1
2025 HESI RN Exit Exam Practice
Questions – Comprehensive Clinical
Scenarios & Verified Answers |
100% Accurate
Question 1
A client with type 2 diabetes mellitus is admitted with hyperglycemia. The nurse observes a
blood glucose level of 350 mg/dL. Which action should the nurse prioritize?
A. Administer insulin as prescribed.
B. Encourage the client to drink water.
C. Check the client’s urine for ketones.
D. Notify the healthcare provider immediately.
Correct Answer: C. Check the client’s urine for ketones.
Rationale: Hyperglycemia (blood glucose >250 mg/dL) in type 2 diabetes can lead to diabetic
ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Checking for ketones is the
priority to assess for DKA, which requires urgent intervention. Administering insulin and
notifying the provider may follow, but assessing ketones guides the urgency and type of
treatment. Encouraging water intake is secondary to confirming the presence of ketones.
Question 2
The nurse is delegating tasks to an unlicensed assistive personnel (UAP) for a client with heart
failure. Which task is appropriate to delegate?
A. Assessing the client’s breath sounds.
B. Administering furosemide 20 mg IV.
C. Measuring the client’s daily weight.
D. Teaching the client about a low-sodium diet.
Correct Answer: C. Measuring the client’s daily weight.
Rationale: Measuring daily weight is within the UAP’s scope of practice and is a critical task for
monitoring fluid status in heart failure. Assessing breath sounds and teaching require clinical
, 2
judgment, which are RN responsibilities. Administering IV medications is outside the UAP’s
scope.
Question 3
A client is prescribed warfarin 5 mg daily for atrial fibrillation. The latest INR is 4.2. What is the
nurse’s best action?
A. Administer the dose as prescribed.
B. Hold the dose and notify the healthcare provider.
C. Administer vitamin K as a standing order.
D. Encourage the client to eat green leafy vegetables.
Correct Answer: B. Hold the dose and notify the healthcare provider.
Rationale: An INR of 4.2 is above the therapeutic range (2.0–3.0) for atrial fibrillation,
indicating an increased risk of bleeding. The nurse should hold the dose and notify the provider
for further instructions, which may include dose adjustment or vitamin K administration.
Administering the dose increases bleeding risk, and vitamin K requires a prescription.
Encouraging green leafy vegetables may further alter INR due to their vitamin K content.
Question 4
A client in the emergency department reports chest pain and shortness of breath. The nurse notes
an oxygen saturation of 88%. Which action should the nurse take first?
A. Administer aspirin 325 mg orally.
B. Apply oxygen via nasal cannula.
C. Obtain a 12-lead ECG.
D. Notify the healthcare provider.
Correct Answer: B. Apply oxygen via nasal cannula.
Rationale: An oxygen saturation of 88% indicates hypoxemia, which is life-threatening and
requires immediate intervention. Applying oxygen is the priority to restore adequate
oxygenation. Obtaining an ECG, administering aspirin, or notifying the provider are important
but secondary to addressing hypoxemia.
Question 5
, 3
A client with chronic obstructive pulmonary disease (COPD) is prescribed albuterol via metered -
dose inhaler. The nurse observes the client using the inhaler incorrectly. What should the nurse
do?
A. Administer the medication for the client.
B. Instruct the client on proper inhaler technique.
C. Switch the client to a nebulizer treatment.
D. Document the observation and continue care.
Correct Answer: B. Instruct the client on proper inhaler technique.
Rationale: Proper inhaler technique is essential for effective medication delivery in COPD. The
nurse’s role includes patient education to ensure correct use, which improves outcomes.
Administering the medication or switching to a nebulizer requires a provider’s order.
Documentation alone does not address the client’s need for education.
Question 6
The nurse is caring for a client with a new diagnosis of hypertension prescribed lisinopril 10 mg
daily. Which statement by the client indicates a need for further teaching?
A. “I should report a persistent dry cough to my doctor.”
B. “I can take this medication with or without food.”
C. “I should avoid potassium supplements while on this drug.”
D. “This medication will cure my high blood pressure.”
Correct Answer: D. “This medication will cure my high blood pressure.”
Rationale: Lisinopril, an ACE inhibitor, controls hypertension but does not cure it. The client’s
statement indicates a misunderstanding that requires further education. The other statements
reflect accurate knowledge: a dry cough is a common side effect, lisinopril can be taken with or
without food, and potassium supplements should be avoided due to the risk of hyperkalemia.
