HESI EXIT RN PRACTICE EXAM – HARD LEVEL LATEST EXAM 2026
FOUNDATIONS / PRIORITIZATION / SAFETY
1. A nurse receives report on four clients. Which client should the nurse assess
first?
Answer: B. Client with chest pain rated 8/10, unrelieved by nitroglycerin
Rationale: Unrelieved chest pain may indicate myocardial infarction. This is an
immediate priority (ABCs: airway, breathing, circulation).
2. A nurse prepares to administer medications through a PEG tube. Which
action requires intervention?
Answer: A. Crushing an extended-release tablet
Rationale: Extended-release tablets should not be crushed because it can cause
toxicity or reduce efficacy.
3. Which infection control action by the nurse requires correction?
Answer: D. Wearing a gown and gloves for a client with C. diff, then using
alcohol sanitizer
Rationale: C. diff spores are resistant to alcohol; soap and water must be used to
wash hands.
4. The nurse is caring for a client who received 5 mg IV morphine 30 minutes
ago and now has RR 8/min. What is the nurse’s priority action?
Answer: B. Administer naloxone per protocol
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, Rationale: Respiratory depression is life-threatening. Naloxone reverses opioid
overdose.
5. The nurse delegates to an experienced UAP. Which task is appropriate?
Answer: B. Record intake and output for a client on diuretics
Rationale: UAPs can safely collect objective data, such as intake and output,
without assessment or interpretation.
CARDIOVASCULAR / RESPIRATORY
6. A client with heart failure reports shortness of breath and 3+ pitting edema.
Which lab value is most important to review?
Answer: A. BNP
Rationale: BNP levels indicate severity of heart failure and fluid overload.
7. The nurse hears crackles in both lungs of a client receiving IV fluids at 150
mL/hr. What should the nurse do first?
Answer: A. Slow the infusion
Rationale: Slowing or stopping fluids prevents worsening pulmonary edema; this
is the first action.
8. Which finding in a client with a chest tube requires immediate
intervention?
Answer: C. Drainage of 400 mL bright red blood in 1 hour
Rationale: Rapid, bright red drainage suggests hemorrhage and is life-threatening.
9. The nurse administers furosemide IV to a client with pulmonary edema.
Which finding indicates effectiveness?
Answer: B. Improved oxygen saturation
Rationale: Diuretics reduce pulmonary congestion, improving oxygenation.
10. A client with COPD is prescribed oxygen at 4 L/min via nasal cannula.
The nurse should:
Answer: B. Lower flow to 2 L/min
Rationale: High O₂ flow can suppress hypoxic drive in COPD; low flow maintains
safe oxygenation.
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EXAMPREPMASTER
FOUNDATIONS / PRIORITIZATION / SAFETY
1. A nurse receives report on four clients. Which client should the nurse assess
first?
Answer: B. Client with chest pain rated 8/10, unrelieved by nitroglycerin
Rationale: Unrelieved chest pain may indicate myocardial infarction. This is an
immediate priority (ABCs: airway, breathing, circulation).
2. A nurse prepares to administer medications through a PEG tube. Which
action requires intervention?
Answer: A. Crushing an extended-release tablet
Rationale: Extended-release tablets should not be crushed because it can cause
toxicity or reduce efficacy.
3. Which infection control action by the nurse requires correction?
Answer: D. Wearing a gown and gloves for a client with C. diff, then using
alcohol sanitizer
Rationale: C. diff spores are resistant to alcohol; soap and water must be used to
wash hands.
4. The nurse is caring for a client who received 5 mg IV morphine 30 minutes
ago and now has RR 8/min. What is the nurse’s priority action?
Answer: B. Administer naloxone per protocol
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Page
EXAMPREPMASTER
, Rationale: Respiratory depression is life-threatening. Naloxone reverses opioid
overdose.
5. The nurse delegates to an experienced UAP. Which task is appropriate?
Answer: B. Record intake and output for a client on diuretics
Rationale: UAPs can safely collect objective data, such as intake and output,
without assessment or interpretation.
CARDIOVASCULAR / RESPIRATORY
6. A client with heart failure reports shortness of breath and 3+ pitting edema.
Which lab value is most important to review?
Answer: A. BNP
Rationale: BNP levels indicate severity of heart failure and fluid overload.
7. The nurse hears crackles in both lungs of a client receiving IV fluids at 150
mL/hr. What should the nurse do first?
Answer: A. Slow the infusion
Rationale: Slowing or stopping fluids prevents worsening pulmonary edema; this
is the first action.
8. Which finding in a client with a chest tube requires immediate
intervention?
Answer: C. Drainage of 400 mL bright red blood in 1 hour
Rationale: Rapid, bright red drainage suggests hemorrhage and is life-threatening.
9. The nurse administers furosemide IV to a client with pulmonary edema.
Which finding indicates effectiveness?
Answer: B. Improved oxygen saturation
Rationale: Diuretics reduce pulmonary congestion, improving oxygenation.
10. A client with COPD is prescribed oxygen at 4 L/min via nasal cannula.
The nurse should:
Answer: B. Lower flow to 2 L/min
Rationale: High O₂ flow can suppress hypoxic drive in COPD; low flow maintains
safe oxygenation.
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Page
EXAMPREPMASTER
