HESI RN COMPASS EXIT EXAM V1 2026
UPDATED PRACTICE TEST | VERIFIED
QUESTIONS & ANSWERS | COMPREHENSIVE
RN EXIT EXAM REVIEW GUIDE
HESI RN COMPASS EXIT EXAM V1 2026 — UPDATED PRACTICE TEST VERIFIED
QUESTIONS & ANSWERS | COMPREHENSIVE RN EXIT EXAM REVIEW GUIDE
• This 200-question practice test mirrors the full HESI RN Compass Exit Exam
blueprint, spanning all high-yield nursing domains — cardiovascular, respiratory,
neurological, endocrine, renal, GI, hematology, pharmacology, pediatrics, maternity,
mental health, fundamentals, and leadership — with a verified correct answer and
evidence-based EXPERT RATIONALE for every item.
• Study tip: Attempt each question independently before reading the answer, then
focus deeply on every EXPERT RATIONALE — especially for missed items — to
close knowledge gaps, sharpen clinical reasoning, and build the test-taking
confidence needed to pass the actual exit exam.
1. A nurse is caring for a client who arrives to the emergency department
reporting crushing chest pain radiating to the left arm. Which action should
the nurse perform FIRST?
A. Obtain a 12-lead ECG
B. Administer aspirin 325 mg orally
C. Draw cardiac enzyme blood samples
D. Establish IV access
E. Administer supplemental oxygen
✓ Correct Answer: A. Obtain a 12-lead ECG
EXPERT RATIONALE: A 12-lead ECG should be obtained within 10 minutes of arrival for
a client presenting with chest pain to determine if an ST-elevation myocardial infarction
(STEMI) is occurring. This guides all subsequent interventions. While aspirin, oxygen, and
,IV access are important, the ECG provides the diagnostic foundation for immediate
treatment decisions.
2. A client with heart failure is experiencing dyspnea and orthopnea. Which
position should the nurse place the client in to provide the most relief?
A. Supine with legs elevated
B. Prone with one pillow under the chest
C. Left lateral Sims' position
D. Trendelenburg position
E. High Fowler's position (head of bed elevated 60–90 degrees)
✓ Correct Answer: E. High Fowler's position (head of bed elevated 60–90
degrees)
EXPERT RATIONALE: High Fowler's position reduces venous return to the heart,
decreases preload, and allows the diaphragm to descend, improving lung expansion and
reducing dyspnea. It is the priority position for clients with heart failure experiencing
respiratory distress. Trendelenburg and leg elevation would worsen fluid return to the
heart.
3. A nurse is assessing a client receiving digoxin. Which finding should cause
the nurse to withhold the medication and notify the provider?
A. Blood pressure 130/82 mmHg
B. Serum potassium 3.1 mEq/L
C. Heart rate of 68 beats per minute
D. Serum digoxin level 1.0 ng/mL
E. Respiratory rate 16 breaths per minute
✓ Correct Answer: B. Serum potassium 3.1 mEq/L
,EXPERT RATIONALE: Hypokalemia (K⁺ below 3.5 mEq/L) potentiates digoxin toxicity by
increasing the drug's binding to myocardial cells. Even at therapeutic serum digoxin
levels, hypokalemia can precipitate life-threatening dysrhythmias. The nurse should hold
the drug and notify the provider immediately. A heart rate below 60 bpm is also a
reason to hold digoxin, but hypokalemia is the more dangerous condition listed here.
4. A client with atrial fibrillation is prescribed warfarin. The nurse explains
that the primary purpose of this medication in this condition is to:
A. Convert atrial fibrillation to normal sinus rhythm
B. Slow the ventricular rate during atrial fibrillation
C. Prevent thrombus formation and reduce stroke risk
D. Increase cardiac output during rapid ventricular response
E. Strengthen myocardial contractions
✓ Correct Answer: C. Prevent thrombus formation and reduce stroke risk
EXPERT RATIONALE: Atrial fibrillation causes blood to pool in the atria due to ineffective
atrial contraction, predisposing clients to clot formation. These clots can embolize to the
brain, causing stroke. Warfarin is an anticoagulant that prevents clot formation,
significantly reducing stroke risk in clients with atrial fibrillation.
