HESI RN Exit Exam
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Free HESI RN Exit Exam Questions
The nurse is completing the admission assessment of a client with multiple sclerosis (MS). Which finding(s) should be reported to the healthcare provider immediately? Select all that apply.
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Fever
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Tachycardia
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Tremors
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Tinnitus
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Paresthesia
Explanation
Correct Answers:
A. Fever. B. Tachycardia.
Explanation of Correct Answers
A. Fever
Fever in a client with MS is urgent because even a slight increase in body temperature can worsen neurological symptoms and trigger an acute exacerbation. It may also signal infection, which requires prompt evaluation and treatment.
B. Tachycardia
Tachycardia may indicate autonomic nervous system involvement or a systemic complication. It should be reported immediately as it may suggest infection, dehydration, or cardiovascular instability that requires urgent management.
History and Physical
A 68-year-old male, with a history of bilateral total hip arthroplasty two years ago, presents to the emergency department (ED) by ambulance. The client reports he simply slipped today and did not feel lightheaded or dizzy before the fall. The client reports he returned home from the store and was putting his groceries away. He dropped a can and bent over to pick it up. He lost his balance and fell face-forward, hitting his head on the wall and his left shoulder on the floor. Reports pain mainly in his shoulder. However, he also notes pain in his right knee. Additionally, the client reports he feels nauseated and tired.
Nurses' Notes
1820:
Client is resting in bed, grimacing. Vital signs assessed. Reports intense pain and the inability to move his left arm. He is guarded. Shoulder swelling and bruising are present. Left arm is cool to the touch. Collarbone appears out of alignment on the left side.
Flow Sheet
1820:
Temperature: 98.1° F (36.7° C) orally
Heart rate: 88 beats/minute
Respirations: 18 breaths/minute
Blood pressure: 136/90 mm Hg
Oxygen saturation: 95% on room air
Pain: 10 on a 0 to 10 scale, sharp, constant pain in the left arm; pain rating of 3 on a 0 to 10 scale, dull, achy pain in the right knee
Weight: 344 lb (156.1 kg)
Height: 6 ft 2 in (182.8 cm)
Body mass index (BMI) is 46.67 kg/m2 (normal 18 to 24.9 kg/m2)
Exhibits
The nurse considers the brief interaction with the client and the triage report.
Which finding(s) should the nurse investigate further? Select all that apply.
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Oxygen saturation 95% on room air
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Bone misalignment
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Swelling at the site of injury
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Nausea and fatigue reported by client
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Decreased range of motion
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Intense pain reported by client Left arm that is cool to touch
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Blood pressure of 136/90 mm Hg
Explanation
Correct Answer:
B. Bone misalignment, C. Swelling at the site of injury, D. Nausea and fatigue reported by client, E. Decreased range of motion, F. Intense pain reported by client Left arm that is cool to touch
Explanation of Correct Answer
B. Bone misalignment. Visible misalignment strongly suggests fracture or dislocation and requires urgent diagnostic evaluation and treatment.
C. Swelling at the site of injury. Localized swelling may indicate fracture, hematoma, or soft tissue damage, all of which warrant further investigation.
D. Nausea and fatigue reported by client. These nonspecific symptoms may point to head injury, concussion, or systemic complications, and must be further assessed.
E. Decreased range of motion. Inability to move the arm is abnormal and consistent with fracture or severe joint injury.
F. Intense pain reported by client Left arm that is cool to touch. Severe pain combined with coolness is highly concerning for neurovascular compromise, requiring immediate follow up.
Why Other Options Are Incorrect
A. Oxygen saturation 95% on room air. This is within an acceptable range for an older adult and does not require immediate investigation in the absence of respiratory distress.
G. Blood pressure of 136/90 mm Hg. This reading is slightly elevated but not critical and unrelated to the acute injury. It does not require urgent investigation compared with musculoskeletal and neurological findings.
A client with chronic obstructive pulmonary disease (COPD) smokes two packs of cigarettes per day and is admitted to the hospital for a respiratory infection. The client reports difficulty controlling respiratory distress at home when using the rescue inhaler. Which comment from the client indicates to the nurse that the client is not using the inhaler properly?
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"I always shake the inhaler several times before I start."
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"After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, but it goes away."
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"I never use the inhaler unless I am feeling really short of breath."
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"I have a hard time inhaling and holding my breath after I squeeze the inhaler, but I do my best."
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None
Explanation
Correct Answer:
B. "After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, but it goes away."
Explanation of Correct Answer
B. "After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, but it goes away."
Inhaled medications should be inhaled into the lungs, not swallowed. Swallowing the medication indicates incorrect technique, reducing the drug’s effectiveness in relieving bronchospasm and leading to poor symptom control.
Why Other Options Are Incorrect
A. "I always shake the inhaler several times before I start."
This is correct technique, as shaking mixes the medication evenly for delivery.
C. "I never use the inhaler unless I am feeling really short of breath."
Rescue inhalers are designed for acute symptoms. While preventive use could be discussed, this statement does not indicate improper technique.
