Page 1 of 255
HESI 700 EXAM AND RATIONALE EXAM COMPREHENSIVE
2026 QUESTIONS EXAM LATEST VERSION SOLVED
QUESTIONS & ANSWERS VERIFIED 100 %
The charge nurse is making assignment on a psychiatric unit for a practical
nurse (PN) and newly license register nurse (RN). Which client should be
assigned to the RN?
a. An adult female who has been depress for the past several months and
denies suicidal ideations.
b. A middle-age male who is in depressive phase on bipolar disease and is
receiving Lithium.
c. A young male with schizophrenia who said voices is telling him to kill his
psychiatric.
d. An elderly male who tell the staff and other client that he is superman and
he can fly.
A young male with schizophrenia who said voices is telling him to kill his psychiatric.
Rationale: The RN should deal with the client with command hallucinations and
these can be very dangerous if the client's acts on the commands, especially if the
command is a homicidal in nature. Other client present low safety risk
A client at 30 week gestation is admitted due to preterm labor. A prescription
of terbutaline sulfate 8.35 mg is gives subcutaneously. Based on which finding
should the nurse withhold the next dose of this drug?
a. Maternal blood pressure of 90/60
, Page 2 of 255
b. Fetal heart rate of 170 beats per minute for 15 mints
c. Maternal pulse rate of 162 beats per min
d. Serum potassium of 2.3 mg/dl
Maternal pulse rate of 162 beats per min
Rationale: The nurse checks the maternal pulse prior to administering the beta
sympathomimetic drug terbutaline (BRONCHDILATOR) and notify the
healthcare provider before administration of the drug if the pulse is over 140
beats in within normal limits because peripheral vasodilation accompanies
pregnancy and causes the BP decrease.
In assessing an older female client with complication associated with chronic
obstructive pulmonary disease (COPD), the nurse notices a change in the
client's appearance. Her face appears tense and she begs the nurse not to
leave her alone. Her pulse rate is 100, and respirations are 26 per min. What is
the primary nursing diagnosis?
a. Impaired gas exchange related to narrowing of small airways
b. Death anxiety related to concern about prognosis
c. Anxiety related to fear of suffocation.
d. Ineffective coping related to knowledge deficit about COPD
Anxiety related to fear of suffocation.
Rationale: A common problem with clients who have COPD is anxiety. These clients
cannot aerate their bodies, so they feel a perpetual state of suffocation which is
worse during exacerbation of their COPD. A classic descriptor of COPD id impaired
gas exchange (A). Because the client has typically adapted to impaired gas
exchange over a long period of time, and the nurse has assessed a change in her
appearance (A) is not the primary diagnosis at this time. Based on the data
presented (B and D) are not the best diagnoses in this situation.
A client with a cervical spinal cord injury (SCI) has Crutchfield tongs and
skeletal traction applied as a method of closed reduction. Which intervention
is most important for the nurse to include in the client's a plan of care?
a. Provide daily care of tong insertion sites using saline and antibiotic
ointment
, Page 3 of 255
b. Modify the client's diet to prevent constipation
c. Encourage active range of motion q2 to 4 hours.
d. Instruct the client to report any symptoms of upper extremity paresthesia.
Provide daily care of tong insertion sites using saline and antibiotic ointment
Rationale: Crutchfield tongs, a skeletal traction device for cervical immobilization,
requires daily care of the surgically inserted tongs to minimize the risk of infection of
the insertion site and cranial bone. Daily cleansing with normal saline solution and
antibiotic applications minimizes bacterial colonization and helps to prevent infection.
A client arrives on the surgical floor after major abdominal surgery. What
intervention should the nurse perform first?
a. Administer prescribed pain medication
b. Assess surgical site
c. Determine the client's vital sign.
d. Apply warmed blankets
Determine the client's vital sign.
Rationale: The First priority must be to obtain baseline vital signs. A and B should
also be accomplished soon, but not until the initial vital signs are determined. C is a
nice thing to do.
