2026
HESI RN Exit Exam 2026 Mastery
Guide: Systems-Based Review, Priority
Nursing Interventions, and Exam
Simulation Questions
The nurse assesses a 78-year-old male client who has left-sided heart failure. Which symptoms
would the nurse expect this client to exhibit?
a. Dyspnea, cough, and fatigue
b. Hepatomegaly and distended neck veins
c. Pain over the pericardium and friction rub
d. Narrowing pulse pressure and distant heart sounds
Correct Answer: a. Dyspnea, cough, and fatigue
Rationale: Left-sided heart failure leads to pulmonary congestion, causing shortness of breath,
cough, and fatigue. Hepatomegaly and distended neck veins are signs of right-sided heart failure.
Pericardial pain and friction rub indicate pericarditis. Narrow pulse pressure and distant heart
sounds are associated with cardiac tamponade.
A female client comes to the clinic complaining of fatigue and inability to sleep because she is
the full-time caretaker for her 22-year-old son who was paralyzed in a motor vehicle collision.
What intervention should the nurse implement?
a. Schedule a home visit in the afternoon
b. Acknowledge the client’s stress and suggest respite care
c. Provide feedback about guilt
d. Teach the client to problem-solve independently
Correct Answer: b. Acknowledge the client’s stress and suggest respite care
Rationale: Caregiver burnout is evident. Acknowledging stress and recommending respite care
provides immediate support. The other options either delay support or fail to address the
caregiver’s emotional and physical exhaustion.
The nurse plans to administer a scheduled dose of metoprolol (Toprol SR). The client has
second-degree heart block with a ventricular rate of 50. What action should the nurse take?
a. Administer immediately
b. Give as scheduled and assign UAP
,2026
c. Give if systolic BP is above 180
d. Hold the dose and notify the healthcare provider
Correct Answer: d. Hold the dose and notify the healthcare provider
Rationale: Beta-blockers worsen heart block and bradycardia. The medication must be held and
reported. Administering it could cause severe hypotension or cardiac arrest.
A client with SIADH is discharged on demeclocycline. Which condition should the nurse
instruct the client to report?
a. Insomnia
b. Muscle cramping
c. Increased appetite
d. Anxiety
Correct Answer: b. Muscle cramping
Rationale: Muscle cramping can indicate electrolyte imbalance, a serious side effect of
demeclocycline. The other symptoms are less concerning.
In determining the client position for urinary catheter insertion, which condition is most
important to recognize?
a. High urinary pH
b. Abdominal ascites
c. Orthopnea
d. Fever
Correct Answer: c. Orthopnea
Rationale: Clients with orthopnea cannot tolerate lying flat and may require position
modification. The other options do not directly affect positioning.
The nurse reviews an ECG and notes a prolonged PR interval. What does this indicate?
a. Ectopic impulse initiation
b. Inability of the SA node to initiate impulses normally
c. Increased conduction time from SA to AV node
d. Ventricular conduction interference
Correct Answer: b. Inability of the SA node to initiate impulses normally
Rationale: A prolonged PR interval reflects delayed conduction, often associated with first-
degree AV block. Other options describe different ECG abnormalities.
,2026
A male client with multiple sclerosis is learning the Crede method. What instruction should the
nurse provide?
a. Stroke inner thigh
b. Contract pelvic muscles
c. Pour warm water over sphincter
d. Apply downward pressure at the suprapubic region
Correct Answer: d. Apply downward pressure at the suprapubic region
Rationale: The Crede method uses manual suprapubic pressure to assist bladder emptying. The
other techniques are for different voiding strategies.
A client is admitted to PACU after partial thyroidectomy. Which statement reflects accurate
understanding of expected outcomes?
a. Hormonal therapy unnecessary
b. Thyroid will regenerate
c. The client will be restricted from eating seafood
d. Remaining thyroid will be removed later
Correct Answer: c. The client will be restricted from eating seafood
Rationale: Iodine-containing foods like seafood may be restricted postoperatively. The thyroid
does not regenerate, and further surgery is not routine.
