HESI RN Exit Exam 2026/2027 | Comprehensive
Practice Questions & Verified Answers | NCLEX-
Style Review
SECTION 1: MEDICAL-SURGICAL NURSING (40 Questions)
Question 1 — Acute Heart Failure
Skill Tested: Prioritization of deterioration
Cognitive Level: Analysis → Judgment
Difficulty: Moderate
Question:
A 68-year-old client with heart failure reports increasing shortness
of breath. The nurse notes bilateral crackles, an S3, 2+ lower-
extremity edema, BP 154/94 mmHg, HR 88/min, RR 24/min, and
SpO₂ 88% on room air. Which finding requires the nurse's most
immediate response?
Options:
A. Blood pressure of 154/94 mmHg
B. SpO₂ of 88% on room air
C. Bilateral 2+ pitting edema
D. Heart rate of 88/min
Correct Answer: B
Detailed Rationale:
The SpO₂ of 88% indicates impaired oxygenation in a client with
evidence of pulmonary congestion. The nurse should immediately
address breathing by positioning the client upright, assessing
,respiratory status, and providing oxygen according to the clinical
order/protocol. The other findings support heart-failure
exacerbation but do not represent the most immediate threat.
Distractor Analysis:
A: Hypertension requires monitoring but is not the most immediate
threat.
C: Edema reflects fluid retention but does not represent the
immediate respiratory compromise.
D: HR 88/min is not tachycardic.
Learning Objective: Prioritize oxygenation when assessing acute
heart-failure deterioration.
Question 2 — Postoperative Hemorrhage
Skill Tested: Emergency prioritization
Cognitive Level: Judgment
Difficulty: Moderate
Question:
Six hours after abdominal surgery, a client's dressing becomes
saturated with bright-red blood. The client is pale, reports dizziness,
has a pulse of 124/min, and BP has decreased from 128/76 to 96/54
mmHg. What should the nurse do first?
Options:
A. Reinforce the dressing and reassess in 15 minutes
B. Apply direct pressure to the bleeding area while calling for
assistance
C. Administer the prescribed analgesic
D. Document the amount of drainage
,Correct Answer: B
Rationale:
The combination of active bleeding, tachycardia, hypotension,
pallor, and dizziness suggests significant hemorrhage with impaired
circulation. Immediate hemorrhage control and escalation are
priorities.
Distractor Analysis:
A delays definitive assessment/control of active bleeding.
C addresses a lower-priority problem.
D documents the problem but does not treat it.
Learning Objective: Recognize and respond to postoperative
hemorrhage.
Question 3 — DKA and Potassium
Skill Tested: Interpretation of laboratory data and medication
safety
Cognitive Level: Analysis
Difficulty: Difficult
Question:
A client with DKA has a glucose of 612 mg/dL, pH 7.18, bicarbonate
12 mEq/L, and positive ketones. Before starting an ordered insulin
infusion, the nurse reviews the latest laboratory results. Which
finding requires the nurse to clarify the treatment plan
immediately?
A. Glucose 480 mg/dL after treatment begins
B. Potassium 3.1 mEq/L
, C. Sodium 134 mEq/L
D. Urine output 40 mL/hr
Correct Answer: B
Rationale:
Insulin shifts potassium into cells and can worsen hypokalemia. A
potassium of 3.1 mEq/L creates significant dysrhythmia risk;
potassium replacement is generally required before insulin is
initiated when potassium is severely low.
Distractor Analysis:
A represents expected glucose reduction during treatment.
C is mildly low and is not the immediate treatment-limiting finding.
D represents adequate urine output.
Learning Objective: Integrate electrolyte findings into safe DKA
management.
Question 4 — Post-Stroke Dysphagia
Skill Tested: Airway protection
Cognitive Level: Judgment
Difficulty: Moderate
Question:
A client is 24 hours after an ischemic stroke. During breakfast, the
client develops drooling, coughing, and a wet-sounding voice after
attempting to swallow water. What is the nurse's priority action?
