HESI PN Exit Exam – 2026 Updated 200
NCLEX-Style Questions with Answers &
Rationales
1. A nurse is caring for a client with heart failure who has an ejection fraction
of 35%. Which medication is most likely to reduce mortality?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Dobutamine
Answer: C
Rationale: Beta-blockers (metoprolol succinate, carvedilol) reduce mortality
in heart failure with reduced ejection fraction (HFrEF). Digoxin and
furosemide improve symptoms but do not reduce mortality.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen
delivery device should the nurse use first?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 28%
Answer: B
Rationale: COPD patients require low-flow oxygen (nasal cannula 1-2 L/min)
to maintain SpO2 88-92% and avoid suppressing the hypoxic drive.
3. A nurse is assessing a client with diabetic ketoacidosis (DKA). Which
finding requires immediate intervention?
A. Blood glucose 350 mg/dL
B. Serum potassium 2.8 mEq/L
,C. Kussmaul respirations
D. Fruity breath odor
Answer: B
Rationale: Hypokalemia (K <3.5) in DKA is life-threatening and can cause
cardiac arrhythmias. Insulin therapy further lowers potassium.
4. A client with cirrhosis has ascites and an abdominal paracentesis is
performed. After the procedure, the nurse should monitor for which
complication?
A. Hyperglycemia
B. Hypotension and hypovolemia
C. Hyponatremia
D. Respiratory alkalosis
Answer: B
Rationale: Rapid removal of large volumes of ascitic fluid can cause
hypotension and hypovolemia due to fluid shift. Monitor vital signs closely.
5. A client with a new colostomy asks how to prevent odor. Which
instruction should the nurse provide?
A. "Place an aspirin tablet in the pouch."
B. "Eat yogurt and buttermilk regularly."
C. "Change the pouch every 4 hours."
D. "Rinse the pouch with vinegar daily."
Answer: B
Rationale: Yogurt and buttermilk contain probiotics that reduce odor.
Aspirin can irritate the stoma. Frequent pouch changes cause skin
breakdown.
6. A nurse is caring for a client with an indwelling urinary catheter. Which
finding suggests a catheter-associated urinary tract infection (CAUTI)?
A. Clear yellow urine
,B. Foul-smelling, cloudy urine with fever
C. Low back pain only
D. Urine output of 30 mL/hour
Answer: B
Rationale: CAUTI signs include cloudy, foul-smelling urine, fever, and
suprapubic tenderness. Clear urine is normal.
7. A client with angina pectoris reports chest pain that is relieved by rest and
nitroglycerin. The nurse recognizes this as:
A. Unstable angina
B. Variant angina
C. Stable angina
D. Myocardial infarction
Answer: C
Rationale: Stable angina is chest pain that occurs with exertion and is
relieved by rest or nitroglycerin. Unstable angina occurs at rest.
8. A nurse is preparing to administer furosemide 40 mg IV push. Which lab
value should the nurse check before administering?
A. Hemoglobin
B. Potassium
C. Platelets
D. Sodium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Check potassium before administration to avoid worsening hypokalemia.
9. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate
B. Prepare for hemodialysis
, C. Place the client on a cardiac monitor
D. Encourage a low-potassium diet
Answer: C
Rationale: Hyperkalemia (K >6.0) can cause life-threatening cardiac
arrhythmias. The priority is cardiac monitoring. Then administer potassium-
lowering medications.
10. A client with pneumonia has a fever of 103°F (39.4°C). Which intervention
should the nurse implement first?
A. Administer acetaminophen
B. Remove excess blankets
C. Apply a cooling blanket
D. Increase oral fluids
Answer: B
Rationale: First, remove insulation (blankets) to promote heat loss.
Antipyretics are given if fever persists after removing blankets.
11. A nurse is assessing a client with a chest tube after thoracic surgery. The
water seal chamber has continuous bubbling. What should the nurse do?
A. Document as normal
B. Check for an air leak
C. Clamp the chest tube immediately
D. Increase suction pressure
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak. The nurse should assess the system for loose connections. Clamping
can cause tension pneumothorax.
12. A client with type 2 diabetes has a fasting blood glucose of 180 mg/dL and
a hemoglobin A1c of 8.5%. Which action should the nurse take first?
