HESI Exit Exam 2026/2027 Actual Exam | Complete
Questions, Answers, and Detailed Rationales for
Nursing Students | Pass Guaranteed - A+ Graded
1. A nurse is caring for a patient with suspected sepsis. Which combination of findings would most
strongly indicate the need for immediate intervention per the Sepsis-3 criteria?
A. Heart rate 98 bpm, respiratory rate 18/min, WBC 11,000/mm³, lactate 1.5 mmol/L
B. Heart rate 112 bpm, respiratory rate 24/min, temperature 38.6°C, platelet count 150,000/mm³
C. Heart rate 105 bpm, respiratory rate 22/min, altered mental status, lactate 2.8 mmol/L
D. Heart rate 88 bpm, respiratory rate 16/min, blood pressure 130/80 mm Hg, urine output 40 mL/hr
Answer: C
Rationale: Sepsis-3 defines sepsis as life-threatening organ dysfunction caused by a dysregulated host
response to infection, indicated by a qSOFA score 2 (altered mental status, respiratory rate 22, systolic
BP 100) or a SOFA score increase 2. Option C includes altered mental status and tachypnea (qSOFA=2)
plus elevated lactate >2 mmol/L, indicating tissue hypoperfusion. Options A and D have normal
parameters; B lacks organ dysfunction criteria.
2. A patient with type 2 diabetes mellitus is started on metformin. Which laboratory value requires
immediate attention before initiating therapy?
A. HbA1c 8.5%
B. Serum creatinine 1.8 mg/dL (eGFR 38 mL/min/1.73 m²)
C. Fasting blood glucose 180 mg/dL
D. ALT 45 U/L
Answer: B
Rationale: Metformin is contraindicated if eGFR is <30 mL/min/1.73 m² and should be used with caution
if eGFR is 30-45 due to risk of lactic acidosis. Option B shows eGFR 38, which is below the threshold
for initiation (some guidelines require eGFR >45). Options A and C indicate poor glycemic control but
are not contraindications. ALT elevation (D) is not a contraindication unless severe liver disease.
3. A nurse is preparing to administer packed red blood cells to a patient with chronic anemia.
Which action is most critical to prevent a transfusion reaction?
A. Obtain a baseline set of vital signs and monitor every 15 minutes
B. Verify patient identification using two identifiers and check blood product compatibility
C. Prime the blood tubing with normal saline and use a dedicated IV line
D. Administer the first 50 mL slowly over 15 minutes and observe for signs of reaction
Answer: B
Rationale: The most critical step to prevent a transfusion reaction is verifying the patient's identity and
blood product compatibility, as errors in identification are the leading cause of hemolytic reactions.
While monitoring (A), priming (C), and slow administration (D) are important, they do not prevent the
Page 1
,most serious errors. Correct identification is the primary safety check.
4. A nurse is reviewing a patient's arterial blood gas results: pH 7.50, PaCO2 30 mm Hg, HCO3 24
mEq/L. Which condition is most consistent with these values?
A. Metabolic alkalosis with full compensation
B. Respiratory alkalosis, uncompensated
C. Respiratory acidosis with renal compensation
D. Metabolic acidosis with respiratory compensation
Answer: B
Rationale: The pH is elevated (alkalemia), PaCO2 is decreased (respiratory alkalosis), and HCO3 is
normal. This indicates an uncompensated respiratory alkalosis, as the primary disturbance is
respiratory and there is no metabolic compensation (HCO3 normal). Option A would show elevated
HCO3. Options C and D show acidosis.
5. A nurse is assessing a patient who has a chest tube connected to a dry suction water seal
drainage system. The nurse notes continuous bubbling in the water seal chamber. Which action
should the nurse take first?
A. Clamp the chest tube near the insertion site
B. Check the suction control setting and adjust if needed
C. Assess the chest tube insertion site and connections for air leaks
D. Notify the healthcare provider immediately
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system. The first
action is to assess the insertion site and all connections to locate the leak. Clamping (A) is not
recommended as it can cause tension pneumothorax. Adjusting suction (B) does not address the leak.
