HESI Exit Exam Prep – Real Practice Questions, Answers & Detailed
Rationales (Updated 2026) | NCLEX-Style Comprehensive
Nursing Review, Medical-Surgical Nursing, Pharmacology, Pediatrics,
Maternal-Newborn, Mental Health, Leadership & Prioritization, Patient
Safety, Clinical Judgment, Delegation & Critical Thinking Strategies
Question 1: A nurse is caring for a client with heart failure who reports increased
shortness of breath. The nurse notes bilateral crackles in the lungs and 3+ pitting
edema in the lower extremities. Which action should the nurse take first?
A. Administer the scheduled dose of furosemide
B. Place the client in high Fowler's position
C. Obtain a stat chest x-ray
D. Notify the healthcare provider
CORRECT ANSWER: B. Place the client in high Fowler's position
Rationale: According to the nursing process and prioritization principles, addressing the
client's immediate airway and breathing needs takes precedence. Placing the client in
high Fowler's position promotes lung expansion and improves oxygenation, which is the
priority intervention for acute respiratory distress. Administering medications, obtaining
diagnostics, or notifying the provider are important but follow after ensuring the client's
immediate physiological stability.
Question 2: A nurse is preparing to administer insulin aspart to a client with type 1
diabetes. The client's blood glucose is 280 mg/dL before breakfast. Which action
should the nurse take?
A. Hold the insulin and recheck the blood glucose in 1 hour
B. Administer the insulin as prescribed and provide the breakfast tray
C. Administer the insulin after the client finishes eating breakfast
D. Contact the healthcare provider for a new insulin order
CORRECT ANSWER: B. Administer the insulin as prescribed and provide the
breakfast tray
Rationale: Insulin aspart is a rapid-acting insulin that should be administered 5-10
minutes before a meal to match the postprandial glucose rise. With a blood glucose of
280 mg/dL, the client requires the prescribed insulin dose to manage hyperglycemia.
Administering insulin after eating or holding the dose could lead to prolonged
hyperglycemia and complications. Contacting the provider is unnecessary unless the
order is unclear or the glucose is critically high per protocol.
Question 3: A postpartum client who delivered 24 hours ago reports severe perineal
pain and rates it 8/10. The nurse notes the perineal area is swollen and ecchymotic.
Which intervention should the nurse implement first?
A. Apply an ice pack to the perineal area
B. Administer the prescribed ibuprofen
,C. Assist the client with a sitz bath
D. Document the findings in the electronic health record
CORRECT ANSWER: A. Apply an ice pack to the perineal area
Rationale: In the immediate postpartum period (first 24-48 hours), cold therapy is the
priority intervention for perineal edema and pain because it reduces swelling, numbs
nerve endings, and minimizes hematoma formation. While analgesics and sitz baths are
beneficial, ice application provides the most immediate relief for acute inflammation.
Documentation is important but does not address the client's immediate comfort need.
Question 4: A nurse is assessing a client who is receiving a blood transfusion. The
client reports chills and back pain, and the nurse notes the temperature has
increased from 98.6°F to 101.2°F. Which action should the nurse take immediately?
A. Slow the transfusion rate and monitor vital signs
B. Stop the transfusion and maintain IV access with normal saline
C. Administer acetaminophen as prescribed
D. Notify the healthcare provider and obtain blood cultures
CORRECT ANSWER: B. Stop the transfusion and maintain IV access with normal
saline
Rationale: The client is exhibiting classic signs of a hemolytic transfusion reaction
(fever, chills, back pain). The immediate priority is to stop the transfusion to prevent
further infusion of incompatible blood, while maintaining IV access with normal saline
to support circulation and allow for emergency medication administration. Slowing the
transfusion is contraindicated, and while notifying the provider and administering
antipyretics are important, they follow after stopping the transfusion.
Question 5: A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. The client's
spouse asks why the oxygen flow cannot be increased to help the client breathe
easier. Which response by the nurse is most appropriate?
A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
B. "The healthcare provider will increase the oxygen if it is needed."
C. "Increasing oxygen can cause the lungs to become dependent on supplemental
oxygen."
D. "The client's oxygen saturation is within normal limits, so more is not necessary."
CORRECT ANSWER: A. "Higher oxygen levels can cause the client to retain more
carbon dioxide."
