FORTIS COLLEGE NUR 210 – HESI RN EXIT EXAM –
ACTUAL EXAM NEWEST UPDATED VERSION Complete
Accurate Questions – Correct Detailed Answers with NGN
– Pass Guaranteed - A+ Graded
Protecting Our Patients: Safe & Effective Care Environment
Q1: A nurse on a medical-surgical unit receives a shift report on four patients. Which
patient should the nurse assess first?
A. A patient reporting a pain level of 6 out of 10 following a laparoscopic
cholecystectomy
B. A patient with a dry, persistent cough who is awaiting discharge instructions
C. A patient with new-onset confusion and a drop in blood pressure from 120/80 to
90/60 [CORRECT]
D. A patient requesting a sleeping pill because they have been awake for two hours
Correct Answer: C
Rationale: This choice is correct because HESI/NCLEX prioritization frameworks tell us
that a sudden drop in blood pressure paired with new mental status changes is a classic
sign of hypovolemia or sepsis, requiring immediate assessment over stable or routine
requests.
Q2: The charge nurse is making assignments for the day shift. Which task is most
appropriate to delegate to the licensed practical nurse (LPN)?
A. Admitting a new patient with chest pain and completing the comprehensive health
history
B. Administering oral medications to a stable patient who is two days post-op from a hip
replacement [CORRECT]
C. Teaching a newly diagnosed diabetic patient how to self-administer insulin injections
D. Developing the nursing care plan for a patient with acute respiratory failure
Correct Answer: B
Rationale: The best answer is administering oral medications to a stable patient
because LPNs can safely administer medications under RN supervision, whereas
teaching, assessing unstable patients, and creating care plans are strictly within the
RN's scope of practice.
Q3: A patient with active tuberculosis (TB) is admitted to the medical unit. Which
transmission-based precaution should the nurse implement?
,A. Contact precautions
B. Droplet precautions
C. Airborne precautions [CORRECT]
D. Standard precautions only
Correct Answer: C
Rationale: That aligns with the standard of care for a patient presenting with TB, as the
bacteria are carried in airborne droplet nuclei much smaller than regular droplets,
requiring a negative pressure room and an N95 respirator mask.
Q4: A nurse is caring for a patient who is on fall precautions. Which action by the nurse
best prevents a fall in this patient?
A. Keeping all four side rails up at all times to physically block the patient
B. Placing the call light within reach and ensuring the bed is in the lowest position
[CORRECT]
C. Telling the patient's family to stay in the room around the clock to watch them
D. Moving the patient to a room closer to the nurse's station but leaving the bed high
Correct Answer: B
Rationale: This matches what we teach in NUR 210 for safe nursing practice because
keeping the bed low and the call light accessible are proven, evidence-based fall
prevention strategies, whereas raising all four side rails is considered an unauthorized
physical restraint.
Q5: A nurse is preparing to administer a blood transfusion. Which patient identification
method is correct?
A. Ask the patient to state their full name and date of birth, then check the armband
B. Verify the patient's identity using the room number and the name on the door
C. Check the patient's armband against the blood product label with a second licensed
nurse [CORRECT]
D. Match the medical record number on the chart with the number on the blood bag
alone
Correct Answer: C
Rationale: The best answer is a two-nurse verification of the blood product against the
patient's armband because this is the absolute gold standard for preventing catastrophic
ABO incompatibility transfusion reactions.
Q6: A patient who is scheduled for a colonoscopy tells the nurse, "I don't understand
why I can't eat anything today, I'm starving." What is the best response by the nurse?
A. "Your doctor ordered it, so you just have to deal with it until the procedure is over."
B. "The bowel needs to be completely empty so the doctor can clearly see any polyps or
abnormalities." [CORRECT]
C. "You can have a light breakfast, just nothing with fiber in it."
,D. "The anesthesia won't work properly if you have food in your stomach."
Correct Answer: B
Rationale: This choice is correct because explaining the anatomical reason for an NPO
status in plain language helps the patient understand the necessity of the preparation
rather than just blindly following a rule.
