HESI EXIT EXAM 2026/2027 – PRACTICE
QUESTIONS & ANSWERS | 200+ VERIFIED Q&A
WITH DETAILED RATIONALES | RN SUCCESS
FINAL REVIEW GUIDE
• 200+ high-yield HESI Exit Exam practice questions with verified answers and
detailed EXPERT RATIONALE — designed to mirror the real exam experience and
sharpen your clinical reasoning before test day.
• Use this guide by reading each question carefully before looking at the answer,
then study the EXPERT RATIONALE deeply to understand the why — not just the
what.
HESI EXIT EXAM 2026/2027 – PRACTICE QUESTIONS & ANSWERS 200+ VERIFIED
Q&A WITH DETAILED EXPERT RATIONALE | RN SUCCESS FINAL REVIEW GUIDE
1. A nurse is caring for a client with chronic kidney disease (CKD). Which
laboratory value requires immediate intervention?
A. Serum creatinine 2.1 mg/dL
B. Blood urea nitrogen (BUN) 30 mg/dL
C. Serum potassium 6.8 mEq/L
D. Serum sodium 138 mEq/L
E. Hemoglobin 10.2 g/dL
CORRECT ANSWER: C. Serum potassium 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L is critically elevated
(hyperkalemia). In CKD, the kidneys cannot excrete potassium effectively.
Hyperkalemia at this level can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. Immediate intervention with cardiac
monitoring, calcium gluconate, sodium bicarbonate, insulin/glucose, or dialysis is
required.
,2. A client is admitted with diabetic ketoacidosis (DKA). Which set of arterial
blood gas (ABG) values is consistent with this condition?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃ 24 mEq/L
B. pH 7.30, PaCO₂ 28 mmHg, HCO₃ 14 mEq/L
C. pH 7.45, PaCO₂ 40 mmHg, HCO₃ 26 mEq/L
D. pH 7.28, PaCO₂ 50 mmHg, HCO₃ 25 mEq/L
E. pH 7.52, PaCO₂ 48 mmHg, HCO₃ 30 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO₂ 28 mmHg, HCO₃ 14 mEq/L
EXPERT RATIONALE: DKA causes metabolic acidosis due to ketone accumulation.
The pH is low (acidosis), HCO₃ is low (metabolic cause), and PaCO₂ is low because
the respiratory system compensates by blowing off CO₂ (Kussmaul respirations).
This pattern — low pH, low HCO₃, low PaCO₂ — is classic for compensated
metabolic acidosis seen in DKA.
3. A nurse is assessing a client with left-sided heart failure. Which finding is
most expected?
A. Peripheral edema and jugular vein distension
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and ascites
D. Bounding peripheral pulses
E. Polyuria and nocturia
CORRECT ANSWER: B. Crackles in the lung bases and orthopnea
EXPERT RATIONALE: Left-sided heart failure causes fluid to back up into the
pulmonary circulation, leading to pulmonary edema. This manifests as crackles
(rales) in the lung bases and orthopnea (difficulty breathing when lying flat). Right-
sided heart failure causes systemic fluid backup (peripheral edema, JVD,
hepatomegaly).
,4. A client is receiving heparin infusion for deep vein thrombosis. The aPTT
result is 120 seconds. What is the nurse's priority action?
A. Increase the heparin infusion rate
B. Administer protamine sulfate immediately
C. Notify the provider and hold the infusion
D. Continue the infusion and recheck in 4 hours
E. Administer vitamin K as antidote
CORRECT ANSWER: C. Notify the provider and hold the infusion
EXPERT RATIONALE: The therapeutic aPTT range for heparin is 60–100 seconds
(1.5–2.5 times normal). An aPTT of 120 seconds indicates supratherapeutic
anticoagulation and bleeding risk. The nurse should notify the provider and hold
the infusion. Protamine sulfate is used only in severe overdose or active bleeding,
not as a first-line response to elevated aPTT.
