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HESI RN Exit Exam (2025/2026) –
Real Questions with Fully Highlighted
Answers and Rationales | Graded A+
Practice Pack
Medical-Surgical Nursing (60 Questions)
1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an acute
exacerbation. The nurse observes the client using accessory muscles to breathe and
reports a respiratory rate of 28 breaths per minute. Which intervention should the nurse
prioritize?
A. Administer a loop diuretic.
B. Initiate oxygen therapy at 2 L/min via nasal cannula.
C. Encourage the client to lie flat to conserve energy.
D. Administer a high-dose corticosteroid intravenously.
Answer: B. Initiate oxygen therapy at 2 L/min via nasal cannula.
Rationale: Clients with COPD experiencing an acute exacerbation often have
hypoxemia, and low-flow oxygen (1-2 L/min via nasal cannula) is the priority to improve
oxygenation while avoiding suppression of the hypoxic drive. Loop diuretics are used for
fluid overload, not respiratory distress. Lying flat may worsen breathing. Corticosteroids
may be used but are not the priority over oxygen.
2. The nurse is caring for a client with a new diagnosis of heart failure. The client has
bilateral crackles in the lungs and +2 pitting edema in the lower extremities. Which
medication is the nurse most likely to administer?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Lisinopril
Answer: B. Furosemide
Rationale: Furosemide, a loop diuretic, is used to treat fluid overload in heart failure, as
evidenced by crackles (pulmonary edema) and pitting edema. Metoprolol and lisinopril
manage heart rate and blood pressure but do not directly address fluid overload. Digoxin
improves contractility but is not the priority for fluid -related symptoms.
3. A client with type 1 diabetes mellitus presents with confusion, diaphoresis, and
shakiness. The blood glucose level is 48 mg/dL. What is the nurse’s first action?
A. Administer insulin aspart 10 units IV.
B. Give 15 grams of a fast-acting carbohydrate.
C. Encourage the client to drink water.
D. Notify the healthcare provider immediately.
Answer: B. Give 15 grams of a fast-acting carbohydrate.
Rationale: The client is experiencing hypoglycemia (blood glucose <70 mg/dL). The
, 2
first action is to administer 15 grams of a fast-acting carbohydrate (e.g., juice or glucose
gel) to raise blood glucose levels quickly. Insulin would worsen hypoglycemia. Water
does not address the low glucose, and notifying the provider is not the priority over
immediate treatment.
4. A client is postoperative day 1 after a total hip replacement. The nurse notes the client
has not voided in 8 hours. What is the priority nursing action?
A. Administer a prescribed diuretic.
B. Assess the client’s bladder using a bladder scanner.
C. Encourage ambulation to stimulate voiding.
D. Insert a straight catheter immediately.
Answer: B. Assess the client’s bladder using a bladder scanner.
Rationale: Postoperative urinary retention is common due to anesthesia and immobility.
The priority is to assess bladder volume with a scanner to determine if retention is present
before intervening. A diuretic is inappropriate without evidence of fluid overload.
Ambulation may help but is not the first step. Catheterization is invasive and requires a
provider order or protocol.
5. A client with pneumonia is prescribed levofloxacin 750 mg daily. The nurse notes the
client has a history of prolonged QT interval. What action should the nurse take?
A. Administer the medication as prescribed.
B. Hold the dose and notify the healthcare provider.
C. Monitor the client’s oxygen saturation.
D. Request a stat chest X-ray.
Answer: B. Hold the dose and notify the healthcare provider.
Rationale: Levofloxacin can prolong the QT interval, increasing the risk of torsades de
pointes in clients with a history of prolonged QT. The nurse should hold the dose and
consult the provider for an alternative antibiotic. Administering the drug risks cardiac
complications. Oxygen saturation and chest X-ray do not address the medication concern.
6. The nurse is assessing a client with suspected appendicitis. Which finding should the
nurse report immediately to the healthcare provider?
A. Nausea and vomiting for 24 hours.
B. Right lower quadrant pain with rebound tenderness.
C. Low-grade fever of 100.4°F (38°C).
D. Decreased appetite.
Answer: B. Right lower quadrant pain with rebound tenderness.
Rationale: Rebound tenderness in the right lower quadrant is a hallmark sign of
appendicitis and suggests peritoneal irritation, which may indicate a ruptured appendix.
This is an emergency requiring immediate reporting. Nausea, fever, and decreased
appetite are common but less specific and urgent.
7. A client with a history of atrial fibrillation is prescribed warfarin. The latest INR is 4.8.
What is the nurse’s priority action?
A. Administer the next dose as scheduled.
B. Hold the dose and notify the healthcare provider.
C. Administer vitamin K intramuscularly.
D. Monitor for signs of bleeding.
Answer: B. Hold the dose and notify the healthcare provider.
