1
HESI RN EXIT EXAM 2025 –
COMPREHENSIVE REVIEW &
VERIFIED ANSWERS | GRADED A+
Medical-Surgical Nursing (40 Questions)
1. A client with a new colostomy is distressed about stoma appearance. What is the
nurse’s priority action?
A. Teach dietary restrictions
B. Administer pain medication
C. Assess the stoma
D. Schedule a follow-up appointment
Correct Answer: C. Assess the stoma
Rationale: Assessing the stoma ensures it is viable (pink, moist) and detects
complications like ischemia, per WOCN 2025 guidelines.
2. A client with heart failure gains 3 lb in 24 hours. What is the nurse’s first action?
A. Increase diuretic dose
B. Assess lung sounds
C. Restrict all fluids
D. Encourage ambulation
Correct Answer: B. Assess lung sounds
Rationale: Rapid weight gain suggests fluid retention; assessing lung sounds detects
pulmonary edema, a priority per AHA 2025 guidelines.
3. A client with COPD reports worsening dyspnea. What should the nurse do first?
A. Administer albuterol nebulizer
B. Increase oxygen to 6 L/min
C. Position in high Fowler’s
D. Check arterial blood gases
Correct Answer: C. Position in high Fowler’s
Rationale: High Fowler’s position optimizes lung expansion, addressing dyspnea
immediately, per GOLD 2025 COPD guidelines.
4. A client with a pulmonary embolism receives heparin. What lab should the nurse
monitor?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B. aPTT
Rationale: Heparin’s anticoagulant effect is monitored via aPTT (target 1.5–2.5 times
normal) to prevent bleeding, per ACCP 2025 guidelines.
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. What is
the priority intervention?
, 2
A. Administer insulin drip
B. Give oral glucose
C. Restrict all fluids
D. Administer potassium supplements
Correct Answer: A. Administer insulin drip
Rationale: Insulin drip corrects hyperglycemia and ketosis in DKA, per ADA 2025
guidelines.
6. A client post-myocardial infarction reports chest pain. What is the nurse’s first
action?
A. Administer nitroglycerin as prescribed
B. Notify the healthcare provider
C. Perform a 12-lead ECG
D. Encourage deep breathing
Correct Answer: B. Notify the healthcare provider
Rationale: Recurrent chest pain post-MI may indicate ischemia, requiring immediate
provider evaluation, per AHA 2025 guidelines.
7. A client with a stage 3 pressure injury is repositioned every 2 hours. What is the
purpose?
A. Increase client comfort
B. Prevent further tissue damage
C. Improve wound drainage
D. Reduce dressing changes
Correct Answer: B. Prevent further tissue damage
Rationale: Repositioning relieves pressure, preventing worsening of pressure injuries,
per NPUAP 2025 guidelines.
8. A client with chronic kidney disease reports muscle cramps. What should the nurse
assess first?
A. Serum potassium
B. Blood pressure
C. Fluid intake
D. Skin turgor
Correct Answer: A. Serum potassium
Rationale: Muscle cramps in CKD may indicate hyperkalemia, requiring urgent
assessment, per NKF 2025 guidelines.
9. A client with a chest tube has sudden shortness of breath. What should the nurse
check first?
A. Tube connections
B. Oxygen saturation
C. Blood pressure
D. Dressing integrity
Correct Answer: A. Tube connections
Rationale: Loose connections can cause air leaks, leading to pneumothorax, a priority to
check, per HESI chest tube protocols.
10. A client with cirrhosis has ascites. What dietary restriction should the nurse
reinforce?
A. Low-protein diet
, 3
B. Low-sodium diet
C. High-fat diet
D. High-carbohydrate diet
Correct Answer: B. Low-sodium diet
Rationale: Low-sodium diet reduces fluid retention, managing ascites, per AASLD 2025
guidelines.
11. A client with a new tracheostomy is coughing during suctioning. What should the
nurse do?
A. Increase suction pressure
B. Stop suctioning and reassess
C. Suction for 20 seconds
D. Apply saline during suctioning
Correct Answer: B. Stop suctioning and reassess
Rationale: Coughing may indicate airway irritation; stopping suctioning prevents
trauma, per HESI tracheostomy care standards.
12. A client with rheumatoid arthritis reports morning stiffness. What should the nurse
recommend?
A. Avoid all physical activity
B. Perform gentle range-of-motion exercises
C. Apply ice to joints daily
D. Take NSAIDs at bedtime only
Correct Answer: B. Perform gentle range-of-motion exercises
Rationale: Gentle exercises reduce stiffness and improve mobility, per ACR 2025
guidelines.
13. A client with a urinary catheter reports discomfort. What should the nurse check
first?
A. Catheter patency
B. Urine color
C. Bladder distension
D. Skin integrity
Correct Answer: A. Catheter patency
Rationale: Discomfort may indicate a blocked catheter, requiring immediate assessment,
per INS 2025 standards.
14. A client with pneumonia has a productive cough. What should the nurse encourage?
A. Suppress the cough
B. Increase fluid intake to 2 L/day
C. Limit ambulation
D. Avoid deep breathing
Correct Answer: B. Increase fluid intake to 2 L/day
Rationale: Hydration thins secretions, facilitating expectoration, per HESI respiratory
care guidelines.
15. A client with a history of stroke has dysphagia. What should the nurse do during
meals?
