HESI EXIT RN EXAM V1–V7 2026/2027 STUDY
GUIDE | COMPLETE QUESTIONS AND ANSWERS
WITH DETAILED RATIONALES | COMPREHENSIVE
NCLEX RN REVIEW | LATEST UPDATED VERSION
• This study guide features 300 exam-style multiple choice questions with five
options each, complete with bolded correct answers and detailed EXPERT
RATIONALE to reinforce clinical reasoning and test-taking confidence.
• Use this material by reading each question independently before checking the
answer, then studying the EXPERT RATIONALE deeply — focus on understanding
the "why" behind each correct choice to master NCLEX-level critical thinking.
HESI EXIT RN EXAM V1–V7 2026/2027
COMPLETE 300-QUESTION STUDY GUIDE WITH EXPERT RATIONALE
SECTION 1: MEDICAL-SURGICAL NURSING
1. A nurse is caring for a client with chronic kidney disease (CKD). Which
laboratory finding requires immediate intervention?
A. Serum creatinine of 2.1 mg/dL
B. Blood urea nitrogen (BUN) of 25 mg/dL
C. Serum potassium of 6.8 mEq/L
D. Hemoglobin of 10 g/dL
E. Serum sodium of 138 mEq/L
✓ Correct Answer: C. Serum potassium of 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L indicates severe
hyperkalemia, which can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. This requires immediate intervention such
as IV calcium gluconate, sodium bicarbonate, insulin with dextrose, or dialysis.
,2. A client is admitted with deep vein thrombosis (DVT). Which assessment
finding requires the nurse to notify the provider immediately?
A. Unilateral leg swelling and warmth
B. Positive Homans sign
C. Sudden onset of chest pain and dyspnea
D. Low-grade fever of 37.8°C
E. Calf tenderness on palpation
✓ Correct Answer: C. Sudden onset of chest pain and dyspnea
EXPERT RATIONALE: Sudden chest pain and dyspnea in a client with DVT suggest
pulmonary embolism (PE), a life-threatening complication where a clot has traveled
to the pulmonary vasculature. This is a medical emergency requiring immediate
intervention.
3. A nurse is caring for a client post-myocardial infarction. The client develops
a heart rate of 38 bpm and is hypotensive. Which intervention is the priority?
A. Administer atropine 0.5 mg IV push
B. Prepare for synchronized cardioversion
C. Administer adenosine 6 mg IV push
D. Initiate transcutaneous pacing
E. Administer amiodarone 150 mg IV
✓ Correct Answer: A. Administer atropine 0.5 mg IV push
EXPERT RATIONALE: For symptomatic bradycardia with hemodynamic instability,
atropine 0.5 mg IV push is the first-line treatment per ACLS guidelines. It blocks
vagal tone and increases the heart rate. Transcutaneous pacing is used if atropine
fails.
,4. A client with type 1 diabetes presents with blood glucose of 48 mg/dL and is
conscious. What is the most appropriate initial intervention?
A. Administer 50% dextrose IV push
B. Give glucagon 1 mg IM
C. Give 15–20 grams of fast-acting carbohydrates orally
D. Administer regular insulin per sliding scale
E. Start a 5% dextrose IV infusion
✓ Correct Answer: C. Give 15–20 grams of fast-acting carbohydrates orally
EXPERT RATIONALE: For a conscious hypoglycemic client, the 15-15 rule is followed
— give 15 grams of fast-acting carbohydrates (e.g., 4 oz juice), recheck blood
glucose in 15 minutes, and repeat if necessary. IV dextrose and glucagon are
reserved for unconscious clients.
5. A nurse is caring for a client with cirrhosis. Which finding indicates hepatic
encephalopathy?
A. Peripheral edema and ascites
B. Asterixis and confusion
C. Spider angiomata on the chest
D. Jaundice and pruritus
E. Elevated serum bilirubin
✓ Correct Answer: B. Asterixis and confusion
EXPERT RATIONALE: Asterixis (flapping tremor of the hands) and confusion are
classic signs of hepatic encephalopathy, caused by ammonia accumulation in the
blood due to the liver's inability to detoxify it. It represents altered cerebral
function.
, 6. A client with COPD is receiving oxygen therapy. Which oxygen delivery rate
is most appropriate to avoid suppressing the hypoxic drive?
A. 6–8 L/min via simple face mask
B. 10–12 L/min via non-rebreather mask
C. 1–2 L/min via nasal cannula
D. 8–10 L/min via Venturi mask
E. 15 L/min via non-rebreather mask
✓ Correct Answer: C. 1–2 L/min via nasal cannula
EXPERT RATIONALE: Clients with COPD rely on hypoxic drive (low oxygen levels) to
breathe, rather than high CO₂ levels. High-flow oxygen can suppress this drive and
cause respiratory depression. Low-flow oxygen at 1–2 L/min via nasal cannula
maintains adequate oxygenation without suppressing respiratory drive.
7. A client returns from a thyroidectomy. Which assessment finding requires
immediate nursing action?
A. Hoarse voice
B. Positive Chvostek's sign
C. Mild throat discomfort
D. Blood pressure 130/80 mmHg
E. Dry dressing at surgical site
✓ Correct Answer: B. Positive Chvostek's sign
EXPERT RATIONALE: A positive Chvostek's sign (facial twitching when the facial
nerve is tapped) indicates hypocalcemia, which can occur post-thyroidectomy if the
parathyroid glands were accidentally removed or damaged. This can lead to tetany
and laryngospasm and requires immediate calcium replacement.
