The Ultimate and Complete HESI Exit Exam (RN & PN) Study Guide 2025,
Covering NCLEX-Style Clinical Judgment and Decision Making,
Medical-Surgical Nursing Across Body Systems, Pharmacology and
Medication Safety Principles, Prioritization and Delegation in Nursing
Care, Fundamentals of Nursing and Patient Safety Concepts, Pediatric
and Maternal-Newborn Nursing Care, Mental Health and Psychiatric
Nursing Principles, Infection Control and Sepsis Management, Fluid
and Electrolyte Balance and Acid-Base Disorders, Leadership and
Management in Nursing Practice, HESI Exit RN and PN Practice
Questions with Verified Answers and Detailed Rationales, Real Clinical
Case Scenarios, Step-by-Step Nursing Care Plans, and Proven
Strategies to Successfully Pass the HESI Exit Exam and Transition to
NCLEX Success
Question 1: A nurse is assessing a client 2 hours post-thoracentesis. Which finding requires
immediate reporting? A. Temp 37.2°C (99.0°F) B. RR 18/min C. Tracheal deviation to the left D.
Pain 4/10 at site CORRECT ANSWER: C. Tracheal deviation to the left Rationale: Tracheal
deviation indicates a tension pneumothorax, a life-threatening complication requiring
immediate intervention.
Question 2: A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement indicates understanding? A. "I will use a soft-bristled toothbrush." B. "I will take
aspirin for headaches." C. "I will eat more green leafy vegetables." D. "I will stop the drug if I
bruise." CORRECT ANSWER: A. "I will use a soft-bristled toothbrush." Rationale: Warfarin
increases bleeding risk; a soft toothbrush minimizes gum bleeding. Aspirin increases bleeding,
vitamin K antagonizes warfarin, and bruising should be reported, not ignored.
Question 3: A client on digoxin therapy reports seeing yellow halos around lights. What is the
nurse's priority action? A. Administer a prescribed antiemetic. B. Withhold the next dose of
digoxin. C. Encourage oral fluid intake. D. Document the finding in the chart. CORRECT
ANSWER: B. Withhold the next dose of digoxin. Rationale: Visual disturbances like yellow halos
are classic signs of digoxin toxicity. The nurse must withhold the medication and notify the
provider immediately.
Question 4: A nurse is caring for a client receiving furosemide. Which lab value requires
immediate intervention? A. Sodium 140 mEq/L B. Potassium 3.2 mEq/L C. Calcium 9.5 mg/dL D.
Magnesium 2.0 mEq/L CORRECT ANSWER: B. Potassium 3.2 mEq/L Rationale: Furosemide is a
,potassium-wasting diuretic. A potassium level of 3.2 mEq/L indicates hypokalemia, which can
cause life-threatening cardiac dysrhythmias.
Question 5: A client with type 1 diabetes presents with confusion, diaphoresis, and a heart
rate of 110/min. What is the nurse's first action? A. Administer regular insulin subcutaneously.
B. Obtain a capillary blood glucose level. C. Administer 50% dextrose IV push. D. Give 4 oz of
orange juice orally. CORRECT ANSWER: B. Obtain a capillary blood glucose level. Rationale:
The client is exhibiting signs of hypoglycemia. The nurse must first confirm the blood glucose
level before administering any treatment to ensure safety.
Question 6: A nurse is administering morphine sulfate IV to a client with severe pain. Which
assessment finding is the priority? A. Blood pressure 110/70 mm Hg B. Respiratory rate 10/min
C. Bowel sounds hypoactive D. Pupils pinpoint CORRECT ANSWER: B. Respiratory rate 10/min
Rationale: Respiratory depression is the most serious adverse effect of opioid analgesics. A
respiratory rate below 12/min requires withholding the dose and notifying the provider.
Question 7: A client is receiving a continuous IV heparin infusion. The aPTT is 110 seconds.
What should the nurse do? A. Continue the infusion as prescribed. B. Increase the infusion rate
by 2 mL/hr. C. Stop the heparin infusion immediately. D. Administer protamine sulfate IV.
