HESI RN Exit Exam (E2) | HESI RN Exit Exam Study
Guide & NCLEX-RN Prep 2026/2027 | HESI Exit
Assessment Review, Comprehensive Nursing Exam
Preparation, Medical-Surgical Nursing, Pharmacology,
Fundamentals, Leadership & Management, Maternal-
Newborn, Pediatrics, Psychiatric-Mental Health,
Community Health, Gerontology, Critical Care, Clinical
Judgment, NGN-Style Practice Questions, Answers &
Detailed Rationales
Question 1: A client with chronic kidney disease is scheduled for hemodialysis.
Which laboratory value is the most critical to report to the healthcare provider
before the procedure?
A. Serum potassium of 5.8 mEq/L
B. Hemoglobin of 10.2 g/dL
C. Serum sodium of 135 mEq/L
D. Serum calcium of 9.0 mg/dL
CORRECT ANSWER: A. Serum potassium of 5.8 mEq/L
Rationale: A serum potassium level of 5.8 mEq/L is dangerously high (hyperkalemia)
and can lead to life-threatening cardiac dysrhythmias. While the other values are also
abnormal, hyperkalemia is the most critical and requires immediate intervention,
potentially including urgent dialysis or medication to lower potassium.
Question 2: A nurse is caring for a client who is 12 hours post-total hip
arthroplasty. Which assessment finding requires the nurse to notify the
healthcare provider immediately?
A. Pain level of 5 on a 0-10 scale
B. Slight serosanguinous drainage on the dressing
C. Oxygen saturation of 89% on room air
D. The client's request for a pain medication
CORRECT ANSWER: C. Oxygen saturation of 89% on room air
Rationale: An oxygen saturation of 89% is below the acceptable range and may indicate
a pulmonary embolism, a major complication following hip surgery. This requires
immediate notification of the healthcare provider. The other options are expected or
manageable findings.
Question 3: A client prescribed phenytoin (Dilantin) for a seizure disorder is
being discharged. Which statement by the client indicates a correct
understanding of the medication's side effects?
A. "I should take the medication with milk to avoid stomach upset."
B. "I need to practice good oral hygiene to prevent gum swelling."
C. "It's fine to take an over-the-counter antacid if I get heartburn."
D. "I can stop the medication if I have no seizures for a year."
,CORRECT ANSWER: B. "I need to practice good oral hygiene to prevent gum
swelling."
Rationale: Phenytoin is known to cause gingival hyperplasia (gum swelling). Diligent oral
hygiene is crucial. Taking it with milk, taking antacids (which can interfere with
absorption), or stopping the medication abruptly are all contraindicated.
Question 4: A client with a history of alcohol use disorder is admitted with
severe abdominal pain and jaundice. Which initial nursing intervention is
most important?
A. Administer a PRN dose of acetaminophen for pain.
B. Provide a high-protein, high-fat meal.
C. Initiate seizure precautions.
D. Encourage the client to express feelings about the diagnosis.
CORRECT ANSWER: C. Initiate seizure precautions.
Rationale: The client's symptoms suggest alcohol-related liver disease. Alcohol
withdrawal is a major risk in the first 24-72 hours, and seizure precautions are essential
to ensure client safety. Acetaminophen should be avoided due to potential liver toxicity.
Question 5: The nurse is reinforcing teaching for a client with a new ileostomy.
Which food should the client be instructed to avoid to prevent blockage?
A. Applesauce
B. White bread
C. Grapes with skin
D. Clear broth
CORRECT ANSWER: C. Grapes with skin
Rationale: Foods with indigestible skins, seeds, or husks (like grapes, corn, and popcorn)
can cause a blockage in an ileostomy. Applesauce, white bread, and clear broth are
generally well-tolerated and do not pose a high risk for obstruction.
Question 6: A client is receiving a continuous infusion of normal saline at 150
mL/hr. The nurse notes crackles in the lung bases and jugular vein distension.
What is the nurse's priority action?
