1
RN HESI Exit Exam Version B –
2024/2025 NGN-Based Questions with
Verified Answers & Detailed Clinical
Rationales | Graded A+
Section 1: Medical-Surgical Nursing (50 Questions)
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. Which finding requires immediate intervention?
A. Oxygen saturation of 92%
B. Respiratory rate of 30 breaths/min
C. Heart rate of 88 beats/min
D. Blood pressure of 130/80 mmHg
Rationale: A respiratory rate of 30 breaths/min indicates tachypnea, suggesting
respiratory distress in a client with COPD, requiring immediate intervention to assess and
optimize oxygenation.
2. (SATA) Which interventions are appropriate for a client with acute pancreatitis?
A. Administer IV fluids as prescribed
B. Provide pain management
C. Encourage a high-fat diet
D. Monitor for signs of hypocalcemia
Rationale: IV fluids and pain management address dehydration and discomfort in acute
pancreatitis. Monitoring for hypocalcemia is crucial due to fat necrosis. A high-fat diet
exacerbates the condition.
3. A client with heart failure reports sudden dyspnea and frothy sputum. What is the nurse’s
priority action?
A. Administer a bronchodilator
B. Position the client in high Fowler’s position
C. Encourage oral fluid intake
D. Apply a warm compress to the chest
Rationale: Sudden dyspnea and frothy sputum suggest pulmonary edema, a medical
emergency. High Fowler’s position reduces preload and improves breathing.
4. A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the
nurse monitor?
A. Platelet count
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin
Rationale: Warfarin’s anticoagulant effect is monitored using INR to ensure therapeutic
levels and prevent bleeding or clotting complications.
, 2
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL. Which
intervention should the nurse anticipate?
A. Administer oral hypoglycemics
B. Administer IV regular insulin
C. Encourage high-carbohydrate intake
D. Restrict all fluids
Rationale: IV regular insulin is the primary treatment for DKA to lower blood glucose
and correct acidosis.
6. Unfolding Case Scenario: A 65-year-old client presents with chest pain, diaphoresis,
and nausea. The ECG shows ST elevation in leads V1–V4.
Question 6.1: What is the nurse’s priority action?
A. Administer a beta-blocker
B. Administer oxygen and notify the provider
C. Encourage the client to ambulate
D. Apply a cooling blanket
Rationale: ST elevation indicates acute myocardial infarction (MI). Administering
oxygen and notifying the provider are priorities to ensure timely intervention, such as
percutaneous coronary intervention (PCI).
Question 6.2: The provider prescribes aspirin and nitroglycerin. Which finding
contraindicates nitroglycerin?
A. Heart rate of 90 beats/min
B. Blood pressure of 90/60 mmHg
C. Pain level of 6/10
D. Oxygen saturation of 94%
Rationale: Nitroglycerin causes vasodilation and is contraindicated in hypotension (BP
90/60 mmHg) to avoid worsening perfusion.
Question 6.3: The client is prepared for PCI. Which laboratory value should the nurse
review before the procedure?
A. Blood glucose
B. Serum creatinine
C. Hemoglobin A1c
D. Thyroid function tests
Rationale: Serum creatinine assesses renal function, critical before PCI due to the use of
contrast dye, which can cause nephrotoxicity.
7. A client with a new colostomy reports leakage from the appliance. What is the nurse’s
priority action?
A. Encourage a high-fiber diet
B. Assess the stoma and skin integrity
C. Administer an antidiarrheal
D. Change the appliance every 24 hours
Rationale: Leakage may indicate improper fit or skin breakdown, requiring assessment
of the stoma and surrounding skin to prevent complications.
, 3
8. (SATA) Which findings indicate fluid volume overload in a client with heart failure?
A. Crackles in the lungs
B. Jugular vein distension
C. Dry mucous membranes
D. Peripheral edema
Rationale: Crackles, jugular vein distension, and peripheral edema are signs of fluid
overload. Dry mucous membranes indicate dehydration.
9. A client with a history of seizures is prescribed phenytoin. Which adverse effect should
the nurse monitor?
A. Hyperglycemia
B. Gingival hyperplasia
C. Hypokalemia
D. Bradycardia
Rationale: Phenytoin commonly causes gingival hyperplasia, requiring oral hygiene
education to manage this effect.
10. A client with a pulmonary embolism is receiving heparin. Which laboratory value should
the nurse monitor?
A. INR
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
Rationale: Heparin’s anticoagulant effect is monitored using aPTT to ensure therapeutic
levels and prevent complications.
11. A client with acute renal failure has a potassium level of 6.8 mEq/L. What is the nurse’s
priority action?
A. Administer a loop diuretic
B. Prepare for cardiac monitoring and notify the provider
C. Encourage potassium-rich foods
D. Restrict fluid intake
Rationale: Hyperkalemia (6.8 mEq/L) can cause life-threatening arrhythmias, requiring
immediate cardiac monitoring and provider notification.
12. (SATA) Which interventions are appropriate for a client with a new tracheostomy?
