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HESI MILESTONE 1 NEWEST 2026 EXAM |150
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALE | ALREADY A
GRADED | NEW AND REVISED
1. A nurse is caring for a client who has been prescribed furosemide
for heart failure. Which assessment finding requires immediate
intervention?
A. Mild ankle edema
B. Serum potassium level of 2.8 mEq/L
C. Blood pressure 118/76 mmHg
D. Heart rate 88 bpm
Rationale: Hypokalemia (<3.5 mEq/L) is a dangerous side effect of
furosemide, increasing the risk of arrhythmias. Immediate
intervention, such as notifying the provider and initiating potassium
replacement, is required.
2. A client with chronic obstructive pulmonary disease (COPD)
reports increasing dyspnea. The nurse notes oxygen saturation of
85% on room air. What is the best initial action?
A. Administer high-flow oxygen at 10 L/min via non-rebreather
B. Apply supplemental oxygen at 2 L/min via nasal cannula
and assess response
C. Encourage deep breathing and coughing exercises
D. Notify the provider only if oxygen saturation remains <80%
Rationale: Clients with COPD are at risk for hypoventilation if given
high-flow oxygen. Low-flow oxygen is safest initially, with continuous
monitoring and titration to maintain 88–92% saturation.
3. A postoperative client develops redness, warmth, and swelling at
the surgical site. Which action should the nurse take first?
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A. Apply warm compresses
B. Notify the surgeon of potential infection
C. Encourage ambulation
D. Document findings only
Rationale: Signs of infection require prompt reporting to the surgeon.
Early intervention can prevent systemic infection or sepsis.
4. A nurse is providing discharge teaching for a client prescribed
warfarin. Which statement indicates the need for further teaching?
A. "I should have my INR checked regularly."
B. "I will eat a consistent amount of leafy green vegetables."
C. "I can take aspirin for headaches whenever I need."
D. "I need to notify my provider of any unusual bleeding."
Rationale: Aspirin increases bleeding risk in clients taking warfarin.
Clients must avoid NSAIDs unless approved by their provider.
5. A client receiving IV morphine reports shortness of breath and
oxygen saturation of 88%. What is the nurse’s priority action?
A. Encourage the client to cough and deep breathe
B. Administer naloxone per protocol
C. Reposition the client to a supine position
D. Document findings
Rationale: Morphine can cause respiratory depression. Naloxone is
the antidote and should be administered promptly to prevent hypoxia.
6. A nurse is assessing a client with type 1 diabetes mellitus. Which
symptom indicates hypoglycemia?
A. Polyuria and polydipsia
B. Weight gain
C. Diaphoresis, confusion, and shakiness
D. Dry skin and constipation
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Rationale: Hypoglycemia presents with autonomic symptoms such as
sweating, shakiness, and neurological symptoms like confusion.
7. A client with a history of myocardial infarction reports sudden
chest pain radiating to the jaw. Which action should the nurse take
first?
A. Administer prescribed nitroglycerin
B. Assess vital signs and apply oxygen
C. Obtain a 12-lead ECG
D. Prepare the client for transfer to the cardiac catheterization lab
Rationale: Immediate assessment and stabilization of vital signs are
priority before interventions. Oxygen is given to improve tissue
perfusion.
8. A nurse is planning care for a client with impaired mobility. Which
intervention best prevents skin breakdown?
A. Limit repositioning to every 6 hours
B. Reposition the client every 2 hours
C. Use a single layer of blankets under the client
D. Encourage only passive range-of-motion exercises
Rationale: Frequent repositioning prevents pressure injuries. Every 2
hours is the recommended interval.
9. A client prescribed metformin reports nausea and abdominal
discomfort. Which lab value is most concerning?
A. Fasting glucose 120 mg/dL
B. Serum creatinine 2.0 mg/dL
C. Hemoglobin A1C 7.2%
D. Blood pressure 130/78 mmHg
Rationale: Metformin is contraindicated in renal impairment due to
risk of lactic acidosis. Elevated serum creatinine indicates decreased
kidney function.
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10. A nurse is caring for a client who refuses a blood transfusion
for religious reasons. Which is the most appropriate action?
A. Explain the risks of refusal in detail
B. Respect the client’s decision and document the refusal
C. Encourage the client to reconsider
D. Administer the transfusion anyway with provider approval
Rationale: Respecting autonomy and religious beliefs is essential.
Documentation ensures legal protection and communication.
11. A client receiving a continuous IV infusion of vancomycin
develops flushing, hypotension, and pruritus. What is the nurse’s
priority action?
A. Administer diphenhydramine
B. Stop the infusion and notify the provider
C. Slow the infusion rate
D. Document the reaction
Rationale: Red man syndrome is a rate-related infusion reaction. The
infusion should be stopped immediately to prevent worsening
symptoms.
12. A nurse is evaluating a client’s understanding of insulin
administration. Which statement indicates correct knowledge?
A. "I will inject insulin into a muscle for faster absorption."
B. "I should rotate injection sites daily."
C. "I should rotate injection sites within the same general
area."
D. "I can reuse the same syringe for multiple injections."
Rationale: Rotating within the same area prevents lipodystrophy.
Intramuscular injections and reusing syringes are unsafe.
13. A client with pneumonia has a temperature of 102.4°F,
tachycardia, and productive cough. Which intervention is highest
priority?
