HESI Exit Exam Prep – 200 High-Yield Questions
with Verifi ed Solutions & Actual | Graded A+ |
2025/2026
Section 1: Medical-Surgical Nursing (Questions 1-40)
1. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment
finding requires immediate action?
Answer: Serum potassium of 3.1 mEq/L.
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(normal 3.5-5.0) increases the risk of digoxin toxicity and cardiac dysrhythmias. The
nurse should hold the furosemide and notify the provider.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation
of 88% on room air. The nurse initiates oxygen at 2 L/min via nasal cannula. Which
follow-up assessment is most important?
Answer: Respiratory rate and depth.
Rationale: Clients with COPD may have a hypoxic drive to breathe. Excessive oxygen
can decrease the respiratory drive, leading to hypoventilation and carbon dioxide
retention. The priority is monitoring for a decreased respiratory rate.
3. A client post-operative day 1 after a right total knee arthroplasty reports sudden
shortness of breath and chest pain. The nurse notes oxygen saturation of 90% and
heart rate of 120 bpm. What is the priority action?
Answer: Apply oxygen and prepare for a ventilation/perfusion (V/Q) scan.
Rationale: These symptoms are classic for pulmonary embolism (PE), a risk after
orthopedic surgery. The priority is to support oxygenation and confirm the diagnosis.
Immediate actions include oxygen, vital signs, and notifying the provider.
4. A client with diabetes mellitus type 2 has a blood glucose of 55 mg/dL and is unconscious.
After opening the airway, what should the nurse do?
Answer: Administer 1 mg of glucagon intramuscularly.
Rationale: The client is unconscious and cannot safely swallow oral glucose. Glucagon
IM raises blood glucose by stimulating glycogenolysis. IV dextrose is another option,
but glucagon is often immediately available.
5. A client is admitted with diabetic ketoacidosis (DKA). Which intravenous fluid and insulin
regimen is most appropriate initially?
Answer: 0.9% normal saline IV bolus, followed by continuous regular insulin infusion.
Rationale: DKA causes severe dehydration and electrolyte imbalances. Normal saline
restores volume, and regular insulin IV is the only form that can be titrated
continuously to lower blood glucose gradually and prevent cerebral edema.
,6. A client with acute pancreatitis reports severe abdominal pain radiating to the back,
nausea, and vomiting. Which laboratory value is most specific for this diagnosis?
Answer: Serum lipase of 300 U/L (normal <60 U/L).
Rationale: Lipase is more specific and sensitive for acute pancreatitis than amylase. It
rises within 4-8 hours and remains elevated longer. Amylase can be elevated in other
conditions like salivary gland disorders.
7. A client with cirrhosis has new-onset confusion, asterixis, and a serum ammonia level of
120 mcg/dL (normal 15-60). Which dietary prescription should the nurse anticipate?
Answer: Low-protein diet with vegetable and dairy proteins.
Rationale: Hepatic encephalopathy is caused by ammonia accumulation. Protein
restriction is needed, but some protein is necessary. Vegetable and dairy proteins are
better tolerated than animal proteins. Lactulose is also prescribed to excrete
ammonia.
8. A client is receiving a blood transfusion of packed red blood cells. Fifteen minutes after
initiation, the client reports low back pain and chills. The nurse observes dark urine. What is
the priority action?
Answer: Stop the transfusion immediately and keep the IV line open with normal
saline.
Rationale: These are signs of an acute hemolytic transfusion reaction (ABO
incompatibility). Stopping the transfusion prevents further hemolysis. The nurse
must also notify the provider and send the blood bag and tubing to the lab.
9. A client with chronic kidney disease stage 4 has a potassium level of 6.2 mEq/L. Which
electrocardiogram (ECG) change is most concerning?
Answer: Wide QRS complex.
Rationale: Hyperkalemia causes peaked T waves first, followed by widened QRS,
prolonged PR interval, and eventually a sine wave pattern or cardiac arrest. Wide
QRS indicates imminent risk of ventricular fibrillation.
