2026/2027
HESI RN Exit Advanced Exam
Preparation and Study Companion:
Comprehensive Review Modules,
Complete Test Bank, Updated
Practice Tests, and Final Readiness
Assessment
Question 1:
A female client presents in the emergency department reporting a sexual assault that
occurred the previous night. Which nursing question is the highest priority during the
initial assessment?
A. Have you bathed or changed clothing since the incident?
B. Do you feel safe returning to your current residence?
C. Do you know the person who assaulted you?
D. Have you reported the incident to law enforcement?
Correct Answer: A. Have you bathed or changed clothing since the incident?
Rationale:
Initial assessment should prioritize preservation of forensic evidence. Bathing or
changing clothes may remove DNA and other trace evidence. Medical stabilization
always comes first, but when assessing the sexual assault history, evidence
preservation is a key early priority. (NIH)
Question 2
A 3-year-old child is admitted with bacterial meningitis and hydrocephalus. Which
finding most strongly suggests increased intracranial pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary response
C. Increased head circumference with bulging fontanels
D. Blood pressure fluctuations with syncope
Correct Answer: B. Sluggish and unequal pupillary response
Rationale:
Pupil changes are important signs of rising ICP and possible brainstem involvement.
,2026/2027
In a 3-year-old, bulging fontanels are not expected because the fontanels should be
closed by this age. (NIH)
Question 3
A client with acute pancreatitis reports severe abdominal pain. Which additional
symptom is most likely?
A. Pain improves when lying supine
B. Pain lasts briefly and resolves completely
C. Right upper quadrant pain radiating to scapula
D. History of alcohol intake twice weekly
Correct Answer: None of the options is ideal; the classic finding is pain relieved
by leaning forward
Rationale:
Acute pancreatitis typically causes severe epigastric pain that is often relieved by
leaning forward or sitting upright; the supine position may worsen pain. Because
none of the options states that correctly, this item should be revised. (AAFP)
Question 4
A child with sickle cell anemia is being discharged. Which instruction is most
important?
A. Ensure adequate daily fluid intake
B. Monitor for opioid addiction
C. Encourage non-pharmacologic pain relief
D. Refer family to social services
Correct Answer: A. Ensure adequate daily fluid intake
Rationale:
Hydration helps prevent sickling and vaso-occlusive crises. Dehydration increases
blood viscosity and worsens complications.
Question 5
Which finding indicates increased intracranial pressure in a pediatric client?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupils
,2026/2027
C. Bulging fontanel and enlarged head
D. Syncope with BP fluctuations
Correct Answer: B. Sluggish and unequal pupils
Rationale:
Pupillary changes are a concerning sign of ICP elevation. Bulging fontanels are
relevant mainly in infants, not older children. (NIH)
Question 6
After report, which client should the nurse assess first?
A. Large bowel obstruction with abdominal distention
B. Postoperative paralytic ileus with absent bowel sounds
C. Small bowel obstruction with NG tube drainage
D. Volvulus with abdominal rigidity
Correct Answer: D. Volvulus with abdominal rigidity
Rationale:
Rigid abdomen with volvulus suggests bowel strangulation and possible ischemia,
which is an emergency.
Question 7
A teenager hyperventilates after vaping and presents with anxiety. Which acid-base
imbalance is expected?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: D. Respiratory alkalosis
Rationale:
Hyperventilation lowers carbon dioxide levels, causing respiratory alkalosis.
Question 8
A client with dyspnea is admitted. Which bed position is most appropriate?
, 2026/2027
A. Supine
B. Supine with feet elevated
C. Supine with head elevated
D. Fowler’s position
Correct Answer: D. Fowler’s position
Rationale:
Fowler’s position improves lung expansion and reduces work of breathing.
Question 9
Which findings in Parkinson’s disease are relevant when planning blood pressure
measurement? (Select all that apply)
A. Frequent syncope
B. Occasional nocturia
C. Flat affect
D. Blurred vision
E. Frequent drooling
Correct Answer: A, D
Rationale:
Parkinson’s disease is commonly associated with orthostatic hypotension, which can
cause syncope and vision changes. Flat affect and drooling are important symptoms
of Parkinson’s disease, but they are not the key findings for planning blood pressure
measurement. (PARKINSON)
Question 10
A wound shows purulent drainage. Which laboratory value should be reviewed first?
A. Serum albumin
B. Wound culture and sensitivity
C. Serum glucose
D. Creatinine level
Correct Answer: B. Wound culture and sensitivity
Rationale:
Purulent drainage suggests infection, and culture and sensitivity identify the organism
and guide treatment.