GUIDE | COMPLETE QUESTIONS AND ANSWERS
WITH DETAILED RATIONALES | COMPREHENSIVE
NCLEX RN REVIEW | LATEST UPDATED VERSION
• This study guide features 300 exam-style multiple choice questions with five
options each, complete with bolded correct answers and detailed EXPERT
RATIONALE to reinforce clinical reasoning and test-taking confidence.
• Use this material by reading each question independently before checking the
answer, then studying the EXPERT RATIONALE deeply — focus on understanding
the "why" behind each correct choice to master NCLEX-level critical thinking.
HESI EXIT RN EXAM V1–V7 2026/2027
COMPLETE 300-QUESTION STUDY GUIDE WITH EXPERT RATIONALE
SECTION 1: MEDICAL-SURGICAL NURSING
1. A nurse is caring for a client with chronic kidney disease (CKD). Which
laboratory finding requires immediate intervention?
A. Serum creatinine of 2.1 mg/dL
B. Blood urea nitrogen (BUN) of 25 mg/dL
C. Serum potassium of 6.8 mEq/L
D. Hemoglobin of 10 g/dL
E. Serum sodium of 138 mEq/L
✓ Correct Answer: C. Serum potassium of 6.8 mEq/L
EXPERT RATIONALE: A serum potassium of 6.8 mEq/L indicates severe
hyperkalemia, which can cause life-threatening cardiac dysrhythmias including
ventricular fibrillation and cardiac arrest. This requires immediate intervention such
as IV calcium gluconate, sodium bicarbonate, insulin with dextrose, or dialysis.
,2. A client is admitted with deep vein thrombosis (DVT). Which assessment
finding requires the nurse to notify the provider immediately?
A. Unilateral leg swelling and warmth
B. Positive Homans sign
C. Sudden onset of chest pain and dyspnea
D. Low-grade fever of 37.8°C
E. Calf tenderness on palpation
✓ Correct Answer: C. Sudden onset of chest pain and dyspnea
EXPERT RATIONALE: Sudden chest pain and dyspnea in a client with DVT suggest
pulmonary embolism (PE), a life-threatening complication where a clot has traveled
to the pulmonary vasculature. This is a medical emergency requiring immediate
intervention.
3. A nurse is caring for a client post-myocardial infarction. The client develops
a heart rate of 38 bpm and is hypotensive. Which intervention is the priority?
A. Administer atropine 0.5 mg IV push
B. Prepare for synchronized cardioversion
C. Administer adenosine 6 mg IV push
D. Initiate transcutaneous pacing
E. Administer amiodarone 150 mg IV
✓ Correct Answer: A. Administer atropine 0.5 mg IV push
EXPERT RATIONALE: For symptomatic bradycardia with hemodynamic instability,
atropine 0.5 mg IV push is the first-line treatment per ACLS guidelines. It blocks
vagal tone and increases the heart rate. Transcutaneous pacing is used if atropine
fails.
,4. A client with type 1 diabetes presents with blood glucose of 48 mg/dL and is
conscious. What is the most appropriate initial intervention?
A. Administer 50% dextrose IV push
B. Give glucagon 1 mg IM
C. Give 15–20 grams of fast-acting carbohydrates orally
D. Administer regular insulin per sliding scale
E. Start a 5% dextrose IV infusion
✓ Correct Answer: C. Give 15–20 grams of fast-acting carbohydrates orally
EXPERT RATIONALE: For a conscious hypoglycemic client, the 15-15 rule is followed
— give 15 grams of fast-acting carbohydrates (e.g., 4 oz juice), recheck blood
glucose in 15 minutes, and repeat if necessary. IV dextrose and glucagon are
reserved for unconscious clients.
5. A nurse is caring for a client with cirrhosis. Which finding indicates hepatic
encephalopathy?
A. Peripheral edema and ascites
B. Asterixis and confusion
C. Spider angiomata on the chest
D. Jaundice and pruritus
E. Elevated serum bilirubin
✓ Correct Answer: B. Asterixis and confusion
EXPERT RATIONALE: Asterixis (flapping tremor of the hands) and confusion are
classic signs of hepatic encephalopathy, caused by ammonia accumulation in the
blood due to the liver's inability to detoxify it. It represents altered cerebral
function.
, 6. A client with COPD is receiving oxygen therapy. Which oxygen delivery rate
is most appropriate to avoid suppressing the hypoxic drive?
A. 6–8 L/min via simple face mask
B. 10–12 L/min via non-rebreather mask
C. 1–2 L/min via nasal cannula
D. 8–10 L/min via Venturi mask
E. 15 L/min via non-rebreather mask
✓ Correct Answer: C. 1–2 L/min via nasal cannula
EXPERT RATIONALE: Clients with COPD rely on hypoxic drive (low oxygen levels) to
breathe, rather than high CO₂ levels. High-flow oxygen can suppress this drive and
cause respiratory depression. Low-flow oxygen at 1–2 L/min via nasal cannula
maintains adequate oxygenation without suppressing respiratory drive.
7. A client returns from a thyroidectomy. Which assessment finding requires
immediate nursing action?
A. Hoarse voice
B. Positive Chvostek's sign
C. Mild throat discomfort
D. Blood pressure 130/80 mmHg
E. Dry dressing at surgical site
✓ Correct Answer: B. Positive Chvostek's sign
EXPERT RATIONALE: A positive Chvostek's sign (facial twitching when the facial
nerve is tapped) indicates hypocalcemia, which can occur post-thyroidectomy if the
parathyroid glands were accidentally removed or damaged. This can lead to tetany
and laryngospasm and requires immediate calcium replacement.