D. "I have a hard time inhaling and holding my breath after I squeeze the inhaler, but I do my best."
Although breath-holding is ideal to allow full medication absorption, even if difficult, this effort still reflects generally correct use.
E. None
Incorrect, because option B clearly reveals improper inhaler technique.
The nurse is caring for a client who has a history of experiencing delusions. The client describes singing in a concert in the afternoon for thousands of people. Which action should the nurse take?
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Attempt to comfort the client by agreeing with the delusions and ask open ended questions.
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Disagree with the statement and set clear limits on talking about it.
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Immediately inform the healthcare provider that the client is experiencing a delusional episode.
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Present a personal perception of reality in a nonconfrontational manner.
Explanation
Correct Answer:
D. Present a personal perception of reality in a nonconfrontational manner.
Explanation of Correct Answer
D. Present a personal perception of reality in a nonconfrontational manner
When caring for a client with delusions, the nurse should avoid agreeing with or directly challenging the delusion. Instead, the nurse should gently present their own view of reality in a calm and supportive way. This approach maintains trust while not reinforcing false beliefs, and helps ground the client without confrontation.
A primigravida in the third trimester is hospitalized for preeclampsia. The nurse determines that the client's blood pressure is increasing. Which action should the nurse take first
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Check the protein level in urine
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Have the client turn to the left side
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Take the temperature
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Monitor the urine output
Explanation
Correct Answer B: Have the client turn to the left side
Explanation:
In preeclampsia, rising blood pressure is a serious warning sign that can progress to eclampsia or complications such as stroke, placental abruption, or fetal distress. The first nursing action is to place the client in the left lateral position, which reduces compression of the vena cava and improves uteroplacental blood flow. This position lowers blood pressure and enhances oxygen delivery to the fetus.
Why the other options are incorrect:
A) Check the protein level in urine
Proteinuria is an important diagnostic indicator, but it does not immediately lower blood pressure or prevent complications. It can be checked after stabilizing the client’s hemodynamics.
C) Take the temperature
Temperature monitoring is routine, but it is not related to acute management of increasing blood pressure in preeclampsia.
D) Monitor the urine output
This is important because decreased urine output may signal worsening renal involvement, but the immediate action to lower blood pressure and protect the fetus is positioning the client on her left side.
The nurse is caring for a client who receives a prescription for parenteral lidocaine. Prior to administering the medication, the nurse should review the medical record for which condition?
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Diabetes mellitus
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Heart block
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Gastric ulcers.
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Glaucoma
Explanation
Correct Answer:
B. Heart block.
Explanation of Correct Answer
B. Heart block.
Lidocaine is an antiarrhythmic used to treat ventricular arrhythmias. It is contraindicated in clients with heart block without a pacemaker because it can further suppress cardiac conduction and worsen the block, potentially leading to severe bradycardia or cardiac arrest. Reviewing the client’s cardiac history is therefore essential before administration.
Why Other Options Are Incorrect
A. Diabetes mellitus.
Lidocaine is not contraindicated in diabetes and does not significantly affect glucose regulation.
C. Gastric ulcers.
Lidocaine does not cause or worsen gastric ulcers, so this condition does not require specific caution.
D. Glaucoma.
Lidocaine does not increase intraocular pressure and is not contraindicated for clients with glaucoma.
A client with limited tolerance for activity needs to walk in the hallway with assistance. Which instruction(s) should the nurse give to the unlicensed assistive personnel (UAP) who is assisting with the client’s care? Select all that apply
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Determine if the client needs to have a gait belt applied
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Offer to assist the client to void prior to walking in the hall
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Instruct the client about signs of orthostatic hypotension
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Report the onset of any dizziness or light headedness
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Measure the client’s vital signs before the client walks
Explanation
Correct Answers:
B. Offer to assist the client to void prior to walking in the hall. D. Report the onset of any dizziness or light headedness. E. Measure the client’s vital signs before the client walks.
Explanation of Correct Answers
B. Offer to assist the client to void prior to walking in the hall
Encouraging the client to void reduces discomfort and prevents interruptions during ambulation. This is appropriate for UAP and ensures safety during activity.
D. Report the onset of any dizziness or light headedness
The UAP should be instructed to closely observe the client for dizziness or lightheadedness during ambulation. Reporting these symptoms immediately allows the nurse to assess for orthostatic hypotension or activity intolerance, preventing falls.
E. Measure the client’s vital signs before the client walks
Measuring vital signs before activity provides a baseline to determine if ambulation is safe. This task is within the scope of UAP practice and ensures that abnormalities can be reported promptly to the nurse.
The client with infective endocarditis must be assessed frequently by the home health nurse. Which finding suggests that antibiotic therapy is not effective, and must be reported by the nurse immediately to the healthcare provider
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Nausea and vomiting
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Fever of 103 degrees Fahrenheit (39.5 degrees Celsius)
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Diffuse macular rash
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Muscle tenderness
Explanation
Correct Answer B: Fever of 103 degrees Fahrenheit (39.5 degrees Celsius)
Explanation:
A high fever after initiation of antibiotic therapy for infective endocarditis indicates that the infection is not under control and the antibiotics may not be effective against the causative organism. Persistent or worsening fever is a red flag for sepsis, worsening valve infection, or embolic complications, and must be reported immediately to prevent progression to heart failure or septic shock.
