HESI RN Specialty Exam Review – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Medical-Surgical Nursing,
Pediatrics & Maternal Health, Pharmacology & Dosage Calculations,
Mental Health & Psychiatric Nursing, Critical Care & Emergency
Concepts, NCLEX-Style Clinical Judgment, Patient Safety, Priority
Interventions & HESI RN Specialty Success
Question 1: A patient with acute decompensated heart failure is receiving
intravenous furosemide. Which assessment finding should prompt the nurse to
immediately notify the provider?
A. Blood pressure 110/70 mm Hg
B. Heart rate 88 beats per minute
C. Serum potassium 3.1 mEq/L
D. Urine output 45 mL/hr
CORRECT ANSWER: C. Serum potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that promotes significant potassium excretion,
placing the patient at high risk for hypokalemia. A serum potassium level of 3.1 mEq/L is
below the normal range (3.5–5.0 mEq/L) and increases the risk of life-threatening
cardiac dysrhythmias, especially in patients with underlying heart disease. Immediate
notification allows for timely potassium replacement and medication adjustment. The
other findings are within acceptable clinical parameters for a patient receiving diuretic
therapy.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is
admitted with an acute exacerbation. Which arterial blood gas (ABG) result is most
consistent with this condition?
A. pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 26 mEq/L
B. pH 7.48, PaCO₂ 30 mm Hg, HCO₃⁻ 22 mEq/L
C. pH 7.35, PaCO₂ 40 mm Hg, HCO₃⁻ 24 mEq/L
D. pH 7.52, PaCO₂ 38 mm Hg, HCO₃⁻ 30 mEq/L
CORRECT ANSWER: A. pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 26 mEq/L
Rationale: COPD exacerbations commonly cause alveolar hypoventilation, leading to
carbon dioxide retention and acute or acute-on-chronic respiratory acidosis. A pH
below 7.35 with an elevated PaCO₂ (>45 mm Hg) confirms respiratory acidosis. The
HCO₃⁻ level may be normal or slightly elevated depending on compensation. Option B
reflects respiratory alkalosis, Option C is normal, and Option D indicates metabolic
alkalosis, none of which align with an acute COPD exacerbation.
Question 3: A nurse is caring for a postoperative client who has undergone a
thyroidectomy. Which intervention is the highest priority during the first 24 hours?
A. Assessing for signs of hypocalcemia
B. Encouraging deep breathing and coughing
,C. Monitoring for neck swelling and airway patency
D. Administering prescribed thyroid hormone replacement
CORRECT ANSWER: C. Monitoring for neck swelling and airway patency
Rationale: The most immediate life-threatening complication following thyroidectomy is
hemorrhage or hematoma formation at the surgical site, which can rapidly compress
the trachea and compromise the airway. Ensuring airway patency and assessing for
neck swelling, stridor, or respiratory distress takes absolute priority. Hypocalcemia is a
concern but typically presents after 24–48 hours. Deep breathing is important but
secondary to airway security. Thyroid hormone replacement is not an acute priority.
Question 4: A client with type 1 diabetes is experiencing symptoms of
hypoglycemia. Which intervention should the nurse implement first if the client is
conscious and able to swallow?
A. Administer intramuscular glucagon
B. Provide 15 grams of fast-acting carbohydrates
C. Check blood glucose level again in 30 minutes
D. Initiate intravenous dextrose 50% infusion
CORRECT ANSWER: B. Provide 15 grams of fast-acting carbohydrates
Rationale: The rule of 15 is the standard initial intervention for conscious patients with
hypoglycemia: administer 15 grams of fast-acting carbohydrates (e.g., glucose tablets,
juice, regular soda) and recheck blood glucose in 15 minutes. Intramuscular glucagon
and IV dextrose are reserved for unconscious or NPO patients who cannot safely
swallow. Delaying oral carbohydrate administration while waiting to recheck glucose
can worsen neuroglycopenia.
Question 5: A patient with septic shock is receiving a norepinephrine infusion.
Which nursing action is most critical to ensure safe administration?
A. Titrate the infusion based on urine output
B. Administer through a peripheral IV in the forearm
C. Monitor mean arterial pressure (MAP) continuously
D. Flush the line with normal saline every 2 hours
CORRECT ANSWER: C. Monitor mean arterial pressure (MAP) continuously
Rationale: Norepinephrine is a potent vasopressor used to maintain adequate tissue
perfusion in septic shock, with a target MAP typically ≥65 mm Hg. Continuous
hemodynamic monitoring is essential to titrate the medication safely and prevent
complications like severe hypertension, arrhythmias, or inadequate perfusion.
