HESI RN Comprehensive Exit Exam
2025/2026 – Updated Actual Questions
with Verified Correct Answers and
Expert Explanations
1. A client with a history of heart failure is admitted with dyspnea and bilateral crackles
in the lungs. Which assessment finding requires immediate intervention by the nurse?
A. Heart rate of 88 beats per minute
B. Oxygen saturation of 88%
C. Blood pressure of 140/90 mm Hg
D. Respiratory rate of 20 breaths per minute
Correct Answer: B. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates hypoxemia, which is a critical finding
in a client with heart failure and requires immediate intervention to prevent further
deterioration. Other findings are within normal limits or less urgent.
2. The nurse is caring for a client receiving a blood transfusion. Which symptom indicates
a potential transfusion reaction?
A. Increased urine output
B. Flushing and chills
C. Stable blood pressure
D. Decreased respiratory rate
Correct Answer: B. Flushing and chills
Rationale: Flushing and chills are classic signs of a transfusion reaction, possibly
hemolytic or allergic, requiring immediate cessation of the transfusion and further
assessment. Other options are not indicative of a reaction.
3. A 3-year-old child is admitted with suspected bacterial meningitis. Which assessment
finding is most concerning for increased intracranial pressure (ICP)?
A. Tachycardia and fever
B. Sluggish pupillary response
C. Hyperactive reflexes
D. Mild headache
Correct Answer: B. Sluggish pupillary response
Rationale: Sluggish pupillary response is a critical sign of increased ICP, indicating
, potential neurological compromise. Other findings may be present but are less specific
to ICP.
4. The nurse is preparing to administer insulin glargine to a client with type 1 diabetes.
Which action is most appropriate?
A. Administer the dose in the deltoid muscle
B. Rotate injection sites within the same region
C. Mix the insulin with regular insulin in the same syringe
D. Warm the insulin to room temperature before drawing it up
Correct Answer: B. Rotate injection sites within the same region
Rationale: Rotating injection sites within the same region prevents lipodystrophy and
ensures consistent insulin absorption. Insulin glargine should not be mixed with other
insulins, and IM injections are inappropriate.
5. A client with acute pancreatitis reports severe abdominal pain. Which position should
the nurse encourage to promote comfort?
A. Supine with legs extended
B. Side-lying with knees flexed
C. Prone with head elevated
D. Sitting upright with legs straight
Correct Answer: B. Side-lying with knees flexed
Rationale: The side-lying position with knees flexed reduces tension on the abdominal
muscles, alleviating pain in acute pancreatitis. Other positions may exacerbate
discomfort.
6. A nurse is assessing a client with a suspected myocardial infarction. Which diagnostic
test is most specific for confirming the diagnosis?
A. Electrocardiogram (ECG)
B. Troponin levels
C. Creatine kinase (CK-MB)
D. Chest X-ray
Correct Answer: B. Troponin levels
Rationale: Troponin levels are the most specific and sensitive biomarker for myocardial
infarction, as they rise within hours of cardiac injury and remain elevated for days.
7. A client with schizophrenia is prescribed risperidone. Which side effect should the
nurse monitor for?
A. Photosensitivity
B. Extrapyramidal symptoms
C. Hypoglycemia
, D. Urinary retention
Correct Answer: B. Extrapyramidal symptoms
Rationale: Risperidone, an atypical antipsychotic, can cause extrapyramidal symptoms
such as tremors or rigidity, especially at higher doses. Other options are less
commonly associated.
8. A postpartum client reports heavy vaginal bleeding. Which assessment finding
indicates the need for immediate intervention?
A. Lochia rubra on day 2
B. Saturation of a perineal pad in 1 hour
C. Small clots in the lochia
D. Mild cramping with bleeding
Correct Answer: B. Saturation of a perineal pad in 1 hour
Rationale: Saturation of a perineal pad in 1 hour indicates excessive bleeding,
suggestive of postpartum hemorrhage, requiring urgent intervention. Other findings
are normal postpartum occurrences.
9. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD)
about pursed-lip breathing. What is the primary purpose of this technique?
A. Increase oxygen saturation
B. Reduce airway inflammation
C. Prolong exhalation to reduce air trapping
D. Strengthen respiratory muscles
Correct Answer: C. Prolong exhalation to reduce air trapping
Rationale: Pursed-lip breathing prolongs exhalation, preventing air trapping and
improving gas exchange in clients with COPD. It does not directly increase oxygen
saturation or reduce inflammation.
