HESI RN Exit Exam 2026/2027: COMBINED MASTER STUDY
GUIDE
All Versions (1, 2, & 3) - 450 Unique Questions with Multiple-Choice
Answers & Detailed Rationales
SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-180)
Cardiovascular Disorders
QUESTION 1
A client with heart failure and pulmonary edema is receiving a nitroglycerin infusion and has just
received IV furosemide 40 mg. Which assessment finding requires the MOST immediate action?
A) Blood pressure drops from 130/80 to 100/70 mmHg
B) Urinary output is 300 mL 15 minutes after furosemide administration
C) The client develops a new, frequent cough with pink, frothy sputum
D) The client's heart rate increases from 72 to 96 bpm with noticeable irregularity
Correct Answer: C) The client develops a new, frequent cough with pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of fulminant pulmonary edema, indicating rapid fluid
accumulation in the alveoli. This signals that current interventions are not controlling the client's
worsening left ventricular failure and gas exchange is severely compromised. The immediate priority is
to raise the head of the bed, ensure the airway, and prepare for emergency escalation of therapy.
QUESTION 2
A client with hypertension who received new antihypertensive prescriptions at his last visit returns to
the clinic two weeks later with BP 158/106. He admits not taking the medication because it makes him
"feel bad." The nurse should stress that elevated BP places the client at risk for which condition?
A) Blindness secondary to cataracts
B) Acute kidney injury due to glomerular damage
,C) Stroke secondary to hemorrhage
D) Heart block due to myocardial damage
Correct Answer: C) Stroke secondary to hemorrhage
Rationale: Uncontrolled hypertension is a major risk factor for hemorrhagic stroke due to weakening
of cerebral blood vessels. This is a life-threatening emergency. While hypertension also damages
kidneys and can cause other complications, stroke from hemorrhage is the most immediate and direct
risk to emphasize for medication adherence.
QUESTION 3
A client is recovering in the critical care unit following a cardiac catheterization. IV nitroglycerin and
heparin are infusing. The client is sedated but responds to instructions. After changing positions, the
client complains of pain at the right groin insertion site. What action should the nurse implement?
A) Stimulate the client to take deep breaths
B) Assess the groin site for bleeding or hematoma
C) Increase the nitroglycerin infusion rate
D) Reposition the client to the left side
Correct Answer: B) Assess the groin site for bleeding or hematoma
Rationale: The client is receiving heparin (anticoagulant), which increases bleeding risk. New pain at
the catheter insertion site after position change suggests possible bleeding or hematoma formation.
The nurse must immediately assess the site for active bleeding, swelling, or discoloration. This is a
potential emergency requiring rapid assessment.
QUESTION 4
The nurse is caring for a client following a total hip replacement. Which finding requires immediate
intervention?
A) Pain rated 4 on a 0-10 scale
B) Urine output 240 mL in 8 hours
C) Shortness of breath and chest pain
D) Temperature 99.8°F (37.7°C)
Correct Answer: C) Shortness of breath and chest pain
Rationale: After hip replacement surgery, clients are at risk for deep vein thrombosis and pulmonary
embolism. Shortness of breath and chest pain are classic signs of pulmonary embolism, a life-
threatening emergency requiring immediate intervention. The nurse should notify the provider and
prepare for emergency treatment.
,QUESTION 5
A client is prescribed digoxin (Lanoxin) 0.25 mg daily. Which finding would indicate digoxin toxicity?
A) Heart rate 62 bpm
B) Anorexia and nausea
C) Blood pressure 130/80 mmHg
D) Urine output 1200 mL in 24 hours
Correct Answer: B) Anorexia and nausea
Rationale: Anorexia, nausea, and vomiting are early signs of digoxin toxicity, along with visual changes
(yellow or blurred vision) and cardiac dysrhythmias. A heart rate of 62 bpm may be therapeutic. The
nurse should assess the digoxin level and hold the medication if toxicity is suspected.
QUESTION 6
A client with heart failure is receiving furosemide (Lasix) and digoxin (Lanoxin). The client reports
nausea and visual changes. Which laboratory value should the nurse check first?
A) Serum potassium
B) Serum digoxin level
C) Serum magnesium
D) BUN and creatinine
Correct Answer: B) Serum digoxin level
Rationale: Nausea and visual changes (yellow or blurred vision) are classic signs of digoxin toxicity. The
priority is to check the serum digoxin level to confirm toxicity. Hypokalemia from furosemide can
precipitate digoxin toxicity, but the digoxin level provides the most direct diagnostic information.
