HESI RN COMPREHENSIVE EXIT
EXAM - LATEST 2026 QUESTIONS
AND ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Management of Care & Prioritization (Questions 1-
10)
1. A nurse in the emergency department is triaging four clients. Which client
should be seen first?
A. A 72-year-old with confusion and a blood glucose of 45 mg/dL.
B. A 45-year-old with substernal chest pain radiating to the jaw and diaphoresis.
C. A 30-year-old with ankle swelling after a fall.
D. A 60-year-old with a headache and BP 168/92 mmHg.
Rationale: Chest pain radiating to the jaw with diaphoresis is the classic presentation
of an acute Myocardial Infarction (MI). This is an immediate life-threatening event
(Airway/Breathing/Circulation - Circulation priority) and requires rapid intervention.
While hypoglycemia (A) is serious, it can be treated orally if the patient is conscious;
the chest pain patient is at immediate risk for dysrhythmias or cardiac arrest .
2. The charge nurse is making assignments for a medical-surgical unit. Which
client should be assigned to the most experienced RN?
A. A client with COPD requiring Q4 hour nebulizer treatments.
B. A client with a fractured hip needing pain medication.
C. A client with a new tracheostomy requiring frequent suctioning.
D. A client with a urinary tract infection on oral antibiotics.
,Rationale: A new tracheostomy poses a high risk for airway loss or obstruction. This
client requires the most experienced nurse who can recognize subtle signs of
respiratory distress and manage an emergency airway situation effectively. The other
assignments are stable and can be delegated to less experienced staff .
3. A nurse receives a handoff report on four clients. Which client should the
nurse assess first?
A. A client post-op day 2 with a temperature of 99.1°F and HR 90.
B. A client 2 hours post-thoracentesis who reports sudden shortness of breath
and has absent breath sounds on the right.
C. A diabetic with a glucose of 185 mg/dL requesting insulin.
D. A COPD patient with an O2 sat of 91% on 2L nasal cannula.
Rationale: Sudden shortness of breath post-thoracentesis is indicative of a tension
pneumothorax (absent breath sounds confirm this). This is a medical emergency
requiring immediate needle decompression or chest tube insertion. This takes
priority over stable vital signs or non-critical lab values .
4. During a fire in the hospital, which action by the nurse is most appropriate?
A. Use the elevator to move bedridden patients quickly.
B. Close all doors in the immediate area.
C. Leave oxygen cylinders in place to avoid delay.
D. Run to activate the alarm before assisting patients.
Rationale: The mnemonic RACE guides fire
response: Rescue, Alarm, Contain, Extinguish. Closing doors (Contain) prevents the
spread of fire and smoke to other areas. Elevators should never be used during a fire
(fire shaft). Assisting patients to safety comes before activating the alarm if you are
the first to discover the fire .
5. A client with a "Do Not Resuscitate" (DNR) order is showing signs of
impending death. After notifying the family, what is the priority action?
A. Document the signs of impending death.
B. Notify the hospital chaplain.
C. Determine the client's need for pain medication.
D. Update the nurse manager on the client's status.
Rationale: Even in the context of terminal illness and DNR status, the nurse has an
ethical and professional obligation to provide comfort and palliate symptoms. Pain
and dyspnea are common at end-of-life; the priority is assessing and treating these
symptoms to ensure a dignified death .
6. A nurse is providing discharge teaching to a client post-ileal conduit surgery.
Which statement indicates the client needs further education?
A. "I will drink cranberry juice to prevent infections."
, B. "I will cut a small hole in the back of my shirt to access the pouch."
C. "I will empty the pouch when it is half full."
D. "I will clean the stoma with mild soap and water."
Rationale: Urostomy pouches should be emptied when they are 1/3 to 1/2 full.
Waiting until it is half full risks leakage due to the weight of the urine pulling the seal
away from the skin. The other statements demonstrate good understanding .
7. A client is being transferred to the ICU. Using the SBAR framework, which
statement should the nurse make first?
A. "The patient is a 65-year-old with heart failure history."
B. "The patient's oxygen saturation has dropped to 84% on 6L oxygen."
C. "I think the patient needs to be intubated."
D. "The lung sounds reveal crackles in all fields."
Rationale: SBAR stands for Situation, Background, Assessment, Recommendation.
The "Situation" (what is happening right now) must be communicated first to alert
the provider to the urgency of the issue .
8. The nurse is caring for a client who just returned from the PACU following a
right colectomy. What is the first action?
A. Check the surgical incision site.
B. Assess the client's airway patency.
C. Review the intake and output record.
D. Monitor vital signs.
Rationale: The ABCs (Airway, Breathing, Circulation) always take priority in post-
operative care. Ensuring a patent airway is the first step to prevent hypoxia and
death. Pain and incision assessment come after .
9. The nurse manager is reviewing fall risks. Which client is at highest risk?
A. A 45-year-old post-cholecystectomy with pain.
B. A 72-year-old with a history of stroke using a walker and has nocturia.
C. A 30-year-old with pneumonia and fever.
D. A 55-year-old with osteoarthritis.
Rationale: The highest risk patient is the elderly patient with multiple intrinsic risk
factors: history of stroke (likely hemiparesis/weakness), use of assistive device
(walker), and nocturia (frequent trips to the bathroom at night in the dark) .
10. A client with a prescription for enoxaparin (Lovenox) develops a large
hematoma at the injection site. What is the correct action?
