HESI Exit Exam VERSION 2 (V2) | Complete
Real Exam Study Guide with Questions, 100%
Verified Correct Answers and Rationales |
Latest Update 2026/2027
Question 1
A school-age client with diabetes is placed on an intermediate-acting insulin and regular
insulin before breakfast and before dinner. She will receive a snack of milk and cereal at
bedtime. What does the nurse tell the client the snack is intended to do?
Answer: Prevent late night hypoglycemia. ✔✔
Rationale: The bedtime snack provides carbohydrates that help maintain blood
glucose levels throughout the night and prevent hypoglycemia caused by the peak action
of intermediate-acting insulin.
Question 2
A well-known public official of a small community is admitted to the emergency
department following an episode of chest pain. Several nurses from the medical unit are
aware of the admission and access the official's electronic medical record to obtain a
status update. What is the best response for the nurse manager to make to the nurses
regarding this situation?
Answer: "Assessing the official's medical record is a breach of confidentiality." ✔✔
Rationale: Accessing a client's medical record without a legitimate need-to-know
violates HIPAA and confidentiality laws, regardless of the client's public status.
Question 3
The nurse is caring for a client with influenza. The most effective way to decrease the
spread of microorganisms is:
Answer: washing the hands frequently. ✔✔
Rationale: Hand hygiene is the single most effective infection control measure to
prevent the spread of microorganisms, including influenza.
pg. 1
,Question 4
A client with a history of hypertension has been prescribed a new antihypertensive
medication and is reporting dizziness. Which is the best way for the nurse to assess
blood pressure?
Answer: in the supine, sitting, and standing positions. ✔✔
Rationale: Orthostatic blood pressure measurements in three positions help detect
postural hypotension, a common side effect of antihypertensive medications.
Question 5
A client has a soft wrist-safety device. Which assessment finding should the nurse
investigate further?
Answer: cool, pale fingers. ✔✔
Rationale: Cool, pale fingers indicate impaired circulation from the wrist restraint.
This requires immediate investigation and intervention to prevent tissue damage.
Question 6
A nurse is caring for a female client before surgery. The client states that she is glad that
she will not be going through menopause as a result of her surgery and is only having
her uterus removed. The nurse reviews the consent form and notes that the surgery is
for a total abdominal hysterectomy with a salpingo-oophorectomy. What should the
nurse do in this situation?
Answer: Contact the surgeon to explain that the client needs further clarification
regarding surgery. ✔✔
Rationale: The client does not understand that the surgery includes removal of the
ovaries, which will cause surgical menopause. The nurse must contact the surgeon for
further clarification.
Question 7
A young client diagnosed with schizophrenia is talking with the nurse and says, "You
know, when I thought everyone was out to get me, I was staying in my apartment all the
time. Now, I would like to get out and do things again." What is the best initial response
by the nurse?
Answer: "What activities did you enjoy in the past?" ✔✔
Rationale: This open-ended question encourages the client to explore past interests
and promotes therapeutic communication, helping to plan meaningful activities.
pg. 2
, Question 8
A client with anemia has been admitted to the medical-surgical unit. Which assessment
findings are characteristic of iron deficiency anemia?
Answer: dyspnea, tachycardia, and pallor. ✔✔
Rationale: Iron deficiency anemia causes decreased oxygen-carrying capacity, leading
to dyspnea, tachycardia, and pallor as compensatory mechanisms.
Question 9
The nurse is discontinuing an intravenous catheter on a 10-year-old client with
hemophilia. What would be the most important intervention for this client?
Answer: Apply firm pressure on the site for 5 minutes after removal. ✔✔
Rationale: Clients with hemophilia have prolonged bleeding due to clotting factor
deficiency. Prolonged pressure is essential to achieve hemostasis.
Question 10
When a client returns from the recovery room postmastectomy, an initial postoperative
assessment is performed by the nurse. What is the nurse's priority assessment?
Answer: assessing the vital signs and oxygen saturation levels. ✔✔
Rationale: Airway, breathing, and circulation are always the priority assessments in
the immediate postoperative period.
Question 11
A client with an uncomplicated term pregnancy arrives at the labor-and-delivery unit in
early labor saying that she thinks her water has broken. What is the nurse's best action?
Answer: Ask what time this happened and note the color, amount, and odor of the
fluid. ✔✔
Rationale: Assessing the time, color, amount, and odor of the fluid is essential to
determine if membranes have ruptured and to detect any signs of infection.
