HESI RN Exit Exam Final 2025–2026 | A+ Verified Questions
& Answers | 100% Pass Guarantee
Q1. Respiratory – COPD Exacerbation
A 68-year-old male with a history of chronic obstructive pulmonary disease
(COPD) is admitted with worsening shortness of breath. He is on 2 L/min oxygen
via nasal cannula. On assessment, the nurse finds the patient in tripod position,
with a respiratory rate of 34/min, oxygen saturation 84%, and use of accessory
muscles. What is the nurse’s priority action?
A. Notify the health care provider immediately
B. Increase oxygen flow to 6 L/min via nasal cannula
C. Position the patient upright and administer a prescribed short-acting
bronchodilator
D. Begin chest physiotherapy and percussion
Correct Answer: C
Rationale (paragraph):
In a patient experiencing an acute COPD exacerbation, the priority is to improve
ventilation and oxygenation using interventions that directly target airway
constriction. Placing the patient upright facilitates maximum lung expansion, and
administering a short-acting bronchodilator addresses bronchospasm, which is
often the cause of acute distress. Although notifying the provider (A) is important,
immediate interventions within the nurse’s scope should come first to stabilize the
patient. Increasing oxygen flow to 6 L/min (B) is not the best option because
,excessive oxygen in COPD can suppress the hypoxic respiratory drive and lead to
CO₂ retention; oxygen should be titrated carefully, often using a Venturi mask if
higher concentrations are required. Chest physiotherapy (D) is not appropriate in
acute respiratory distress as it does not provide immediate relief and may worsen
fatigue. Therefore, the correct priority intervention is positioning combined with
bronchodilator therapy.
Q2. Postpartum – Pulmonary Embolism
Two hours after a cesarean delivery, a 32-year-old woman reports sudden shortness
of breath and chest pain. She appears anxious, diaphoretic, and tachypneic. Her
blood pressure is 88/56 mm Hg, heart rate 132/min, respiratory rate 30/min, and
oxygen saturation 82% on 4 L nasal cannula. The nurse suspects a pulmonary
embolism. What is the nurse’s most important immediate action?
A. Place the client in Trendelenburg position
B. Administer prescribed morphine for chest pain
C. Apply high-flow oxygen via non-rebreather mask
D. Call the rapid response team for emergency management
Correct Answer: C
Rationale (paragraph):
Pulmonary embolism is a life-threatening complication characterized by acute
hypoxemia, chest pain, and hemodynamic instability. The nurse’s first
responsibility is to support oxygenation and minimize hypoxia. Applying high-
flow oxygen using a non-rebreather mask delivers a FiO₂ up to 100%, which is
critical for stabilizing the client until advanced interventions are initiated. While
calling the rapid response team (D) is essential, this must occur after the nurse
,addresses the airway and breathing priorities. Administering morphine (B) for
chest pain does not address the underlying hypoxemia and may even worsen
hypotension due to vasodilation. Placing the client in Trendelenburg (A) is
inappropriate because it impairs diaphragmatic movement and can further
compromise ventilation. Therefore, the most important immediate nursing action is
applying high-flow oxygen via a non-rebreather mask.
Q3. Pharmacology – Vancomycin Infusion Reaction
A patient receiving an IV infusion of vancomycin suddenly develops flushing of
the face and upper body, generalized itching, and hypotension. The nurse
recognizes these symptoms as “Red Man Syndrome.” What is the nurse’s best
action?
A. Stop the infusion immediately and notify the provider
B. Slow the infusion rate and monitor for improvement
C. Document findings as an expected side effect
D. Administer diphenhydramine and restart the infusion rapidly
Correct Answer: B
Rationale (paragraph):
Red Man Syndrome is an infusion-related reaction that occurs when vancomycin is
administered too quickly. It is not a true allergic reaction but a histamine-mediated
response. The appropriate nursing action is to slow the infusion rate and carefully
monitor the patient’s symptoms. Stopping the infusion immediately (A) is
unnecessary unless symptoms progress to more severe manifestations such as
airway compromise or anaphylaxis, which would indicate a true allergic reaction.
Documenting it as an expected side effect (C) minimizes the seriousness of the
, condition and fails to address the patient’s current symptoms. Restarting the
infusion rapidly (D), even after diphenhydramine, would worsen the problem
because the underlying cause is the rate of administration. Therefore, slowing the
infusion rate and monitoring the patient is the best action.
Q3. Diabetes – DKA Management
A 22-year-old patient with type 1 diabetes is admitted with diabetic ketoacidosis
(DKA). The client is lethargic, with a blood glucose of 498 mg/dL, potassium of
3.0 mEq/L, and arterial blood gas showing metabolic acidosis. Which physician
order should the nurse implement first?
A. Begin IV regular insulin infusion at 0.1 units/kg/hr
B. Start 0.9% normal saline at 1 L over 1 hour
C. Administer 40 mEq potassium chloride IV over 1 hour
D. Draw hemoglobin A1c level
Correct Answer: B
Rationale:
In the management of DKA, the priority intervention is fluid resuscitation with
isotonic saline. Patients in DKA are profoundly dehydrated due to osmotic diuresis,
and restoring intravascular volume is critical before initiating insulin therapy.