5. A nurse is caring for a postoperative client who develops sudden onset
chest pain, tachycardia, and decreased oxygen saturation. Which condition is
the priority concern?
A. Pneumonia
B. Atelectasis
C. Pulmonary embolism
D. Myocardial infarction
E. Pleural effusion
CORRECT ANSWER: C. Pulmonary embolism
EXPERT RATIONALE: Sudden onset pleuritic chest pain, tachycardia, dyspnea, and
decreased SpO₂ in a postoperative client are classic signs of pulmonary embolism
(PE). PE is a life-threatening emergency caused by a thrombus (often from DVT)
, traveling to the pulmonary vasculature. Immediate oxygen, IV access, and
notification of the provider are required.
6. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen delivery method and rate is safest?
A. Non-rebreather mask at 12 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 1–2 L/min
D. Venturi mask at 50% FiO₂
E. Mechanical ventilator at FiO₂ 0.80
CORRECT ANSWER: C. Nasal cannula at 1–2 L/min
EXPERT RATIONALE: Clients with COPD may rely on hypoxic drive to breathe (low
oxygen stimulates breathing, not CO₂ as in healthy individuals). Administering high-
flow oxygen can suppress this drive and cause respiratory depression. Low-flow
oxygen at 1–2 L/min via nasal cannula maintains SpO₂ at 88–92% — the safe target
range for COPD.
7. A nurse is teaching a client newly diagnosed with type 1 diabetes. Which
statement by the client indicates a need for further teaching?
A. "I will check my blood sugar before and after exercise."
B. "I can stop taking insulin if I feel sick and am not eating."
C. "I will carry a fast-acting carbohydrate snack with me."
D. "I will rotate my injection sites to prevent lipodystrophy."
E. "I need to monitor my feet daily for cuts or sores."
CORRECT ANSWER: B. "I can stop taking insulin if I feel sick and am not
eating."
QUESTIONS & ANSWERS | 200+ VERIFIED Q&A
WITH DETAILED RATIONALES | RN SUCCESS
FINAL REVIEW GUIDE
• 200+ high-yield HESI Exit Exam practice questions with verified answers and
detailed EXPERT RATIONALE — designed to mirror the real exam experience and
sharpen your clinical reasoning before test day.
• Use this guide by reading each question carefully before looking at the answer,
then study the EXPERT RATIONALE deeply to understand the why — not just the
what.
HESI EXIT EXAM 2026/2027 – PRACTICE QUESTIONS & ANSWERS 200+ VERIFIED
Q&A WITH DETAILED EXPERT RATIONALE | RN SUCCESS FINAL REVIEW GUIDE
1. A nurse is caring for a client with chronic kidney disease (CKD). Which
laboratory value requires immediate intervention?
A. Serum creatinine 2.1 mg/dL
B. Blood urea nitrogen (BUN) 30 mg/dL
C. Serum potassium 6.8 mEq/L
D. Serum sodium 138 mEq/L
E. Hemoglobin 10.2 g/dL
CORRECT ANSWER: C. Serum potassium 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L is critically elevated
(hyperkalemia). In CKD, the kidneys cannot excrete potassium effectively.
Hyperkalemia at this level can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. Immediate intervention with cardiac
monitoring, calcium gluconate, sodium bicarbonate, insulin/glucose, or dialysis is
required.
,2. A client is admitted with diabetic ketoacidosis (DKA). Which set of arterial
blood gas (ABG) values is consistent with this condition?
A. pH 7.50, PaCO₂ 30 mmHg, HCO₃ 24 mEq/L
B. pH 7.30, PaCO₂ 28 mmHg, HCO₃ 14 mEq/L
C. pH 7.45, PaCO₂ 40 mmHg, HCO₃ 26 mEq/L
D. pH 7.28, PaCO₂ 50 mmHg, HCO₃ 25 mEq/L
E. pH 7.52, PaCO₂ 48 mmHg, HCO₃ 30 mEq/L
CORRECT ANSWER: B. pH 7.30, PaCO₂ 28 mmHg, HCO₃ 14 mEq/L
EXPERT RATIONALE: DKA causes metabolic acidosis due to ketone accumulation.