10. A client with a chest tube to water seal drainage has continuous bubbling in the suction
control chamber. What is the correct interpretation?
Answer: This is an expected finding if suction is applied.
Rationale: The suction control chamber bubbles continuously when wall suction is
connected. The water seal chamber should have tidaling with respirations but not
continuous bubbling. Continuous bubbling in the water seal chamber indicates an air
leak.
11. A client post-myelogram reports a severe headache when sitting up that resolves when
lying flat. What is the priority nursing action?
Answer: Keep the client supine and encourage oral fluids.
, Rationale: This is a post-dural puncture headache. Keeping the client flat reduces
cerebrospinal fluid (CSF) leakage. Hydration and caffeine may help. Severe cases may
require an epidural blood patch.
12. A client with a history of seizures is taking phenytoin (Dilantin). Which assessment
finding indicates a therapeutic drug level?
Answer: Absence of seizure activity and normal gingiva.
Rationale: Therapeutic phenytoin levels (10-20 mcg/mL) control seizures. Gingival
hyperplasia is a common side effect, not an indicator of therapeutic level. Nystagmus
and ataxia indicate toxicity.
13. A client with a new tracheostomy has thick, tenacious secretions. Which intervention is
most effective to loosen secretions?
Answer: Instill 3-5 mL of normal saline before suctioning.
Rationale: Current evidence supports that saline instillation is not routinely
recommended and may increase infection risk. The best method to loosen secretions
is adequate humidification (heated humidifier or nebulizer). However, in the HESI
exam, instilling saline before suctioning is still tested as a method to loosen thick
mucus.
14. A client with a pulmonary embolism is prescribed heparin infusion. Which laboratory
test is used to monitor the therapeutic effect of heparin?
Answer: Activated partial thromboplastin time (aPTT).
Rationale: Heparin therapy is titrated to maintain an aPTT 1.5-2.5 times the normal
control (usually 60-80 seconds). INR monitors warfarin.
15. A client with a burn injury has eschar on the anterior chest. The nurse notes increasing
difficulty breathing, decreased breath sounds, and hypoxia. What is the priority
intervention?
Answer: Prepare for an escharotomy.
Rationale: Circumferential chest eschar can restrict chest wall expansion, leading to
respiratory failure. An escharotomy (surgical incision through the eschar) is needed
to relieve pressure and allow ventilation.
16. A client with a head injury has a Glasgow Coma Scale (GCS) score of 6. Which nursing
intervention is most important?
Answer: Maintain a patent airway and prepare for intubation.
Rationale: A GCS of 8 or less indicates severe brain injury and inability to protect the
airway. The priority is airway management to prevent aspiration and hypoxia.
17. A client with a spinal cord injury at C6 develops sudden severe hypertension,
bradycardia, and a pounding headache. What is the priority action?
Answer: Sit the client upright and check for a distended bladder.
Rationale: These are symptoms of autonomic dysreflexia, a medical emergency
triggered by noxious stimuli below the injury level (e.g., full bladder, fecal impaction).
Sitting upright lowers blood pressure. The most common cause is a distended
bladder.
, 18. A client with acute kidney injury has a urine output of 200 mL in 24 hours and a serum
potassium of 6.8 mEq/L. Which medication should the nurse prepare to administer?
Answer: Calcium gluconate.
Rationale: Severe hyperkalemia (potassium >6.5) with oliguria requires immediate
cardiac membrane stabilization. Calcium gluconate does not lower potassium but
protects the heart from dysrhythmias. Insulin and glucose, albuterol, and kayexalate
then lower potassium.
19. A client with a history of alcohol use disorder is admitted with jaundice, ascites, and
asterixis. Which breakfast selection indicates the client understands the prescribed diet?
Answer: Oatmeal with blueberries, whole wheat toast, and apple juice.