Q7: [Select All That Apply] A nurse is caring for a patient who has a methicillin-resistant
Staphylococcus aureus (MRSA) wound infection. Which interventions should the nurse
include in the plan of care?
A. Placing the patient in a private room
B. Wearing a gown and gloves when providing direct care
C. Instructing the patient to wear a surgical mask when walking in the hallway
D. Removing personal protective equipment (PPE) before leaving the patient's room
E. Placing a surgical mask on the patient during transport
Correct Answer: A, B, D, E [CORRECT]
Rationale: This choice is correct because HESI/NCLEX prioritization frameworks tell us
MRSA requires contact precautions, meaning a private room, gown/gloves, proper
doffing to avoid spreading the bacteria, and masking the patient during transport to
protect others; the patient doesn't need a mask inside the room.
Q8: A nurse walks into a patient's room and finds the patient unresponsive with no
pulse. What is the nurse's immediate action?
A. Pull the emergency code alarm and wait for the crash cart to arrive
B. Begin chest compressions immediately [CORRECT]
C. Call the patient's primary care provider to get an order for resuscitation
D. Run to the nurses' station to grab the automated external defibrillator (AED)
Correct Answer: B
Rationale: That aligns with the standard of care for a pulseless patient, as high-quality
CPR must be initiated immediately to perfuse the brain and vital organs before doing
anything else, including calling a code or grabbing equipment.
Q9: A nurse is caring for a patient who just had a lumbar puncture. Which
post-procedure position is most important for this patient?
A. High Fowler's position to promote lung expansion
B. Prone position to apply direct pressure to the puncture site
C. Flat in bed for 1 to 2 hours to prevent a spinal headache [CORRECT]
D. Trendelenburg position to increase intracranial pressure
Correct Answer: C
Rationale: The best answer is keeping the patient flat because this position prevents the
leakage of cerebrospinal fluid from the puncture site, which is what triggers that severe,
debilitating post-lumbar puncture headache.
, Q10: A nurse is reviewing a patient's advance directive. The document states the
patient does not want mechanical ventilation. The patient's family demands the nurse to
"do everything possible" when the patient stops breathing. What should the nurse do?
A. Follow the family's wishes because they are the next of kin
B. Initiate mechanical ventilation to avoid a lawsuit from the family
C. Honor the patient's advance directive and provide comfort measures only
[CORRECT]
D. Ask the hospital administrator to overrule the advance directive
Correct Answer: C
Rationale: This matches what we teach in NUR 210 for safe nursing practice because
an advance directive is a legally binding document that represents the patient's
autonomous wishes, and it supersedes the family's desires when the patient can no
longer speak for themselves.
Q11: A patient tells the nurse, "I am so mad at my doctor! He diagnosed me with cancer
but didn't even have the guts to tell me himself, he sent a resident." What is the best
initial response by the nurse?
A. "You should file a formal complaint with the hospital administration immediately."
B. "It sounds like you are feeling really frustrated and disrespected by how you found
out." [CORRECT]
C. "The resident is fully qualified to give you your diagnosis, so there is nothing to worry
about."
D. "Maybe the doctor was busy saving someone else's life."
Correct Answer: B
Rationale: This choice is correct because using therapeutic communication to validate
the patient's emotional response is the essential first step before problem-solving or
defending the medical team.
Q12: (Ordered Response) A nurse is preparing to insert a nasogastric (NG) tube for a
patient with a bowel obstruction. Place the steps in the correct order.
A. Have the patient take a sip of water and advance the tube as they swallow
B. Measure the tube from the tip of the nose to the earlobe to the xiphoid process
C. Verify placement by aspirating stomach contents or checking the pH
D. Lubricate the tip of the tube with a water-soluble lubricant
Correct Answer: B, D, A, C [CORRECT]
Rationale: The best answer sequence follows the logical steps for NG insertion: you
have to measure first to know how far to insert, then lubricate to reduce friction, then
advance it with the patient's swallow reflex, and finally verify you are actually in the
stomach before using it.