A. Massage the area to promote absorption.
B. Aspirate the hematoma with a needle.
EXAM - LATEST 2026 QUESTIONS
AND ANSWERS WITH
RATIONALES/GRADED A+/2026
UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Section 1: Management of Care & Prioritization (Questions 1-
10)
1. A nurse in the emergency department is triaging four clients. Which client
should be seen first?
A. A 72-year-old with confusion and a blood glucose of 45 mg/dL.
B. A 45-year-old with substernal chest pain radiating to the jaw and diaphoresis.
C. A 30-year-old with ankle swelling after a fall.
D. A 60-year-old with a headache and BP 168/92 mmHg.
Rationale: Chest pain radiating to the jaw with diaphoresis is the classic presentation
of an acute Myocardial Infarction (MI). This is an immediate life-threatening event
(Airway/Breathing/Circulation - Circulation priority) and requires rapid intervention.
While hypoglycemia (A) is serious, it can be treated orally if the patient is conscious;
the chest pain patient is at immediate risk for dysrhythmias or cardiac arrest .
2. The charge nurse is making assignments for a medical-surgical unit. Which
client should be assigned to the most experienced RN?
A. A client with COPD requiring Q4 hour nebulizer treatments.
B. A client with a fractured hip needing pain medication.
C. A client with a new tracheostomy requiring frequent suctioning.
D. A client with a urinary tract infection on oral antibiotics.
,Rationale: A new tracheostomy poses a high risk for airway loss or obstruction. This
client requires the most experienced nurse who can recognize subtle signs of
respiratory distress and manage an emergency airway situation effectively. The other
assignments are stable and can be delegated to less experienced staff .
3. A nurse receives a handoff report on four clients. Which client should the
nurse assess first?
A. A client post-op day 2 with a temperature of 99.1°F and HR 90.
B. A client 2 hours post-thoracentesis who reports sudden shortness of breath
and has absent breath sounds on the right.
C. A diabetic with a glucose of 185 mg/dL requesting insulin.
D. A COPD patient with an O2 sat of 91% on 2L nasal cannula.
Rationale: Sudden shortness of breath post-thoracentesis is indicative of a tension
pneumothorax (absent breath sounds confirm this). This is a medical emergency
requiring immediate needle decompression or chest tube insertion. This takes
priority over stable vital signs or non-critical lab values .
4. During a fire in the hospital, which action by the nurse is most appropriate?
A. Use the elevator to move bedridden patients quickly.
B. Close all doors in the immediate area.
C. Leave oxygen cylinders in place to avoid delay.
D. Run to activate the alarm before assisting patients.
Rationale: The mnemonic RACE guides fire
response: Rescue, Alarm, Contain, Extinguish. Closing doors (Contain) prevents the
spread of fire and smoke to other areas. Elevators should never be used during a fire
(fire shaft). Assisting patients to safety comes before activating the alarm if you are
the first to discover the fire .
5. A client with a "Do Not Resuscitate" (DNR) order is showing signs of
impending death. After notifying the family, what is the priority action?
A. Document the signs of impending death.
B. Notify the hospital chaplain.
C. Determine the client's need for pain medication.
D. Update the nurse manager on the client's status.
Rationale: Even in the context of terminal illness and DNR status, the nurse has an
ethical and professional obligation to provide comfort and palliate symptoms. Pain
and dyspnea are common at end-of-life; the priority is assessing and treating these
symptoms to ensure a dignified death .
6. A nurse is providing discharge teaching to a client post-ileal conduit surgery.
Which statement indicates the client needs further education?
A. "I will drink cranberry juice to prevent infections."
, B. "I will cut a small hole in the back of my shirt to access the pouch."
C. "I will empty the pouch when it is half full."
D. "I will clean the stoma with mild soap and water."
Rationale: Urostomy pouches should be emptied when they are 1/3 to 1/2 full.
Waiting until it is half full risks leakage due to the weight of the urine pulling the seal
away from the skin. The other statements demonstrate good understanding .
7. A client is being transferred to the ICU. Using the SBAR framework, which
statement should the nurse make first?
A. "The patient is a 65-year-old with heart failure history."
B. "The patient's oxygen saturation has dropped to 84% on 6L oxygen."
C. "I think the patient needs to be intubated."
D. "The lung sounds reveal crackles in all fields."
Rationale: SBAR stands for Situation, Background, Assessment, Recommendation.
The "Situation" (what is happening right now) must be communicated first to alert
the provider to the urgency of the issue .
8. The nurse is caring for a client who just returned from the PACU following a
right colectomy. What is the first action?
A. Check the surgical incision site.
B. Assess the client's airway patency.
C. Review the intake and output record.
D. Monitor vital signs.
Rationale: The ABCs (Airway, Breathing, Circulation) always take priority in post-
operative care. Ensuring a patent airway is the first step to prevent hypoxia and
death. Pain and incision assessment come after .
9. The nurse manager is reviewing fall risks. Which client is at highest risk?
A. A 45-year-old post-cholecystectomy with pain.
B. A 72-year-old with a history of stroke using a walker and has nocturia.
C. A 30-year-old with pneumonia and fever.
D. A 55-year-old with osteoarthritis.
Rationale: The highest risk patient is the elderly patient with multiple intrinsic risk
factors: history of stroke (likely hemiparesis/weakness), use of assistive device
(walker), and nocturia (frequent trips to the bathroom at night in the dark) .
10. A client with a prescription for enoxaparin (Lovenox) develops a large
hematoma at the injection site. What is the correct action?
A. Massage the area to promote absorption.
B. Aspirate the hematoma with a needle.