Notifying the provider (D) may be necessary after assessment, but the nurse must first assess and attempt
to resolve the issue.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Which oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% FiO2
C. Simple face mask at 10 L/min
D. Nasal cannula at 6 L/min
Answer: B
Rationale: For patients with COPD and acute respiratory failure, controlled oxygen therapy is essential
to avoid suppressing the hypoxic drive. Venturi mask provides precise FiO2 (24-50%) and is preferred.
Non-rebreather (A) delivers high FiO2 and may cause hypercapnia. Simple mask (C) and nasal cannula
(D) at higher flows are less accurate and may lead to excessive oxygen.
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,7. A nurse is caring for a patient receiving a continuous heparin infusion. The activated partial
thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds). What is the priority
nursing action?
A. Continue the infusion at the same rate and recheck aPTT in 6 hours
B. Stop the infusion and administer protamine sulfate
C. Stop the infusion for 1 hour and restart at a lower rate per protocol
D. Increase the infusion rate to achieve therapeutic aPTT
Answer: C
Rationale: An aPTT >100 seconds indicates excessive anticoagulation and risk of bleeding. The standard
protocol is to stop the infusion temporarily and reduce the rate when restarting. Continuing (A) or
increasing (D) would worsen the risk. Protamine (B) is used for severe bleeding or reversal, not as
first-line for elevated aPTT without bleeding.
8. A nurse is teaching a patient with heart failure about a low-sodium diet. Which food selection
indicates the patient understands the teaching?
A. Canned vegetable soup with crackers
B. Grilled chicken breast with steamed broccoli and a baked potato
C. Turkey sandwich with Swiss cheese and pickles on whole wheat bread
D. Instant oatmeal with a banana and a glass of skim milk
Answer: B
Rationale: A low-sodium diet for heart failure should avoid processed and high-sodium foods. Grilled
chicken with steamed vegetables and a plain baked potato are naturally low in sodium. Canned soup (A)
is high in sodium, as are cheese and pickles (C). Instant oatmeal (D) often contains added sodium; plain
oatmeal is better.
9. A nurse is assessing a patient who has been on mechanical ventilation for 3 days. The patient
suddenly becomes agitated, has decreased breath sounds on the right side, and tracheal deviation
to the left. What is the priority nursing intervention?
A. Administer a sedative as prescribed
B. Increase the ventilator rate
C. Prepare for needle decompression of the right chest
D. Obtain a stat chest X-ray
Answer: C
Rationale: The signs (sudden agitation, decreased breath sounds on one side, tracheal deviation away
from the affected side) indicate a tension pneumothorax, which is life-threatening. Immediate needle
decompression is required to relieve pressure. Sedation (A) would mask symptoms. Increasing ventilator
rate (B) is not indicated. While chest X-ray (D) confirms, it delays treatment.
10. A nurse is evaluating a patient's understanding of insulin administration. The patient has a
prescription for 10 units of NPH insulin and 5 units of regular insulin. Which statement indicates
correct understanding of how to prepare the injection?
A. I will draw up the regular insulin first, then the NPH insulin into the same syringe.
Page 3
, B. I will draw up the NPH insulin first, then the regular insulin into the same syringe.
C. I will inject the NPH insulin and regular insulin as separate injections.
D. I will mix the insulins in the vial before drawing up.
Answer: A
Rationale: When mixing regular and NPH insulin, the clear (regular) should be drawn first to avoid
contaminating the regular vial with NPH. Then the cloudy (NPH) is drawn. Option B is incorrect and
could lead to inaccurate dosing. Separate injections (C) are not necessary. Mixing in the vial (D) is not
recommended as it alters the action profile.
11. A patient with a history of chronic heart failure (HFrEF) is admitted with acute
decompensation. Current medications include lisinopril 10 mg daily, metoprolol succinate 50 mg
daily, and furosemide 40 mg daily. On admission, blood pressure is 88/58 mm Hg, heart rate 52
bpm, and oxygen saturation 89% on room air. Which of the following interventions should the
nurse prioritize?