A. Decrease the IV infusion rate.
B. Administer a diuretic as prescribed.
C. Place the client in a high-Fowler's position.
D. Assess urine output.
CORRECT ANSWER: A. Decrease the IV infusion rate.
Rationale: The assessment findings indicate fluid volume overload. The priority nursing
action is to stop or decrease the infusion to prevent further fluid accumulation. While
administering a diuretic and repositioning are important, they are subsequent actions
after stopping the source.
,Question 7: A nurse is preparing to administer a blood transfusion to a client.
Which action is most important to perform just before hanging the unit of
packed red blood cells?
A. Verify the client's blood type with a second nurse.
B. Assess the client's vital signs.
C. Prime the IV tubing with normal saline.
D. Ensure informed consent is on the chart.
CORRECT ANSWER: B. Assess the client's vital signs.
Rationale: While all actions are correct and important, obtaining a baseline set of vital
signs is the priority just before starting the transfusion to allow for comparison if a
transfusion reaction occurs. The verification and consent should have been done prior.
Question 8: A client with major depressive disorder is started on phenelzine
(Nardil). Which dietary item should the nurse instruct the client to avoid?
A. Coffee
B. Aged cheese
C. Chocolate cake
D. Chicken
CORRECT ANSWER: B. Aged cheese
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Tyramine-rich foods
like aged cheese, cured meats, and fermented products can precipitate a hypertensive
crisis when combined with MAOIs.
Question 9: A client is 2 days post-operative from an abdominal hysterectomy.
Which finding would indicate a potential wound infection?
A. Serous drainage from the incision site
B. Incision edges that are well-approximated
C. A purulent, foul-smelling discharge from the incision
D. A temperature of 99°F (37.2°C)
CORRECT ANSWER: C. A purulent, foul-smelling discharge from the incision
Rationale: Purulent, odorous drainage is a classic sign of infection. A temperature of
99°F is not significant. Serous drainage and well-approximated edges are signs of
normal healing.
Question 10: A client is admitted with diabetic ketoacidosis (DKA). Which
intervention is the priority for the nurse to implement?
A. Administer intravenous potassium.
B. Administer intravenous regular insulin.
C. Begin a continuous IV infusion of 0.9% normal saline.
D. Monitor the client's blood glucose every 4 hours.
, CORRECT ANSWER: C. Begin a continuous IV infusion of 0.9% normal saline.
Rationale: Fluid resuscitation is the immediate priority in DKA to replace massive fluid
losses, correct dehydration, and improve tissue perfusion, which also helps lower blood
glucose.
Question 11: The nurse is caring for a client with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber.
B. No fluctuation (tidaling) in the water-seal chamber.
C. Intermittent bubbling in the suction control chamber.
D. An air leak that is greater than the amount of suction applied.
CORRECT ANSWER: C. Intermittent bubbling in the suction control chamber.
Rationale: If suction is applied, intermittent bubbling in the suction control chamber is
expected. Continuous bubbling in the water-seal chamber indicates an air leak.
Fluctuations (tidaling) should be present in the water-seal chamber.
Question 12: A client with heart failure is prescribed furosemide (Lasix). The
nurse should monitor for which adverse effect?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Furosemide is a loop diuretic that blocks sodium and chloride reabsorption in
the ascending limb of the loop of Henle. This leads to increased excretion of potassium,
which can result in hypokalemia.
Question 13: A nurse is assessing a newborn and notes a heart rate of 110
beats per minute, a strong cry, and good muscle tone. What is the Apgar score
for this newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
Rationale: The Apgar score assesses five categories: heart rate (2 points for >100),
respiratory effort (2 points for strong cry), muscle tone (2 points for active motion),
reflex irritability (2 points for vigorous cry), and color. The score is 8 or 9. Since the
question doesn't specify color, the maximum score is 9, making 9 the correct answer for
a healthy newborn.
