HESI Midpoint Exam V2 | Complete 130 Questions &
Answers with Rationales | Latest 2026 Study Guide |
Guaranteed Pass Prep.
1. A nurse is caring for a patient with heart failure who gains 2 kg (4.4 lbs) in 24 hours. Which
action should the nurse take first?
A. Restrict fluids to 1 L/day
B. Administer furosemide as ordered
C. Elevate the head of the bed
D. Auscultate lung sounds
Rationale: Weight gain indicates fluid retention. Furosemide removes excess fluid. ABCs still
apply, but diuresis addresses the cause.
2. A patient reports chest pain after eating. The nurse suspects gastroesophageal reflux disease
(GERD). Which question is most relevant?
A. "Does the pain radiate to your left arm?"
B. "Do you have a sour taste in your mouth?"
C. "Does nitroglycerin relieve the pain?"
D. "Is the pain worse with deep breathing?"
Rationale: Sour taste indicates reflux. Arm radiation suggests cardiac origin.
3. The nurse administers enalapril. Which finding requires immediate action?
,A. Dry cough
B. Serum potassium 4.2 mEq/L
C. Blood pressure 110/70 mmHg
D. Swelling of the tongue and lips
Rationale: Tongue/lip swelling = angioedema, a life-threatening allergic reaction to ACE
inhibitors.
4. A patient on lithium has a level of 1.8 mEq/L. What is the priority?
A. Encourage fluids
B. Hold the next dose and notify the provider
C. Monitor for tremors
D. Administer haloperidol
Rationale: Lithium therapeutic range = 0.6–1.2. 1.8 is toxic. Hold dose immediately.
5. A postpartum nurse notes a boggy fundus and heavy lochia with clots. First action?
A. Call the provider
B. Administer oxytocin
C. Massage the fundus
D. Increase IV fluids
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. Fundal
massage stimulates contraction.
6. A patient on warfarin has an INR of 4.5. The nurse should question which order?
A. Hold warfarin
,B. Administer vitamin K
C. Give enoxaparin
D. Check occult blood
Rationale: INR 4.5 increases bleeding risk. Warfarin + enoxaparin = double anticoagulation.
Enoxaparin is not needed.
7. A nurse finds a patient crying after receiving a new cancer diagnosis. Which response is best?
A. "Don't worry, treatment has improved a lot."
B. "It's okay to cry. I'm here with you."
C. "You need to stay positive for your family."
D. "Let me get you something for anxiety."
Rationale: Therapeutic communication validates feelings. Avoid false reassurance or minimizing.
8. A patient with type 1 diabetes has blood glucose 45 mg/dL and is alert. What should the
nurse give first?
A. Glucagon IM
B. 4 oz of orange juice
C. 2 tsp of sugar
D. Peanut butter crackers
Rationale: Hypoglycemia in an alert patient = 15 g rapid-acting carbohydrate. Juice acts fastest.
9. Which finding in a new tracheostomy requires immediate action?
A. Small amount of bloody drainage
B. Crackles at lung bases
, C. Coughing during suctioning
D. White mucus from stoma
Rationale: Crackles suggest fluid overload or aspiration. Slight bleeding is expected.
10. A nurse on a med-surg unit has four patients. Which should be seen first?
A. Post-op day 2 with nausea
B. Post-op day 1 with HR 130, BP 90/60
C. Patient requesting pain medication
D. Patient needing discharge teaching
Rationale: Tachycardia + hypotension suggests bleeding or shock — highest priority.
11. A patient with COPD has SpO₂ 86% on room air. Correct initial oxygen delivery?
A. 6 L/min via simple mask
B. 4 L/min via nasal cannula
C. 2 L/min via nasal cannula
D. 10 L/min via non-rebreather
Rationale: COPD patients need low-flow oxygen to avoid suppressing hypoxic drive. Start at 2
L/min.
