HESI EXIT EXAM QUESTIONS AND
ANSWERS | 2026 UPDATE | 100%
CORRECT.
While assessing a radial artery catheter, the client complains of numbness and pain distal to the
insertion site. What interventions should the nurse implement? - ANS Promptly remove the
arterial catheter from the radial artery.
A client is admitted with an epidural hematoma that resulted from a skateboarding accident. To
differentiate the vascular source of the intracranial bleeding, which finding should the nurse
monitor? - ANS Rapid onset of decreased level of consciousness.
When preparing a client for discharge from the hospital following a cystectomy and a urinary
diversion to treat bladder cancer, which instruction is most important for the nurse to include in
the client's discharge teaching plan? - ANS Report any signs of cloudy urine output.
After repositioning an immobile client, the nurse observes an area of hyperemia. To assess for
blanching, what action should the nurse take? - ANS Apply light pressure over the area.
The nurse enters a client's room and observes the client's wrist restraint secured as seen in the
picture. What action should the nurse take? - ANS Reposition the restraint tie onto the
bedframe.
A female client with acute respiratory distress syndrome (ARDS) is chemically paralyzed and
sedated while she is on as assist-control ventilator using 50% FIO2. Which assessment finding
warrants
immediate intervention by the nurse? - ANS Diminished left lower lobe sounds
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 81
,Rationale: Diminished lobe sounds indicate collapsed alveoli or tension pneumothorax, which
required
immediate chest tube insertion to re-inflate the lung.
The development of atherosclerosis is a process of sequential events. Arrange the
pathophysiological events in orders of occurrence. (Place the first event on top and the last on
the bottom) - ANS Arterial endothelium injury causes inflammation
Macrophages consume low density lipoprotein (LDL), creating foam cells
Foam cells release growth factors for smooth muscle cells
Smooth muscle grows over fatty streaks creating fibrous plaques
Vessel narrowing results in ischemia
Following a motor vehicle collision, an adult female with a ruptured spleen and a blood pressure
of 70/44, had an emergency splenectomy. Twelve hours after the surgery, her urine output is 25
ml/hour for the last two hours. What pathophysiological reason supports the nurse's decision to
report this finding to the healthcare provider? - ANS Oliguria signals tubular necrosis related
to hypoperfusion
A nurse-manager is preparing the curricula for a class for charge nurses. A staffing formula
based on what data ensures quality client care and is most cost-effective? - ANS Skills of staff
and client acuity
When performing postural drainage on a client with Chronic Obstructive Pulmonary Disease
(COPD), which approach should the nurse use? - ANS Explain that the client may be placed in
five positions
A client presents in the emergency room with right-sided facial asymmetry. The nurse asks the
client to perform a series of movements that require use of the facial muscles. What symptoms
suggest that the client has most likely experience a Bell's palsy rather than a stroke? -
ANS Inability to close the affected eye, raise brow, or smile
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 81
,The nurse is teaching a client how to perform colostomy irrigations. When observing the client's
return demonstration, which action indicated that the client understood the teaching? -
ANS Keeps the irrigating container less than 18 inches above the stoma
The nurse should teach the client to observe which precaution while taking dronedarone? -
ANS Avoid grapefruits and its juice
A client who sustained a head injury following an automobile collision is admitted to the
hospital. The nurse include the client's risk for developing increased intracranial pressure (ICP)
in the plan of care. Which signs indicate to the nurse that ICP has increased? - ANS Increased
Glasgow coma scale score.
Nuchal rigidity and papilledema.
Confusion and papilledema
Periorbital ecchymosis.
Rationale: papilledema is always an indicator of increased ICP, and confusion is usually the first
sign of
increased ICP. Other options do not necessarily reflect increased ICP.
The nurse is caring for a client receiving continuous IV fluids through a single lumen central
venous catheter (CVC). Based on the CVC care bundle, which action should be completed daily
to reduce the
risk for infection? - ANS Confirm the necessity for continued use of the CVC.
During an annual physical examination, an older woman's fasting blood sugar (FBS) is
determined to be 140 mg/dl or 7.8 mmol/L (SI). Which additional finding obtained during a
follow-up visit 2 weeks later is most indicative that the client has diabetes mellitus (DM)? -
ANS Repeated fasting blood sugar (FBS) is 132 mg/dl or 7.4 mmol/L (SI).
