# **HESI RN Exit Exam Version 4 | Questions,
Answers & Rationales**
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**Question 1**
A nurse is assessing a client who is 24 hours post‑gastrectomy. The client reports dizziness, sweating,
and palpitations 30 minutes after eating. Which complication should the nurse suspect?
A. Dumping syndrome
B. Gastric outlet obstruction
C. Peritonitis
D. Hemorrhage
💫ANSWER✔️✔️: A. Dumping syndrome
💫RATIONALE✔️✔️: Rapid gastric emptying after gastrectomy causes fluid shift into bowel, producing
vasomotor symptoms 15‑30 minutes postprandial.
---
**Question 2**
A client with chronic kidney disease has a phosphate level of 7.2 mg/dL. Which medication should the
nurse anticipate administering?
A. Calcium acetate
B. Sevelamer
C. Calcitriol
D. Ferrous sulfate
💫ANSWER✔️✔️: A. Calcium acetate
,💫RATIONALE✔️✔️: Calcium acetate binds dietary phosphate in the GI tract, reducing absorption and
lowering serum phosphate levels.
---
**Question 3**
A nurse is caring for a client receiving a blood transfusion. Which finding indicates a febrile
non‑hemolytic transfusion reaction?
A. Hypotension and back pain
B. Temperature 101.5°F (38.6°C) and chills
C. Wheezing and urticaria
D. Hemoglobinuria and jaundice
💫ANSWER✔️✔️: B. Temperature 101.5°F (38.6°C) and chills
💫RATIONALE✔️✔️: Febrile reactions present with fever and chills without hemolysis, caused by recipient
antibodies against donor white blood cells.
---
**Question 4**
A nurse is providing discharge teaching to a client with a new ileal conduit. Which statement indicates
correct understanding?
A. "I will change my entire appliance every day"
B. "I can use an adhesive remover to protect my skin"
C. "I will restrict fluids to prevent leakage"
D. "I should expect my stoma to shrink after 6 months"
💫ANSWER✔️✔️: B. "I can use an adhesive remover to protect my skin"
💫RATIONALE✔️✔️: Adhesive remover prevents skin stripping during appliance changes, maintaining
peristomal skin integrity.
,---
**Question 5**
A client with major depressive disorder has been taking fluoxetine for 8 weeks with minimal
improvement. Which action should the nurse take?
A. Increase the dose without consulting the provider
B. Document and continue current therapy
C. Notify the provider to discuss medication adjustment
D. Discontinue fluoxetine and start bupropion
💫ANSWER✔️✔️: C. Notify the provider to discuss medication adjustment
💫RATIONALE✔️✔️: Full antidepressant effect typically occurs by 6‑8 weeks; lack of response requires
provider evaluation for dose change or augmentation.
---
**Question 6**
A nurse is assessing a client with a bowel obstruction. Which finding requires immediate surgical
consultation?
A. Nausea and vomiting
B. Abdominal distention
C. Passage of bloody mucus
D. Hyperactive bowel sounds
💫ANSWER✔️✔️: C. Passage of bloody mucus
💫RATIONALE✔️✔️: Bloody mucus (currant jelly stool) indicates strangulated obstruction with bowel
ischemia, a surgical emergency.
---
, **Question 7**
A nurse is administering IV hydromorphone to a client post‑operatively. Which assessment finding
requires immediate action?
A. Respiratory rate 10 breaths/min
B. Pain rated 3 on a 0‑10 scale
C. Blood pressure 110/70 mm Hg
D. Sedation level 2 on Ramsay scale
💫ANSWER✔️✔️: A. Respiratory rate 10 breaths/min
💫RATIONALE✔️✔️: Respiratory depression (<12 breaths/min) from opioids requires withholding
medication and possibly administering naloxone.
---
**Question 8**
A nurse is caring for a client with a new diagnosis of type 2 diabetes who is prescribed metformin. Which
adverse effect should the nurse include in teaching?
A. Weight gain
B. Hypoglycemia
C. Lactic acidosis
D. Hyperkalemia
💫ANSWER✔️✔️: C. Lactic acidosis
💫RATIONALE✔️✔️: Metformin carries a rare but serious risk of lactic acidosis, especially in renal
impairment or hypoxic states.
