HESI Exit Exam Questions and Answers -
Latest Update Study Guide & Practice Test
LATEST UPDATE
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
A comprehensive, high-fidelity practice exam modeled on the HESI Exit Examination, spanning
medical-surgical, pharmacology, maternal-newborn, pediatric, psychiatric, community health, leadership, and
dosage calculation domains. Items emphasize clinical judgment, prioritization, safety, and evidence-based
practice consistent with current NCLEX-RN and AACN standards.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 900 (HESI scaled score; recommended benchmark for
NCLEX readiness).
HIGHP - Page 1 of 46
,1. A postoperative patient receiving morphine via PCA has a respiratory rate of 8/min and
SpO2 of 88% on room air. Which action should the nurse take FIRST?
[ ] A. Administer naloxone 0.4 mg IV push.
[ ] B. Stimulate the patient and encourage deep breathing.
[ ] C. Apply supplemental oxygen via nasal cannula.
[ ] D. Notify the provider and prepare for intubation.
CORRECT: B. Stimulate the patient and encourage deep breathing.
Stimulation and arousal are the immediate first-line interventions for opioid-induced respiratory depression,
as they can reverse sedation without reversing analgesia. Naloxone is reserved for unresponsive patients or
those not responding to stimulation. Oxygen alone does not address the underlying cause, and intubation is
premature.
2. A patient with heart failure is prescribed furosemide 40 mg IV. Which laboratory value
should the nurse monitor MOST closely after administration?
[ ] A. Serum sodium
[ ] B. Serum potassium
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum potassium
Loop diuretics like furosemide cause significant potassium loss, increasing the risk of hypokalemia and
dysrhythmias. While sodium, calcium, and magnesium can also be affected, potassium is the most critical
and commonly monitored electrolyte with loop diuretic therapy.
3. Which finding in a patient with a new colostomy requires IMMEDIATE nursing
intervention?
[ ] A. Stoma is dark red and moist.
[ ] B. Stoma is pale and dry.
[ ] C. Output is liquid and green.
[ ] D. Mild peristomal irritation.
CORRECT: B. Stoma is pale and dry.
A pale, dry stoma indicates inadequate perfusion and possible ischemia/necrosis, requiring immediate
intervention. A dark red, moist stoma is normal. Liquid green output is expected initially. Mild peristomal
irritation is common and not urgent.
4. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
MOST appropriate to delegate?
[ ] A. Administering oral medications to stable patients.
HIGHP - Page 2 of 46
, [ ] B. Obtaining vital signs on a postoperative patient.
[ ] C. Assessing a patient's incisional pain level.
[ ] D. Teaching a patient about insulin injection technique.
CORRECT: B. Obtaining vital signs on a postoperative patient.
Vital sign measurement on stable patients is within UAP scope. Medication administration, assessment, and
patient teaching require a licensed nurse and cannot be delegated. Delegation must follow the Five Rights of
Delegation.
5. A laboring patient at 38 weeks gestation has a Category III fetal heart tracing. Which
action should the nurse take FIRST?
[ ] A. Prepare for immediate cesarean delivery.
[ ] B. Reposition the patient to left lateral and administer oxygen.
[ ] C. Increase oxytocin infusion rate.
[ ] D. Document the tracing and continue monitoring.
CORRECT: B. Reposition the patient to left lateral and administer oxygen.
Category III tracings require immediate intrauterine resuscitation: repositioning, oxygen, and stopping
oxytocin. Cesarean delivery is considered if resuscitation fails. Increasing oxytocin is contraindicated.
Documentation alone is insufficient.
6. A patient prescribed lithium carbonate reports a 3-day history of vomiting and diarrhea.
Which finding is MOST concerning?
[ ] A. Lithium level of 0.8 mEq/L
[ ] B. Lithium level of 1.8 mEq/L
[ ] C. Serum sodium of 138 mEq/L
[ ] D. Serum potassium of 4.0 mEq/L
CORRECT: B. Lithium level of 1.8 mEq/L
Dehydration from vomiting/diarrhea can cause lithium toxicity; a level of 1.8 mEq/L exceeds therapeutic
range (0.6-1.2 mEq/L) and is dangerous. Other values are within normal limits. Lithium toxicity can cause
tremors, ataxia, and seizures.
7. A community health nurse is planning a primary prevention program. Which activity
BEST exemplifies primary prevention?
[ ] A. Providing influenza vaccinations at a senior center.
[ ] B. Screening for hypertension at a health fair.
[ ] C. Teaching a patient with diabetes about foot care.
