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HESI RN EXIT EXAM 2025/2026 | 320 NCLEX-STYLE
QUESTIONS WITH VERIFIED ANSWERS & A+
RATIONALES | COMPLETE NURSING STUDY GUIDE
Question 1
A nurse is caring for a client admitted with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The client is restless, has a respiratory rate
of 28/min, and an oxygen saturation of 88% on room air. Which action should the
nurse take first?
A. Apply 6 L/min oxygen via nasal cannula
B. Place the client in high Fowler’s position
C. Notify the healthcare provider
D. Encourage the client to increase fluid intake
Correct Answer: B. Place the client in high Fowler’s position
Rationale: High Fowler’s position immediately improves ventilation and lung
expansion. Oxygen should be administered cautiously in COPD (not high-flow
without provider order). Notifying the provider and encouraging fluids are
appropriate but not priority interventions.
Question 2
The nurse is caring for a client receiving IV furosemide for management of heart
failure. Which laboratory value should the nurse monitor most closely?
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A. Hemoglobin
B. Sodium
C. Potassium
D. Creatinine
Correct Answer: C. Potassium
Rationale: Loop diuretics such as furosemide cause significant potassium loss,
placing the client at risk for hypokalemia, dysrhythmias, and muscle weakness.
Sodium and creatinine should be monitored as well, but potassium depletion is the
priority.
Question 3
Before administering a scheduled dose of digoxin to an adult client, the nurse
auscultates an apical heart rate of 52 beats per minute. What is the most
appropriate nursing action?
A. Administer the digoxin with food to reduce gastrointestinal upset
B. Hold the medication and notify the healthcare provider
C. Recheck the heart rate in 30 minutes and give if greater than 60
D. Document the finding and proceed with medication administration
Correct Answer: B. Hold the medication and notify the healthcare provider
Rationale: Digoxin slows conduction through the AV node and decreases heart
rate. It should not be administered if the pulse is less than 60 beats/min in adults.
Administering the drug could cause severe bradycardia.
Question 4
A client is admitted with diabetic ketoacidosis (DKA). The nurse notes Kussmaul
respirations, fruity odor to the breath, blood glucose of 320 mg/dL, and polyuria.
Which finding is the priority concern?
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A. Blood glucose of 320 mg/dL
B. Kussmaul respirations
C. Fruity odor to the breath
D. Polyuria
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations indicate the body’s attempt to correct severe
metabolic acidosis. While elevated glucose, fruity breath, and polyuria are classic
signs of DKA, the priority is monitoring and managing the acid-base imbalance
and respiratory effort.
Question 5
A client undergoing chemotherapy reports painful mouth sores and difficulty
eating. Which nursing action is most appropriate?
A. Provide lemon glycerin swabs for oral care
B. Offer soft, bland foods that are non-irritating
C. Encourage use of commercial mouthwash with alcohol
D. Restrict fluid intake before meals to prevent nausea
Correct Answer: B. Offer soft, bland foods that are non-irritating
Rationale: Chemotherapy can cause stomatitis and mucositis. Soft, bland foods
reduce irritation and promote nutritional intake. Alcohol-based mouthwashes and
lemon swabs increase irritation. Restricting fluids before meals does not address
the underlying problem.
Question 6
The nurse is assessing a client with pneumonia who is receiving oxygen therapy.
Which finding indicates early hypoxemia?
A. Cyanosis of lips and nail beds
B. Confusion and decreased level of consciousness
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C. Restlessness and anxiety
D. Bradycardia with irregular rhythm
Correct Answer: C. Restlessness and anxiety
Rationale: Restlessness and anxiety are early manifestations of hypoxemia.
Cyanosis and confusion occur as oxygenation worsens. Bradycardia is a late sign
of severe hypoxemia.
Question 7
A nurse is caring for a client who had a thyroidectomy 4 hours ago. Which
assessment finding requires immediate action?
A. Hoarseness when speaking and stridor
B. Small amount of serosanguinous drainage on the dressing
C. Mild pain at the incision site
D. Calcium level of 8.9 mg/dL
Correct Answer: A. Hoarseness when speaking and stridor
Rationale: Stridor or hoarseness may indicate airway obstruction from edema or
bleeding, which is a life-threatening complication. The other findings are expected
or non-urgent.
