HESI COMPASS COMPREHENSIVE EXIT
EXAM PRACTICE QUESTIONS AND
ANSWERS WITH RATIONALES LATEST
UPDATE
It covers medical-surgical nursing, pharmacology, maternity, pediatrics, psychiatric/mental
health, prioritization, delegation, and critical care. Each question includes a correct answer and a
detailed, evidence‑based rationale explaining the clinical reasoning and priority action. This tool
is intended for self‑assessment and content review only. It is not a leaked official HESI exam.
Users must supplement this practice with official study guides and their nursing program’s
resources for complete exam preparation.
1. A patient with acute myocardial infarction is receiving thrombolytic therapy.
Which assessment finding would indicate a major complication of this therapy?
A. Chest pain relief
B. ST-segment elevation resolution
C. Sudden severe headache and vomiting
D. Reperfusion arrhythmias
Answer: C
Rationale: Thrombolytic therapy can cause intracranial hemorrhage. Sudden severe
headache, vomiting, and altered consciousness are signs of bleeding in the brain.
Chest pain relief and ST resolution are desired effects; reperfusion arrhythmias are
common but not as immediately life‑threatening as intracranial bleed.
2. A patient with chronic kidney disease has a serum phosphate of 7.2 mg/dL.
Which medication does the nurse expect to administer?
A. Calcium acetate
B. Ferrous sulfate
1
,C. Erythropoietin
D. Calcitriol
Answer: A
Rationale: Calcium acetate is a phosphate binder that binds dietary phosphate in
the GI tract, reducing serum phosphate levels. Ferrous sulfate treats anemia;
erythropoietin stimulates RBC production; calcitriol is active vitamin D used for
hypocalcemia.
3. A patient is prescribed amiodarone for atrial fibrillation. Which baseline
assessment is most important before starting this drug?
A. Liver function tests
B. Pulmonary function tests
C. Thyroid function tests and chest X‑ray
D. Renal function tests
Answer: C
Rationale: Amiodarone contains iodine and can cause thyroid dysfunction (hyper‑
or hypothyroidism) and pulmonary toxicity (pulmonary fibrosis). Baseline thyroid
function and chest imaging are essential. Liver and renal tests are also monitored
but thyroid and lung are most specific.
4. A post‑operative patient has a Jackson‑Pratt drain with 200 mL of bright red
blood in the first hour after surgery. What should the nurse do first?
A. Document the output as normal
B. Clamp the drain to prevent further loss
C. Notify the surgeon immediately
D. Apply pressure to the insertion site
Answer: C
2
,Rationale: Bright red blood >100 mL/hour in the immediate post‑op period
suggests active hemorrhage. The surgeon must be notified promptly. Clamping the
drain could cause hematoma; applying pressure may be done but notification is the
priority.
5. A patient with asthma is prescribed montelukast. The nurse teaches that this
medication is most effective for which purpose?
A. Acute relief of bronchospasm
B. Prevention of exercise‑induced bronchospasm
C. Treatment of respiratory infections
D. Reduction of mucus production
Answer: B
Rationale: Montelukast is a leukotriene receptor antagonist used for long‑term
control and prevention of exercise‑induced bronchospasm. It is not a rescue
medication for acute attacks.
6. A patient with liver cirrhosis is noted to have spider angiomas and palmar
erythema. These findings are due to which physiological change?
A. Portal hypertension
B. Increased estrogen levels
C. Decreased albumin production
D. Impaired bilirubin conjugation
Answer: B
Rationale: Spider angiomas and palmar erythema are caused by increased
circulating estrogen due to impaired liver metabolism of hormones. Portal
hypertension causes ascites and varices; decreased albumin causes edema;
impaired bilirubin causes jaundice.
3
, 7. A patient on a mechanical ventilator has an endotracheal tube cuff pressure of 30
cm H2O. What action should the nurse take?
A. Document this as a normal finding
B. Deflate the cuff immediately
C. Notify the respiratory therapist to adjust the pressure
D. Add more air to prevent aspiration
Answer: C
Rationale: Recommended cuff pressure is 20–30 cm H2O; 30 is at the upper limit
but may still be acceptable. However, pressures >30 can cause tracheal necrosis.
The nurse should verify with respiratory therapy, but 30 is not an emergency;
deflating could cause aspiration. Notifying is appropriate.
8. A patient with diabetes insipidus is receiving desmopressin. Which finding
indicates the treatment is effective?
A. Increased urine output
B. Decreased serum sodium
C. Decreased thirst and increased urine specific gravity
D. Increased blood glucose
Answer: C
Rationale: Desmopressin (ADH analogue) reduces urine output, increases urine
specific gravity, and decreases thirst. Urine output should decrease, not increase;
serum sodium should rise toward normal; blood glucose is not affected.
9. A patient with a history of gout is prescribed allopurinol. The nurse instructs the
patient to take this medication with which precaution?
