2026
HESI RN Fundamentals Exit Exam 2026
Test Bank: High-Yield Practice Questions
with Detailed Rationales
The nurse is completing the admission assessment of a 3-year-old admitted with bacterial
meningitis and hydrocephalus. Which assessment finding is evidence of increased intracranial
pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary responses
C. Increased head circumference and bulging fontanels
D. Blood pressure fluctuations and syncope
Rationale: Sluggish and unequal pupillary responses indicate neurologic impairment and rising
ICP. Tachycardia and tachypnea are nonspecific stress responses. Increased head circumference
and bulging fontanels are expected in infants, not a 3-year-old. Blood pressure fluctuations occur
later and syncope is not a typical early ICP sign.
A client with acute pancreatitis is admitted with severe abdominal pain and elevated serum
amylase. 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 the right scapula
D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Pancreatitis pain often improves when the client lies still or flexes forward.
Gallbladder disease causes referred scapular pain. Short-lasting pain is inconsistent with
pancreatitis. Alcohol use may be a cause but not a symptom the client reports.
A child newly diagnosed with sickle cell anemia is being discharged. Which information is most
important for the nurse to provide the parents?
A. Instructions about how much fluid the child should drink daily
B. Signs of addiction to opioid pain medications
,2026
C. Non-pharmacologic pain relief measures
D. Referral to social services
Rationale: Adequate hydration is essential to prevent vaso-occlusive crises. Opioid addiction
education is secondary. Non-pharmacologic measures and referrals are helpful but not the
highest priority.
After receiving report on an acute care unit, which client should the nurse assess first?
A. Client with large bowel obstruction and abdominal distention
B. Client with postoperative paralytic ileus
C. Client with small bowel obstruction and NG tube draining green fluid
D. Client with volvulus and abdominal rigidity
Rationale: Abdominal rigidity suggests peritonitis or bowel ischemia, a life-threatening
emergency requiring immediate assessment. The other conditions are serious but less acute.
A teenager presents with palpitations after vaping and is hyperventilating. Which acid-base
imbalance does the nurse anticipate?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
Rationale: Hyperventilation causes excessive carbon dioxide loss, leading to respiratory
alkalosis. The other imbalances do not result from rapid breathing.
A client with dyspnea is being admitted. To best prepare, the nurse should place the bed in which
position?
A. Supine
B. Supine with feet elevated
C. Supine with head elevated
D. Fowler’s
Rationale: Fowler’s position maximizes lung expansion and reduces work of breathing. Supine
positions worsen dyspnea.
,2026
The nurse is taking the blood pressure of a client with Parkinson’s disease. Which assessment
findings are relevant to the plan? (Select all that apply)
A. Frequent syncope
B. Occasional nocturia
C. Flat affect
D. Blurred vision
E. Frequent drooling
Rationale: Parkinson’s disease is associated with orthostatic hypotension, which can cause
syncope, blurred vision, and affect cooperation during BP measurement. Nocturia and drooling
are unrelated.
While caring for a postoperative wound, the nurse notes purulent drainage. Before notifying the
provider, which lab value should the nurse review?
A. Serum albumin
B. Culture for sensitive organisms
C. Serum blood glucose
D. Creatinine
Rationale: Reviewing culture and sensitivity results helps guide appropriate antibiotic therapy.
Other labs do not directly guide infection treatment.
A preschool child is admitted after a near-drowning incident. The nurse speaks with the older
sibling who performed the rescue and notices withdrawal. What should the nurse do?
A. Develop a water safety plan
B. Ask the sibling how he felt during the incident
C. Tell the sibling he seems depressed
D. Commend heroic actions
Rationale: Encouraging expression of feelings supports emotional processing. Teaching and
praise are premature. Labeling emotions is inappropriate.
A client with cirrhosis has jaundice and pruritus and reports soaking in hot baths without relief.
Which action should the nurse take?
A. Encourage cooler water and apply calamine lotion
B. Obtain a PRN analgesic
, 2026
C. Suggest hot showers and oil-based lotion
D. Explain symptoms cannot be relieved
Rationale: Hot water worsens pruritus. Cooler water and soothing lotions help relieve itching.
Analgesics are ineffective, and reassurance alone is inappropriate.
A client with acute heart failure receives IV furosemide. Which therapeutic effect should the
nurse expect?
A. Increased cardiac contractility
B. Reduced preload
C. Relaxed vascular tone
D. Decreased afterload
Rationale: Furosemide reduces intravascular volume, lowering preload and pulmonary
congestion. It does not directly affect contractility or vascular tone.
Which intervention should be included in the care of a child with tetanus?
A. Encourage coughing
B. Minimize environmental stimuli
C. Reposition hourly
D. Open window shades
Rationale: Tetanus causes severe muscle spasms triggered by stimuli. Minimizing light, sound,
and touch reduces spasms.
An adolescent with type 1 diabetes is admitted with diabetic ketoacidosis. What is the most
likely cause?
A. Extra food intake
B. Excess insulin
C. Recent infection
D. Skipped lunch
Rationale: Infection increases insulin demand and commonly precipitates DKA. Eating more or
skipping a meal does not cause ketoacidosis when insulin is adequate.
