HESI RN EXIT EXAM VERSION 1
(V1)
LATEST 2026 PRACTICE TEST
80+ QUESTIONS WITH
RATIONALESQUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
SECTION 1: MEDICAL-SURGICAL NURSING
1. A nurse is assessing a client with left-sided heart failure. Which finding is
most consistent with this diagnosis?
• A. Jugular vein distention
• B. Peripheral edema
• C. Hepatomegaly
• D. Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion due to the
inability of the left ventricle to pump blood forward, causing fluid backup into
the lungs (crackles). The other options are signs of right-sided heart failure.
2. A client with heart failure is prescribed furosemide 40 mg IV. Which
laboratory value should the nurse monitor most closely?
• A. Sodium
• B. Potassium
, • C. Hemoglobin
• D. Platelets
Rationale: Loop diuretics like furosemide cause potassium loss in the urine.
Hypokalemia can lead to life-threatening arrhythmias, especially if the patient
is also taking Digoxin.
3. A client is admitted with acute myocardial infarction (MI). Which lab value is
the most specific indicator of myocardial damage?
• A. Creatine Kinase-MB (CK-MB)
• B. Troponin I
• C. Myoglobin
• D. C-reactive protein (CRP)
Rationale: Troponin I and T are the most specific cardiac markers for
myocardial necrosis. Troponin remains elevated for days, making it the gold
standard for MI diagnosis.
4. A nurse is caring for a client with pneumonia who is receiving IV antibiotics.
Which finding requires the nurse's immediate intervention?
• A. Productive cough with thick sputum
• B. Temperature of 100.8°F (38.2°C)
• C. Oxygen saturation of 84% on room air
• D. White blood cell count of 12,000/mm³
Rationale: An O₂ sat of 84% indicates severe hypoxemia requiring immediate
intervention (oxygen therapy). The other findings are expected in pneumonia.
5. A client with type 1 diabetes mellitus has a blood glucose of 42 mg/dL and is
unconscious. Which action should the nurse take first?
• A. Administer glucagon 1 mg IM or subcutaneously
• B. Start an IV line with D50W
• C. Call the provider
• D. Check a fingerstick glucose again
Rationale: Glucagon raises blood glucose by stimulating glycogenolysis and
does not require IV access, making it the best option for an unconscious
patient. IV dextrose is the next step after IV access is established.
6. A client is admitted with acute pancreatitis. Which additional information is
the client most likely to report?
• A. Abdominal pain decreases when lying supine
• B. Pain lasts an hour and leaves the abdomen tender
• C. Right upper quadrant pain refers to right scapula
, • D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Clients with acute pancreatitis often find relief by lying supine with
knees flexed. Alcohol use may be a contributing factor but is not the most
immediate reported relief measure.
7. A client with bacterial meningitis is receiving phenytoin. Which assessment
finding indicates to the nurse that the client is experiencing a therapeutic
response?
• A. Increased time of ambulation between periods of rest
• B. Decrease in intracranial pressure and cerebral edema
• C. Absence of seizure activity for the duration of treatment
• D. Normal electroencephalogram after drug administration
Rationale: Phenytoin is an anticonvulsant. The therapeutic response is the
absence of seizure activity. Normal EEG may be seen but is not the primary
clinical indicator of therapeutic effect.
8. A client with peptic ulcer disease receives a prescription for intermittent
suction via a Salem Sump nasogastric tube (NGT). After inserting the NGT and
obtaining coffee-ground gastric contents, the nurse clamps the NGT because
the client must leave the unit for diagnostic studies. Upon return to the unit,
the client complains of nausea. What action should the nurse implement first?
• A. Administer a prescribed antiemetic agent
• B. Unclamp the NGT and connect to suction
• C. Auscultate the abdomen for bowel sounds
• D. Irrigate the NGT with 30 mL of normal saline
Rationale: Clamping an NGT allows gastric contents to accumulate, leading to
nausea. The priority is to unclamp and re-establish suction to decompress the
stomach and relieve nausea.
SECTION 2: PHARMACOLOGY
9. A nurse is preparing to administer digoxin. The apical pulse is 56 bpm. What
is the nurse's priority action?
