**Ace the HESI Exit Exam V4: The Ultimate 2025-2026
Test Bank with 100% Correct Questions and Verified
Answers – 100 Questions**
---
**1.** A client with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and ECG changes
(peaked T waves). Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate (Kayexalate)
B) Give IV calcium gluconate
C) Start an insulin and dextrose infusion
D) Prepare for emergent hemodialysis
🔍 **RATIONALE** 💡-- Severe hyperkalemia with ECG changes is a medical emergency. IV calcium
gluconate stabilizes the cardiac membrane and is given first. Insulin/dextrose shifts potassium
intracellularly but takes longer. Kayexalate and hemodialysis are later interventions.
ANSWER💫✔️-- **B) Give IV calcium gluconate**
---
**2.** A client with chronic obstructive pulmonary disease (COPD) has an SpO₂ of 88% on room air. The
nurse initiates oxygen at 2 L/min via nasal cannula. Which statement best explains this low flow rate?
A) High oxygen flow can cause oxygen toxicity
B) Clients with COPD are at risk for hypoxic drive depression
C) Nasal cannula cannot deliver more than 2 L/min accurately
D) The client’s lungs are too damaged to absorb higher oxygen
,🔍 **RATIONALE** 💡-- Some COPD clients with chronic hypercapnia rely on a hypoxic drive to breathe.
High oxygen can suppress this drive, leading to CO₂ retention and respiratory depression.
ANSWER💫✔️-- **B) Clients with COPD are at risk for hypoxic drive depression**
---
**3.** A nurse is assessing a client who is 6 hours post‑thyroidectomy. The client reports tingling
around the mouth and in the fingers. What is the nurse’s priority action?
A) Administer oral calcium supplements
B) Assess for Chvostek’s and Trousseau’s signs
C) Increase the IV fluid rate
D) Notify the provider of possible hypothyroidism
🔍 **RATIONALE** 💡-- Tingling suggests hypocalcemia due to accidental parathyroid injury during
thyroidectomy. The nurse should first assess for Chvostek’s (facial twitching) and Trousseau’s (carpal
spasm) signs.
ANSWER💫✔️-- **B) Assess for Chvostek’s and Trousseau’s signs**
---
**4.** A client with heart failure is prescribed digoxin (Lanoxin). Which finding indicates digoxin
toxicity?
A) Heart rate of 62 bpm
B) Serum potassium of 4.0 mEq/L
C) Nausea, vomiting, and yellow‑tinged vision
D) Serum digoxin level of 1.2 ng/mL
🔍 **RATIONALE** 💡-- Nausea, vomiting, and visual disturbances (yellow/green halos) are classic signs
of digoxin toxicity. Therapeutic digoxin level is 0.8‑2.0 ng/mL; a level of 1.2 is normal.
,ANSWER💫✔️-- **C) Nausea, vomiting, and yellow‑tinged vision**
---
**5.** A client with a spinal cord injury at T6 develops a sudden, pounding headache, diaphoresis, and
bradycardia with a blood pressure of 200/110 mm Hg. What is the priority action?
A) Administer hydralazine IV
B) Elevate the head of the bed to 90 degrees
C) Check for a distended bladder or fecal impaction
D) Notify the provider immediately
🔍 **RATIONALE** 💡-- These symptoms are characteristic of autonomic dysreflexia. The priority is to
identify and remove the noxious stimulus, commonly a distended bladder or fecal impaction.
ANSWER💫✔️-- **C) Check for a distended bladder or fecal impaction**
---
**6.** A client with a new diagnosis of type 1 diabetes mellitus is being discharged. Which statement
indicates a need for further teaching?
A) “I will check my blood sugar before meals and at bedtime.”
B) “If I feel shaky and sweaty, I should drink orange juice and then eat a snack.”
C) “I will give my insulin injection after I eat my meal to match the dose to what I ate.”
D) “I will always carry a source of fast‑acting sugar with me.”
🔍 **RATIONALE** 💡-- Rapid‑acting insulin is usually given just before (or with) meals, not after eating.
Giving it after meals may cause postprandial hyperglycemia.
, ANSWER💫✔️-- **C) “I will give my insulin injection after I eat my meal to match the dose to what I
ate.”**
---
**7.** A client receiving a blood transfusion develops chills, fever, and low back pain 20 minutes after
the start. What is the nurse’s priority action?
A) Slow the infusion rate and notify the provider
B) Stop the transfusion and infuse normal saline with new tubing
C) Administer acetaminophen as ordered
D) Obtain a urine sample for hemoglobin
🔍 **RATIONALE** 💡-- Chills, fever, and back pain suggest a hemolytic transfusion reaction. The
transfusion must be stopped immediately, the IV line kept open with normal saline using new tubing,
and the provider notified.
ANSWER💫✔️-- **B) Stop the transfusion and infuse normal saline with new tubing**
---
**8.** A client with a new diagnosis of myasthenia gravis is prescribed pyridostigmine (Mestinon).
Which finding indicates the medication is effective?
A) Increased heart rate and blood pressure
B) Decreased muscle weakness and improved swallowing
C) Resolution of diplopia within 1 hour
D) Normalization of acetylcholine receptor antibodies
🔍 **RATIONALE** 💡-- Pyridostigmine is a cholinesterase inhibitor that increases available
acetylcholine at the neuromuscular junction. Effectiveness is demonstrated by reduced muscle
weakness and improved swallowing.
