HESI Exit Exam 2026/2027 Actual Exam | Complete
Questions, Answers, and Detailed Rationales for Nursing
Students | Pass Guaranteed - A+ Graded
(Advanced Clinical Judgment, Prioritization, and Core Content)
Question 1
Topic: Medical-Surgical: Cardiovascular
Question: The nurse is caring for a client with acute decompensated heart failure.
Which of the following assessment findings indicates a need for the nurse to
immediately contact the primary healthcare provider?
o A) 2+ pitting edema in both ankles
o B) Crackles in the lung bases that do not clear with coughing
o C) A weight gain of 0.5 kg (1 pound) over 24 hours
o D) Blood pressure of 130/80 mmHg
Correct Answer: B
, Rationale: Crackles that do not clear with coughing indicate fluid accumulation in the
alveoli, a hallmark sign of worsening heart failure and developing pulmonary edema.
This is a life-threatening change in respiratory status. The other findings are
expected manifestations of heart failure or within acceptable ranges that require
monitoring but not immediate emergency escalation.
Hint: Think about airway and breathing. Which finding points directly to fluid backing
up into the respiratory system, potentially causing pulmonary edema?
Question 2
Topic: Pharmacology
Question: A client is receiving a continuous intravenous heparin infusion for a
pulmonary embolism. The nurse notes the client's aPTT is 110 seconds. What is the
priority nursing action?
o A) Continue the infusion as prescribed.
o B) Prepare to administer protamine sulfate.
o C) Stop the heparin infusion and notify the provider.
o D) Draw a stat Complete Blood Count (CBC).
Correct Answer: C
, Rationale: An aPTT of 110 seconds is critically elevated and significantly exceeds
the standard therapeutic range (typically 46 to 70 seconds), placing the client at
severe risk for spontaneous hemorrhage. The immediate safety action is to stop the
continuous source of the medication and notify the provider. Antidotes like protamine
sulfate require a specific order, though the infusion must be halted first.
Hint: Consider the therapeutic range for aPTT during heparin therapy. What is the
safest action when labs are critically high?
Question 3
Topic: Maternity
Question: A postpartum client who delivered a 9-pound infant vaginally 2 hours ago
is experiencing heavy vaginal bleeding. The nurse assesses a boggy uterus. Which
medication does the nurse anticipate the provider will prescribe?
o A) Methylergonovine
o B) Magnesium sulfate
o C) Terbutaline
o D) Nifedipine
Correct Answer: A
, Rationale: Methylergonovine is an oxytocic medication used to prevent and control
postpartum hemorrhage by causing sustained uterine contractions to firm up a boggy
uterus. Magnesium sulfate, terbutaline, and nifedipine are tocolytics (uterine
relaxants) or anti-hypertensives that would worsen a postpartum hemorrhage.
Hint: The client's uterus is boggy (lacking tone), leading to hemorrhage. The priority
is to firm up the uterus. Which drug class is used to induce uterine contractions?
Question 4
Topic: Mental Health
Question: A client with schizophrenia is experiencing auditory hallucinations that
command them to harm others. Which nursing intervention is the priority?
o A) Place the client in seclusion to limit sensory stimulation.
o B) Administer a PRN antipsychotic medication.
o C) Encourage the client to express their feelings about the
hallucinations.
o D) Assign a 1:1 staff member to continuously monitor the client.
Correct Answer: D
Rationale: Command hallucinations directing harm to others indicate an immediate,
high risk for violence. The priority is client and public safety via continuous 1:1
Questions, Answers, and Detailed Rationales for Nursing
Students | Pass Guaranteed - A+ Graded
(Advanced Clinical Judgment, Prioritization, and Core Content)
Question 1
Topic: Medical-Surgical: Cardiovascular
Question: The nurse is caring for a client with acute decompensated heart failure.
Which of the following assessment findings indicates a need for the nurse to
immediately contact the primary healthcare provider?
o A) 2+ pitting edema in both ankles
o B) Crackles in the lung bases that do not clear with coughing
o C) A weight gain of 0.5 kg (1 pound) over 24 hours
o D) Blood pressure of 130/80 mmHg
Correct Answer: B
, Rationale: Crackles that do not clear with coughing indicate fluid accumulation in the
alveoli, a hallmark sign of worsening heart failure and developing pulmonary edema.
This is a life-threatening change in respiratory status. The other findings are
expected manifestations of heart failure or within acceptable ranges that require
monitoring but not immediate emergency escalation.
Hint: Think about airway and breathing. Which finding points directly to fluid backing
up into the respiratory system, potentially causing pulmonary edema?
Question 2
Topic: Pharmacology
Question: A client is receiving a continuous intravenous heparin infusion for a
pulmonary embolism. The nurse notes the client's aPTT is 110 seconds. What is the
priority nursing action?
o A) Continue the infusion as prescribed.
o B) Prepare to administer protamine sulfate.
o C) Stop the heparin infusion and notify the provider.
o D) Draw a stat Complete Blood Count (CBC).
Correct Answer: C
, Rationale: An aPTT of 110 seconds is critically elevated and significantly exceeds
the standard therapeutic range (typically 46 to 70 seconds), placing the client at
severe risk for spontaneous hemorrhage. The immediate safety action is to stop the
continuous source of the medication and notify the provider. Antidotes like protamine
sulfate require a specific order, though the infusion must be halted first.
Hint: Consider the therapeutic range for aPTT during heparin therapy. What is the
safest action when labs are critically high?
Question 3
Topic: Maternity
Question: A postpartum client who delivered a 9-pound infant vaginally 2 hours ago
is experiencing heavy vaginal bleeding. The nurse assesses a boggy uterus. Which
medication does the nurse anticipate the provider will prescribe?
o A) Methylergonovine
o B) Magnesium sulfate
o C) Terbutaline
o D) Nifedipine
Correct Answer: A
, Rationale: Methylergonovine is an oxytocic medication used to prevent and control
postpartum hemorrhage by causing sustained uterine contractions to firm up a boggy
uterus. Magnesium sulfate, terbutaline, and nifedipine are tocolytics (uterine
relaxants) or anti-hypertensives that would worsen a postpartum hemorrhage.
Hint: The client's uterus is boggy (lacking tone), leading to hemorrhage. The priority
is to firm up the uterus. Which drug class is used to induce uterine contractions?
Question 4
Topic: Mental Health
Question: A client with schizophrenia is experiencing auditory hallucinations that
command them to harm others. Which nursing intervention is the priority?
o A) Place the client in seclusion to limit sensory stimulation.
o B) Administer a PRN antipsychotic medication.
o C) Encourage the client to express their feelings about the
hallucinations.
o D) Assign a 1:1 staff member to continuously monitor the client.
Correct Answer: D
Rationale: Command hallucinations directing harm to others indicate an immediate,
high risk for violence. The priority is client and public safety via continuous 1:1
