HESI RN CAT Practice 2026: Computer Adaptive
Exam Prep & Review | Pass on First Try
1. A patient with a history of chronic heart failure presents with acute dyspnea, oxygen saturation
of 88% on room air, and jugular venous distention. The nurse notes a new S3 heart sound and
bibasilar crackles. Which intervention should the nurse prioritize?
A. Administer a dose of intravenous furosemide
B. Place the patient in a high Fowler's position
C. Prepare for immediate endotracheal intubation
D. Obtain a stat electrocardiogram
Answer: A
Rationale: The patient is in acute decompensated heart failure with pulmonary edema. Intravenous
furosemide reduces preload and pulmonary congestion, addressing the primary pathophysiology. While
positioning helps, it does not directly reduce fluid overload. Intubation is not yet indicated, and ECG is
not the priority.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for a deep vein
thrombosis. The aPTT result is 110 seconds (therapeutic range 60-80 seconds). What should the
nurse do first?
A. Stop the heparin infusion
B. Decrease the infusion rate by 50%
C. Administer protamine sulfate
D. Continue the infusion and recheck aPTT in 6 hours
Answer: A
Rationale: An aPTT of 110 seconds indicates supratherapeutic anticoagulation, placing the patient at
risk for bleeding. The immediate action is to stop the heparin infusion to prevent further anticoagulation.
Decreasing the rate may not be sufficient, and protamine is reserved for severe bleeding. Continuing the
infusion is unsafe.
3. During a home visit, a nurse assesses a postpartum patient who reports heavy lochia with clots
and a boggy uterus on palpation. The patient's heart rate is 110 bpm and blood pressure is 90/60
mmHg. Which action should the nurse take first?
A. Massage the uterine fundus
B. Administer oxytocin as prescribed
C. Encourage the patient to empty her bladder
D. Place the patient in Trendelenburg position
Answer: A
Rationale: A boggy uterus suggests uterine atony, the most common cause of postpartum hemorrhage.
Fundal massage stimulates uterine contraction to reduce bleeding. Oxytocin may be given after massage
if bleeding persists, but massage is the immediate intervention. Bladder distention can contribute to
Page 1
,atony but is not the first step. Trendelenburg position is not recommended for hemorrhage.
4. A child with a history of asthma presents to the emergency department with an acute
exacerbation. The child is sitting upright, using accessory muscles, and has a peak expiratory flow
rate of 40% of personal best. Oxygen saturation is 89%. After administering a nebulized
beta-agonist, which assessment finding indicates a need for immediate escalation of care?
A. Increased wheezing intensity
B. Decreased breath sounds with no wheezing
C. Mild improvement in peak expiratory flow to 50%
D. Respiratory rate of 30 breaths per minute
Answer: B
Rationale: A 'silent chest' (decreased breath sounds with no wheezing) indicates severe airway
obstruction and impending respiratory failure, requiring immediate intervention such as intubation.
Increased wheezing may indicate some airflow, while a mild improvement in PEFR is a positive sign. A
respiratory rate of 30 is not necessarily alarming.
5. A patient with a diagnosis of paranoid schizophrenia has been receiving haloperidol for 2 weeks.
The nurse observes the patient's head turning to one side with neck muscle spasms and upward
gaze deviation. What should the nurse do first?
A. Administer diphenhydramine intramuscularly
B. Hold the next dose of haloperidol
C. Prepare for electroconvulsive therapy
D. Reassure the patient and monitor closely
Answer: A
Rationale: The symptoms describe an acute dystonic reaction, a medical emergency. Diphenhydramine
(or benztropine) is the first-line treatment to reverse the dystonia. Holding the antipsychotic is
appropriate but does not address the acute symptoms. ECT is not indicated, and monitoring alone is
insufficient.
6. A patient is receiving a blood transfusion of packed red blood cells. After 15 minutes, the patient
develops a temperature of 101.2°F (38.4°C), chills, and low back pain. What is the nurse's priority
action?
A. Stop the transfusion immediately
B. Slow the transfusion rate and administer acetaminophen
C. Notify the healthcare provider and obtain a urine specimen
D. Increase the rate of normal saline infusion
Answer: A
Rationale: Fever, chills, and back pain suggest an acute hemolytic transfusion reaction, which can be
life-threatening. The transfusion must be stopped immediately to prevent further hemolysis. Slowing the
transfusion or continuing it is dangerous. After stopping, the nurse should notify the provider and
monitor vital signs.
Page 2
,7. A nurse is teaching a patient with a new colostomy about dietary modifications to prevent
obstruction. Which food should the patient be advised to avoid initially?
