RN HESI EXIT EXAM PREP 2026
Comprehensive Test Bank – Version V1
200 Detailed Questions with Answers & Rationales
Description:
This test bank is meticulously designed for candidates preparing for the RN
HESI Exit Exam V1 (2026 Edition) . It reflects the most current NCLEX-RN test
plan standards, clinical judgment measurement models, and evidence-based
practice guidelines. The content encompasses all core nursing domains:
Medical-Surgical, Pharmacology, Maternity, Pediatrics, Psychiatric/Mental
Health, Leadership/Management, Prioritization/Delegation, Infection Control,
Emergency Care, and End-of-Life/Ethics. Each question is paired with a bolded
correct answer and a detailed, instructional rationale to reinforce clinical
reasoning and decision-making skills essential for first-time pass success.
Content Breakdown:
1. Medical-Surgical (Cardiac & Respiratory)
Heart failure, MI, COPD, asthma, PE, chest tubes, EKG interpretation
2. Pharmacology
Digoxin, warfarin, lithium, insulin, opioids, antiepileptics, MAOIs, anticoagulants
3. Maternity & Newborn
Preeclampsia, placenta previa, cord prolapse, postpartum hemorrhage, neonatal
resuscitation
4. Pediatrics
RSV, sickle cell crisis, DKA, shunt malfunction, febrile neutropenia, cystic fibrosis
5. Psychiatric/Mental Health
Depression, bipolar disorder, PTSD, schizophrenia, eating disorders, substance withdrawal
6. Leadership, Delegation & Management
Scope of practice, task delegation, ethical dilemmas, incident reporting, just culture
7. Prioritization & Emergency
Triage, shock, anaphylaxis, status epilepticus, tension pneumothorax, DKA, toxic ingestions
8. Infection Control & Safety
*Isolation precautions, needlestick protocol, C. diff, TB, COVID-19, PPE*
9. End-of-Life & Ethics
Advance directives, DNR, withdrawal of support, brain death, hospice philosophy
10. Comprehensive / Integrated
Complex co-morbidities, transplant complications, autonomic dysreflexia, rare but critical
presentations
,Medical-Surgical (Cardiac & Respiratory)
1. A client with heart failure presents with dyspnea, crackles, and jugular vein distention.
Which medication should the nurse expect to administer first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving pulmonary
congestion. Digoxin improves contractility but is not first-line for acute symptoms.
Metoprolol and lisinopril are chronic management drugs.
2. A client on a cardiac monitor shows a regular rhythm with a rate of 42 bpm, no P waves,
and wide QRS complexes. What is the priority action?
A. Administer atropine
B. Prepare for transcutaneous pacing
C. Defibrillate immediately
D. Give amiodarone
Answer: B. Prepare for transcutaneous pacing
Rationale: This rhythm is ventricular escape rhythm (no P waves, wide QRS, bradycardia).
Transcutaneous pacing is indicated for symptomatic bradycardia unresponsive to atropine.
Atropine may be tried but pacing is definitive if unstable.
3. A client post-MI develops sudden shortness of breath and muffled heart sounds. What
condition should the nurse suspect?
A. Pulmonary embolism
B. Cardiac tamponade
C. Pericarditis
D. Left ventricular aneurysm
Answer: B. Cardiac tamponade
Rationale: Beck’s triad (hypotension, muffled heart sounds, JVD) suggests tamponade. Post-
MI, it can occur from ventricular rupture. Immediate pericardiocentesis is needed.
4. A client with COPD has an SpO2 of 88% on 2L nasal cannula. What action should the
nurse take?
A. Increase oxygen to 4L
B. Titrate oxygen to maintain SpO2 88–92%
C. Apply a non-rebreather mask
D. Prepare for intubation
,Answer: B. Titrate oxygen to maintain SpO2 88–92%
Rationale: In COPD, hypoxic drive may be present. Target SpO2 is 88–92% to avoid CO2
retention. Increasing O2 too high can worsen acidosis.
5. A client with asthma has an acute exacerbation. Which finding indicates improvement
after albuterol?
A. Peak expiratory flow increased from 150 to 350 L/min
B. Respiratory rate 28/min
C. Use of accessory muscles
D. Wheezing in all fields
Answer: A. Peak expiratory flow increased from 150 to 350 L/min
Rationale: Improved PEFR indicates bronchodilation. Continued tachypnea, accessory muscle
use, or wheezing suggests ongoing obstruction.
6. A client with pulmonary embolism is on heparin. Which lab value requires immediate
notification of the provider?
A. aPTT 70 seconds
B. Platelets 80,000/mm³
C. INR 1.2
D. Hemoglobin 12 g/dL
Answer: B. Platelets 80,000/mm³
Rationale: Thrombocytopenia (HIT) can occur with heparin. aPTT 70 sec is therapeutic (goal
60–80). Low platelets increase bleeding risk and require stopping heparin.