A. Teach the client about insulin administration
NCLEX-Style Questions with Answers &
Rationales
1. A nurse is caring for a client with heart failure who has an ejection fraction
of 35%. Which medication is most likely to reduce mortality?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Dobutamine
Answer: C
Rationale: Beta-blockers (metoprolol succinate, carvedilol) reduce mortality
in heart failure with reduced ejection fraction (HFrEF). Digoxin and
furosemide improve symptoms but do not reduce mortality.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen
delivery device should the nurse use first?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 28%
Answer: B
Rationale: COPD patients require low-flow oxygen (nasal cannula 1-2 L/min)
to maintain SpO2 88-92% and avoid suppressing the hypoxic drive.
3. A nurse is assessing a client with diabetic ketoacidosis (DKA). Which
finding requires immediate intervention?
A. Blood glucose 350 mg/dL
B. Serum potassium 2.8 mEq/L
,C. Kussmaul respirations
D. Fruity breath odor
Answer: B
Rationale: Hypokalemia (K <3.5) in DKA is life-threatening and can cause
cardiac arrhythmias. Insulin therapy further lowers potassium.
4. A client with cirrhosis has ascites and an abdominal paracentesis is
performed. After the procedure, the nurse should monitor for which
complication?
A. Hyperglycemia
B. Hypotension and hypovolemia
C. Hyponatremia
D. Respiratory alkalosis
Answer: B
Rationale: Rapid removal of large volumes of ascitic fluid can cause
hypotension and hypovolemia due to fluid shift. Monitor vital signs closely.
5. A client with a new colostomy asks how to prevent odor. Which
instruction should the nurse provide?
A. "Place an aspirin tablet in the pouch."
B. "Eat yogurt and buttermilk regularly."
C. "Change the pouch every 4 hours."
D. "Rinse the pouch with vinegar daily."
Answer: B
Rationale: Yogurt and buttermilk contain probiotics that reduce odor.
Aspirin can irritate the stoma. Frequent pouch changes cause skin
breakdown.
6. A nurse is caring for a client with an indwelling urinary catheter. Which
finding suggests a catheter-associated urinary tract infection (CAUTI)?
A. Clear yellow urine
,B. Foul-smelling, cloudy urine with fever
C. Low back pain only
D. Urine output of 30 mL/hour
Answer: B
Rationale: CAUTI signs include cloudy, foul-smelling urine, fever, and
suprapubic tenderness. Clear urine is normal.
7. A client with angina pectoris reports chest pain that is relieved by rest and
nitroglycerin. The nurse recognizes this as:
A. Unstable angina
B. Variant angina
C. Stable angina
D. Myocardial infarction
Answer: C
Rationale: Stable angina is chest pain that occurs with exertion and is
relieved by rest or nitroglycerin. Unstable angina occurs at rest.
8. A nurse is preparing to administer furosemide 40 mg IV push. Which lab
value should the nurse check before administering?
A. Hemoglobin
B. Potassium
C. Platelets
D. Sodium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Check potassium before administration to avoid worsening hypokalemia.
9. A client with chronic kidney disease (CKD) has a potassium level of 6.2
mEq/L. Which intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate
B. Prepare for hemodialysis
, C. Place the client on a cardiac monitor
D. Encourage a low-potassium diet
Answer: C
Rationale: Hyperkalemia (K >6.0) can cause life-threatening cardiac
arrhythmias. The priority is cardiac monitoring. Then administer potassium-
lowering medications.
10. A client with pneumonia has a fever of 103°F (39.4°C). Which intervention
should the nurse implement first?
A. Administer acetaminophen
B. Remove excess blankets
C. Apply a cooling blanket
D. Increase oral fluids
Answer: B
Rationale: First, remove insulation (blankets) to promote heat loss.
Antipyretics are given if fever persists after removing blankets.
11. A nurse is assessing a client with a chest tube after thoracic surgery. The
water seal chamber has continuous bubbling. What should the nurse do?
A. Document as normal
B. Check for an air leak
C. Clamp the chest tube immediately
D. Increase suction pressure
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak. The nurse should assess the system for loose connections. Clamping
can cause tension pneumothorax.
12. A client with type 2 diabetes has a fasting blood glucose of 180 mg/dL and
a hemoglobin A1c of 8.5%. Which action should the nurse take first?
A. Teach the client about insulin administration