---
**Question 9**
Answers & Rationales**
---
**Question 1**
A nurse is assessing a client who is 24 hours post‑gastrectomy. The client reports dizziness, sweating,
and palpitations 30 minutes after eating. Which complication should the nurse suspect?
A. Dumping syndrome
B. Gastric outlet obstruction
C. Peritonitis
D. Hemorrhage
💫ANSWER✔️✔️: A. Dumping syndrome
💫RATIONALE✔️✔️: Rapid gastric emptying after gastrectomy causes fluid shift into bowel, producing
vasomotor symptoms 15‑30 minutes postprandial.
---
**Question 2**
A client with chronic kidney disease has a phosphate level of 7.2 mg/dL. Which medication should the
nurse anticipate administering?
A. Calcium acetate
B. Sevelamer
C. Calcitriol
D. Ferrous sulfate
💫ANSWER✔️✔️: A. Calcium acetate
,💫RATIONALE✔️✔️: Calcium acetate binds dietary phosphate in the GI tract, reducing absorption and
lowering serum phosphate levels.
---
**Question 3**
A nurse is caring for a client receiving a blood transfusion. Which finding indicates a febrile
non‑hemolytic transfusion reaction?
A. Hypotension and back pain
B. Temperature 101.5°F (38.6°C) and chills
C. Wheezing and urticaria
D. Hemoglobinuria and jaundice
💫ANSWER✔️✔️: B. Temperature 101.5°F (38.6°C) and chills
💫RATIONALE✔️✔️: Febrile reactions present with fever and chills without hemolysis, caused by recipient
antibodies against donor white blood cells.
---
**Question 4**
A nurse is providing discharge teaching to a client with a new ileal conduit. Which statement indicates
correct understanding?
A. "I will change my entire appliance every day"
B. "I can use an adhesive remover to protect my skin"
C. "I will restrict fluids to prevent leakage"
D. "I should expect my stoma to shrink after 6 months"
💫ANSWER✔️✔️: B. "I can use an adhesive remover to protect my skin"
💫RATIONALE✔️✔️: Adhesive remover prevents skin stripping during appliance changes, maintaining
peristomal skin integrity.
,---
**Question 5**
A client with major depressive disorder has been taking fluoxetine for 8 weeks with minimal
improvement. Which action should the nurse take?
A. Increase the dose without consulting the provider
B. Document and continue current therapy
C. Notify the provider to discuss medication adjustment
D. Discontinue fluoxetine and start bupropion
💫ANSWER✔️✔️: C. Notify the provider to discuss medication adjustment
💫RATIONALE✔️✔️: Full antidepressant effect typically occurs by 6‑8 weeks; lack of response requires
provider evaluation for dose change or augmentation.
---
**Question 6**
A nurse is assessing a client with a bowel obstruction. Which finding requires immediate surgical
consultation?
A. Nausea and vomiting
B. Abdominal distention
C. Passage of bloody mucus
D. Hyperactive bowel sounds
💫ANSWER✔️✔️: C. Passage of bloody mucus
💫RATIONALE✔️✔️: Bloody mucus (currant jelly stool) indicates strangulated obstruction with bowel
ischemia, a surgical emergency.
---
, **Question 7**
A nurse is administering IV hydromorphone to a client post‑operatively. Which assessment finding
requires immediate action?
A. Respiratory rate 10 breaths/min
B. Pain rated 3 on a 0‑10 scale
C. Blood pressure 110/70 mm Hg
D. Sedation level 2 on Ramsay scale
💫ANSWER✔️✔️: A. Respiratory rate 10 breaths/min
💫RATIONALE✔️✔️: Respiratory depression (<12 breaths/min) from opioids requires withholding
medication and possibly administering naloxone.
---
**Question 8**
A nurse is caring for a client with a new diagnosis of type 2 diabetes who is prescribed metformin. Which
adverse effect should the nurse include in teaching?
A. Weight gain
B. Hypoglycemia
C. Lactic acidosis
D. Hyperkalemia
💫ANSWER✔️✔️: C. Lactic acidosis
💫RATIONALE✔️✔️: Metformin carries a rare but serious risk of lactic acidosis, especially in renal
impairment or hypoxic states.
---
**Question 9**