CORRECT ANSWER: C. Stop the heparin infusion immediately. Rationale: The therapeutic aPTT
for heparin is 1.5 to 2.5 times the control (usually 46-70 seconds). An aPTT of 110 seconds
indicates a high risk of bleeding; the infusion must be stopped.
Question 8: A client with bipolar disorder is taking lithium. Which symptom suggests lithium
toxicity? A. Increased urinary output B. Coarse hand tremors C. Weight loss D. Mild thirst
CORRECT ANSWER: B. Coarse hand tremors Rationale: Coarse tremors, ataxia, confusion, and
vomiting are signs of lithium toxicity. Fine tremors, polyuria, and mild thirst are common side
effects, not toxicity.
Question 9: A nurse is teaching a client prescribed phenytoin. Which instruction is essential?
A. "Take the medication on an empty stomach." B. "Maintain good oral hygiene and see a
dentist regularly." C. "Stop the medication if you experience nausea." D. "Increase your intake
of dairy products." CORRECT ANSWER: B. "Maintain good oral hygiene and see a dentist
regularly." Rationale: Phenytoin causes gingival hyperplasia. Meticulous oral hygiene and
regular dental check-ups can minimize this effect.
Question 10: A client with type 2 diabetes is prescribed metformin. Which condition increases
the risk of lactic acidosis? A. Hypertension B. Renal impairment C. Hyperlipidemia D. Obesity
CORRECT ANSWER: B. Renal impairment Rationale: Metformin is excreted unchanged by the
kidneys. Renal impairment decreases its clearance, increasing the risk of accumulation and
lactic acidosis.
Question 11: A nurse is caring for a client with a chest tube connected to a closed drainage
system. The water seal chamber shows continuous bubbling. What does this indicate? A. The
,lung has fully re-expanded. B. There is an air leak in the system. C. The suction pressure is too
high. D. The chest tube is occluded. CORRECT ANSWER: B. There is an air leak in the system.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. Intermittent
bubbling is normal and corresponds with respiration.
Question 12: A client with COPD is prescribed supplemental oxygen. What is the target SpO2
for this client? A. 85% - 89% B. 88% - 92% C. 94% - 98% D. 98% - 100% CORRECT ANSWER: B.
88% - 92% Rationale: Clients with chronic CO2 retention rely on a hypoxic drive to stimulate
breathing. High oxygen levels can suppress this drive, leading to respiratory arrest.
Question 13: A nurse is assessing a client with suspected meningitis. Which finding is
expected? A. Positive Brudzinski's sign B. Negative Kernig's sign C. Hyperactive deep tendon
reflexes D. Sluggish pupillary response CORRECT ANSWER: A. Positive Brudzinski's sign
Rationale: Brudzinski's sign (flexion of the hips and knees in response to passive flexion of the
neck) and Kernig's sign are classic meningeal signs.
Question 14: A client with a head injury has a Glasgow Coma Scale (GCS) score of 7. What
does this indicate? A. Mild brain injury B. Moderate brain injury C. Severe brain injury D.
Normal neurological function CORRECT ANSWER: C. Severe brain injury Rationale: A GCS score
of 8 or less indicates a severe brain injury and typically requires intubation to protect the
airway.
Question 15: A nurse is caring for a client following a thyroidectomy. Which finding is the
priority? A. Hoarseness B. Laryngeal stridor C. Pain at the incision site D. Mild swelling of the
neck CORRECT ANSWER: B. Laryngeal stridor Rationale: Laryngeal stridor indicates airway
obstruction, possibly due to laryngeal nerve damage, hemorrhage, or tetany. This is a medical
emergency.
Question 16: A client with Addison's disease is experiencing an adrenal crisis. Which
medication should the nurse prepare to administer? A. Levothyroxine B. Hydrocortisone C.
Regular insulin D. Potassium chloride CORRECT ANSWER: B. Hydrocortisone Rationale: Adrenal
crisis is a life-threatening deficiency of cortisol. Immediate IV administration of hydrocortisone
is critical to restore vascular tone and glucose levels.