Vasopressors should ideally be administered through a central venous catheter to
prevent tissue necrosis from extravasation. Titrating based solely on urine output delays
necessary pressure management.
,Question 6: A nurse is reviewing the medication orders for a client diagnosed with
major depressive disorder. Which medication class is most likely to be prescribed
as first-line therapy?
A. Monoamine oxidase inhibitors (MAOIs)
B. Tricyclic antidepressants (TCAs)
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Atypical antipsychotics
CORRECT ANSWER: C. Selective serotonin reuptake inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacological treatment for major depressive
disorder due to their favorable side-effect profile, lower toxicity in overdose, and
established efficacy. MAOIs and TCAs are older classes with significant dietary
restrictions, anticholinergic effects, and cardiovascular risks, making them second- or
third-line options. Atypical antipsychotics are used as adjuncts for treatment-resistant
depression, not as initial monotherapy.
Question 7: A client with acute kidney injury (AKI) is in the oliguric phase. Which
laboratory finding should the nurse anticipate?
A. Decreased serum creatinine
B. Elevated blood urea nitrogen (BUN)
C. Hypernatremia
D. Metabolic alkalosis
CORRECT ANSWER: B. Elevated blood urea nitrogen (BUN)
Rationale: During the oliguric phase of AKI, the kidneys lose the ability to adequately
filter waste products, leading to accumulation of nitrogenous wastes. Both BUN and
serum creatinine rise significantly. Hyperkalemia, not hypernatremia, is common due to
decreased renal potassium excretion. Metabolic acidosis, not alkalosis, typically
develops due to impaired hydrogen ion excretion and bicarbonate regeneration.
Question 8: A postpartum client is experiencing heavy vaginal bleeding 2 hours
after delivery. The uterus is boggy on palpation. What is the nurse’s initial action?
A. Administer prescribed oxytocin
B. Perform fundal massage
C. Insert a Foley catheter
D. Notify the obstetrician immediately
CORRECT ANSWER: B. Perform fundal massage
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. The
immediate nursing intervention for a boggy uterus is firm fundal massage to stimulate
uterine contraction and control bleeding. Once the uterus is firm, the nurse should
assess for continued bleeding, monitor vital signs, and administer uterotonics like
, oxytocin as ordered. Notifying the provider is important but follows immediate hands-
on intervention.
Question 9: A client with a history of deep vein thrombosis (DVT) is receiving
warfarin therapy. Which dietary instruction is most appropriate?
A. Increase intake of leafy green vegetables daily
B. Maintain a consistent intake of vitamin K-rich foods
C. Avoid all foods containing vitamin C
D. Consume high-fat meals to enhance drug absorption
CORRECT ANSWER: B. Maintain a consistent intake of vitamin K-rich foods
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. Sudden
increases or decreases in vitamin K intake can cause unpredictable fluctuations in INR
levels. Patients are educated to maintain a consistent, not necessarily restricted, intake
of vitamin K-containing foods like leafy greens. Vitamin C does not interfere with
warfarin, and high-fat meals are not required for absorption.
Question 10: A patient with a traumatic brain injury (TBI) has an intracranial
pressure (ICP) monitor. Which finding indicates the need for immediate
intervention?
A. ICP 18 mm Hg
B. Cerebral perfusion pressure (CPP) 68 mm Hg
C. Glasgow Coma Scale (GCS) score 12
D. Pupils equal and reactive to light
CORRECT ANSWER: A. ICP 18 mm Hg
Rationale: Normal ICP ranges from 5 to 15 mm Hg. A reading of 18 mm Hg indicates
intracranial hypertension, which can compromise cerebral blood flow and lead to
herniation. Immediate interventions include elevating the head of the bed, ensuring
neutral neck alignment, and administering prescribed osmotic diuretics. A CPP of 68
mm Hg is within the acceptable range (typically >60–70 mm Hg), and GCS 12 with
reactive pupils, while concerning, does not require as urgent intervention as elevated
ICP.
Question 11: A client is scheduled for a paracentesis to relieve ascites. Which
position should the nurse assist the client into during the procedure?
A. Supine with legs elevated
B. Sitting upright at a 45-degree angle
C. Left lateral recumbent with knees flexed
D. High Fowler’s position leaning forward
CORRECT ANSWER: B. Sitting upright at a 45-degree angle
Rationale: Sitting upright at a 45- to 90-degree angle allows the abdominal organs to
shift downward, providing better access to the peritoneal cavity and reducing the risk of
Detailed Rationales (Updated 2026) | Medical-Surgical Nursing,
Pediatrics & Maternal Health, Pharmacology & Dosage Calculations,
Mental Health & Psychiatric Nursing, Critical Care & Emergency
Concepts, NCLEX-Style Clinical Judgment, Patient Safety, Priority
Interventions & HESI RN Specialty Success
Question 1: A patient with acute decompensated heart failure is receiving
intravenous furosemide. Which assessment finding should prompt the nurse to
immediately notify the provider?