• A. Administer the medication as prescribed
• B. Hold the medication and reassess the pulse
• C. Administer atropine to increase the heart rate
• D. Give half of the prescribed dose
Rationale: The general rule for digoxin is to hold the dose if the apical pulse is
(V1)
LATEST 2026 PRACTICE TEST
80+ QUESTIONS WITH
RATIONALESQUESTIONS AND
ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
SECTION 1: MEDICAL-SURGICAL NURSING
1. A nurse is assessing a client with left-sided heart failure. Which finding is
most consistent with this diagnosis?
• A. Jugular vein distention
• B. Peripheral edema
• C. Hepatomegaly
• D. Crackles in the lung bases
Rationale: Left-sided heart failure leads to pulmonary congestion due to the
inability of the left ventricle to pump blood forward, causing fluid backup into
the lungs (crackles). The other options are signs of right-sided heart failure.
2. A client with heart failure is prescribed furosemide 40 mg IV. Which
laboratory value should the nurse monitor most closely?
• A. Sodium
• B. Potassium
, • C. Hemoglobin
• D. Platelets
Rationale: Loop diuretics like furosemide cause potassium loss in the urine.
Hypokalemia can lead to life-threatening arrhythmias, especially if the patient
is also taking Digoxin.
3. A client is admitted with acute myocardial infarction (MI). Which lab value is
the most specific indicator of myocardial damage?
• A. Creatine Kinase-MB (CK-MB)
• B. Troponin I
• C. Myoglobin
• D. C-reactive protein (CRP)
Rationale: Troponin I and T are the most specific cardiac markers for
myocardial necrosis. Troponin remains elevated for days, making it the gold
standard for MI diagnosis.
4. A nurse is caring for a client with pneumonia who is receiving IV antibiotics.
Which finding requires the nurse's immediate intervention?
• A. Productive cough with thick sputum
• B. Temperature of 100.8°F (38.2°C)
• C. Oxygen saturation of 84% on room air
• D. White blood cell count of 12,000/mm³
Rationale: An O₂ sat of 84% indicates severe hypoxemia requiring immediate
intervention (oxygen therapy). The other findings are expected in pneumonia.
5. A client with type 1 diabetes mellitus has a blood glucose of 42 mg/dL and is
unconscious. Which action should the nurse take first?
• A. Administer glucagon 1 mg IM or subcutaneously
• B. Start an IV line with D50W
• C. Call the provider
• D. Check a fingerstick glucose again
Rationale: Glucagon raises blood glucose by stimulating glycogenolysis and
does not require IV access, making it the best option for an unconscious
patient. IV dextrose is the next step after IV access is established.
6. A client is admitted with acute pancreatitis. Which additional information is
the client most likely to report?
• A. Abdominal pain decreases when lying supine
• B. Pain lasts an hour and leaves the abdomen tender
• C. Right upper quadrant pain refers to right scapula
, • D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Clients with acute pancreatitis often find relief by lying supine with
knees flexed. Alcohol use may be a contributing factor but is not the most
immediate reported relief measure.
7. A client with bacterial meningitis is receiving phenytoin. Which assessment
finding indicates to the nurse that the client is experiencing a therapeutic
response?
• A. Increased time of ambulation between periods of rest
• B. Decrease in intracranial pressure and cerebral edema
• C. Absence of seizure activity for the duration of treatment
• D. Normal electroencephalogram after drug administration
Rationale: Phenytoin is an anticonvulsant. The therapeutic response is the
absence of seizure activity. Normal EEG may be seen but is not the primary
clinical indicator of therapeutic effect.
8. A client with peptic ulcer disease receives a prescription for intermittent
suction via a Salem Sump nasogastric tube (NGT). After inserting the NGT and
obtaining coffee-ground gastric contents, the nurse clamps the NGT because
the client must leave the unit for diagnostic studies. Upon return to the unit,
the client complains of nausea. What action should the nurse implement first?
• A. Administer a prescribed antiemetic agent
• B. Unclamp the NGT and connect to suction
• C. Auscultate the abdomen for bowel sounds
• D. Irrigate the NGT with 30 mL of normal saline
Rationale: Clamping an NGT allows gastric contents to accumulate, leading to
nausea. The priority is to unclamp and re-establish suction to decompress the
stomach and relieve nausea.
SECTION 2: PHARMACOLOGY
9. A nurse is preparing to administer digoxin. The apical pulse is 56 bpm. What
is the nurse's priority action?
• A. Administer the medication as prescribed
• B. Hold the medication and reassess the pulse
• C. Administer atropine to increase the heart rate
• D. Give half of the prescribed dose
Rationale: The general rule for digoxin is to hold the dose if the apical pulse is