HESI RN Exit Advanced Exam
Preparation and Study Companion:
Comprehensive Review Modules,
Complete Test Bank, Updated
Practice Tests, and Final Readiness
Assessment
Question 1:
A female client presents in the emergency department reporting a sexual assault that
occurred the previous night. Which nursing question is the highest priority during the
initial assessment?
A. Have you bathed or changed clothing since the incident?
B. Do you feel safe returning to your current residence?
C. Do you know the person who assaulted you?
D. Have you reported the incident to law enforcement?
Correct Answer: A. Have you bathed or changed clothing since the incident?
Rationale:
Initial assessment should prioritize preservation of forensic evidence. Bathing or
changing clothes may remove DNA and other trace evidence. Medical stabilization
always comes first, but when assessing the sexual assault history, evidence
preservation is a key early priority. (NIH)
Question 2
A 3-year-old child is admitted with bacterial meningitis and hydrocephalus. Which
finding most strongly suggests increased intracranial pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary response
C. Increased head circumference with bulging fontanels
D. Blood pressure fluctuations with syncope
Correct Answer: B. Sluggish and unequal pupillary response
Rationale:
Pupil changes are important signs of rising ICP and possible brainstem involvement.
,2026/2027
In a 3-year-old, bulging fontanels are not expected because the fontanels should be
closed by this age. (NIH)
Question 3
A client with acute pancreatitis reports severe abdominal pain. Which additional
symptom is most likely?
A. Pain improves when lying supine
B. Pain lasts briefly and resolves completely
C. Right upper quadrant pain radiating to scapula
D. History of alcohol intake twice weekly
Correct Answer: None of the options is ideal; the classic finding is pain relieved
by leaning forward
Rationale:
Acute pancreatitis typically causes severe epigastric pain that is often relieved by
leaning forward or sitting upright; the supine position may worsen pain. Because
none of the options states that correctly, this item should be revised. (AAFP)
Question 4
A child with sickle cell anemia is being discharged. Which instruction is most
important?
A. Ensure adequate daily fluid intake
B. Monitor for opioid addiction
C. Encourage non-pharmacologic pain relief
D. Refer family to social services
Correct Answer: A. Ensure adequate daily fluid intake
Rationale:
Hydration helps prevent sickling and vaso-occlusive crises. Dehydration increases
blood viscosity and worsens complications.
Question 5
Which finding indicates increased intracranial pressure in a pediatric client?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupils
,2026/2027
C. Bulging fontanel and enlarged head
D. Syncope with BP fluctuations
Correct Answer: B. Sluggish and unequal pupils
Rationale:
Pupillary changes are a concerning sign of ICP elevation. Bulging fontanels are
relevant mainly in infants, not older children. (NIH)
Question 6
After report, which client should the nurse assess first?
A. Large bowel obstruction with abdominal distention
B. Postoperative paralytic ileus with absent bowel sounds
C. Small bowel obstruction with NG tube drainage
D. Volvulus with abdominal rigidity
Correct Answer: D. Volvulus with abdominal rigidity
Rationale:
Rigid abdomen with volvulus suggests bowel strangulation and possible ischemia,
which is an emergency.
Question 7
A teenager hyperventilates after vaping and presents with anxiety. Which acid-base
imbalance is expected?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: D. Respiratory alkalosis
Rationale:
Hyperventilation lowers carbon dioxide levels, causing respiratory alkalosis.
Question 8
A client with dyspnea is admitted. Which bed position is most appropriate?
, 2026/2027
A. Supine
B. Supine with feet elevated
C. Supine with head elevated
D. Fowler’s position
Correct Answer: D. Fowler’s position
Rationale:
Fowler’s position improves lung expansion and reduces work of breathing.
Question 9
Which findings in Parkinson’s disease are relevant when planning blood pressure
measurement? (Select all that apply)
A. Frequent syncope
B. Occasional nocturia
C. Flat affect
D. Blurred vision
E. Frequent drooling
Correct Answer: A, D
Rationale:
Parkinson’s disease is commonly associated with orthostatic hypotension, which can
cause syncope and vision changes. Flat affect and drooling are important symptoms
of Parkinson’s disease, but they are not the key findings for planning blood pressure
measurement. (PARKINSON)
Question 10
A wound shows purulent drainage. Which laboratory value should be reviewed first?
A. Serum albumin
B. Wound culture and sensitivity
C. Serum glucose
D. Creatinine level
Correct Answer: B. Wound culture and sensitivity
Rationale:
Purulent drainage suggests infection, and culture and sensitivity identify the organism
and guide treatment.
