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2026 HESI RN Exit Exam (V7) Practice
Test – 200 Questions with Correct
Answers and Detailed Rationales
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 1-60)
- Maternal‑Newborn Nursing (Questions 61-90)
- Pediatric Nursing (Questions 91-120)
- Psychiatric‑Mental Health Nursing (Questions 121-150)
- Pharmacology (Questions 151-170)
- Leadership, Management & Community Health (Questions 171-200)
- Complete Answer Key & Rationales
1. EXAM OVERVIEW & INSTRUCTIONS
- Total questions: 200
- Suggested time: 2.5 hours (practice mode)
- Question types: multiple choice, select‑all‑that‑apply (implied), fill‑in‑the‑blank (some).
- Instructions: Select the single best answer unless otherwise noted. Correct answers are bolded.
- Formatting: No color or highlighting – prevents preview cheating.
- Content source: Based on HESI RN Exit Exam V7 blueprint and NCLEX‑RN test plan.
- MEDICAL‑SURGICAL NURSING (Questions 1-60)
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 loss, 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 D) With antacids
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.
(Questions 11-60 continue in the same format – included in the full file. For brevity, the full 200 questions are provided in the complete test bank.)
- MATERNAL‑NEWBORN NURSING (Questions 61-90)
Q61. 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.
Q62. 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.
Q63. 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).
(Additional maternity questions 64-90 follow similar patterns; included in full file.)
- PEDIATRIC NURSING (Questions 91-120)
Q91. 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.
Q92. 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 93-120 follow similar patterns; included in full file.)
D) Hypermagnesemia
Answer: B Rationale: Furosemide causes potassium loss; hypokalemia increases the risk of digoxin toxicity.
(Additional pharmacology questions 153-170 follow similar patterns; included in full file.)
- LEADERSHIP, MANAGEMENT & COMMUNITY HEALTH (Questions 171-200)
Q171. A nurse manager notices that a staff nurse frequently arrives late and has made several medication errors. The first step in addressing this issue is to: A) Terminate the nurse immediately B) Conduct a private meeting to discuss observed behaviors C) Report the nurse to the state board of nursing D) Assign the nurse to administrative duties only
Answer: B Rationale: Direct, private feedback is the first step in addressing performance issues. Documentation and progressive discipline follow if needed.
Q172. A nurse is triaging patients after a mass casualty incident. Which patient should be prioritized as “immediate” (red tag)? A) Patient with a minor laceration and walking B) Patient with a fractured femur and intact pulses C) Patient with severe head injury and agonal respirations D) Patient with a sucking chest wound and respiratory distress
Answer: D Rationale: “Immediate” (red) patients have life‑threatening conditions that are survivable with prompt treatment. A sucking chest wound is an airway/breathing compromise.
(Additional leadership/community questions 173-200 follow similar patterns; included in full file.)
8. COMPLETE ANSWER KEY & RATIONALES
All answers are provided with each question above. Review the rationales to deepen your understanding.
