HESI RN Exam Newest Update 2025/26 Multiple Choice
Questions & Verified Answers, 100% Guaranteed Pass ||
Complete A+ Guide | 150 Verified Questions
HESI RN Exam 2025-2026 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 150 multiple-choice questions and verified answers
for the HESI RN Exam, updated for the 2025/2026 academic year. Each question is accompanied by
detailed rationales and distractor explanations to reinforce learning. Designed to guarantee a pass, this
guide covers all core nursing subjects including medical-surgical, maternal-newborn, pediatric,
psychiatric, and leadership. Perfect for nursing students seeking a complete A+ guide to ace the HESI
exit exam.
Key Features:
Medical-Surgical Nursing (adult health, perioperative care, fluid/electrolytes)
Maternal-Newborn Nursing (antepartum, intrapartum, postpartum, newborn care)
Pediatric Nursing (growth/development, common illnesses, immunizations)
Psychiatric Nursing (therapeutic communication, disorders, interventions)
Leadership & Management (delegation, prioritization, ethics, quality improvement)
Pharmacology (drug calculations, side effects, nursing considerations)
Updates for 2026:
- Updated to reflect 2025/2026 HESI RN test plan changes
- Revised rationales with evidence-based practice guidelines
- Added new questions on COVID-19 management and telehealth
- Enhanced distractor explanations for common misconceptions
- Aligned with latest NCLEX-RN test blueprint standards
Abstract:
The HESI RN Exam is a critical milestone for nursing students, assessing readiness for professional practice. This
document provides 150 meticulously curated multiple-choice questions covering all major content areas:
medical-surgical, maternal-newborn, pediatric, psychiatric, and leadership. Each question includes a verified
answer, a detailed rationale explaining the correct choice, and distractor analyses clarifying why other options are
incorrect. Updated for the 2025/2026 academic year, the content reflects the latest evidence-based guidelines and
test plan changes. Designed to promote deep understanding and retention, this guide ensures students are
well-prepared to achieve a passing score. With a focus on high-yield topics and clinical reasoning, it serves as a
comprehensive study tool for nursing students aiming for an A+ grade. The structured format allows for systematic
review, while the answer format enhances critical thinking. This resource is essential for anyone seeking to
confidently pass the HESI RN Exam on their first attempt.
Keywords:
HESI RN Exam, Nursing exam prep, Multiple choice questions, Verified answers, Medical-surgical nursing,
Maternal-newborn nursing, Pediatric nursing, Psychiatric nursing
Answer Format:
Each question is followed by the correct answer letter (A, B, C, or D) and a detailed rationale explaining the
reasoning behind the correct choice. Additionally, distractor explanations are provided for each incorrect option,
clarifying common errors and reinforcing key concepts. This format helps students understand not only what is
correct but also why other options are wrong.
Page 1
,Compliance Checklist:
All questions aligned with 2025/2026 HESI RN test plan
Answers verified by subject matter experts
Rationales cite current evidence-based practice
Distractor explanations address common student errors
Content covers all major nursing specialties
Suitable for self-study or group review
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-40 Adult health, perioperative care, 27%
fluid/electrolytes, cardiovascular,
respiratory, gastrointestinal, endocrine,
renal, oncology
Maternal-Newborn Nursing 41-65 Antepartum, intrapartum, postpartum, 17%
newborn assessment, breastfeeding,
complications
Pediatric Nursing 66-90 Growth and development, common 17%
childhood illnesses, immunizations, safety,
family-centered care
Psychiatric Nursing 91-115 Therapeutic communication, mood 17%
disorders, anxiety disorders, schizophrenia,
substance abuse, crisis intervention
Leadership & Management 116-135 Delegation, prioritization, ethics, legal 13%
issues, quality improvement, conflict
resolution
Pharmacology 136-150 Drug calculations, side effects, nursing 9%
considerations, medication administration,
IV therapy
Page 2
,Q1. A patient with a history of chronic heart failure (HFrEF) presents with acute dyspnea, orthopnea, and
frothy pink sputum. Current medications include lisinopril 20 mg daily, metoprolol succinate 100 mg daily,
and furosemide 40 mg twice daily. Vital signs: BP 88/52 mmHg, HR 112 bpm, RR 28, SpO2 88% on room
air. Which intervention should the nurse implement FIRST?