Question 7
A client with a history of myocardial infarction is admitted with atrial fibrillation. The nurse
notes a heart rate of 120 bpm. Which medication should the nurse anticipate administering?
A. Digoxin 0.25 mg IV.
B. Metoprolol 25 mg orally.
C. Warfarin 5 mg orally.
D. Heparin 5000 units subcutaneously.
, 4
Correct Answer: B. Metoprolol 25 mg orally.
Rationale: Atrial fibrillation with a heart rate of 120 bpm requires rate control to reduce cardiac
workload. Metoprolol, a beta-blocker, is commonly used for this purpose. Digoxin may be used
but is less preferred for acute rate control. Warfarin and heparin address anticoagulation, not
heart rate.
Question 8
The nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client with diabetes reporting mild nausea.
B. A client with chest pain and diaphoresis.
C. A client with a fever of 100.4°F (38°C).
D. A client awaiting discharge instructions.
Correct Answer: B. A client with chest pain and diaphoresis.
Rationale: Chest pain with diaphoresis suggests a potential acute coronary syndrome, a life-
threatening condition requiring immediate assessment. Mild nausea, a low-grade fever, and
discharge teaching are lower priorities compared to a potential cardiac emergency.
Question 9
A client with a history of seizures is prescribed phenytoin 100 mg three times daily. The nurse
notes a serum phenytoin level of 8 mcg/mL. What is the nurse’s best action?
A. Administer the next dose as scheduled.
B. Hold the dose and notify the healthcare provider.
C. Increase the dose to 200 mg three times daily.
D. Monitor the client for seizure activity.
Correct Answer: B. Hold the dose and notify the healthcare provider.
Rationale: A phenytoin level of 8 mcg/mL is below the therapeutic range (10–20 mcg/mL),
indicating a risk of subtherapeutic effect and seizures. The nurse should hold the dose and notify
the provider for dose adjustment. Administering the dose continues ineffective treatment, and
increasing the dose requires a prescription. Monitoring alone does not address the subtherapeutic
level.
Question 10
2025 HESI RN Exit Exam Practice
Questions – Comprehensive Clinical
Scenarios & Verified Answers |
100% Accurate
Question 1
A client with type 2 diabetes mellitus is admitted with hyperglycemia. The nurse observes a
blood glucose level of 350 mg/dL. Which action should the nurse prioritize?
A. Administer insulin as prescribed.
B. Encourage the client to drink water.
C. Check the client’s urine for ketones.
D. Notify the healthcare provider immediately.
Correct Answer: C. Check the client’s urine for ketones.
Rationale: Hyperglycemia (blood glucose >250 mg/dL) in type 2 diabetes can lead to diabetic
ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Checking for ketones is the
priority to assess for DKA, which requires urgent intervention. Administering insulin and
notifying the provider may follow, but assessing ketones guides the urgency and type of
treatment. Encouraging water intake is secondary to confirming the presence of ketones.
Question 2
The nurse is delegating tasks to an unlicensed assistive personnel (UAP) for a client with heart
failure. Which task is appropriate to delegate?
A. Assessing the client’s breath sounds.
B. Administering furosemide 20 mg IV.
C. Measuring the client’s daily weight.
D. Teaching the client about a low-sodium diet.
Correct Answer: C. Measuring the client’s daily weight.
Rationale: Measuring daily weight is within the UAP’s scope of practice and is a critical task for
monitoring fluid status in heart failure. Assessing breath sounds and teaching require clinical
, 2
judgment, which are RN responsibilities. Administering IV medications is outside the UAP’s
scope.
Question 3
A client is prescribed warfarin 5 mg daily for atrial fibrillation. The latest INR is 4.2. What is the
nurse’s best action?
A. Administer the dose as prescribed.
B. Hold the dose and notify the healthcare provider.
C. Administer vitamin K as a standing order.
D. Encourage the client to eat green leafy vegetables.
Correct Answer: B. Hold the dose and notify the healthcare provider.
Rationale: An INR of 4.2 is above the therapeutic range (2.0–3.0) for atrial fibrillation,
indicating an increased risk of bleeding. The nurse should hold the dose and notify the provider
for further instructions, which may include dose adjustment or vitamin K administration.
