HESI EXIT RN V2 COMPLETE STUDY GUIDE 2025/2026 | VERIFIED HESI EXIT
QUESTIONS AND ANSWERS WITH DETAILED RATIONALES | FULL COVERAGE OF
MEDICAL-SURGICAL, PEDIATRIC, OB/GYN, MENTAL HEALTH, PHARMACOLOGY,
AND COMMUNITY HEALTH NURSING | NCLEX-STYLE PRACTICE QUESTIONS,
TEST-TAKING STRATEGIES, AND INTENSIVE EXIT EXAM REVIEW FOR
GUARANTEED PASS AND TOP SCORES
Question 1: A nurse is caring for a client with heart failure who has been prescribed furosemide 40 mg
IV push. Which assessment finding should the nurse prioritize before administering the medication?
A. Blood pressure of 110/70 mm Hg
B. Potassium level of 3.2 mEq/L
C. Respiratory rate of 20 breaths/min
D. Urine output of 40 mL/hr
CORRECT ANSWER: B. Potassium level of 3.2 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes potassium excretion, increasing the risk of
hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L) and places the
client at risk for cardiac dysrhythmias. The nurse should notify the provider before administering
furosemide, as potassium replacement may be needed. While blood pressure, respiratory rate, and
urine output are important, hypokalemia poses the most immediate safety concern with this
medication.
Question 2: A nurse is teaching a client with newly diagnosed type 2 diabetes about self-management.
Which statement by the client indicates a need for further teaching?
A. "I will check my blood sugar before meals and at bedtime."
B. "I can skip my metformin if I don't eat a meal."
C. "I should rotate injection sites if I start insulin."
D. "I will wear a medical alert bracelet at all times."
CORRECT ANSWER: B. "I can skip my metformin if I don't eat a meal."
RATIONALE: Metformin is an oral antihyperglycemic agent that works primarily by decreasing hepatic
glucose production and improving insulin sensitivity; it is not dependent on food intake for efficacy and
should not be skipped without provider guidance. Skipping doses can lead to poor glycemic control. The
other statements reflect accurate understanding of diabetes self-management: regular blood glucose
monitoring, injection site rotation to prevent lipodystrophy, and wearing medical identification for
emergency situations.
Question 3: A postoperative client who had abdominal surgery 24 hours ago reports sudden onset of
shortness of breath and chest pain. The nurse notes tachycardia and oxygen saturation of 88% on
room air. Which action should the nurse take first?
A. Administer prescribed morphine sulfate for pain
B. Notify the rapid response team
,C. Apply oxygen via nasal cannula at 2 L/min
D. Obtain a stat chest x-ray
CORRECT ANSWER: B. Notify the rapid response team
RATIONALE: The client's symptoms (sudden dyspnea, chest pain, tachycardia, hypoxia) are classic signs
of pulmonary embolism, a life-threatening postoperative complication. Activating the rapid response
team ensures immediate multidisciplinary intervention, which is the priority. While applying oxygen is
important, it should not delay summoning emergency assistance. Pain management and diagnostic
testing are secondary to stabilizing the client and initiating emergency protocols.
Question 4: A nurse is assessing a newborn 2 hours after birth. Which finding requires immediate
intervention?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 50 breaths/min with brief apical pauses
C. Central cyanosis of the lips and tongue
D. Heart rate of 130 beats/min with regular rhythm
CORRECT ANSWER: C. Central cyanosis of the lips and tongue
RATIONALE: Central cyanosis (bluish discoloration of the lips, tongue, and trunk) indicates inadequate
oxygenation and may signal congenital heart disease, respiratory distress, or other critical conditions
requiring immediate evaluation and intervention. Acrocyanosis (peripheral cyanosis) is normal in the
first 24–48 hours due to immature peripheral circulation. A respiratory rate of 50 breaths/min with brief
pauses (<15 seconds) is within normal limits for a newborn. A heart rate of 130 beats/min is also normal
(normal range: 110–160 beats/min).
Question 5: A nurse is preparing to administer digoxin 0.125 mg orally to a client with atrial
fibrillation. The client's apical pulse is 58 beats/min. Which action should the nurse take?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Recheck the pulse in 30 minutes
D. Administer half the prescribed dose
CORRECT ANSWER: B. Hold the dose and notify the provider
RATIONALE: Digoxin slows the heart rate and is contraindicated if the apical pulse is below 60
beats/min in adults due to the risk of severe bradycardia or heart block. The nurse should hold the dose
and contact the provider for further instructions. Rechecking the pulse or altering the dose without an
order is outside the nurse's scope. Administering digoxin with a pulse of 58 could exacerbate
bradycardia and compromise cardiac output.
Question 6: A client with chronic kidney disease is scheduled for hemodialysis. Which laboratory value
should the nurse anticipate will be elevated prior to treatment?