ACTUAL EXAM NEWEST UPDATED VERSION Complete
Accurate Questions – Correct Detailed Answers with NGN
– Pass Guaranteed - A+ Graded
Protecting Our Patients: Safe & Effective Care Environment
Q1: A nurse on a medical-surgical unit receives a shift report on four patients. Which
patient should the nurse assess first?
A. A patient reporting a pain level of 6 out of 10 following a laparoscopic
cholecystectomy
B. A patient with a dry, persistent cough who is awaiting discharge instructions
C. A patient with new-onset confusion and a drop in blood pressure from 120/80 to
90/60 [CORRECT]
D. A patient requesting a sleeping pill because they have been awake for two hours
Correct Answer: C
Rationale: This choice is correct because HESI/NCLEX prioritization frameworks tell us
that a sudden drop in blood pressure paired with new mental status changes is a classic
sign of hypovolemia or sepsis, requiring immediate assessment over stable or routine
requests.
Q2: The charge nurse is making assignments for the day shift. Which task is most
appropriate to delegate to the licensed practical nurse (LPN)?
A. Admitting a new patient with chest pain and completing the comprehensive health
history
B. Administering oral medications to a stable patient who is two days post-op from a hip
replacement [CORRECT]
C. Teaching a newly diagnosed diabetic patient how to self-administer insulin injections
D. Developing the nursing care plan for a patient with acute respiratory failure
Correct Answer: B
Rationale: The best answer is administering oral medications to a stable patient
because LPNs can safely administer medications under RN supervision, whereas
teaching, assessing unstable patients, and creating care plans are strictly within the
RN's scope of practice.
Q3: A patient with active tuberculosis (TB) is admitted to the medical unit. Which
transmission-based precaution should the nurse implement?
,A. Contact precautions
B. Droplet precautions
C. Airborne precautions [CORRECT]
D. Standard precautions only
Correct Answer: C
Rationale: That aligns with the standard of care for a patient presenting with TB, as the
bacteria are carried in airborne droplet nuclei much smaller than regular droplets,
requiring a negative pressure room and an N95 respirator mask.
Q4: A nurse is caring for a patient who is on fall precautions. Which action by the nurse
best prevents a fall in this patient?
A. Keeping all four side rails up at all times to physically block the patient
B. Placing the call light within reach and ensuring the bed is in the lowest position
[CORRECT]
C. Telling the patient's family to stay in the room around the clock to watch them
D. Moving the patient to a room closer to the nurse's station but leaving the bed high
Correct Answer: B
Rationale: This matches what we teach in NUR 210 for safe nursing practice because
keeping the bed low and the call light accessible are proven, evidence-based fall
prevention strategies, whereas raising all four side rails is considered an unauthorized
physical restraint.
Q5: A nurse is preparing to administer a blood transfusion. Which patient identification
method is correct?
A. Ask the patient to state their full name and date of birth, then check the armband
B. Verify the patient's identity using the room number and the name on the door
C. Check the patient's armband against the blood product label with a second licensed
nurse [CORRECT]
D. Match the medical record number on the chart with the number on the blood bag
alone
Correct Answer: C
Rationale: The best answer is a two-nurse verification of the blood product against the
patient's armband because this is the absolute gold standard for preventing catastrophic
ABO incompatibility transfusion reactions.
Q6: A patient who is scheduled for a colonoscopy tells the nurse, "I don't understand
why I can't eat anything today, I'm starving." What is the best response by the nurse?
A. "Your doctor ordered it, so you just have to deal with it until the procedure is over."
B. "The bowel needs to be completely empty so the doctor can clearly see any polyps or
abnormalities." [CORRECT]
C. "You can have a light breakfast, just nothing with fiber in it."
,D. "The anesthesia won't work properly if you have food in your stomach."
Correct Answer: B
Rationale: This choice is correct because explaining the anatomical reason for an NPO
status in plain language helps the patient understand the necessity of the preparation
rather than just blindly following a rule.
