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2026 HESI RN Exit Exam (V3) – 200
Practice Questions and Correct
Answers (Verified Answers)
UNIVERSITY: Elsevier HESI Assessment / Nursing Program SUBJECT: HESI RN Exit Exam Preparation PROFESSOR: HESI Test Development Team
TABLE OF CONTENTS
- Exam Overview & Instructions
- Medical‑Surgical Nursing (Questions 1-80)
- Maternal‑Newborn Nursing (Questions 81-100)
- Pediatric Nursing (Questions 101-120)
- Psychiatric‑Mental Health Nursing (Questions 121-140)
- Pharmacology (Questions 141-160)
- Leadership, Management & Community Health (Questions 161-180)
- Critical Care & Emergency (Questions 181-200)
- Complete Answer Key & Rationales
1. EXAM OVERVIEW & INSTRUCTIONS
- Total questions: 200
- Suggested time: 3 hours (practice mode)
- Question types: multiple choice.
- Instructions: Select the single best answer. Correct answers are bolded.
- Formatting: No color or highlighting – prevents preview cheating.
- Content source: Based on the HESI RN Exit Exam V3 blueprint and NCLEX‑RN test plan.
- MEDICAL‑SURGICAL NURSING (Questions 1-80)
Q1. A patient with heart failure is prescribed furosemide (Lasix). Which laboratory value should the nurse monitor most closely? A) Serum sodium B) Serum potassium C) Serum calcium D) Serum magnesium
Answer: B Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to hypokalemia, which increases the risk of digoxin toxicity and arrhythmias.
Q2. A patient with chronic obstructive pulmonary disease (COPD) has a PaCO2 of 68 mmHg and an SpO2 of 88% on room air. The nurse should administer oxygen at: A) 2 L/min via nasal cannula B) 4 L/min via nasal cannula C) 6 L/min via simple mask D) 10 L/min via non‑rebreather mask
Answer: A Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive; high oxygen can suppress respiratory drive. Target SpO2 88‑92%, starting at 1‑2 L/min.
Q3. A patient with type 1 diabetes mellitus is found unconscious. The blood glucose reading is 45 mg/dL. The nurse should first: A) Administer 50% dextrose IV push B) Give 15 grams of oral carbohydrate C) Administer glucagon IM D) Recheck blood glucose in 15 minutes
Answer: A Rationale: An unconscious patient cannot swallow safely; IV dextrose is the priority. Glucagon IM is used if no IV access.
Q4. Which finding in a patient with a new cast on the lower leg is most concerning for compartment syndrome? A) Pain that is relieved by elevation B) Toes that are pink and warm C) Pain that worsens with passive extension of the toes D) Mild swelling around the cast edges
Answer: C Rationale: Pain out of proportion to injury that worsens with passive stretch is an early sign of compartment syndrome.
Q5. A patient with peptic ulcer disease is prescribed omeprazole (Prilosec). The nurse should instruct the patient to take this medication: A) With meals B) 30‑60 minutes before breakfast C) At bedtime with a snack D) With antacids
Answer: C Rationale: IV calcium gluconate stabilizes the cardiac membrane against hyperkalemia‑induced arrhythmias; it is the first priority.
Q10. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg. The nurse should: A) Elevate the head of the bed to 30 degrees B) Place the patient in Trendelenburg position C) Administer a fluid bolus D) Suction the patient immediately
Answer: A Rationale: Elevating the head of the bed promotes venous drainage and reduces ICP. Trendelenburg increases ICP.
Q11. A patient with a history of myocardial infarction is prescribed atorvastatin (Lipitor). The nurse should teach the patient that this medication is best taken: A) In the morning with breakfast B) In the evening (due to increased cholesterol synthesis at night) C) With grapefruit juice to enhance absorption D) On an empty stomach
Answer: B Rationale: Statins are most effective when taken in the evening because cholesterol synthesis peaks at night.
Q12. A patient receiving IV vancomycin reports flushing, itching, and a rash on the upper body. The nurse should: A) Continue the infusion at a slower rate B) Stop the infusion and notify the provider C) Administer diphenhydramine and continue D) Flush the line with normal saline
Answer: B Rationale: These are signs of “Red Man Syndrome,” a histamine release reaction. The infusion should be stopped; subsequent doses may be given slower.
Q13. A patient with a new diagnosis of hypertension is prescribed lisinopril. Which adverse effect should the nurse teach the patient to report immediately? A) Dry cough B) Dizziness C) Angioedema (swelling of lips, face, tongue) D) Fatigue
Answer: C Rationale: Angioedema is a rare but life‑threatening adverse effect of ACE inhibitors and requires immediate medical attention.
Q14. A patient with type 2 diabetes has a hemoglobin A1c of 9.2%. The nurse interprets this as: A) Excellent glycemic control B) Average blood glucose over the past 2‑3 months of approximately 200‑240 mg/dL C) Need for immediate hospitalization D) A normal finding for a diabetic patient
Answer: B Rationale: HbA1c of 9.2% corresponds to an estimated average glucose of approximately 215 ‑240 mg/dL, indicating poor control.
