2026
HESI RN Exit Exam 2026 Strategic Exam
Preparation Workbook: Clinical
Judgment, Safety, and Priority-Based
Care
A 38 year-old female client is admitted to the hospital with an acute exacerbation of asthma. This
is her third admission for asthma in 7 months. She describes how she doesn't really like having to
use her medications all the time. Which explanation by the nurse best describes the long-term
consequence of uncontrolled airway inflammation?
A) Degeneration of the alveoli
B) Chronic bronchoconstriction of the large airways
C) Lung remodeling and permanent changes in lung function
D) Frequent pneumonia
Correct Answer: C) Lung remodeling and permanent changes in lung function
Rationale:
Uncontrolled airway inflammation leads to structural changes in the lungs, known as airway
remodeling, which causes permanent decreases in lung function. Alveolar degeneration is
associated with emphysema. Bronchoconstriction is usually reversible. Frequent pneumonia is
not the primary long-term consequence.
A mother wants to switch her 9 month-old infant from an iron-fortified formula to whole milk
because of the expense. Upon further assessment, the nurse finds that the baby eats table foods
well, but drinks less milk than before. What is the best advice by the nurse?
A) Change the baby to whole milk
B) Add chocolate syrup to the bottle
C) Continue with the present formula
D) Offer fruit juice frequently
Correct Answer: C) Continue with the present formula
Rationale:
Infants under 12 months require iron-fortified formula to prevent iron deficiency anemia. Whole
,2026
milk lacks adequate iron and should not be introduced before 1 year. Chocolate syrup and juice
reduce nutritional intake.
Privacy and confidentiality of all client information is legally protected. In which of these
situations would the nurse make an exception to this practice?
A) When a family member offers information about their loved one
B) When the client threatens self-harm and harm to others
C) When the health care provider decides the family has a right to know the client's diagnosis
D) When a visitor insists they have permission from the client
Correct Answer: B) When the client threatens self-harm and harm to others
Rationale:
Confidentiality may be breached when there is imminent danger to the client or others. The nurse
has a duty to warn and protect. The other situations do not legally justify breaching
confidentiality.
The nurse is caring for a client who is in the late stage of multiple myeloma. Which of the
following should be included in the plan of care?
A) Monitor for hyperkalemia
B) Place in protective isolation
C) Precautions with position changes
D) Administer diuretics as ordered
Correct Answer: C) Precautions with position changes
Rationale:
Multiple myeloma weakens bones, increasing fracture risk. Gentle handling and position change
precautions are essential. Hypercalcemia, not hyperkalemia, is more common. Protective
isolation and diuretics are not primary concerns.
The nurse is making a home visit to a client with chronic obstructive pulmonary disease (COPD).
The client reports increased shortness of breath during routine activities. Which diagnosis is most
appropriate?
A) Activity intolerance caused by fatigue related to chronic tissue hypoxia
B) Impaired mobility related to COPD
, 2026
C) Self-care deficit related to dyspnea
D) Ineffective airway clearance related to secretions
Correct Answer: A) Activity intolerance caused by fatigue related to chronic tissue hypoxia
Rationale:
The client’s inability to perform activities without dyspnea reflects activity intolerance due to
hypoxia. Mobility, self-care, and airway clearance are not the primary issues described.
The nurse admits a client newly diagnosed with hypertension. What is the best method for
assessing blood pressure?
A) Standing and sitting
B) In both arms
C) After exercising
D) Supine position
Correct Answer: B) In both arms
Rationale:
Initial blood pressure assessment should be taken in both arms to detect vascular differences.
Other positions may be used later but are not optimal for baseline assessment.
The nurse is caring for elderly residents in a long-term care facility. Which activity best meets
their growth and development needs?
A) Aerobic exercise classes
B) Transportation for shopping
C) Reminiscence groups
D) Regular social activities
Correct Answer: C) Reminiscence groups
Rationale:
Older adults benefit from life review and reminiscence, which supports ego integrity and
psychological well-being. Social and physical activities are beneficial but less developmentally
focused.