Rationale: An INR of 4.8 is above the therapeutic range (2.0-3.0 for atrial fibrillation),
, 3
indicating an increased bleeding risk. The nurse should hold the dose and notify the
provider for further instructions, which may include vitamin K administration or dose
adjustment. Administering the dose increases bleeding risk, and vitamin K requires a
provider order.
8. A client with a chest tube for a pneumothorax reports sudden shortness of breath. The
nurse notes no drainage in the collection chamber and absent breath sounds on the
affected side. What is the likely cause?
A. The chest tube is disconnected.
B. The chest tube is occluded.
C. The pneumothorax has resolved.
D. The client has developed pneumonia.
Answer: B. The chest tube is occluded.
Rationale: Sudden shortness of breath, absent breath sounds, and no drainage suggest an
occluded chest tube, which prevents air or fluid from escaping the pleural space,
worsening the pneumothorax. A disconnected tube would cause air leaks, not absent
drainage. Resolution would improve breath sounds. Pneumonia is unlikely without other
signs like fever.
9. The nurse is caring for a client with a history of peptic ulcer disease who reports sudden,
severe epigastric pain. Which complication should the nurse suspect?
A. Gastrointestinal bleeding
B. Perforation
C. Gastric outlet obstruction
D. Esophagitis
Answer: B. Perforation
Rationale: Sudden, severe epigastric pain in a client with peptic ulcer disease suggests
perforation, a life-threatening complication where the ulcer erodes through the stomach
or duodenum wall, causing peritonitis. Bleeding may present with hematemesis or
melena. Obstruction causes vomiting, and esophagitis is unrelated to epigastric pain.
10. A client with chronic kidney disease is prescribed epoetin alfa. Which laboratory value
should the nurse monitor to evaluate the effectiveness of this medication?
A. Serum potassium
B. Hemoglobin
C. Blood urea nitrogen
D. Serum creatinine
Answer: B. Hemoglobin
Rationale: Epoetin alfa stimulates red blood cell production to treat anemia in chronic
kidney disease. Hemoglobin is the primary indicator of its effectiveness. Potassium,
BUN, and creatinine are monitored for kidney function but do not directly reflect epoetin
alfa’s efficacy.
11. The nurse is assessing a client with a suspected myocardial infarction. Which symptom is
most indicative of this condition?
A. Epigastric pain relieved by antacids
B. Chest pain radiating to the left arm
C. Shortness of breath with exertion
D. Palpitations without chest discomfort
Answer: B. Chest pain radiating to the left arm
HESI RN Exit Exam (2025/2026) –
Real Questions with Fully Highlighted
Answers and Rationales | Graded A+
Practice Pack
Medical-Surgical Nursing (60 Questions)
1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an acute
exacerbation. The nurse observes the client using accessory muscles to breathe and
reports a respiratory rate of 28 breaths per minute. Which intervention should the nurse
prioritize?
A. Administer a loop diuretic.
B. Initiate oxygen therapy at 2 L/min via nasal cannula.
C. Encourage the client to lie flat to conserve energy.
D. Administer a high-dose corticosteroid intravenously.
Answer: B. Initiate oxygen therapy at 2 L/min via nasal cannula.
Rationale: Clients with COPD experiencing an acute exacerbation often have
hypoxemia, and low-flow oxygen (1-2 L/min via nasal cannula) is the priority to improve
oxygenation while avoiding suppression of the hypoxic drive. Loop diuretics are used for
fluid overload, not respiratory distress. Lying flat may worsen breathing. Corticosteroids
may be used but are not the priority over oxygen.
2. The nurse is caring for a client with a new diagnosis of heart failure. The client has
bilateral crackles in the lungs and +2 pitting edema in the lower extremities. Which
medication is the nurse most likely to administer?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Lisinopril
Answer: B. Furosemide
Rationale: Furosemide, a loop diuretic, is used to treat fluid overload in heart failure, as
evidenced by crackles (pulmonary edema) and pitting edema. Metoprolol and lisinopril
manage heart rate and blood pressure but do not directly address fluid overload. Digoxin
improves contractility but is not the priority for fluid -related symptoms.
3. A client with type 1 diabetes mellitus presents with confusion, diaphoresis, and
shakiness. The blood glucose level is 48 mg/dL. What is the nurse’s first action?
A. Administer insulin aspart 10 units IV.
B. Give 15 grams of a fast-acting carbohydrate.
C. Encourage the client to drink water.
D. Notify the healthcare provider immediately.
Answer: B. Give 15 grams of a fast-acting carbohydrate.
Rationale: The client is experiencing hypoglycemia (blood glucose <70 mg/dL). The
, 2
first action is to administer 15 grams of a fast-acting carbohydrate (e.g., juice or glucose
gel) to raise blood glucose levels quickly. Insulin would worsen hypoglycemia. Water
does not address the low glucose, and notifying the provider is not the priority over
immediate treatment.