5. A client presents with a blood pressure of 218/118 mmHg, severe headache,
and blurred vision. The nurse should anticipate which priority intervention?
A. Administer oral antihypertensive medication and recheck in 2 hours
B. Encourage the client to rest quietly in a darkened room
C. Administer IV antihypertensive therapy and continuously monitor blood pressure
D. Prepare the client for emergency cardiac catheterization
E. Apply ice packs to the neck and forehead
, ✓ Correct Answer: C. Administer IV antihypertensive therapy and
continuously monitor blood pressure
EXPERT RATIONALE: This client is experiencing a hypertensive emergency (BP >180/120
with end-organ symptoms such as headache and visual changes). IV antihypertensives
such as labetalol or nicardipine are required for rapid but controlled blood pressure
reduction. Continuous monitoring is essential to prevent overly rapid reduction, which
can cause cerebral ischemia. Oral medications are too slow for this emergency.
6. A nurse is caring for a postoperative cardiac client who suddenly develops
muffled heart sounds, distended neck veins, and hypotension. These findings
are most consistent with:
A. Pulmonary embolism
B. Tension pneumothorax
C. Cardiac tamponade
D. Acute myocardial infarction
E. Aortic dissection
✓ Correct Answer: C. Cardiac tamponade
EXPERT RATIONALE: Beck's triad — muffled heart sounds, jugular vein distension (JVD),
and hypotension — is the classic presentation of cardiac tamponade. Fluid
accumulation in the pericardial sac compresses the heart, reducing cardiac output.
Emergency pericardiocentesis is required. Tension pneumothorax presents with tracheal
deviation and absent breath sounds, not muffled heart sounds.
7. Following coronary artery bypass graft (CABG) surgery, a client's chest tube
drainage suddenly increases to 250 mL in 30 minutes. The nurse should:
A. Clamp the chest tube to prevent further blood loss
B. Increase the suction pressure on the chest drainage system
C. Reposition the client to the Trendelenburg position
UPDATED PRACTICE TEST | VERIFIED
QUESTIONS & ANSWERS | COMPREHENSIVE
RN EXIT EXAM REVIEW GUIDE
HESI RN COMPASS EXIT EXAM V1 2026 — UPDATED PRACTICE TEST VERIFIED
QUESTIONS & ANSWERS | COMPREHENSIVE RN EXIT EXAM REVIEW GUIDE
• This 200-question practice test mirrors the full HESI RN Compass Exit Exam
blueprint, spanning all high-yield nursing domains — cardiovascular, respiratory,
neurological, endocrine, renal, GI, hematology, pharmacology, pediatrics, maternity,
mental health, fundamentals, and leadership — with a verified correct answer and
evidence-based EXPERT RATIONALE for every item.
• Study tip: Attempt each question independently before reading the answer, then
focus deeply on every EXPERT RATIONALE — especially for missed items — to
close knowledge gaps, sharpen clinical reasoning, and build the test-taking
confidence needed to pass the actual exit exam.
1. A nurse is caring for a client who arrives to the emergency department
reporting crushing chest pain radiating to the left arm. Which action should
the nurse perform FIRST?
A. Obtain a 12-lead ECG
B. Administer aspirin 325 mg orally
C. Draw cardiac enzyme blood samples
D. Establish IV access
E. Administer supplemental oxygen
✓ Correct Answer: A. Obtain a 12-lead ECG
EXPERT RATIONALE: A 12-lead ECG should be obtained within 10 minutes of arrival for
a client presenting with chest pain to determine if an ST-elevation myocardial infarction
(STEMI) is occurring. This guides all subsequent interventions. While aspirin, oxygen, and
,IV access are important, the ECG provides the diagnostic foundation for immediate
treatment decisions.
2. A client with heart failure is experiencing dyspnea and orthopnea. Which
position should the nurse place the client in to provide the most relief?
