HESI RN Exit Exam Advanced Review &
Test Bank – Evidence-Based Clinical
Judgment PREPARATION REAL EXAM
200+ QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES|A+
GRADE
1. A client with acute pancreatitis has severe abdominal pain and elevated serum
amylase. Which additional history is most likely?
Correct Answer: A
o A. Abdominal pain that decreases when lying supine
o B. Pain lasting an hour, leaving the abdomen tender
o C. Right upper quadrant pain referring to the right scapula
o D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Clients with acute pancreatitis often report that lying supine reduces
pain because it decreases tension on the inflamed pancreas. Although alcohol use
is a common etiology, the specific pain pattern is most characteristic.
2. The nurse is assessing a 3-year-old with bacterial meningitis and hydrocephalus.
Which finding suggests increased intracranial pressure (ICP)?
Correct Answer: B
o A. Tachycardia and tachypnea
o B. Sluggish and unequal pupillary responses
o C. Increased head circumference and bulging fontanels
,o D. Blood pressure fluctuations and syncope
Rationale: Late signs of increased ICP include sluggish, unequal, or nonreactive
pupils due to pressure on the oculomotor nerve. Increased head circumference
and bulging fontanels are early signs in infants.
3. A client is scheduled for an upper GI series. Which statement indicates the client
needs further instruction?
Correct Answer: C
o A. “The test will take about 30 minutes.”
o B. “I need to fast for 8 hours before the test.”
o C. “I need to drink citrate of magnesia the night before and give myself a
Fleet enema the morning of the test.”
o D. “I need to take a laxative after the test because the barium can be
constipating.”
Rationale: No bowel prep is required for an upper GI series; only NPO status for 8
hours. Bowel prep is used for lower GI studies like a barium enema.
4. A client with new-onset type 1 diabetes tells the nurse, “I can exercise when my
blood glucose is over 250 and I have ketones.” How should the nurse respond?
Correct Answer: C
o A. “That is correct as long as you drink extra water.”
o B. “You should exercise only when your glucose is between 150 and 200.”
o C. “That is incorrect; exercising with high glucose and ketones is dangerous.”
o D. “You are right, but always check your glucose before exercising.”
Rationale: Exercise when blood glucose >250 mg/dL with ketones can worsen
hyperglycemia and increase ketone production. The client should avoid exercise
until glucose is controlled and ketones are negative.
5. A client on warfarin tells the nurse, “I will take ibuprofen for my headaches.” What
is the nurse’s best response?
Correct Answer: C
o A. “Ibuprofen is fine as long as you take it with food.”
o B. “You should take acetaminophen instead of ibuprofen.”
,o C. “Ibuprofen can increase your bleeding risk; you should avoid it.”
o D. “Warfarin and ibuprofen are safe to take together occasionally.”
Rationale: NSAIDs like ibuprofen increase bleeding risk by affecting platelet
function. Acetaminophen is a safer analgesic for clients taking warfarin.
6. A client 2 hours post-femoral cardiac catheterization has a pulse rate of 80 bpm
and a hematoma at the insertion site. Which action should the nurse take?
Correct Answer: B
o A. Continue to monitor the client every hour.
o B. Apply firm pressure proximal to the insertion site and notify the provider.
o C. Apply a warm compress to the hematoma.
o D. Document the findings as expected.
Rationale: A hematoma at the arterial puncture site indicates bleeding. The nurse
should apply firm pressure and notify the provider immediately. Pulse rate of 80 is
within normal limits.
7. A client has low T3 and T4 levels with an elevated TSH. What assessment finding
would the nurse anticipate?
Correct Answer: A
o A. Lethargy
o B. Heat intolerance
o C. Diarrhea
o D. Skin eruptions
Rationale: This pattern indicates hypothyroidism (low T3/T4, high TSH).
Symptoms include fatigue, lethargy, cold intolerance, and constipation. Heat
intolerance and diarrhea are seen in hyperthyroidism.
8. The nurse hears a sound in synchrony with the fetal heartbeat that is caused by
blood rushing through the umbilical vessels. How should this be documented?
Correct Answer: B
o A. Goodell’s sign
o B. Funic soufflé
o C. Hegar’s sign
, o D. Quickening
Rationale: Funic soufflé is the sound of blood rushing through the umbilical
vessels and is synchronous with the fetal heartbeat. Goodell’s sign (cervical
softening) and Hegar’s sign (uterine isthmus softening) are early pregnancy signs.
9. A nurse is caring for four clients. Which client should the nurse assess first?
Correct Answer: D
o A. 36 weeks’ gestation, reports back pain after intercourse
o B. 10 weeks’ gestation, reports frequent urination
o C. 24 weeks’ gestation, reports periodic finger tingling
o D. 8 weeks’ gestation, reports severe vomiting
Rationale: Severe vomiting at 8 weeks may indicate hyperemesis gravidarum,
which can lead to dehydration, electrolyte imbalance, and weight loss, requiring
prompt assessment.
10. A newborn 2 hours old has a single transverse palmar crease bilaterally. What
should the nurse do?
Correct Answer: C
o A. Document this as a normal newborn variation.
o B. Place the newborn on a cardiac monitor.
o C. Report this finding to the healthcare provider.
o D. Check the newborn’s blood glucose immediately.
Rationale: A single transverse palmar crease can be associated with Down
syndrome. This finding should be reported for further evaluation. Transient
nystagmus, molding, and lanugo are normal.
11. A client 24 hours postpartum has a hemoglobin of 9.0 g/dL and hematocrit of
25%. What should the nurse do?
Correct Answer: C
o A. Prepare the client for a blood transfusion.
o B. Initiate IV access with an 18-gauge catheter.
o C. Administer an iron supplement to the client.