A client is admitted to the emergency department with a respiratory rate of 34
breaths per minute and high pitched wheezing on inspiration and expiration,
the medical diagnosis is severe exacerbation of asthma. Which assessment
finding, obtained 10 min after the admission assessment, should the nurse
report immediately to the emergency department healthcare provider?
a. An apical pulse of 120 beats per minute
b. Extreme agitation with staff and family
c. Client report being anxious
d. No wheezing upon auscultation of the chest.
No wheezing upon auscultation of the chest.
Rationale: No wheezing an auscultation indicates that the client is not exchanging air
, Page 4 of 255
and is highly compromised immediate action is indicated A, B, and C are sign of
hypoxia but no as critical as D
The nurse is planning a class for a group of clients with diabetes mellitus
about blood glucose monitoring. In teaching the class as a whole, the nurse
should emphasize the need to check glucose levels in which situation?
a. Prior to exercising
b. Immediately after meals
c. Before going to bed
d. During acute illness.
During acute illness
Rationale: Client should be instructed to always check their blood glucose whenever
they feel sick or nauseated. There is great variability in recommendations for
frequency of blood glucose testing. When first diagnosed, clients are often advised to
test before and after meals and at bedtime, then after meals and at bedtime for a
short period. Once they are stable, clients may be advised to test as often as four
times a day or as little as once each week, depending on the consistency of their diet
and exercise.
A 350-bed acute care hospital declares an internal disaster because the
emergency generators malfunctioned during a city-wide power failure. The
UAPs working on a general medical unit ask the charge nurse what they
should do first. What instruction should the charge nurse provide to these
UAPs?
a. Go to the emergency department and complete assigned tasks
b. Shut all doors to client rooms on the unit in case a fire erupts
c. Offer to assist the ICY with ventilator-dependent clients
d. Tell all their assigned clients to stay in their rooms.
Tell all their assigned clients to stay in their rooms.
Rationale: A power failure leaves a unit in total darkness except for battery operated
lighting. The top priority should be ensuring client safety by having clients stay in
their rooms, and UAP can implement this. A is a higher priority in external disaster. B
HESI 700 EXAM AND RATIONALE EXAM COMPREHENSIVE
2026 QUESTIONS EXAM LATEST VERSION SOLVED
QUESTIONS & ANSWERS VERIFIED 100 %
The charge nurse is making assignment on a psychiatric unit for a practical
nurse (PN) and newly license register nurse (RN). Which client should be
assigned to the RN?
a. An adult female who has been depress for the past several months and
denies suicidal ideations.
b. A middle-age male who is in depressive phase on bipolar disease and is
receiving Lithium.
c. A young male with schizophrenia who said voices is telling him to kill his
psychiatric.
d. An elderly male who tell the staff and other client that he is superman and
he can fly.
A young male with schizophrenia who said voices is telling him to kill his psychiatric.
Rationale: The RN should deal with the client with command hallucinations and
these can be very dangerous if the client's acts on the commands, especially if the
command is a homicidal in nature. Other client present low safety risk
A client at 30 week gestation is admitted due to preterm labor. A prescription
of terbutaline sulfate 8.35 mg is gives subcutaneously. Based on which finding
should the nurse withhold the next dose of this drug?
a. Maternal blood pressure of 90/60
, Page 2 of 255
b. Fetal heart rate of 170 beats per minute for 15 mints
c. Maternal pulse rate of 162 beats per min
d. Serum potassium of 2.3 mg/dl
Maternal pulse rate of 162 beats per min
Rationale: The nurse checks the maternal pulse prior to administering the beta
sympathomimetic drug terbutaline (BRONCHDILATOR) and notify the
healthcare provider before administration of the drug if the pulse is over 140
beats in within normal limits because peripheral vasodilation accompanies
pregnancy and causes the BP decrease.
In assessing an older female client with complication associated with chronic
obstructive pulmonary disease (COPD), the nurse notices a change in the
client's appearance. Her face appears tense and she begs the nurse not to
leave her alone. Her pulse rate is 100, and respirations are 26 per min. What is
the primary nursing diagnosis?
a. Impaired gas exchange related to narrowing of small airways
b. Death anxiety related to concern about prognosis
c. Anxiety related to fear of suffocation.
d. Ineffective coping related to knowledge deficit about COPD
Anxiety related to fear of suffocation.