A. Offer thin liquids
B. Position the client upright
C. Encourage large bites
HESI RN EXIT EXAM 2025 –
COMPREHENSIVE REVIEW &
VERIFIED ANSWERS | GRADED A+
Medical-Surgical Nursing (40 Questions)
1. A client with a new colostomy is distressed about stoma appearance. What is the
nurse’s priority action?
A. Teach dietary restrictions
B. Administer pain medication
C. Assess the stoma
D. Schedule a follow-up appointment
Correct Answer: C. Assess the stoma
Rationale: Assessing the stoma ensures it is viable (pink, moist) and detects
complications like ischemia, per WOCN 2025 guidelines.
2. A client with heart failure gains 3 lb in 24 hours. What is the nurse’s first action?
A. Increase diuretic dose
B. Assess lung sounds
C. Restrict all fluids
D. Encourage ambulation
Correct Answer: B. Assess lung sounds
Rationale: Rapid weight gain suggests fluid retention; assessing lung sounds detects
pulmonary edema, a priority per AHA 2025 guidelines.
3. A client with COPD reports worsening dyspnea. What should the nurse do first?
A. Administer albuterol nebulizer
B. Increase oxygen to 6 L/min
C. Position in high Fowler’s
D. Check arterial blood gases
Correct Answer: C. Position in high Fowler’s
Rationale: High Fowler’s position optimizes lung expansion, addressing dyspnea
immediately, per GOLD 2025 COPD guidelines.
4. A client with a pulmonary embolism receives heparin. What lab should the nurse
monitor?
A. INR
B. aPTT
C. Platelet count
D. Hemoglobin
Correct Answer: B. aPTT
Rationale: Heparin’s anticoagulant effect is monitored via aPTT (target 1.5–2.5 times
normal) to prevent bleeding, per ACCP 2025 guidelines.
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL. What is
the priority intervention?
, 2
A. Administer insulin drip
B. Give oral glucose
C. Restrict all fluids
D. Administer potassium supplements
Correct Answer: A. Administer insulin drip
Rationale: Insulin drip corrects hyperglycemia and ketosis in DKA, per ADA 2025
guidelines.
6. A client post-myocardial infarction reports chest pain. What is the nurse’s first
action?
A. Administer nitroglycerin as prescribed
B. Notify the healthcare provider
C. Perform a 12-lead ECG
D. Encourage deep breathing
Correct Answer: B. Notify the healthcare provider
Rationale: Recurrent chest pain post-MI may indicate ischemia, requiring immediate
provider evaluation, per AHA 2025 guidelines.
7. A client with a stage 3 pressure injury is repositioned every 2 hours. What is the
purpose?
A. Increase client comfort
B. Prevent further tissue damage
C. Improve wound drainage
D. Reduce dressing changes
Correct Answer: B. Prevent further tissue damage
Rationale: Repositioning relieves pressure, preventing worsening of pressure injuries,
per NPUAP 2025 guidelines.
8. A client with chronic kidney disease reports muscle cramps. What should the nurse
assess first?
A. Serum potassium
B. Blood pressure
C. Fluid intake
D. Skin turgor
Correct Answer: A. Serum potassium
Rationale: Muscle cramps in CKD may indicate hyperkalemia, requiring urgent
assessment, per NKF 2025 guidelines.
9. A client with a chest tube has sudden shortness of breath. What should the nurse
check first?
A. Tube connections
B. Oxygen saturation
C. Blood pressure
D. Dressing integrity
Correct Answer: A. Tube connections
Rationale: Loose connections can cause air leaks, leading to pneumothorax, a priority to
check, per HESI chest tube protocols.
10. A client with cirrhosis has ascites. What dietary restriction should the nurse
reinforce?
A. Low-protein diet
, 3
B. Low-sodium diet
C. High-fat diet
D. High-carbohydrate diet
Correct Answer: B. Low-sodium diet
Rationale: Low-sodium diet reduces fluid retention, managing ascites, per AASLD 2025
guidelines.
11. A client with a new tracheostomy is coughing during suctioning. What should the
nurse do?
A. Increase suction pressure
B. Stop suctioning and reassess
C. Suction for 20 seconds
D. Apply saline during suctioning
Correct Answer: B. Stop suctioning and reassess
Rationale: Coughing may indicate airway irritation; stopping suctioning prevents
trauma, per HESI tracheostomy care standards.
12. A client with rheumatoid arthritis reports morning stiffness. What should the nurse
recommend?
A. Avoid all physical activity
B. Perform gentle range-of-motion exercises
C. Apply ice to joints daily
D. Take NSAIDs at bedtime only
Correct Answer: B. Perform gentle range-of-motion exercises
Rationale: Gentle exercises reduce stiffness and improve mobility, per ACR 2025
guidelines.
13. A client with a urinary catheter reports discomfort. What should the nurse check
first?
A. Catheter patency
B. Urine color
C. Bladder distension
D. Skin integrity
Correct Answer: A. Catheter patency
Rationale: Discomfort may indicate a blocked catheter, requiring immediate assessment,
per INS 2025 standards.
14. A client with pneumonia has a productive cough. What should the nurse encourage?
A. Suppress the cough
B. Increase fluid intake to 2 L/day
C. Limit ambulation
D. Avoid deep breathing
Correct Answer: B. Increase fluid intake to 2 L/day
Rationale: Hydration thins secretions, facilitating expectoration, per HESI respiratory
care guidelines.
15. A client with a history of stroke has dysphagia. What should the nurse do during
meals?
A. Offer thin liquids
B. Position the client upright
C. Encourage large bites
