit alcohol to no more than one drink per day for women.”
Rationale: Antihypertensive medications are typically lifelong; stopping
them can cause rebound hypertension. The other statements are
accurate.
6. The nurse is caring for a client receiving warfarin for atrial
fibrillation. Which laboratory value requires immediate notification of
,3|Page
the provider?
A) INR 2.5
B) Platelets 180,000/mm³
C) Hemoglobin 12 g/dL
D) INR 4.8
Rationale: Therapeutic INR for atrial fibrillation is 2.0–3.0. INR 4.8
significantly increases bleeding risk; the provider may need to hold the
dose or order vitamin K.
7. A client with major depressive disorder is started on phenelzine, a
monoamine oxidase inhibitor (MAOI). Which statement by the client
indicates understanding of dietary restrictions?
A) “I can still drink my morning coffee as long as it’s decaf.”
B) “I need to avoid aged cheeses, smoked meats, and red wine.”
C) “I must never eat chocolate again.”
D) “I can eat pizza as long as I take the medication after the meal.”
Rationale: MAOIs require avoidance of tyramine-rich foods (aged
cheeses, cured meats, fermented products) to prevent hypertensive crisis.
Coffee and chocolate are allowed in moderation; pizza with aged cheese
is problematic.
8. The nurse assesses a client 6 hours after a total hip arthroplasty. The
client’s oxygen saturation is 88% on room air, and they report sudden
onset of dyspnea. The nurse suspects:
A) Atelectasis
B) Pulmonary embolism
C) Pneumonia
D) Anesthesia reaction
Rationale: Postoperative, especially orthopedic surgery, plus sudden
dyspnea and hypoxia is highly suspicious for venous thromboembolism.
Atelectasis is more gradual.
9. A primigravida at 38 weeks gestation presents with a blood pressure
of 160/100 mm Hg, 3+ proteinuria, and a headache. The nurse should
prepare for which intervention first?
A) Administer oral labetalol
, 4|Page
B) Initiate intravenous magnesium sulfate
C) Encourage oral hydration
D) Apply fetal heart rate monitor
Rationale: Severe preeclampsia (severe hypertension + proteinuria +
headache) requires seizure prophylaxis with IV magnesium sulfate.
Fetal monitoring is important but not first after identifying severe
features.
10. The charge nurse is making assignments for a surgical unit. Which
client should be assigned to the most experienced RN?
A) Client with a urinary tract infection requiring oral antibiotics
B) Client 2 hours post-thyroidectomy with stridor
C) Client scheduled for discharge teaching on wound care
D) Client with a fractured hip awaiting surgery
Rationale: Stridor after thyroidectomy indicates airway compromise
from laryngeal edema or hematoma – a life-threatening emergency
needing expert assessment and intervention.
11. The nurse administers digoxin to a client with heart failure. Which
finding requires withholding the medication and notifying the provider?
A) Heart rate 68 beats/min
B) Serum potassium 4.0 mEq/L
C) Apical pulse 52 beats/min with nausea and yellow vision
D) Blood pressure 130/80 mm Hg
*Rationale: Digoxin toxicity presents with bradycardia, nausea, and
visual disturbances (yellow/green halos). A pulse <60 in adults typically
warrants holding digoxin.*
12. A client with end-stage renal disease (ESRD) on hemodialysis
reports muscle cramps and tingling around the mouth. The nurse notes a
positive Chvostek’s sign. Which electrolyte imbalance is most likely?
A) Hyperkalemia
B) Hyponatremia
C) Hypocalcemia
D) Hypermagnesemia
Rationale: Hypocalcemia causes neuromuscular irritability – muscle