A. Administer a 500 mL normal saline bolus over 30 minutes
B. Hold the metoprolol succinate and administer intravenous furosemide
C. Increase the lisinopril dose to 20 mg and monitor urine output
D. Administer atropine 0.5 mg intravenously for bradycardia
Answer: B
Rationale: The patient is hypotensive and bradycardic, likely due to beta-blocker toxicity in the setting of
acute decompensation. Holding metoprolol and giving IV furosemide addresses fluid overload without
further reducing heart rate or blood pressure. Saline bolus could worsen heart failure. Increasing
lisinopril could worsen hypotension. Atropine is not first-line for beta-blocker-induced bradycardia
without hemodynamic instability.
12. A nurse is caring for a patient receiving a continuous infusion of norepinephrine for septic
shock. The patient's mean arterial pressure (MAP) is 55 mm Hg. The nurse notes that the infusion
site is pale and cool, and the patient complains of severe pain at the site. What is the priority
nursing action?
A. Decrease the infusion rate and apply a warm compress
B. Stop the infusion immediately and notify the prescriber
C. Administer phentolamine locally and continue the infusion
D. Increase the infusion rate to achieve target MAP
Answer: B
Rationale: These signs indicate extravasation of norepinephrine, a vasopressor that can cause tissue
necrosis. The infusion must be stopped immediately to prevent further damage. Phentolamine is an
antidote but is given after stopping the infusion. Continuing or increasing the infusion would worsen
extravasation.
13. A nurse is reviewing the laboratory results of a patient with acute kidney injury (AKI) stage 3.
Which finding is most consistent with the oliguric phase of AKI?
A. Urine osmolality 600 mOsm/kg, urine sodium 20 mEq/L
B. Urine osmolality 300 mOsm/kg, urine sodium 80 mEq/L
Page 4
Questions, Answers, and Detailed Rationales for
Nursing Students | Pass Guaranteed - A+ Graded
1. A nurse is caring for a patient with suspected sepsis. Which combination of findings would most
strongly indicate the need for immediate intervention per the Sepsis-3 criteria?
A. Heart rate 98 bpm, respiratory rate 18/min, WBC 11,000/mm³, lactate 1.5 mmol/L
B. Heart rate 112 bpm, respiratory rate 24/min, temperature 38.6°C, platelet count 150,000/mm³
C. Heart rate 105 bpm, respiratory rate 22/min, altered mental status, lactate 2.8 mmol/L
D. Heart rate 88 bpm, respiratory rate 16/min, blood pressure 130/80 mm Hg, urine output 40 mL/hr
Answer: C
Rationale: Sepsis-3 defines sepsis as life-threatening organ dysfunction caused by a dysregulated host
response to infection, indicated by a qSOFA score 2 (altered mental status, respiratory rate 22, systolic
BP 100) or a SOFA score increase 2. Option C includes altered mental status and tachypnea (qSOFA=2)
plus elevated lactate >2 mmol/L, indicating tissue hypoperfusion. Options A and D have normal
parameters; B lacks organ dysfunction criteria.
2. A patient with type 2 diabetes mellitus is started on metformin. Which laboratory value requires
immediate attention before initiating therapy?
A. HbA1c 8.5%
B. Serum creatinine 1.8 mg/dL (eGFR 38 mL/min/1.73 m²)
C. Fasting blood glucose 180 mg/dL
D. ALT 45 U/L
Answer: B
Rationale: Metformin is contraindicated if eGFR is <30 mL/min/1.73 m² and should be used with caution
if eGFR is 30-45 due to risk of lactic acidosis. Option B shows eGFR 38, which is below the threshold
for initiation (some guidelines require eGFR >45). Options A and C indicate poor glycemic control but
are not contraindications. ALT elevation (D) is not a contraindication unless severe liver disease.
3. A nurse is preparing to administer packed red blood cells to a patient with chronic anemia.
Which action is most critical to prevent a transfusion reaction?