Rationale: A common problem with clients who have COPD is anxiety. These clients
cannot aerate their bodies, so they feel a perpetual state of suffocation which is
worse during exacerbation of their COPD. A classic descriptor of COPD id impaired
gas exchange (A). Because the client has typically adapted to impaired gas
exchange over a long period of time, and the nurse has assessed a change in her
appearance (A) is not the primary diagnosis at this time. Based on the data
presented (B and D) are not the best diagnoses in this situation.
A client with a cervical spinal cord injury (SCI) has Crutchfield tongs and
skeletal traction applied as a method of closed reduction. Which intervention
is most important for the nurse to include in the client's a plan of care?
a. Provide daily care of tong insertion sites using saline and antibiotic
ointment
, Page 3 of 255
b. Modify the client's diet to prevent constipation
c. Encourage active range of motion q2 to 4 hours.
d. Instruct the client to report any symptoms of upper extremity paresthesia.
Provide daily care of tong insertion sites using saline and antibiotic ointment
Rationale: Crutchfield tongs, a skeletal traction device for cervical immobilization,
requires daily care of the surgically inserted tongs to minimize the risk of infection of
the insertion site and cranial bone. Daily cleansing with normal saline solution and
antibiotic applications minimizes bacterial colonization and helps to prevent infection.
A client arrives on the surgical floor after major abdominal surgery. What
intervention should the nurse perform first?
a. Administer prescribed pain medication
b. Assess surgical site
c. Determine the client's vital sign.
d. Apply warmed blankets
Determine the client's vital sign.
Rationale: The First priority must be to obtain baseline vital signs. A and B should
also be accomplished soon, but not until the initial vital signs are determined. C is a
nice thing to do.
A client is admitted to the emergency department with a respiratory rate of 34
breaths per minute and high pitched wheezing on inspiration and expiration,
the medical diagnosis is severe exacerbation of asthma. Which assessment
finding, obtained 10 min after the admission assessment, should the nurse
report immediately to the emergency department healthcare provider?
a. An apical pulse of 120 beats per minute
b. Extreme agitation with staff and family
c. Client report being anxious
d. No wheezing upon auscultation of the chest.
No wheezing upon auscultation of the chest.
Rationale: No wheezing an auscultation indicates that the client is not exchanging air
, Page 4 of 255
and is highly compromised immediate action is indicated A, B, and C are sign of
hypoxia but no as critical as D
The nurse is planning a class for a group of clients with diabetes mellitus
about blood glucose monitoring. In teaching the class as a whole, the nurse
should emphasize the need to check glucose levels in which situation?
a. Prior to exercising
b. Immediately after meals
c. Before going to bed
d. During acute illness.
During acute illness
Rationale: Client should be instructed to always check their blood glucose whenever
they feel sick or nauseated. There is great variability in recommendations for
frequency of blood glucose testing. When first diagnosed, clients are often advised to
test before and after meals and at bedtime, then after meals and at bedtime for a
short period. Once they are stable, clients may be advised to test as often as four
times a day or as little as once each week, depending on the consistency of their diet
and exercise.
A 350-bed acute care hospital declares an internal disaster because the
emergency generators malfunctioned during a city-wide power failure. The
UAPs working on a general medical unit ask the charge nurse what they
should do first. What instruction should the charge nurse provide to these
UAPs?
a. Go to the emergency department and complete assigned tasks
b. Shut all doors to client rooms on the unit in case a fire erupts
c. Offer to assist the ICY with ventilator-dependent clients
d. Tell all their assigned clients to stay in their rooms.
Tell all their assigned clients to stay in their rooms.
Rationale: A power failure leaves a unit in total darkness except for battery operated
lighting. The top priority should be ensuring client safety by having clients stay in
their rooms, and UAP can implement this. A is a higher priority in external disaster. B
