EXIT HESI PN exam-style (249 QQUESTIONS AND
ANSWERS ) EXAM QUESTIONS AND
ANSWERS PLUS RATIONALES | WITH
COMPLETE SOLUTION
TABLE OF CONTENT
Category Questions
Medical-Surgical 80
Pharmacology 40
Maternal-Newborn 30
Pediatrics 30
Mental Health 30
Fundamentals 30
Leadership & Management 20
QUESTIONS
Q1 of 249Medical-Surgical
A client with deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory value
is the priority for the PN to monitor?
A. Prothrombin time (PT)
,B. Activated partial thromboplastin time (aPTT) ✓ — (Correct Answer)
C. International normalized ratio (INR)
D. Platelet count
Rationale: Heparin therapy is monitored using aPTT. The therapeutic range is 1.5–2.5 times the
normal control value. PT/INR monitors warfarin therapy, not heparin.
Q2 of 249Medical-Surgical
A client with heart failure is receiving furosemide (Lasix). Which electrolyte imbalance should
the PN anticipate?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia ✓ — (Correct Answer)
D. Hypercalcemia
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is the
primary concern. The PN should monitor potassium levels and assess for muscle weakness and
cardiac dysrhythmias.
Q3 of 249Medical-Surgical
A post-operative client reports pain of 8/10 and has an order for morphine sulfate 4 mg IV PRN
every 4 hours. The last dose was 5 hours ago. What is the priority nursing action?
A. Reassess the pain in 30 minutes
B. Administer the morphine as ordered ✓ — (Correct Answer)
C. Notify the physician
D. Encourage non-pharmacological measures first
,Rationale: The client has severe pain (8/10), the medication is ordered, and 5 hours have elapsed
since the last dose (beyond the 4-hour interval). The priority is to administer the ordered
analgesic to relieve suffering.
Q4 of 249Medical-Surgical
A client with COPD is receiving supplemental oxygen. Which oxygen flow rate is safest for this
client?
A. 6–8 L/min
B. 10–12 L/min
C. 1–2 L/min ✓ — (Correct Answer)
D. 15 L/min
Rationale: Clients with COPD retain CO2 and rely on hypoxic drive to breathe. High-flow
oxygen can suppress this drive and cause respiratory depression. Low-flow O2 at 1–2 L/min is
safe.
Q5 of 249Medical-Surgical
A client with type 1 diabetes mellitus has a blood glucose of 48 mg/dL and is conscious. What is
the priority intervention?
A. Administer glucagon IM
B. Give 15–20 g of fast-acting carbohydrates orally ✓ — (Correct Answer)
C. Start an IV and give D50W
D. Call the physician immediately
Rationale: For a conscious client with mild-moderate hypoglycemia, the rule of 15 applies: give
15–20 g of fast-acting carbs (e.g., 4 oz juice), recheck in 15 min. Glucagon/IV dextrose is
reserved for unconscious clients.
, Q6 of 249Medical-Surgical
A client is admitted with acute pancreatitis. Which dietary modification should the PN teach?
A. High-fat, high-protein diet
B. Low-fat, bland diet with small frequent meals ✓ — (Correct Answer)
C. High-carbohydrate diet with large meals
D. No dietary restrictions are needed
Rationale: In acute pancreatitis, fat stimulates pancreatic enzyme secretion and worsens
inflammation. A low-fat, bland diet with small frequent meals reduces pancreatic stimulation and
pain.
Q7 of 249Medical-Surgical
A client with a new colostomy expresses that they feel 'disgusting' and refuses to look at the
stoma. The PN's best response is:
A. 'It will get better with time.'
B. 'Tell me more about how you are feeling.' ✓ — (Correct Answer)
C. 'The stoma looks very healthy.'
D. 'You must learn to care for it before discharge.'
Rationale: This response uses therapeutic communication by encouraging the client to express
feelings. It acknowledges the client's emotional state and opens dialogue, which is essential for
coping with a major body image change.