HESI MILESTONE 1 NEWEST 2026 EXAM |150
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALE | ALREADY A
GRADED | NEW AND REVISED
1. A nurse is caring for a client who has been prescribed furosemide
for heart failure. Which assessment finding requires immediate
intervention?
A. Mild ankle edema
B. Serum potassium level of 2.8 mEq/L
C. Blood pressure 118/76 mmHg
D. Heart rate 88 bpm
Rationale: Hypokalemia (<3.5 mEq/L) is a dangerous side effect of
furosemide, increasing the risk of arrhythmias. Immediate
intervention, such as notifying the provider and initiating potassium
replacement, is required.
2. A client with chronic obstructive pulmonary disease (COPD)
reports increasing dyspnea. The nurse notes oxygen saturation of
85% on room air. What is the best initial action?
A. Administer high-flow oxygen at 10 L/min via non-rebreather
B. Apply supplemental oxygen at 2 L/min via nasal cannula
and assess response
C. Encourage deep breathing and coughing exercises
D. Notify the provider only if oxygen saturation remains <80%
Rationale: Clients with COPD are at risk for hypoventilation if given
high-flow oxygen. Low-flow oxygen is safest initially, with continuous
monitoring and titration to maintain 88–92% saturation.
3. A postoperative client develops redness, warmth, and swelling at
the surgical site. Which action should the nurse take first?
,2|Page
A. Apply warm compresses
B. Notify the surgeon of potential infection
C. Encourage ambulation
D. Document findings only
Rationale: Signs of infection require prompt reporting to the surgeon.
Early intervention can prevent systemic infection or sepsis.
4. A nurse is providing discharge teaching for a client prescribed
warfarin. Which statement indicates the need for further teaching?
A. "I should have my INR checked regularly."
B. "I will eat a consistent amount of leafy green vegetables."
C. "I can take aspirin for headaches whenever I need."
D. "I need to notify my provider of any unusual bleeding."
Rationale: Aspirin increases bleeding risk in clients taking warfarin.
Clients must avoid NSAIDs unless approved by their provider.
5. A client receiving IV morphine reports shortness of breath and
oxygen saturation of 88%. What is the nurse’s priority action?
A. Encourage the client to cough and deep breathe
B. Administer naloxone per protocol
C. Reposition the client to a supine position
D. Document findings
Rationale: Morphine can cause respiratory depression. Naloxone is
the antidote and should be administered promptly to prevent hypoxia.
6. A nurse is assessing a client with type 1 diabetes mellitus. Which
symptom indicates hypoglycemia?
A. Polyuria and polydipsia
B. Weight gain
C. Diaphoresis, confusion, and shakiness
D. Dry skin and constipation
,3|Page
Rationale: Hypoglycemia presents with autonomic symptoms such as
sweating, shakiness, and neurological symptoms like confusion.
7. A client with a history of myocardial infarction reports sudden
chest pain radiating to the jaw. Which action should the nurse take
first?
A. Administer prescribed nitroglycerin
B. Assess vital signs and apply oxygen
C. Obtain a 12-lead ECG
D. Prepare the client for transfer to the cardiac catheterization lab
Rationale: Immediate assessment and stabilization of vital signs are
priority before interventions. Oxygen is given to improve tissue
perfusion.
8. A nurse is planning care for a client with impaired mobility. Which
intervention best prevents skin breakdown?
A. Limit repositioning to every 6 hours
B. Reposition the client every 2 hours
C. Use a single layer of blankets under the client
D. Encourage only passive range-of-motion exercises
Rationale: Frequent repositioning prevents pressure injuries. Every 2
hours is the recommended interval.
9. A client prescribed metformin reports nausea and abdominal
discomfort. Which lab value is most concerning?
A. Fasting glucose 120 mg/dL
B. Serum creatinine 2.0 mg/dL
C. Hemoglobin A1C 7.2%
D. Blood pressure 130/78 mmHg
Rationale: Metformin is contraindicated in renal impairment due to
risk of lactic acidosis. Elevated serum creatinine indicates decreased
kidney function.
, 4|Page
10. A nurse is caring for a client who refuses a blood transfusion
for religious reasons. Which is the most appropriate action?
A. Explain the risks of refusal in detail
B. Respect the client’s decision and document the refusal
C. Encourage the client to reconsider
D. Administer the transfusion anyway with provider approval
Rationale: Respecting autonomy and religious beliefs is essential.
Documentation ensures legal protection and communication.
11. A client receiving a continuous IV infusion of vancomycin
develops flushing, hypotension, and pruritus. What is the nurse’s
priority action?
A. Administer diphenhydramine
B. Stop the infusion and notify the provider
C. Slow the infusion rate
D. Document the reaction
Rationale: Red man syndrome is a rate-related infusion reaction. The
infusion should be stopped immediately to prevent worsening
symptoms.
12. A nurse is evaluating a client’s understanding of insulin
administration. Which statement indicates correct knowledge?
A. "I will inject insulin into a muscle for faster absorption."
B. "I should rotate injection sites daily."
C. "I should rotate injection sites within the same general
area."
D. "I can reuse the same syringe for multiple injections."
Rationale: Rotating within the same area prevents lipodystrophy.
Intramuscular injections and reusing syringes are unsafe.
13. A client with pneumonia has a temperature of 102.4°F,
tachycardia, and productive cough. Which intervention is highest
priority?