A. Obtain a baseline set of vital signs and monitor every 15 minutes
B. Verify patient identification using two identifiers and check blood product compatibility
C. Prime the blood tubing with normal saline and use a dedicated IV line
D. Administer the first 50 mL slowly over 15 minutes and observe for signs of reaction
Answer: B
Rationale: The most critical step to prevent a transfusion reaction is verifying the patient's identity and
blood product compatibility, as errors in identification are the leading cause of hemolytic reactions.
While monitoring (A), priming (C), and slow administration (D) are important, they do not prevent the
Page 1
,most serious errors. Correct identification is the primary safety check.
4. A nurse is reviewing a patient's arterial blood gas results: pH 7.50, PaCO2 30 mm Hg, HCO3 24
mEq/L. Which condition is most consistent with these values?
A. Metabolic alkalosis with full compensation
B. Respiratory alkalosis, uncompensated
C. Respiratory acidosis with renal compensation
D. Metabolic acidosis with respiratory compensation
Answer: B
Rationale: The pH is elevated (alkalemia), PaCO2 is decreased (respiratory alkalosis), and HCO3 is
normal. This indicates an uncompensated respiratory alkalosis, as the primary disturbance is
respiratory and there is no metabolic compensation (HCO3 normal). Option A would show elevated
HCO3. Options C and D show acidosis.
5. A nurse is assessing a patient who has a chest tube connected to a dry suction water seal
drainage system. The nurse notes continuous bubbling in the water seal chamber. Which action
should the nurse take first?
A. Clamp the chest tube near the insertion site
B. Check the suction control setting and adjust if needed
C. Assess the chest tube insertion site and connections for air leaks
D. Notify the healthcare provider immediately
Answer: C
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system. The first
action is to assess the insertion site and all connections to locate the leak. Clamping (A) is not
recommended as it can cause tension pneumothorax. Adjusting suction (B) does not address the leak.
Notifying the provider (D) may be necessary after assessment, but the nurse must first assess and attempt
to resolve the issue.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Which oxygen delivery method is most appropriate initially?
A. Non-rebreather mask at 15 L/min
B. Venturi mask at 28% FiO2
C. Simple face mask at 10 L/min
D. Nasal cannula at 6 L/min
Answer: B
Rationale: For patients with COPD and acute respiratory failure, controlled oxygen therapy is essential
to avoid suppressing the hypoxic drive. Venturi mask provides precise FiO2 (24-50%) and is preferred.
Non-rebreather (A) delivers high FiO2 and may cause hypercapnia. Simple mask (C) and nasal cannula
(D) at higher flows are less accurate and may lead to excessive oxygen.
Page 2
,7. A nurse is caring for a patient receiving a continuous heparin infusion. The activated partial
thromboplastin time (aPTT) is 120 seconds (therapeutic range 60-80 seconds). What is the priority
nursing action?
A. Continue the infusion at the same rate and recheck aPTT in 6 hours
B. Stop the infusion and administer protamine sulfate
C. Stop the infusion for 1 hour and restart at a lower rate per protocol
D. Increase the infusion rate to achieve therapeutic aPTT
Answer: C
Rationale: An aPTT >100 seconds indicates excessive anticoagulation and risk of bleeding. The standard
protocol is to stop the infusion temporarily and reduce the rate when restarting. Continuing (A) or
increasing (D) would worsen the risk. Protamine (B) is used for severe bleeding or reversal, not as
first-line for elevated aPTT without bleeding.
8. A nurse is teaching a patient with heart failure about a low-sodium diet. Which food selection
indicates the patient understands the teaching?
A. Canned vegetable soup with crackers
B. Grilled chicken breast with steamed broccoli and a baked potato
C. Turkey sandwich with Swiss cheese and pickles on whole wheat bread
D. Instant oatmeal with a banana and a glass of skim milk
Answer: B
Rationale: A low-sodium diet for heart failure should avoid processed and high-sodium foods. Grilled
chicken with steamed vegetables and a plain baked potato are naturally low in sodium. Canned soup (A)
is high in sodium, as are cheese and pickles (C). Instant oatmeal (D) often contains added sodium; plain
oatmeal is better.