QUESTION 7
A client with a new diagnosis of pericarditis is being monitored. Which finding most specifically
indicates a life-threatening complication?
A) Pericardial friction rub at the left lower sternal border
B) Pulsus alternans on blood pressure monitoring
C) Muffled heart tones, jugular venous distension, and paradoxical pulse
D) Electrical alternans on the cardiac monitor
Correct Answer: C) Muffled heart tones, jugular venous distension, and paradoxical pulse
, Rationale: This combination of findings (Beck's triad: muffled heart tones, JVD, and hypotension with
pulsus paradoxus) is pathognomonic for cardiac tamponade. Pericarditis can lead to pericardial
effusion, and the resulting fluid accumulation can compress the heart, preventing ventricular filling.
QUESTION 8
A client with heart failure has a nursing diagnosis of "Excess Fluid Volume." Which assessment finding
indicates that the treatment is effective?
A) Weight gain of 2 kg in 24 hours
B) Jugular vein distension while sitting upright
C) C essation of crackles in the lung bases
D) Presence of 3+ pitting edema in lower extremities
Correct Answer: C) Cessation of crackles in the lung bases
Rationale: Cessation of crackles indicates that pulmonary congestion is resolving, which is a key sign
that fluid volume is decreasing and treatment is effective. Weight gain, JVD, and edema indicate
worsening fluid overload, not improvement.
QUESTION 9
The nurse is assessing a client following a cardiac catheterization. Which finding requires immediate
intervention?
A) Blood pressure 110/70 mmHg
B) Heart rate 88 bpm and regular
C) Hematoma at the insertion site
D) Pedal pulse +2 bilaterally
Correct Answer: C) Hematoma at the insertion site
Rationale: A hematoma at the catheter insertion site indicates bleeding, which can lead to significant
blood loss and pseudoaneurysm formation. This requires immediate intervention, including applying
pressure and notifying the healthcare provider.
QUESTION 10
A client with hypertension is prescribed lisinopril (Prinivil). Which finding requires the nurse to hold the
medication?
GUIDE
All Versions (1, 2, & 3) - 450 Unique Questions with Multiple-Choice
Answers & Detailed Rationales
SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-180)
Cardiovascular Disorders
QUESTION 1
A client with heart failure and pulmonary edema is receiving a nitroglycerin infusion and has just
received IV furosemide 40 mg. Which assessment finding requires the MOST immediate action?
A) Blood pressure drops from 130/80 to 100/70 mmHg
B) Urinary output is 300 mL 15 minutes after furosemide administration
C) The client develops a new, frequent cough with pink, frothy sputum
D) The client's heart rate increases from 72 to 96 bpm with noticeable irregularity
Correct Answer: C) The client develops a new, frequent cough with pink, frothy sputum
Rationale: Pink, frothy sputum is a hallmark sign of fulminant pulmonary edema, indicating rapid fluid
accumulation in the alveoli. This signals that current interventions are not controlling the client's
worsening left ventricular failure and gas exchange is severely compromised. The immediate priority is
to raise the head of the bed, ensure the airway, and prepare for emergency escalation of therapy.
QUESTION 2
A client with hypertension who received new antihypertensive prescriptions at his last visit returns to
the clinic two weeks later with BP 158/106. He admits not taking the medication because it makes him
"feel bad." The nurse should stress that elevated BP places the client at risk for which condition?
A) Blindness secondary to cataracts
B) Acute kidney injury due to glomerular damage
,C) Stroke secondary to hemorrhage
D) Heart block due to myocardial damage
Correct Answer: C) Stroke secondary to hemorrhage
Rationale: Uncontrolled hypertension is a major risk factor for hemorrhagic stroke due to weakening
of cerebral blood vessels. This is a life-threatening emergency. While hypertension also damages
kidneys and can cause other complications, stroke from hemorrhage is the most immediate and direct
risk to emphasize for medication adherence.
QUESTION 3
A client is recovering in the critical care unit following a cardiac catheterization. IV nitroglycerin and
heparin are infusing. The client is sedated but responds to instructions. After changing positions, the
client complains of pain at the right groin insertion site. What action should the nurse implement?