Rationale: Clients with COPD often have chronic hypercapnia and rely on hypoxic drive
for respiratory stimulation. Administering high concentrations of oxygen can suppress
this drive, leading to CO2 retention, respiratory acidosis, and potential respiratory
failure. This explanation provides accurate, evidence-based education. While options B
,and D contain elements of truth, they do not address the physiological rationale. Option
C is inaccurate; oxygen dependence is not the concern.
Question 6: A nurse is preparing to administer digoxin to a client with heart failure.
The client's apical pulse is 58 beats per minute. Which action should the nurse
take?
A. Administer the digoxin as prescribed
B. Hold the dose and notify the healthcare provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes before administering
CORRECT ANSWER: B. Hold the dose and notify the healthcare provider
Rationale: Digoxin is a cardiac glycoside that can cause bradycardia. The standard
nursing protocol is to hold digoxin and notify the provider if the apical pulse is below 60
beats per minute in adults (or per specific facility policy). Administering digoxin with
bradycardia could exacerbate the condition and lead to serious dysrhythmias.
Rechecking the pulse does not change the initial finding, and adjusting the dose without
a provider order is outside the nurse's scope.
Question 7: A nurse is caring for a client who is 2 days postoperative following a
total hip arthroplasty. Which assessment finding requires immediate intervention?
A. The client reports pain rated 5/10 at the surgical site
B. The client's affected leg is slightly edematous compared to the unaffected leg
C. The client reports sudden onset of shortness of breath and chest pain
D. The client has a temperature of 99.8°F orally
CORRECT ANSWER: C. The client reports sudden onset of shortness of breath and
chest pain
Rationale: Sudden shortness of breath and chest pain in a postoperative orthopedic
client are classic signs of pulmonary embolism, a life-threatening complication
requiring immediate intervention. While pain, mild edema, and low-grade fever are
expected postoperative findings, respiratory distress with chest pain indicates a
potential emergency. The nurse should activate the rapid response team, administer
oxygen, and prepare for diagnostic testing.
Question 8: A nurse is teaching a client with newly diagnosed hypertension about
lifestyle modifications. Which statement by the client indicates a need for further
teaching?
A. "I will limit my sodium intake to less than 2,300 mg per day."
B. "I will engage in moderate exercise for at least 30 minutes most days of the week."
C. "I will stop taking my blood pressure medication once my readings are normal."
D. "I will monitor my blood pressure at home and keep a log."
, CORRECT ANSWER: C. "I will stop taking my blood pressure medication once my
readings are normal."
Rationale: Hypertension is a chronic condition that requires lifelong management.
Antihypertensive medications control but do not cure hypertension; discontinuing
medication when readings normalize can lead to rebound hypertension and increased
cardiovascular risk. The other statements reflect appropriate understanding of sodium
restriction, exercise, and self-monitoring, which are evidence-based lifestyle
modifications for hypertension management.
Question 9: A nurse is caring for a client with a stage 3 pressure injury on the
sacrum. Which intervention should the nurse include in the plan of care?
A. Massage the area surrounding the pressure injury to promote circulation
B. Apply a dry gauze dressing and change it every 4 hours
C. Use a donut-shaped cushion when the client is sitting
D. Reposition the client every 2 hours and use a pressure-redistributing mattress
CORRECT ANSWER: D. Reposition the client every 2 hours and use a pressure-
redistributing mattress
Rationale: Pressure injury management focuses on relieving pressure, maintaining a
moist wound environment, and preventing further tissue damage. Repositioning every 2
hours and using specialized support surfaces are evidence-based interventions to
reduce pressure and promote healing. Massaging bony prominences can cause shear
and further tissue damage. Dry gauze is not ideal for stage 3 injuries, which require
moisture-balanced dressings. Donut cushions increase pressure on surrounding tissue
and are contraindicated.
Question 10: A nurse is assessing a client who is receiving magnesium sulfate for
preeclampsia. Which finding indicates magnesium toxicity?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 breaths per minute
D. Blood pressure of 140/90 mm Hg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium sulfate is a central nervous system depressant, and toxicity can
manifest as respiratory depression (rate <12/min), absent deep tendon reflexes, and
decreased level of consciousness. A respiratory rate of 10 breaths per minute is a
critical finding requiring immediate intervention, including stopping the infusion and
administering calcium gluconate as the antidote. Urine output of 40 mL/hr is adequate,
2+ reflexes are normal, and the blood pressure, while elevated, is expected in
preeclampsia and not indicative of magnesium toxicity.