Q7: [Select All That Apply] A nurse is caring for a patient who has a methicillin-resistant
Staphylococcus aureus (MRSA) wound infection. Which interventions should the nurse
include in the plan of care?
A. Placing the patient in a private room
B. Wearing a gown and gloves when providing direct care
C. Instructing the patient to wear a surgical mask when walking in the hallway
D. Removing personal protective equipment (PPE) before leaving the patient's room
E. Placing a surgical mask on the patient during transport
Correct Answer: A, B, D, E [CORRECT]
Rationale: This choice is correct because HESI/NCLEX prioritization frameworks tell us
MRSA requires contact precautions, meaning a private room, gown/gloves, proper
doffing to avoid spreading the bacteria, and masking the patient during transport to
protect others; the patient doesn't need a mask inside the room.
Q8: A nurse walks into a patient's room and finds the patient unresponsive with no
pulse. What is the nurse's immediate action?
A. Pull the emergency code alarm and wait for the crash cart to arrive
B. Begin chest compressions immediately [CORRECT]
C. Call the patient's primary care provider to get an order for resuscitation
D. Run to the nurses' station to grab the automated external defibrillator (AED)
Correct Answer: B
Rationale: That aligns with the standard of care for a pulseless patient, as high-quality
CPR must be initiated immediately to perfuse the brain and vital organs before doing
anything else, including calling a code or grabbing equipment.
Q9: A nurse is caring for a patient who just had a lumbar puncture. Which
post-procedure position is most important for this patient?
A. High Fowler's position to promote lung expansion
B. Prone position to apply direct pressure to the puncture site
C. Flat in bed for 1 to 2 hours to prevent a spinal headache [CORRECT]
D. Trendelenburg position to increase intracranial pressure
Correct Answer: C
Rationale: The best answer is keeping the patient flat because this position prevents the
leakage of cerebrospinal fluid from the puncture site, which is what triggers that severe,
debilitating post-lumbar puncture headache.
, Q10: A nurse is reviewing a patient's advance directive. The document states the
patient does not want mechanical ventilation. The patient's family demands the nurse to
"do everything possible" when the patient stops breathing. What should the nurse do?
A. Follow the family's wishes because they are the next of kin
B. Initiate mechanical ventilation to avoid a lawsuit from the family
C. Honor the patient's advance directive and provide comfort measures only
[CORRECT]
D. Ask the hospital administrator to overrule the advance directive
Correct Answer: C
Rationale: This matches what we teach in NUR 210 for safe nursing practice because
an advance directive is a legally binding document that represents the patient's
autonomous wishes, and it supersedes the family's desires when the patient can no
longer speak for themselves.
Q11: A patient tells the nurse, "I am so mad at my doctor! He diagnosed me with cancer
but didn't even have the guts to tell me himself, he sent a resident." What is the best
initial response by the nurse?
A. "You should file a formal complaint with the hospital administration immediately."
B. "It sounds like you are feeling really frustrated and disrespected by how you found
out." [CORRECT]
C. "The resident is fully qualified to give you your diagnosis, so there is nothing to worry
about."
D. "Maybe the doctor was busy saving someone else's life."
Correct Answer: B
Rationale: This choice is correct because using therapeutic communication to validate
the patient's emotional response is the essential first step before problem-solving or
defending the medical team.
Q12: (Ordered Response) A nurse is preparing to insert a nasogastric (NG) tube for a
patient with a bowel obstruction. Place the steps in the correct order.
A. Have the patient take a sip of water and advance the tube as they swallow
B. Measure the tube from the tip of the nose to the earlobe to the xiphoid process
C. Verify placement by aspirating stomach contents or checking the pH
D. Lubricate the tip of the tube with a water-soluble lubricant
Correct Answer: B, D, A, C [CORRECT]
Rationale: The best answer sequence follows the logical steps for NG insertion: you
have to measure first to know how far to insert, then lubricate to reduce friction, then
advance it with the patient's swallow reflex, and finally verify you are actually in the
stomach before using it.