Question 12
When documenting the care of a client, the nurse is aware of the need to use
pg. 3
Real Exam Study Guide with Questions, 100%
Verified Correct Answers and Rationales |
Latest Update 2026/2027
Question 1
A school-age client with diabetes is placed on an intermediate-acting insulin and regular
insulin before breakfast and before dinner. She will receive a snack of milk and cereal at
bedtime. What does the nurse tell the client the snack is intended to do?
Answer: Prevent late night hypoglycemia. ✔✔
Rationale: The bedtime snack provides carbohydrates that help maintain blood
glucose levels throughout the night and prevent hypoglycemia caused by the peak action
of intermediate-acting insulin.
Question 2
A well-known public official of a small community is admitted to the emergency
department following an episode of chest pain. Several nurses from the medical unit are
aware of the admission and access the official's electronic medical record to obtain a
status update. What is the best response for the nurse manager to make to the nurses
regarding this situation?
Answer: "Assessing the official's medical record is a breach of confidentiality." ✔✔
Rationale: Accessing a client's medical record without a legitimate need-to-know
violates HIPAA and confidentiality laws, regardless of the client's public status.
Question 3
The nurse is caring for a client with influenza. The most effective way to decrease the
spread of microorganisms is:
Answer: washing the hands frequently. ✔✔
Rationale: Hand hygiene is the single most effective infection control measure to
prevent the spread of microorganisms, including influenza.
pg. 1
,Question 4
A client with a history of hypertension has been prescribed a new antihypertensive
medication and is reporting dizziness. Which is the best way for the nurse to assess
blood pressure?
Answer: in the supine, sitting, and standing positions. ✔✔
Rationale: Orthostatic blood pressure measurements in three positions help detect
postural hypotension, a common side effect of antihypertensive medications.
Question 5
A client has a soft wrist-safety device. Which assessment finding should the nurse
investigate further?
Answer: cool, pale fingers. ✔✔
Rationale: Cool, pale fingers indicate impaired circulation from the wrist restraint.
This requires immediate investigation and intervention to prevent tissue damage.
Question 6
A nurse is caring for a female client before surgery. The client states that she is glad that
she will not be going through menopause as a result of her surgery and is only having
her uterus removed. The nurse reviews the consent form and notes that the surgery is
for a total abdominal hysterectomy with a salpingo-oophorectomy. What should the
nurse do in this situation?
Answer: Contact the surgeon to explain that the client needs further clarification
regarding surgery. ✔✔
Rationale: The client does not understand that the surgery includes removal of the
ovaries, which will cause surgical menopause. The nurse must contact the surgeon for
further clarification.
Question 7
A young client diagnosed with schizophrenia is talking with the nurse and says, "You
know, when I thought everyone was out to get me, I was staying in my apartment all the
time. Now, I would like to get out and do things again." What is the best initial response
by the nurse?
Answer: "What activities did you enjoy in the past?" ✔✔
Rationale: This open-ended question encourages the client to explore past interests
and promotes therapeutic communication, helping to plan meaningful activities.
pg. 2
, Question 8
A client with anemia has been admitted to the medical-surgical unit. Which assessment
findings are characteristic of iron deficiency anemia?
Answer: dyspnea, tachycardia, and pallor. ✔✔
Rationale: Iron deficiency anemia causes decreased oxygen-carrying capacity, leading
to dyspnea, tachycardia, and pallor as compensatory mechanisms.
Question 9
The nurse is discontinuing an intravenous catheter on a 10-year-old client with
hemophilia. What would be the most important intervention for this client?
Answer: Apply firm pressure on the site for 5 minutes after removal. ✔✔
Rationale: Clients with hemophilia have prolonged bleeding due to clotting factor
deficiency. Prolonged pressure is essential to achieve hemostasis.
Question 10
When a client returns from the recovery room postmastectomy, an initial postoperative
assessment is performed by the nurse. What is the nurse's priority assessment?
Answer: assessing the vital signs and oxygen saturation levels. ✔✔
Rationale: Airway, breathing, and circulation are always the priority assessments in
the immediate postoperative period.
Question 11
A client with an uncomplicated term pregnancy arrives at the labor-and-delivery unit in
early labor saying that she thinks her water has broken. What is the nurse's best action?
Answer: Ask what time this happened and note the color, amount, and odor of the
fluid. ✔✔
Rationale: Assessing the time, color, amount, and odor of the fluid is essential to
determine if membranes have ruptured and to detect any signs of infection.
Question 12
When documenting the care of a client, the nurse is aware of the need to use
pg. 3