A. Applesauce
B. Cooked carrots
C. Popcorn
D. White bread
Answer: C
Rationale: Popcorn is a high-fiber food that can form a bolus and cause a stoma obstruction, especially
in the early postoperative period. Applesauce, cooked carrots, and white bread are low-residue foods
that are less likely to cause blockage.
8. A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. The nurse
reviews the medication administration record. Which medication should the nurse question?
A. Calcium acetate 667 mg with meals
B. Spironolactone 25 mg daily
C. Sevelamer 800 mg with meals
D. Epoetin alfa 40,000 units subcutaneously weekly
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that can exacerbate hyperkalemia. In a patient
with CKD and elevated potassium, it is contraindicated. Calcium acetate and sevelamer are phosphate
binders, and epoetin alfa treats anemia; these do not directly affect potassium levels.
9. A nurse is assessing a patient with suspected meningitis. The patient reports headache and
photophobia, and has a temperature of 102°F (38.9°C). The nurse attempts to flex the patient's
neck and notes resistance and pain. What is the significance of this finding?
A. Indicates a positive Kernig's sign
B. Indicates a positive Brudzinski's sign
C. Indicates a positive Babinski reflex
D. Indicates a positive Romberg test
Answer: B
Rationale: Brudzinski's sign is positive when passive flexion of the neck results in involuntary flexion of
the hips and knees. This is a classic sign of meningeal irritation in meningitis. Kernig's sign is assessed
by flexing the hip and then extending the knee. Babinski and Romberg are not specific for meningitis.
10. A patient with a history of type 2 diabetes mellitus is admitted with a blood glucose of 480
mg/dL. The nurse notes that the patient's breath has a fruity odor and the serum pH is 7.25. Which
intravenous fluid should the nurse anticipate administering first?
A. 0.9% normal saline at 1 L/hour
B. 5% dextrose in water at 100 mL/hour
C. Lactated Ringer's solution at 250 mL/hour
D. 0.45% normal saline at 500 mL/hour
Answer: A
Page 3
, Rationale: The patient is in diabetic ketoacidosis (DKA) with severe hyperglycemia and acidosis. Initial fluid resuscitation
with 0.9% normal saline at a rapid rate (e.g., 1 L/hour) is essential to correct hypovolemia and improve tissue perfusion.
Dextrose solutions are given after glucose drops, and lactated Ringer's may worsen acidosis.
11. A client with acute pancreatitis has a nasogastric tube to low intermittent suction. Which
laboratory value requires immediate intervention?
A. Serum calcium 7.8 mg/dL
B. Serum amylase 250 U/L
C. Serum lipase 180 U/L
D. Serum glucose 140 mg/dL
Answer: A
Rationale: Hypocalcemia (calcium <8.5 mg/dL) in acute pancreatitis can indicate fat necrosis and
saponification, leading to tetany and cardiac arrhythmias. Elevated amylase/lipase are expected, and
glucose of 140 mg/dL is mildly elevated but not immediately critical.
12. A client receiving IV heparin for deep vein thrombosis has an activated partial thromboplastin
time (aPTT) of 95 seconds. The nurse notes the client has a nosebleed. What should the nurse do
first?
A. Administer vitamin K intramuscularly
B. Apply direct pressure to the nose and notify the healthcare provider
C. Decrease the heparin infusion rate by 50%
D. Prepare to administer protamine sulfate
Answer: B
Rationale: The aPTT is supratherapeutic (therapeutic range 60-80 seconds), indicating increased
bleeding risk. The immediate action is to apply direct pressure to control the nosebleed and notify the
provider for further orders. Protamine sulfate is the reversal agent for heparin, but not the first step;
vitamin K reverses warfarin, not heparin.
13. A client with chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory
acidosis. The nurse reviews arterial blood gas results: pH 7.25, PaCO2 65 mm Hg, PaO2 55 mm
Hg, HCO3- 26 mEq/L. Which intervention should the nurse prioritize?
A. Administer oxygen via nasal cannula at 2 L/min
B. Place the client in a high Fowler's position
C. Increase the intravenous fluid rate
D. Administer sodium bicarbonate 50 mEq intravenously
Answer: B
Rationale: Positioning the client upright (high Fowler's) optimizes diaphragmatic excursion and
ventilation, aiding CO2 elimination. Oxygen should be given cautiously (low flow) but positioning is the
immediate priority. Sodium bicarbonate is not indicated for respiratory acidosis; it may cause metabolic
alkalosis and worsen CO2 retention.
