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HESI RN Exit Exam V4: | Exam Practice Questions And Correct
Answers (Verified Answers) Plus Rationale 2026 Q&A |
Instant Download Pdf
Question 1
A client 24 hours post-partial thyroidectomy reports numbness and tingling around the mouth
and a sensation of tightness in the throat. The nurse observes carpopedal spasm when the blood
pressure cuff is inflated. Which action should the nurse take first?
A. Prepare to administer intravenous calcium gluconate.
B. Notify the healthcare provider of the assessment findings.
C. Ensure emergency airway equipment is at the bedside.
D. Instruct the client to breathe slowly into a paper bag.
Correct Answer: C
Expert Rationale: The client exhibits signs of acute hypocalcemia (tetany) from accidental
removal of or damage to the parathyroid glands. Positive Trousseau's sign (carpopedal spasm
with BP cuff inflation), circumoral numbness, and throat tightness indicate severe
neuromuscular excitability. The throat tightness is a particularly ominous sign, suggesting
imminent laryngospasm, which can cause complete airway obstruction. Before any
pharmacological intervention, the nurse's immediate priority is ensuring that emergency airway
equipment (tracheostomy tray, intubation supplies, suction) is at the bedside to manage a life-
threatening airway emergency. Calcium replacement comes next, but without an available
airway, the client could die from asphyxiation.
,© Academic_Excellence
Question 2
A client with chronic heart failure is admitted with acute decompensation. The nurse initiates a
nitroglycerin infusion and administers IV furosemide 80 mg. Thirty minutes later, the client's
blood pressure drops from 118/78 to 84/56 mm Hg, and the client reports dizziness. What is
the priority nursing action?
A. Place the client flat with legs elevated.
B. Titrate the nitroglycerin infusion downward or stop it.
C. Administer a 250 mL normal saline fluid bolus.
D. Administer prescribed dopamine infusion.
Correct Answer: B
Expert Rationale: The client is experiencing significant hypotension secondary to the combined
vasodilatory effect of nitroglycerin and the volume-depleting effect of furosemide. The
nitroglycerin drip, which is causing venous and arterial dilation, is the most immediately
titratable cause. The nurse's first action is to decrease or temporarily stop the nitroglycerin
infusion as per titration protocol to reduce its hypotensive effect. Placing the client flat can be
done simultaneously, but reducing the causative agent is critical. A fluid bolus or vasopressors
like dopamine require provider orders and are not the first independent action.
Question 3
The nurse is caring for a client with acute pancreatitis. The client's pain was rated 9/10, but
over the last hour, the client reports the pain has suddenly decreased to 3/10. The abdomen is
distended with absent bowel sounds. What is the priority nursing action?
A. Notify the healthcare provider immediately.
B. Document the improvement and continue monitoring.
,© Academic_Excellence
C. Administer the prescribed PRN analgesic for residual pain.
D. Encourage the client to ambulate to pass flatus.
Correct Answer: A
Expert Rationale: A sudden decrease in pain in a client with acute pancreatitis, especially when
accompanied by a distended abdomen and absent bowel sounds (paralytic ileus), is a critical
warning sign of pancreatic necrosis or hemorrhagic pancreatitis. The destruction of the
pancreatic tissue can paradoxically reduce pain as nerve fibers are destroyed. This indicates a
catastrophic deterioration, not improvement. Immediate notification of the provider for
emergency CT scan and surgical evaluation is essential. Documenting as improvement or giving
analgesics masks a life-threatening event.
Question 4
A client who had a cardiac catheterization via the right femoral artery 1 hour ago reports a
sudden sharp pain in the right groin and lower back. The nurse notes a new, large, firm swelling
at the access site and the client's heart rate is 118 bpm with BP 92/60. What is the priority
action?
A. Apply manual pressure directly over the puncture site.
B. Notify the cardiologist and prepare for vascular surgery.
C. Apply a sandbag and ice pack to the groin area.
D. Elevate the head of the bed and administer oxygen.
Correct Answer: A
Expert Rationale: Sudden groin and back pain, tachycardia, hypotension, and a large, firm
hematoma at the femoral access site 1 hour post-catheterization indicate a retroperitoneal
hemorrhage—a life-threatening complication where the femoral artery bleeds into the
, © Academic_Excellence
retroperitoneal space. The nurse's immediate action is to apply firm manual pressure to the
artery (1 inch above the skin puncture, compressing against the pelvic bone) to tamponade the
bleeding while calling for help. Sandbags are insufficient for active hemorrhage. The provider
must be notified, but applying pressure is the immediate, independent nursing action that can
prevent exsanguination.
Question 5
A client with a chest tube to underwater seal drainage following a right pneumothorax has
continuous bubbling in the water seal chamber. The nurse briefly clamps the tube at the
insertion site and the bubbling stops. What does this finding indicate?
A. The lung has fully re-expanded.
B. There is an air leak from the client's lung (bronchopleural fistula).
C. The drainage system has an air leak at or near the insertion site.
D. This is normal tidaling and no action is needed.
Correct Answer: B
Expert Rationale: When the chest tube is clamped at the insertion site and the bubbling stops,
this indicates the source of the air leak is distal to the clamp—meaning the air is coming from
the patient's lung (a bronchopleural fistula, where lung tissue is leaking air into the pleural
space). If the bubbling had continued after clamping at the insertion site, it would indicate the
leak is in the drainage system itself, between the clamp and the collection unit. Continuous
bubbling in the water seal chamber always indicates an air leak; it is never normal. Tidaling is
fluctuation of the water level with respiration, not bubbling.