10. A client is receiving heparin for a deep vein thrombosis (DVT). Which laboratory value
should the nurse monitor?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. Prothrombin time (PT)
Correct Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin’s anticoagulant effect is monitored by aPTT, which assesses the
intrinsic clotting pathway. INR and PT are used for warfarin, while platelet count
monitors for heparin-induced thrombocytopenia.
, 11. A nurse is caring for a client with a nasogastric tube. Which action ensures proper
placement before administering feedings?
A. Checking the pH of aspirated gastric contents
B. Auscultating air injected into the tube
C. Observing for bubbling at the tube’s end
D. Measuring the tube length externally
Correct Answer: A. Checking the pH of aspirated gastric contents
Rationale: Checking the pH of aspirated gastric contents (pH 1–5.5) is the most reliable
method to confirm nasogastric tube placement in the stomach. Auscultation is no
longer recommended due to potential errors.
12. A client with type 2 diabetes is prescribed metformin. Which statement by the client
indicates a need for further teaching?
A. “I should take this medication with meals.”
B. “I need to monitor my blood sugar regularly.”
C. “This medication can cause weight gain.”
D. “I should report muscle pain or weakness.”
Correct Answer: C. “This medication can cause weight gain.”
Rationale: Metformin is weight-neutral or may promote slight weight loss, not weight
gain. The other statements reflect accurate understanding of metformin use.
13. A nurse is preparing to assist with a lumbar puncture. In which position should the
client be placed?
A. Prone with head turned to one side
B. Supine with knees flexed
C. Lateral with knees drawn to chest
D. Sitting upright leaning forward
Correct Answer: C. Lateral with knees drawn to chest
Rationale: The lateral position with knees drawn to the chest maximizes spinal flexion,
facilitating access to the subarachnoid space for a lumbar puncture.
14. A client with a new colostomy asks about dietary restrictions. Which food should the
nurse recommend avoiding to reduce gas and odor?
A. Broccoli
B. Rice
C. Yogurt
D. Bananas
Correct Answer: A. Broccoli
Rationale: Broccoli is a gas-forming food that can increase flatulence and odor in
2025/2026 – Updated Actual Questions
with Verified Correct Answers and
Expert Explanations
1. A client with a history of heart failure is admitted with dyspnea and bilateral crackles
in the lungs. Which assessment finding requires immediate intervention by the nurse?
A. Heart rate of 88 beats per minute
B. Oxygen saturation of 88%
C. Blood pressure of 140/90 mm Hg
D. Respiratory rate of 20 breaths per minute
Correct Answer: B. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates hypoxemia, which is a critical finding
in a client with heart failure and requires immediate intervention to prevent further
deterioration. Other findings are within normal limits or less urgent.
2. The nurse is caring for a client receiving a blood transfusion. Which symptom indicates
a potential transfusion reaction?
A. Increased urine output
B. Flushing and chills
C. Stable blood pressure
D. Decreased respiratory rate
Correct Answer: B. Flushing and chills
Rationale: Flushing and chills are classic signs of a transfusion reaction, possibly
hemolytic or allergic, requiring immediate cessation of the transfusion and further
assessment. Other options are not indicative of a reaction.
3. A 3-year-old child is admitted with suspected bacterial meningitis. Which assessment
finding is most concerning for increased intracranial pressure (ICP)?
A. Tachycardia and fever
B. Sluggish pupillary response
C. Hyperactive reflexes
D. Mild headache
Correct Answer: B. Sluggish pupillary response
Rationale: Sluggish pupillary response is a critical sign of increased ICP, indicating
, potential neurological compromise. Other findings may be present but are less specific
to ICP.
4. The nurse is preparing to administer insulin glargine to a client with type 1 diabetes.
Which action is most appropriate?
A. Administer the dose in the deltoid muscle
B. Rotate injection sites within the same region
C. Mix the insulin with regular insulin in the same syringe
D. Warm the insulin to room temperature before drawing it up
Correct Answer: B. Rotate injection sites within the same region
Rationale: Rotating injection sites within the same region prevents lipodystrophy and
ensures consistent insulin absorption. Insulin glargine should not be mixed with other
insulins, and IM injections are inappropriate.
5. A client with acute pancreatitis reports severe abdominal pain. Which position should
the nurse encourage to promote comfort?
