HESI Comprehensive Exit Exam Prep Document 2026/2027 | NCLEX Readiness,
Clinical Judgment & Comprehensive Nursing Review | 150 Verified
Questions with Detailed Rationales
SECTION 1: SAFE, EFFECTIVE CARE ENVIRONMENT (Questions 1-30)
MANAGEMENT OF CARE (Questions 1-15)
Question 1
A nurse is caring for a client with a new tracheostomy. Which assessment finding requires
immediate intervention?
A) Small amount of blood-tinged secretions
B) Subcutaneous emphysema around the stoma
C) The client's ability to speak in a hoarse whisper
D) 5 mL of serosanguineous drainage on dressing
Correct Answer: B
Rationale: Subcutaneous emphysema (crepitus around the stoma) indicates air trapping in
the tissues and can signal a tracheal perforation or a dislodged tracheostomy tube that is no
longer in the tracheal lumen. This is a medical emergency that requires immediate
assessment of tube placement and possible intervention. Small amounts of blood-tinged
secretions (A) are expected in the first 24-48 hours. The ability to speak (C) indicates air is
passing through the vocal cords, which is actually a good sign (though speech should be
assessed). A small amount of drainage (D) is expected.
Question 2
Which client should the nurse assess first after receiving the morning shift report?
,A) A client with heart failure who has 2+ pitting edema
B) A client with diabetes mellitus whose blood glucose is 180 mg/dL
C) A client with pneumonia who has a new onset of confusion
D) A client with a fractured hip who is requesting pain medication
Correct Answer: C
Rationale: New onset confusion in a client with pneumonia may indicate hypoxia, sepsis,
or worsening infection—all of which are medical emergencies. Changes in mental status is a
priority assessment that suggests a decline in the client's condition and requires immediate
evaluation. The heart failure client's edema (A) is stable, the glucose of 180 mg/dL (B) is
elevated but not critical for a diabetic, and the pain request (D), while important, can be
addressed after the unstable client.
Question 3
A charge nurse is making assignments for the shift. Which client should be assigned to the
most experienced nurse?
A) A client with hypertension who is scheduled for discharge
B) A client with COPD who needs oxygen therapy
C) A client with septic shock on multiple vasopressors
D) A client with a urinary tract infection on antibiotics
Correct Answer: C
Rationale: The client with septic shock requires the most experienced nurse as they are
hemodynamically unstable and require complex assessment skills, rapid intervention, and
careful monitoring of multiple vasopressor infusions. The stable clients (A, B, D) can be
assigned to less experienced nurses, and AP can assist with basic care.
Question 4
Which client can the nurse delegate to an assistive personnel (AP)?
A) A client requiring a sterile dressing change
B) A client requiring assistance with ambulation
C) A client with a new tracheostomy requiring suctioning
D) A client requiring a blood transfusion
,Correct Answer: B
Rationale: Assistance with ambulation is a routine, non-invasive task that falls within the
scope of AP practice. Sterile dressing changes (A) and tracheostomy suctioning (C) require
sterile technique and assessment skills performed by licensed nursing staff. Blood transfusion
(D) requires a licensed nurse to monitor for reactions and verify blood products.
Question 5
A client is being discharged with a new diagnosis of heart failure. Which statement indicates
that the client understands dietary restrictions?
A) "I should limit my intake of foods containing potassium."
B) "I should eat a diet high in protein and low in calories."
C) "I should limit my intake of sodium to 2 grams per day."
D) "I should increase my intake of fluids."
Correct Answer: C
Rationale: Heart failure clients should restrict sodium to 2 grams (2,000 mg) per day to
reduce fluid retention and lower the workload on the heart. Potassium restriction (A) is not
typically indicated for heart failure; in fact, potassium may be supplemented if diuretics are
prescribed. A high-protein/low-calorie diet (B) is not specific to heart failure, and fluid
restriction (D)—not increased intake—is often necessary.
Question 6
A nurse is caring for a client who is on fall precautions. Which intervention should the nurse
implement to prevent a fall?
A) Keep the bed in the highest position for easy access
B) Place the call light within the client's reach
C) Keep the room lights dim to promote rest
D) Apply restraints to prevent wandering
Correct Answer: B
Rationale: Keeping the call light within the client's reach is a key fall prevention
intervention that allows the client to call for assistance when needed. The bed should be in
, the lowest position (A) to reduce fall height. Room lights should be adequate for safety (C).
Restraints (D) should be used only as a last resort and require a prescription.
Question 7
Which client finding should the nurse report to the provider immediately?
A) Blood pressure of 140/90 in a client on antihypertensives
B) Temperature of 38.3°C (101°F) in a client post-surgery
C) Respiratory rate of 26 in a client with COPD
D) Heart rate of 120 in a client receiving a blood transfusion
Correct Answer: D
Rationale: A heart rate of 120 in a client receiving a blood transfusion may indicate a
transfusion reaction, which is a medical emergency requiring immediate intervention. The
blood transfusion should be stopped immediately and the provider notified. The elevated blood
pressure (A) may require intervention but is not emergent, the temperature (B) may indicate
infection but should be monitored, and the respiratory rate of 26 (C) is within expected range
for a COPD client.
Question 8
A nurse is preparing to administer a blood transfusion. Which action is most important before
starting the transfusion?
A) Verify the client's blood type and crossmatch
B) Pre-medicate the client with an antihistamine
C) Obtain baseline vital signs
D) Explain the procedure to the client
Correct Answer: A
Rationale: Verifying the client's blood type and crossmatch is the most critical action to
ensure the correct blood is given to the correct client. A transfusion reaction can be fatal if
the blood is incompatible. While obtaining baseline vital signs (C), explaining the procedure
(D), and pre-medicating (B) are also important, they are secondary to verifying the correct
blood product.