Test Bank – Evidence-Based Clinical
Judgment PREPARATION REAL EXAM
200+ QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES|A+
GRADE
1. A client with acute pancreatitis has severe abdominal pain and elevated serum
amylase. Which additional history is most likely?
Correct Answer: A
o A. Abdominal pain that decreases when lying supine
o B. Pain lasting an hour, leaving the abdomen tender
o C. Right upper quadrant pain referring to the right scapula
o D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Clients with acute pancreatitis often report that lying supine reduces
pain because it decreases tension on the inflamed pancreas. Although alcohol use
is a common etiology, the specific pain pattern is most characteristic.
2. The nurse is assessing a 3-year-old with bacterial meningitis and hydrocephalus.
Which finding suggests increased intracranial pressure (ICP)?
Correct Answer: B
o A. Tachycardia and tachypnea
o B. Sluggish and unequal pupillary responses
o C. Increased head circumference and bulging fontanels
,o D. Blood pressure fluctuations and syncope
Rationale: Late signs of increased ICP include sluggish, unequal, or nonreactive
pupils due to pressure on the oculomotor nerve. Increased head circumference
and bulging fontanels are early signs in infants.
3. A client is scheduled for an upper GI series. Which statement indicates the client
needs further instruction?
Correct Answer: C
o A. “The test will take about 30 minutes.”
o B. “I need to fast for 8 hours before the test.”
o C. “I need to drink citrate of magnesia the night before and give myself a
Fleet enema the morning of the test.”
o D. “I need to take a laxative after the test because the barium can be
constipating.”
Rationale: No bowel prep is required for an upper GI series; only NPO status for 8
hours. Bowel prep is used for lower GI studies like a barium enema.
4. A client with new-onset type 1 diabetes tells the nurse, “I can exercise when my
blood glucose is over 250 and I have ketones.” How should the nurse respond?
Correct Answer: C
o A. “That is correct as long as you drink extra water.”
o B. “You should exercise only when your glucose is between 150 and 200.”
o C. “That is incorrect; exercising with high glucose and ketones is dangerous.”
o D. “You are right, but always check your glucose before exercising.”
Rationale: Exercise when blood glucose >250 mg/dL with ketones can worsen
hyperglycemia and increase ketone production. The client should avoid exercise
until glucose is controlled and ketones are negative.
5. A client on warfarin tells the nurse, “I will take ibuprofen for my headaches.” What
is the nurse’s best response?
Correct Answer: C
o A. “Ibuprofen is fine as long as you take it with food.”
o B. “You should take acetaminophen instead of ibuprofen.”
,o C. “Ibuprofen can increase your bleeding risk; you should avoid it.”
o D. “Warfarin and ibuprofen are safe to take together occasionally.”
Rationale: NSAIDs like ibuprofen increase bleeding risk by affecting platelet
function. Acetaminophen is a safer analgesic for clients taking warfarin.
6. A client 2 hours post-femoral cardiac catheterization has a pulse rate of 80 bpm
and a hematoma at the insertion site. Which action should the nurse take?
Correct Answer: B
o A. Continue to monitor the client every hour.
o B. Apply firm pressure proximal to the insertion site and notify the provider.
o C. Apply a warm compress to the hematoma.
o D. Document the findings as expected.
Rationale: A hematoma at the arterial puncture site indicates bleeding. The nurse
should apply firm pressure and notify the provider immediately. Pulse rate of 80 is
within normal limits.
7. A client has low T3 and T4 levels with an elevated TSH. What assessment finding
would the nurse anticipate?
Correct Answer: A
o A. Lethargy
o B. Heat intolerance
o C. Diarrhea
o D. Skin eruptions
Rationale: This pattern indicates hypothyroidism (low T3/T4, high TSH).
Symptoms include fatigue, lethargy, cold intolerance, and constipation. Heat
intolerance and diarrhea are seen in hyperthyroidism.
8. The nurse hears a sound in synchrony with the fetal heartbeat that is caused by
blood rushing through the umbilical vessels. How should this be documented?
Correct Answer: B
o A. Goodell’s sign
o B. Funic soufflé
o C. Hegar’s sign
, o D. Quickening
Rationale: Funic soufflé is the sound of blood rushing through the umbilical
vessels and is synchronous with the fetal heartbeat. Goodell’s sign (cervical
softening) and Hegar’s sign (uterine isthmus softening) are early pregnancy signs.
9. A nurse is caring for four clients. Which client should the nurse assess first?
Correct Answer: D
o A. 36 weeks’ gestation, reports back pain after intercourse
o B. 10 weeks’ gestation, reports frequent urination
o C. 24 weeks’ gestation, reports periodic finger tingling
o D. 8 weeks’ gestation, reports severe vomiting
Rationale: Severe vomiting at 8 weeks may indicate hyperemesis gravidarum,
which can lead to dehydration, electrolyte imbalance, and weight loss, requiring
prompt assessment.
10. A newborn 2 hours old has a single transverse palmar crease bilaterally. What
should the nurse do?
Correct Answer: C
o A. Document this as a normal newborn variation.
o B. Place the newborn on a cardiac monitor.
o C. Report this finding to the healthcare provider.
o D. Check the newborn’s blood glucose immediately.
Rationale: A single transverse palmar crease can be associated with Down
syndrome. This finding should be reported for further evaluation. Transient
nystagmus, molding, and lanugo are normal.
11. A client 24 hours postpartum has a hemoglobin of 9.0 g/dL and hematocrit of
25%. What should the nurse do?
Correct Answer: C
o A. Prepare the client for a blood transfusion.
o B. Initiate IV access with an 18-gauge catheter.
o C. Administer an iron supplement to the client.