Question 17: A nurse is caring for a client with syndrome of inappropriate antidiuretic
hormone (SIADH). Which finding is expected? A. Hypernatremia B. Hyponatremia C. Polyuria
D. Decreased urine specific gravity CORRECT ANSWER: B. Hyponatremia Rationale: SIADH
causes excessive water retention, leading to dilutional hyponatremia, concentrated urine (high
specific gravity), and decreased urine output.
Question 18: A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL.
What is the initial IV fluid of choice? A. 0.45% Sodium chloride B. 0.9% Sodium chloride C. 5%
Dextrose in water D. Lactated Ringer's CORRECT ANSWER: B. 0.9% Sodium chloride Rationale:
, Initial fluid resuscitation in DKA involves rapid infusion of 0.9% NaCl to restore intravascular
volume and tissue perfusion.
Question 19: A nurse is assessing a client with cirrhosis. Which finding indicates hepatic
encephalopathy? A. Jaundice B. Asterixis C. Ascites D. Spider angiomas CORRECT ANSWER: B.
Asterixis Rationale: Asterixis (a flapping tremor of the hands) is a classic neurological sign of
hepatic encephalopathy caused by ammonia accumulation.
Question 20: A client with peptic ulcer disease is prescribed sucralfate. When should the
nurse administer this medication? A. With meals B. 1 hour before meals and at bedtime C.
Immediately after meals D. Only when pain occurs CORRECT ANSWER: B. 1 hour before meals
and at bedtime Rationale: Sucralfate forms a protective barrier over the ulcer. It must be taken
on an empty stomach (1 hour before meals) to be effective.
Question 21: A nurse is caring for a client with acute pancreatitis. Which lab value is most
indicative of this condition? A. Decreased serum amylase B. Elevated serum lipase C.
Decreased blood glucose D. Elevated serum calcium CORRECT ANSWER: B. Elevated serum
lipase Rationale: Serum lipase is more specific to the pancreas than amylase and remains
elevated longer, making it the preferred diagnostic marker for acute pancreatitis.
Question 22: A client with inflammatory bowel disease (IBD) is experiencing a severe
exacerbation. Which dietary modification is appropriate? A. High-fiber diet B. Low-residue,
low-fiber diet C. High-fat diet D. Lactose-rich diet CORRECT ANSWER: B. Low-residue, low-fiber
diet Rationale: During an acute exacerbation of IBD, a low-residue, low-fiber diet reduces bowel
stimulation and decreases the frequency of stools.
Question 23: A nurse is caring for a client with a newly placed colostomy. The stoma appears
dark purple. What is the nurse's priority action? A. Document the finding as normal. B. Apply a
warm compress to the stoma. C. Notify the healthcare provider immediately. D. Increase the
frequency of stoma assessments. CORRECT ANSWER: C. Notify the healthcare provider
immediately. Rationale: A healthy stoma should be beefy red or pink. A dark purple or black
stoma indicates impaired blood supply and tissue necrosis, requiring immediate surgical
intervention.
Question 24: A client with chronic kidney disease (CKD) has a serum potassium level of 6.2
mEq/L. Which ECG change should the nurse anticipate? A. Prominent U waves B. Peaked T
waves C. Prolonged QT interval D. ST segment depression CORRECT ANSWER: B. Peaked T
waves Rationale: Hyperkalemia causes peaked T waves, widened QRS complexes, and
prolonged PR intervals on an ECG. Prominent U waves are associated with hypokalemia.
