2026
HESI RN Exit Exam 2026 In-Depth
Preparation Manual: Medical-Surgical,
Pharmacology, and Nursing Leadership
Focus
To determine the client’s distal pulse rate most accurately, the nurse should palpate the radial
pulse using the pads of two or three fingers.
Correct Answer: d. Palpate at the radial pulse site with the pads of two or three fingers.
Rationale:
Palpating the radial pulse distal to the IV site provides the most accurate assessment of
circulation without interfering with the infusion. Elevating the arm or stopping fluids is
unnecessary, and Doppler use is not indicated when a pulse is palpable.
A child admitted with sickle cell crisis should be repositioned with the head of the bed elevated.
Correct Answer: a. Reposition the client with the head of the bed elevated.
Rationale:
Elevation promotes lung expansion and oxygenation, which is essential during a sickle cell
crisis. Supine positioning can compromise respiratory status. Ambulation may worsen pain, and
the UAP’s action needs correction, not praise.
When the preadolescent brother becomes withdrawn after discussing a near-drowning incident,
the nurse should ask how he felt during the event.
Correct Answer: a. Ask the older brother how he felt during the incident.
Rationale:
This therapeutic communication encourages emotional expression and coping. Commending
actions or giving advice bypasses emotional needs, while labeling emotions can be
nontherapeutic.
,2026
The most important intervention for a recently extubated client who coughs while swallowing is
to hold oral intake until a swallow evaluation is completed.
Correct Answer: c. Hold oral intake until swallow evaluation is done.
Rationale:
Coughing during swallowing indicates possible aspiration risk. Oral intake must be stopped until
swallowing safety is assessed. Elevation alone does not address aspiration risk.
A client with an Aldrete score of 8 should be transferred to the surgical floor.
Correct Answer: d. Transfer the client to the surgical floor.
Rationale:
An Aldrete score of 8 or higher indicates readiness for discharge from PACU. No immediate
complications are implied that require surgeon notification.
Clients with a history of penicillin allergy should be alerted about possible cross-sensitivity with
cephalosporins.
Correct Answer: a. Be alert for possible cross-sensitivity to cephalosporin agents.
Rationale:
Cross-reactivity can occur between penicillins and cephalosporins. The other options do not
address allergy risks.
For a DNR client showing signs of impending death, the nurse’s priority is to assess the need for
pain medication.
Correct Answer: b. The client’s need for pain medication should be determined.
Rationale:
Comfort care is the priority at end of life. Documentation and notifications are secondary to
symptom relief.
Heart failure clients should report a weight gain of 2 pounds in 24 hours.
Correct Answer: d. Report weight gain of 2 pounds (0.9 kg) in 24 hours.
Rationale:
Rapid weight gain indicates fluid retention and worsening heart failure. Daily weighing habits
support this critical action.
,2026
A history of aura migraine headaches is important to note before starting an SSRI.
Correct Answer: c. Aural migraine headaches.
Rationale:
SSRIs may increase serotonin levels and potentially worsen migraines. The other conditions are
not contraindications.
The first step in disaster planning is identifying a command center.
Correct Answer: b. Identify a command center where activities are coordinated.
Rationale:
Centralized coordination ensures effective communication and resource management before
implementing other interventions.
Fever and dysuria support the diagnosis of high risk for injury related to a urinary tract infection.
Correct Answer: c. Fever and dysuria.
Rationale:
These are classic signs of infection that can contribute to weakness, confusion, and falls.
Elevating both lower extremities is the best intervention for a client with severe edema and
constricting stockings.
Correct Answer: a. Maintain both lower extremities elevated on pillows.
Rationale:
Elevation reduces edema and discomfort. Removing stockings may increase clot risk without
addressing fluid overload.
Teaching family proper range-of-motion exercises promotes independence in clients with
muscular dystrophy.
Correct Answer: b. Teach family proper range of motion exercises.
Rationale:
ROM exercises preserve mobility, prevent contractures, and promote independence.
, 2026
Postmenopausal women require at least 1,500 mg of calcium daily to prevent osteoporosis.
Correct Answer: d. Postmenopausal women need an intake of at least 1,500 mg of calcium
daily.
Rationale:
Calcium requirements increase after menopause due to bone density loss. Smoking cessation is
important but does not replace calcium needs.
The most important documentation for rectal bleeding is stool color.
Correct Answer: d. Color characteristics of each stool.
Rationale:
Stool color helps identify the source and severity of bleeding. Odor and clots are less clinically
significant initially.
High-pitched fine crackles should be documented as such.
Correct Answer: a. High pitched or fine crackles.
Rationale:
This is the correct descriptive terminology for auscultated lung sounds.
The nurse should explain why only non-narcotic medication is used before a CT scan.
Correct Answer: d. Explain the reason for using only non-narcotics.
Rationale:
Narcotics can mask neurological symptoms, interfering with accurate assessment after head
injury.
Pain and anxiety management is the most important intervention in palliative care for advanced
MS.
Correct Answer: b. Medicate as needed for pain and anxiety.
Rationale:
Comfort and symptom control are priorities in palliative care settings.
