HESI Comprehensive Nursing Exam | ACTUAL
EXAM | Complete Questions & Verified Answers |
Latest Update | Already Graded A
1. A postoperative client who underwent a total abdominal hysterectomy reports
sudden shortness of breath and chest pain. The nurse notes a respiratory rate of
32/min, SpO₂ 88%, and asymmetrical chest expansion. Which action should the
nurse take FIRST?
A. Administer oxygen via non-rebreather mask
B. Obtain a stat chest x-ray
C. Auscultate bilateral breath sounds
D. Notify the surgeon immediately
Correct Answer: C
Rationale: The assessment findings (sudden dyspnea, pleuritic pain, hypoxemia,
asymmetrical expansion) strongly suggest a pulmonary embolism or pneumothorax.
Before intervening, the nurse must quickly auscultate to differentiate between
absent/unilateral breath sounds (pneumothorax) versus crackles or pleural rub
(embolism). This 15-second assessment drives the next priority intervention (needle
decompression vs. oxygen vs. anticoagulation). Administering oxygen (A) is appropriate
but not the FIRST action when diagnostic clues are still needed. A chest x-ray (B) takes
too long to obtain. Notification (D) occurs after the nurse has completed the focused
respiratory assessment.
, 2. A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa
4,000 units subcutaneous three times weekly. Which laboratory value best
indicates the effectiveness of this therapy after 4 weeks?
A. Serum creatinine
B. Hemoglobin
C. Serum ferritin
D. Blood urea nitrogen
Correct Answer: B
Rationale: Epoetin alfa stimulates erythropoiesis; therefore, the desired outcome is an
increase in hemoglobin (target 10–11 g/dL in CKD). Serum creatinine (A) and BUN (D)
reflect renal function, not drug efficacy. Ferritin (C) evaluates iron stores—important to
assess before and during therapy because functional iron deficiency can blunt
response—but it does not directly measure epoetin effectiveness.
3. A 6-month-old infant is admitted with moderate dehydration secondary to viral
gastroenteritis. The provider orders intravenous fluid resuscitation. Which
intravenous fluid and rate are MOST appropriate for the initial phase?
A. 0.45% sodium chloride at 20 mL/h
B. D5W at 10 mL/h
C. Lactated Ringer’s 20 mL/kg bolus over 20 minutes
D. 0.225% sodium chloride with 5% dextrose at 40 mL/h
Correct Answer: C
,Rationale: Current pediatric guidelines recommend isotonic crystalloid (LR or 0.9%
NaCl) 20 mL/kg bolus over 15–20 minutes for rapid intravascular re-expansion.
Hypotonic fluids (A, D) and dextrose solutions without sodium (B) are contraindicated in
initial resuscitation because they may cause hyponatremia or cerebral edema.
4. A client on the psychiatric unit states, “I’m a terrible person; I should be
punished.” Which response by the nurse is BEST?
A. “Why do you think you’re a terrible person?”
B. “You seem upset; tell me what’s happening.”
C. “You’re not a terrible person; you’re ill.”
D. “Let’s talk about something more positive.”
Correct Answer: B
Rationale: The client’s statement conveys self-blame and possible suicidal ideation. The
priority is to invite further disclosure while conveying empathy and non-judgment.
Option B uses therapeutic communication (broad opening, restating feeling) and keeps
the conversation open. Option A probes and may sound interrogative; C offers false
reassurance; D blocks communication.
5. A client receiving morphine patient-controlled analgesia (PCA) after a total knee
replacement has a respiratory rate of 8/min and is difficult to arouse. Which
medication should the nurse prepare to administer?
A. Naloxone 0.04 mg IV push, repeat every 2 minutes
B. Flumazenil 0.2 mg IV push once
C. Naloxone 0.4 mg IV push once
, D. Naltrexone 50 mg PO once
Correct Answer: A
Rationale: The client shows opioid-induced respiratory depression. The safest reversal
strategy is titrated naloxone (0.04 mg IV q2 min) to improve respiratory rate without
precipitating acute pain or withdrawal. A large bolus (C) can reverse analgesia abruptly
and cause hypertensive crisis. Flumazenil (B) reverses benzodiazepines; naltrexone (D)
is oral and long-acting, inappropriate for acute reversal.
6. A client with left-sided heart failure is receiving furosemide 80 mg IV twice daily.
Which assessment finding requires IMMEDIATE nursing intervention?
A. 2+ pitting edema of lower extremities
B. Serum potassium 3.1 mEq/L
C. Daily weight increase of 0.5 kg
D. Urine output 35 mL/h
Correct Answer: B
Rationale: Furosemide causes potassium wasting; a level of 3.1 mEq/L places the client
at high risk for life-threatening ventricular dysrhythmias. The nurse should immediately
notify the provider for potassium replacement. Edema (A) and 0.5 kg weight gain (C)
indicate chronic fluid overload, not acute danger. Urine output 35 mL/h (D) is
acceptable.