[ ] D. Referring a patient with depression to counseling.
HIGHP - Page 3 of 46
, CORRECT: A. Providing influenza vaccinations at a senior center.
Primary prevention aims to prevent disease before it occurs; vaccination is a classic example. Screening is
secondary prevention. Teaching foot care to a diabetic and referring for depression are tertiary prevention
(managing existing disease).
8. A nurse is calculating a pediatric dose. The order is for ceftriaxone 50 mg/kg/day IV
divided every 12 hours. The child weighs 22 lb. How many mg should the nurse administer
per dose? (Round to the nearest whole number.)
[ ] A. 250 mg
[ ] B. 500 mg
[ ] C. 1000 mg
[ ] D. 125 mg
CORRECT: A. 250 mg
Convert weight: 22 lb ÷ 2.2 = 10 kg. Total daily dose = 50 mg × 10 kg = 500 mg/day. Divided every 12 hours =
250 mg per dose. Other options reflect calculation errors.
9. A patient with schizophrenia is started on clozapine. Which adverse effect requires
IMMEDIATE notification of the provider?
[ ] A. Weight gain of 2 kg over 1 month.
[ ] B. Temperature of 101.5°F and sore throat.
[ ] C. Mild sedation in the morning.
[ ] D. Constipation relieved by diet.
CORRECT: B. Temperature of 101.5°F and sore throat.
Clozapine can cause agranulocytosis; fever and sore throat may indicate infection due to neutropenia,
requiring immediate CBC and provider notification. Weight gain, sedation, and constipation are common side
effects but not emergencies.
10. A client receiving continuous IV heparin therapy has an aPTT of 92 seconds (control
30 seconds). Based on the standard heparin nomogram, which action should the nurse
anticipate?
[ ] A. Increase the infusion rate by 2 units/kg/hr
[ ] B. Hold the infusion for 1 hour, then restart at a reduced rate
[ ] C. Continue the current rate and recheck aPTT in 6 hours
[ ] D. Administer protamine sulfate IV push immediately
CORRECT: B. Hold the infusion for 1 hour, then restart at a reduced rate
A therapeutic aPTT is typically 1.5-2.5 times control (45-75 seconds); 92 seconds exceeds this, so the
HIGHP - Page 4 of 46
Latest Update Study Guide & Practice Test
LATEST UPDATE
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
146 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
A comprehensive, high-fidelity practice exam modeled on the HESI Exit Examination, spanning
medical-surgical, pharmacology, maternal-newborn, pediatric, psychiatric, community health, leadership, and
dosage calculation domains. Items emphasize clinical judgment, prioritization, safety, and evidence-based
practice consistent with current NCLEX-RN and AACN standards.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 900 (HESI scaled score; recommended benchmark for
NCLEX readiness).
HIGHP - Page 1 of 46
,1. A postoperative patient receiving morphine via PCA has a respiratory rate of 8/min and
SpO2 of 88% on room air. Which action should the nurse take FIRST?
[ ] A. Administer naloxone 0.4 mg IV push.
[ ] B. Stimulate the patient and encourage deep breathing.
[ ] C. Apply supplemental oxygen via nasal cannula.
[ ] D. Notify the provider and prepare for intubation.
CORRECT: B. Stimulate the patient and encourage deep breathing.
Stimulation and arousal are the immediate first-line interventions for opioid-induced respiratory depression,
as they can reverse sedation without reversing analgesia. Naloxone is reserved for unresponsive patients or
those not responding to stimulation. Oxygen alone does not address the underlying cause, and intubation is
premature.
2. A patient with heart failure is prescribed furosemide 40 mg IV. Which laboratory value
should the nurse monitor MOST closely after administration?
[ ] A. Serum sodium
[ ] B. Serum potassium
[ ] C. Serum calcium
[ ] D. Serum magnesium
CORRECT: B. Serum potassium
Loop diuretics like furosemide cause significant potassium loss, increasing the risk of hypokalemia and
dysrhythmias. While sodium, calcium, and magnesium can also be affected, potassium is the most critical
and commonly monitored electrolyte with loop diuretic therapy.
3. Which finding in a patient with a new colostomy requires IMMEDIATE nursing
intervention?
[ ] A. Stoma is dark red and moist.
[ ] B. Stoma is pale and dry.
[ ] C. Output is liquid and green.
[ ] D. Mild peristomal irritation.
CORRECT: B. Stoma is pale and dry.
A pale, dry stoma indicates inadequate perfusion and possible ischemia/necrosis, requiring immediate
intervention. A dark red, moist stoma is normal. Liquid green output is expected initially. Mild peristomal
irritation is common and not urgent.
4. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is
MOST appropriate to delegate?
[ ] A. Administering oral medications to stable patients.
HIGHP - Page 2 of 46
, [ ] B. Obtaining vital signs on a postoperative patient.
[ ] C. Assessing a patient's incisional pain level.
[ ] D. Teaching a patient about insulin injection technique.
CORRECT: B. Obtaining vital signs on a postoperative patient.
Vital sign measurement on stable patients is within UAP scope. Medication administration, assessment, and
patient teaching require a licensed nurse and cannot be delegated. Delegation must follow the Five Rights of
Delegation.
5. A laboring patient at 38 weeks gestation has a Category III fetal heart tracing. Which
action should the nurse take FIRST?
[ ] A. Prepare for immediate cesarean delivery.
[ ] B. Reposition the patient to left lateral and administer oxygen.
[ ] C. Increase oxytocin infusion rate.
[ ] D. Document the tracing and continue monitoring.
CORRECT: B. Reposition the patient to left lateral and administer oxygen.
Category III tracings require immediate intrauterine resuscitation: repositioning, oxygen, and stopping
oxytocin. Cesarean delivery is considered if resuscitation fails. Increasing oxytocin is contraindicated.
Documentation alone is insufficient.
6. A patient prescribed lithium carbonate reports a 3-day history of vomiting and diarrhea.
Which finding is MOST concerning?
[ ] A. Lithium level of 0.8 mEq/L
[ ] B. Lithium level of 1.8 mEq/L
[ ] C. Serum sodium of 138 mEq/L
[ ] D. Serum potassium of 4.0 mEq/L
CORRECT: B. Lithium level of 1.8 mEq/L
Dehydration from vomiting/diarrhea can cause lithium toxicity; a level of 1.8 mEq/L exceeds therapeutic
range (0.6-1.2 mEq/L) and is dangerous. Other values are within normal limits. Lithium toxicity can cause
tremors, ataxia, and seizures.
7. A community health nurse is planning a primary prevention program. Which activity
BEST exemplifies primary prevention?
[ ] A. Providing influenza vaccinations at a senior center.
[ ] B. Screening for hypertension at a health fair.
[ ] C. Teaching a patient with diabetes about foot care.
[ ] D. Referring a patient with depression to counseling.
HIGHP - Page 3 of 46
, CORRECT: A. Providing influenza vaccinations at a senior center.
Primary prevention aims to prevent disease before it occurs; vaccination is a classic example. Screening is
secondary prevention. Teaching foot care to a diabetic and referring for depression are tertiary prevention
(managing existing disease).
8. A nurse is calculating a pediatric dose. The order is for ceftriaxone 50 mg/kg/day IV
divided every 12 hours. The child weighs 22 lb. How many mg should the nurse administer
per dose? (Round to the nearest whole number.)
[ ] A. 250 mg
[ ] B. 500 mg
[ ] C. 1000 mg
[ ] D. 125 mg
CORRECT: A. 250 mg
Convert weight: 22 lb ÷ 2.2 = 10 kg. Total daily dose = 50 mg × 10 kg = 500 mg/day. Divided every 12 hours =
250 mg per dose. Other options reflect calculation errors.
9. A patient with schizophrenia is started on clozapine. Which adverse effect requires
IMMEDIATE notification of the provider?
[ ] A. Weight gain of 2 kg over 1 month.
[ ] B. Temperature of 101.5°F and sore throat.
[ ] C. Mild sedation in the morning.
[ ] D. Constipation relieved by diet.
CORRECT: B. Temperature of 101.5°F and sore throat.
Clozapine can cause agranulocytosis; fever and sore throat may indicate infection due to neutropenia,
requiring immediate CBC and provider notification. Weight gain, sedation, and constipation are common side
effects but not emergencies.
10. A client receiving continuous IV heparin therapy has an aPTT of 92 seconds (control
30 seconds). Based on the standard heparin nomogram, which action should the nurse
anticipate?
[ ] A. Increase the infusion rate by 2 units/kg/hr
[ ] B. Hold the infusion for 1 hour, then restart at a reduced rate
[ ] C. Continue the current rate and recheck aPTT in 6 hours
[ ] D. Administer protamine sulfate IV push immediately
CORRECT: B. Hold the infusion for 1 hour, then restart at a reduced rate
A therapeutic aPTT is typically 1.5-2.5 times control (45-75 seconds); 92 seconds exceeds this, so the
HIGHP - Page 4 of 46