A. Monitor for signs of infection
B. Suction as needed
C. Change the tracheostomy tube daily
D. Keep spare supplies at the bedside
Rationale: Monitoring for infection, suctioning as needed, and keeping spare supplies
ensure airway patency and safety. Daily tube changes are unnecessary and risky.
13. A client with cirrhosis reports abdominal distension. Which finding suggests ascites?
A. Hyperactive bowel sounds
B. Fluid wave on palpation
C. Decreased abdominal girth
D. Epigastric pain
Rationale: A fluid wave on palpation is a classic sign of ascites, indicating fluid
accumulation in the peritoneal cavity.
, 4
14. A client is receiving vancomycin for a bacterial infection. Which laboratory value should
the nurse monitor?
A. Blood glucose
B. Serum creatinine
C. Hemoglobin
D. Platelet count
Rationale: Vancomycin is nephrotoxic, requiring monitoring of serum creatinine to
assess kidney function.
15. A client with a history of stroke reports sudden weakness in the left arm. What is the
nurse’s priority action?
A. Encourage range-of-motion exercises
B. Assess neurological status and notify the provider
C. Administer aspirin immediately
D. Apply a warm compress to the arm
Rationale: Sudden weakness may indicate a transient ischemic attack or stroke
recurrence, requiring immediate neurological assessment and provider notification.
16. Unfolding Case Scenario: A 55-year-old client presents with abdominal pain, nausea,
and fever. The provider suspects appendicitis.
Question 16.1: What is the nurse’s priority action?
A. Administer an antiemetic
B. Assess for rebound tenderness
C. Encourage oral fluids
D. Apply a heating pad to the abdomen
Rationale: Rebound tenderness is a hallmark of appendicitis, indicating peritoneal
irritation and requiring urgent surgical evaluation.
Question 16.2: The client is scheduled for an appendectomy. Which preoperative instruction is
most important?
A. Encourage ambulation
B. Maintain NPO status
C. Administer a laxative
D. Apply compression stockings
Rationale: NPO status prevents aspiration during surgery, a critical preoperative requirement.
Question 16.3: Postoperatively, the client reports severe pain at the incision site. Which finding
requires immediate intervention?
A. Pain rated 6/10
B. Redness and warmth at the site
C. Heart rate of 90 beats/min
D. Serosanguinous drainage
Rationale: Redness and warmth suggest infection, requiring immediate intervention to prevent
complications like abscess formation.
17. A client with a history of diabetes is prescribed metformin. Which instruction should the
nurse provide?
A. Take the medication with grapefruit juice
RN HESI Exit Exam Version B –
2024/2025 NGN-Based Questions with
Verified Answers & Detailed Clinical
Rationales | Graded A+
Section 1: Medical-Surgical Nursing (50 Questions)
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2
L/min via nasal cannula. Which finding requires immediate intervention?
A. Oxygen saturation of 92%
B. Respiratory rate of 30 breaths/min
C. Heart rate of 88 beats/min
D. Blood pressure of 130/80 mmHg
Rationale: A respiratory rate of 30 breaths/min indicates tachypnea, suggesting
respiratory distress in a client with COPD, requiring immediate intervention to assess and
optimize oxygenation.
2. (SATA) Which interventions are appropriate for a client with acute pancreatitis?
A. Administer IV fluids as prescribed
B. Provide pain management
C. Encourage a high-fat diet
D. Monitor for signs of hypocalcemia
Rationale: IV fluids and pain management address dehydration and discomfort in acute
pancreatitis. Monitoring for hypocalcemia is crucial due to fat necrosis. A high-fat diet
exacerbates the condition.
3. A client with heart failure reports sudden dyspnea and frothy sputum. What is the nurse’s
priority action?
A. Administer a bronchodilator
B. Position the client in high Fowler’s position
C. Encourage oral fluid intake
D. Apply a warm compress to the chest
Rationale: Sudden dyspnea and frothy sputum suggest pulmonary edema, a medical
emergency. High Fowler’s position reduces preload and improves breathing.
4. A client is prescribed warfarin for atrial fibrillation. Which laboratory value should the
nurse monitor?
A. Platelet count
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Hemoglobin
Rationale: Warfarin’s anticoagulant effect is monitored using INR to ensure therapeutic
levels and prevent bleeding or clotting complications.
, 2
5. A client with diabetic ketoacidosis (DKA) has a blood glucose of 600 mg/dL. Which
intervention should the nurse anticipate?
A. Administer oral hypoglycemics
B. Administer IV regular insulin
C. Encourage high-carbohydrate intake
D. Restrict all fluids
Rationale: IV regular insulin is the primary treatment for DKA to lower blood glucose
and correct acidosis.
6. Unfolding Case Scenario: A 65-year-old client presents with chest pain, diaphoresis,
and nausea. The ECG shows ST elevation in leads V1–V4.
Question 6.1: What is the nurse’s priority action?
A. Administer a beta-blocker
B. Administer oxygen and notify the provider
C. Encourage the client to ambulate
D. Apply a cooling blanket
Rationale: ST elevation indicates acute myocardial infarction (MI). Administering
oxygen and notifying the provider are priorities to ensure timely intervention, such as
percutaneous coronary intervention (PCI).