Rationales (Updated 2026) | NCLEX-Style Comprehensive
Nursing Review, Medical-Surgical Nursing, Pharmacology, Pediatrics,
Maternal-Newborn, Mental Health, Leadership & Prioritization, Patient
Safety, Clinical Judgment, Delegation & Critical Thinking Strategies
Question 1: A nurse is caring for a client with heart failure who reports increased
shortness of breath. The nurse notes bilateral crackles in the lungs and 3+ pitting
edema in the lower extremities. Which action should the nurse take first?
A. Administer the scheduled dose of furosemide
B. Place the client in high Fowler's position
C. Obtain a stat chest x-ray
D. Notify the healthcare provider
CORRECT ANSWER: B. Place the client in high Fowler's position
Rationale: According to the nursing process and prioritization principles, addressing the
client's immediate airway and breathing needs takes precedence. Placing the client in
high Fowler's position promotes lung expansion and improves oxygenation, which is the
priority intervention for acute respiratory distress. Administering medications, obtaining
diagnostics, or notifying the provider are important but follow after ensuring the client's
immediate physiological stability.
Question 2: A nurse is preparing to administer insulin aspart to a client with type 1
diabetes. The client's blood glucose is 280 mg/dL before breakfast. Which action
should the nurse take?
A. Hold the insulin and recheck the blood glucose in 1 hour
B. Administer the insulin as prescribed and provide the breakfast tray
C. Administer the insulin after the client finishes eating breakfast
D. Contact the healthcare provider for a new insulin order
CORRECT ANSWER: B. Administer the insulin as prescribed and provide the
breakfast tray
Rationale: Insulin aspart is a rapid-acting insulin that should be administered 5-10
minutes before a meal to match the postprandial glucose rise. With a blood glucose of
280 mg/dL, the client requires the prescribed insulin dose to manage hyperglycemia.
Administering insulin after eating or holding the dose could lead to prolonged
hyperglycemia and complications. Contacting the provider is unnecessary unless the
order is unclear or the glucose is critically high per protocol.
Question 3: A postpartum client who delivered 24 hours ago reports severe perineal
pain and rates it 8/10. The nurse notes the perineal area is swollen and ecchymotic.
Which intervention should the nurse implement first?
A. Apply an ice pack to the perineal area
B. Administer the prescribed ibuprofen
,C. Assist the client with a sitz bath
D. Document the findings in the electronic health record
CORRECT ANSWER: A. Apply an ice pack to the perineal area
Rationale: In the immediate postpartum period (first 24-48 hours), cold therapy is the
priority intervention for perineal edema and pain because it reduces swelling, numbs
nerve endings, and minimizes hematoma formation. While analgesics and sitz baths are
beneficial, ice application provides the most immediate relief for acute inflammation.
Documentation is important but does not address the client's immediate comfort need.
Question 4: A nurse is assessing a client who is receiving a blood transfusion. The
client reports chills and back pain, and the nurse notes the temperature has
increased from 98.6°F to 101.2°F. Which action should the nurse take immediately?
A. Slow the transfusion rate and monitor vital signs
B. Stop the transfusion and maintain IV access with normal saline
C. Administer acetaminophen as prescribed
D. Notify the healthcare provider and obtain blood cultures
CORRECT ANSWER: B. Stop the transfusion and maintain IV access with normal
saline
Rationale: The client is exhibiting classic signs of a hemolytic transfusion reaction
(fever, chills, back pain). The immediate priority is to stop the transfusion to prevent
further infusion of incompatible blood, while maintaining IV access with normal saline
to support circulation and allow for emergency medication administration. Slowing the
transfusion is contraindicated, and while notifying the provider and administering
antipyretics are important, they follow after stopping the transfusion.
Question 5: A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal cannula. The client's
spouse asks why the oxygen flow cannot be increased to help the client breathe
easier. Which response by the nurse is most appropriate?
A. "Higher oxygen levels can cause the client to retain more carbon dioxide."
B. "The healthcare provider will increase the oxygen if it is needed."
C. "Increasing oxygen can cause the lungs to become dependent on supplemental
oxygen."
D. "The client's oxygen saturation is within normal limits, so more is not necessary."
CORRECT ANSWER: A. "Higher oxygen levels can cause the client to retain more
carbon dioxide."
Rationale: Clients with COPD often have chronic hypercapnia and rely on hypoxic drive
for respiratory stimulation. Administering high concentrations of oxygen can suppress
this drive, leading to CO2 retention, respiratory acidosis, and potential respiratory
failure. This explanation provides accurate, evidence-based education. While options B
,and D contain elements of truth, they do not address the physiological rationale. Option
C is inaccurate; oxygen dependence is not the concern.