A client with gestational diabetes experiences shoulder dystocia. What intervention should the
nurse implement first?
a. Prepare for cesarean birth
b. Hands-and-knees position
c. Sharply flex the thighs against the abdomen
d. Lower head of bed and apply suprapubic pressure
Correct Answer: c. Sharply flex the thighs against the abdomen
Rationale: The McRoberts maneuver is the first-line intervention for shoulder dystocia. Other
actions may follow if unsuccessful.
The nurse should observe most closely for drug toxicity when a medication has which
characteristic?
a. Low bioavailability
b. Rapid onset
c. Short half-life
d. Narrow therapeutic index
, 2026
Correct Answer: d. Narrow therapeutic index
Rationale: Drugs with a narrow therapeutic index have a small margin between therapeutic and
toxic levels, requiring close monitoring.
Following insertion of a LeVeen shunt, which finding indicates effectiveness?
a. Decreased abdominal girth
b. Increased blood pressure
c. Clear breath sounds
d. Decreased serum albumin
Correct Answer: a. Decreased abdominal girth
Rationale: A LeVeen shunt reduces ascites by diverting fluid, resulting in decreased abdominal
girth.
When finding a client sitting on the floor, which task should the nurse delegate to the UAP?
a. Check for abrasions
b. Help the client stand
c. Get a blood pressure cuff
d. Report the fall
Correct Answer: c. Get a blood pressure cuff
Rationale: Obtaining equipment is appropriate for UAP. Assessment, assisting to stand, and
reporting require nursing judgment.
During newborn assessment, the nurse finds an irregular heart rate. What intervention is
appropriate?
a. Notify pediatrician immediately
b. Teach parents
c. Document the finding
d. Apply oxygen
Correct Answer: c. Document the finding
Rationale: Irregular heart rhythms are common in newborns and often benign. Documentation is
appropriate unless other symptoms are present.
Which finding indicates readiness for pulmonary function tests?
a. Expresses understanding of the procedure
b. NPO for 6 hours
HESI RN Exit Exam 2026 Mastery
Guide: Systems-Based Review, Priority
Nursing Interventions, and Exam
Simulation Questions
The nurse assesses a 78-year-old male client who has left-sided heart failure. Which symptoms
would the nurse expect this client to exhibit?
a. Dyspnea, cough, and fatigue
b. Hepatomegaly and distended neck veins
c. Pain over the pericardium and friction rub
d. Narrowing pulse pressure and distant heart sounds
Correct Answer: a. Dyspnea, cough, and fatigue
Rationale: Left-sided heart failure leads to pulmonary congestion, causing shortness of breath,
cough, and fatigue. Hepatomegaly and distended neck veins are signs of right-sided heart failure.
Pericardial pain and friction rub indicate pericarditis. Narrow pulse pressure and distant heart
sounds are associated with cardiac tamponade.
A female client comes to the clinic complaining of fatigue and inability to sleep because she is
the full-time caretaker for her 22-year-old son who was paralyzed in a motor vehicle collision.
What intervention should the nurse implement?
a. Schedule a home visit in the afternoon
b. Acknowledge the client’s stress and suggest respite care
c. Provide feedback about guilt
d. Teach the client to problem-solve independently
Correct Answer: b. Acknowledge the client’s stress and suggest respite care
Rationale: Caregiver burnout is evident. Acknowledging stress and recommending respite care
provides immediate support. The other options either delay support or fail to address the
caregiver’s emotional and physical exhaustion.
The nurse plans to administer a scheduled dose of metoprolol (Toprol SR). The client has
second-degree heart block with a ventricular rate of 50. What action should the nurse take?
a. Administer immediately
b. Give as scheduled and assign UAP
,2026
c. Give if systolic BP is above 180
d. Hold the dose and notify the healthcare provider
Correct Answer: d. Hold the dose and notify the healthcare provider
Rationale: Beta-blockers worsen heart block and bradycardia. The medication must be held and
reported. Administering it could cause severe hypotension or cardiac arrest.