A client who was admitted yesterday with severe dehydration is complaining of pain a 24 gauge
IV with normal saline is infusing at a rate of 150 ml/hour. Which intervention should the nurse
implement first? - ANS Stop the normal saline infusion.
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 81
, An elderly female is admitted because of a change in her level of sensorium. During the evening
shift, the client attempts to get out bed and falls, breaking her left hip. Buck's skin traction is
applied to the left leg while waiting for surgery. Which intervention is most important for the
nurse to include in this client's plan care? - ANS Ensure proper alignment of the leg in
traction.
A client who had a right hip replacement 3 day ago is pale has diminished breath sound over the
left lower lung fields, a temperature of 100.2 F, and an oxygen saturation rate of 90%. The client
is scheduled to be transferred to a skilled nursing facility (SNF) tomorrow for rehabilitative
critical pathway. Based on the client's symptoms, what recommendation should the nurse give
the healthcare provider? - ANS Reassess readiness for SNF transfer.
A client who is newly diagnosed with type 2 diabetes mellitus (DM) receives a prescription for
metformin (Glucophage) 500 mg PO twice daily. What information should the nurse include in
this client's teaching plan? (Select all that apply.) - ANS Recognize signs and symptoms of
hypoglycemia.
Report persist polyuria to the healthcare provider.
Take Glucophage with the morning and evening meal.
The nurse is developing an educational program for older clients who are being discharged with
new antihypertensive medications. The nurse should ensure that the educational materials
include which
characteristics? Select all that apply - ANS Written at a twelfth grade reading level
Contains a list with definitions of unfamiliar terms
Uses common words with few Syllables
Printed using a 12 point type font
Uses pictures to help illustrate complex ideas
Rationale: During the aging process older clients often experience sensory or cognitive changes,
such as
decreased visual or hearing acuity, slower thought or reasoning processes, and shorter attention
span.
Materials for this age group should include at least of terms, such as a medical terminology that
incline
@COPYRIGHT ALL RIGHTS RESERVED PAGE 4 OF 81
ANSWERS | 2026 UPDATE | 100%
CORRECT.
While assessing a radial artery catheter, the client complains of numbness and pain distal to the
insertion site. What interventions should the nurse implement? - ANS Promptly remove the
arterial catheter from the radial artery.
A client is admitted with an epidural hematoma that resulted from a skateboarding accident. To
differentiate the vascular source of the intracranial bleeding, which finding should the nurse
monitor? - ANS Rapid onset of decreased level of consciousness.
When preparing a client for discharge from the hospital following a cystectomy and a urinary
diversion to treat bladder cancer, which instruction is most important for the nurse to include in
the client's discharge teaching plan? - ANS Report any signs of cloudy urine output.
After repositioning an immobile client, the nurse observes an area of hyperemia. To assess for
blanching, what action should the nurse take? - ANS Apply light pressure over the area.
The nurse enters a client's room and observes the client's wrist restraint secured as seen in the
picture. What action should the nurse take? - ANS Reposition the restraint tie onto the
bedframe.
A female client with acute respiratory distress syndrome (ARDS) is chemically paralyzed and
sedated while she is on as assist-control ventilator using 50% FIO2. Which assessment finding
warrants
immediate intervention by the nurse? - ANS Diminished left lower lobe sounds
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 81
,Rationale: Diminished lobe sounds indicate collapsed alveoli or tension pneumothorax, which
required
immediate chest tube insertion to re-inflate the lung.
