**HESI RN Exit Exam Version 7:
Comprehensive 110-Question Final Readiness
Assessment**
---
Question 1
A nurse is assessing a client who is receiving a continuous IV heparin infusion for deep vein thrombosis.
Which of the following laboratory values indicates that the therapy is therapeutic?
A. INR of 2.5
B. aPTT of 75 seconds (control 30 seconds)
C. Platelet count of 150,000/mm³
D. PT of 15 seconds (control 12 seconds)
💫ANSWER✔️✔️: B. aPTT of 75 seconds (control 30 seconds)
💫RATIONALE✔️✔️: Therapeutic aPTT for heparin is 1.5 to 2.5 times the normal control value; 75 seconds
is 2.5 times 30 seconds.
---
Question 2
A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client asks, "Why
do I have to take insulin instead of pills?" Which of the following responses should the nurse provide?
A. "Your pancreas produces too much glucagon, so insulin is needed to balance it."
B. "Your body is resistant to the insulin your pancreas makes, so you need more."
C. "Your immune system destroyed the cells that make insulin, so you must replace it."
D. "Your liver cannot store glucose properly, so insulin helps it function."
💫ANSWER✔️✔️: C. "Your immune system destroyed the cells that make insulin, so you must replace it."
💫RATIONALE✔️✔️: Type 1 diabetes is an autoimmune destruction of pancreatic beta cells, resulting in
absolute insulin deficiency.
---
Question 3
,A nurse is assessing a client who is 6 hours post‑operative following a carotid endarterectomy. Which of
the following findings should the nurse report to the provider immediately?
A. Blood pressure 148/88 mmHg
B. Difficulty swallowing thin liquids
C. Heart rate 88/min
D. Pain rating of 4 on a 0‑10 scale
💫ANSWER✔️✔️: B. Difficulty swallowing thin liquids
💫RATIONALE✔️✔️: Dysphagia after carotid surgery may indicate cranial nerve injury (hypoglossal or
vagus) or hematoma compressing the airway.
---
Question 4
A nurse is providing discharge teaching to a client who has a new prescription for clopidogrel after a
drug‑eluting stent placement. Which of the following instructions should the nurse include?
A. "You can stop this medication after 6 months if you have no chest pain."
B. "Avoid taking omeprazole for heartburn without talking to your provider."
C. "Take this medication on an empty stomach with a full glass of water."
D. "It is safe to take ibuprofen for headaches while on this medication."
💫ANSWER✔️✔️: B. "Avoid taking omeprazole for heartburn without talking to your provider."
💫RATIONALE✔️✔️: Omeprazole (a proton pump inhibitor) reduces the antiplatelet effect of clopidogrel
by inhibiting CYP2C19.
---
Question 5
A nurse is assessing a client who has a sodium level of 118 mEq/L. Which of the following clinical
manifestations should the nurse expect?
A. Hyperreflexia and muscle twitching
B. Thirst and dry mucous membranes
C. Nausea, vomiting, and confusion
D. Hypertension and bounding pulses
💫ANSWER✔️✔️: C. Nausea, vomiting, and confusion
,💫RATIONALE✔️✔️: Severe hyponatremia (<120 mEq/L) causes cerebral edema, leading to nausea,
vomiting, headache, confusion, and seizures.
---
Question 6
A nurse is caring for a client who has a chest tube following a pneumonectomy. The chest tube is
attached to a closed drainage system. The nurse notes continuous bubbling in the water seal chamber.
Which of the following actions should the nurse take?
A. Clamp the chest tube immediately
B. Increase the suction pressure
C. Check for an air leak in the system
D. Document this as an expected finding
💫ANSWER✔️✔️: C. Check for an air leak in the system
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak, which requires
assessment of connections and the insertion site.
---
Question 7
A nurse is providing teaching to a client who has a new prescription for levothyroxine for
hypothyroidism. Which of the following instructions should the nurse include?
A. "Take this medication with a high‑fiber breakfast."
B. "Take this medication at bedtime to avoid drowsiness."
C. "Take this medication on an empty stomach, 30‑60 minutes before breakfast."
D. "Take this medication with an antacid to prevent nausea."
💫ANSWER✔️✔️: C. "Take this medication on an empty stomach, 30‑60 minutes before breakfast."