Guide & NCLEX-RN Prep 2026/2027 | HESI Exit
Assessment Review, Comprehensive Nursing Exam
Preparation, Medical-Surgical Nursing, Pharmacology,
Fundamentals, Leadership & Management, Maternal-
Newborn, Pediatrics, Psychiatric-Mental Health,
Community Health, Gerontology, Critical Care, Clinical
Judgment, NGN-Style Practice Questions, Answers &
Detailed Rationales
Question 1: A client with chronic kidney disease is scheduled for hemodialysis.
Which laboratory value is the most critical to report to the healthcare provider
before the procedure?
A. Serum potassium of 5.8 mEq/L
B. Hemoglobin of 10.2 g/dL
C. Serum sodium of 135 mEq/L
D. Serum calcium of 9.0 mg/dL
CORRECT ANSWER: A. Serum potassium of 5.8 mEq/L
Rationale: A serum potassium level of 5.8 mEq/L is dangerously high (hyperkalemia)
and can lead to life-threatening cardiac dysrhythmias. While the other values are also
abnormal, hyperkalemia is the most critical and requires immediate intervention,
potentially including urgent dialysis or medication to lower potassium.
Question 2: A nurse is caring for a client who is 12 hours post-total hip
arthroplasty. Which assessment finding requires the nurse to notify the
healthcare provider immediately?
A. Pain level of 5 on a 0-10 scale
B. Slight serosanguinous drainage on the dressing
C. Oxygen saturation of 89% on room air
D. The client's request for a pain medication
CORRECT ANSWER: C. Oxygen saturation of 89% on room air
Rationale: An oxygen saturation of 89% is below the acceptable range and may indicate
a pulmonary embolism, a major complication following hip surgery. This requires
immediate notification of the healthcare provider. The other options are expected or
manageable findings.
Question 3: A client prescribed phenytoin (Dilantin) for a seizure disorder is
being discharged. Which statement by the client indicates a correct
understanding of the medication's side effects?
A. "I should take the medication with milk to avoid stomach upset."
B. "I need to practice good oral hygiene to prevent gum swelling."
C. "It's fine to take an over-the-counter antacid if I get heartburn."
D. "I can stop the medication if I have no seizures for a year."
,CORRECT ANSWER: B. "I need to practice good oral hygiene to prevent gum
swelling."
Rationale: Phenytoin is known to cause gingival hyperplasia (gum swelling). Diligent oral
hygiene is crucial. Taking it with milk, taking antacids (which can interfere with
absorption), or stopping the medication abruptly are all contraindicated.
Question 4: A client with a history of alcohol use disorder is admitted with
severe abdominal pain and jaundice. Which initial nursing intervention is
most important?
A. Administer a PRN dose of acetaminophen for pain.
B. Provide a high-protein, high-fat meal.
C. Initiate seizure precautions.
D. Encourage the client to express feelings about the diagnosis.
CORRECT ANSWER: C. Initiate seizure precautions.
Rationale: The client's symptoms suggest alcohol-related liver disease. Alcohol
withdrawal is a major risk in the first 24-72 hours, and seizure precautions are essential
to ensure client safety. Acetaminophen should be avoided due to potential liver toxicity.
Question 5: The nurse is reinforcing teaching for a client with a new ileostomy.
Which food should the client be instructed to avoid to prevent blockage?
A. Applesauce
B. White bread
C. Grapes with skin
D. Clear broth
CORRECT ANSWER: C. Grapes with skin
Rationale: Foods with indigestible skins, seeds, or husks (like grapes, corn, and popcorn)
can cause a blockage in an ileostomy. Applesauce, white bread, and clear broth are
generally well-tolerated and do not pose a high risk for obstruction.
Question 6: A client is receiving a continuous infusion of normal saline at 150
mL/hr. The nurse notes crackles in the lung bases and jugular vein distension.
What is the nurse's priority action?
A. Decrease the IV infusion rate.
B. Administer a diuretic as prescribed.
C. Place the client in a high-Fowler's position.
D. Assess urine output.
CORRECT ANSWER: A. Decrease the IV infusion rate.