A. Administer intravenous furosemide 80 mg push over 2 minutes.
B. Apply non-rebreather mask at 15 L/min and prepare for noninvasive positive pressure ventilation.
C. Hold metoprolol succinate and administer intravenous normal saline bolus of 500 mL.
D. Obtain a stat echocardiogram and notify the electrophysiology team.
Correct Answer: B. Apply non-rebreather mask at 15 L/min and prepare for noninvasive positive pressure
ventilation.
Rationale: The patient is in acute cardiogenic pulmonary edema with severe hypoxemia. The priority is to improve
oxygenation and reduce work of breathing; noninvasive positive pressure ventilation (NIPPV) provides positive
end-expiratory pressure (PEEP) to decrease preload and improve gas exchange. Furosemide is indicated but
should be given slowly (not push) to avoid ototoxicity; the hypotension precludes aggressive diuresis initially.
Metoprolol should be held but a fluid bolus is contraindicated in acute decompensated HF due to fluid overload.
Echocardiogram is not the first priority.
Why Wrong:
A - IV furosemide is needed but rapid push risks ototoxicity and the hypotension suggests cautious
administration; also, oxygenation takes precedence.
C - Fluid bolus would worsen pulmonary edema; holding metoprolol is appropriate but not the first action.
D - Echocardiogram is diagnostic, not therapeutic; delay in oxygenation could be fatal.
Reference: Yancy, C.W., et al. (2023). ACC/AHA/HFSA Guideline for the Management of Heart Failure.
Circulation, 145(18), e895-e1032.
Q2. A patient receiving a continuous infusion of heparin for acute pulmonary embolism has an aPTT of 110
seconds (therapeutic range 60-80 seconds). The nurse notes a small amount of blood in the urine and a new
bruise on the arm. What is the nurse's priority action?
A. Decrease the heparin infusion rate by 50% and recheck aPTT in 4 hours.
B. Stop the heparin infusion immediately and administer protamine sulfate.
C. Obtain a complete blood count and assess for signs of retroperitoneal bleeding.
D. Administer vitamin K 10 mg orally and apply pressure to the bruise.
Correct Answer: B. Stop the heparin infusion immediately and administer protamine sulfate.
Rationale: The patient has a supratherapeutic aPTT with evidence of bleeding (hematuria, bruising), indicating
heparin overdose. The priority is to stop the infusion and reverse heparin with protamine sulfate (1 mg per 100
units of heparin) to prevent life-threatening hemorrhage. Decreasing the rate is insufficient because the aPTT is
dangerously high. CBC is important but not the first action; vitamin K reverses warfarin, not heparin. Immediate
reversal is critical.
Why Wrong:
A - Decreasing the rate does not correct the existing supratherapeutic level and ongoing bleeding risk;
reversal is needed.
C - Assessing for retroperitoneal bleeding is important but should follow immediate reversal of
anticoagulation.
D - Vitamin K is used for warfarin reversal, not heparin; pressure on bruise is supportive but not the priority.
Reference: Garcia, D.A., et al. (2022). Antithrombotic Therapy for VTE Disease: CHEST Guideline. Chest, 162(1),
e1-e52.
Page 3
, Q3. A patient with end-stage renal disease (ESRD) on hemodialysis is admitted with confusion and muscle
weakness. ECG shows peaked T waves and widened QRS complex. Serum potassium is 7.2 mEq/L. The nurse
prepares to administer intravenous calcium gluconate. Which statement best explains the rationale for this
intervention?
A. Calcium gluconate directly lowers serum potassium by binding to it.
B. Calcium gluconate stabilizes the cardiac membrane, reducing the risk of ventricular fibrillation.
C. Calcium gluconate shifts potassium from the extracellular to the intracellular compartment.
D. Calcium gluconate enhances renal excretion of potassium through the dialysis membrane.
Correct Answer: B. Calcium gluconate stabilizes the cardiac membrane, reducing the risk of ventricular fibrillation.
Rationale: Calcium gluconate does not lower serum potassium; it antagonizes the cardiotoxic effects of hyperkalemia by
stabilizing the myocardial cell membrane and raising the threshold for ventricular arrhythmias. It is a temporizing measure
while initiating definitive treatment (e.g., insulin + glucose, albuterol, dialysis). Option A is incorrect because calcium does not
bind potassium. Option C describes the action of insulin and beta-agonists. Option D is false; calcium does not enhance
potassium excretion.
Why Wrong:
A - Calcium does not chemically bind potassium; it acts on cardiac membranes.
C - Shifting potassium intracellularly is achieved by insulin or beta-agonists, not calcium.
