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2024–2025-2026 HESI RN Medical-Surgical, Pharmacology,
Pediatrics, Health Assessment & Comprehensive Exit Exam Bundle |
300 Verified NCLEX-Style Questions with Detailed Rationales
Question 1
A 68-year-old male with a history of COPD presents with increased shortness of breath,
productive cough, and confusion. His oxygen saturation is 84% on room air, respiratory rate is
30 breaths/min, and he is using accessory muscles. Which is the most appropriate initial nursing
intervention?
A. Administer albuterol via metered-dose inhaler
B. Place the patient in high Fowler’s position and initiate oxygen via nasal cannula
C. Call the provider to request a chest X-ray
D. Encourage the patient to cough and deep breathe
Correct Answer: B.
Rationale: Placing the patient in high Fowler’s position maximizes lung expansion, and oxygen
via nasal cannula is appropriate to address hypoxia. The nurse must address airway and
oxygenation as a priority (ABCs). Confusion suggests hypoxia. (Lewis, Med-Surg Nursing, 11th
ed.)
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Question 2
A nurse is caring for a client with type 2 diabetes mellitus who is scheduled for surgery in the
morning. The client’s blood glucose is 68 mg/dL. What is the nurse’s best action?
A. Administer the scheduled dose of insulin glargine
B. Notify the provider and withhold all insulin
C. Give a glass of orange juice and recheck in 15 minutes
D. Proceed with pre-op checklist and monitor
Correct Answer: C.
Rationale: A blood glucose of 68 mg/dL is below normal and requires immediate action to
prevent hypoglycemia. Giving a fast-acting carbohydrate such as orange juice is the correct
initial intervention. (HESI Comprehensive Review, 6th ed.)
Question 3
A client with heart failure is prescribed furosemide 40 mg IV twice daily. The nurse notes muscle
cramps and a serum potassium level of 2.9 mEq/L. What is the most appropriate nursing
intervention?
A. Encourage fluid intake to prevent dehydration
B. Notify the provider and prepare to administer potassium supplements
C. Administer the furosemide as scheduled and monitor urine output
D. Place the client on a cardiac monitor and restrict potassium intake
Correct Answer: B.
Rationale: Hypokalemia (K+ < 3.5 mEq/L) is a known side effect of loop diuretics like
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furosemide. Muscle cramps are a sign of low potassium, which can lead to cardiac arrhythmias.
The provider should be notified to correct the deficiency. (Lewis, 11th ed.)
Question 4
The nurse is assessing a client post-thyroidectomy and notices stridor, hoarseness, and difficulty
breathing. What is the priority nursing action?
A. Elevate the head of the bed and reassess in 15 minutes
B. Apply oxygen and notify the rapid response team
C. Suction the airway and administer IV fluids
D. Document the findings and monitor oxygen saturation
Correct Answer: B.
Rationale: Stridor and breathing difficulty post-thyroidectomy may indicate airway obstruction
from laryngeal nerve damage or hematoma. This is a medical emergency requiring immediate
intervention. (HESI Comprehensive Review)
Question 5
A client with cirrhosis has ascites and reports increasing abdominal discomfort. What
intervention should the nurse anticipate first?
A. Monitor intake and output
B. Prepare for paracentesis
C. Encourage increased oral fluid intake
D. Administer lactulose
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Correct Answer: B.
Rationale: Paracentesis relieves fluid buildup in the peritoneal cavity and alleviates discomfort
in clients with severe ascites. Lactulose helps with hepatic encephalopathy but does not relieve
ascites directly. (Lewis, 11th ed.)
Question 6
Which assessment finding in a client with chronic renal failure requires immediate attention?
A. Hemoglobin 10.2 g/dL
B. Serum potassium 6.7 mEq/L
C. Blood pressure 158/88 mm Hg
D. Urine output 400 mL in 24 hours
Correct Answer: B.
Rationale: Hyperkalemia (K+ > 6.5 mEq/L) is life-threatening due to the risk of cardiac
dysrhythmias. This warrants immediate intervention, such as administration of insulin/glucose,
calcium gluconate, or dialysis. (HESI Med-Surg)
Question 7
A client newly diagnosed with tuberculosis is started on isoniazid (INH), rifampin, and
pyrazinamide. Which teaching by the nurse is correct?