Question 25: A nurse is preparing a client for hemodialysis. Which access site should the
nurse avoid using for blood draws or blood pressure measurements? A. The arm with an
arteriovenous (AV) fistula B. The leg with a peripheral IV C. The arm with a PICC line D. The neck
with a central line CORRECT ANSWER: A. The arm with an arteriovenous (AV) fistula Rationale:
Covering NCLEX-Style Clinical Judgment and Decision Making,
Medical-Surgical Nursing Across Body Systems, Pharmacology and
Medication Safety Principles, Prioritization and Delegation in Nursing
Care, Fundamentals of Nursing and Patient Safety Concepts, Pediatric
and Maternal-Newborn Nursing Care, Mental Health and Psychiatric
Nursing Principles, Infection Control and Sepsis Management, Fluid
and Electrolyte Balance and Acid-Base Disorders, Leadership and
Management in Nursing Practice, HESI Exit RN and PN Practice
Questions with Verified Answers and Detailed Rationales, Real Clinical
Case Scenarios, Step-by-Step Nursing Care Plans, and Proven
Strategies to Successfully Pass the HESI Exit Exam and Transition to
NCLEX Success
Question 1: A nurse is assessing a client 2 hours post-thoracentesis. Which finding requires
immediate reporting? A. Temp 37.2°C (99.0°F) B. RR 18/min C. Tracheal deviation to the left D.
Pain 4/10 at site CORRECT ANSWER: C. Tracheal deviation to the left Rationale: Tracheal
deviation indicates a tension pneumothorax, a life-threatening complication requiring
immediate intervention.
Question 2: A nurse is providing discharge teaching to a client prescribed warfarin. Which
statement indicates understanding? A. "I will use a soft-bristled toothbrush." B. "I will take
aspirin for headaches." C. "I will eat more green leafy vegetables." D. "I will stop the drug if I
bruise." CORRECT ANSWER: A. "I will use a soft-bristled toothbrush." Rationale: Warfarin
increases bleeding risk; a soft toothbrush minimizes gum bleeding. Aspirin increases bleeding,
vitamin K antagonizes warfarin, and bruising should be reported, not ignored.
Question 3: A client on digoxin therapy reports seeing yellow halos around lights. What is the
nurse's priority action? A. Administer a prescribed antiemetic. B. Withhold the next dose of
digoxin. C. Encourage oral fluid intake. D. Document the finding in the chart. CORRECT
ANSWER: B. Withhold the next dose of digoxin. Rationale: Visual disturbances like yellow halos
are classic signs of digoxin toxicity. The nurse must withhold the medication and notify the
provider immediately.
Question 4: A nurse is caring for a client receiving furosemide. Which lab value requires
immediate intervention? A. Sodium 140 mEq/L B. Potassium 3.2 mEq/L C. Calcium 9.5 mg/dL D.
Magnesium 2.0 mEq/L CORRECT ANSWER: B. Potassium 3.2 mEq/L Rationale: Furosemide is a
,potassium-wasting diuretic. A potassium level of 3.2 mEq/L indicates hypokalemia, which can
cause life-threatening cardiac dysrhythmias.
Question 5: A client with type 1 diabetes presents with confusion, diaphoresis, and a heart
rate of 110/min. What is the nurse's first action? A. Administer regular insulin subcutaneously.
B. Obtain a capillary blood glucose level. C. Administer 50% dextrose IV push. D. Give 4 oz of
orange juice orally. CORRECT ANSWER: B. Obtain a capillary blood glucose level. Rationale:
The client is exhibiting signs of hypoglycemia. The nurse must first confirm the blood glucose
level before administering any treatment to ensure safety.
Question 6: A nurse is administering morphine sulfate IV to a client with severe pain. Which
assessment finding is the priority? A. Blood pressure 110/70 mm Hg B. Respiratory rate 10/min
C. Bowel sounds hypoactive D. Pupils pinpoint CORRECT ANSWER: B. Respiratory rate 10/min
Rationale: Respiratory depression is the most serious adverse effect of opioid analgesics. A
respiratory rate below 12/min requires withholding the dose and notifying the provider.
Question 7: A client is receiving a continuous IV heparin infusion. The aPTT is 110 seconds.
What should the nurse do? A. Continue the infusion as prescribed. B. Increase the infusion rate
by 2 mL/hr. C. Stop the heparin infusion immediately. D. Administer protamine sulfate IV.