HESI RN Exit Exam 2026 In-Depth
Preparation Manual: Medical-Surgical,
Pharmacology, and Nursing Leadership
Focus
To determine the client’s distal pulse rate most accurately, the nurse should palpate the radial
pulse using the pads of two or three fingers.
Correct Answer: d. Palpate at the radial pulse site with the pads of two or three fingers.
Rationale:
Palpating the radial pulse distal to the IV site provides the most accurate assessment of
circulation without interfering with the infusion. Elevating the arm or stopping fluids is
unnecessary, and Doppler use is not indicated when a pulse is palpable.
A child admitted with sickle cell crisis should be repositioned with the head of the bed elevated.
Correct Answer: a. Reposition the client with the head of the bed elevated.
Rationale:
Elevation promotes lung expansion and oxygenation, which is essential during a sickle cell
crisis. Supine positioning can compromise respiratory status. Ambulation may worsen pain, and
the UAP’s action needs correction, not praise.
When the preadolescent brother becomes withdrawn after discussing a near-drowning incident,
the nurse should ask how he felt during the event.
Correct Answer: a. Ask the older brother how he felt during the incident.
Rationale:
This therapeutic communication encourages emotional expression and coping. Commending
actions or giving advice bypasses emotional needs, while labeling emotions can be
nontherapeutic.
,2026
The most important intervention for a recently extubated client who coughs while swallowing is
to hold oral intake until a swallow evaluation is completed.
Correct Answer: c. Hold oral intake until swallow evaluation is done.
Rationale:
Coughing during swallowing indicates possible aspiration risk. Oral intake must be stopped until
swallowing safety is assessed. Elevation alone does not address aspiration risk.
A client with an Aldrete score of 8 should be transferred to the surgical floor.
Correct Answer: d. Transfer the client to the surgical floor.
Rationale:
An Aldrete score of 8 or higher indicates readiness for discharge from PACU. No immediate
complications are implied that require surgeon notification.
Clients with a history of penicillin allergy should be alerted about possible cross-sensitivity with
cephalosporins.
Correct Answer: a. Be alert for possible cross-sensitivity to cephalosporin agents.
Rationale:
Cross-reactivity can occur between penicillins and cephalosporins. The other options do not
address allergy risks.
For a DNR client showing signs of impending death, the nurse’s priority is to assess the need for
pain medication.
Correct Answer: b. The client’s need for pain medication should be determined.
Rationale:
Comfort care is the priority at end of life. Documentation and notifications are secondary to
symptom relief.
Heart failure clients should report a weight gain of 2 pounds in 24 hours.
Correct Answer: d. Report weight gain of 2 pounds (0.9 kg) in 24 hours.
Rationale:
Rapid weight gain indicates fluid retention and worsening heart failure. Daily weighing habits
support this critical action.
,2026
A history of aura migraine headaches is important to note before starting an SSRI.
Correct Answer: c. Aural migraine headaches.
Rationale:
SSRIs may increase serotonin levels and potentially worsen migraines. The other conditions are
not contraindications.
The first step in disaster planning is identifying a command center.
Correct Answer: b. Identify a command center where activities are coordinated.
Rationale:
Centralized coordination ensures effective communication and resource management before
implementing other interventions.
Fever and dysuria support the diagnosis of high risk for injury related to a urinary tract infection.
Correct Answer: c. Fever and dysuria.
Rationale:
These are classic signs of infection that can contribute to weakness, confusion, and falls.
Elevating both lower extremities is the best intervention for a client with severe edema and
constricting stockings.
Correct Answer: a. Maintain both lower extremities elevated on pillows.
Rationale:
Elevation reduces edema and discomfort. Removing stockings may increase clot risk without
addressing fluid overload.
Teaching family proper range-of-motion exercises promotes independence in clients with
muscular dystrophy.
Correct Answer: b. Teach family proper range of motion exercises.
Rationale:
ROM exercises preserve mobility, prevent contractures, and promote independence.
, 2026
Postmenopausal women require at least 1,500 mg of calcium daily to prevent osteoporosis.
Correct Answer: d. Postmenopausal women need an intake of at least 1,500 mg of calcium
daily.
Rationale:
Calcium requirements increase after menopause due to bone density loss. Smoking cessation is
important but does not replace calcium needs.
The most important documentation for rectal bleeding is stool color.
Correct Answer: d. Color characteristics of each stool.
Rationale:
Stool color helps identify the source and severity of bleeding. Odor and clots are less clinically
significant initially.
High-pitched fine crackles should be documented as such.
Correct Answer: a. High pitched or fine crackles.
Rationale:
This is the correct descriptive terminology for auscultated lung sounds.
The nurse should explain why only non-narcotic medication is used before a CT scan.
Correct Answer: d. Explain the reason for using only non-narcotics.
Rationale:
Narcotics can mask neurological symptoms, interfering with accurate assessment after head
injury.
Pain and anxiety management is the most important intervention in palliative care for advanced
MS.
Correct Answer: b. Medicate as needed for pain and anxiety.
Rationale:
Comfort and symptom control are priorities in palliative care settings.