HESI RN Fundamentals Exit Exam 2026
Test Bank: High-Yield Practice Questions
with Detailed Rationales
The nurse is completing the admission assessment of a 3-year-old admitted with bacterial
meningitis and hydrocephalus. Which assessment finding is evidence of increased intracranial
pressure (ICP)?
A. Tachycardia and tachypnea
B. Sluggish and unequal pupillary responses
C. Increased head circumference and bulging fontanels
D. Blood pressure fluctuations and syncope
Rationale: Sluggish and unequal pupillary responses indicate neurologic impairment and rising
ICP. Tachycardia and tachypnea are nonspecific stress responses. Increased head circumference
and bulging fontanels are expected in infants, not a 3-year-old. Blood pressure fluctuations occur
later and syncope is not a typical early ICP sign.
A client with acute pancreatitis is admitted with severe abdominal pain and elevated serum
amylase. 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 the right scapula
D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Pancreatitis pain often improves when the client lies still or flexes forward.
Gallbladder disease causes referred scapular pain. Short-lasting pain is inconsistent with
pancreatitis. Alcohol use may be a cause but not a symptom the client reports.
A child newly diagnosed with sickle cell anemia is being discharged. Which information is most
important for the nurse to provide the parents?
A. Instructions about how much fluid the child should drink daily
B. Signs of addiction to opioid pain medications
,2026
C. Non-pharmacologic pain relief measures
D. Referral to social services
Rationale: Adequate hydration is essential to prevent vaso-occlusive crises. Opioid addiction
education is secondary. Non-pharmacologic measures and referrals are helpful but not the
highest priority.
After receiving report on an acute care unit, which client should the nurse assess first?
A. Client with large bowel obstruction and abdominal distention
B. Client with postoperative paralytic ileus
C. Client with small bowel obstruction and NG tube draining green fluid
D. Client with volvulus and abdominal rigidity
Rationale: Abdominal rigidity suggests peritonitis or bowel ischemia, a life-threatening
emergency requiring immediate assessment. The other conditions are serious but less acute.
A teenager presents with palpitations after vaping and is hyperventilating. Which acid-base
imbalance does the nurse anticipate?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
Rationale: Hyperventilation causes excessive carbon dioxide loss, leading to respiratory
alkalosis. The other imbalances do not result from rapid breathing.
A client with dyspnea is being admitted. To best prepare, the nurse should place the bed in which
position?
A. Supine
B. Supine with feet elevated
C. Supine with head elevated
D. Fowler’s
Rationale: Fowler’s position maximizes lung expansion and reduces work of breathing. Supine
positions worsen dyspnea.
,2026
The nurse is taking the blood pressure of a client with Parkinson’s disease. Which assessment
findings are relevant to the plan? (Select all that apply)
A. Frequent syncope
B. Occasional nocturia
C. Flat affect
D. Blurred vision
E. Frequent drooling
Rationale: Parkinson’s disease is associated with orthostatic hypotension, which can cause
syncope, blurred vision, and affect cooperation during BP measurement. Nocturia and drooling
are unrelated.
While caring for a postoperative wound, the nurse notes purulent drainage. Before notifying the
provider, which lab value should the nurse review?
A. Serum albumin
B. Culture for sensitive organisms
C. Serum blood glucose
D. Creatinine
Rationale: Reviewing culture and sensitivity results helps guide appropriate antibiotic therapy.
Other labs do not directly guide infection treatment.
A preschool child is admitted after a near-drowning incident. The nurse speaks with the older
sibling who performed the rescue and notices withdrawal. What should the nurse do?
A. Develop a water safety plan
B. Ask the sibling how he felt during the incident
C. Tell the sibling he seems depressed
D. Commend heroic actions
Rationale: Encouraging expression of feelings supports emotional processing. Teaching and
praise are premature. Labeling emotions is inappropriate.
A client with cirrhosis has jaundice and pruritus and reports soaking in hot baths without relief.
Which action should the nurse take?
A. Encourage cooler water and apply calamine lotion
B. Obtain a PRN analgesic
, 2026
C. Suggest hot showers and oil-based lotion
D. Explain symptoms cannot be relieved
Rationale: Hot water worsens pruritus. Cooler water and soothing lotions help relieve itching.
Analgesics are ineffective, and reassurance alone is inappropriate.
A client with acute heart failure receives IV furosemide. Which therapeutic effect should the
nurse expect?
A. Increased cardiac contractility
B. Reduced preload
C. Relaxed vascular tone
D. Decreased afterload
Rationale: Furosemide reduces intravascular volume, lowering preload and pulmonary
congestion. It does not directly affect contractility or vascular tone.
Which intervention should be included in the care of a child with tetanus?
A. Encourage coughing
B. Minimize environmental stimuli
C. Reposition hourly
D. Open window shades
Rationale: Tetanus causes severe muscle spasms triggered by stimuli. Minimizing light, sound,
and touch reduces spasms.
An adolescent with type 1 diabetes is admitted with diabetic ketoacidosis. What is the most
likely cause?
A. Extra food intake
B. Excess insulin
C. Recent infection
D. Skipped lunch
Rationale: Infection increases insulin demand and commonly precipitates DKA. Eating more or
skipping a meal does not cause ketoacidosis when insulin is adequate.