Administering the dose increases bleeding risk, and vitamin K requires a prescription.
Encouraging green leafy vegetables may further alter INR due to their vitamin K content.
Question 4
A client in the emergency department reports chest pain and shortness of breath. The nurse notes
an oxygen saturation of 88%. Which action should the nurse take first?
A. Administer aspirin 325 mg orally.
B. Apply oxygen via nasal cannula.
C. Obtain a 12-lead ECG.
D. Notify the healthcare provider.
Correct Answer: B. Apply oxygen via nasal cannula.
Rationale: An oxygen saturation of 88% indicates hypoxemia, which is life-threatening and
requires immediate intervention. Applying oxygen is the priority to restore adequate
oxygenation. Obtaining an ECG, administering aspirin, or notifying the provider are important
but secondary to addressing hypoxemia.
Question 5
, 3
A client with chronic obstructive pulmonary disease (COPD) is prescribed albuterol via metered -
dose inhaler. The nurse observes the client using the inhaler incorrectly. What should the nurse
do?
A. Administer the medication for the client.
B. Instruct the client on proper inhaler technique.
C. Switch the client to a nebulizer treatment.
D. Document the observation and continue care.
Correct Answer: B. Instruct the client on proper inhaler technique.
Rationale: Proper inhaler technique is essential for effective medication delivery in COPD. The
nurse’s role includes patient education to ensure correct use, which improves outcomes.
Administering the medication or switching to a nebulizer requires a provider’s order.
Documentation alone does not address the client’s need for education.
Question 6
The nurse is caring for a client with a new diagnosis of hypertension prescribed lisinopril 10 mg
daily. Which statement by the client indicates a need for further teaching?
A. “I should report a persistent dry cough to my doctor.”
B. “I can take this medication with or without food.”
C. “I should avoid potassium supplements while on this drug.”
D. “This medication will cure my high blood pressure.”
Correct Answer: D. “This medication will cure my high blood pressure.”
Rationale: Lisinopril, an ACE inhibitor, controls hypertension but does not cure it. The client’s
statement indicates a misunderstanding that requires further education. The other statements
reflect accurate knowledge: a dry cough is a common side effect, lisinopril can be taken with or
without food, and potassium supplements should be avoided due to the risk of hyperkalemia.
Question 7
A client with a history of myocardial infarction is admitted with atrial fibrillation. The nurse
notes a heart rate of 120 bpm. Which medication should the nurse anticipate administering?
A. Digoxin 0.25 mg IV.
B. Metoprolol 25 mg orally.
C. Warfarin 5 mg orally.
D. Heparin 5000 units subcutaneously.
, 4
Correct Answer: B. Metoprolol 25 mg orally.
Rationale: Atrial fibrillation with a heart rate of 120 bpm requires rate control to reduce cardiac
workload. Metoprolol, a beta-blocker, is commonly used for this purpose. Digoxin may be used
but is less preferred for acute rate control. Warfarin and heparin address anticoagulation, not
heart rate.
Question 8
The nurse is prioritizing care for four clients. Which client should the nurse assess first?
A. A client with diabetes reporting mild nausea.
B. A client with chest pain and diaphoresis.
C. A client with a fever of 100.4°F (38°C).
D. A client awaiting discharge instructions.
Correct Answer: B. A client with chest pain and diaphoresis.
Rationale: Chest pain with diaphoresis suggests a potential acute coronary syndrome, a life-
threatening condition requiring immediate assessment. Mild nausea, a low-grade fever, and
discharge teaching are lower priorities compared to a potential cardiac emergency.
Question 9
A client with a history of seizures is prescribed phenytoin 100 mg three times daily. The nurse
notes a serum phenytoin level of 8 mcg/mL. What is the nurse’s best action?
A. Administer the next dose as scheduled.
B. Hold the dose and notify the healthcare provider.
C. Increase the dose to 200 mg three times daily.
D. Monitor the client for seizure activity.
Correct Answer: B. Hold the dose and notify the healthcare provider.
Rationale: A phenytoin level of 8 mcg/mL is below the therapeutic range (10–20 mcg/mL),
indicating a risk of subtherapeutic effect and seizures. The nurse should hold the dose and notify
the provider for dose adjustment. Administering the dose continues ineffective treatment, and
increasing the dose requires a prescription. Monitoring alone does not address the subtherapeutic
level.
Question 10
