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HESI RN Exit Exam V1 – NGN 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A nurse is caring for a client with heart failure who has gained 3
pounds in 24 hours. The nurse should first:
A. Notify the healthcare provider
B. Assess the client's respiratory status
C. Restrict the client's fluid intake
D. Document the finding as the only action
Answer: B. Assess the client's respiratory status
Rationale: A rapid weight gain of 3 pounds in 24 hours suggests fluid
retention, which can quickly lead to pulmonary edema. Using the
nursing process, assessment comes first. The nurse must immediately
auscultate lung sounds and assess for dyspnea, crackles, or decreased
oxygen saturation before implementing interventions or notifying the
provider. While the provider will need to be notified and
documentation is required, the priority is determining the client's
current physiologic status.
2. A client is receiving a blood transfusion and develops chills and fever.
Which action should the nurse take first?
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A. Administer acetaminophen as ordered
B. Slow the transfusion rate
C. Stop the transfusion immediately
D. Notify the blood bank
Answer: C. Stop the transfusion immediately
Rationale: Chills and fever during a blood transfusion are signs of a
potential hemolytic or febrile non-hemolytic transfusion reaction. The
priority action is to stop the transfusion to prevent further introduction
of potentially incompatible blood products into the client's circulation.
After stopping the infusion, the nurse should maintain IV access with
normal saline, monitor vital signs, and then notify the healthcare
provider and blood bank.
3. A nurse is teaching a client with newly diagnosed type 2 diabetes
mellitus about foot care. Which statement by the client indicates a
need for further teaching?
A. "I will wash my feet daily with warm water."
B. "I should apply moisturizer between my toes."
C. "I will inspect my feet daily for any cuts or sores."
D. "I should wear cotton socks to absorb moisture."
Answer: B. "I should apply moisturizer between my toes."
Rationale: Moisture between the toes creates an environment
conducive to fungal infections and skin breakdown. Clients with
diabetes are at high risk for infections due to impaired circulation and
immune response. The client should apply moisturizer to the tops and
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bottoms of the feet but avoid the interdigital spaces. Washing with
warm (not hot) water, daily inspection, and wearing moisture-wicking
socks are all appropriate foot care measures.
4. A client is admitted with a suspected pulmonary embolism. Which
diagnostic test should the nurse anticipate preparing the client for first?
A. D-dimer blood test
B. Chest X-ray
C. V/Q scan
D. CT pulmonary angiography
Answer: D. CT pulmonary angiography
Rationale: CT pulmonary angiography (CTPA) is the gold standard
diagnostic test for pulmonary embolism because it provides direct
visualization of the pulmonary arteries and can detect filling defects
caused by emboli. While D-dimer may be elevated, it is nonspecific.
Chest X-ray is used to rule out other conditions. V/Q scanning is used
when CT is contraindicated, such as in renal insufficiency with contrast
allergy, but CTPA is preferred for definitive diagnosis.
5. The nurse is caring for a client with increased intracranial pressure
following a traumatic brain injury. Which intervention is most
appropriate?
A. Keep the head of the bed flat
B. Cluster nursing care activities
C. Maintain head in midline position
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D. Encourage vigorous coughing to clear secretions
Answer: C. Maintain head in midline position
Rationale: Keeping the head in midline facilitates venous drainage from
the brain, which helps lower intracranial pressure. Turning the head to
the side can compress the jugular veins and impede venous outflow,
consequently increasing ICP. The head of bed should be elevated to 30
degrees, not flat. Activities should be spaced out to avoid cumulative
increases in ICP, and vigorous coughing or straining should be avoided
as it increases intrathoracic and intracranial pressure.
6. A client is prescribed warfarin following a mechanical heart valve
replacement. The nurse should teach the client to avoid which food?
A. Bananas
B. Green leafy vegetables
C. Dairy products
D. Lean meats
Answer: B. Green leafy vegetables
Rationale: Green leafy vegetables such as spinach, kale, and broccoli
are rich in vitamin K, which is the antagonist of warfarin. Consistently
high or fluctuating intake of vitamin K can reduce the anticoagulant
effect of warfarin and increase the risk of thromboembolic events. The
client does not need to completely avoid these foods but must
maintain a consistent intake and have regular INR monitoring. Bananas,
dairy, and lean meats do not significantly interact with warfarin.
