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HESI RN COMPASS EXIT EXAM V2 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 the
nurse assess first?
A) Client with pneumonia, oxygen saturation 94% on 2 L/min via nasal
cannula
B) Client with a new tracheostomy who has thick, blood-tinged
secretions and a respiratory rate of 32
C) Client with heart failure, 1+ pitting edema, and weight gain of 0.5 kg
in 24 hours
D) Client post-appendectomy day 2 with temperature 100.1°F (37.8°C)
*Rationale: The client with a new tracheostomy and tachypnea (RR 32)
has an unstable airway and possible mucus plugging or bleeding. This is
an immediate priority over stable oxygen saturation, mild edema, or
low-grade fever.*
2. An RN is delegating tasks to an LPN and a UAP on a medical-
surgical unit. Which task is most appropriate for the LPN?
A) Assist a client with a bath and oral care
B) Irrigate a nasogastric tube for a client with a gastrointestinal
bleed
C) Ambulate a client with a fractured hip who uses a walker
D) Feed a client with dysphagia and a pureed diet
Rationale: LPNs may perform stable, predictable tasks including
nasogastric tube irrigation when within their scope and facility policy.
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Bathing, ambulation, and feeding are appropriate for UAPs under
supervision.
3. A client with a chest tube for a hemothorax has 250 mL of bright red
drainage in the last hour. The nurse’s priority action is to:
A) Clamp the chest tube
B) Notify the provider immediately
C) Increase the suction pressure
D) Continue monitoring as this is expected
*Rationale: >200 mL/hour of bright red drainage suggests active
hemorrhage. The provider must be notified promptly. Clamping a chest
tube is dangerous and not indicated.*
4. The nurse is administering IV hydromorphone to a client
postoperatively. The client’s respiratory rate drops to 8 breaths/min and
they are difficult to arouse. Which medication should the nurse prepare
to administer?
A) Flumazenil
B) Naloxone
C) Naltrexone
D) Protamine sulfate
Rationale: Hydromorphone is an opioid; respiratory depression
requires reversal with naloxone. Flumazenil reverses benzodiazepines;
protamine reverses heparin.
5. The nurse is teaching a client with chronic kidney disease (CKD)
stage 3 about dietary phosphorus restriction. Which food should the
client avoid?
A) Apples
B) Dairy products and nuts
C) White bread
D) Cranberry juice
Rationale: Dairy products, nuts, beans, and colas are high in
phosphorus. Apples, white bread, and cranberry juice are low-
phosphorus options.
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6. A client with type 1 diabetes is found unconscious. The nurse
administers glucagon IM. Which finding indicates the glucagon is
effective?
A) Heart rate decreases from 110 to 90 bpm
B) Blood glucose increases from 40 mg/dL to 80 mg/dL within 15
minutes
C) The client develops nausea and vomiting
D) Pupils become equal and reactive
Rationale: Glucagon stimulates hepatic glucose release; effectiveness is
measured by rising blood glucose. Nausea is a side effect but not the
desired outcome.
7. A client with a history of alcohol use disorder is admitted with acute
pancreatitis. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated serum lipase and amylase
B) Elevated serum lipase and amylase
C) Elevated alkaline phosphatase
D) Decreased serum calcium
Rationale: Elevated lipase and amylase are the hallmark laboratory
findings in acute pancreatitis. Elevated alk phos suggests biliary
obstruction; hypocalcemia may occur but is not diagnostic.
8. The nurse is caring for a client with a new colostomy. The stoma is
deep purple and dry. Which action should the nurse take?
A) Apply a warm compress
B) Notify the surgeon immediately
C) Document the finding as normal
D) Increase oral fluids
Rationale: Dark purple/black stoma indicates ischemia or necrosis – a
surgical emergency. Pink/moist is normal. Warm compresses will not
help.
9. The nurse is providing discharge teaching to a client with heart
failure. Which statement indicates a need for further teaching?
A) “I will weigh myself every morning before breakfast.”
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B) “I can stop taking my furosemide if I feel short of breath.”
C) “I will limit my sodium intake to less than 2,000 mg per day.”
D) “I will call my provider if I gain 3 pounds in one week.”
Rationale: Furosemide is a maintenance medication; stopping it for
shortness of breath (a sign of worsening failure) is dangerous and
indicates misunderstanding. Daily weights and sodium restriction are
correct.
10. The nurse is assessing a client with a suspected pulmonary
embolism. Which finding is most common?
A) Bradycardia and hypertension
B) Sudden onset of dyspnea and pleuritic chest pain
C) Productive cough with green sputum
D) Fever and chills
Rationale: Sudden dyspnea and pleuritic chest pain are classic for PE.
Tachycardia and hypotension may occur but are not the most common;
bradycardia is not typical.
11. A client with bipolar disorder is prescribed lithium. The nurse should
teach the client to report which early sign of toxicity?
A) Polyuria and polydipsia
B) Fine hand tremor and nausea
C) Weight gain and acne
D) Sedation and dry mouth
*Rationale: Early lithium toxicity (1.5–2.0 mEq/L) presents with fine
tremor, nausea, diarrhea, and lethargy. Polyuria/polydipsia are common
side effects at therapeutic levels but not toxicity. Weight gain/acne are
long-term side effects.*
12. The nurse is caring for a client 2 hours after a transurethral resection
of the prostate (TURP). The client has continuous bladder irrigation
(CBI) and reports bladder spasms. Which intervention should the nurse
implement first?
A) Increase the irrigation flow rate
B) Assess for clots and ensure the catheter is patent
C) Administer prescribed antispasmodic
HESI RN COMPASS EXIT EXAM V2 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 the
nurse assess first?