4. A client is postoperative day 1 after a total hip replacement. The nurse notes the client
has not voided in 8 hours. What is the priority nursing action?
A. Administer a prescribed diuretic.
B. Assess the client’s bladder using a bladder scanner.
C. Encourage ambulation to stimulate voiding.
D. Insert a straight catheter immediately.
Answer: B. Assess the client’s bladder using a bladder scanner.
Rationale: Postoperative urinary retention is common due to anesthesia and immobility.
The priority is to assess bladder volume with a scanner to determine if retention is present
before intervening. A diuretic is inappropriate without evidence of fluid overload.
Ambulation may help but is not the first step. Catheterization is invasive and requires a
provider order or protocol.
5. A client with pneumonia is prescribed levofloxacin 750 mg daily. The nurse notes the
client has a history of prolonged QT interval. What action should the nurse take?
A. Administer the medication as prescribed.
B. Hold the dose and notify the healthcare provider.
C. Monitor the client’s oxygen saturation.
D. Request a stat chest X-ray.
Answer: B. Hold the dose and notify the healthcare provider.
Rationale: Levofloxacin can prolong the QT interval, increasing the risk of torsades de
pointes in clients with a history of prolonged QT. The nurse should hold the dose and
consult the provider for an alternative antibiotic. Administering the drug risks cardiac
complications. Oxygen saturation and chest X-ray do not address the medication concern.
6. The nurse is assessing a client with suspected appendicitis. Which finding should the
nurse report immediately to the healthcare provider?
A. Nausea and vomiting for 24 hours.
B. Right lower quadrant pain with rebound tenderness.
C. Low-grade fever of 100.4°F (38°C).
D. Decreased appetite.
Answer: B. Right lower quadrant pain with rebound tenderness.
Rationale: Rebound tenderness in the right lower quadrant is a hallmark sign of
appendicitis and suggests peritoneal irritation, which may indicate a ruptured appendix.
This is an emergency requiring immediate reporting. Nausea, fever, and decreased
appetite are common but less specific and urgent.
7. A client with a history of atrial fibrillation is prescribed warfarin. The latest INR is 4.8.
What is the nurse’s priority action?
A. Administer the next dose as scheduled.
B. Hold the dose and notify the healthcare provider.
C. Administer vitamin K intramuscularly.
D. Monitor for signs of bleeding.
Answer: B. Hold the dose and notify the healthcare provider.
Rationale: An INR of 4.8 is above the therapeutic range (2.0-3.0 for atrial fibrillation),
, 3
indicating an increased bleeding risk. The nurse should hold the dose and notify the
provider for further instructions, which may include vitamin K administration or dose
adjustment. Administering the dose increases bleeding risk, and vitamin K requires a
provider order.
8. A client with a chest tube for a pneumothorax reports sudden shortness of breath. The
nurse notes no drainage in the collection chamber and absent breath sounds on the
affected side. What is the likely cause?
A. The chest tube is disconnected.
B. The chest tube is occluded.
C. The pneumothorax has resolved.
D. The client has developed pneumonia.
Answer: B. The chest tube is occluded.
Rationale: Sudden shortness of breath, absent breath sounds, and no drainage suggest an
occluded chest tube, which prevents air or fluid from escaping the pleural space,
worsening the pneumothorax. A disconnected tube would cause air leaks, not absent
drainage. Resolution would improve breath sounds. Pneumonia is unlikely without other
signs like fever.
9. The nurse is caring for a client with a history of peptic ulcer disease who reports sudden,
severe epigastric pain. Which complication should the nurse suspect?
A. Gastrointestinal bleeding
B. Perforation
C. Gastric outlet obstruction
D. Esophagitis
Answer: B. Perforation
Rationale: Sudden, severe epigastric pain in a client with peptic ulcer disease suggests
perforation, a life-threatening complication where the ulcer erodes through the stomach
or duodenum wall, causing peritonitis. Bleeding may present with hematemesis or
melena. Obstruction causes vomiting, and esophagitis is unrelated to epigastric pain.
10. A client with chronic kidney disease is prescribed epoetin alfa. Which laboratory value
should the nurse monitor to evaluate the effectiveness of this medication?
A. Serum potassium
B. Hemoglobin
C. Blood urea nitrogen
D. Serum creatinine
Answer: B. Hemoglobin
Rationale: Epoetin alfa stimulates red blood cell production to treat anemia in chronic
kidney disease. Hemoglobin is the primary indicator of its effectiveness. Potassium,
BUN, and creatinine are monitored for kidney function but do not directly reflect epoetin
alfa’s efficacy.
11. The nurse is assessing a client with a suspected myocardial infarction. Which symptom is
most indicative of this condition?
A. Epigastric pain relieved by antacids
B. Chest pain radiating to the left arm
C. Shortness of breath with exertion
D. Palpitations without chest discomfort
Answer: B. Chest pain radiating to the left arm