A. “You may stop medications once your cough improves.”
B. “Avoid sunlight while taking these medications.”
C. “Report yellowing of the eyes or skin immediately.”
D. “Limit fluid intake while on these medications.”
2024–2025-2026 HESI RN Medical-Surgical, Pharmacology,
Pediatrics, Health Assessment & Comprehensive Exit Exam Bundle |
300 Verified NCLEX-Style Questions with Detailed Rationales
Question 1
A 68-year-old male with a history of COPD presents with increased shortness of breath,
productive cough, and confusion. His oxygen saturation is 84% on room air, respiratory rate is
30 breaths/min, and he is using accessory muscles. Which is the most appropriate initial nursing
intervention?
A. Administer albuterol via metered-dose inhaler
B. Place the patient in high Fowler’s position and initiate oxygen via nasal cannula
C. Call the provider to request a chest X-ray
D. Encourage the patient to cough and deep breathe
Correct Answer: B.
Rationale: Placing the patient in high Fowler’s position maximizes lung expansion, and oxygen
via nasal cannula is appropriate to address hypoxia. The nurse must address airway and
oxygenation as a priority (ABCs). Confusion suggests hypoxia. (Lewis, Med-Surg Nursing, 11th
ed.)
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Question 2
A nurse is caring for a client with type 2 diabetes mellitus who is scheduled for surgery in the
morning. The client’s blood glucose is 68 mg/dL. What is the nurse’s best action?
A. Administer the scheduled dose of insulin glargine
B. Notify the provider and withhold all insulin
C. Give a glass of orange juice and recheck in 15 minutes
D. Proceed with pre-op checklist and monitor
Correct Answer: C.
Rationale: A blood glucose of 68 mg/dL is below normal and requires immediate action to
prevent hypoglycemia. Giving a fast-acting carbohydrate such as orange juice is the correct
initial intervention. (HESI Comprehensive Review, 6th ed.)
Question 3
A client with heart failure is prescribed furosemide 40 mg IV twice daily. The nurse notes muscle
cramps and a serum potassium level of 2.9 mEq/L. What is the most appropriate nursing
intervention?
A. Encourage fluid intake to prevent dehydration
B. Notify the provider and prepare to administer potassium supplements
C. Administer the furosemide as scheduled and monitor urine output
D. Place the client on a cardiac monitor and restrict potassium intake
Correct Answer: B.
Rationale: Hypokalemia (K+ < 3.5 mEq/L) is a known side effect of loop diuretics like
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furosemide. Muscle cramps are a sign of low potassium, which can lead to cardiac arrhythmias.
The provider should be notified to correct the deficiency. (Lewis, 11th ed.)
Question 4
The nurse is assessing a client post-thyroidectomy and notices stridor, hoarseness, and difficulty
breathing. What is the priority nursing action?
A. Elevate the head of the bed and reassess in 15 minutes
B. Apply oxygen and notify the rapid response team
C. Suction the airway and administer IV fluids
D. Document the findings and monitor oxygen saturation
Correct Answer: B.
Rationale: Stridor and breathing difficulty post-thyroidectomy may indicate airway obstruction
from laryngeal nerve damage or hematoma. This is a medical emergency requiring immediate
intervention. (HESI Comprehensive Review)
Question 5
A client with cirrhosis has ascites and reports increasing abdominal discomfort. What
intervention should the nurse anticipate first?
A. Monitor intake and output
B. Prepare for paracentesis
C. Encourage increased oral fluid intake
D. Administer lactulose
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Correct Answer: B.
Rationale: Paracentesis relieves fluid buildup in the peritoneal cavity and alleviates discomfort
in clients with severe ascites. Lactulose helps with hepatic encephalopathy but does not relieve
ascites directly. (Lewis, 11th ed.)
Question 6
Which assessment finding in a client with chronic renal failure requires immediate attention?
A. Hemoglobin 10.2 g/dL
B. Serum potassium 6.7 mEq/L
C. Blood pressure 158/88 mm Hg
D. Urine output 400 mL in 24 hours
Correct Answer: B.
Rationale: Hyperkalemia (K+ > 6.5 mEq/L) is life-threatening due to the risk of cardiac
dysrhythmias. This warrants immediate intervention, such as administration of insulin/glucose,
calcium gluconate, or dialysis. (HESI Med-Surg)
Question 7
A client newly diagnosed with tuberculosis is started on isoniazid (INH), rifampin, and
pyrazinamide. Which teaching by the nurse is correct?
A. “You may stop medications once your cough improves.”
B. “Avoid sunlight while taking these medications.”
C. “Report yellowing of the eyes or skin immediately.”
D. “Limit fluid intake while on these medications.”