A. Serum calcium
B. Serum potassium
,C. Serum sodium
D. Serum bicarbonate
CORRECT ANSWER: B. Serum potassium
RATIONALE: In chronic kidney disease, the kidneys cannot effectively excrete potassium, leading to
hyperkalemia, especially between dialysis sessions. Elevated potassium (>5.0 mEq/L) is a common pre-
dialysis finding and poses a risk for life-threatening cardiac dysrhythmias. Serum calcium is often low
due to impaired vitamin D activation; sodium may be normal or low; bicarbonate is typically low
(metabolic acidosis) due to reduced acid excretion.
Question 7: A nurse is caring for a client receiving a blood transfusion. Thirty minutes after initiation,
the client reports chills, back pain, and headache. The nurse notes fever and tachycardia. Which action
should the nurse take first?
A. Stop the transfusion immediately
B. Administer acetaminophen for fever
C. Notify the blood bank
D. Obtain a urine specimen
CORRECT ANSWER: A. Stop the transfusion immediately
RATIONALE: The symptoms described (chills, back pain, headache, fever, tachycardia) are indicative of
an acute hemolytic transfusion reaction, a medical emergency. The first action is to stop the transfusion
to prevent further infusion of incompatible blood. The nurse should then maintain IV access with normal
saline, notify the provider and blood bank, monitor vital signs, and collect specimens as ordered.
Administering medications or obtaining specimens before stopping the transfusion delays critical
intervention.
Question 8: A nurse is developing a care plan for a client with Parkinson's disease. Which intervention
should be included to promote safety?
A. Encourage the client to walk quickly to improve mobility
B. Place the client in a low bed with side rails up
C. Schedule activities during peak medication effectiveness
D. Provide a high-protein diet with each meal
CORRECT ANSWER: C. Schedule activities during peak medication effectiveness
RATIONALE: Parkinson's disease causes bradykinesia, rigidity, and tremors that fluctuate with
medication timing. Scheduling activities during peak levodopa/carbidopa effectiveness maximizes
mobility and reduces fall risk. Walking quickly increases fall risk due to festination. Low beds and side
rails may increase confusion or injury in some clients and are not first-line safety measures. High-protein
meals can interfere with levodopa absorption and should be timed separately from medication doses.
Question 9: A nurse is assessing a client with a suspected stroke. Which finding indicates a right-
hemisphere stroke?
, A. Aphasia and right-sided weakness
B. Left-sided neglect and impulsivity
C. Right visual field deficit and dysphagia
D. Left-sided weakness and expressive aphasia
CORRECT ANSWER: B. Left-sided neglect and impulsivity
RATIONALE: The right cerebral hemisphere controls the left side of the body and is responsible for
spatial perception and judgment. A right-hemisphere stroke typically causes left-sided hemiparesis, left
visual field deficits, unilateral neglect (ignoring the left side), and impulsivity/poor judgment. Aphasia
(language disturbance) is associated with left-hemisphere strokes in right-handed individuals. Dysphagia
can occur with brainstem involvement but is not lateralizing.
Question 10: A nurse is teaching a client about warfarin therapy. Which statement by the client
indicates understanding?
A. "I will take ibuprofen for headaches while on warfarin."
B. "I need to avoid foods high in vitamin K, like spinach and broccoli."
C. "I should use a soft-bristled toothbrush and electric razor."
D. "I can stop taking warfarin once my leg swelling improves."
CORRECT ANSWER: C. "I should use a soft-bristled toothbrush and electric razor."
RATIONALE: Warfarin increases bleeding risk, so injury prevention measures like using a soft
toothbrush and electric razor reduce the risk of mucosal trauma and bleeding. Clients should avoid
NSAIDs (e.g., ibuprofen) due to increased bleeding risk and should maintain consistent vitamin K intake
rather than avoiding it entirely, as sudden changes affect INR stability. Warfarin is often long-term
therapy for conditions like atrial fibrillation or DVT and should not be discontinued without provider
guidance.
Question 11: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water-seal chamber
B. Tidaling in the water-seal chamber with respiration
C. Continuous bubbling in the water-seal chamber
D. 50 mL of serosanguinous drainage in the collection chamber
CORRECT ANSWER: C. Continuous bubbling in the water-seal chamber
RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which
could compromise lung re-expansion and lead to tension pneumothorax. The nurse should assess the
system for loose connections, tubing cracks, or insertion site issues. Intermittent bubbling with
exhalation is normal if a pneumothorax is present; tidaling (fluctuation with respiration) indicates proper
system function; 50 mL of drainage is expected in the immediate post-insertion period.
Question 12: A nurse is preparing to administer insulin aspart and insulin glargine to a client with type
1 diabetes. Which action should the nurse take?
