HESI Exit V2 – Chamberlain College of Nursing | Questions & Verified
Answers | RN Exit Exam Prep
Medical-Surgical (1–40)
1. A client with heart failure has crackles in both lungs, 3+ pitting edema, and
dyspnea on exertion. Which intervention should the nurse implement first?
A. Administer furosemide IV push
B. Place the client in high-Fowler’s position
C. Check daily weight
D. Restrict fluids to 1.5 L/day
Answer: B. High-Fowler’s position promotes lung expansion and reduces venous
return, improving breathing.
Rationale: Airway and breathing come first (ABCs). Positioning is immediate;
furosemide is important but not first.
2. A client on warfarin has an INR of 4.5. Which assessment finding is most
concerning?
,A. Bruising on arms
B. Blood in the urine
C. Gum bleeding when brushing
D. Headache with confusion
Answer: D. Headache with confusion suggests intracranial bleeding.
Rationale: Neurologic changes are life-threatening. The other options indicate
anticoagulation effects but not imminent danger.
3. A client with diabetes insipidus is receiving desmopressin (DDAVP). Which
finding indicates effectiveness?
A. Urine output increases to 300 mL/hr
B. Serum sodium decreases toward normal
C. Urine specific gravity increases
D. Blood glucose normalizes
Answer: C. Desmopressin reduces urine output and increases urine specific
gravity (more concentrated urine).
Rationale: Diabetes insipidus causes dilute urine; DDAVP replaces ADH, causing
water retention and concentrated urine.
,4. A client post-MI develops crackles in the lung bases, S3 heart sound, and
tachycardia. What complication does the nurse suspect?
A. Cardiogenic shock
B. Pericarditis
C. Left-sided heart failure
D. Pulmonary embolism
Answer: C. Left-sided heart failure.
Rationale: Crackles, S3, and tachycardia indicate fluid backup into lungs from left
ventricular dysfunction.
5. A client with cirrhosis has ascites and shortened breath. Which procedure has
the highest priority?
A. Paracentesis
B. Low-sodium diet education
C. Daily weight
D. Spironolactone administration
Answer: A. Paracentesis.
, Rationale: Severe ascites causing respiratory compromise requires immediate
fluid removal.
6. A client with COPD has a pulse oximetry of 88% on 2 L/min oxygen. What
should the nurse do first?
A. Increase oxygen to 4 L/min
B. Have the client perform pursed-lip breathing
C. Notify the respiratory therapist
D. Draw arterial blood gases
Answer: B. Pursed-lip breathing.
Rationale: Improves airway pressure and gas exchange; don’t increase O2 blindly
(risk of CO2 retention).
7. A client on a ventilator has a sudden drop in oxygen saturation to 80% and
absent breath sounds on the right. What action is priority?
A. Call a code
B. Reposition the endotracheal tube
C. Prepare for chest tube insertion
D. Stat chest x-ray
Answers | RN Exit Exam Prep
Medical-Surgical (1–40)
1. A client with heart failure has crackles in both lungs, 3+ pitting edema, and
dyspnea on exertion. Which intervention should the nurse implement first?
A. Administer furosemide IV push
B. Place the client in high-Fowler’s position
C. Check daily weight
D. Restrict fluids to 1.5 L/day
Answer: B. High-Fowler’s position promotes lung expansion and reduces venous
return, improving breathing.
Rationale: Airway and breathing come first (ABCs). Positioning is immediate;
furosemide is important but not first.
2. A client on warfarin has an INR of 4.5. Which assessment finding is most
concerning?
,A. Bruising on arms
B. Blood in the urine
C. Gum bleeding when brushing
D. Headache with confusion
Answer: D. Headache with confusion suggests intracranial bleeding.
Rationale: Neurologic changes are life-threatening. The other options indicate
anticoagulation effects but not imminent danger.
3. A client with diabetes insipidus is receiving desmopressin (DDAVP). Which
finding indicates effectiveness?
A. Urine output increases to 300 mL/hr
B. Serum sodium decreases toward normal
C. Urine specific gravity increases
D. Blood glucose normalizes
Answer: C. Desmopressin reduces urine output and increases urine specific
gravity (more concentrated urine).
Rationale: Diabetes insipidus causes dilute urine; DDAVP replaces ADH, causing
water retention and concentrated urine.
,4. A client post-MI develops crackles in the lung bases, S3 heart sound, and
tachycardia. What complication does the nurse suspect?
A. Cardiogenic shock
B. Pericarditis
C. Left-sided heart failure
D. Pulmonary embolism
Answer: C. Left-sided heart failure.
Rationale: Crackles, S3, and tachycardia indicate fluid backup into lungs from left
ventricular dysfunction.
5. A client with cirrhosis has ascites and shortened breath. Which procedure has
the highest priority?
A. Paracentesis
B. Low-sodium diet education
C. Daily weight
D. Spironolactone administration
Answer: A. Paracentesis.
, Rationale: Severe ascites causing respiratory compromise requires immediate
fluid removal.
6. A client with COPD has a pulse oximetry of 88% on 2 L/min oxygen. What
should the nurse do first?
A. Increase oxygen to 4 L/min
B. Have the client perform pursed-lip breathing
C. Notify the respiratory therapist
D. Draw arterial blood gases
Answer: B. Pursed-lip breathing.
Rationale: Improves airway pressure and gas exchange; don’t increase O2 blindly
(risk of CO2 retention).
7. A client on a ventilator has a sudden drop in oxygen saturation to 80% and
absent breath sounds on the right. What action is priority?
A. Call a code
B. Reposition the endotracheal tube
C. Prepare for chest tube insertion
D. Stat chest x-ray
