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HESI RN EXIT Exam 2026 HESI Nursing Nightingale
College -100+QUESTIONS AND ANSWERS WITH
RATIONALES
Category Question Numbers
1, 5, 9, 13, 17, 21, 28, 30, 34, 38, 42, 45, 48, 51, 59, 64, 68, 70, 77, 82, 86,
Medical-Surgical
89, 94, 96, 97, 98
3, 7, 10, 14, 19, 26, 32, 36, 40, 47, 54, 58, 60, 62, 66, 72, 75, 80, 85, 88, 92,
Pharmacology
93, 95, 99
Pediatrics 2, 11
Maternity/Newborn 6, 35, 73
Psychiatry 3, 12, 31, 54, 60, 74, 83
Critical Care 16, 17, 30, 34, 38, 43, 49, 84, 86
Leadership/Delegation 4
Community/Disaster 8
Lab Values 10, 22, 28, 32, 40, 50, 59, 66, 68, 77, 90, 96
Procedures/Skills 24, 27, 33, 37, 41, 44, 55, 63, 67, 69, 71, 81, 87
,HESI EXIT EXAM – MIXED QUESTION BANK (50 Q&A)
Question 1
A client with heart failure has crackles in both lung bases, an S3 gallop, and
jugular venous distension. Which medication should the nurse prepare 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 acts slowly. Beta-
blockers and ACE inhibitors are long-term therapies.
Question 2
A nurse is assessing a 2-day-old newborn. Which finding requires immediate
intervention?
A. Acrocyanosis
B. Respiratory rate of 65 with nasal flaring
C. Heart rate of 160 bpm during crying
D. Transient strabismus
Answer: B. Respiratory rate of 65 with nasal flaring
Rationale: Normal newborn respiratory rate is 30–60 bpm. Nasal flaring indicates
respiratory distress. Acrocyanosis, tachycardia with crying, and intermittent
strabismus are normal in the first few days.
Question 3
A client with bipolar disorder who takes lithium presents with diarrhea, vomiting,
and coarse hand tremors. Which lab value is most important to check?
A. Serum sodium
,B. Serum lithium level
C. Serum potassium
D. Thyroid-stimulating hormone
Answer: B. Serum lithium level
Rationale: Diarrhea and vomiting cause dehydration, increasing lithium
reabsorption and risk of toxicity. Coarse tremors are a sign of lithium toxicity.
Normal lithium level is 0.6–1.2 mEq/L; toxicity occurs above 1.5 mEq/L.
Question 4
The charge nurse is making assignments. Which client should be assigned to the
RN with the most experience?
A. Client with diabetes needing foot care teaching
B. Client with pneumonia on room air
C. Client with chest tube and continuous bubbling in water seal chamber
D. Client with a urinary tract infection receiving oral antibiotics
Answer: C. Client with chest tube and continuous bubbling in water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak,
which requires expert assessment and intervention. Stable clients with
predictable needs can be assigned to less experienced RNs or LPNs.
Question 5
A client is admitted with diabetic ketoacidosis (DKA). Which IV fluid and insulin
regimen is most appropriate initially?
A. 0.9% NS at 250 mL/hr + regular insulin IV bolus then continuous infusion
B. 0.45% NS at 100 mL/hr + NPH insulin subcutaneously every 6 hours
C. D5W at 50 mL/hr + insulin glargine subcutaneously once daily
D. 0.9% NS at 500 mL/hr + lispro insulin subcutaneously every 2 hours
Answer: A. 0.9% NS at 250 mL/hr + regular insulin IV bolus then continuous
infusion
Rationale: DKA requires aggressive fluid resuscitation with isotonic saline and IV
regular insulin (short half-life, titratable). NPH, glargine, and lispro are
subcutaneous and not used for acute DKA management.
, Question 6
A postpartum client reports a large gush of blood and a firm, displaced fundus to
the right. What is the priority action?
A. Massage the fundus
B. Catheterize the bladder
C. Administer oxytocin
D. Notify the provider
Answer: B. Catheterize the bladder
Rationale: A displaced, firm fundus suggests a full bladder displacing the uterus,
preventing contraction. Emptying the bladder allows the uterus to contract and
reduces bleeding. Fundal massage is ineffective if the bladder is full.
Question 7
A nurse is teaching a client with a new prescription for warfarin. Which statement
indicates understanding?
A. "I will take ibuprofen if I get a headache."
B. "I should avoid eating large amounts of spinach and kale."
C. "I can stop this medication when my INR is normal."
D. "I will take my warfarin in the morning with my aspirin."
Answer: B. "I should avoid eating large amounts of spinach and kale."
Rationale: Warfarin is antagonized by vitamin K. Green leafy vegetables (spinach,
kale) are high in vitamin K and reduce warfarin’s effect. NSAIDs increase bleeding
risk. Never stop warfarin without provider order. Aspirin + warfarin increases
bleeding risk.
Question 8
In a disaster triage, which client receives a red tag?
