© Academic_Excellence
HESI RN Exit Exam V2: Hard-Level | Exam Practice
Questions And Correct Answers (Verified Answers) Plus
Rationale 2026 Q&A | Instant Download Pdf
Question 1
A client 12 hours post-thyroidectomy reports numbness and tingling around the mouth and
fingertips. The nurse elicits a positive Chvostek's sign. Which action should the nurse take
first?
A. Administer the prescribed oral calcium supplement with a full glass of water.
B. Notify the healthcare provider of the assessment findings immediately.
C. Prepare to administer intravenous calcium gluconate.
D. Place a padded tongue blade at the bedside and initiate seizure precautions.
Correct Answer: D
Expert Rationale: The client exhibits classic signs of acute hypocalcemia from inadvertent
parathyroid gland removal or damage during thyroidectomy. A positive Chvostek's sign and
perioral/finger paresthesias indicate increased neuromuscular excitability, which can rapidly
progress to tetany, laryngospasm, and generalized seizures. Before any pharmacological
intervention, the nurse's priority is ensuring client safety by preventing injury from an
imminent seizure. Seizure precautions are an independent nursing action that does not
require a provider's order and takes precedence over notification or medication
administration.
Question 2
A client with heart failure and pulmonary edema is receiving a nitroglycerin infusion and has
just received IV furosemide 40 mg. Which assessment finding requires the most immediate
action?
,© Academic_Excellence
A. Blood pressure drops from 130/80 to 100/70 mm Hg.
B. Urinary output is 300 mL only 15 minutes after furosemide administration.
C. The client develops a new, frequent cough with pink, frothy sputum.
D. The client's heart rate increases from 72 to 96 bpm with a noticeable irregularity.
Correct Answer: C
Expert Rationale: Pink, frothy sputum is a hallmark sign of fulminant pulmonary edema,
indicating rapid fluid accumulation in the alveoli. This signals that current interventions are
not controlling the client's worsening left ventricular failure and gas exchange is severely
compromised. The immediate priority is to raise the head of the bed, ensure the airway, and
prepare for emergency escalation of therapy. A slight drop in blood pressure, a normal
initial diuretic response, and a moderate sinus tachycardia are all anticipated effects and do
not indicate an acute, life-threatening deterioration in the same way.
Question 3
The home health nurse visits a client with stage III heart failure taking carvedilol, lisinopril,
and furosemide. The client reports a 3 kg weight gain in 2 days and increased dyspnea.
The nurse notes bilateral crackles upon auscultation. What is the priority nursing action?
A. Administer sublingual nitroglycerin as prescribed for dyspnea.
B. Place the client in a supine position to promote venous return.
C. Notify the healthcare provider immediately for hospital admission.
D. Assess medication adherence and dietary sodium intake over the past 48 hours.
Correct Answer: D
Expert Rationale: While the weight gain and crackles confirm worsening fluid overload, the
priority action for the home health nurse is to first determine the etiology of the
decompensation to guide the next intervention. The most common cause of heart failure
exacerbation is medication or dietary non-adherence. By assessing exactly which
medications were missed or what high-sodium foods were consumed, the nurse gathers
critical data to report to the provider who can then determine the appropriate intervention.
,© Academic_Excellence
Placing the client supine worsens dyspnea; nitroglycerin treats preload but not the primary
volume problem.
Question 4
A client with cirrhosis and ascites undergoes paracentesis with removal of 5 liters of ascitic
fluid. Four hours later, the client becomes confused, blood pressure drops to 82/50 mm Hg,
and heart rate rises to 118 bpm. What is the priority intervention?
A. Position the client flat with legs elevated to promote cerebral perfusion.
B. Prepare to administer the prescribed albumin infusion.
C. Initiate a rapid IV fluid bolus of normal saline as prescribed.
D. Monitor serum albumin and total protein levels stat.
Correct Answer: C
Expert Rationale: The client is exhibiting signs of post-paracentesis circulatory dysfunction
(PCD), a life-threatening hemodynamic complication caused by rapid fluid shifts after large-
volume paracentesis. The sudden removal of large volumes of ascitic fluid reduces intra-
abdominal pressure, causing splanchnic vasodilation and relative hypovolemia. This leads
to decreased effective circulating volume, hypotension, and tachycardia, with confusion
indicating cerebral hypoperfusion and risk for hepatorenal syndrome. The immediate priority
is rapid volume expansion with IV normal saline or albumin to restore intravascular volume.