A client with SIADH is discharged on demeclocycline. Which condition should the nurse
instruct the client to report?
a. Insomnia
b. Muscle cramping
c. Increased appetite
d. Anxiety
Correct Answer: b. Muscle cramping
Rationale: Muscle cramping can indicate electrolyte imbalance, a serious side effect of
demeclocycline. The other symptoms are less concerning.
In determining the client position for urinary catheter insertion, which condition is most
important to recognize?
a. High urinary pH
b. Abdominal ascites
c. Orthopnea
d. Fever
Correct Answer: c. Orthopnea
Rationale: Clients with orthopnea cannot tolerate lying flat and may require position
modification. The other options do not directly affect positioning.
The nurse reviews an ECG and notes a prolonged PR interval. What does this indicate?
a. Ectopic impulse initiation
b. Inability of the SA node to initiate impulses normally
c. Increased conduction time from SA to AV node
d. Ventricular conduction interference
Correct Answer: b. Inability of the SA node to initiate impulses normally
Rationale: A prolonged PR interval reflects delayed conduction, often associated with first-
degree AV block. Other options describe different ECG abnormalities.
,2026
A male client with multiple sclerosis is learning the Crede method. What instruction should the
nurse provide?
a. Stroke inner thigh
b. Contract pelvic muscles
c. Pour warm water over sphincter
d. Apply downward pressure at the suprapubic region
Correct Answer: d. Apply downward pressure at the suprapubic region
Rationale: The Crede method uses manual suprapubic pressure to assist bladder emptying. The
other techniques are for different voiding strategies.
A client is admitted to PACU after partial thyroidectomy. Which statement reflects accurate
understanding of expected outcomes?
a. Hormonal therapy unnecessary
b. Thyroid will regenerate
c. The client will be restricted from eating seafood
d. Remaining thyroid will be removed later
Correct Answer: c. The client will be restricted from eating seafood
Rationale: Iodine-containing foods like seafood may be restricted postoperatively. The thyroid
does not regenerate, and further surgery is not routine.
A client with gestational diabetes experiences shoulder dystocia. What intervention should the
nurse implement first?
a. Prepare for cesarean birth
b. Hands-and-knees position
c. Sharply flex the thighs against the abdomen
d. Lower head of bed and apply suprapubic pressure
Correct Answer: c. Sharply flex the thighs against the abdomen
Rationale: The McRoberts maneuver is the first-line intervention for shoulder dystocia. Other
actions may follow if unsuccessful.
The nurse should observe most closely for drug toxicity when a medication has which
characteristic?
a. Low bioavailability
b. Rapid onset
c. Short half-life
d. Narrow therapeutic index
, 2026
Correct Answer: d. Narrow therapeutic index
Rationale: Drugs with a narrow therapeutic index have a small margin between therapeutic and
toxic levels, requiring close monitoring.
Following insertion of a LeVeen shunt, which finding indicates effectiveness?
a. Decreased abdominal girth
b. Increased blood pressure
c. Clear breath sounds
d. Decreased serum albumin
Correct Answer: a. Decreased abdominal girth
Rationale: A LeVeen shunt reduces ascites by diverting fluid, resulting in decreased abdominal
girth.
When finding a client sitting on the floor, which task should the nurse delegate to the UAP?
a. Check for abrasions
b. Help the client stand
c. Get a blood pressure cuff
d. Report the fall
Correct Answer: c. Get a blood pressure cuff
Rationale: Obtaining equipment is appropriate for UAP. Assessment, assisting to stand, and
reporting require nursing judgment.
During newborn assessment, the nurse finds an irregular heart rate. What intervention is
appropriate?
a. Notify pediatrician immediately
b. Teach parents
c. Document the finding
d. Apply oxygen
Correct Answer: c. Document the finding
Rationale: Irregular heart rhythms are common in newborns and often benign. Documentation is
appropriate unless other symptoms are present.
Which finding indicates readiness for pulmonary function tests?
a. Expresses understanding of the procedure
b. NPO for 6 hours