The pH is low (acidosis), HCO₃ is low (metabolic cause), and PaCO₂ is low because
the respiratory system compensates by blowing off CO₂ (Kussmaul respirations).
This pattern — low pH, low HCO₃, low PaCO₂ — is classic for compensated
metabolic acidosis seen in DKA.
3. A nurse is assessing a client with left-sided heart failure. Which finding is
most expected?
A. Peripheral edema and jugular vein distension
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and ascites
D. Bounding peripheral pulses
E. Polyuria and nocturia
CORRECT ANSWER: B. Crackles in the lung bases and orthopnea
EXPERT RATIONALE: Left-sided heart failure causes fluid to back up into the
pulmonary circulation, leading to pulmonary edema. This manifests as crackles
(rales) in the lung bases and orthopnea (difficulty breathing when lying flat). Right-
sided heart failure causes systemic fluid backup (peripheral edema, JVD,
hepatomegaly).
,4. A client is receiving heparin infusion for deep vein thrombosis. The aPTT
result is 120 seconds. What is the nurse's priority action?
A. Increase the heparin infusion rate
B. Administer protamine sulfate immediately
C. Notify the provider and hold the infusion
D. Continue the infusion and recheck in 4 hours
E. Administer vitamin K as antidote
CORRECT ANSWER: C. Notify the provider and hold the infusion
EXPERT RATIONALE: The therapeutic aPTT range for heparin is 60–100 seconds
(1.5–2.5 times normal). An aPTT of 120 seconds indicates supratherapeutic
anticoagulation and bleeding risk. The nurse should notify the provider and hold
the infusion. Protamine sulfate is used only in severe overdose or active bleeding,
not as a first-line response to elevated aPTT.
5. A nurse is caring for a postoperative client who develops sudden onset
chest pain, tachycardia, and decreased oxygen saturation. Which condition is
the priority concern?
A. Pneumonia
B. Atelectasis
C. Pulmonary embolism
D. Myocardial infarction
E. Pleural effusion
CORRECT ANSWER: C. Pulmonary embolism
EXPERT RATIONALE: Sudden onset pleuritic chest pain, tachycardia, dyspnea, and
decreased SpO₂ in a postoperative client are classic signs of pulmonary embolism
(PE). PE is a life-threatening emergency caused by a thrombus (often from DVT)
, traveling to the pulmonary vasculature. Immediate oxygen, IV access, and
notification of the provider are required.
6. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen delivery method and rate is safest?
A. Non-rebreather mask at 12 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 1–2 L/min
D. Venturi mask at 50% FiO₂
E. Mechanical ventilator at FiO₂ 0.80
CORRECT ANSWER: C. Nasal cannula at 1–2 L/min
EXPERT RATIONALE: Clients with COPD may rely on hypoxic drive to breathe (low
oxygen stimulates breathing, not CO₂ as in healthy individuals). Administering high-
flow oxygen can suppress this drive and cause respiratory depression. Low-flow
oxygen at 1–2 L/min via nasal cannula maintains SpO₂ at 88–92% — the safe target
range for COPD.
7. A nurse is teaching a client newly diagnosed with type 1 diabetes. Which
statement by the client indicates a need for further teaching?
A. "I will check my blood sugar before and after exercise."
B. "I can stop taking insulin if I feel sick and am not eating."
C. "I will carry a fast-acting carbohydrate snack with me."
D. "I will rotate my injection sites to prevent lipodystrophy."
E. "I need to monitor my feet daily for cuts or sores."
CORRECT ANSWER: B. "I can stop taking insulin if I feel sick and am not
eating."