D - Calcium does not affect renal or dialysis excretion of potassium.
Reference: Mount, D.B. (2024). Treatment and Prevention of Hyperkalemia in Adults. UpToDate. Retrieved from
www.uptodate.com.
Q4. A patient on a medical-surgical unit is receiving a blood transfusion of packed red blood cells. Fifteen
minutes into the transfusion, the patient develops a temperature of 38.9°C, chills, and lower back pain. Vital
signs: BP 100/60 mmHg, HR 110 bpm, RR 22. What is the nurse's priority action?
A. Slow the transfusion rate and administer acetaminophen per protocol.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Obtain a blood culture and start broad-spectrum antibiotics.
D. Increase the infusion rate to complete the transfusion quickly and reduce symptoms.
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline.
Rationale: The symptoms suggest a hemolytic transfusion reaction (fever, chills, back pain), which is a medical
emergency. The priority is to stop the transfusion immediately to prevent further hemolysis and acute kidney injury.
The IV line should be kept open with normal saline to maintain access for emergency medications. Slowing the rate
(A) still exposes the patient to incompatible blood. Antibiotics (C) are not indicated unless infection is confirmed.
Increasing the rate (D) would worsen the reaction.
Why Wrong:
A - Slowing the rate does not prevent continued hemolysis; transfusion must be stopped.
C - Blood cultures are not the first priority; the reaction is likely immune-mediated, not infectious.
D - Increasing the rate would exacerbate the hemolytic reaction and could be fatal.
Reference: American Association of Blood Banks. (2023). Standards for Blood Banks and Transfusion Services,
33rd Ed. Bethesda, MD: AABB.
Q5. A nurse is caring for a patient who has just been diagnosed with metastatic lung cancer. The patient's
family asks the nurse to withhold the diagnosis from the patient to avoid emotional distress. Which ethical
principle primarily guides the nurse's response?
A. Beneficence: the duty to do good by protecting the patient from harm.
B. Nonmaleficence: the duty to avoid causing harm by disclosing distressing information.
C. Autonomy: the patient's right to be informed and make decisions about their own care.
D. Justice: the duty to allocate resources fairly and not favor the family's wishes.
Correct Answer: C. Autonomy: the patient's right to be informed and make decisions about their own care.
Page 4
Questions & Verified Answers, 100% Guaranteed Pass ||
Complete A+ Guide | 150 Verified Questions
HESI RN Exam 2025-2026 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document contains 150 multiple-choice questions and verified answers
for the HESI RN Exam, updated for the 2025/2026 academic year. Each question is accompanied by
detailed rationales and distractor explanations to reinforce learning. Designed to guarantee a pass, this
guide covers all core nursing subjects including medical-surgical, maternal-newborn, pediatric,
psychiatric, and leadership. Perfect for nursing students seeking a complete A+ guide to ace the HESI
exit exam.
Key Features:
Medical-Surgical Nursing (adult health, perioperative care, fluid/electrolytes)
Maternal-Newborn Nursing (antepartum, intrapartum, postpartum, newborn care)
Pediatric Nursing (growth/development, common illnesses, immunizations)
Psychiatric Nursing (therapeutic communication, disorders, interventions)
Leadership & Management (delegation, prioritization, ethics, quality improvement)
Pharmacology (drug calculations, side effects, nursing considerations)
Updates for 2026:
- Updated to reflect 2025/2026 HESI RN test plan changes
- Revised rationales with evidence-based practice guidelines
- Added new questions on COVID-19 management and telehealth
- Enhanced distractor explanations for common misconceptions
- Aligned with latest NCLEX-RN test blueprint standards
Abstract:
The HESI RN Exam is a critical milestone for nursing students, assessing readiness for professional practice. This
document provides 150 meticulously curated multiple-choice questions covering all major content areas:
medical-surgical, maternal-newborn, pediatric, psychiatric, and leadership. Each question includes a verified
answer, a detailed rationale explaining the correct choice, and distractor analyses clarifying why other options are
incorrect. Updated for the 2025/2026 academic year, the content reflects the latest evidence-based guidelines and
test plan changes. Designed to promote deep understanding and retention, this guide ensures students are
well-prepared to achieve a passing score. With a focus on high-yield topics and clinical reasoning, it serves as a
comprehensive study tool for nursing students aiming for an A+ grade. The structured format allows for systematic
review, while the answer format enhances critical thinking. This resource is essential for anyone seeking to
confidently pass the HESI RN Exam on their first attempt.