CORRECT ANSWER: C. Stop the heparin infusion immediately. Rationale: The therapeutic aPTT
for heparin is 1.5 to 2.5 times the control (usually 46-70 seconds). An aPTT of 110 seconds
indicates a high risk of bleeding; the infusion must be stopped.
Question 8: A client with bipolar disorder is taking lithium. Which symptom suggests lithium
toxicity? A. Increased urinary output B. Coarse hand tremors C. Weight loss D. Mild thirst
CORRECT ANSWER: B. Coarse hand tremors Rationale: Coarse tremors, ataxia, confusion, and
vomiting are signs of lithium toxicity. Fine tremors, polyuria, and mild thirst are common side
effects, not toxicity.
Question 9: A nurse is teaching a client prescribed phenytoin. Which instruction is essential?
A. "Take the medication on an empty stomach." B. "Maintain good oral hygiene and see a
dentist regularly." C. "Stop the medication if you experience nausea." D. "Increase your intake
of dairy products." CORRECT ANSWER: B. "Maintain good oral hygiene and see a dentist
regularly." Rationale: Phenytoin causes gingival hyperplasia. Meticulous oral hygiene and
regular dental check-ups can minimize this effect.
Question 10: A client with type 2 diabetes is prescribed metformin. Which condition increases
the risk of lactic acidosis? A. Hypertension B. Renal impairment C. Hyperlipidemia D. Obesity
CORRECT ANSWER: B. Renal impairment Rationale: Metformin is excreted unchanged by the
kidneys. Renal impairment decreases its clearance, increasing the risk of accumulation and
lactic acidosis.
Question 11: A nurse is caring for a client with a chest tube connected to a closed drainage
system. The water seal chamber shows continuous bubbling. What does this indicate? A. The
,lung has fully re-expanded. B. There is an air leak in the system. C. The suction pressure is too
high. D. The chest tube is occluded. CORRECT ANSWER: B. There is an air leak in the system.
Rationale: Continuous bubbling in the water seal chamber indicates an air leak. Intermittent
bubbling is normal and corresponds with respiration.
Question 12: A client with COPD is prescribed supplemental oxygen. What is the target SpO2
for this client? A. 85% - 89% B. 88% - 92% C. 94% - 98% D. 98% - 100% CORRECT ANSWER: B.
88% - 92% Rationale: Clients with chronic CO2 retention rely on a hypoxic drive to stimulate
breathing. High oxygen levels can suppress this drive, leading to respiratory arrest.
Question 13: A nurse is assessing a client with suspected meningitis. Which finding is
expected? A. Positive Brudzinski's sign B. Negative Kernig's sign C. Hyperactive deep tendon
reflexes D. Sluggish pupillary response CORRECT ANSWER: A. Positive Brudzinski's sign
Rationale: Brudzinski's sign (flexion of the hips and knees in response to passive flexion of the
neck) and Kernig's sign are classic meningeal signs.
Question 14: A client with a head injury has a Glasgow Coma Scale (GCS) score of 7. What
does this indicate? A. Mild brain injury B. Moderate brain injury C. Severe brain injury D.
Normal neurological function CORRECT ANSWER: C. Severe brain injury Rationale: A GCS score
of 8 or less indicates a severe brain injury and typically requires intubation to protect the
airway.
Question 15: A nurse is caring for a client following a thyroidectomy. Which finding is the
priority? A. Hoarseness B. Laryngeal stridor C. Pain at the incision site D. Mild swelling of the
neck CORRECT ANSWER: B. Laryngeal stridor Rationale: Laryngeal stridor indicates airway
obstruction, possibly due to laryngeal nerve damage, hemorrhage, or tetany. This is a medical
emergency.
Question 16: A client with Addison's disease is experiencing an adrenal crisis. Which
medication should the nurse prepare to administer? A. Levothyroxine B. Hydrocortisone C.
Regular insulin D. Potassium chloride CORRECT ANSWER: B. Hydrocortisone Rationale: Adrenal
crisis is a life-threatening deficiency of cortisol. Immediate IV administration of hydrocortisone
is critical to restore vascular tone and glucose levels.