A. Supine with legs elevated
B. Prone with one pillow under the chest
C. Left lateral Sims' position
D. Trendelenburg position
E. High Fowler's position (head of bed elevated 60–90 degrees)
✓ Correct Answer: E. High Fowler's position (head of bed elevated 60–90
degrees)
EXPERT RATIONALE: High Fowler's position reduces venous return to the heart,
decreases preload, and allows the diaphragm to descend, improving lung expansion and
reducing dyspnea. It is the priority position for clients with heart failure experiencing
respiratory distress. Trendelenburg and leg elevation would worsen fluid return to the
heart.
3. A nurse is assessing a client receiving digoxin. Which finding should cause
the nurse to withhold the medication and notify the provider?
A. Blood pressure 130/82 mmHg
B. Serum potassium 3.1 mEq/L
C. Heart rate of 68 beats per minute
D. Serum digoxin level 1.0 ng/mL
E. Respiratory rate 16 breaths per minute
✓ Correct Answer: B. Serum potassium 3.1 mEq/L
,EXPERT RATIONALE: Hypokalemia (K⁺ below 3.5 mEq/L) potentiates digoxin toxicity by
increasing the drug's binding to myocardial cells. Even at therapeutic serum digoxin
levels, hypokalemia can precipitate life-threatening dysrhythmias. The nurse should hold
the drug and notify the provider immediately. A heart rate below 60 bpm is also a
reason to hold digoxin, but hypokalemia is the more dangerous condition listed here.
4. A client with atrial fibrillation is prescribed warfarin. The nurse explains
that the primary purpose of this medication in this condition is to:
A. Convert atrial fibrillation to normal sinus rhythm
B. Slow the ventricular rate during atrial fibrillation
C. Prevent thrombus formation and reduce stroke risk
D. Increase cardiac output during rapid ventricular response
E. Strengthen myocardial contractions
✓ Correct Answer: C. Prevent thrombus formation and reduce stroke risk
EXPERT RATIONALE: Atrial fibrillation causes blood to pool in the atria due to ineffective
atrial contraction, predisposing clients to clot formation. These clots can embolize to the
brain, causing stroke. Warfarin is an anticoagulant that prevents clot formation,
significantly reducing stroke risk in clients with atrial fibrillation.
5. A client presents with a blood pressure of 218/118 mmHg, severe headache,
and blurred vision. The nurse should anticipate which priority intervention?
A. Administer oral antihypertensive medication and recheck in 2 hours
B. Encourage the client to rest quietly in a darkened room
C. Administer IV antihypertensive therapy and continuously monitor blood pressure
D. Prepare the client for emergency cardiac catheterization
E. Apply ice packs to the neck and forehead
, ✓ Correct Answer: C. Administer IV antihypertensive therapy and
continuously monitor blood pressure
EXPERT RATIONALE: This client is experiencing a hypertensive emergency (BP >180/120
with end-organ symptoms such as headache and visual changes). IV antihypertensives
such as labetalol or nicardipine are required for rapid but controlled blood pressure
reduction. Continuous monitoring is essential to prevent overly rapid reduction, which
can cause cerebral ischemia. Oral medications are too slow for this emergency.
6. A nurse is caring for a postoperative cardiac client who suddenly develops
muffled heart sounds, distended neck veins, and hypotension. These findings
are most consistent with:
A. Pulmonary embolism
B. Tension pneumothorax
C. Cardiac tamponade
D. Acute myocardial infarction
E. Aortic dissection
✓ Correct Answer: C. Cardiac tamponade
EXPERT RATIONALE: Beck's triad — muffled heart sounds, jugular vein distension (JVD),
and hypotension — is the classic presentation of cardiac tamponade. Fluid
accumulation in the pericardial sac compresses the heart, reducing cardiac output.
Emergency pericardiocentesis is required. Tension pneumothorax presents with tracheal
deviation and absent breath sounds, not muffled heart sounds.
7. Following coronary artery bypass graft (CABG) surgery, a client's chest tube
drainage suddenly increases to 250 mL in 30 minutes. The nurse should:
A. Clamp the chest tube to prevent further blood loss
B. Increase the suction pressure on the chest drainage system
C. Reposition the client to the Trendelenburg position