💫RATIONALE✔️✔️: Levothyroxine is best absorbed on an empty stomach; food, especially calcium and
iron, decreases absorption.
---
Question 8
A nurse is assessing a client who is 2 days postpartum and reports a firm, tender area on the left breast.
The overlying skin is erythematous and warm. The client is breastfeeding. Which of the following actions
should the nurse recommend?
A. Stop breastfeeding from the affected breast
, B. Apply cold compresses to the area after feeding
C. Empty the affected breast completely with each feeding
D. Restrict fluid intake to reduce breast engorgement
💫ANSWER✔️✔️: C. Empty the affected breast completely with each feeding
💫RATIONALE✔️✔️: Complete emptying of the affected breast helps resolve mastitis; breastfeeding
should continue to prevent stasis.
---
Question 9
A nurse is caring for a client who has a new prescription for enoxaparin 40 mg subcutaneously daily.
Which of the following actions should the nurse take?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Inject the medication into the lateral abdominal tissue
D. Use a 21‑gauge, 1.5‑inch needle for administration
💫ANSWER✔️✔️: C. Inject the medication into the lateral abdominal tissue
💫RATIONALE✔️✔️: Enoxaparin is given subcutaneously in the abdomen; do not aspirate or rub the site
to prevent bruising.
---
Question 10
A nurse is assessing a client who has a new diagnosis of appendicitis. The client reports sudden relief of
severe right lower quadrant pain. Which of the following actions should the nurse take?
A. Document the finding as expected pain resolution
B. Prepare the client for an immediate appendectomy
C. Assess for signs of peritoneal irritation
D. Discharge the client with oral antibiotics
💫ANSWER✔️✔️: C. Assess for signs of peritoneal irritation
💫RATIONALE✔️✔️: Sudden pain relief may indicate rupture of the appendix; the nurse should assess for
rebound tenderness and rigidity.
---
Question 11
Comprehensive 110-Question Final Readiness
Assessment**
---
Question 1
A nurse is assessing a client who is receiving a continuous IV heparin infusion for deep vein thrombosis.
Which of the following laboratory values indicates that the therapy is therapeutic?
A. INR of 2.5
B. aPTT of 75 seconds (control 30 seconds)
C. Platelet count of 150,000/mm³
D. PT of 15 seconds (control 12 seconds)
💫ANSWER✔️✔️: B. aPTT of 75 seconds (control 30 seconds)
💫RATIONALE✔️✔️: Therapeutic aPTT for heparin is 1.5 to 2.5 times the normal control value; 75 seconds
is 2.5 times 30 seconds.
---
Question 2
A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client asks, "Why
do I have to take insulin instead of pills?" Which of the following responses should the nurse provide?
A. "Your pancreas produces too much glucagon, so insulin is needed to balance it."
B. "Your body is resistant to the insulin your pancreas makes, so you need more."
C. "Your immune system destroyed the cells that make insulin, so you must replace it."
D. "Your liver cannot store glucose properly, so insulin helps it function."
💫ANSWER✔️✔️: C. "Your immune system destroyed the cells that make insulin, so you must replace it."
💫RATIONALE✔️✔️: Type 1 diabetes is an autoimmune destruction of pancreatic beta cells, resulting in
absolute insulin deficiency.
---
Question 3
,A nurse is assessing a client who is 6 hours post‑operative following a carotid endarterectomy. Which of
the following findings should the nurse report to the provider immediately?
A. Blood pressure 148/88 mmHg
B. Difficulty swallowing thin liquids
C. Heart rate 88/min
D. Pain rating of 4 on a 0‑10 scale
💫ANSWER✔️✔️: B. Difficulty swallowing thin liquids
💫RATIONALE✔️✔️: Dysphagia after carotid surgery may indicate cranial nerve injury (hypoglossal or
vagus) or hematoma compressing the airway.
---
Question 4
A nurse is providing discharge teaching to a client who has a new prescription for clopidogrel after a
drug‑eluting stent placement. Which of the following instructions should the nurse include?