Test Bank with 100% Correct Questions and Verified
Answers – 100 Questions**
---
**1.** A client with acute kidney injury (AKI) has a serum potassium of 6.8 mEq/L and ECG changes
(peaked T waves). Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate (Kayexalate)
B) Give IV calcium gluconate
C) Start an insulin and dextrose infusion
D) Prepare for emergent hemodialysis
🔍 **RATIONALE** 💡-- Severe hyperkalemia with ECG changes is a medical emergency. IV calcium
gluconate stabilizes the cardiac membrane and is given first. Insulin/dextrose shifts potassium
intracellularly but takes longer. Kayexalate and hemodialysis are later interventions.
ANSWER💫✔️-- **B) Give IV calcium gluconate**
---
**2.** A client with chronic obstructive pulmonary disease (COPD) has an SpO₂ of 88% on room air. The
nurse initiates oxygen at 2 L/min via nasal cannula. Which statement best explains this low flow rate?
A) High oxygen flow can cause oxygen toxicity
B) Clients with COPD are at risk for hypoxic drive depression
C) Nasal cannula cannot deliver more than 2 L/min accurately
D) The client’s lungs are too damaged to absorb higher oxygen
,🔍 **RATIONALE** 💡-- Some COPD clients with chronic hypercapnia rely on a hypoxic drive to breathe.
High oxygen can suppress this drive, leading to CO₂ retention and respiratory depression.
ANSWER💫✔️-- **B) Clients with COPD are at risk for hypoxic drive depression**
---
**3.** A nurse is assessing a client who is 6 hours post‑thyroidectomy. The client reports tingling
around the mouth and in the fingers. What is the nurse’s priority action?
A) Administer oral calcium supplements
B) Assess for Chvostek’s and Trousseau’s signs
C) Increase the IV fluid rate
D) Notify the provider of possible hypothyroidism
🔍 **RATIONALE** 💡-- Tingling suggests hypocalcemia due to accidental parathyroid injury during
thyroidectomy. The nurse should first assess for Chvostek’s (facial twitching) and Trousseau’s (carpal
spasm) signs.
ANSWER💫✔️-- **B) Assess for Chvostek’s and Trousseau’s signs**
---
**4.** A client with heart failure is prescribed digoxin (Lanoxin). Which finding indicates digoxin
toxicity?
A) Heart rate of 62 bpm
B) Serum potassium of 4.0 mEq/L
C) Nausea, vomiting, and yellow‑tinged vision
D) Serum digoxin level of 1.2 ng/mL
🔍 **RATIONALE** 💡-- Nausea, vomiting, and visual disturbances (yellow/green halos) are classic signs
of digoxin toxicity. Therapeutic digoxin level is 0.8‑2.0 ng/mL; a level of 1.2 is normal.
,ANSWER💫✔️-- **C) Nausea, vomiting, and yellow‑tinged vision**
---
**5.** A client with a spinal cord injury at T6 develops a sudden, pounding headache, diaphoresis, and
bradycardia with a blood pressure of 200/110 mm Hg. What is the priority action?
A) Administer hydralazine IV
B) Elevate the head of the bed to 90 degrees
C) Check for a distended bladder or fecal impaction
D) Notify the provider immediately
🔍 **RATIONALE** 💡-- These symptoms are characteristic of autonomic dysreflexia. The priority is to
identify and remove the noxious stimulus, commonly a distended bladder or fecal impaction.
ANSWER💫✔️-- **C) Check for a distended bladder or fecal impaction**
---
**6.** A client with a new diagnosis of type 1 diabetes mellitus is being discharged. Which statement
indicates a need for further teaching?
A) “I will check my blood sugar before meals and at bedtime.”
B) “If I feel shaky and sweaty, I should drink orange juice and then eat a snack.”
C) “I will give my insulin injection after I eat my meal to match the dose to what I ate.”
D) “I will always carry a source of fast‑acting sugar with me.”
🔍 **RATIONALE** 💡-- Rapid‑acting insulin is usually given just before (or with) meals, not after eating.
Giving it after meals may cause postprandial hyperglycemia.
, ANSWER💫✔️-- **C) “I will give my insulin injection after I eat my meal to match the dose to what I
ate.”**
---
**7.** A client receiving a blood transfusion develops chills, fever, and low back pain 20 minutes after
the start. What is the nurse’s priority action?
A) Slow the infusion rate and notify the provider
B) Stop the transfusion and infuse normal saline with new tubing
C) Administer acetaminophen as ordered
D) Obtain a urine sample for hemoglobin
🔍 **RATIONALE** 💡-- Chills, fever, and back pain suggest a hemolytic transfusion reaction. The
transfusion must be stopped immediately, the IV line kept open with normal saline using new tubing,
and the provider notified.
ANSWER💫✔️-- **B) Stop the transfusion and infuse normal saline with new tubing**
---
**8.** A client with a new diagnosis of myasthenia gravis is prescribed pyridostigmine (Mestinon).
Which finding indicates the medication is effective?
A) Increased heart rate and blood pressure
B) Decreased muscle weakness and improved swallowing
C) Resolution of diplopia within 1 hour
D) Normalization of acetylcholine receptor antibodies
🔍 **RATIONALE** 💡-- Pyridostigmine is a cholinesterase inhibitor that increases available
acetylcholine at the neuromuscular junction. Effectiveness is demonstrated by reduced muscle
weakness and improved swallowing.