Question 6: A nurse is preparing to administer digoxin to a client with heart failure.
The client's apical pulse is 58 beats per minute. Which action should the nurse
take?
A. Administer the digoxin as prescribed
B. Hold the dose and notify the healthcare provider
C. Administer half the prescribed dose
D. Recheck the pulse in 30 minutes before administering
CORRECT ANSWER: B. Hold the dose and notify the healthcare provider
Rationale: Digoxin is a cardiac glycoside that can cause bradycardia. The standard
nursing protocol is to hold digoxin and notify the provider if the apical pulse is below 60
beats per minute in adults (or per specific facility policy). Administering digoxin with
bradycardia could exacerbate the condition and lead to serious dysrhythmias.
Rechecking the pulse does not change the initial finding, and adjusting the dose without
a provider order is outside the nurse's scope.
Question 7: A nurse is caring for a client who is 2 days postoperative following a
total hip arthroplasty. Which assessment finding requires immediate intervention?
A. The client reports pain rated 5/10 at the surgical site
B. The client's affected leg is slightly edematous compared to the unaffected leg
C. The client reports sudden onset of shortness of breath and chest pain
D. The client has a temperature of 99.8°F orally
CORRECT ANSWER: C. The client reports sudden onset of shortness of breath and
chest pain
Rationale: Sudden shortness of breath and chest pain in a postoperative orthopedic
client are classic signs of pulmonary embolism, a life-threatening complication
requiring immediate intervention. While pain, mild edema, and low-grade fever are
expected postoperative findings, respiratory distress with chest pain indicates a
potential emergency. The nurse should activate the rapid response team, administer
oxygen, and prepare for diagnostic testing.
Question 8: A nurse is teaching a client with newly diagnosed hypertension about
lifestyle modifications. Which statement by the client indicates a need for further
teaching?
A. "I will limit my sodium intake to less than 2,300 mg per day."
B. "I will engage in moderate exercise for at least 30 minutes most days of the week."
C. "I will stop taking my blood pressure medication once my readings are normal."
D. "I will monitor my blood pressure at home and keep a log."
, CORRECT ANSWER: C. "I will stop taking my blood pressure medication once my
readings are normal."
Rationale: Hypertension is a chronic condition that requires lifelong management.
Antihypertensive medications control but do not cure hypertension; discontinuing
medication when readings normalize can lead to rebound hypertension and increased
cardiovascular risk. The other statements reflect appropriate understanding of sodium
restriction, exercise, and self-monitoring, which are evidence-based lifestyle
modifications for hypertension management.
Question 9: A nurse is caring for a client with a stage 3 pressure injury on the
sacrum. Which intervention should the nurse include in the plan of care?
A. Massage the area surrounding the pressure injury to promote circulation
B. Apply a dry gauze dressing and change it every 4 hours
C. Use a donut-shaped cushion when the client is sitting
D. Reposition the client every 2 hours and use a pressure-redistributing mattress
CORRECT ANSWER: D. Reposition the client every 2 hours and use a pressure-
redistributing mattress
Rationale: Pressure injury management focuses on relieving pressure, maintaining a
moist wound environment, and preventing further tissue damage. Repositioning every 2
hours and using specialized support surfaces are evidence-based interventions to
reduce pressure and promote healing. Massaging bony prominences can cause shear
and further tissue damage. Dry gauze is not ideal for stage 3 injuries, which require
moisture-balanced dressings. Donut cushions increase pressure on surrounding tissue
and are contraindicated.
Question 10: A nurse is assessing a client who is receiving magnesium sulfate for
preeclampsia. Which finding indicates magnesium toxicity?
A. Urine output of 40 mL/hr
B. Deep tendon reflexes of 2+
C. Respiratory rate of 10 breaths per minute
D. Blood pressure of 140/90 mm Hg
CORRECT ANSWER: C. Respiratory rate of 10 breaths per minute
Rationale: Magnesium sulfate is a central nervous system depressant, and toxicity can
manifest as respiratory depression (rate <12/min), absent deep tendon reflexes, and
decreased level of consciousness. A respiratory rate of 10 breaths per minute is a
critical finding requiring immediate intervention, including stopping the infusion and
administering calcium gluconate as the antidote. Urine output of 40 mL/hr is adequate,
2+ reflexes are normal, and the blood pressure, while elevated, is expected in
preeclampsia and not indicative of magnesium toxicity.