Rationale: This is a low-protein, high-carbohydrate meal appropriate for hepatic
encephalopathy. Bacon, eggs, and ham are high in animal protein, which increases
ammonia.
20. A client with a new colostomy reports that the effluent is liquid and continuous. What
should the nurse teach the client?
Answer: This is expected for a new ascending or transverse colostomy.
Rationale: The more proximal the colostomy, the more liquid and frequent the
effluent. The ascending colon absorbs little water. Over time, the effluent may
thicken, but initially, it is normal to be liquid.
21. A client with a deep vein thrombosis (DVT) in the left calf is on bed rest. Which
assessment finding requires immediate notification of the provider?
Answer: New onset of shortness of breath and pleuritic chest pain.
Rationale: This indicates a possible pulmonary embolism (PE), the most serious
complication of DVT. The nurse should not wait; the client needs immediate
evaluation and anticoagulation.
22. A client with a history of atrial fibrillation is taking warfarin. The INR is 5.2. The client has
no signs of bleeding. What should the nurse do?
Answer: Hold the warfarin and notify the provider.
Rationale: The therapeutic INR for atrial fibrillation is 2.0-3.0. An INR >5.0 without
bleeding requires holding warfarin. The provider may order vitamin K if bleeding
occurs or if INR is >10.
23. A client with hyperthyroidism is scheduled for a thyroidectomy. Which preoperative
medication is used to decrease thyroid vascularity and reduce the risk of hemorrhage?
Answer: Potassium iodide (Lugol's solution).
Rationale: Potassium iodide decreases blood flow to the thyroid gland, reducing
vascularity and the risk of surgical bleeding. It is given for 7-10 days before surgery.
24. A client with myasthenia gravis is experiencing increased weakness and difficulty
swallowing. The nurse administers edrophonium (Tensilon) and the client’s strength
improves temporarily. What does this indicate?
Answer: The client is in a myasthenic crisis.
with Verifi ed Solutions & Actual | Graded A+ |
2025/2026
Section 1: Medical-Surgical Nursing (Questions 1-40)
1. A client with heart failure is prescribed furosemide 40 mg IV push. Which assessment
finding requires immediate action?
Answer: Serum potassium of 3.1 mEq/L.
Rationale: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia
(normal 3.5-5.0) increases the risk of digoxin toxicity and cardiac dysrhythmias. The
nurse should hold the furosemide and notify the provider.
2. A client with chronic obstructive pulmonary disease (COPD) has an oxygen saturation
of 88% on room air. The nurse initiates oxygen at 2 L/min via nasal cannula. Which
follow-up assessment is most important?
Answer: Respiratory rate and depth.
Rationale: Clients with COPD may have a hypoxic drive to breathe. Excessive oxygen
can decrease the respiratory drive, leading to hypoventilation and carbon dioxide
retention. The priority is monitoring for a decreased respiratory rate.
3. A client post-operative day 1 after a right total knee arthroplasty reports sudden
shortness of breath and chest pain. The nurse notes oxygen saturation of 90% and
heart rate of 120 bpm. What is the priority action?
Answer: Apply oxygen and prepare for a ventilation/perfusion (V/Q) scan.
Rationale: These symptoms are classic for pulmonary embolism (PE), a risk after
orthopedic surgery. The priority is to support oxygenation and confirm the diagnosis.
Immediate actions include oxygen, vital signs, and notifying the provider.
4. A client with diabetes mellitus type 2 has a blood glucose of 55 mg/dL and is unconscious.
After opening the airway, what should the nurse do?
Answer: Administer 1 mg of glucagon intramuscularly.
Rationale: The client is unconscious and cannot safely swallow oral glucose. Glucagon
IM raises blood glucose by stimulating glycogenolysis. IV dextrose is another option,
but glucagon is often immediately available.
5. A client is admitted with diabetic ketoacidosis (DKA). Which intravenous fluid and insulin
regimen is most appropriate initially?
