HESI RN EXIT EXAM (2026 EDITION) — 400
CORE QUESTIONS Answers & Rationales |
High-Yield Content Bank
Exam blueprint (200 questions):
Safe & Effective Care Environment (15%) – 30 Qs
Health Promotion & Maintenance (10%) – 20 Qs
Psychosocial Integrity (10%) – 20 Qs
Physiological Integrity (65%) – 130 Qs
Basic Care & Comfort (10%) – 20 Qs
Pharmacological & Parenteral Therapies (15%) – 30 Qs
Reduction of Risk Potential (20%) – 40 Qs
Physiological Adaptation (20%) – 40 Qs
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (30 Questions)
1. A client is receiving a blood transfusion. 15 minutes after initiation, the
client reports chills, low back pain, and anxiety. Which action should the
nurse take first?
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Notify the provider
D) Administer acetaminophen
Answer: B
Rationale: Suspected hemolytic transfusion reaction → stop transfusion
immediately, keep IV line open with NS, then notify provider.
,2. A nurse is caring for a client with a chest tube. The collector unit
accidentally cracks. What is the priority action?
A) Clamp the chest tube
B) Place the end of the tube in sterile water
C) Replace the unit immediately
D) Disconnect the tube from suction
Answer: B
Rationale: Place the tube end in sterile water at 2 cm depth to restore water
seal and prevent air re-entry; do not clamp.
3. A client on a medical-surgical unit becomes aggressive and throws a chair.
Which intervention should the nurse implement first?
A) Call a code gray (behavioral emergency)
B) Restrain the client
C) Ask the client to stop
D) Leave the room
Answer: A
Rationale: Call for help first; ensure staff safety before attempting de-
escalation.
4. A nurse accidentally administers IV potassium chloride as a bolus instead
of piggyback. The client develops cardiac arrest. What is the nurse's legal
responsibility?
A) Complete an incident report
B) Destroy the medication vial
C) Do nothing
D) Only inform the charge nurse
Answer: A
,Rationale: Incident reports are required for medication errors; they are
confidential and used for quality improvement.
5. A client with C. difficile has which type of precaution?
A) Airborne
B) Droplet
C) Contact
D) Standard
Answer: C
Rationale: C. diff requires contact precautions (gown, gloves) plus hand
hygiene with soap and water (alcohol ineffective).
6. A client with active tuberculosis requires which type of isolation?
A) Contact
B) Droplet
C) Airborne (N95 mask, negative pressure)
D) Protective
Answer: C
Rationale: TB requires airborne precautions (N95, negative pressure room).
7. A client on fall precautions attempts to get up alone. Which is the best
intervention?
A) Apply a vest restraint
B) Place bed alarm and Answer call light promptly
C) Raise all four side rails
D) Sedate the client
Answer: B
Rationale: Least restrictive: bed alarm + frequent rounding. Restraints are
last resort.
, 8. A postoperative client has a PRN order for morphine 2 mg IV. The nurse
notes a respiratory rate of 8. Which action is correct?
A) Give the morphine as ordered
B) Hold the morphine and reassess in 30 minutes
C) Notify the provider and hold morphine
D) Give half the dose
Answer: C
Rationale: RR <10 is contraindication for opioids; notify provider and hold.
9. A client refuses a prescribed medication. Which action demonstrates
respect for client rights?
A) Hide the medication in food
B) Document refusal and notify provider
C) Call the family for permission
D) Give the injection anyway
Answer: B
Rationale: Competent adults have the right to refuse treatment; document
refusal, notify provider.
10. A nurse witnesses a colleague taking a narcotic from a patient's PCA
pump for personal use. Which action should the nurse take?
A) Ignore it
B) Report to the nurse manager immediately
C) Confront the colleague privately
D) Call the police
Answer: B
Rationale: Diversion of controlled substances is illegal; report to supervisor.
CORE QUESTIONS Answers & Rationales |
High-Yield Content Bank
Exam blueprint (200 questions):
Safe & Effective Care Environment (15%) – 30 Qs
Health Promotion & Maintenance (10%) – 20 Qs
Psychosocial Integrity (10%) – 20 Qs
Physiological Integrity (65%) – 130 Qs
Basic Care & Comfort (10%) – 20 Qs
Pharmacological & Parenteral Therapies (15%) – 30 Qs
Reduction of Risk Potential (20%) – 40 Qs
Physiological Adaptation (20%) – 40 Qs
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (30 Questions)
1. A client is receiving a blood transfusion. 15 minutes after initiation, the
client reports chills, low back pain, and anxiety. Which action should the
nurse take first?
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Notify the provider
D) Administer acetaminophen
Answer: B
Rationale: Suspected hemolytic transfusion reaction → stop transfusion
immediately, keep IV line open with NS, then notify provider.
,2. A nurse is caring for a client with a chest tube. The collector unit
accidentally cracks. What is the priority action?
A) Clamp the chest tube
B) Place the end of the tube in sterile water
C) Replace the unit immediately
D) Disconnect the tube from suction
Answer: B
Rationale: Place the tube end in sterile water at 2 cm depth to restore water
seal and prevent air re-entry; do not clamp.
3. A client on a medical-surgical unit becomes aggressive and throws a chair.
Which intervention should the nurse implement first?
A) Call a code gray (behavioral emergency)
B) Restrain the client
C) Ask the client to stop
D) Leave the room
Answer: A
Rationale: Call for help first; ensure staff safety before attempting de-
escalation.
4. A nurse accidentally administers IV potassium chloride as a bolus instead
of piggyback. The client develops cardiac arrest. What is the nurse's legal
responsibility?
A) Complete an incident report
B) Destroy the medication vial
C) Do nothing
D) Only inform the charge nurse
Answer: A
,Rationale: Incident reports are required for medication errors; they are
confidential and used for quality improvement.
5. A client with C. difficile has which type of precaution?
A) Airborne
B) Droplet
C) Contact
D) Standard
Answer: C
Rationale: C. diff requires contact precautions (gown, gloves) plus hand
hygiene with soap and water (alcohol ineffective).
6. A client with active tuberculosis requires which type of isolation?
A) Contact
B) Droplet
C) Airborne (N95 mask, negative pressure)
D) Protective
Answer: C
Rationale: TB requires airborne precautions (N95, negative pressure room).
7. A client on fall precautions attempts to get up alone. Which is the best
intervention?
A) Apply a vest restraint
B) Place bed alarm and Answer call light promptly
C) Raise all four side rails
D) Sedate the client
Answer: B
Rationale: Least restrictive: bed alarm + frequent rounding. Restraints are
last resort.
, 8. A postoperative client has a PRN order for morphine 2 mg IV. The nurse
notes a respiratory rate of 8. Which action is correct?
A) Give the morphine as ordered
B) Hold the morphine and reassess in 30 minutes
C) Notify the provider and hold morphine
D) Give half the dose
Answer: C
Rationale: RR <10 is contraindication for opioids; notify provider and hold.
9. A client refuses a prescribed medication. Which action demonstrates
respect for client rights?
A) Hide the medication in food
B) Document refusal and notify provider
C) Call the family for permission
D) Give the injection anyway
Answer: B
Rationale: Competent adults have the right to refuse treatment; document
refusal, notify provider.
10. A nurse witnesses a colleague taking a narcotic from a patient's PCA
pump for personal use. Which action should the nurse take?
A) Ignore it
B) Report to the nurse manager immediately
C) Confront the colleague privately
D) Call the police
Answer: B
Rationale: Diversion of controlled substances is illegal; report to supervisor.