Question 17: A nurse is caring for a client with syndrome of inappropriate antidiuretic
hormone (SIADH). Which finding is expected? A. Hypernatremia B. Hyponatremia C. Polyuria
D. Decreased urine specific gravity CORRECT ANSWER: B. Hyponatremia Rationale: SIADH
causes excessive water retention, leading to dilutional hyponatremia, concentrated urine (high
specific gravity), and decreased urine output.
Question 18: A client with diabetic ketoacidosis (DKA) has a blood glucose of 450 mg/dL.
What is the initial IV fluid of choice? A. 0.45% Sodium chloride B. 0.9% Sodium chloride C. 5%
Dextrose in water D. Lactated Ringer's CORRECT ANSWER: B. 0.9% Sodium chloride Rationale:
, Initial fluid resuscitation in DKA involves rapid infusion of 0.9% NaCl to restore intravascular
volume and tissue perfusion.
Question 19: A nurse is assessing a client with cirrhosis. Which finding indicates hepatic
encephalopathy? A. Jaundice B. Asterixis C. Ascites D. Spider angiomas CORRECT ANSWER: B.
Asterixis Rationale: Asterixis (a flapping tremor of the hands) is a classic neurological sign of
hepatic encephalopathy caused by ammonia accumulation.
Question 20: A client with peptic ulcer disease is prescribed sucralfate. When should the
nurse administer this medication? A. With meals B. 1 hour before meals and at bedtime C.
Immediately after meals D. Only when pain occurs CORRECT ANSWER: B. 1 hour before meals
and at bedtime Rationale: Sucralfate forms a protective barrier over the ulcer. It must be taken
on an empty stomach (1 hour before meals) to be effective.
Question 21: A nurse is caring for a client with acute pancreatitis. Which lab value is most
indicative of this condition? A. Decreased serum amylase B. Elevated serum lipase C.
Decreased blood glucose D. Elevated serum calcium CORRECT ANSWER: B. Elevated serum
lipase Rationale: Serum lipase is more specific to the pancreas than amylase and remains
elevated longer, making it the preferred diagnostic marker for acute pancreatitis.
Question 22: A client with inflammatory bowel disease (IBD) is experiencing a severe
exacerbation. Which dietary modification is appropriate? A. High-fiber diet B. Low-residue,
low-fiber diet C. High-fat diet D. Lactose-rich diet CORRECT ANSWER: B. Low-residue, low-fiber
diet Rationale: During an acute exacerbation of IBD, a low-residue, low-fiber diet reduces bowel
stimulation and decreases the frequency of stools.
Question 23: A nurse is caring for a client with a newly placed colostomy. The stoma appears
dark purple. What is the nurse's priority action? A. Document the finding as normal. B. Apply a
warm compress to the stoma. C. Notify the healthcare provider immediately. D. Increase the
frequency of stoma assessments. CORRECT ANSWER: C. Notify the healthcare provider
immediately. Rationale: A healthy stoma should be beefy red or pink. A dark purple or black
stoma indicates impaired blood supply and tissue necrosis, requiring immediate surgical
intervention.
Question 24: A client with chronic kidney disease (CKD) has a serum potassium level of 6.2
mEq/L. Which ECG change should the nurse anticipate? A. Prominent U waves B. Peaked T
waves C. Prolonged QT interval D. ST segment depression CORRECT ANSWER: B. Peaked T
waves Rationale: Hyperkalemia causes peaked T waves, widened QRS complexes, and
prolonged PR intervals on an ECG. Prominent U waves are associated with hypokalemia.
Question 25: A nurse is preparing a client for hemodialysis. Which access site should the
nurse avoid using for blood draws or blood pressure measurements? A. The arm with an
arteriovenous (AV) fistula B. The leg with a peripheral IV C. The arm with a PICC line D. The neck
with a central line CORRECT ANSWER: A. The arm with an arteriovenous (AV) fistula Rationale:
