2026
HESI RN Exit Exam 2026 Advanced
Review and Test Bank: Evidence-Based
Nursing Concepts and Clinical Judgment
Practice
The nurse is preparing a client for discharge from the hospital following a liver transplant. Which
instruction is most important for the nurse to include in this client's discharge teaching plan?
a. Monitor for an elevated temperature
b. Measure the abdominal girth daily
c. Report the onset of sclera jaundice
d. Keep a record of daily urinary output
Correct Answer: a. Monitor for an elevated temperature
Rationale:
Post–liver transplant clients are immunosuppressed and at high risk for infection. Fever is often
the first and most critical sign of infection and must be reported immediately.
The nurse is conducting health assessments. Which assessment finding increases a 56-year-old
woman's risk for developing osteoporosis?
a. Body mass index (BMI) of 31
b. 20 pack-year history of cigarette smoking
c. Birth control pill usage until age 45
d. Diabetes mellitus in family history
Correct Answer: b. 20 pack-year history of cigarette smoking
Rationale:
Smoking decreases bone density and interferes with calcium absorption, significantly increasing
osteoporosis risk.
The nurse administers an oral antiviral to a client with shingles. Which finding is most important
for the nurse to report to the healthcare provider?
a. Decreased white blood cell count
b. Pruritus and muscle aches
,2026
c. Elevated liver function tests
d. Vomiting and diarrhea
Correct Answer: c. Elevated liver function tests
Rationale:
Antiviral medications can be hepatotoxic. Elevated liver enzymes indicate potential liver injury
and require immediate follow-up.
A client in the intensive care unit is mechanically ventilated, has an indwelling urinary catheter,
and is restless. Which action should the nurse take first?
a. Review heart rhythm on the monitor
b. Check the urinary catheter for obstruction
c. Auscultate bilateral breath sounds
d. Administer PRN lorazepam
Correct Answer: c. Auscultate bilateral breath sounds
Rationale:
Restlessness in a ventilated client may indicate hypoxia or airway compromise. Airway and
breathing take priority over sedation or other assessments.
The nurse observes a UAP caring for a client with Alzheimer’s disease. When the client becomes
upset, the UAP changes the subject. What action should the nurse take?
a. Tell the UAP to offer more choices
b. Role model assertive communication later
c. Assume care of the client
d. Affirm the UAP’s effective strategy
Correct Answer: d. Affirm the UAP’s effective strategy
Rationale:
Redirecting conversation is an appropriate technique to reduce anxiety in clients with dementia.
Positive reinforcement supports effective caregiving.
In evaluating the effectiveness of intermittent pneumatic compression devices, which assessment
is most important?
a. Incentive spirometer use
b. Incision drainage
,2026
c. Redness and swelling of lower extremities
d. Peripheral pulse strength
Correct Answer: c. Observe both lower extremities for redness and swelling
Rationale:
Compression devices prevent deep vein thrombosis. Monitoring for redness and swelling helps
detect clot formation.
A nurse encounters a motorcycle accident victim lying face down in water. What action should
the nurse take first?
a. Check for arterial bleeding
b. Stabilize the neck and roll the victim
c. Call 911
d. Open airway and begin CPR
Correct Answer: b. Stabilize the victim’s neck and roll over to evaluate status
Rationale:
Spinal precautions are critical. The airway cannot be assessed while the victim is prone and face
down in water.
At a 6-month well-baby visit, which vaccine has reduced the incidence of otitis media?
a. Varicella
b. Hemophilus influenzae type B (HiB)
c. Pneumococcal
d. Palivizumab
Correct Answer: b. Hemophilus influenzae type B (HiB)
Rationale:
HiB vaccination significantly reduces middle ear infections and invasive bacterial disease in
infants.
A labor and delivery nurse is reassigned to a cardiac unit. Which assignment is best?
a. Transfer a client
b. Monitor telemetry
c. Perform an admission
d. Assist cardiac nurses
, 2026
Correct Answer: d. Assist cardiac nurses with their assignments
Rationale:
Floating nurses should be assigned tasks consistent with their competency and scope of practice.
A client with SLE is admitted with edema and hematuria. Which finding requires immediate
intervention?
a. Rust-colored urine
b. Urine output 300 mL/hr
c. Joint pain
d. Blood pressure 170/98
Correct Answer: d. Blood pressure 170/98
Rationale:
Severe hypertension suggests renal involvement and possible lupus nephritis, which is life-
threatening.
A mechanically ventilated client has wrist restraints in place. Which outcome is most important?
a. Understand pain scale
b. Maintain effective breathing patterns
c. Absence of ventilator-associated pneumonia
d. No restraint-related injuries
Correct Answer: b. Maintain effective breathing patterns
Rationale:
Airway and breathing remain the highest priority for a ventilated client.
Why should a client with hypertension reduce salt intake?
a. Salt damages vessels
b. Salt causes fluid retention by kidneys
c. Salt constricts vessels
d. Salt causes inflammation
Correct Answer: b. Too much salt can cause the kidneys to retain fluid
Rationale:
Fluid retention increases blood volume and blood pressure, worsening hypertension.