A. Blood pressure 110/70 mm Hg
B. Heart rate 88 beats per minute
C. Serum potassium 3.1 mEq/L
D. Urine output 45 mL/hr
CORRECT ANSWER: C. Serum potassium 3.1 mEq/L
Rationale: Furosemide is a loop diuretic that promotes significant potassium excretion,
placing the patient at high risk for hypokalemia. A serum potassium level of 3.1 mEq/L is
below the normal range (3.5–5.0 mEq/L) and increases the risk of life-threatening
cardiac dysrhythmias, especially in patients with underlying heart disease. Immediate
notification allows for timely potassium replacement and medication adjustment. The
other findings are within acceptable clinical parameters for a patient receiving diuretic
therapy.
Question 2: A client with chronic obstructive pulmonary disease (COPD) is
admitted with an acute exacerbation. Which arterial blood gas (ABG) result is most
consistent with this condition?
A. pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 26 mEq/L
B. pH 7.48, PaCO₂ 30 mm Hg, HCO₃⁻ 22 mEq/L
C. pH 7.35, PaCO₂ 40 mm Hg, HCO₃⁻ 24 mEq/L
D. pH 7.52, PaCO₂ 38 mm Hg, HCO₃⁻ 30 mEq/L
CORRECT ANSWER: A. pH 7.30, PaCO₂ 55 mm Hg, HCO₃⁻ 26 mEq/L
Rationale: COPD exacerbations commonly cause alveolar hypoventilation, leading to
carbon dioxide retention and acute or acute-on-chronic respiratory acidosis. A pH
below 7.35 with an elevated PaCO₂ (>45 mm Hg) confirms respiratory acidosis. The
HCO₃⁻ level may be normal or slightly elevated depending on compensation. Option B
reflects respiratory alkalosis, Option C is normal, and Option D indicates metabolic
alkalosis, none of which align with an acute COPD exacerbation.
Question 3: A nurse is caring for a postoperative client who has undergone a
thyroidectomy. Which intervention is the highest priority during the first 24 hours?
A. Assessing for signs of hypocalcemia
B. Encouraging deep breathing and coughing
,C. Monitoring for neck swelling and airway patency
D. Administering prescribed thyroid hormone replacement
CORRECT ANSWER: C. Monitoring for neck swelling and airway patency
Rationale: The most immediate life-threatening complication following thyroidectomy is
hemorrhage or hematoma formation at the surgical site, which can rapidly compress
the trachea and compromise the airway. Ensuring airway patency and assessing for
neck swelling, stridor, or respiratory distress takes absolute priority. Hypocalcemia is a
concern but typically presents after 24–48 hours. Deep breathing is important but
secondary to airway security. Thyroid hormone replacement is not an acute priority.
Question 4: A client with type 1 diabetes is experiencing symptoms of
hypoglycemia. Which intervention should the nurse implement first if the client is
conscious and able to swallow?
A. Administer intramuscular glucagon
B. Provide 15 grams of fast-acting carbohydrates
C. Check blood glucose level again in 30 minutes
D. Initiate intravenous dextrose 50% infusion
CORRECT ANSWER: B. Provide 15 grams of fast-acting carbohydrates
Rationale: The rule of 15 is the standard initial intervention for conscious patients with
hypoglycemia: administer 15 grams of fast-acting carbohydrates (e.g., glucose tablets,
juice, regular soda) and recheck blood glucose in 15 minutes. Intramuscular glucagon
and IV dextrose are reserved for unconscious or NPO patients who cannot safely
swallow. Delaying oral carbohydrate administration while waiting to recheck glucose
can worsen neuroglycopenia.
Question 5: A patient with septic shock is receiving a norepinephrine infusion.
Which nursing action is most critical to ensure safe administration?
A. Titrate the infusion based on urine output
B. Administer through a peripheral IV in the forearm
C. Monitor mean arterial pressure (MAP) continuously
D. Flush the line with normal saline every 2 hours
CORRECT ANSWER: C. Monitor mean arterial pressure (MAP) continuously
Rationale: Norepinephrine is a potent vasopressor used to maintain adequate tissue
perfusion in septic shock, with a target MAP typically ≥65 mm Hg. Continuous
hemodynamic monitoring is essential to titrate the medication safely and prevent
complications like severe hypertension, arrhythmias, or inadequate perfusion.