12. A patient's IV site is red, warm, and tender. First action?
A. Apply a warm compress
B. Discontinue the IV line
C. Notify the provider
Answers with Rationales | Latest 2026 Study Guide |
Guaranteed Pass Prep.
1. A nurse is caring for a patient with heart failure who gains 2 kg (4.4 lbs) in 24 hours. Which
action should the nurse take first?
A. Restrict fluids to 1 L/day
B. Administer furosemide as ordered
C. Elevate the head of the bed
D. Auscultate lung sounds
Rationale: Weight gain indicates fluid retention. Furosemide removes excess fluid. ABCs still
apply, but diuresis addresses the cause.
2. A patient reports chest pain after eating. The nurse suspects gastroesophageal reflux disease
(GERD). Which question is most relevant?
A. "Does the pain radiate to your left arm?"
B. "Do you have a sour taste in your mouth?"
C. "Does nitroglycerin relieve the pain?"
D. "Is the pain worse with deep breathing?"
Rationale: Sour taste indicates reflux. Arm radiation suggests cardiac origin.
3. The nurse administers enalapril. Which finding requires immediate action?
,A. Dry cough
B. Serum potassium 4.2 mEq/L
C. Blood pressure 110/70 mmHg
D. Swelling of the tongue and lips
Rationale: Tongue/lip swelling = angioedema, a life-threatening allergic reaction to ACE
inhibitors.
4. A patient on lithium has a level of 1.8 mEq/L. What is the priority?
A. Encourage fluids
B. Hold the next dose and notify the provider
C. Monitor for tremors
D. Administer haloperidol
Rationale: Lithium therapeutic range = 0.6–1.2. 1.8 is toxic. Hold dose immediately.
5. A postpartum nurse notes a boggy fundus and heavy lochia with clots. First action?
A. Call the provider
B. Administer oxytocin
C. Massage the fundus
D. Increase IV fluids
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. Fundal
massage stimulates contraction.
6. A patient on warfarin has an INR of 4.5. The nurse should question which order?
A. Hold warfarin
,B. Administer vitamin K
C. Give enoxaparin
D. Check occult blood
Rationale: INR 4.5 increases bleeding risk. Warfarin + enoxaparin = double anticoagulation.
Enoxaparin is not needed.
7. A nurse finds a patient crying after receiving a new cancer diagnosis. Which response is best?
A. "Don't worry, treatment has improved a lot."
B. "It's okay to cry. I'm here with you."
C. "You need to stay positive for your family."
D. "Let me get you something for anxiety."
Rationale: Therapeutic communication validates feelings. Avoid false reassurance or minimizing.
8. A patient with type 1 diabetes has blood glucose 45 mg/dL and is alert. What should the
nurse give first?
A. Glucagon IM
B. 4 oz of orange juice
C. 2 tsp of sugar
D. Peanut butter crackers
Rationale: Hypoglycemia in an alert patient = 15 g rapid-acting carbohydrate. Juice acts fastest.
9. Which finding in a new tracheostomy requires immediate action?
A. Small amount of bloody drainage
B. Crackles at lung bases
, C. Coughing during suctioning
D. White mucus from stoma
Rationale: Crackles suggest fluid overload or aspiration. Slight bleeding is expected.
10. A nurse on a med-surg unit has four patients. Which should be seen first?
A. Post-op day 2 with nausea
B. Post-op day 1 with HR 130, BP 90/60
C. Patient requesting pain medication
D. Patient needing discharge teaching
Rationale: Tachycardia + hypotension suggests bleeding or shock — highest priority.
11. A patient with COPD has SpO₂ 86% on room air. Correct initial oxygen delivery?
A. 6 L/min via simple mask
B. 4 L/min via nasal cannula
C. 2 L/min via nasal cannula
D. 10 L/min via non-rebreather
Rationale: COPD patients need low-flow oxygen to avoid suppressing hypoxic drive. Start at 2
L/min.
12. A patient's IV site is red, warm, and tender. First action?
A. Apply a warm compress
B. Discontinue the IV line
C. Notify the provider
