HESI RN Exit Exam V3 | 2026 Q&A with
Rationale (HESI RN Exit Exam 2026)
1. A nurse is caring for a client with heart failure who is receiving furosemide. Which
laboratory result should the nurse prioritize reporting to the healthcare provider?
A. Sodium 136 mEq/L
B. Creatinine 1.1 mg/dL
C. Potassium 2.9 mEq/L
D. Glucose 110 mg/dL
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes the excretion of potassium, potentially
leading to severe hypokalemia. A potassium level of 2.9 mEq/L is significantly below the
normal range of 3.5 to 5.0 mEq/L and can cause life-threatening cardiac dysrhythmias. The
other values provided are within normal or near-normal limits and do not represent an
acute priority over the potassium level.
2. A client is diagnosed with a pulmonary embolism and is started on a heparin infusion.
Which laboratory value should the nurse monitor to adjust the dosage of the infusion?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT)
,D. Platelet count
Correct Answer: A
Rationale: The aPTT is the standard laboratory test used to monitor the effectiveness and
safety of unfractionated heparin therapy. PT and INR are used primarily to monitor
warfarin therapy, not heparin. While platelet counts are monitored to check for heparin-
induced thrombocytopenia (HIT), they are not used to titration the infusion rate.
3. The nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding would require the nurse to hold the medication and notify the provider?
A. Apical heart rate of 52 beats/minute
B. Blood pressure of 140/90 mmHg
C. Respiratory rate of 18 breaths/minute
D. Digoxin level of 1.2 ng/mL
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, it is standard
practice to hold the medication if the heart rate is below 60 beats/minute in an adult. A
digoxin level of 1.2 ng/mL is within the therapeutic range (0.5 to 2.0 ng/mL). The blood
pressure and respiratory rate provided are not contraindications for administering digoxin.
4. A client with schizophrenia is experiencing auditory hallucinations and tells the nurse, ‘The
voices are telling me to hurt my roommate.’ What is the nurse’s priority action?
A. Administer an as-needed antipsychotic medication.
,B. Place the client in a seclusion room immediately.
C. Initiate one-on-one observation for safety.
D. Ask the client what the voices are saying specifically.
Correct Answer: C
Rationale: Safety is the absolute priority when a client expresses command hallucinations
to harm others. One-on-one observation ensures the nurse can intervene immediately to
prevent violence. Seclusion is a restrictive measure and should only be used after less
restrictive options fail, while medication treats the symptoms but doesn’t provide
immediate physical restraint or safety.
5. A nurse is teaching a client with Type 1 Diabetes Mellitus about the signs of hypoglycemia.
Which symptoms should the nurse include in the teaching? (Select all that apply)
A. Shakiness
B. Increased thirst
C. Diaphoresis
D. Fruity breath odor
E. Confusion
F. Palpitations
Correct Answer: ACEF
, Rationale: Hypoglycemia triggers the sympathetic nervous system, leading to symptoms
like shakiness, sweating (diaphoresis), confusion, and palpitations. Increased thirst
(polydipsia) and fruity breath (acetone breath) are classic signs of hyperglycemia and
diabetic ketoacidosis, not hypoglycemia. Recognizing these early signs allows for prompt
treatment with fast-acting carbohydrates.
6. Which task is most appropriate for the registered nurse (RN) to delegate to an unlicensed
assistive personnel (UAP)?
A. Assessing the skin of a new admission with a history of pressure ulcers.
B. Feeding a client with dysphagia who is at high risk for aspiration.
C. Obtaining a blood glucose level on a stable client with diabetes.
D. Providing discharge instructions to a client following a colonoscopy.
Correct Answer: C
Rationale: UAPs can perform routine tasks on stable clients, such as finger-stick blood
glucose monitoring, if they have been trained and it is within facility policy. Assessment,
feeding high-risk clients (dysphagia), and teaching/discharge instructions are
responsibilities of the RN that require clinical judgment. Delegating these higher-level tasks
would be inappropriate and potentially unsafe.
7. A client is admitted with a diagnosis of Cushing’s Syndrome. Which clinical manifestation
should the nurse expect to observe?