A. Take with food to avoid GI upset
B. Increase fluid intake to prevent kidney stones
C. Avoid sunlight due to photosensitivity
4
EXAM PRACTICE QUESTIONS AND
ANSWERS WITH RATIONALES LATEST
UPDATE
It covers medical-surgical nursing, pharmacology, maternity, pediatrics, psychiatric/mental
health, prioritization, delegation, and critical care. Each question includes a correct answer and a
detailed, evidence‑based rationale explaining the clinical reasoning and priority action. This tool
is intended for self‑assessment and content review only. It is not a leaked official HESI exam.
Users must supplement this practice with official study guides and their nursing program’s
resources for complete exam preparation.
1. A patient with acute myocardial infarction is receiving thrombolytic therapy.
Which assessment finding would indicate a major complication of this therapy?
A. Chest pain relief
B. ST-segment elevation resolution
C. Sudden severe headache and vomiting
D. Reperfusion arrhythmias
Answer: C
Rationale: Thrombolytic therapy can cause intracranial hemorrhage. Sudden severe
headache, vomiting, and altered consciousness are signs of bleeding in the brain.
Chest pain relief and ST resolution are desired effects; reperfusion arrhythmias are
common but not as immediately life‑threatening as intracranial bleed.
2. A patient with chronic kidney disease has a serum phosphate of 7.2 mg/dL.
Which medication does the nurse expect to administer?
A. Calcium acetate
B. Ferrous sulfate
1
,C. Erythropoietin
D. Calcitriol
Answer: A
Rationale: Calcium acetate is a phosphate binder that binds dietary phosphate in
the GI tract, reducing serum phosphate levels. Ferrous sulfate treats anemia;
erythropoietin stimulates RBC production; calcitriol is active vitamin D used for
hypocalcemia.
3. A patient is prescribed amiodarone for atrial fibrillation. Which baseline
assessment is most important before starting this drug?
A. Liver function tests
B. Pulmonary function tests
C. Thyroid function tests and chest X‑ray
D. Renal function tests
Answer: C
Rationale: Amiodarone contains iodine and can cause thyroid dysfunction (hyper‑
or hypothyroidism) and pulmonary toxicity (pulmonary fibrosis). Baseline thyroid
function and chest imaging are essential. Liver and renal tests are also monitored
but thyroid and lung are most specific.
4. A post‑operative patient has a Jackson‑Pratt drain with 200 mL of bright red
blood in the first hour after surgery. What should the nurse do first?
A. Document the output as normal
B. Clamp the drain to prevent further loss
C. Notify the surgeon immediately
D. Apply pressure to the insertion site
Answer: C
2
,Rationale: Bright red blood >100 mL/hour in the immediate post‑op period
suggests active hemorrhage. The surgeon must be notified promptly. Clamping the
drain could cause hematoma; applying pressure may be done but notification is the
priority.
5. A patient with asthma is prescribed montelukast. The nurse teaches that this
medication is most effective for which purpose?
A. Acute relief of bronchospasm
B. Prevention of exercise‑induced bronchospasm
C. Treatment of respiratory infections
D. Reduction of mucus production
Answer: B
Rationale: Montelukast is a leukotriene receptor antagonist used for long‑term
control and prevention of exercise‑induced bronchospasm. It is not a rescue
medication for acute attacks.
6. A patient with liver cirrhosis is noted to have spider angiomas and palmar
erythema. These findings are due to which physiological change?
A. Portal hypertension
B. Increased estrogen levels
C. Decreased albumin production
D. Impaired bilirubin conjugation
Answer: B
Rationale: Spider angiomas and palmar erythema are caused by increased
circulating estrogen due to impaired liver metabolism of hormones. Portal
hypertension causes ascites and varices; decreased albumin causes edema;
impaired bilirubin causes jaundice.
3
, 7. A patient on a mechanical ventilator has an endotracheal tube cuff pressure of 30
cm H2O. What action should the nurse take?
A. Document this as a normal finding
B. Deflate the cuff immediately
C. Notify the respiratory therapist to adjust the pressure
D. Add more air to prevent aspiration
Answer: C
Rationale: Recommended cuff pressure is 20–30 cm H2O; 30 is at the upper limit
but may still be acceptable. However, pressures >30 can cause tracheal necrosis.
The nurse should verify with respiratory therapy, but 30 is not an emergency;
deflating could cause aspiration. Notifying is appropriate.
8. A patient with diabetes insipidus is receiving desmopressin. Which finding
indicates the treatment is effective?
A. Increased urine output
B. Decreased serum sodium
C. Decreased thirst and increased urine specific gravity
D. Increased blood glucose
Answer: C
Rationale: Desmopressin (ADH analogue) reduces urine output, increases urine
specific gravity, and decreases thirst. Urine output should decrease, not increase;
serum sodium should rise toward normal; blood glucose is not affected.
9. A patient with a history of gout is prescribed allopurinol. The nurse instructs the
patient to take this medication with which precaution?
A. Take with food to avoid GI upset
B. Increase fluid intake to prevent kidney stones
C. Avoid sunlight due to photosensitivity
4