Keywords:
HESI RN Exam, Nursing exam prep, Multiple choice questions, Verified answers, Medical-surgical nursing,
Maternal-newborn nursing, Pediatric nursing, Psychiatric nursing
Answer Format:
Each question is followed by the correct answer letter (A, B, C, or D) and a detailed rationale explaining the
reasoning behind the correct choice. Additionally, distractor explanations are provided for each incorrect option,
clarifying common errors and reinforcing key concepts. This format helps students understand not only what is
correct but also why other options are wrong.
Page 1
,Compliance Checklist:
All questions aligned with 2025/2026 HESI RN test plan
Answers verified by subject matter experts
Rationales cite current evidence-based practice
Distractor explanations address common student errors
Content covers all major nursing specialties
Suitable for self-study or group review
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-40 Adult health, perioperative care, 27%
fluid/electrolytes, cardiovascular,
respiratory, gastrointestinal, endocrine,
renal, oncology
Maternal-Newborn Nursing 41-65 Antepartum, intrapartum, postpartum, 17%
newborn assessment, breastfeeding,
complications
Pediatric Nursing 66-90 Growth and development, common 17%
childhood illnesses, immunizations, safety,
family-centered care
Psychiatric Nursing 91-115 Therapeutic communication, mood 17%
disorders, anxiety disorders, schizophrenia,
substance abuse, crisis intervention
Leadership & Management 116-135 Delegation, prioritization, ethics, legal 13%
issues, quality improvement, conflict
resolution
Pharmacology 136-150 Drug calculations, side effects, nursing 9%
considerations, medication administration,
IV therapy
Page 2
,Q1. A patient with a history of chronic heart failure (HFrEF) presents with acute dyspnea, orthopnea, and
frothy pink sputum. Current medications include lisinopril 20 mg daily, metoprolol succinate 100 mg daily,
and furosemide 40 mg twice daily. Vital signs: BP 88/52 mmHg, HR 112 bpm, RR 28, SpO2 88% on room
air. Which intervention should the nurse implement FIRST?
A. Administer intravenous furosemide 80 mg push over 2 minutes.
B. Apply non-rebreather mask at 15 L/min and prepare for noninvasive positive pressure ventilation.
C. Hold metoprolol succinate and administer intravenous normal saline bolus of 500 mL.
D. Obtain a stat echocardiogram and notify the electrophysiology team.
Correct Answer: B. Apply non-rebreather mask at 15 L/min and prepare for noninvasive positive pressure
ventilation.
Rationale: The patient is in acute cardiogenic pulmonary edema with severe hypoxemia. The priority is to improve
oxygenation and reduce work of breathing; noninvasive positive pressure ventilation (NIPPV) provides positive
end-expiratory pressure (PEEP) to decrease preload and improve gas exchange. Furosemide is indicated but
should be given slowly (not push) to avoid ototoxicity; the hypotension precludes aggressive diuresis initially.
Metoprolol should be held but a fluid bolus is contraindicated in acute decompensated HF due to fluid overload.
Echocardiogram is not the first priority.
Why Wrong:
A - IV furosemide is needed but rapid push risks ototoxicity and the hypotension suggests cautious
administration; also, oxygenation takes precedence.
C - Fluid bolus would worsen pulmonary edema; holding metoprolol is appropriate but not the first action.
D - Echocardiogram is diagnostic, not therapeutic; delay in oxygenation could be fatal.
Reference: Yancy, C.W., et al. (2023). ACC/AHA/HFSA Guideline for the Management of Heart Failure.
Circulation, 145(18), e895-e1032.
Q2. A patient receiving a continuous infusion of heparin for acute pulmonary embolism has an aPTT of 110
seconds (therapeutic range 60-80 seconds). The nurse notes a small amount of blood in the urine and a new
bruise on the arm. What is the nurse's priority action?
A. Decrease the heparin infusion rate by 50% and recheck aPTT in 4 hours.
B. Stop the heparin infusion immediately and administer protamine sulfate.
C. Obtain a complete blood count and assess for signs of retroperitoneal bleeding.
D. Administer vitamin K 10 mg orally and apply pressure to the bruise.
Correct Answer: B. Stop the heparin infusion immediately and administer protamine sulfate.
Rationale: The patient has a supratherapeutic aPTT with evidence of bleeding (hematuria, bruising), indicating
heparin overdose. The priority is to stop the infusion and reverse heparin with protamine sulfate (1 mg per 100
units of heparin) to prevent life-threatening hemorrhage. Decreasing the rate is insufficient because the aPTT is
dangerously high. CBC is important but not the first action; vitamin K reverses warfarin, not heparin. Immediate
reversal is critical.
