1|Page
COMPREHENSIVE HESI EXIT EXAM V2
(VERSION 2) TEST BANK 2026-2027 Edition | 150
Practice Questions & Answers High-Yield Content |
Detailed Rationales | Graded A+
TABLE OF CONTENTS
Section Topic Area Questions
I Medical-Surgical Nursing 35
II Pharmacology & Medication Administration 20
III Maternal-Newborn Nursing 15
IV Pediatric Nursing 15
V Psychiatric/Mental Health Nursing 15
VI Leadership & Management 10
VII Community Health & Public Health 10
VIII Critical Care & Emergency Nursing 15
,2|Page
Section Topic Area Questions
IX Clinical Case Vignettes 15
TOTAL 150 Questions
SECTION I: MEDICAL-SURGICAL NURSING
1. A nurse is caring for a patient with heart failure who has gained 5
pounds in 3 days. Which assessment finding is most concerning?
A) Blood pressure 140/90 mm Hg
B) Heart rate 88 beats per minute
C) Respiratory rate 26 breaths per minute with crackles in lung bases
D) Urine output 50 mL/hour
Answer: C) Respiratory rate 26 breaths per minute with crackles in
lung bases
Rationale: The weight gain indicates fluid retention. Crackles in the
lung bases with tachypnea indicate pulmonary congestion, a sign of
worsening heart failure requiring immediate intervention. While elevated
blood pressure is concerning, respiratory symptoms take priority. Heart
rate is within normal limits. Urine output is adequate (30 mL/hour
minimum) .
2. A nurse is assessing a patient with chronic obstructive pulmonary
disease (COPD). Which finding requires immediate intervention?
,3|Page
A) Oxygen saturation of 88% on 2 L/min nasal cannula
B) Respiratory rate of 24 breaths per minute
C) Use of accessory muscles and confusion
D) Productive cough with green sputum
Answer: C) Use of accessory muscles and confusion
Rationale: Confusion and use of accessory muscles indicate impending
respiratory failure and require immediate intervention. Oxygen
saturation of 88% is expected in COPD patients (target 88-92%).
Tachypnea and productive cough are expected findings but not
immediately life-threatening .
3. A nurse is caring for a patient with diabetes mellitus who has a
blood glucose of 45 mg/dL. The patient is awake and alert. Which
action should the nurse take first?
A) Administer glucagon IM
B) Give 15 g of fast-acting carbohydrate
C) Notify the healthcare provider
D) Recheck blood glucose in 15 minutes
Answer: B) Give 15 g of fast-acting carbohydrate
Rationale: For an awake and alert patient with hypoglycemia, the
priority is to administer 15 g of fast-acting carbohydrate (e.g., 4 oz juice,
3-4 glucose tablets). Blood glucose should be rechecked in 15 minutes.
Glucagon is used for unconscious patients. The provider can be notified
after initial treatment .
4. A patient with cirrhosis has an ammonia level of 150 mcg/dL.
Which assessment finding would the nurse expect?
, 4|Page
A) Asterixis (liver flap)
B) Jaundice
C) Spider angiomas
D) Palmar erythema
Answer: A) Asterixis (liver flap)
Rationale: Elevated ammonia in cirrhosis causes hepatic
encephalopathy. Asterixis (involuntary flapping of the hands when wrists
are extended) is a characteristic sign of hepatic encephalopathy.
Jaundice, spider angiomas, and palmar erythema are signs of chronic
liver disease but not directly related to ammonia levels .
5. A nurse is caring for a patient with acute pancreatitis. Which
laboratory value is most specific for pancreatitis?
A) Elevated amylase
B) Elevated lipase
C) Elevated bilirubin
D) Elevated alkaline phosphatase
Answer: B) Elevated lipase
Rationale: Lipase is the most specific laboratory test for acute
pancreatitis. It remains elevated longer than amylase (up to 8-14 days).
Amylase is also elevated but is less specific (can be elevated in salivary
gland disorders, bowel obstruction). Bilirubin and alkaline phosphatase
may be elevated in biliary obstruction .
6. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
provider before dialysis?
