HESI RN Exit Exam Test Bank – Comprehensive NCLEX Review Questions & Answers

This comprehensive HESI RN Exit Exam test bank includes over 300 practice questions and detailed rationales covering all major nursing topics: Safety & Fundamentals, Medical-Surgical, Maternal-Newborn, Pediatrics, Pharmacology, Psychiatric Nursing, and Leadership & Management. Designed for NCLEX-RN preparation with updated content aligned with the 2025–2026 exam guidelines. HESI RN Comprehensive Review Exam 2026 – Safety & Fundamentals Q1. A nurse is caring for a client on fall precautions. Which intervention has the highest priority? A. Keep the bed in the lowest position. B. Place non-slip socks on the client. C. Remove clutter from the room. D. Keep the call light within reach. Answer: A. Keep the bed in the lowest position. Rationale: While all options reduce fall risk, the lowest bed position most directly prevents injury if the client does fall or attempts to get out of bed unsafely. Q2. A nurse receives a client from PACU who is drowsy but arousable. What is the first action? A. Monitor vital signs. B. Assess airway patency. C. Check IV site. D. Review intake and output. Answer: B. Assess airway patency. Rationale: Airway is always the priority in post-anesthesia care (ABCs). Monitoring vital signs follows after airway is confirmed. Q3. A nurse prepares to administer digoxin. The apical pulse is 56 bpm. What should the nurse do? A. Administer the dose. B. Hold the medication and notify the provider. C. Document the pulse and reassess in 30 minutes. D. Give half the dose. Answer: B. Hold the medication and notify the provider. Rationale: Digoxin can cause bradycardia. The safe hold parameter is HR 60 bpm. Q4. A confused elderly client keeps trying to pull out their IV. What is the best nursing intervention? A. Apply wrist restraints. B. Cover the IV site with a protective sleeve. C. Remove the IV. D. Ask family to stay with the client. Answer: B. Cover the IV site with a protective sleeve. Rationale: The least restrictive option that still protects the client should always be chosen before restraints. Q5. The nurse finds a fire in a client’s room. Which action should the nurse take first? A. Pull the fire alarm. B. Attempt to extinguish the fire. C. Rescue the client from the room. D. Close the door. Answer: C. Rescue the client from the room. Rationale: Follow RACE (Rescue, Alarm, Contain, Extinguish). Safety of the client comes first. Q6. The nurse is caring for four clients. Which client should be seen first? A. Client with a temperature of 100.8°F and productive cough. B. Client with O₂ saturation of 85% on room air. C. Client requesting pain medication rated 7/10. D. Client with blood glucose of 180 mg/dL. Answer: B. Client with O₂ saturation of 85% on room air. Rationale: Hypoxemia is life-threatening and must be addressed before pain or fever. Prioritization uses ABCs. Q7. A nurse prepares to insert an indwelling urinary catheter. Which step is correct for maintaining sterile technique? A. Place the sterile kit on the client’s bed. B. Clean the perineal area with povidone-iodine. C. Keep the sterile gloves above waist level. D. Apply lubricant to the catheter tip after insertion. Answer: C. Keep the sterile gloves above waist level. Rationale: Sterility is maintained only when gloves remain above waist and in the sterile field. Medical-Surgical Nursing (Q8–Q18) Q8. A client with COPD has O₂ at 4 L/min via nasal cannula. The nurse should: A. Maintain oxygen at 4 L/min. B. Decrease oxygen to 2 L/min. C. Discontinue oxygen. D. Switch to non-rebreather mask. Answer: B. Decrease oxygen to 2 L/min. Rationale: COPD clients rely on hypoxic drive; oxygen 2 L can suppress respiratory drive. Q9. Which ECG finding indicates hyperkalemia? A. U waves B. Prolonged QT interval C. Tall peaked T waves D. Flattened P waves Answer: C. Tall peaked T waves. Rationale: Tall peaked T waves are a hallmark of hyperkalemia. Q10. A client with heart failure is prescribed furosemide. Which lab requires immediate intervention? A. Potassium 2.8 mEq/L B. Sodium 140 mEq/L C. Creatinine 1.0 mg/dL D. BUN 18 mg/dL Answer: A. Potassium 2.8 mEq/L. Rationale: Severe hypokalemia increases risk of dysrhythmias when using loop diuretics. Q11. A client with pneumonia is restless and has RR 28/min, O₂ sat 88%. Which is the priority? A. Obtain sputum culture. B. Increase b oxygen b flow b rate. C. Encourage b fluids. D. Administer b acetaminophen. Answer: b B. b Increase b oxygen b flow b rate. Rationale: b Oxygenation b is b priority; b cultures b and b fever b treatment b can b wait. Q12. A b nurse b is b caring b for b a b client b with b DKA. b Which b finding b requires b priority b intervention? A. Blood b glucose b 320 b mg/dL B. Serum b potassium b 2.9 b mEq/L C. Fruity b breath b odor D. pH b 7.28 Answer: b B. b Serum b potassium b 2.9 b mEq/L. Rationale: b Hypokalemia b is b life-threatening b and b must b be b corrected b to b prevent b arrhythmias. Q13. A b client b with b cirrhosis b develops b ascites. b Which b intervention b is b priority? A. Administer b furosemide. B. Elevate b head b of b bed. C. Measure b abdominal b girth. D. Restrict b sodium b intake. Answer: b B. b Elevate b head b of b bed. Rationale: b Airway b support b and b comfort b take b priority b before b fluid b management. Q14. Which b finding b in b a b client b with b a b chest b tube b requires b immediate b action? A. Intermittent b bubbling b in b water-seal b chamber. B. Fluctuation b of b water b level b with b respirations. C. Drainage b of b 80 b mL/hr b bright b red b blood. D. Occasional b crepitus b at b insertion b site. Answer: b C. b Drainage b of b 80 b mL/hr b bright b red b blood. Rationale: b This b indicates b active b hemorrhage b and b must b be b reported b immediately. Q15. Which b instruction b is b most b important b for b a b client b after b total b hip b replacement? A. Sit b in b low b chairs. B. Avoid b crossing b legs. C. Lie b flat b on b the b back. D. Keep b hips b internally b rotated. Answer: b B. b Avoid b crossing b legs. Rationale: b Prevents b dislocation b by b maintaining b hip b precautions.