Page 4
Exam Prep & Review | Pass on First Try
1. A patient with a history of chronic heart failure presents with acute dyspnea, oxygen saturation
of 88% on room air, and jugular venous distention. The nurse notes a new S3 heart sound and
bibasilar crackles. Which intervention should the nurse prioritize?
A. Administer a dose of intravenous furosemide
B. Place the patient in a high Fowler's position
C. Prepare for immediate endotracheal intubation
D. Obtain a stat electrocardiogram
Answer: A
Rationale: The patient is in acute decompensated heart failure with pulmonary edema. Intravenous
furosemide reduces preload and pulmonary congestion, addressing the primary pathophysiology. While
positioning helps, it does not directly reduce fluid overload. Intubation is not yet indicated, and ECG is
not the priority.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for a deep vein
thrombosis. The aPTT result is 110 seconds (therapeutic range 60-80 seconds). What should the
nurse do first?
A. Stop the heparin infusion
B. Decrease the infusion rate by 50%
C. Administer protamine sulfate
D. Continue the infusion and recheck aPTT in 6 hours
Answer: A
Rationale: An aPTT of 110 seconds indicates supratherapeutic anticoagulation, placing the patient at
risk for bleeding. The immediate action is to stop the heparin infusion to prevent further anticoagulation.
Decreasing the rate may not be sufficient, and protamine is reserved for severe bleeding. Continuing the
infusion is unsafe.
3. During a home visit, a nurse assesses a postpartum patient who reports heavy lochia with clots
and a boggy uterus on palpation. The patient's heart rate is 110 bpm and blood pressure is 90/60
mmHg. Which action should the nurse take first?
A. Massage the uterine fundus
B. Administer oxytocin as prescribed
C. Encourage the patient to empty her bladder
D. Place the patient in Trendelenburg position
Answer: A
Rationale: A boggy uterus suggests uterine atony, the most common cause of postpartum hemorrhage.
Fundal massage stimulates uterine contraction to reduce bleeding. Oxytocin may be given after massage
if bleeding persists, but massage is the immediate intervention. Bladder distention can contribute to
Page 1
,atony but is not the first step. Trendelenburg position is not recommended for hemorrhage.
4. A child with a history of asthma presents to the emergency department with an acute
exacerbation. The child is sitting upright, using accessory muscles, and has a peak expiratory flow
rate of 40% of personal best. Oxygen saturation is 89%. After administering a nebulized
beta-agonist, which assessment finding indicates a need for immediate escalation of care?
A. Increased wheezing intensity
B. Decreased breath sounds with no wheezing
C. Mild improvement in peak expiratory flow to 50%
D. Respiratory rate of 30 breaths per minute
Answer: B
Rationale: A 'silent chest' (decreased breath sounds with no wheezing) indicates severe airway
obstruction and impending respiratory failure, requiring immediate intervention such as intubation.
Increased wheezing may indicate some airflow, while a mild improvement in PEFR is a positive sign. A
respiratory rate of 30 is not necessarily alarming.
5. A patient with a diagnosis of paranoid schizophrenia has been receiving haloperidol for 2 weeks.
The nurse observes the patient's head turning to one side with neck muscle spasms and upward
gaze deviation. What should the nurse do first?
A. Administer diphenhydramine intramuscularly
B. Hold the next dose of haloperidol
C. Prepare for electroconvulsive therapy
D. Reassure the patient and monitor closely
Answer: A
Rationale: The symptoms describe an acute dystonic reaction, a medical emergency. Diphenhydramine
(or benztropine) is the first-line treatment to reverse the dystonia. Holding the antipsychotic is
appropriate but does not address the acute symptoms. ECT is not indicated, and monitoring alone is
insufficient.
6. A patient is receiving a blood transfusion of packed red blood cells. After 15 minutes, the patient
develops a temperature of 101.2°F (38.4°C), chills, and low back pain. What is the nurse's priority
action?
A. Stop the transfusion immediately
B. Slow the transfusion rate and administer acetaminophen
C. Notify the healthcare provider and obtain a urine specimen
D. Increase the rate of normal saline infusion
Answer: A
Rationale: Fever, chills, and back pain suggest an acute hemolytic transfusion reaction, which can be
life-threatening. The transfusion must be stopped immediately to prevent further hemolysis. Slowing the
transfusion or continuing it is dangerous. After stopping, the nurse should notify the provider and
monitor vital signs.
Page 2
,7. A nurse is teaching a patient with a new colostomy about dietary modifications to prevent
obstruction. Which food should the patient be advised to avoid initially?