COMPREHENSIVE HESI EXIT EXAM V2
(VERSION 2) TEST BANK 2026-2027 Edition | 150
Practice Questions & Answers High-Yield Content |
Detailed Rationales | Graded A+
TABLE OF CONTENTS
Section Topic Area Questions
I Medical-Surgical Nursing 35
II Pharmacology & Medication Administration 20
III Maternal-Newborn Nursing 15
IV Pediatric Nursing 15
V Psychiatric/Mental Health Nursing 15
VI Leadership & Management 10
VII Community Health & Public Health 10
VIII Critical Care & Emergency Nursing 15
,2|Page
Section Topic Area Questions
IX Clinical Case Vignettes 15
TOTAL 150 Questions
SECTION I: MEDICAL-SURGICAL NURSING
1. A nurse is caring for a patient with heart failure who has gained 5
pounds in 3 days. Which assessment finding is most concerning?
A) Blood pressure 140/90 mm Hg
B) Heart rate 88 beats per minute
C) Respiratory rate 26 breaths per minute with crackles in lung bases
D) Urine output 50 mL/hour
Answer: C) Respiratory rate 26 breaths per minute with crackles in
lung bases
Rationale: The weight gain indicates fluid retention. Crackles in the
lung bases with tachypnea indicate pulmonary congestion, a sign of
worsening heart failure requiring immediate intervention. While elevated
blood pressure is concerning, respiratory symptoms take priority. Heart
rate is within normal limits. Urine output is adequate (30 mL/hour
minimum) .
2. A nurse is assessing a patient with chronic obstructive pulmonary
disease (COPD). Which finding requires immediate intervention?
,3|Page
A) Oxygen saturation of 88% on 2 L/min nasal cannula
B) Respiratory rate of 24 breaths per minute
C) Use of accessory muscles and confusion
D) Productive cough with green sputum
Answer: C) Use of accessory muscles and confusion
Rationale: Confusion and use of accessory muscles indicate impending
respiratory failure and require immediate intervention. Oxygen
saturation of 88% is expected in COPD patients (target 88-92%).
Tachypnea and productive cough are expected findings but not
immediately life-threatening .
3. A nurse is caring for a patient with diabetes mellitus who has a
blood glucose of 45 mg/dL. The patient is awake and alert. Which
action should the nurse take first?
A) Administer glucagon IM
B) Give 15 g of fast-acting carbohydrate
C) Notify the healthcare provider
D) Recheck blood glucose in 15 minutes
Answer: B) Give 15 g of fast-acting carbohydrate
Rationale: For an awake and alert patient with hypoglycemia, the
priority is to administer 15 g of fast-acting carbohydrate (e.g., 4 oz juice,
3-4 glucose tablets). Blood glucose should be rechecked in 15 minutes.
Glucagon is used for unconscious patients. The provider can be notified
after initial treatment .
4. A patient with cirrhosis has an ammonia level of 150 mcg/dL.
Which assessment finding would the nurse expect?
, 4|Page
A) Asterixis (liver flap)
B) Jaundice
C) Spider angiomas
D) Palmar erythema
Answer: A) Asterixis (liver flap)
Rationale: Elevated ammonia in cirrhosis causes hepatic
encephalopathy. Asterixis (involuntary flapping of the hands when wrists
are extended) is a characteristic sign of hepatic encephalopathy.
Jaundice, spider angiomas, and palmar erythema are signs of chronic
liver disease but not directly related to ammonia levels .
5. A nurse is caring for a patient with acute pancreatitis. Which
laboratory value is most specific for pancreatitis?
A) Elevated amylase
B) Elevated lipase
C) Elevated bilirubin
D) Elevated alkaline phosphatase
Answer: B) Elevated lipase
Rationale: Lipase is the most specific laboratory test for acute
pancreatitis. It remains elevated longer than amylase (up to 8-14 days).
Amylase is also elevated but is less specific (can be elevated in salivary
gland disorders, bowel obstruction). Bilirubin and alkaline phosphatase
may be elevated in biliary obstruction .
6. A patient with end-stage renal disease (ESRD) is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
provider before dialysis?