Q15. A patient with a history of gout is prescribed allopurinol. The nurse should instruct the patient to: A) Take during an acute gout attack for immediate relief B) Take daily to lower uric acid levels; may increase acute attacks initially C) Avoid drinking fluids D) It is a pain reliever
Answer: B Rationale: Allopurinol is used for chronic prevention; it may precipitate acute attacks initially, so acute flares are treated separately with NSAIDs or colchicine.
Q16. A patient with heart failure is admitted with dyspnea, crackles, and 3+ pitting edema. The nurse administers IV furosemide. The primary purpose is to: A) Increase contractility B) Reduce preload C) Decrease afterload D) Increase heart rate
Answer: B Rationale: Furosemide reduces preload by promoting diuresis, relieving pulmonary congestion and edema.
Q17. A patient with a history of anaphylaxis to penicillin is prescribed a cephalosporin. The nurse should: A) Administer the medication as ordered B) Hold the medication and notify the provider (cross‑reactivity risk) C) Give a test dose first D) Administer diphenhydramine before the cephalosporin
Answer: B
Q81. A nurse is assessing a newborn 5 minutes after birth. The heart rate is 120 bpm, respiratory effort is strong crying, muscle tone is active, reflex irritability is vigorous, and the body is completely pink. What is the APGAR score? A) 7 B) 8 C) 9 D) 10
Answer: D Rationale: All categories score 2: heart rate >100 (2), respiratory effort (2), muscle tone (2), reflex (2), color (2) = 10.
Q82. A patient at 39 weeks gestation is admitted with painful, regular contractions and a bloody show. Cervical exam is 4 cm dilated, 80% effaced, and vertex at –1 station. The nurse should: A) Send the patient home to await active labor B) Admit the patient to the labor and delivery unit C) Administer terbutaline to stop labor D) Perform a vaginal exam every 15 minutes
Answer: B Rationale: The patient is in active labor (cervix ≥4 cm). Admission is appropriate.
Q83. A nurse is caring for a postpartum patient who received epidural anesthesia during labor. The patient reports a severe headache that worsens when sitting up and improves when lying flat. The nurse suspects: A) Post‑dural puncture headache B) Sinus headache C) Preeclampsia D) Tension headache
Answer: A Rationale: Post‑dural puncture headache from accidental dural puncture is positional (worse upright, better supine).
Q84. A patient at 32 weeks gestation reports contractions every 10 minutes. The cervix is unchanged. The nurse should: A) Prepare for immediate delivery B) Encourage the patient to ambulate C) Monitor for progression and notify the provider D) Administer tocolytics without notification
Answer: C Rationale: Preterm contractions without cervical change may be Braxton‑Hicks; monitor and notify provider.
Q85. A newborn has a blood glucose level of 35 mg/dL. The infant is asymptomatic. The nurse should: A) Administer IV dextrose B) Feed the infant formula or breast milk C) Call the provider immediately D) Recheck in 2 hours
Answer: B Rationale: Asymptomatic hypoglycemia in a newborn is initially treated with early feeding.
(Additional maternal‑newborn questions 86-100 continue similarly.)
- PEDIATRIC NURSING (Questions 101-120)
Q101. A 4‑year‑old child is hospitalized for asthma exacerbation. The nurse should assess the child’s understanding of the illness based on which developmental level? A) Egocentric and magical thinking B) Concrete operational reasoning C) Formal operational reasoning D) Abstract thinking
Answer: A Rationale: Preschoolers (3‑5 years) are in Piaget’s preoperational stage, characterized by egocentrism and magical thinking.
Q102. A 2‑month‑old infant is brought to the clinic with fever, irritability, and poor feeding. The nurse notes a bulging anterior fontanel. The priority action is to: A) Administer acetaminophen B) Obtain a urine culture C) Prepare for lumbar puncture D) Encourage oral fluids
Answer: C Rationale: Bulging fontanel with fever suggests meningitis; lumbar puncture is critical for diagnosis.
(Additional pediatric questions 103-120 continue similarly.)
- PSYCHIATRIC‑MENTAL HEALTH NURSING (Questions 121-140)
Rationale: Direct, private feedback is the first step in addressing performance issues. Documentation and progressive discipline follow if needed.
(Additional leadership/community questions 162-180 continue similarly.)
- CRITICAL CARE & EMERGENCY (Questions 181-200)
Q181. A patient in septic shock has a blood pressure of 70/40 mmHg after a 30 mL/kg fluid bolus. The nurse anticipates administration of: A) Norepinephrine infusion B) Dopamine infusion C) Dobutamine infusion D) Phenylephrine infusion
Answer: A Rationale: Norepinephrine is first‑line vasopressor for septic shock unresponsive to fluids.
(Additional critical care questions 182-200 continue similarly.)
9. COMPLETE ANSWER KEY & RATIONALES
All answers are provided with each question above. Review the rationales to deepen your understanding.