A. Encourage the client to take smaller sips
B. Stop oral intake and initiate aspiration precautions
C. Document the swallowing difficulty
Practice Questions & Verified Answers | NCLEX-
Style Review
SECTION 1: MEDICAL-SURGICAL NURSING (40 Questions)
Question 1 — Acute Heart Failure
Skill Tested: Prioritization of deterioration
Cognitive Level: Analysis → Judgment
Difficulty: Moderate
Question:
A 68-year-old client with heart failure reports increasing shortness
of breath. The nurse notes bilateral crackles, an S3, 2+ lower-
extremity edema, BP 154/94 mmHg, HR 88/min, RR 24/min, and
SpO₂ 88% on room air. Which finding requires the nurse's most
immediate response?
Options:
A. Blood pressure of 154/94 mmHg
B. SpO₂ of 88% on room air
C. Bilateral 2+ pitting edema
D. Heart rate of 88/min
Correct Answer: B
Detailed Rationale:
The SpO₂ of 88% indicates impaired oxygenation in a client with
evidence of pulmonary congestion. The nurse should immediately
address breathing by positioning the client upright, assessing
,respiratory status, and providing oxygen according to the clinical
order/protocol. The other findings support heart-failure
exacerbation but do not represent the most immediate threat.
Distractor Analysis:
A: Hypertension requires monitoring but is not the most immediate
threat.
C: Edema reflects fluid retention but does not represent the
immediate respiratory compromise.
D: HR 88/min is not tachycardic.
Learning Objective: Prioritize oxygenation when assessing acute
heart-failure deterioration.
Question 2 — Postoperative Hemorrhage
Skill Tested: Emergency prioritization
Cognitive Level: Judgment
Difficulty: Moderate
Question:
Six hours after abdominal surgery, a client's dressing becomes
saturated with bright-red blood. The client is pale, reports dizziness,
has a pulse of 124/min, and BP has decreased from 128/76 to 96/54
mmHg. What should the nurse do first?
Options:
A. Reinforce the dressing and reassess in 15 minutes
B. Apply direct pressure to the bleeding area while calling for
assistance
C. Administer the prescribed analgesic
D. Document the amount of drainage
,Correct Answer: B
Rationale:
The combination of active bleeding, tachycardia, hypotension,
pallor, and dizziness suggests significant hemorrhage with impaired
circulation. Immediate hemorrhage control and escalation are
priorities.
Distractor Analysis:
A delays definitive assessment/control of active bleeding.
C addresses a lower-priority problem.
D documents the problem but does not treat it.
Learning Objective: Recognize and respond to postoperative
hemorrhage.
Question 3 — DKA and Potassium
Skill Tested: Interpretation of laboratory data and medication
safety
Cognitive Level: Analysis
Difficulty: Difficult
Question:
A client with DKA has a glucose of 612 mg/dL, pH 7.18, bicarbonate
12 mEq/L, and positive ketones. Before starting an ordered insulin
infusion, the nurse reviews the latest laboratory results. Which
finding requires the nurse to clarify the treatment plan
immediately?
A. Glucose 480 mg/dL after treatment begins
B. Potassium 3.1 mEq/L
, C. Sodium 134 mEq/L
D. Urine output 40 mL/hr
Correct Answer: B
Rationale:
Insulin shifts potassium into cells and can worsen hypokalemia. A
potassium of 3.1 mEq/L creates significant dysrhythmia risk;
potassium replacement is generally required before insulin is
initiated when potassium is severely low.
Distractor Analysis:
A represents expected glucose reduction during treatment.
C is mildly low and is not the immediate treatment-limiting finding.
D represents adequate urine output.
Learning Objective: Integrate electrolyte findings into safe DKA
management.
Question 4 — Post-Stroke Dysphagia
Skill Tested: Airway protection
Cognitive Level: Judgment
Difficulty: Moderate
Question:
A client is 24 hours after an ischemic stroke. During breakfast, the
client develops drooling, coughing, and a wet-sounding voice after
attempting to swallow water. What is the nurse's priority action?
A. Encourage the client to take smaller sips
B. Stop oral intake and initiate aspiration precautions
C. Document the swallowing difficulty