QUESTIONS AND ANSWERS WITH DETAILED RATIONALES | FULL COVERAGE OF
MEDICAL-SURGICAL, PEDIATRIC, OB/GYN, MENTAL HEALTH, PHARMACOLOGY,
AND COMMUNITY HEALTH NURSING | NCLEX-STYLE PRACTICE QUESTIONS,
TEST-TAKING STRATEGIES, AND INTENSIVE EXIT EXAM REVIEW FOR
GUARANTEED PASS AND TOP SCORES
Question 1: A nurse is caring for a client with heart failure who has been prescribed furosemide 40 mg
IV push. Which assessment finding should the nurse prioritize before administering the medication?
A. Blood pressure of 110/70 mm Hg
B. Potassium level of 3.2 mEq/L
C. Respiratory rate of 20 breaths/min
D. Urine output of 40 mL/hr
CORRECT ANSWER: B. Potassium level of 3.2 mEq/L
RATIONALE: Furosemide is a loop diuretic that promotes potassium excretion, increasing the risk of
hypokalemia. A potassium level of 3.2 mEq/L is below the normal range (3.5–5.0 mEq/L) and places the
client at risk for cardiac dysrhythmias. The nurse should notify the provider before administering
furosemide, as potassium replacement may be needed. While blood pressure, respiratory rate, and
urine output are important, hypokalemia poses the most immediate safety concern with this
medication.
Question 2: A nurse is teaching a client with newly diagnosed type 2 diabetes about self-management.
Which statement by the client indicates a need for further teaching?
A. "I will check my blood sugar before meals and at bedtime."
B. "I can skip my metformin if I don't eat a meal."
C. "I should rotate injection sites if I start insulin."
D. "I will wear a medical alert bracelet at all times."
CORRECT ANSWER: B. "I can skip my metformin if I don't eat a meal."
RATIONALE: Metformin is an oral antihyperglycemic agent that works primarily by decreasing hepatic
glucose production and improving insulin sensitivity; it is not dependent on food intake for efficacy and
should not be skipped without provider guidance. Skipping doses can lead to poor glycemic control. The
other statements reflect accurate understanding of diabetes self-management: regular blood glucose
monitoring, injection site rotation to prevent lipodystrophy, and wearing medical identification for
emergency situations.
Question 3: A postoperative client who had abdominal surgery 24 hours ago reports sudden onset of
shortness of breath and chest pain. The nurse notes tachycardia and oxygen saturation of 88% on
room air. Which action should the nurse take first?
A. Administer prescribed morphine sulfate for pain
B. Notify the rapid response team
,C. Apply oxygen via nasal cannula at 2 L/min
D. Obtain a stat chest x-ray
CORRECT ANSWER: B. Notify the rapid response team
RATIONALE: The client's symptoms (sudden dyspnea, chest pain, tachycardia, hypoxia) are classic signs
of pulmonary embolism, a life-threatening postoperative complication. Activating the rapid response
team ensures immediate multidisciplinary intervention, which is the priority. While applying oxygen is
important, it should not delay summoning emergency assistance. Pain management and diagnostic
testing are secondary to stabilizing the client and initiating emergency protocols.
Question 4: A nurse is assessing a newborn 2 hours after birth. Which finding requires immediate
intervention?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 50 breaths/min with brief apical pauses
C. Central cyanosis of the lips and tongue
D. Heart rate of 130 beats/min with regular rhythm
CORRECT ANSWER: C. Central cyanosis of the lips and tongue
RATIONALE: Central cyanosis (bluish discoloration of the lips, tongue, and trunk) indicates inadequate
oxygenation and may signal congenital heart disease, respiratory distress, or other critical conditions
requiring immediate evaluation and intervention. Acrocyanosis (peripheral cyanosis) is normal in the
first 24–48 hours due to immature peripheral circulation. A respiratory rate of 50 breaths/min with brief
pauses (<15 seconds) is within normal limits for a newborn. A heart rate of 130 beats/min is also normal
(normal range: 110–160 beats/min).
Question 5: A nurse is preparing to administer digoxin 0.125 mg orally to a client with atrial
fibrillation. The client's apical pulse is 58 beats/min. Which action should the nurse take?
A. Administer the dose as prescribed
B. Hold the dose and notify the provider
C. Recheck the pulse in 30 minutes
D. Administer half the prescribed dose
CORRECT ANSWER: B. Hold the dose and notify the provider
RATIONALE: Digoxin slows the heart rate and is contraindicated if the apical pulse is below 60
beats/min in adults due to the risk of severe bradycardia or heart block. The nurse should hold the dose
and contact the provider for further instructions. Rechecking the pulse or altering the dose without an
order is outside the nurse's scope. Administering digoxin with a pulse of 58 could exacerbate
bradycardia and compromise cardiac output.
Question 6: A client with chronic kidney disease is scheduled for hemodialysis. Which laboratory value
should the nurse anticipate will be elevated prior to treatment?