Why the other options are incorrect:
A) Nausea and vomiting
This can be a side effect of antibiotic therapy or related to illness but is not the most urgent indicator of treatment failure.
C) Diffuse macular rash
This may reflect a drug reaction (e.g., to antibiotics) or immune-mediated complication, but it is not as immediately concerning as ongoing infection with persistent fever.
D) Muscle tenderness
Could indicate embolic complications or general malaise but is nonspecific. Without other findings (e.g., localized pain, ischemia), it does not confirm ineffective antibiotic therapy.
The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately
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Blood urea nitrogen 50 mg/dl
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Hemoglobin of 10.3 mg/dl
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Venous blood pH 7.30
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Serum potassium 6 mEq/L
Explanation
Correct Answer D. Serum potassium 6 mEq/L
Explanation:
D. Serum potassium 6 mEq/L
Hyperkalemia is the most life-threatening complication of acute renal failure because it can lead to severe cardiac dysrhythmias and cardiac arrest. A potassium level above 5.5 mEq/L is considered elevated; 6 mEq/L requires immediate intervention, including cardiac monitoring and potential emergency treatment with calcium gluconate, insulin with glucose, sodium bicarbonate, or dialysis. This result is the priority for immediate reporting and action.
Why Other Options Are Incorrect:
A. Blood urea nitrogen 50 mg/dl
This is elevated (normal 7–20 mg/dl) but expected in acute renal failure and not immediately life-threatening compared to hyperkalemia.
B. Hemoglobin of 10.3 mg/dl
This reflects mild anemia, which is common in renal failure due to decreased erythropoietin. It requires monitoring but is not emergent.
C. Venous blood pH 7.30
This indicates mild metabolic acidosis (normal 7.35–7.45), which is expected in renal failure. Although it requires management, it is less immediately dangerous than hyperkalemia.
An adult client who is admitted to the mental health unit for treatment of bipolar disorder has a slightly slurred speech pattern and an unsteady gait. Which assessment finding is most important for the nurse to report to the healthcare provider?
Reference Range:
Blood alcohol level [0 to 0.05% (0 to 10.9 mmol/L)]
Lithium [0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L)]
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Blood alcohol level of 0.09% (19.5 mmol/L)
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Weight loss of 10 lb (4.5 kg) in past month.
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Six hours of sleep in the past three days
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Serum lithium level of 1.6 mEq/L (1.6 mmol/L).
Explanation
Correct Answer:
D. Serum lithium level of 1.6 mEq/L (1.6 mmol/L).
Explanation of Correct Answer
D. Serum lithium level of 1.6 mEq/L (1.6 mmol/L).
Lithium levels above 1.2 mEq/L are considered toxic. Signs of toxicity include slurred speech, unsteady gait, confusion, and tremors—all symptoms this client is displaying. Toxic lithium levels can rapidly progress to seizures, coma, and death, so immediate reporting and intervention are essential. This is the most urgent finding.
Why Other Options Are Incorrect
A. Blood alcohol level of 0.09% (19.5 mmol/L).
Although elevated, alcohol intoxication at this level usually causes mild impairment. It does not explain all the client’s symptoms as urgently as lithium toxicity does. Lithium toxicity poses the greater immediate risk.
B. Weight loss of 10 lb (4.5 kg) in past month.
Unintended weight loss is concerning but not immediately life-threatening. It requires follow up but does not need urgent reporting compared to toxic lithium levels.
C. Six hours of sleep in the past three days.
Severe sleep deprivation increases the risk of mania, but it is not as acutely dangerous as lithium toxicity. While important to address, it does not take priority over a critical toxic level.
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Frequently Asked Question
The HESI RN Exit Exam is a comprehensive assessment designed to evaluate the readiness of nursing students for licensure and practice. It covers a wide range of topics, including clinical reasoning, pharmacology, medical-surgical nursing, and more, to assess your understanding and application of nursing knowledge.
Preparation for the HESI RN Exit Exam involves reviewing nursing fundamentals, practicing with exam-aligned questions, studying detailed rationales, and using case studies to enhance critical thinking. Updated materials for 2025 standards will also ensure you’re well-prepared for the exam content.
The detailed answer rationales explain why each answer is correct or incorrect, helping you to understand the underlying nursing principles. This is crucial for developing a deeper understanding of nursing concepts, improving clinical decision-making, and preventing errors in practice.
Yes, the practice questions in our guide are designed to closely mirror the format and difficulty level of the HESI RN Exit Exam. They include multiple-choice questions, case studies, and scenarios that require critical thinking and clinical judgment.
The study materials are updated to reflect the latest evidence-based practices, clinical guidelines, and nursing standards for 2025. This ensures you’re studying current, relevant content that matches the exam’s expectations.