A) Client with pneumonia, oxygen saturation 94% on 2 L/min via nasal
cannula
B) Client with a new tracheostomy who has thick, blood-tinged
secretions and a respiratory rate of 32
C) Client with heart failure, 1+ pitting edema, and weight gain of 0.5 kg
in 24 hours
D) Client post-appendectomy day 2 with temperature 100.1°F (37.8°C)
*Rationale: The client with a new tracheostomy and tachypnea (RR 32)
has an unstable airway and possible mucus plugging or bleeding. This is
an immediate priority over stable oxygen saturation, mild edema, or
low-grade fever.*
2. An RN is delegating tasks to an LPN and a UAP on a medical-
surgical unit. Which task is most appropriate for the LPN?
A) Assist a client with a bath and oral care
B) Irrigate a nasogastric tube for a client with a gastrointestinal
bleed
C) Ambulate a client with a fractured hip who uses a walker
D) Feed a client with dysphagia and a pureed diet
Rationale: LPNs may perform stable, predictable tasks including
nasogastric tube irrigation when within their scope and facility policy.
,2|Page
Bathing, ambulation, and feeding are appropriate for UAPs under
supervision.
3. A client with a chest tube for a hemothorax has 250 mL of bright red
drainage in the last hour. The nurse’s priority action is to:
A) Clamp the chest tube
B) Notify the provider immediately
C) Increase the suction pressure
D) Continue monitoring as this is expected
*Rationale: >200 mL/hour of bright red drainage suggests active
hemorrhage. The provider must be notified promptly. Clamping a chest
tube is dangerous and not indicated.*
4. The nurse is administering IV hydromorphone to a client
postoperatively. The client’s respiratory rate drops to 8 breaths/min and
they are difficult to arouse. Which medication should the nurse prepare
to administer?
A) Flumazenil
B) Naloxone
C) Naltrexone
D) Protamine sulfate
Rationale: Hydromorphone is an opioid; respiratory depression
requires reversal with naloxone. Flumazenil reverses benzodiazepines;
protamine reverses heparin.
5. The nurse is teaching a client with chronic kidney disease (CKD)
stage 3 about dietary phosphorus restriction. Which food should the
client avoid?
A) Apples
B) Dairy products and nuts
C) White bread
D) Cranberry juice
Rationale: Dairy products, nuts, beans, and colas are high in
phosphorus. Apples, white bread, and cranberry juice are low-
phosphorus options.
,3|Page
6. A client with type 1 diabetes is found unconscious. The nurse
administers glucagon IM. Which finding indicates the glucagon is
effective?
A) Heart rate decreases from 110 to 90 bpm
B) Blood glucose increases from 40 mg/dL to 80 mg/dL within 15
minutes
C) The client develops nausea and vomiting
D) Pupils become equal and reactive
Rationale: Glucagon stimulates hepatic glucose release; effectiveness is
measured by rising blood glucose. Nausea is a side effect but not the
desired outcome.
7. A client with a history of alcohol use disorder is admitted with acute
pancreatitis. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated serum lipase and amylase
B) Elevated serum lipase and amylase
C) Elevated alkaline phosphatase
D) Decreased serum calcium
Rationale: Elevated lipase and amylase are the hallmark laboratory
findings in acute pancreatitis. Elevated alk phos suggests biliary
obstruction; hypocalcemia may occur but is not diagnostic.
8. The nurse is caring for a client with a new colostomy. The stoma is
deep purple and dry. Which action should the nurse take?
A) Apply a warm compress
B) Notify the surgeon immediately
C) Document the finding as normal
D) Increase oral fluids
Rationale: Dark purple/black stoma indicates ischemia or necrosis – a
surgical emergency. Pink/moist is normal. Warm compresses will not
help.
9. The nurse is providing discharge teaching to a client with heart
failure. Which statement indicates a need for further teaching?
A) “I will weigh myself every morning before breakfast.”
, 4|Page
B) “I can stop taking my furosemide if I feel short of breath.”
C) “I will limit my sodium intake to less than 2,000 mg per day.”
D) “I will call my provider if I gain 3 pounds in one week.”
Rationale: Furosemide is a maintenance medication; stopping it for
shortness of breath (a sign of worsening failure) is dangerous and
indicates misunderstanding. Daily weights and sodium restriction are
correct.
10. The nurse is assessing a client with a suspected pulmonary
embolism. Which finding is most common?
A) Bradycardia and hypertension
B) Sudden onset of dyspnea and pleuritic chest pain
C) Productive cough with green sputum
D) Fever and chills
Rationale: Sudden dyspnea and pleuritic chest pain are classic for PE.
Tachycardia and hypotension may occur but are not the most common;
bradycardia is not typical.
11. A client with bipolar disorder is prescribed lithium. The nurse should
teach the client to report which early sign of toxicity?
A) Polyuria and polydipsia
B) Fine hand tremor and nausea
C) Weight gain and acne
D) Sedation and dry mouth
*Rationale: Early lithium toxicity (1.5–2.0 mEq/L) presents with fine
tremor, nausea, diarrhea, and lethargy. Polyuria/polydipsia are common
side effects at therapeutic levels but not toxicity. Weight gain/acne are
long-term side effects.*
12. The nurse is caring for a client 2 hours after a transurethral resection
of the prostate (TURP). The client has continuous bladder irrigation
(CBI) and reports bladder spasms. Which intervention should the nurse
implement first?
A) Increase the irrigation flow rate
B) Assess for clots and ensure the catheter is patent
C) Administer prescribed antispasmodic