7. A 28-week-pregnant client reports severe, constant abdominal pain with dark-red
vaginal bleeding. The uterus is board-like on palpation, and fetal heart rate
EXAM | Complete Questions & Verified Answers |
Latest Update | Already Graded A
1. A postoperative client who underwent a total abdominal hysterectomy reports
sudden shortness of breath and chest pain. The nurse notes a respiratory rate of
32/min, SpO₂ 88%, and asymmetrical chest expansion. Which action should the
nurse take FIRST?
A. Administer oxygen via non-rebreather mask
B. Obtain a stat chest x-ray
C. Auscultate bilateral breath sounds
D. Notify the surgeon immediately
Correct Answer: C
Rationale: The assessment findings (sudden dyspnea, pleuritic pain, hypoxemia,
asymmetrical expansion) strongly suggest a pulmonary embolism or pneumothorax.
Before intervening, the nurse must quickly auscultate to differentiate between
absent/unilateral breath sounds (pneumothorax) versus crackles or pleural rub
(embolism). This 15-second assessment drives the next priority intervention (needle
decompression vs. oxygen vs. anticoagulation). Administering oxygen (A) is appropriate
but not the FIRST action when diagnostic clues are still needed. A chest x-ray (B) takes
too long to obtain. Notification (D) occurs after the nurse has completed the focused
respiratory assessment.
, 2. A client with chronic kidney disease (CKD) stage 4 is prescribed epoetin alfa
4,000 units subcutaneous three times weekly. Which laboratory value best
indicates the effectiveness of this therapy after 4 weeks?
A. Serum creatinine
B. Hemoglobin
C. Serum ferritin
D. Blood urea nitrogen
Correct Answer: B
Rationale: Epoetin alfa stimulates erythropoiesis; therefore, the desired outcome is an
increase in hemoglobin (target 10–11 g/dL in CKD). Serum creatinine (A) and BUN (D)
reflect renal function, not drug efficacy. Ferritin (C) evaluates iron stores—important to
assess before and during therapy because functional iron deficiency can blunt
response—but it does not directly measure epoetin effectiveness.
3. A 6-month-old infant is admitted with moderate dehydration secondary to viral
gastroenteritis. The provider orders intravenous fluid resuscitation. Which
intravenous fluid and rate are MOST appropriate for the initial phase?
A. 0.45% sodium chloride at 20 mL/h
B. D5W at 10 mL/h
C. Lactated Ringer’s 20 mL/kg bolus over 20 minutes
D. 0.225% sodium chloride with 5% dextrose at 40 mL/h
Correct Answer: C
,Rationale: Current pediatric guidelines recommend isotonic crystalloid (LR or 0.9%
NaCl) 20 mL/kg bolus over 15–20 minutes for rapid intravascular re-expansion.
Hypotonic fluids (A, D) and dextrose solutions without sodium (B) are contraindicated in
initial resuscitation because they may cause hyponatremia or cerebral edema.
4. A client on the psychiatric unit states, “I’m a terrible person; I should be
punished.” Which response by the nurse is BEST?
A. “Why do you think you’re a terrible person?”
B. “You seem upset; tell me what’s happening.”
C. “You’re not a terrible person; you’re ill.”
D. “Let’s talk about something more positive.”
Correct Answer: B
Rationale: The client’s statement conveys self-blame and possible suicidal ideation. The
priority is to invite further disclosure while conveying empathy and non-judgment.
Option B uses therapeutic communication (broad opening, restating feeling) and keeps
the conversation open. Option A probes and may sound interrogative; C offers false
reassurance; D blocks communication.
5. A client receiving morphine patient-controlled analgesia (PCA) after a total knee
replacement has a respiratory rate of 8/min and is difficult to arouse. Which
medication should the nurse prepare to administer?
A. Naloxone 0.04 mg IV push, repeat every 2 minutes
B. Flumazenil 0.2 mg IV push once
C. Naloxone 0.4 mg IV push once
, D. Naltrexone 50 mg PO once
Correct Answer: A
Rationale: The client shows opioid-induced respiratory depression. The safest reversal
strategy is titrated naloxone (0.04 mg IV q2 min) to improve respiratory rate without
precipitating acute pain or withdrawal. A large bolus (C) can reverse analgesia abruptly
and cause hypertensive crisis. Flumazenil (B) reverses benzodiazepines; naltrexone (D)
is oral and long-acting, inappropriate for acute reversal.
6. A client with left-sided heart failure is receiving furosemide 80 mg IV twice daily.
Which assessment finding requires IMMEDIATE nursing intervention?
A. 2+ pitting edema of lower extremities
B. Serum potassium 3.1 mEq/L
C. Daily weight increase of 0.5 kg
D. Urine output 35 mL/h
Correct Answer: B
Rationale: Furosemide causes potassium wasting; a level of 3.1 mEq/L places the client
at high risk for life-threatening ventricular dysrhythmias. The nurse should immediately
notify the provider for potassium replacement. Edema (A) and 0.5 kg weight gain (C)
indicate chronic fluid overload, not acute danger. Urine output 35 mL/h (D) is
acceptable.
7. A 28-week-pregnant client reports severe, constant abdominal pain with dark-red
vaginal bleeding. The uterus is board-like on palpation, and fetal heart rate