Answer: 0.9% normal saline IV bolus, followed by continuous regular insulin infusion.
Rationale: DKA causes severe dehydration and electrolyte imbalances. Normal saline
restores volume, and regular insulin IV is the only form that can be titrated
continuously to lower blood glucose gradually and prevent cerebral edema.
,6. A client with acute pancreatitis reports severe abdominal pain radiating to the back,
nausea, and vomiting. Which laboratory value is most specific for this diagnosis?
Answer: Serum lipase of 300 U/L (normal <60 U/L).
Rationale: Lipase is more specific and sensitive for acute pancreatitis than amylase. It
rises within 4-8 hours and remains elevated longer. Amylase can be elevated in other
conditions like salivary gland disorders.
7. A client with cirrhosis has new-onset confusion, asterixis, and a serum ammonia level of
120 mcg/dL (normal 15-60). Which dietary prescription should the nurse anticipate?
Answer: Low-protein diet with vegetable and dairy proteins.
Rationale: Hepatic encephalopathy is caused by ammonia accumulation. Protein
restriction is needed, but some protein is necessary. Vegetable and dairy proteins are
better tolerated than animal proteins. Lactulose is also prescribed to excrete
ammonia.
8. A client is receiving a blood transfusion of packed red blood cells. Fifteen minutes after
initiation, the client reports low back pain and chills. The nurse observes dark urine. What is
the priority action?
Answer: Stop the transfusion immediately and keep the IV line open with normal
saline.
Rationale: These are signs of an acute hemolytic transfusion reaction (ABO
incompatibility). Stopping the transfusion prevents further hemolysis. The nurse
must also notify the provider and send the blood bag and tubing to the lab.
9. A client with chronic kidney disease stage 4 has a potassium level of 6.2 mEq/L. Which
electrocardiogram (ECG) change is most concerning?
Answer: Wide QRS complex.
Rationale: Hyperkalemia causes peaked T waves first, followed by widened QRS,
prolonged PR interval, and eventually a sine wave pattern or cardiac arrest. Wide
QRS indicates imminent risk of ventricular fibrillation.
10. A client with a chest tube to water seal drainage has continuous bubbling in the suction
control chamber. What is the correct interpretation?
Answer: This is an expected finding if suction is applied.
Rationale: The suction control chamber bubbles continuously when wall suction is
connected. The water seal chamber should have tidaling with respirations but not
continuous bubbling. Continuous bubbling in the water seal chamber indicates an air
leak.
11. A client post-myelogram reports a severe headache when sitting up that resolves when
lying flat. What is the priority nursing action?
Answer: Keep the client supine and encourage oral fluids.
, Rationale: This is a post-dural puncture headache. Keeping the client flat reduces
cerebrospinal fluid (CSF) leakage. Hydration and caffeine may help. Severe cases may
require an epidural blood patch.
12. A client with a history of seizures is taking phenytoin (Dilantin). Which assessment
finding indicates a therapeutic drug level?
Answer: Absence of seizure activity and normal gingiva.
Rationale: Therapeutic phenytoin levels (10-20 mcg/mL) control seizures. Gingival
hyperplasia is a common side effect, not an indicator of therapeutic level. Nystagmus
and ataxia indicate toxicity.
13. A client with a new tracheostomy has thick, tenacious secretions. Which intervention is
most effective to loosen secretions?
Answer: Instill 3-5 mL of normal saline before suctioning.
Rationale: Current evidence supports that saline instillation is not routinely
recommended and may increase infection risk. The best method to loosen secretions
is adequate humidification (heated humidifier or nebulizer). However, in the HESI
exam, instilling saline before suctioning is still tested as a method to loosen thick
mucus.
14. A client with a pulmonary embolism is prescribed heparin infusion. Which laboratory
test is used to monitor the therapeutic effect of heparin?
Answer: Activated partial thromboplastin time (aPTT).