A. Supine with legs extended
B. Side-lying with knees flexed
C. Prone with head elevated
D. Sitting upright with legs straight
Correct Answer: B. Side-lying with knees flexed
Rationale: The side-lying position with knees flexed reduces tension on the abdominal
muscles, alleviating pain in acute pancreatitis. Other positions may exacerbate
discomfort.
6. A nurse is assessing a client with a suspected myocardial infarction. Which diagnostic
test is most specific for confirming the diagnosis?
A. Electrocardiogram (ECG)
B. Troponin levels
C. Creatine kinase (CK-MB)
D. Chest X-ray
Correct Answer: B. Troponin levels
Rationale: Troponin levels are the most specific and sensitive biomarker for myocardial
infarction, as they rise within hours of cardiac injury and remain elevated for days.
7. A client with schizophrenia is prescribed risperidone. Which side effect should the
nurse monitor for?
A. Photosensitivity
B. Extrapyramidal symptoms
C. Hypoglycemia
, D. Urinary retention
Correct Answer: B. Extrapyramidal symptoms
Rationale: Risperidone, an atypical antipsychotic, can cause extrapyramidal symptoms
such as tremors or rigidity, especially at higher doses. Other options are less
commonly associated.
8. A postpartum client reports heavy vaginal bleeding. Which assessment finding
indicates the need for immediate intervention?
A. Lochia rubra on day 2
B. Saturation of a perineal pad in 1 hour
C. Small clots in the lochia
D. Mild cramping with bleeding
Correct Answer: B. Saturation of a perineal pad in 1 hour
Rationale: Saturation of a perineal pad in 1 hour indicates excessive bleeding,
suggestive of postpartum hemorrhage, requiring urgent intervention. Other findings
are normal postpartum occurrences.
9. The nurse is teaching a client with chronic obstructive pulmonary disease (COPD)
about pursed-lip breathing. What is the primary purpose of this technique?
A. Increase oxygen saturation
B. Reduce airway inflammation
C. Prolong exhalation to reduce air trapping
D. Strengthen respiratory muscles
Correct Answer: C. Prolong exhalation to reduce air trapping
Rationale: Pursed-lip breathing prolongs exhalation, preventing air trapping and
improving gas exchange in clients with COPD. It does not directly increase oxygen
saturation or reduce inflammation.
10. A client is receiving heparin for a deep vein thrombosis (DVT). Which laboratory value
should the nurse monitor?
A. International normalized ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
D. Prothrombin time (PT)
Correct Answer: B. Activated partial thromboplastin time (aPTT)
Rationale: Heparin’s anticoagulant effect is monitored by aPTT, which assesses the
intrinsic clotting pathway. INR and PT are used for warfarin, while platelet count
monitors for heparin-induced thrombocytopenia.
, 11. A nurse is caring for a client with a nasogastric tube. Which action ensures proper
placement before administering feedings?
A. Checking the pH of aspirated gastric contents
B. Auscultating air injected into the tube
C. Observing for bubbling at the tube’s end
D. Measuring the tube length externally
Correct Answer: A. Checking the pH of aspirated gastric contents
Rationale: Checking the pH of aspirated gastric contents (pH 1–5.5) is the most reliable
method to confirm nasogastric tube placement in the stomach. Auscultation is no
longer recommended due to potential errors.
12. A client with type 2 diabetes is prescribed metformin. Which statement by the client
indicates a need for further teaching?
A. “I should take this medication with meals.”
B. “I need to monitor my blood sugar regularly.”
C. “This medication can cause weight gain.”
D. “I should report muscle pain or weakness.”
Correct Answer: C. “This medication can cause weight gain.”
Rationale: Metformin is weight-neutral or may promote slight weight loss, not weight
gain. The other statements reflect accurate understanding of metformin use.
13. A nurse is preparing to assist with a lumbar puncture. In which position should the
client be placed?
A. Prone with head turned to one side
B. Supine with knees flexed
C. Lateral with knees drawn to chest
D. Sitting upright leaning forward
Correct Answer: C. Lateral with knees drawn to chest
Rationale: The lateral position with knees drawn to the chest maximizes spinal flexion,
facilitating access to the subarachnoid space for a lumbar puncture.
14. A client with a new colostomy asks about dietary restrictions. Which food should the
nurse recommend avoiding to reduce gas and odor?
A. Broccoli
B. Rice
C. Yogurt
D. Bananas
Correct Answer: A. Broccoli
Rationale: Broccoli is a gas-forming food that can increase flatulence and odor in