A. Ambulatory client with minor abrasions
B. Client with no pulse and agonal breathing
C. Client with an open femur fracture and weak radial pulse
D. Client with a minor burn on one hand
HESI RN EXIT Exam 2026 HESI Nursing Nightingale
College -100+QUESTIONS AND ANSWERS WITH
RATIONALES
Category Question Numbers
1, 5, 9, 13, 17, 21, 28, 30, 34, 38, 42, 45, 48, 51, 59, 64, 68, 70, 77, 82, 86,
Medical-Surgical
89, 94, 96, 97, 98
3, 7, 10, 14, 19, 26, 32, 36, 40, 47, 54, 58, 60, 62, 66, 72, 75, 80, 85, 88, 92,
Pharmacology
93, 95, 99
Pediatrics 2, 11
Maternity/Newborn 6, 35, 73
Psychiatry 3, 12, 31, 54, 60, 74, 83
Critical Care 16, 17, 30, 34, 38, 43, 49, 84, 86
Leadership/Delegation 4
Community/Disaster 8
Lab Values 10, 22, 28, 32, 40, 50, 59, 66, 68, 77, 90, 96
Procedures/Skills 24, 27, 33, 37, 41, 44, 55, 63, 67, 69, 71, 81, 87
,HESI EXIT EXAM – MIXED QUESTION BANK (50 Q&A)
Question 1
A client with heart failure has crackles in both lung bases, an S3 gallop, and
jugular venous distension. Which medication should the nurse prepare 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 acts slowly. Beta-
blockers and ACE inhibitors are long-term therapies.
Question 2
A nurse is assessing a 2-day-old newborn. Which finding requires immediate
intervention?
A. Acrocyanosis
B. Respiratory rate of 65 with nasal flaring
C. Heart rate of 160 bpm during crying
D. Transient strabismus
Answer: B. Respiratory rate of 65 with nasal flaring
Rationale: Normal newborn respiratory rate is 30–60 bpm. Nasal flaring indicates
respiratory distress. Acrocyanosis, tachycardia with crying, and intermittent
strabismus are normal in the first few days.
Question 3
A client with bipolar disorder who takes lithium presents with diarrhea, vomiting,
and coarse hand tremors. Which lab value is most important to check?
A. Serum sodium
,B. Serum lithium level
C. Serum potassium
D. Thyroid-stimulating hormone
Answer: B. Serum lithium level
Rationale: Diarrhea and vomiting cause dehydration, increasing lithium
reabsorption and risk of toxicity. Coarse tremors are a sign of lithium toxicity.
Normal lithium level is 0.6–1.2 mEq/L; toxicity occurs above 1.5 mEq/L.
Question 4
The charge nurse is making assignments. Which client should be assigned to the
RN with the most experience?
A. Client with diabetes needing foot care teaching
B. Client with pneumonia on room air
C. Client with chest tube and continuous bubbling in water seal chamber
D. Client with a urinary tract infection receiving oral antibiotics
Answer: C. Client with chest tube and continuous bubbling in water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak,
which requires expert assessment and intervention. Stable clients with
predictable needs can be assigned to less experienced RNs or LPNs.
Question 5
A client is admitted with diabetic ketoacidosis (DKA). Which IV fluid and insulin
regimen is most appropriate initially?
A. 0.9% NS at 250 mL/hr + regular insulin IV bolus then continuous infusion
B. 0.45% NS at 100 mL/hr + NPH insulin subcutaneously every 6 hours
C. D5W at 50 mL/hr + insulin glargine subcutaneously once daily
D. 0.9% NS at 500 mL/hr + lispro insulin subcutaneously every 2 hours
Answer: A. 0.9% NS at 250 mL/hr + regular insulin IV bolus then continuous
infusion
Rationale: DKA requires aggressive fluid resuscitation with isotonic saline and IV
regular insulin (short half-life, titratable). NPH, glargine, and lispro are
subcutaneous and not used for acute DKA management.
, Question 6
A postpartum client reports a large gush of blood and a firm, displaced fundus to
the right. What is the priority action?
A. Massage the fundus
B. Catheterize the bladder
C. Administer oxytocin
D. Notify the provider
Answer: B. Catheterize the bladder
Rationale: A displaced, firm fundus suggests a full bladder displacing the uterus,
preventing contraction. Emptying the bladder allows the uterus to contract and
reduces bleeding. Fundal massage is ineffective if the bladder is full.
Question 7
A nurse is teaching a client with a new prescription for warfarin. Which statement
indicates understanding?
A. "I will take ibuprofen if I get a headache."
B. "I should avoid eating large amounts of spinach and kale."
C. "I can stop this medication when my INR is normal."
D. "I will take my warfarin in the morning with my aspirin."
Answer: B. "I should avoid eating large amounts of spinach and kale."
Rationale: Warfarin is antagonized by vitamin K. Green leafy vegetables (spinach,
kale) are high in vitamin K and reduce warfarin’s effect. NSAIDs increase bleeding
risk. Never stop warfarin without provider order. Aspirin + warfarin increases
bleeding risk.
Question 8
In a disaster triage, which client receives a red tag?
A. Ambulatory client with minor abrasions
B. Client with no pulse and agonal breathing
C. Client with an open femur fracture and weak radial pulse
D. Client with a minor burn on one hand