A) Stimulate the client to take deep breaths
B) Assess the groin site for bleeding or hematoma
C) Increase the nitroglycerin infusion rate
D) Reposition the client to the left side
Correct Answer: B) Assess the groin site for bleeding or hematoma
Rationale: The client is receiving heparin (anticoagulant), which increases bleeding risk. New pain at
the catheter insertion site after position change suggests possible bleeding or hematoma formation.
The nurse must immediately assess the site for active bleeding, swelling, or discoloration. This is a
potential emergency requiring rapid assessment.
QUESTION 4
The nurse is caring for a client following a total hip replacement. Which finding requires immediate
intervention?
A) Pain rated 4 on a 0-10 scale
B) Urine output 240 mL in 8 hours
C) Shortness of breath and chest pain
D) Temperature 99.8°F (37.7°C)
Correct Answer: C) Shortness of breath and chest pain
Rationale: After hip replacement surgery, clients are at risk for deep vein thrombosis and pulmonary
embolism. Shortness of breath and chest pain are classic signs of pulmonary embolism, a life-
threatening emergency requiring immediate intervention. The nurse should notify the provider and
prepare for emergency treatment.
,QUESTION 5
A client is prescribed digoxin (Lanoxin) 0.25 mg daily. Which finding would indicate digoxin toxicity?
A) Heart rate 62 bpm
B) Anorexia and nausea
C) Blood pressure 130/80 mmHg
D) Urine output 1200 mL in 24 hours
Correct Answer: B) Anorexia and nausea
Rationale: Anorexia, nausea, and vomiting are early signs of digoxin toxicity, along with visual changes
(yellow or blurred vision) and cardiac dysrhythmias. A heart rate of 62 bpm may be therapeutic. The
nurse should assess the digoxin level and hold the medication if toxicity is suspected.
QUESTION 6
A client with heart failure is receiving furosemide (Lasix) and digoxin (Lanoxin). The client reports
nausea and visual changes. Which laboratory value should the nurse check first?
A) Serum potassium
B) Serum digoxin level
C) Serum magnesium
D) BUN and creatinine
Correct Answer: B) Serum digoxin level
Rationale: Nausea and visual changes (yellow or blurred vision) are classic signs of digoxin toxicity. The
priority is to check the serum digoxin level to confirm toxicity. Hypokalemia from furosemide can
precipitate digoxin toxicity, but the digoxin level provides the most direct diagnostic information.
QUESTION 7
A client with a new diagnosis of pericarditis is being monitored. Which finding most specifically
indicates a life-threatening complication?
A) Pericardial friction rub at the left lower sternal border
B) Pulsus alternans on blood pressure monitoring
C) Muffled heart tones, jugular venous distension, and paradoxical pulse
D) Electrical alternans on the cardiac monitor
Correct Answer: C) Muffled heart tones, jugular venous distension, and paradoxical pulse
, Rationale: This combination of findings (Beck's triad: muffled heart tones, JVD, and hypotension with
pulsus paradoxus) is pathognomonic for cardiac tamponade. Pericarditis can lead to pericardial
effusion, and the resulting fluid accumulation can compress the heart, preventing ventricular filling.
QUESTION 8
A client with heart failure has a nursing diagnosis of "Excess Fluid Volume." Which assessment finding
indicates that the treatment is effective?
A) Weight gain of 2 kg in 24 hours
B) Jugular vein distension while sitting upright
C) C essation of crackles in the lung bases
D) Presence of 3+ pitting edema in lower extremities
Correct Answer: C) Cessation of crackles in the lung bases
Rationale: Cessation of crackles indicates that pulmonary congestion is resolving, which is a key sign
that fluid volume is decreasing and treatment is effective. Weight gain, JVD, and edema indicate
worsening fluid overload, not improvement.
QUESTION 9
The nurse is assessing a client following a cardiac catheterization. Which finding requires immediate
intervention?
A) Blood pressure 110/70 mmHg
B) Heart rate 88 bpm and regular
C) Hematoma at the insertion site
D) Pedal pulse +2 bilaterally
Correct Answer: C) Hematoma at the insertion site
Rationale: A hematoma at the catheter insertion site indicates bleeding, which can lead to significant
blood loss and pseudoaneurysm formation. This requires immediate intervention, including applying
pressure and notifying the healthcare provider.
QUESTION 10
A client with hypertension is prescribed lisinopril (Prinivil). Which finding requires the nurse to hold the
medication?