Q8 of 249Medical-Surgical
A client with renal failure has a serum potassium of 6.8 mEq/L. The PN notes peaked T waves
on the ECG. The priority action is:
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
ANSWERS ) EXAM QUESTIONS AND
ANSWERS PLUS RATIONALES | WITH
COMPLETE SOLUTION
TABLE OF CONTENT
Category Questions
Medical-Surgical 80
Pharmacology 40
Maternal-Newborn 30
Pediatrics 30
Mental Health 30
Fundamentals 30
Leadership & Management 20
QUESTIONS
Q1 of 249Medical-Surgical
A client with deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory value
is the priority for the PN to monitor?
A. Prothrombin time (PT)
,B. Activated partial thromboplastin time (aPTT) ✓ — (Correct Answer)
C. International normalized ratio (INR)
D. Platelet count
Rationale: Heparin therapy is monitored using aPTT. The therapeutic range is 1.5–2.5 times the
normal control value. PT/INR monitors warfarin therapy, not heparin.
Q2 of 249Medical-Surgical
A client with heart failure is receiving furosemide (Lasix). Which electrolyte imbalance should
the PN anticipate?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia ✓ — (Correct Answer)
D. Hypercalcemia
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia is the
primary concern. The PN should monitor potassium levels and assess for muscle weakness and
cardiac dysrhythmias.
Q3 of 249Medical-Surgical
A post-operative client reports pain of 8/10 and has an order for morphine sulfate 4 mg IV PRN
every 4 hours. The last dose was 5 hours ago. What is the priority nursing action?
A. Reassess the pain in 30 minutes
B. Administer the morphine as ordered ✓ — (Correct Answer)
C. Notify the physician
D. Encourage non-pharmacological measures first
,Rationale: The client has severe pain (8/10), the medication is ordered, and 5 hours have elapsed
since the last dose (beyond the 4-hour interval). The priority is to administer the ordered
analgesic to relieve suffering.
Q4 of 249Medical-Surgical
A client with COPD is receiving supplemental oxygen. Which oxygen flow rate is safest for this
client?
A. 6–8 L/min
B. 10–12 L/min
C. 1–2 L/min ✓ — (Correct Answer)
D. 15 L/min
Rationale: Clients with COPD retain CO2 and rely on hypoxic drive to breathe. High-flow
oxygen can suppress this drive and cause respiratory depression. Low-flow O2 at 1–2 L/min is
safe.
Q5 of 249Medical-Surgical
A client with type 1 diabetes mellitus has a blood glucose of 48 mg/dL and is conscious. What is
the priority intervention?
A. Administer glucagon IM
B. Give 15–20 g of fast-acting carbohydrates orally ✓ — (Correct Answer)
C. Start an IV and give D50W
D. Call the physician immediately
Rationale: For a conscious client with mild-moderate hypoglycemia, the rule of 15 applies: give
15–20 g of fast-acting carbs (e.g., 4 oz juice), recheck in 15 min. Glucagon/IV dextrose is
reserved for unconscious clients.
, Q6 of 249Medical-Surgical
A client is admitted with acute pancreatitis. Which dietary modification should the PN teach?
A. High-fat, high-protein diet
B. Low-fat, bland diet with small frequent meals ✓ — (Correct Answer)
C. High-carbohydrate diet with large meals
D. No dietary restrictions are needed
Rationale: In acute pancreatitis, fat stimulates pancreatic enzyme secretion and worsens
inflammation. A low-fat, bland diet with small frequent meals reduces pancreatic stimulation and
pain.
Q7 of 249Medical-Surgical
A client with a new colostomy expresses that they feel 'disgusting' and refuses to look at the
stoma. The PN's best response is:
A. 'It will get better with time.'
B. 'Tell me more about how you are feeling.' ✓ — (Correct Answer)
C. 'The stoma looks very healthy.'
D. 'You must learn to care for it before discharge.'
Rationale: This response uses therapeutic communication by encouraging the client to express
feelings. It acknowledges the client's emotional state and opens dialogue, which is essential for
coping with a major body image change.
Q8 of 249Medical-Surgical
A client with renal failure has a serum potassium of 6.8 mEq/L. The PN notes peaked T waves
on the ECG. The priority action is:
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