7. A client with aortic stenosis reports chest pain and syncope on exertion. The nurse
understands this is due to:
A. Decreased coronary artery perfusion
B. Right ventricular failure
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: A. Decreased coronary artery perfusion
Rationale: Aortic stenosis increases afterload, reducing stroke volume and coronary
perfusion pressure, leading to angina and syncope.
8. A client with heart failure is prescribed carvedilol. Which instruction is most important?
A. Take with food to prevent GI upset
B. Monitor for weight gain and dyspnea initially
C. Do not stop abruptly
D. Take at bedtime only
, Answer: C. Do not stop abruptly
Rationale: Abrupt beta-blocker withdrawal can cause rebound tachycardia and worsening
HF. Carvedilol should be tapered. Weight monitoring is also important but safety first.
9. A client after cardiac catheterization has a retroperitoneal hematoma. What assessment
finding is most concerning?
A. Back pain and hypotension
B. Bruising at the insertion site
C. Heart rate 88 bpm
D. Urine output 40 mL/hr
Answer: A. Back pain and hypotension
Rationale: Retroperitoneal bleeding presents with back/flank pain, hypotension, and
dropping Hgb. It is a life-threatening complication.
10. A client with pneumonia has a fever of 102°F, productive cough, and confusion. What is
the priority nursing diagnosis?
A. Ineffective airway clearance
B. Hyperthermia
C. Acute confusion
D. Impaired gas exchange
Answer: D. Impaired gas exchange
Rationale: Confusion in pneumonia suggests hypoxemia. Gas exchange is the priority over
airway clearance or fever.
11. A client with tuberculosis is started on rifampin. Which statement indicates
understanding?
A. “I will take my contacts to be tested.”
B. “My urine may turn orange.”
C. “I can stop when symptoms resolve.”
D. “I need a low-protein diet.”
Answer: B. “My urine may turn orange.”
Rationale: Rifampin causes orange-red discoloration of body fluids. It is harmless but must
be explained to avoid alarm. Treatment is 6–12 months, not symptom-based.
12. A client with a chest tube has continuous bubbling in the water seal chamber. What
action should the nurse take?
A. Clamp the chest tube
B. Check for an air leak
C. Increase suction
Comprehensive Test Bank – Version V1
200 Detailed Questions with Answers & Rationales
Description:
This test bank is meticulously designed for candidates preparing for the RN
HESI Exit Exam V1 (2026 Edition) . It reflects the most current NCLEX-RN test
plan standards, clinical judgment measurement models, and evidence-based
practice guidelines. The content encompasses all core nursing domains:
Medical-Surgical, Pharmacology, Maternity, Pediatrics, Psychiatric/Mental
Health, Leadership/Management, Prioritization/Delegation, Infection Control,
Emergency Care, and End-of-Life/Ethics. Each question is paired with a bolded
correct answer and a detailed, instructional rationale to reinforce clinical
reasoning and decision-making skills essential for first-time pass success.
Content Breakdown:
1. Medical-Surgical (Cardiac & Respiratory)
Heart failure, MI, COPD, asthma, PE, chest tubes, EKG interpretation
2. Pharmacology
Digoxin, warfarin, lithium, insulin, opioids, antiepileptics, MAOIs, anticoagulants
3. Maternity & Newborn
Preeclampsia, placenta previa, cord prolapse, postpartum hemorrhage, neonatal
resuscitation
4. Pediatrics
RSV, sickle cell crisis, DKA, shunt malfunction, febrile neutropenia, cystic fibrosis
5. Psychiatric/Mental Health
Depression, bipolar disorder, PTSD, schizophrenia, eating disorders, substance withdrawal
6. Leadership, Delegation & Management
Scope of practice, task delegation, ethical dilemmas, incident reporting, just culture
7. Prioritization & Emergency
Triage, shock, anaphylaxis, status epilepticus, tension pneumothorax, DKA, toxic ingestions
8. Infection Control & Safety
*Isolation precautions, needlestick protocol, C. diff, TB, COVID-19, PPE*
9. End-of-Life & Ethics
Advance directives, DNR, withdrawal of support, brain death, hospice philosophy
10. Comprehensive / Integrated
Complex co-morbidities, transplant complications, autonomic dysreflexia, rare but critical
presentations
,Medical-Surgical (Cardiac & Respiratory)
1. A client with heart failure presents with dyspnea, crackles, and jugular vein distention.
Which medication should the nurse expect to administer first?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Lisinopril
Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload, relieving pulmonary
congestion. Digoxin improves contractility but is not first-line for acute symptoms.