Post-procedure nursing interventions for electroconvulsive therapy include
HESI RN Exit Exam 2026 Strategic Exam
Preparation Workbook: Clinical
Judgment, Safety, and Priority-Based
Care
A 38 year-old female client is admitted to the hospital with an acute exacerbation of asthma. This
is her third admission for asthma in 7 months. She describes how she doesn't really like having to
use her medications all the time. Which explanation by the nurse best describes the long-term
consequence of uncontrolled airway inflammation?
A) Degeneration of the alveoli
B) Chronic bronchoconstriction of the large airways
C) Lung remodeling and permanent changes in lung function
D) Frequent pneumonia
Correct Answer: C) Lung remodeling and permanent changes in lung function
Rationale:
Uncontrolled airway inflammation leads to structural changes in the lungs, known as airway
remodeling, which causes permanent decreases in lung function. Alveolar degeneration is
associated with emphysema. Bronchoconstriction is usually reversible. Frequent pneumonia is
not the primary long-term consequence.
A mother wants to switch her 9 month-old infant from an iron-fortified formula to whole milk
because of the expense. Upon further assessment, the nurse finds that the baby eats table foods
well, but drinks less milk than before. What is the best advice by the nurse?
A) Change the baby to whole milk
B) Add chocolate syrup to the bottle
C) Continue with the present formula
D) Offer fruit juice frequently
Correct Answer: C) Continue with the present formula
Rationale:
Infants under 12 months require iron-fortified formula to prevent iron deficiency anemia. Whole
,2026
milk lacks adequate iron and should not be introduced before 1 year. Chocolate syrup and juice
reduce nutritional intake.
Privacy and confidentiality of all client information is legally protected. In which of these
situations would the nurse make an exception to this practice?
A) When a family member offers information about their loved one
B) When the client threatens self-harm and harm to others
C) When the health care provider decides the family has a right to know the client's diagnosis
D) When a visitor insists they have permission from the client
Correct Answer: B) When the client threatens self-harm and harm to others
Rationale:
Confidentiality may be breached when there is imminent danger to the client or others. The nurse
has a duty to warn and protect. The other situations do not legally justify breaching
confidentiality.
The nurse is caring for a client who is in the late stage of multiple myeloma. Which of the
following should be included in the plan of care?
A) Monitor for hyperkalemia
B) Place in protective isolation
C) Precautions with position changes
D) Administer diuretics as ordered
Correct Answer: C) Precautions with position changes
Rationale:
Multiple myeloma weakens bones, increasing fracture risk. Gentle handling and position change
precautions are essential. Hypercalcemia, not hyperkalemia, is more common. Protective
isolation and diuretics are not primary concerns.
The nurse is making a home visit to a client with chronic obstructive pulmonary disease (COPD).
The client reports increased shortness of breath during routine activities. Which diagnosis is most
appropriate?
A) Activity intolerance caused by fatigue related to chronic tissue hypoxia
B) Impaired mobility related to COPD
, 2026
C) Self-care deficit related to dyspnea
D) Ineffective airway clearance related to secretions
Correct Answer: A) Activity intolerance caused by fatigue related to chronic tissue hypoxia
Rationale:
The client’s inability to perform activities without dyspnea reflects activity intolerance due to
hypoxia. Mobility, self-care, and airway clearance are not the primary issues described.
The nurse admits a client newly diagnosed with hypertension. What is the best method for
assessing blood pressure?
A) Standing and sitting
B) In both arms
C) After exercising
D) Supine position
Correct Answer: B) In both arms
Rationale:
Initial blood pressure assessment should be taken in both arms to detect vascular differences.
Other positions may be used later but are not optimal for baseline assessment.
The nurse is caring for elderly residents in a long-term care facility. Which activity best meets
their growth and development needs?
A) Aerobic exercise classes
B) Transportation for shopping
C) Reminiscence groups
D) Regular social activities
Correct Answer: C) Reminiscence groups
Rationale:
Older adults benefit from life review and reminiscence, which supports ego integrity and
psychological well-being. Social and physical activities are beneficial but less developmentally
focused.
Post-procedure nursing interventions for electroconvulsive therapy include