A. "You can stop this medication after 6 months if you have no chest pain."
B. "Avoid taking omeprazole for heartburn without talking to your provider."
C. "Take this medication on an empty stomach with a full glass of water."
D. "It is safe to take ibuprofen for headaches while on this medication."
💫ANSWER✔️✔️: B. "Avoid taking omeprazole for heartburn without talking to your provider."
💫RATIONALE✔️✔️: Omeprazole (a proton pump inhibitor) reduces the antiplatelet effect of clopidogrel
by inhibiting CYP2C19.
---
Question 5
A nurse is assessing a client who has a sodium level of 118 mEq/L. Which of the following clinical
manifestations should the nurse expect?
A. Hyperreflexia and muscle twitching
B. Thirst and dry mucous membranes
C. Nausea, vomiting, and confusion
D. Hypertension and bounding pulses
💫ANSWER✔️✔️: C. Nausea, vomiting, and confusion
,💫RATIONALE✔️✔️: Severe hyponatremia (<120 mEq/L) causes cerebral edema, leading to nausea,
vomiting, headache, confusion, and seizures.
---
Question 6
A nurse is caring for a client who has a chest tube following a pneumonectomy. The chest tube is
attached to a closed drainage system. The nurse notes continuous bubbling in the water seal chamber.
Which of the following actions should the nurse take?
A. Clamp the chest tube immediately
B. Increase the suction pressure
C. Check for an air leak in the system
D. Document this as an expected finding
💫ANSWER✔️✔️: C. Check for an air leak in the system
💫RATIONALE✔️✔️: Continuous bubbling in the water seal chamber indicates an air leak, which requires
assessment of connections and the insertion site.
---
Question 7
A nurse is providing teaching to a client who has a new prescription for levothyroxine for
hypothyroidism. Which of the following instructions should the nurse include?
A. "Take this medication with a high‑fiber breakfast."
B. "Take this medication at bedtime to avoid drowsiness."
C. "Take this medication on an empty stomach, 30‑60 minutes before breakfast."
D. "Take this medication with an antacid to prevent nausea."
💫ANSWER✔️✔️: C. "Take this medication on an empty stomach, 30‑60 minutes before breakfast."
💫RATIONALE✔️✔️: Levothyroxine is best absorbed on an empty stomach; food, especially calcium and
iron, decreases absorption.
---
Question 8
A nurse is assessing a client who is 2 days postpartum and reports a firm, tender area on the left breast.
The overlying skin is erythematous and warm. The client is breastfeeding. Which of the following actions
should the nurse recommend?
A. Stop breastfeeding from the affected breast
, B. Apply cold compresses to the area after feeding
C. Empty the affected breast completely with each feeding
D. Restrict fluid intake to reduce breast engorgement
💫ANSWER✔️✔️: C. Empty the affected breast completely with each feeding
💫RATIONALE✔️✔️: Complete emptying of the affected breast helps resolve mastitis; breastfeeding
should continue to prevent stasis.
---
Question 9
A nurse is caring for a client who has a new prescription for enoxaparin 40 mg subcutaneously daily.
Which of the following actions should the nurse take?
A. Aspirate before injecting the medication
B. Massage the injection site after administration
C. Inject the medication into the lateral abdominal tissue
D. Use a 21‑gauge, 1.5‑inch needle for administration
💫ANSWER✔️✔️: C. Inject the medication into the lateral abdominal tissue
💫RATIONALE✔️✔️: Enoxaparin is given subcutaneously in the abdomen; do not aspirate or rub the site
to prevent bruising.
---
Question 10
A nurse is assessing a client who has a new diagnosis of appendicitis. The client reports sudden relief of
severe right lower quadrant pain. Which of the following actions should the nurse take?
A. Document the finding as expected pain resolution
B. Prepare the client for an immediate appendectomy
C. Assess for signs of peritoneal irritation
D. Discharge the client with oral antibiotics
💫ANSWER✔️✔️: C. Assess for signs of peritoneal irritation
💫RATIONALE✔️✔️: Sudden pain relief may indicate rupture of the appendix; the nurse should assess for
rebound tenderness and rigidity.
---
Question 11