A. Weight loss and hypotension
Rationale (HESI RN Exit Exam 2026)
1. A nurse is caring for a client with heart failure who is receiving furosemide. Which
laboratory result should the nurse prioritize reporting to the healthcare provider?
A. Sodium 136 mEq/L
B. Creatinine 1.1 mg/dL
C. Potassium 2.9 mEq/L
D. Glucose 110 mg/dL
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes the excretion of potassium, potentially
leading to severe hypokalemia. A potassium level of 2.9 mEq/L is significantly below the
normal range of 3.5 to 5.0 mEq/L and can cause life-threatening cardiac dysrhythmias. The
other values provided are within normal or near-normal limits and do not represent an
acute priority over the potassium level.
2. A client is diagnosed with a pulmonary embolism and is started on a heparin infusion.
Which laboratory value should the nurse monitor to adjust the dosage of the infusion?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT)
,D. Platelet count
Correct Answer: A
Rationale: The aPTT is the standard laboratory test used to monitor the effectiveness and
safety of unfractionated heparin therapy. PT and INR are used primarily to monitor
warfarin therapy, not heparin. While platelet counts are monitored to check for heparin-
induced thrombocytopenia (HIT), they are not used to titration the infusion rate.
3. The nurse is preparing to administer digoxin to a client with atrial fibrillation. Which
assessment finding would require the nurse to hold the medication and notify the provider?
A. Apical heart rate of 52 beats/minute
B. Blood pressure of 140/90 mmHg
C. Respiratory rate of 18 breaths/minute
D. Digoxin level of 1.2 ng/mL
Correct Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, it is standard
practice to hold the medication if the heart rate is below 60 beats/minute in an adult. A
digoxin level of 1.2 ng/mL is within the therapeutic range (0.5 to 2.0 ng/mL). The blood
pressure and respiratory rate provided are not contraindications for administering digoxin.
4. A client with schizophrenia is experiencing auditory hallucinations and tells the nurse, ‘The
voices are telling me to hurt my roommate.’ What is the nurse’s priority action?
A. Administer an as-needed antipsychotic medication.
,B. Place the client in a seclusion room immediately.
C. Initiate one-on-one observation for safety.
D. Ask the client what the voices are saying specifically.
Correct Answer: C
Rationale: Safety is the absolute priority when a client expresses command hallucinations
to harm others. One-on-one observation ensures the nurse can intervene immediately to
prevent violence. Seclusion is a restrictive measure and should only be used after less
restrictive options fail, while medication treats the symptoms but doesn’t provide
immediate physical restraint or safety.
5. A nurse is teaching a client with Type 1 Diabetes Mellitus about the signs of hypoglycemia.
Which symptoms should the nurse include in the teaching? (Select all that apply)
A. Shakiness
B. Increased thirst
C. Diaphoresis
D. Fruity breath odor
E. Confusion
F. Palpitations
Correct Answer: ACEF
, Rationale: Hypoglycemia triggers the sympathetic nervous system, leading to symptoms
like shakiness, sweating (diaphoresis), confusion, and palpitations. Increased thirst
(polydipsia) and fruity breath (acetone breath) are classic signs of hyperglycemia and
diabetic ketoacidosis, not hypoglycemia. Recognizing these early signs allows for prompt
treatment with fast-acting carbohydrates.
6. Which task is most appropriate for the registered nurse (RN) to delegate to an unlicensed
assistive personnel (UAP)?
A. Assessing the skin of a new admission with a history of pressure ulcers.
B. Feeding a client with dysphagia who is at high risk for aspiration.
C. Obtaining a blood glucose level on a stable client with diabetes.
D. Providing discharge instructions to a client following a colonoscopy.
Correct Answer: C
Rationale: UAPs can perform routine tasks on stable clients, such as finger-stick blood
glucose monitoring, if they have been trained and it is within facility policy. Assessment,
feeding high-risk clients (dysphagia), and teaching/discharge instructions are
responsibilities of the RN that require clinical judgment. Delegating these higher-level tasks
would be inappropriate and potentially unsafe.
7. A client is admitted with a diagnosis of Cushing’s Syndrome. Which clinical manifestation
should the nurse expect to observe?
A. Weight loss and hypotension