Question 8
The nurse is reviewing lab results for a client prescribed warfarin. Which value is
most important to monitor for therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Hemoglobin level
Correct Answer: B. International normalized ratio (INR)
HESI RN EXIT EXAM 2025/2026 | 320 NCLEX-STYLE
QUESTIONS WITH VERIFIED ANSWERS & A+
RATIONALES | COMPLETE NURSING STUDY GUIDE
Question 1
A nurse is caring for a client admitted with an acute exacerbation of chronic
obstructive pulmonary disease (COPD). The client is restless, has a respiratory rate
of 28/min, and an oxygen saturation of 88% on room air. Which action should the
nurse take first?
A. Apply 6 L/min oxygen via nasal cannula
B. Place the client in high Fowler’s position
C. Notify the healthcare provider
D. Encourage the client to increase fluid intake
Correct Answer: B. Place the client in high Fowler’s position
Rationale: High Fowler’s position immediately improves ventilation and lung
expansion. Oxygen should be administered cautiously in COPD (not high-flow
without provider order). Notifying the provider and encouraging fluids are
appropriate but not priority interventions.
Question 2
The nurse is caring for a client receiving IV furosemide for management of heart
failure. Which laboratory value should the nurse monitor most closely?
,2|Page
A. Hemoglobin
B. Sodium
C. Potassium
D. Creatinine
Correct Answer: C. Potassium
Rationale: Loop diuretics such as furosemide cause significant potassium loss,
placing the client at risk for hypokalemia, dysrhythmias, and muscle weakness.
Sodium and creatinine should be monitored as well, but potassium depletion is the
priority.
Question 3
Before administering a scheduled dose of digoxin to an adult client, the nurse
auscultates an apical heart rate of 52 beats per minute. What is the most
appropriate nursing action?
A. Administer the digoxin with food to reduce gastrointestinal upset
B. Hold the medication and notify the healthcare provider
C. Recheck the heart rate in 30 minutes and give if greater than 60
D. Document the finding and proceed with medication administration
Correct Answer: B. Hold the medication and notify the healthcare provider
Rationale: Digoxin slows conduction through the AV node and decreases heart
rate. It should not be administered if the pulse is less than 60 beats/min in adults.
Administering the drug could cause severe bradycardia.
Question 4
A client is admitted with diabetic ketoacidosis (DKA). The nurse notes Kussmaul
respirations, fruity odor to the breath, blood glucose of 320 mg/dL, and polyuria.
Which finding is the priority concern?
,3|Page
A. Blood glucose of 320 mg/dL
B. Kussmaul respirations
C. Fruity odor to the breath
D. Polyuria
Correct Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations indicate the body’s attempt to correct severe
metabolic acidosis. While elevated glucose, fruity breath, and polyuria are classic
signs of DKA, the priority is monitoring and managing the acid-base imbalance
and respiratory effort.
Question 5
A client undergoing chemotherapy reports painful mouth sores and difficulty
eating. Which nursing action is most appropriate?
A. Provide lemon glycerin swabs for oral care
B. Offer soft, bland foods that are non-irritating
C. Encourage use of commercial mouthwash with alcohol
D. Restrict fluid intake before meals to prevent nausea
Correct Answer: B. Offer soft, bland foods that are non-irritating
Rationale: Chemotherapy can cause stomatitis and mucositis. Soft, bland foods
reduce irritation and promote nutritional intake. Alcohol-based mouthwashes and
lemon swabs increase irritation. Restricting fluids before meals does not address
the underlying problem.
Question 6
The nurse is assessing a client with pneumonia who is receiving oxygen therapy.
Which finding indicates early hypoxemia?
A. Cyanosis of lips and nail beds
B. Confusion and decreased level of consciousness
, 4|Page
C. Restlessness and anxiety
D. Bradycardia with irregular rhythm
Correct Answer: C. Restlessness and anxiety
Rationale: Restlessness and anxiety are early manifestations of hypoxemia.
Cyanosis and confusion occur as oxygenation worsens. Bradycardia is a late sign
of severe hypoxemia.
Question 7
A nurse is caring for a client who had a thyroidectomy 4 hours ago. Which
assessment finding requires immediate action?
A. Hoarseness when speaking and stridor
B. Small amount of serosanguinous drainage on the dressing
C. Mild pain at the incision site
D. Calcium level of 8.9 mg/dL
Correct Answer: A. Hoarseness when speaking and stridor
Rationale: Stridor or hoarseness may indicate airway obstruction from edema or
bleeding, which is a life-threatening complication. The other findings are expected
or non-urgent.
Question 8
The nurse is reviewing lab results for a client prescribed warfarin. Which value is
most important to monitor for therapeutic effectiveness?
A. Activated partial thromboplastin time (aPTT)
B. International normalized ratio (INR)
C. Platelet count
D. Hemoglobin level
Correct Answer: B. International normalized ratio (INR)