9. A nurse is assessing a patient who has been on mechanical ventilation for 3 days. The patient
suddenly becomes agitated, has decreased breath sounds on the right side, and tracheal deviation
to the left. What is the priority nursing intervention?
A. Administer a sedative as prescribed
B. Increase the ventilator rate
C. Prepare for needle decompression of the right chest
D. Obtain a stat chest X-ray
Answer: C
Rationale: The signs (sudden agitation, decreased breath sounds on one side, tracheal deviation away
from the affected side) indicate a tension pneumothorax, which is life-threatening. Immediate needle
decompression is required to relieve pressure. Sedation (A) would mask symptoms. Increasing ventilator
rate (B) is not indicated. While chest X-ray (D) confirms, it delays treatment.
10. A nurse is evaluating a patient's understanding of insulin administration. The patient has a
prescription for 10 units of NPH insulin and 5 units of regular insulin. Which statement indicates
correct understanding of how to prepare the injection?
A. I will draw up the regular insulin first, then the NPH insulin into the same syringe.
Page 3
, B. I will draw up the NPH insulin first, then the regular insulin into the same syringe.
C. I will inject the NPH insulin and regular insulin as separate injections.
D. I will mix the insulins in the vial before drawing up.
Answer: A
Rationale: When mixing regular and NPH insulin, the clear (regular) should be drawn first to avoid
contaminating the regular vial with NPH. Then the cloudy (NPH) is drawn. Option B is incorrect and
could lead to inaccurate dosing. Separate injections (C) are not necessary. Mixing in the vial (D) is not
recommended as it alters the action profile.
11. A patient with a history of chronic heart failure (HFrEF) is admitted with acute
decompensation. Current medications include lisinopril 10 mg daily, metoprolol succinate 50 mg
daily, and furosemide 40 mg daily. On admission, blood pressure is 88/58 mm Hg, heart rate 52
bpm, and oxygen saturation 89% on room air. Which of the following interventions should the
nurse prioritize?
A. Administer a 500 mL normal saline bolus over 30 minutes
B. Hold the metoprolol succinate and administer intravenous furosemide
C. Increase the lisinopril dose to 20 mg and monitor urine output
D. Administer atropine 0.5 mg intravenously for bradycardia
Answer: B
Rationale: The patient is hypotensive and bradycardic, likely due to beta-blocker toxicity in the setting of
acute decompensation. Holding metoprolol and giving IV furosemide addresses fluid overload without
further reducing heart rate or blood pressure. Saline bolus could worsen heart failure. Increasing
lisinopril could worsen hypotension. Atropine is not first-line for beta-blocker-induced bradycardia
without hemodynamic instability.
12. A nurse is caring for a patient receiving a continuous infusion of norepinephrine for septic
shock. The patient's mean arterial pressure (MAP) is 55 mm Hg. The nurse notes that the infusion
site is pale and cool, and the patient complains of severe pain at the site. What is the priority
nursing action?
A. Decrease the infusion rate and apply a warm compress
B. Stop the infusion immediately and notify the prescriber
C. Administer phentolamine locally and continue the infusion
D. Increase the infusion rate to achieve target MAP
Answer: B
Rationale: These signs indicate extravasation of norepinephrine, a vasopressor that can cause tissue
necrosis. The infusion must be stopped immediately to prevent further damage. Phentolamine is an
antidote but is given after stopping the infusion. Continuing or increasing the infusion would worsen
extravasation.
13. A nurse is reviewing the laboratory results of a patient with acute kidney injury (AKI) stage 3.
Which finding is most consistent with the oliguric phase of AKI?
A. Urine osmolality 600 mOsm/kg, urine sodium 20 mEq/L
B. Urine osmolality 300 mOsm/kg, urine sodium 80 mEq/L
Page 4