Waiting for an albumin infusion or simply monitoring labs delays life-saving volume
resuscitation.
Question 5
A client with a chest tube to water seal after a right pneumothorax is being transferred from
the ICU. The nurse notes the water seal chamber has continuous bubbling and the client's
oxygen saturation has dropped from 97% to 90%. After checking all connections and
finding them secure, what is the priority action?
, © Academic_Excellence
A. Clamp the chest tube briefly to locate the source of the air leak.
B. Place the client in Trendelenburg position to improve oxygenation.
C. Strip the chest tube to remove any clots or obstructions.
D. Increase the wall suction to the maximum setting.
Correct Answer: A
Expert Rationale: Continuous bubbling in the water seal chamber with a simultaneous
drop in oxygen saturation indicates a large, active air leak compromising respiratory status.
Once all external connections are confirmed secure, the nurse must determine whether the
leak is from the patient (bronchopleural fistula) or the drainage system itself. Briefly and
carefully clamping the tube at intervals starting near the insertion site allows for systematic
identification of the leak location. Stripping a chest tube is contraindicated due to extreme
negative pressure risks. Trendelenburg position worsens respiratory mechanics, and
increasing suction without an order is inappropriate.
Question 6
A client is admitted with a new diagnosis of pericarditis. The nurse monitors for which
finding that most specifically indicates a life-threatening complication?
A. A pericardial friction rub auscultated at the left lower sternal border.
B. Pulsus alternans noted on blood pressure monitoring.
C. Muffled heart tones, jugular venous distension, and a paradoxical pulse.
D. Electrical alternans visible on the cardiac monitor.
Correct Answer: C
Expert Rationale: This combination of findings (Beck's triad: muffled heart tones, JVD, and
hypotension; with pulsus paradoxus) is pathognomonic for cardiac tamponade. Pericarditis
causes inflammation of the pericardium, and the resulting effusion can rapidly accumulate
and compress the heart, preventing ventricular filling. Muffled tones reflect fluid around the
heart, JVD reflects impaired venous return, and pulsus paradoxus (an exaggerated drop in
systolic BP >10 mm Hg during inspiration) is the most sensitive and specific clinical
HESI RN Exit Exam V2: Hard-Level | Exam Practice
Questions And Correct Answers (Verified Answers) Plus
Rationale 2026 Q&A | Instant Download Pdf
Question 1
A client 12 hours post-thyroidectomy reports numbness and tingling around the mouth and
fingertips. The nurse elicits a positive Chvostek's sign. Which action should the nurse take
first?
A. Administer the prescribed oral calcium supplement with a full glass of water.
B. Notify the healthcare provider of the assessment findings immediately.
C. Prepare to administer intravenous calcium gluconate.
D. Place a padded tongue blade at the bedside and initiate seizure precautions.
Correct Answer: D
Expert Rationale: The client exhibits classic signs of acute hypocalcemia from inadvertent
parathyroid gland removal or damage during thyroidectomy. A positive Chvostek's sign and
perioral/finger paresthesias indicate increased neuromuscular excitability, which can rapidly
progress to tetany, laryngospasm, and generalized seizures. Before any pharmacological
intervention, the nurse's priority is ensuring client safety by preventing injury from an
imminent seizure. Seizure precautions are an independent nursing action that does not
require a provider's order and takes precedence over notification or medication
administration.
Question 2
A client with heart failure and pulmonary edema is receiving a nitroglycerin infusion and has
just received IV furosemide 40 mg. Which assessment finding requires the most immediate
action?
,© Academic_Excellence
A. Blood pressure drops from 130/80 to 100/70 mm Hg.
B. Urinary output is 300 mL only 15 minutes after furosemide administration.
C. The client develops a new, frequent cough with pink, frothy sputum.
D. The client's heart rate increases from 72 to 96 bpm with a noticeable irregularity.
Correct Answer: C
Expert Rationale: Pink, frothy sputum is a hallmark sign of fulminant pulmonary edema,
indicating rapid fluid accumulation in the alveoli. This signals that current interventions are
not controlling the client's worsening left ventricular failure and gas exchange is severely
compromised. The immediate priority is to raise the head of the bed, ensure the airway, and
prepare for emergency escalation of therapy. A slight drop in blood pressure, a normal
initial diuretic response, and a moderate sinus tachycardia are all anticipated effects and do
not indicate an acute, life-threatening deterioration in the same way.
