RN HESI EXIT EXAM PRACTICE
VERSION 4 QUESTIONS AND ANSWERS
1. A nurse is assigned to four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client with a history of heart failure who has 2+ pitting edema in the lower extremities.
B. A client post-operative day 1 after a bowel resection reporting pain as 7 out of 10.
C. A client with a new onset of confusion and restlessness who was previously oriented.
D. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90% on room air.
Answer: C
Conceptual Explanation: A change in mental status, such as new-onset confusion and
restlessness, is an early indicator of hypoxia or neurological decline and requires
immediate assessment (ABC priority).
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which
laboratory value is most important for the nurse to monitor to prevent toxicity?
A. Serum potassium levels.
B. Serum calcium levels.
,C. Serum glucose levels.
D. Serum sodium levels.
Answer: D
Conceptual Explanation: Lithium is a salt; low sodium levels can cause lithium retention
in the kidneys, leading to toxic levels. Maintaining consistent sodium intake is crucial.
3. The nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water seal chamber. What is the priority action?
A. Document the finding as normal for a patient post-lobectomy.
B. Increase the suction to the drainage system.
C. Check all connections for a potential air leak.
D. Clamp the chest tube immediately to prevent tension pneumothorax.
Answer: C
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak in the system or from the patient’s pleural space. Intermittent bubbling is normal
during expiration or coughing.
4. A client with Type 1 Diabetes Mellitus is found unconscious and clammy. What is the
nurse’s first action?
A. Administer 15 grams of oral glucose paste.
B. Call the healthcare provider for an order of insulin.
, C. Obtain a stat hemoglobin A1c level.
D. Administer Glucagon IM or SubQ per standing orders.
Answer: D
Conceptual Explanation: For an unconscious client with suspected hypoglycemia,
Glucagon is administered because the client cannot safely swallow oral glucose.
5. A client is admitted with suspected bacterial meningitis. Which isolation precaution should
the nurse implement immediately?
A. Standard precautions.
B. Airborne precautions.
C. Contact precautions.
D. Droplet precautions.
Answer: D
Conceptual Explanation: Bacterial meningitis is transmitted through large-particle
droplets and requires droplet precautions until 24 hours after the initiation of effective
antibiotic therapy.
6. A client in the third trimester of pregnancy presents with painless, bright red vaginal
bleeding. Which procedure is contraindicated?
A. External fetal monitoring.
B. Transabdominal ultrasound.
VERSION 4 QUESTIONS AND ANSWERS
1. A nurse is assigned to four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client with a history of heart failure who has 2+ pitting edema in the lower extremities.
B. A client post-operative day 1 after a bowel resection reporting pain as 7 out of 10.
C. A client with a new onset of confusion and restlessness who was previously oriented.
D. A client with chronic obstructive pulmonary disease (COPD) with an oxygen saturation
of 90% on room air.
Answer: C
Conceptual Explanation: A change in mental status, such as new-onset confusion and
restlessness, is an early indicator of hypoxia or neurological decline and requires
immediate assessment (ABC priority).
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which
laboratory value is most important for the nurse to monitor to prevent toxicity?
A. Serum potassium levels.
B. Serum calcium levels.
,C. Serum glucose levels.
D. Serum sodium levels.
Answer: D
Conceptual Explanation: Lithium is a salt; low sodium levels can cause lithium retention
in the kidneys, leading to toxic levels. Maintaining consistent sodium intake is crucial.
3. The nurse is caring for a client with a chest tube following a lobectomy. The nurse notes
continuous bubbling in the water seal chamber. What is the priority action?
A. Document the finding as normal for a patient post-lobectomy.
B. Increase the suction to the drainage system.
C. Check all connections for a potential air leak.
D. Clamp the chest tube immediately to prevent tension pneumothorax.
Answer: C
Conceptual Explanation: Continuous bubbling in the water seal chamber indicates an air
leak in the system or from the patient’s pleural space. Intermittent bubbling is normal
during expiration or coughing.
4. A client with Type 1 Diabetes Mellitus is found unconscious and clammy. What is the
nurse’s first action?
A. Administer 15 grams of oral glucose paste.
B. Call the healthcare provider for an order of insulin.
, C. Obtain a stat hemoglobin A1c level.
D. Administer Glucagon IM or SubQ per standing orders.
Answer: D
Conceptual Explanation: For an unconscious client with suspected hypoglycemia,
Glucagon is administered because the client cannot safely swallow oral glucose.
5. A client is admitted with suspected bacterial meningitis. Which isolation precaution should
the nurse implement immediately?
A. Standard precautions.
B. Airborne precautions.
C. Contact precautions.
D. Droplet precautions.
Answer: D
Conceptual Explanation: Bacterial meningitis is transmitted through large-particle
droplets and requires droplet precautions until 24 hours after the initiation of effective
antibiotic therapy.
6. A client in the third trimester of pregnancy presents with painless, bright red vaginal
bleeding. Which procedure is contraindicated?
A. External fetal monitoring.
B. Transabdominal ultrasound.