The development of atherosclerosis is a process of sequential events. Arrange the
pathophysiological events in orders of occurrence. (Place the first event on top and the last on
the bottom) - ANS Arterial endothelium injury causes inflammation
Macrophages consume low density lipoprotein (LDL), creating foam cells
Foam cells release growth factors for smooth muscle cells
Smooth muscle grows over fatty streaks creating fibrous plaques
Vessel narrowing results in ischemia
Following a motor vehicle collision, an adult female with a ruptured spleen and a blood pressure
of 70/44, had an emergency splenectomy. Twelve hours after the surgery, her urine output is 25
ml/hour for the last two hours. What pathophysiological reason supports the nurse's decision to
report this finding to the healthcare provider? - ANS Oliguria signals tubular necrosis related
to hypoperfusion
A nurse-manager is preparing the curricula for a class for charge nurses. A staffing formula
based on what data ensures quality client care and is most cost-effective? - ANS Skills of staff
and client acuity
When performing postural drainage on a client with Chronic Obstructive Pulmonary Disease
(COPD), which approach should the nurse use? - ANS Explain that the client may be placed in
five positions
A client presents in the emergency room with right-sided facial asymmetry. The nurse asks the
client to perform a series of movements that require use of the facial muscles. What symptoms
suggest that the client has most likely experience a Bell's palsy rather than a stroke? -
ANS Inability to close the affected eye, raise brow, or smile
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 81
,The nurse is teaching a client how to perform colostomy irrigations. When observing the client's
return demonstration, which action indicated that the client understood the teaching? -
ANS Keeps the irrigating container less than 18 inches above the stoma
The nurse should teach the client to observe which precaution while taking dronedarone? -
ANS Avoid grapefruits and its juice
A client who sustained a head injury following an automobile collision is admitted to the
hospital. The nurse include the client's risk for developing increased intracranial pressure (ICP)
in the plan of care. Which signs indicate to the nurse that ICP has increased? - ANS Increased
Glasgow coma scale score.
Nuchal rigidity and papilledema.
Confusion and papilledema
Periorbital ecchymosis.
Rationale: papilledema is always an indicator of increased ICP, and confusion is usually the first
sign of
increased ICP. Other options do not necessarily reflect increased ICP.
The nurse is caring for a client receiving continuous IV fluids through a single lumen central
venous catheter (CVC). Based on the CVC care bundle, which action should be completed daily
to reduce the
risk for infection? - ANS Confirm the necessity for continued use of the CVC.
During an annual physical examination, an older woman's fasting blood sugar (FBS) is
determined to be 140 mg/dl or 7.8 mmol/L (SI). Which additional finding obtained during a
follow-up visit 2 weeks later is most indicative that the client has diabetes mellitus (DM)? -
ANS Repeated fasting blood sugar (FBS) is 132 mg/dl or 7.4 mmol/L (SI).
A client who was admitted yesterday with severe dehydration is complaining of pain a 24 gauge
IV with normal saline is infusing at a rate of 150 ml/hour. Which intervention should the nurse
implement first? - ANS Stop the normal saline infusion.
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 81
, An elderly female is admitted because of a change in her level of sensorium. During the evening
shift, the client attempts to get out bed and falls, breaking her left hip. Buck's skin traction is
applied to the left leg while waiting for surgery. Which intervention is most important for the
nurse to include in this client's plan care? - ANS Ensure proper alignment of the leg in
traction.
A client who had a right hip replacement 3 day ago is pale has diminished breath sound over the
left lower lung fields, a temperature of 100.2 F, and an oxygen saturation rate of 90%. The client
is scheduled to be transferred to a skilled nursing facility (SNF) tomorrow for rehabilitative
critical pathway. Based on the client's symptoms, what recommendation should the nurse give
the healthcare provider? - ANS Reassess readiness for SNF transfer.
A client who is newly diagnosed with type 2 diabetes mellitus (DM) receives a prescription for
metformin (Glucophage) 500 mg PO twice daily. What information should the nurse include in
this client's teaching plan? (Select all that apply.) - ANS Recognize signs and symptoms of
hypoglycemia.
Report persist polyuria to the healthcare provider.
Take Glucophage with the morning and evening meal.
The nurse is developing an educational program for older clients who are being discharged with
new antihypertensive medications. The nurse should ensure that the educational materials
include which
characteristics? Select all that apply - ANS Written at a twelfth grade reading level
Contains a list with definitions of unfamiliar terms
Uses common words with few Syllables
Printed using a 12 point type font
Uses pictures to help illustrate complex ideas
Rationale: During the aging process older clients often experience sensory or cognitive changes,
such as
decreased visual or hearing acuity, slower thought or reasoning processes, and shorter attention
span.
Materials for this age group should include at least of terms, such as a medical terminology that
incline
@COPYRIGHT ALL RIGHTS RESERVED PAGE 4 OF 81