HESI RN Exit Exam 2026 Advanced
Review and Test Bank: Evidence-Based
Nursing Concepts and Clinical Judgment
Practice
The nurse is preparing a client for discharge from the hospital following a liver transplant. Which
instruction is most important for the nurse to include in this client's discharge teaching plan?
a. Monitor for an elevated temperature
b. Measure the abdominal girth daily
c. Report the onset of sclera jaundice
d. Keep a record of daily urinary output
Correct Answer: a. Monitor for an elevated temperature
Rationale:
Post–liver transplant clients are immunosuppressed and at high risk for infection. Fever is often
the first and most critical sign of infection and must be reported immediately.
The nurse is conducting health assessments. Which assessment finding increases a 56-year-old
woman's risk for developing osteoporosis?
a. Body mass index (BMI) of 31
b. 20 pack-year history of cigarette smoking
c. Birth control pill usage until age 45
d. Diabetes mellitus in family history
Correct Answer: b. 20 pack-year history of cigarette smoking
Rationale:
Smoking decreases bone density and interferes with calcium absorption, significantly increasing
osteoporosis risk.
The nurse administers an oral antiviral to a client with shingles. Which finding is most important
for the nurse to report to the healthcare provider?
a. Decreased white blood cell count
b. Pruritus and muscle aches
,2026
c. Elevated liver function tests
d. Vomiting and diarrhea
Correct Answer: c. Elevated liver function tests
Rationale:
Antiviral medications can be hepatotoxic. Elevated liver enzymes indicate potential liver injury
and require immediate follow-up.
A client in the intensive care unit is mechanically ventilated, has an indwelling urinary catheter,
and is restless. Which action should the nurse take first?
a. Review heart rhythm on the monitor
b. Check the urinary catheter for obstruction
c. Auscultate bilateral breath sounds
d. Administer PRN lorazepam
Correct Answer: c. Auscultate bilateral breath sounds
Rationale:
Restlessness in a ventilated client may indicate hypoxia or airway compromise. Airway and
breathing take priority over sedation or other assessments.
The nurse observes a UAP caring for a client with Alzheimer’s disease. When the client becomes
upset, the UAP changes the subject. What action should the nurse take?
a. Tell the UAP to offer more choices
b. Role model assertive communication later
c. Assume care of the client
d. Affirm the UAP’s effective strategy
Correct Answer: d. Affirm the UAP’s effective strategy
Rationale:
Redirecting conversation is an appropriate technique to reduce anxiety in clients with dementia.
Positive reinforcement supports effective caregiving.
In evaluating the effectiveness of intermittent pneumatic compression devices, which assessment
is most important?
a. Incentive spirometer use
b. Incision drainage
,2026
c. Redness and swelling of lower extremities
d. Peripheral pulse strength
Correct Answer: c. Observe both lower extremities for redness and swelling
Rationale:
Compression devices prevent deep vein thrombosis. Monitoring for redness and swelling helps
detect clot formation.
A nurse encounters a motorcycle accident victim lying face down in water. What action should
the nurse take first?
a. Check for arterial bleeding
b. Stabilize the neck and roll the victim
c. Call 911
d. Open airway and begin CPR
Correct Answer: b. Stabilize the victim’s neck and roll over to evaluate status
Rationale:
Spinal precautions are critical. The airway cannot be assessed while the victim is prone and face
down in water.
At a 6-month well-baby visit, which vaccine has reduced the incidence of otitis media?
a. Varicella
b. Hemophilus influenzae type B (HiB)
c. Pneumococcal
d. Palivizumab
Correct Answer: b. Hemophilus influenzae type B (HiB)
Rationale:
HiB vaccination significantly reduces middle ear infections and invasive bacterial disease in
infants.
A labor and delivery nurse is reassigned to a cardiac unit. Which assignment is best?
a. Transfer a client
b. Monitor telemetry
c. Perform an admission
d. Assist cardiac nurses
, 2026
Correct Answer: d. Assist cardiac nurses with their assignments
Rationale:
Floating nurses should be assigned tasks consistent with their competency and scope of practice.
A client with SLE is admitted with edema and hematuria. Which finding requires immediate
intervention?
a. Rust-colored urine
b. Urine output 300 mL/hr
c. Joint pain
d. Blood pressure 170/98
Correct Answer: d. Blood pressure 170/98
Rationale:
Severe hypertension suggests renal involvement and possible lupus nephritis, which is life-
threatening.
A mechanically ventilated client has wrist restraints in place. Which outcome is most important?
a. Understand pain scale
b. Maintain effective breathing patterns
c. Absence of ventilator-associated pneumonia
d. No restraint-related injuries
Correct Answer: b. Maintain effective breathing patterns
Rationale:
Airway and breathing remain the highest priority for a ventilated client.
Why should a client with hypertension reduce salt intake?
a. Salt damages vessels
b. Salt causes fluid retention by kidneys
c. Salt constricts vessels
d. Salt causes inflammation
Correct Answer: b. Too much salt can cause the kidneys to retain fluid
Rationale:
Fluid retention increases blood volume and blood pressure, worsening hypertension.