Rationale: The assessment findings indicate fluid volume overload. The priority nursing
action is to stop or decrease the infusion to prevent further fluid accumulation. While
administering a diuretic and repositioning are important, they are subsequent actions
after stopping the source.
,Question 7: A nurse is preparing to administer a blood transfusion to a client.
Which action is most important to perform just before hanging the unit of
packed red blood cells?
A. Verify the client's blood type with a second nurse.
B. Assess the client's vital signs.
C. Prime the IV tubing with normal saline.
D. Ensure informed consent is on the chart.
CORRECT ANSWER: B. Assess the client's vital signs.
Rationale: While all actions are correct and important, obtaining a baseline set of vital
signs is the priority just before starting the transfusion to allow for comparison if a
transfusion reaction occurs. The verification and consent should have been done prior.
Question 8: A client with major depressive disorder is started on phenelzine
(Nardil). Which dietary item should the nurse instruct the client to avoid?
A. Coffee
B. Aged cheese
C. Chocolate cake
D. Chicken
CORRECT ANSWER: B. Aged cheese
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Tyramine-rich foods
like aged cheese, cured meats, and fermented products can precipitate a hypertensive
crisis when combined with MAOIs.
Question 9: A client is 2 days post-operative from an abdominal hysterectomy.
Which finding would indicate a potential wound infection?
A. Serous drainage from the incision site
B. Incision edges that are well-approximated
C. A purulent, foul-smelling discharge from the incision
D. A temperature of 99°F (37.2°C)
CORRECT ANSWER: C. A purulent, foul-smelling discharge from the incision
Rationale: Purulent, odorous drainage is a classic sign of infection. A temperature of
99°F is not significant. Serous drainage and well-approximated edges are signs of
normal healing.
Question 10: A client is admitted with diabetic ketoacidosis (DKA). Which
intervention is the priority for the nurse to implement?
A. Administer intravenous potassium.
B. Administer intravenous regular insulin.
C. Begin a continuous IV infusion of 0.9% normal saline.
D. Monitor the client's blood glucose every 4 hours.
, CORRECT ANSWER: C. Begin a continuous IV infusion of 0.9% normal saline.
Rationale: Fluid resuscitation is the immediate priority in DKA to replace massive fluid
losses, correct dehydration, and improve tissue perfusion, which also helps lower blood
glucose.
Question 11: The nurse is caring for a client with a chest tube connected to a
water-seal drainage system. Which observation indicates that the system is
functioning correctly?
A. Continuous bubbling in the water-seal chamber.
B. No fluctuation (tidaling) in the water-seal chamber.
C. Intermittent bubbling in the suction control chamber.
D. An air leak that is greater than the amount of suction applied.
CORRECT ANSWER: C. Intermittent bubbling in the suction control chamber.
Rationale: If suction is applied, intermittent bubbling in the suction control chamber is
expected. Continuous bubbling in the water-seal chamber indicates an air leak.
Fluctuations (tidaling) should be present in the water-seal chamber.
Question 12: A client with heart failure is prescribed furosemide (Lasix). The
nurse should monitor for which adverse effect?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
CORRECT ANSWER: C. Hypokalemia
Rationale: Furosemide is a loop diuretic that blocks sodium and chloride reabsorption in
the ascending limb of the loop of Henle. This leads to increased excretion of potassium,
which can result in hypokalemia.
Question 13: A nurse is assessing a newborn and notes a heart rate of 110
beats per minute, a strong cry, and good muscle tone. What is the Apgar score
for this newborn?
A. 6
B. 7
C. 8
D. 9
CORRECT ANSWER: D. 9
Rationale: The Apgar score assesses five categories: heart rate (2 points for >100),
respiratory effort (2 points for strong cry), muscle tone (2 points for active motion),
reflex irritability (2 points for vigorous cry), and color. The score is 8 or 9. Since the
question doesn't specify color, the maximum score is 9, making 9 the correct answer for
a healthy newborn.