Metoprolol and lisinopril are chronic management drugs.
2. A client on a cardiac monitor shows a regular rhythm with a rate of 42 bpm, no P waves,
and wide QRS complexes. What is the priority action?
A. Administer atropine
B. Prepare for transcutaneous pacing
C. Defibrillate immediately
D. Give amiodarone
Answer: B. Prepare for transcutaneous pacing
Rationale: This rhythm is ventricular escape rhythm (no P waves, wide QRS, bradycardia).
Transcutaneous pacing is indicated for symptomatic bradycardia unresponsive to atropine.
Atropine may be tried but pacing is definitive if unstable.
3. A client post-MI develops sudden shortness of breath and muffled heart sounds. What
condition should the nurse suspect?
A. Pulmonary embolism
B. Cardiac tamponade
C. Pericarditis
D. Left ventricular aneurysm
Answer: B. Cardiac tamponade
Rationale: Beck’s triad (hypotension, muffled heart sounds, JVD) suggests tamponade. Post-
MI, it can occur from ventricular rupture. Immediate pericardiocentesis is needed.
4. A client with COPD has an SpO2 of 88% on 2L nasal cannula. What action should the
nurse take?
A. Increase oxygen to 4L
B. Titrate oxygen to maintain SpO2 88–92%
C. Apply a non-rebreather mask
D. Prepare for intubation
,Answer: B. Titrate oxygen to maintain SpO2 88–92%
Rationale: In COPD, hypoxic drive may be present. Target SpO2 is 88–92% to avoid CO2
retention. Increasing O2 too high can worsen acidosis.
5. A client with asthma has an acute exacerbation. Which finding indicates improvement
after albuterol?
A. Peak expiratory flow increased from 150 to 350 L/min
B. Respiratory rate 28/min
C. Use of accessory muscles
D. Wheezing in all fields
Answer: A. Peak expiratory flow increased from 150 to 350 L/min
Rationale: Improved PEFR indicates bronchodilation. Continued tachypnea, accessory muscle
use, or wheezing suggests ongoing obstruction.
6. A client with pulmonary embolism is on heparin. Which lab value requires immediate
notification of the provider?
A. aPTT 70 seconds
B. Platelets 80,000/mm³
C. INR 1.2
D. Hemoglobin 12 g/dL
Answer: B. Platelets 80,000/mm³
Rationale: Thrombocytopenia (HIT) can occur with heparin. aPTT 70 sec is therapeutic (goal
60–80). Low platelets increase bleeding risk and require stopping heparin.
7. A client with aortic stenosis reports chest pain and syncope on exertion. The nurse
understands this is due to:
A. Decreased coronary artery perfusion
B. Right ventricular failure
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: A. Decreased coronary artery perfusion
Rationale: Aortic stenosis increases afterload, reducing stroke volume and coronary
perfusion pressure, leading to angina and syncope.
8. A client with heart failure is prescribed carvedilol. Which instruction is most important?
A. Take with food to prevent GI upset
B. Monitor for weight gain and dyspnea initially
C. Do not stop abruptly
D. Take at bedtime only
, Answer: C. Do not stop abruptly
Rationale: Abrupt beta-blocker withdrawal can cause rebound tachycardia and worsening
HF. Carvedilol should be tapered. Weight monitoring is also important but safety first.
9. A client after cardiac catheterization has a retroperitoneal hematoma. What assessment
finding is most concerning?
A. Back pain and hypotension
B. Bruising at the insertion site
C. Heart rate 88 bpm
D. Urine output 40 mL/hr
Answer: A. Back pain and hypotension
Rationale: Retroperitoneal bleeding presents with back/flank pain, hypotension, and
dropping Hgb. It is a life-threatening complication.
10. A client with pneumonia has a fever of 102°F, productive cough, and confusion. What is
the priority nursing diagnosis?
A. Ineffective airway clearance
B. Hyperthermia
C. Acute confusion
D. Impaired gas exchange
Answer: D. Impaired gas exchange
Rationale: Confusion in pneumonia suggests hypoxemia. Gas exchange is the priority over
airway clearance or fever.
11. A client with tuberculosis is started on rifampin. Which statement indicates
understanding?
A. “I will take my contacts to be tested.”
B. “My urine may turn orange.”
C. “I can stop when symptoms resolve.”
D. “I need a low-protein diet.”
Answer: B. “My urine may turn orange.”
Rationale: Rifampin causes orange-red discoloration of body fluids. It is harmless but must
be explained to avoid alarm. Treatment is 6–12 months, not symptom-based.
12. A client with a chest tube has continuous bubbling in the water seal chamber. What
action should the nurse take?
A. Clamp the chest tube
B. Check for an air leak
C. Increase suction