HESI RN Exit Exam V4: | Exam Practice Questions And Correct
Answers (Verified Answers) Plus Rationale 2026 Q&A |
Instant Download Pdf
Question 1
A client 24 hours post-partial thyroidectomy reports numbness and tingling around the mouth
and a sensation of tightness in the throat. The nurse observes carpopedal spasm when the blood
pressure cuff is inflated. Which action should the nurse take first?
A. Prepare to administer intravenous calcium gluconate.
B. Notify the healthcare provider of the assessment findings.
C. Ensure emergency airway equipment is at the bedside.
D. Instruct the client to breathe slowly into a paper bag.
Correct Answer: C
Expert Rationale: The client exhibits signs of acute hypocalcemia (tetany) from accidental
removal of or damage to the parathyroid glands. Positive Trousseau's sign (carpopedal spasm
with BP cuff inflation), circumoral numbness, and throat tightness indicate severe
neuromuscular excitability. The throat tightness is a particularly ominous sign, suggesting
imminent laryngospasm, which can cause complete airway obstruction. Before any
pharmacological intervention, the nurse's immediate priority is ensuring that emergency airway
equipment (tracheostomy tray, intubation supplies, suction) is at the bedside to manage a life-
threatening airway emergency. Calcium replacement comes next, but without an available
airway, the client could die from asphyxiation.
,© Academic_Excellence
Question 2
A client with chronic heart failure is admitted with acute decompensation. The nurse initiates a
nitroglycerin infusion and administers IV furosemide 80 mg. Thirty minutes later, the client's
blood pressure drops from 118/78 to 84/56 mm Hg, and the client reports dizziness. What is
the priority nursing action?
A. Place the client flat with legs elevated.
B. Titrate the nitroglycerin infusion downward or stop it.
C. Administer a 250 mL normal saline fluid bolus.
D. Administer prescribed dopamine infusion.
Correct Answer: B
Expert Rationale: The client is experiencing significant hypotension secondary to the combined
vasodilatory effect of nitroglycerin and the volume-depleting effect of furosemide. The
nitroglycerin drip, which is causing venous and arterial dilation, is the most immediately
titratable cause. The nurse's first action is to decrease or temporarily stop the nitroglycerin
infusion as per titration protocol to reduce its hypotensive effect. Placing the client flat can be
done simultaneously, but reducing the causative agent is critical. A fluid bolus or vasopressors
like dopamine require provider orders and are not the first independent action.
Question 3
The nurse is caring for a client with acute pancreatitis. The client's pain was rated 9/10, but
over the last hour, the client reports the pain has suddenly decreased to 3/10. The abdomen is
distended with absent bowel sounds. What is the priority nursing action?
A. Notify the healthcare provider immediately.
B. Document the improvement and continue monitoring.
,© Academic_Excellence
C. Administer the prescribed PRN analgesic for residual pain.
D. Encourage the client to ambulate to pass flatus.
Correct Answer: A
Expert Rationale: A sudden decrease in pain in a client with acute pancreatitis, especially when
accompanied by a distended abdomen and absent bowel sounds (paralytic ileus), is a critical
warning sign of pancreatic necrosis or hemorrhagic pancreatitis. The destruction of the
pancreatic tissue can paradoxically reduce pain as nerve fibers are destroyed. This indicates a
catastrophic deterioration, not improvement. Immediate notification of the provider for
emergency CT scan and surgical evaluation is essential. Documenting as improvement or giving
analgesics masks a life-threatening event.
Question 4
A client who had a cardiac catheterization via the right femoral artery 1 hour ago reports a
sudden sharp pain in the right groin and lower back. The nurse notes a new, large, firm swelling
at the access site and the client's heart rate is 118 bpm with BP 92/60. What is the priority
action?
A. Apply manual pressure directly over the puncture site.
B. Notify the cardiologist and prepare for vascular surgery.
C. Apply a sandbag and ice pack to the groin area.
D. Elevate the head of the bed and administer oxygen.
Correct Answer: A
Expert Rationale: Sudden groin and back pain, tachycardia, hypotension, and a large, firm
hematoma at the femoral access site 1 hour post-catheterization indicate a retroperitoneal
hemorrhage—a life-threatening complication where the femoral artery bleeds into the
, © Academic_Excellence
retroperitoneal space. The nurse's immediate action is to apply firm manual pressure to the
artery (1 inch above the skin puncture, compressing against the pelvic bone) to tamponade the
bleeding while calling for help. Sandbags are insufficient for active hemorrhage. The provider
must be notified, but applying pressure is the immediate, independent nursing action that can
prevent exsanguination.
Question 5
A client with a chest tube to underwater seal drainage following a right pneumothorax has
continuous bubbling in the water seal chamber. The nurse briefly clamps the tube at the
insertion site and the bubbling stops. What does this finding indicate?
A. The lung has fully re-expanded.
B. There is an air leak from the client's lung (bronchopleural fistula).
C. The drainage system has an air leak at or near the insertion site.
D. This is normal tidaling and no action is needed.
Correct Answer: B
Expert Rationale: When the chest tube is clamped at the insertion site and the bubbling stops,
this indicates the source of the air leak is distal to the clamp—meaning the air is coming from
the patient's lung (a bronchopleural fistula, where lung tissue is leaking air into the pleural
space). If the bubbling had continued after clamping at the insertion site, it would indicate the
leak is in the drainage system itself, between the clamp and the collection unit. Continuous
bubbling in the water seal chamber always indicates an air leak; it is never normal. Tidaling is
fluctuation of the water level with respiration, not bubbling.