Vasopressors should ideally be administered through a central venous catheter to
prevent tissue necrosis from extravasation. Titrating based solely on urine output delays
necessary pressure management.
,Question 6: A nurse is reviewing the medication orders for a client diagnosed with
major depressive disorder. Which medication class is most likely to be prescribed
as first-line therapy?
A. Monoamine oxidase inhibitors (MAOIs)
B. Tricyclic antidepressants (TCAs)
C. Selective serotonin reuptake inhibitors (SSRIs)
D. Atypical antipsychotics
CORRECT ANSWER: C. Selective serotonin reuptake inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacological treatment for major depressive
disorder due to their favorable side-effect profile, lower toxicity in overdose, and
established efficacy. MAOIs and TCAs are older classes with significant dietary
restrictions, anticholinergic effects, and cardiovascular risks, making them second- or
third-line options. Atypical antipsychotics are used as adjuncts for treatment-resistant
depression, not as initial monotherapy.
Question 7: A client with acute kidney injury (AKI) is in the oliguric phase. Which
laboratory finding should the nurse anticipate?
A. Decreased serum creatinine
B. Elevated blood urea nitrogen (BUN)
C. Hypernatremia
D. Metabolic alkalosis
CORRECT ANSWER: B. Elevated blood urea nitrogen (BUN)
Rationale: During the oliguric phase of AKI, the kidneys lose the ability to adequately
filter waste products, leading to accumulation of nitrogenous wastes. Both BUN and
serum creatinine rise significantly. Hyperkalemia, not hypernatremia, is common due to
decreased renal potassium excretion. Metabolic acidosis, not alkalosis, typically
develops due to impaired hydrogen ion excretion and bicarbonate regeneration.
Question 8: A postpartum client is experiencing heavy vaginal bleeding 2 hours
after delivery. The uterus is boggy on palpation. What is the nurse’s initial action?
A. Administer prescribed oxytocin
B. Perform fundal massage
C. Insert a Foley catheter
D. Notify the obstetrician immediately
CORRECT ANSWER: B. Perform fundal massage
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. The
immediate nursing intervention for a boggy uterus is firm fundal massage to stimulate
uterine contraction and control bleeding. Once the uterus is firm, the nurse should
assess for continued bleeding, monitor vital signs, and administer uterotonics like
, oxytocin as ordered. Notifying the provider is important but follows immediate hands-
on intervention.
Question 9: A client with a history of deep vein thrombosis (DVT) is receiving
warfarin therapy. Which dietary instruction is most appropriate?
A. Increase intake of leafy green vegetables daily
B. Maintain a consistent intake of vitamin K-rich foods
C. Avoid all foods containing vitamin C
D. Consume high-fat meals to enhance drug absorption
CORRECT ANSWER: B. Maintain a consistent intake of vitamin K-rich foods
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors. Sudden
increases or decreases in vitamin K intake can cause unpredictable fluctuations in INR
levels. Patients are educated to maintain a consistent, not necessarily restricted, intake
of vitamin K-containing foods like leafy greens. Vitamin C does not interfere with
warfarin, and high-fat meals are not required for absorption.
Question 10: A patient with a traumatic brain injury (TBI) has an intracranial
pressure (ICP) monitor. Which finding indicates the need for immediate
intervention?
A. ICP 18 mm Hg
B. Cerebral perfusion pressure (CPP) 68 mm Hg
C. Glasgow Coma Scale (GCS) score 12
D. Pupils equal and reactive to light
CORRECT ANSWER: A. ICP 18 mm Hg
Rationale: Normal ICP ranges from 5 to 15 mm Hg. A reading of 18 mm Hg indicates
intracranial hypertension, which can compromise cerebral blood flow and lead to
herniation. Immediate interventions include elevating the head of the bed, ensuring
neutral neck alignment, and administering prescribed osmotic diuretics. A CPP of 68
mm Hg is within the acceptable range (typically >60–70 mm Hg), and GCS 12 with
reactive pupils, while concerning, does not require as urgent intervention as elevated
ICP.
Question 11: A client is scheduled for a paracentesis to relieve ascites. Which
position should the nurse assist the client into during the procedure?
A. Supine with legs elevated
B. Sitting upright at a 45-degree angle
C. Left lateral recumbent with knees flexed
D. High Fowler’s position leaning forward
CORRECT ANSWER: B. Sitting upright at a 45-degree angle
Rationale: Sitting upright at a 45- to 90-degree angle allows the abdominal organs to
shift downward, providing better access to the peritoneal cavity and reducing the risk of