Question 3
The home health nurse visits a client with stage III heart failure taking carvedilol, lisinopril,
and furosemide. The client reports a 3 kg weight gain in 2 days and increased dyspnea.
The nurse notes bilateral crackles upon auscultation. What is the priority nursing action?
A. Administer sublingual nitroglycerin as prescribed for dyspnea.
B. Place the client in a supine position to promote venous return.
C. Notify the healthcare provider immediately for hospital admission.
D. Assess medication adherence and dietary sodium intake over the past 48 hours.
Correct Answer: D
Expert Rationale: While the weight gain and crackles confirm worsening fluid overload, the
priority action for the home health nurse is to first determine the etiology of the
decompensation to guide the next intervention. The most common cause of heart failure
exacerbation is medication or dietary non-adherence. By assessing exactly which
medications were missed or what high-sodium foods were consumed, the nurse gathers
critical data to report to the provider who can then determine the appropriate intervention.
,© Academic_Excellence
Placing the client supine worsens dyspnea; nitroglycerin treats preload but not the primary
volume problem.
Question 4
A client with cirrhosis and ascites undergoes paracentesis with removal of 5 liters of ascitic
fluid. Four hours later, the client becomes confused, blood pressure drops to 82/50 mm Hg,
and heart rate rises to 118 bpm. What is the priority intervention?
A. Position the client flat with legs elevated to promote cerebral perfusion.
B. Prepare to administer the prescribed albumin infusion.
C. Initiate a rapid IV fluid bolus of normal saline as prescribed.
D. Monitor serum albumin and total protein levels stat.
Correct Answer: C
Expert Rationale: The client is exhibiting signs of post-paracentesis circulatory dysfunction
(PCD), a life-threatening hemodynamic complication caused by rapid fluid shifts after large-
volume paracentesis. The sudden removal of large volumes of ascitic fluid reduces intra-
abdominal pressure, causing splanchnic vasodilation and relative hypovolemia. This leads
to decreased effective circulating volume, hypotension, and tachycardia, with confusion
indicating cerebral hypoperfusion and risk for hepatorenal syndrome. The immediate priority
is rapid volume expansion with IV normal saline or albumin to restore intravascular volume.
Waiting for an albumin infusion or simply monitoring labs delays life-saving volume
resuscitation.
Question 5
A client with a chest tube to water seal after a right pneumothorax is being transferred from
the ICU. The nurse notes the water seal chamber has continuous bubbling and the client's
oxygen saturation has dropped from 97% to 90%. After checking all connections and
finding them secure, what is the priority action?
, © Academic_Excellence
A. Clamp the chest tube briefly to locate the source of the air leak.
B. Place the client in Trendelenburg position to improve oxygenation.
C. Strip the chest tube to remove any clots or obstructions.
D. Increase the wall suction to the maximum setting.
Correct Answer: A
Expert Rationale: Continuous bubbling in the water seal chamber with a simultaneous
drop in oxygen saturation indicates a large, active air leak compromising respiratory status.
Once all external connections are confirmed secure, the nurse must determine whether the
leak is from the patient (bronchopleural fistula) or the drainage system itself. Briefly and
carefully clamping the tube at intervals starting near the insertion site allows for systematic
identification of the leak location. Stripping a chest tube is contraindicated due to extreme
negative pressure risks. Trendelenburg position worsens respiratory mechanics, and
increasing suction without an order is inappropriate.
Question 6
A client is admitted with a new diagnosis of pericarditis. The nurse monitors for which
finding that most specifically indicates a life-threatening complication?
A. A pericardial friction rub auscultated at the left lower sternal border.
B. Pulsus alternans noted on blood pressure monitoring.
C. Muffled heart tones, jugular venous distension, and a paradoxical pulse.
D. Electrical alternans visible on the cardiac monitor.
Correct Answer: C
Expert Rationale: This combination of findings (Beck's triad: muffled heart tones, JVD, and
hypotension; with pulsus paradoxus) is pathognomonic for cardiac tamponade. Pericarditis
causes inflammation of the pericardium, and the resulting effusion can rapidly accumulate
and compress the heart, preventing ventricular filling. Muffled tones reflect fluid around the
heart, JVD reflects impaired venous return, and pulsus paradoxus (an exaggerated drop in
systolic BP >10 mm Hg during inspiration) is the most sensitive and specific clinical