A. Serum calcium
B. Serum potassium
,C. Serum sodium
D. Serum bicarbonate
CORRECT ANSWER: B. Serum potassium
RATIONALE: In chronic kidney disease, the kidneys cannot effectively excrete potassium, leading to
hyperkalemia, especially between dialysis sessions. Elevated potassium (>5.0 mEq/L) is a common pre-
dialysis finding and poses a risk for life-threatening cardiac dysrhythmias. Serum calcium is often low
due to impaired vitamin D activation; sodium may be normal or low; bicarbonate is typically low
(metabolic acidosis) due to reduced acid excretion.
Question 7: A nurse is caring for a client receiving a blood transfusion. Thirty minutes after initiation,
the client reports chills, back pain, and headache. The nurse notes fever and tachycardia. Which action
should the nurse take first?
A. Stop the transfusion immediately
B. Administer acetaminophen for fever
C. Notify the blood bank
D. Obtain a urine specimen
CORRECT ANSWER: A. Stop the transfusion immediately
RATIONALE: The symptoms described (chills, back pain, headache, fever, tachycardia) are indicative of
an acute hemolytic transfusion reaction, a medical emergency. The first action is to stop the transfusion
to prevent further infusion of incompatible blood. The nurse should then maintain IV access with normal
saline, notify the provider and blood bank, monitor vital signs, and collect specimens as ordered.
Administering medications or obtaining specimens before stopping the transfusion delays critical
intervention.
Question 8: A nurse is developing a care plan for a client with Parkinson's disease. Which intervention
should be included to promote safety?
A. Encourage the client to walk quickly to improve mobility
B. Place the client in a low bed with side rails up
C. Schedule activities during peak medication effectiveness
D. Provide a high-protein diet with each meal
CORRECT ANSWER: C. Schedule activities during peak medication effectiveness
RATIONALE: Parkinson's disease causes bradykinesia, rigidity, and tremors that fluctuate with
medication timing. Scheduling activities during peak levodopa/carbidopa effectiveness maximizes
mobility and reduces fall risk. Walking quickly increases fall risk due to festination. Low beds and side
rails may increase confusion or injury in some clients and are not first-line safety measures. High-protein
meals can interfere with levodopa absorption and should be timed separately from medication doses.
Question 9: A nurse is assessing a client with a suspected stroke. Which finding indicates a right-
hemisphere stroke?
, A. Aphasia and right-sided weakness
B. Left-sided neglect and impulsivity
C. Right visual field deficit and dysphagia
D. Left-sided weakness and expressive aphasia
CORRECT ANSWER: B. Left-sided neglect and impulsivity
RATIONALE: The right cerebral hemisphere controls the left side of the body and is responsible for
spatial perception and judgment. A right-hemisphere stroke typically causes left-sided hemiparesis, left
visual field deficits, unilateral neglect (ignoring the left side), and impulsivity/poor judgment. Aphasia
(language disturbance) is associated with left-hemisphere strokes in right-handed individuals. Dysphagia
can occur with brainstem involvement but is not lateralizing.
Question 10: A nurse is teaching a client about warfarin therapy. Which statement by the client
indicates understanding?
A. "I will take ibuprofen for headaches while on warfarin."
B. "I need to avoid foods high in vitamin K, like spinach and broccoli."
C. "I should use a soft-bristled toothbrush and electric razor."
D. "I can stop taking warfarin once my leg swelling improves."
CORRECT ANSWER: C. "I should use a soft-bristled toothbrush and electric razor."
RATIONALE: Warfarin increases bleeding risk, so injury prevention measures like using a soft
toothbrush and electric razor reduce the risk of mucosal trauma and bleeding. Clients should avoid
NSAIDs (e.g., ibuprofen) due to increased bleeding risk and should maintain consistent vitamin K intake
rather than avoiding it entirely, as sudden changes affect INR stability. Warfarin is often long-term
therapy for conditions like atrial fibrillation or DVT and should not be discontinued without provider
guidance.
Question 11: A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water-seal chamber
B. Tidaling in the water-seal chamber with respiration
C. Continuous bubbling in the water-seal chamber
D. 50 mL of serosanguinous drainage in the collection chamber
CORRECT ANSWER: C. Continuous bubbling in the water-seal chamber
RATIONALE: Continuous bubbling in the water-seal chamber indicates an air leak in the system, which
could compromise lung re-expansion and lead to tension pneumothorax. The nurse should assess the
system for loose connections, tubing cracks, or insertion site issues. Intermittent bubbling with
exhalation is normal if a pneumothorax is present; tidaling (fluctuation with respiration) indicates proper
system function; 50 mL of drainage is expected in the immediate post-insertion period.
Question 12: A nurse is preparing to administer insulin aspart and insulin glargine to a client with type
1 diabetes. Which action should the nurse take?