Clinical Judgment & Comprehensive Nursing Review | 150 Verified
Questions with Detailed Rationales
SECTION 1: SAFE, EFFECTIVE CARE ENVIRONMENT (Questions 1-30)
MANAGEMENT OF CARE (Questions 1-15)
Question 1
A nurse is caring for a client with a new tracheostomy. Which assessment finding requires
immediate intervention?
A) Small amount of blood-tinged secretions
B) Subcutaneous emphysema around the stoma
C) The client's ability to speak in a hoarse whisper
D) 5 mL of serosanguineous drainage on dressing
Correct Answer: B
Rationale: Subcutaneous emphysema (crepitus around the stoma) indicates air trapping in
the tissues and can signal a tracheal perforation or a dislodged tracheostomy tube that is no
longer in the tracheal lumen. This is a medical emergency that requires immediate
assessment of tube placement and possible intervention. Small amounts of blood-tinged
secretions (A) are expected in the first 24-48 hours. The ability to speak (C) indicates air is
passing through the vocal cords, which is actually a good sign (though speech should be
assessed). A small amount of drainage (D) is expected.
Question 2
Which client should the nurse assess first after receiving the morning shift report?
,A) A client with heart failure who has 2+ pitting edema
B) A client with diabetes mellitus whose blood glucose is 180 mg/dL
C) A client with pneumonia who has a new onset of confusion
D) A client with a fractured hip who is requesting pain medication
Correct Answer: C
Rationale: New onset confusion in a client with pneumonia may indicate hypoxia, sepsis,
or worsening infection—all of which are medical emergencies. Changes in mental status is a
priority assessment that suggests a decline in the client's condition and requires immediate
evaluation. The heart failure client's edema (A) is stable, the glucose of 180 mg/dL (B) is
elevated but not critical for a diabetic, and the pain request (D), while important, can be
addressed after the unstable client.
Question 3
A charge nurse is making assignments for the shift. Which client should be assigned to the
most experienced nurse?
A) A client with hypertension who is scheduled for discharge
B) A client with COPD who needs oxygen therapy
C) A client with septic shock on multiple vasopressors
D) A client with a urinary tract infection on antibiotics
Correct Answer: C
Rationale: The client with septic shock requires the most experienced nurse as they are
hemodynamically unstable and require complex assessment skills, rapid intervention, and
careful monitoring of multiple vasopressor infusions. The stable clients (A, B, D) can be
assigned to less experienced nurses, and AP can assist with basic care.
Question 4
Which client can the nurse delegate to an assistive personnel (AP)?
A) A client requiring a sterile dressing change
B) A client requiring assistance with ambulation
C) A client with a new tracheostomy requiring suctioning
D) A client requiring a blood transfusion
,Correct Answer: B
Rationale: Assistance with ambulation is a routine, non-invasive task that falls within the
scope of AP practice. Sterile dressing changes (A) and tracheostomy suctioning (C) require
sterile technique and assessment skills performed by licensed nursing staff. Blood transfusion
(D) requires a licensed nurse to monitor for reactions and verify blood products.
Question 5
A client is being discharged with a new diagnosis of heart failure. Which statement indicates
that the client understands dietary restrictions?
A) "I should limit my intake of foods containing potassium."
B) "I should eat a diet high in protein and low in calories."
C) "I should limit my intake of sodium to 2 grams per day."
D) "I should increase my intake of fluids."
Correct Answer: C
Rationale: Heart failure clients should restrict sodium to 2 grams (2,000 mg) per day to
reduce fluid retention and lower the workload on the heart. Potassium restriction (A) is not
typically indicated for heart failure; in fact, potassium may be supplemented if diuretics are
prescribed. A high-protein/low-calorie diet (B) is not specific to heart failure, and fluid
restriction (D)—not increased intake—is often necessary.
Question 6
A nurse is caring for a client who is on fall precautions. Which intervention should the nurse
implement to prevent a fall?
A) Keep the bed in the highest position for easy access
B) Place the call light within the client's reach
C) Keep the room lights dim to promote rest
D) Apply restraints to prevent wandering
Correct Answer: B
Rationale: Keeping the call light within the client's reach is a key fall prevention
intervention that allows the client to call for assistance when needed. The bed should be in
, the lowest position (A) to reduce fall height. Room lights should be adequate for safety (C).
Restraints (D) should be used only as a last resort and require a prescription.
Question 7
Which client finding should the nurse report to the provider immediately?
A) Blood pressure of 140/90 in a client on antihypertensives
B) Temperature of 38.3°C (101°F) in a client post-surgery
C) Respiratory rate of 26 in a client with COPD
D) Heart rate of 120 in a client receiving a blood transfusion
Correct Answer: D
Rationale: A heart rate of 120 in a client receiving a blood transfusion may indicate a
transfusion reaction, which is a medical emergency requiring immediate intervention. The
blood transfusion should be stopped immediately and the provider notified. The elevated blood
pressure (A) may require intervention but is not emergent, the temperature (B) may indicate
infection but should be monitored, and the respiratory rate of 26 (C) is within expected range
for a COPD client.
Question 8
A nurse is preparing to administer a blood transfusion. Which action is most important before
starting the transfusion?
A) Verify the client's blood type and crossmatch
B) Pre-medicate the client with an antihistamine
C) Obtain baseline vital signs
D) Explain the procedure to the client
Correct Answer: A
Rationale: Verifying the client's blood type and crossmatch is the most critical action to
ensure the correct blood is given to the correct client. A transfusion reaction can be fatal if
the blood is incompatible. While obtaining baseline vital signs (C), explaining the procedure
(D), and pre-medicating (B) are also important, they are secondary to verifying the correct
blood product.
