HESI CAT Exam 2025/2026:
Comprehensive Nursing Assessment
Test Bank with 100 Verified Questions
and Correct Answers for an A+ Grade
**Question 1**
Twenty minutes after a continuous epidural anesthetic is administered,
a laboring client's blood pressure drops from 120/80 to 90/60 mm Hg.
Which action should the nurse take immediately?
A. Notify the health care provider or anesthesiologist.
B. Continue to assess the blood pressure every 5 minutes.
C. Place the client in a lateral position.
D. Turn off the continuous epidural.
**Answer: C. Place the client in a lateral position.**
**Rationale:** The nurse should immediately turn the client to a lateral
position or place a pillow or wedge under one hip to deflect the uterus
off the vena cava, improving venous return. Other immediate
interventions include increasing the IV rate and administering oxygen.
Notifying the provider is important but not the first action .
**Question 2**
The nurse is teaching a new mother about diet and breastfeeding.
Which instruction is **most important** to include in the teaching
plan?
,A. Avoid alcohol because it is excreted in breast milk.
B. Eat a high-roughage diet to help prevent constipation.
C. Increase caloric intake by approximately 500 cal/day.
D. Increase fluid intake to at least 3 quarts each day.
**Answer: A. Avoid alcohol because it is excreted in breast milk.**
**Rationale:** Alcohol should be avoided while breastfeeding because
it is excreted in breast milk and may cause problems for the infant,
including slower growth and cognitive impairment. This is a safety
concern for the infant, making it the highest priority over the other
healthy lifestyle choices .
**Question 3**
A client at 28-weeks gestation calls the clinic and states she has just
experienced a small amount of bright red vaginal bleeding that has
subsided. She denies uterine contractions or abdominal pain. What
instruction should the nurse provide?
A. Come to the clinic today for an ultrasound.
B. Go immediately to the emergency department.
C. Lie on your left side for about 1 hour and see if the bleeding stops.
D. Take a urine specimen to the laboratory to check for a UTI.
**Answer: A. Come to the clinic today for an ultrasound.**
**Rationale:** Third-trimester painless bleeding is characteristic of a
**placenta previa**. Diagnosis is confirmed by transabdominal
ultrasound. While this requires prompt attention, it is rarely
immediately life-threatening unless bleeding is heavy, so the client does
,not need to go to the ER if bleeding has subsided, but must be
evaluated soon .
**Question 4**
A 41-week multigravida is receiving oxytocin (Pitocin) to augment labor.
Contractions are firm every 5 minutes, with a 30- to 40-second
duration. The fetal heart rate increases with each contraction and
returns to baseline after. Which action should the nurse implement?
A. Place a wedge under the client's left side.
B. Determine cervical dilation and effacement.
C. Administer 10 L of oxygen via facemask.
D. Increase the rate of the oxytocin (Pitocin) infusion.
**Answer: B. Determine cervical dilation and effacement.**
**Rationale:** The goal of labor augmentation is to produce firm
contractions every 2 to 3 minutes, lasting 60-70 seconds. FHR
accelerations are a normal response. The oxytocin infusion should be
increased per protocol to stimulate more frequent and intense
contractions, but first the nurse should assess cervical progress to
determine if the increase is safe and effective .
**Question 5**
A client who delivered by cesarean section 24 hours ago is using a PCA
pump. Her oral intake has been ice chips only. She now complains of
nausea and bloating and states she is too weak to breastfeed. Which
nursing diagnosis has the highest priority?
, A. Altered nutrition, less than body requirements for lactation
B. Alteration in comfort related to nausea and abdominal distention
C. Impaired bowel motility related to pain medication and immobility
D. Fatigue related to cesarean delivery and physical care demands of
infant
**Answer: C. Impaired bowel motility related to pain medication and
immobility**
**Rationale:** The symptoms of nausea and bloating 24 hours post-op
suggest **paralytic ileus**, a common complication following
abdominal surgery, especially with opioid use. This physiological issue
takes priority over comfort or nutrition, as it can lead to more serious
complications if not addressed .
**Question 6**
A terminally ill client tells the nurse, "I am so tired and in so much pain!
Please help me to die." Which is the best response for the nurse to
provide?
A. Administer the prescribed maximum dose of pain medication.
B. Talk with the client about thoughts and feelings about death.
C. Collaborate with the health care provider about initiating
antidepressant therapy.