Question 6.2: The provider prescribes aspirin and nitroglycerin. Which finding
contraindicates nitroglycerin?
A. Heart rate of 90 beats/min
B. Blood pressure of 90/60 mmHg
C. Pain level of 6/10
D. Oxygen saturation of 94%
Rationale: Nitroglycerin causes vasodilation and is contraindicated in hypotension (BP
90/60 mmHg) to avoid worsening perfusion.
Question 6.3: The client is prepared for PCI. Which laboratory value should the nurse
review before the procedure?
A. Blood glucose
B. Serum creatinine
C. Hemoglobin A1c
D. Thyroid function tests
Rationale: Serum creatinine assesses renal function, critical before PCI due to the use of
contrast dye, which can cause nephrotoxicity.
7. A client with a new colostomy reports leakage from the appliance. What is the nurse’s
priority action?
A. Encourage a high-fiber diet
B. Assess the stoma and skin integrity
C. Administer an antidiarrheal
D. Change the appliance every 24 hours
Rationale: Leakage may indicate improper fit or skin breakdown, requiring assessment
of the stoma and surrounding skin to prevent complications.
, 3
8. (SATA) Which findings indicate fluid volume overload in a client with heart failure?
A. Crackles in the lungs
B. Jugular vein distension
C. Dry mucous membranes
D. Peripheral edema
Rationale: Crackles, jugular vein distension, and peripheral edema are signs of fluid
overload. Dry mucous membranes indicate dehydration.
9. A client with a history of seizures is prescribed phenytoin. Which adverse effect should
the nurse monitor?
A. Hyperglycemia
B. Gingival hyperplasia
C. Hypokalemia
D. Bradycardia
Rationale: Phenytoin commonly causes gingival hyperplasia, requiring oral hygiene
education to manage this effect.
10. A client with a pulmonary embolism is receiving heparin. Which laboratory value should
the nurse monitor?
A. INR
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Platelet count
Rationale: Heparin’s anticoagulant effect is monitored using aPTT to ensure therapeutic
levels and prevent complications.
11. A client with acute renal failure has a potassium level of 6.8 mEq/L. What is the nurse’s
priority action?
A. Administer a loop diuretic
B. Prepare for cardiac monitoring and notify the provider
C. Encourage potassium-rich foods
D. Restrict fluid intake
Rationale: Hyperkalemia (6.8 mEq/L) can cause life-threatening arrhythmias, requiring
immediate cardiac monitoring and provider notification.
12. (SATA) Which interventions are appropriate for a client with a new tracheostomy?
A. Monitor for signs of infection
B. Suction as needed
C. Change the tracheostomy tube daily
D. Keep spare supplies at the bedside
Rationale: Monitoring for infection, suctioning as needed, and keeping spare supplies
ensure airway patency and safety. Daily tube changes are unnecessary and risky.
13. A client with cirrhosis reports abdominal distension. Which finding suggests ascites?
A. Hyperactive bowel sounds
B. Fluid wave on palpation
C. Decreased abdominal girth
D. Epigastric pain
Rationale: A fluid wave on palpation is a classic sign of ascites, indicating fluid
accumulation in the peritoneal cavity.
, 4
14. A client is receiving vancomycin for a bacterial infection. Which laboratory value should
the nurse monitor?
A. Blood glucose
B. Serum creatinine
C. Hemoglobin
D. Platelet count
Rationale: Vancomycin is nephrotoxic, requiring monitoring of serum creatinine to
assess kidney function.
15. A client with a history of stroke reports sudden weakness in the left arm. What is the
nurse’s priority action?
A. Encourage range-of-motion exercises
B. Assess neurological status and notify the provider
C. Administer aspirin immediately
D. Apply a warm compress to the arm
Rationale: Sudden weakness may indicate a transient ischemic attack or stroke
recurrence, requiring immediate neurological assessment and provider notification.
16. Unfolding Case Scenario: A 55-year-old client presents with abdominal pain, nausea,
and fever. The provider suspects appendicitis.
Question 16.1: What is the nurse’s priority action?
A. Administer an antiemetic
B. Assess for rebound tenderness
C. Encourage oral fluids
D. Apply a heating pad to the abdomen
Rationale: Rebound tenderness is a hallmark of appendicitis, indicating peritoneal
irritation and requiring urgent surgical evaluation.
Question 16.2: The client is scheduled for an appendectomy. Which preoperative instruction is
most important?
A. Encourage ambulation
B. Maintain NPO status
C. Administer a laxative
D. Apply compression stockings
Rationale: NPO status prevents aspiration during surgery, a critical preoperative requirement.
Question 16.3: Postoperatively, the client reports severe pain at the incision site. Which finding
requires immediate intervention?
A. Pain rated 6/10
B. Redness and warmth at the site
C. Heart rate of 90 beats/min
D. Serosanguinous drainage
Rationale: Redness and warmth suggest infection, requiring immediate intervention to prevent
complications like abscess formation.
17. A client with a history of diabetes is prescribed metformin. Which instruction should the
nurse provide?
A. Take the medication with grapefruit juice