Why Wrong:
A - Decreasing the rate does not correct the existing supratherapeutic level and ongoing bleeding risk;
reversal is needed.
C - Assessing for retroperitoneal bleeding is important but should follow immediate reversal of
anticoagulation.
D - Vitamin K is used for warfarin reversal, not heparin; pressure on bruise is supportive but not the priority.
Reference: Garcia, D.A., et al. (2022). Antithrombotic Therapy for VTE Disease: CHEST Guideline. Chest, 162(1),
e1-e52.
Page 3
, Q3. A patient with end-stage renal disease (ESRD) on hemodialysis is admitted with confusion and muscle
weakness. ECG shows peaked T waves and widened QRS complex. Serum potassium is 7.2 mEq/L. The nurse
prepares to administer intravenous calcium gluconate. Which statement best explains the rationale for this
intervention?
A. Calcium gluconate directly lowers serum potassium by binding to it.
B. Calcium gluconate stabilizes the cardiac membrane, reducing the risk of ventricular fibrillation.
C. Calcium gluconate shifts potassium from the extracellular to the intracellular compartment.
D. Calcium gluconate enhances renal excretion of potassium through the dialysis membrane.
Correct Answer: B. Calcium gluconate stabilizes the cardiac membrane, reducing the risk of ventricular fibrillation.
Rationale: Calcium gluconate does not lower serum potassium; it antagonizes the cardiotoxic effects of hyperkalemia by
stabilizing the myocardial cell membrane and raising the threshold for ventricular arrhythmias. It is a temporizing measure
while initiating definitive treatment (e.g., insulin + glucose, albuterol, dialysis). Option A is incorrect because calcium does not
bind potassium. Option C describes the action of insulin and beta-agonists. Option D is false; calcium does not enhance
potassium excretion.
Why Wrong:
A - Calcium does not chemically bind potassium; it acts on cardiac membranes.
C - Shifting potassium intracellularly is achieved by insulin or beta-agonists, not calcium.
D - Calcium does not affect renal or dialysis excretion of potassium.
Reference: Mount, D.B. (2024). Treatment and Prevention of Hyperkalemia in Adults. UpToDate. Retrieved from
www.uptodate.com.
Q4. A patient on a medical-surgical unit is receiving a blood transfusion of packed red blood cells. Fifteen
minutes into the transfusion, the patient develops a temperature of 38.9°C, chills, and lower back pain. Vital
signs: BP 100/60 mmHg, HR 110 bpm, RR 22. What is the nurse's priority action?
A. Slow the transfusion rate and administer acetaminophen per protocol.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Obtain a blood culture and start broad-spectrum antibiotics.
D. Increase the infusion rate to complete the transfusion quickly and reduce symptoms.
Correct Answer: B. Stop the transfusion immediately and maintain IV access with normal saline.
Rationale: The symptoms suggest a hemolytic transfusion reaction (fever, chills, back pain), which is a medical
emergency. The priority is to stop the transfusion immediately to prevent further hemolysis and acute kidney injury.
The IV line should be kept open with normal saline to maintain access for emergency medications. Slowing the rate
(A) still exposes the patient to incompatible blood. Antibiotics (C) are not indicated unless infection is confirmed.
Increasing the rate (D) would worsen the reaction.
Why Wrong:
A - Slowing the rate does not prevent continued hemolysis; transfusion must be stopped.
C - Blood cultures are not the first priority; the reaction is likely immune-mediated, not infectious.
D - Increasing the rate would exacerbate the hemolytic reaction and could be fatal.
Reference: American Association of Blood Banks. (2023). Standards for Blood Banks and Transfusion Services,
33rd Ed. Bethesda, MD: AABB.
Q5. A nurse is caring for a patient who has just been diagnosed with metastatic lung cancer. The patient's
family asks the nurse to withhold the diagnosis from the patient to avoid emotional distress. Which ethical
principle primarily guides the nurse's response?
A. Beneficence: the duty to do good by protecting the patient from harm.
B. Nonmaleficence: the duty to avoid causing harm by disclosing distressing information.
C. Autonomy: the patient's right to be informed and make decisions about their own care.
D. Justice: the duty to allocate resources fairly and not favor the family's wishes.
Correct Answer: C. Autonomy: the patient's right to be informed and make decisions about their own care.
Page 4