D. Refer the client to the ethics committee.
**Answer: B. Talk with the client about thoughts and feelings about
death.**
Comprehensive Nursing Assessment
Test Bank with 100 Verified Questions
and Correct Answers for an A+ Grade
**Question 1**
Twenty minutes after a continuous epidural anesthetic is administered,
a laboring client's blood pressure drops from 120/80 to 90/60 mm Hg.
Which action should the nurse take immediately?
A. Notify the health care provider or anesthesiologist.
B. Continue to assess the blood pressure every 5 minutes.
C. Place the client in a lateral position.
D. Turn off the continuous epidural.
**Answer: C. Place the client in a lateral position.**
**Rationale:** The nurse should immediately turn the client to a lateral
position or place a pillow or wedge under one hip to deflect the uterus
off the vena cava, improving venous return. Other immediate
interventions include increasing the IV rate and administering oxygen.
Notifying the provider is important but not the first action .
**Question 2**
The nurse is teaching a new mother about diet and breastfeeding.
Which instruction is **most important** to include in the teaching
plan?
,A. Avoid alcohol because it is excreted in breast milk.
B. Eat a high-roughage diet to help prevent constipation.
C. Increase caloric intake by approximately 500 cal/day.
D. Increase fluid intake to at least 3 quarts each day.
**Answer: A. Avoid alcohol because it is excreted in breast milk.**
**Rationale:** Alcohol should be avoided while breastfeeding because
it is excreted in breast milk and may cause problems for the infant,
including slower growth and cognitive impairment. This is a safety
concern for the infant, making it the highest priority over the other
healthy lifestyle choices .
**Question 3**
A client at 28-weeks gestation calls the clinic and states she has just
experienced a small amount of bright red vaginal bleeding that has
subsided. She denies uterine contractions or abdominal pain. What
instruction should the nurse provide?
A. Come to the clinic today for an ultrasound.
B. Go immediately to the emergency department.
C. Lie on your left side for about 1 hour and see if the bleeding stops.
D. Take a urine specimen to the laboratory to check for a UTI.
**Answer: A. Come to the clinic today for an ultrasound.**
**Rationale:** Third-trimester painless bleeding is characteristic of a
**placenta previa**. Diagnosis is confirmed by transabdominal
ultrasound. While this requires prompt attention, it is rarely
immediately life-threatening unless bleeding is heavy, so the client does
,not need to go to the ER if bleeding has subsided, but must be
evaluated soon .
**Question 4**
A 41-week multigravida is receiving oxytocin (Pitocin) to augment labor.
Contractions are firm every 5 minutes, with a 30- to 40-second
duration. The fetal heart rate increases with each contraction and
returns to baseline after. Which action should the nurse implement?
A. Place a wedge under the client's left side.
B. Determine cervical dilation and effacement.
C. Administer 10 L of oxygen via facemask.
D. Increase the rate of the oxytocin (Pitocin) infusion.
**Answer: B. Determine cervical dilation and effacement.**
**Rationale:** The goal of labor augmentation is to produce firm
contractions every 2 to 3 minutes, lasting 60-70 seconds. FHR
accelerations are a normal response. The oxytocin infusion should be
increased per protocol to stimulate more frequent and intense
contractions, but first the nurse should assess cervical progress to
determine if the increase is safe and effective .
**Question 5**
A client who delivered by cesarean section 24 hours ago is using a PCA
pump. Her oral intake has been ice chips only. She now complains of
nausea and bloating and states she is too weak to breastfeed. Which
nursing diagnosis has the highest priority?
, A. Altered nutrition, less than body requirements for lactation
B. Alteration in comfort related to nausea and abdominal distention
C. Impaired bowel motility related to pain medication and immobility
D. Fatigue related to cesarean delivery and physical care demands of
infant
**Answer: C. Impaired bowel motility related to pain medication and
immobility**
**Rationale:** The symptoms of nausea and bloating 24 hours post-op
suggest **paralytic ileus**, a common complication following
abdominal surgery, especially with opioid use. This physiological issue
takes priority over comfort or nutrition, as it can lead to more serious
complications if not addressed .
**Question 6**
A terminally ill client tells the nurse, "I am so tired and in so much pain!
Please help me to die." Which is the best response for the nurse to
provide?
A. Administer the prescribed maximum dose of pain medication.
B. Talk with the client about thoughts and feelings about death.
C. Collaborate with the health care provider about initiating
antidepressant therapy.
D. Refer the client to the ethics committee.
**Answer: B. Talk with the client about thoughts and feelings about
death.**