Insulin (A) is necessary but should not be started until after fluids, as insulin
without volume expansion can precipitate shock. Potassium replacement (C) is also
essential because insulin will drive potassium into the cells, worsening
hypokalemia, but it follows after fluids are initiated and cardiac monitoring is
established. Drawing HbA1c (D) is part of long-term diabetes management and is
& Answers | 100% Pass Guarantee
Q1. Respiratory – COPD Exacerbation
A 68-year-old male with a history of chronic obstructive pulmonary disease
(COPD) is admitted with worsening shortness of breath. He is on 2 L/min oxygen
via nasal cannula. On assessment, the nurse finds the patient in tripod position,
with a respiratory rate of 34/min, oxygen saturation 84%, and use of accessory
muscles. What is the nurse’s priority action?
A. Notify the health care provider immediately
B. Increase oxygen flow to 6 L/min via nasal cannula
C. Position the patient upright and administer a prescribed short-acting
bronchodilator
D. Begin chest physiotherapy and percussion
Correct Answer: C
Rationale (paragraph):
In a patient experiencing an acute COPD exacerbation, the priority is to improve
ventilation and oxygenation using interventions that directly target airway
constriction. Placing the patient upright facilitates maximum lung expansion, and
administering a short-acting bronchodilator addresses bronchospasm, which is
often the cause of acute distress. Although notifying the provider (A) is important,
immediate interventions within the nurse’s scope should come first to stabilize the
patient. Increasing oxygen flow to 6 L/min (B) is not the best option because
,excessive oxygen in COPD can suppress the hypoxic respiratory drive and lead to
CO₂ retention; oxygen should be titrated carefully, often using a Venturi mask if
higher concentrations are required. Chest physiotherapy (D) is not appropriate in
acute respiratory distress as it does not provide immediate relief and may worsen
fatigue. Therefore, the correct priority intervention is positioning combined with
bronchodilator therapy.
Q2. Postpartum – Pulmonary Embolism
Two hours after a cesarean delivery, a 32-year-old woman reports sudden shortness
of breath and chest pain. She appears anxious, diaphoretic, and tachypneic. Her
blood pressure is 88/56 mm Hg, heart rate 132/min, respiratory rate 30/min, and
oxygen saturation 82% on 4 L nasal cannula. The nurse suspects a pulmonary
embolism. What is the nurse’s most important immediate action?
A. Place the client in Trendelenburg position
B. Administer prescribed morphine for chest pain
C. Apply high-flow oxygen via non-rebreather mask
D. Call the rapid response team for emergency management
Correct Answer: C
Rationale (paragraph):
Pulmonary embolism is a life-threatening complication characterized by acute
hypoxemia, chest pain, and hemodynamic instability. The nurse’s first
responsibility is to support oxygenation and minimize hypoxia. Applying high-
flow oxygen using a non-rebreather mask delivers a FiO₂ up to 100%, which is
critical for stabilizing the client until advanced interventions are initiated. While
calling the rapid response team (D) is essential, this must occur after the nurse
,addresses the airway and breathing priorities. Administering morphine (B) for
chest pain does not address the underlying hypoxemia and may even worsen
hypotension due to vasodilation. Placing the client in Trendelenburg (A) is
inappropriate because it impairs diaphragmatic movement and can further
compromise ventilation. Therefore, the most important immediate nursing action is
applying high-flow oxygen via a non-rebreather mask.
Q3. Pharmacology – Vancomycin Infusion Reaction
A patient receiving an IV infusion of vancomycin suddenly develops flushing of
the face and upper body, generalized itching, and hypotension. The nurse
recognizes these symptoms as “Red Man Syndrome.” What is the nurse’s best
action?
A. Stop the infusion immediately and notify the provider
B. Slow the infusion rate and monitor for improvement
C. Document findings as an expected side effect
D. Administer diphenhydramine and restart the infusion rapidly
Correct Answer: B
Rationale (paragraph):
Red Man Syndrome is an infusion-related reaction that occurs when vancomycin is
administered too quickly. It is not a true allergic reaction but a histamine-mediated
response. The appropriate nursing action is to slow the infusion rate and carefully
monitor the patient’s symptoms. Stopping the infusion immediately (A) is
unnecessary unless symptoms progress to more severe manifestations such as
airway compromise or anaphylaxis, which would indicate a true allergic reaction.
Documenting it as an expected side effect (C) minimizes the seriousness of the
, condition and fails to address the patient’s current symptoms. Restarting the
infusion rapidly (D), even after diphenhydramine, would worsen the problem
because the underlying cause is the rate of administration. Therefore, slowing the
infusion rate and monitoring the patient is the best action.
Q3. Diabetes – DKA Management
A 22-year-old patient with type 1 diabetes is admitted with diabetic ketoacidosis
(DKA). The client is lethargic, with a blood glucose of 498 mg/dL, potassium of
3.0 mEq/L, and arterial blood gas showing metabolic acidosis. Which physician
order should the nurse implement first?
A. Begin IV regular insulin infusion at 0.1 units/kg/hr
B. Start 0.9% normal saline at 1 L over 1 hour
C. Administer 40 mEq potassium chloride IV over 1 hour
D. Draw hemoglobin A1c level
Correct Answer: B
Rationale:
In the management of DKA, the priority intervention is fluid resuscitation with
isotonic saline. Patients in DKA are profoundly dehydrated due to osmotic diuresis,
and restoring intravascular volume is critical before initiating insulin therapy.
Insulin (A) is necessary but should not be started until after fluids, as insulin
without volume expansion can precipitate shock. Potassium replacement (C) is also
essential because insulin will drive potassium into the cells, worsening
hypokalemia, but it follows after fluids are initiated and cardiac monitoring is
established. Drawing HbA1c (D) is part of long-term diabetes management and is