Rationale: Heparin therapy is titrated to maintain an aPTT 1.5-2.5 times the normal
control (usually 60-80 seconds). INR monitors warfarin.
15. A client with a burn injury has eschar on the anterior chest. The nurse notes increasing
difficulty breathing, decreased breath sounds, and hypoxia. What is the priority
intervention?
Answer: Prepare for an escharotomy.
Rationale: Circumferential chest eschar can restrict chest wall expansion, leading to
respiratory failure. An escharotomy (surgical incision through the eschar) is needed
to relieve pressure and allow ventilation.
16. A client with a head injury has a Glasgow Coma Scale (GCS) score of 6. Which nursing
intervention is most important?
Answer: Maintain a patent airway and prepare for intubation.
Rationale: A GCS of 8 or less indicates severe brain injury and inability to protect the
airway. The priority is airway management to prevent aspiration and hypoxia.
17. A client with a spinal cord injury at C6 develops sudden severe hypertension,
bradycardia, and a pounding headache. What is the priority action?
Answer: Sit the client upright and check for a distended bladder.
Rationale: These are symptoms of autonomic dysreflexia, a medical emergency
triggered by noxious stimuli below the injury level (e.g., full bladder, fecal impaction).
Sitting upright lowers blood pressure. The most common cause is a distended
bladder.
, 18. A client with acute kidney injury has a urine output of 200 mL in 24 hours and a serum
potassium of 6.8 mEq/L. Which medication should the nurse prepare to administer?
Answer: Calcium gluconate.
Rationale: Severe hyperkalemia (potassium >6.5) with oliguria requires immediate
cardiac membrane stabilization. Calcium gluconate does not lower potassium but
protects the heart from dysrhythmias. Insulin and glucose, albuterol, and kayexalate
then lower potassium.
19. A client with a history of alcohol use disorder is admitted with jaundice, ascites, and
asterixis. Which breakfast selection indicates the client understands the prescribed diet?
Answer: Oatmeal with blueberries, whole wheat toast, and apple juice.
Rationale: This is a low-protein, high-carbohydrate meal appropriate for hepatic
encephalopathy. Bacon, eggs, and ham are high in animal protein, which increases
ammonia.
20. A client with a new colostomy reports that the effluent is liquid and continuous. What
should the nurse teach the client?
Answer: This is expected for a new ascending or transverse colostomy.
Rationale: The more proximal the colostomy, the more liquid and frequent the
effluent. The ascending colon absorbs little water. Over time, the effluent may
thicken, but initially, it is normal to be liquid.
21. A client with a deep vein thrombosis (DVT) in the left calf is on bed rest. Which
assessment finding requires immediate notification of the provider?
Answer: New onset of shortness of breath and pleuritic chest pain.
Rationale: This indicates a possible pulmonary embolism (PE), the most serious
complication of DVT. The nurse should not wait; the client needs immediate
evaluation and anticoagulation.
22. A client with a history of atrial fibrillation is taking warfarin. The INR is 5.2. The client has
no signs of bleeding. What should the nurse do?
Answer: Hold the warfarin and notify the provider.
Rationale: The therapeutic INR for atrial fibrillation is 2.0-3.0. An INR >5.0 without
bleeding requires holding warfarin. The provider may order vitamin K if bleeding
occurs or if INR is >10.
23. A client with hyperthyroidism is scheduled for a thyroidectomy. Which preoperative
medication is used to decrease thyroid vascularity and reduce the risk of hemorrhage?
Answer: Potassium iodide (Lugol's solution).
Rationale: Potassium iodide decreases blood flow to the thyroid gland, reducing
vascularity and the risk of surgical bleeding. It is given for 7-10 days before surgery.
24. A client with myasthenia gravis is experiencing increased weakness and difficulty
swallowing. The nurse administers edrophonium (Tensilon) and the client’s strength
improves temporarily. What does this indicate?
Answer: The client is in a myasthenic crisis.