HESI RN Exit Exam V1 – NGN 2026-2027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A nurse is caring for a client with heart failure who has gained 3
pounds in 24 hours. The nurse should first:
A. Notify the healthcare provider
B. Assess the client's respiratory status
C. Restrict the client's fluid intake
D. Document the finding as the only action
Answer: B. Assess the client's respiratory status
Rationale: A rapid weight gain of 3 pounds in 24 hours suggests fluid
retention, which can quickly lead to pulmonary edema. Using the
nursing process, assessment comes first. The nurse must immediately
auscultate lung sounds and assess for dyspnea, crackles, or decreased
oxygen saturation before implementing interventions or notifying the
provider. While the provider will need to be notified and
documentation is required, the priority is determining the client's
current physiologic status.
2. A client is receiving a blood transfusion and develops chills and fever.
Which action should the nurse take first?
,2|Page
A. Administer acetaminophen as ordered
B. Slow the transfusion rate
C. Stop the transfusion immediately
D. Notify the blood bank
Answer: C. Stop the transfusion immediately
Rationale: Chills and fever during a blood transfusion are signs of a
potential hemolytic or febrile non-hemolytic transfusion reaction. The
priority action is to stop the transfusion to prevent further introduction
of potentially incompatible blood products into the client's circulation.
After stopping the infusion, the nurse should maintain IV access with
normal saline, monitor vital signs, and then notify the healthcare
provider and blood bank.
3. A nurse is teaching a client with newly diagnosed type 2 diabetes
mellitus about foot care. Which statement by the client indicates a
need for further teaching?
A. "I will wash my feet daily with warm water."
B. "I should apply moisturizer between my toes."
C. "I will inspect my feet daily for any cuts or sores."
D. "I should wear cotton socks to absorb moisture."
Answer: B. "I should apply moisturizer between my toes."
Rationale: Moisture between the toes creates an environment
conducive to fungal infections and skin breakdown. Clients with
diabetes are at high risk for infections due to impaired circulation and
immune response. The client should apply moisturizer to the tops and
,3|Page
bottoms of the feet but avoid the interdigital spaces. Washing with
warm (not hot) water, daily inspection, and wearing moisture-wicking
socks are all appropriate foot care measures.
4. A client is admitted with a suspected pulmonary embolism. Which
diagnostic test should the nurse anticipate preparing the client for first?
A. D-dimer blood test
B. Chest X-ray
C. V/Q scan
D. CT pulmonary angiography
Answer: D. CT pulmonary angiography
Rationale: CT pulmonary angiography (CTPA) is the gold standard
diagnostic test for pulmonary embolism because it provides direct
visualization of the pulmonary arteries and can detect filling defects
caused by emboli. While D-dimer may be elevated, it is nonspecific.
Chest X-ray is used to rule out other conditions. V/Q scanning is used
when CT is contraindicated, such as in renal insufficiency with contrast
allergy, but CTPA is preferred for definitive diagnosis.
5. The nurse is caring for a client with increased intracranial pressure
following a traumatic brain injury. Which intervention is most
appropriate?
A. Keep the head of the bed flat
B. Cluster nursing care activities
C. Maintain head in midline position
, 4|Page
D. Encourage vigorous coughing to clear secretions
Answer: C. Maintain head in midline position
Rationale: Keeping the head in midline facilitates venous drainage from
the brain, which helps lower intracranial pressure. Turning the head to
the side can compress the jugular veins and impede venous outflow,
consequently increasing ICP. The head of bed should be elevated to 30
degrees, not flat. Activities should be spaced out to avoid cumulative
increases in ICP, and vigorous coughing or straining should be avoided
as it increases intrathoracic and intracranial pressure.
6. A client is prescribed warfarin following a mechanical heart valve
replacement. The nurse should teach the client to avoid which food?
A. Bananas
B. Green leafy vegetables
C. Dairy products
D. Lean meats
Answer: B. Green leafy vegetables
Rationale: Green leafy vegetables such as spinach, kale, and broccoli
are rich in vitamin K, which is the antagonist of warfarin. Consistently
high or fluctuating intake of vitamin K can reduce the anticoagulant
effect of warfarin and increase the risk of thromboembolic events. The
client does not need to completely avoid these foods but must
maintain a consistent intake and have regular INR monitoring. Bananas,
dairy, and lean meats do not significantly interact with warfarin.