A. Applesauce
B. Cooked carrots
C. Popcorn
D. White bread
Answer: C
Rationale: Popcorn is a high-fiber food that can form a bolus and cause a stoma obstruction, especially
in the early postoperative period. Applesauce, cooked carrots, and white bread are low-residue foods
that are less likely to cause blockage.
8. A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. The nurse
reviews the medication administration record. Which medication should the nurse question?
A. Calcium acetate 667 mg with meals
B. Spironolactone 25 mg daily
C. Sevelamer 800 mg with meals
D. Epoetin alfa 40,000 units subcutaneously weekly
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that can exacerbate hyperkalemia. In a patient
with CKD and elevated potassium, it is contraindicated. Calcium acetate and sevelamer are phosphate
binders, and epoetin alfa treats anemia; these do not directly affect potassium levels.
9. A nurse is assessing a patient with suspected meningitis. The patient reports headache and
photophobia, and has a temperature of 102°F (38.9°C). The nurse attempts to flex the patient's
neck and notes resistance and pain. What is the significance of this finding?
A. Indicates a positive Kernig's sign
B. Indicates a positive Brudzinski's sign
C. Indicates a positive Babinski reflex
D. Indicates a positive Romberg test
Answer: B
Rationale: Brudzinski's sign is positive when passive flexion of the neck results in involuntary flexion of
the hips and knees. This is a classic sign of meningeal irritation in meningitis. Kernig's sign is assessed
by flexing the hip and then extending the knee. Babinski and Romberg are not specific for meningitis.
10. A patient with a history of type 2 diabetes mellitus is admitted with a blood glucose of 480
mg/dL. The nurse notes that the patient's breath has a fruity odor and the serum pH is 7.25. Which
intravenous fluid should the nurse anticipate administering first?
A. 0.9% normal saline at 1 L/hour
B. 5% dextrose in water at 100 mL/hour
C. Lactated Ringer's solution at 250 mL/hour
D. 0.45% normal saline at 500 mL/hour
Answer: A
Page 3
, Rationale: The patient is in diabetic ketoacidosis (DKA) with severe hyperglycemia and acidosis. Initial fluid resuscitation
with 0.9% normal saline at a rapid rate (e.g., 1 L/hour) is essential to correct hypovolemia and improve tissue perfusion.
Dextrose solutions are given after glucose drops, and lactated Ringer's may worsen acidosis.
11. A client with acute pancreatitis has a nasogastric tube to low intermittent suction. Which
laboratory value requires immediate intervention?
A. Serum calcium 7.8 mg/dL
B. Serum amylase 250 U/L
C. Serum lipase 180 U/L
D. Serum glucose 140 mg/dL
Answer: A
Rationale: Hypocalcemia (calcium <8.5 mg/dL) in acute pancreatitis can indicate fat necrosis and
saponification, leading to tetany and cardiac arrhythmias. Elevated amylase/lipase are expected, and
glucose of 140 mg/dL is mildly elevated but not immediately critical.
12. A client receiving IV heparin for deep vein thrombosis has an activated partial thromboplastin
time (aPTT) of 95 seconds. The nurse notes the client has a nosebleed. What should the nurse do
first?
A. Administer vitamin K intramuscularly
B. Apply direct pressure to the nose and notify the healthcare provider
C. Decrease the heparin infusion rate by 50%
D. Prepare to administer protamine sulfate
Answer: B
Rationale: The aPTT is supratherapeutic (therapeutic range 60-80 seconds), indicating increased
bleeding risk. The immediate action is to apply direct pressure to control the nosebleed and notify the
provider for further orders. Protamine sulfate is the reversal agent for heparin, but not the first step;
vitamin K reverses warfarin, not heparin.
13. A client with chronic obstructive pulmonary disease (COPD) is admitted with acute respiratory
acidosis. The nurse reviews arterial blood gas results: pH 7.25, PaCO2 65 mm Hg, PaO2 55 mm
Hg, HCO3- 26 mEq/L. Which intervention should the nurse prioritize?
A. Administer oxygen via nasal cannula at 2 L/min
B. Place the client in a high Fowler's position
C. Increase the intravenous fluid rate
D. Administer sodium bicarbonate 50 mEq intravenously
Answer: B
Rationale: Positioning the client upright (high Fowler's) optimizes diaphragmatic excursion and
ventilation, aiding CO2 elimination. Oxygen should be given cautiously (low flow) but positioning is the
immediate priority. Sodium bicarbonate is not indicated for respiratory acidosis; it may cause metabolic
alkalosis and worsen CO2 retention.
Page 4
