HESI RN Exit Exam
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Free HESI RN Exit Exam Questions
An unresponsive victim of a diving accident is brought to the emergency department where it is determined that immediate surgery is required to save the client's life. The client is accompanied by a close friend, but no family members are available. Which action should the nurse take first?
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Continue to provide life support until a thorough search for a guardian is completed
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Carry on with surgical preparation of the client without a signed informed consent.
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Ask the client's friend to sign the informed consent since the client is unresponsive.
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Notify the unit manager that an emergency court order is needed to allow surgery
Explanation
Correct Answer:
B. Carry on with surgical preparation of the client without a signed informed consent.
Explanation of Correct Answer
B. Carry on with surgical preparation of the client without a signed informed consent.
In emergency situations where immediate surgery is required to preserve life or prevent serious harm, informed consent is legally implied. Delaying treatment to obtain consent could result in the client’s death or permanent disability. The nurse’s priority is to facilitate urgent surgical preparation.
The nurse is evaluating the diet teaching of a client with hypertension. What dinner selection indicates that the client understands the dietary recommendations for hypertension
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Tomato soup, grilled cheese sandwich, pickles, skim milk, and lemon meringue pie.
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Baked pork chop, applesauce, corn on the cob, 2% milk, and key-lime pie.
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Grilled steak, baked potato with sour cream, green beans, coffee, and raisin cream pie.
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Beef stir fry, fried rice, egg drop soup, diet coke, and pumpkin pie.
Explanation
Correct Answer B. Baked pork chop, applesauce, corn on the cob, 2% milk, and key-lime pie.
Explanation:
Baked pork chop, applesauce, corn on the cob, 2% milk, and key-lime pie is the best option because it avoids excess sodium and includes a lean protein (pork chop when baked), a fruit serving, a vegetable (corn), and low-fat dairy. This meal aligns with the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, lean proteins, and reduced sodium intake.
Why Other Options Are Wrong:
A. Tomato soup, grilled cheese sandwich, pickles, skim milk, and lemon meringue pie
This is incorrect because tomato soup, pickles, and processed cheese are all very high in sodium, which worsens hypertension control despite skim milk being healthy.
C. Grilled steak, baked potato with sour cream, green beans, coffee, and raisin cream pie
This is incorrect because steak and sour cream add excess saturated fat, which can worsen hypertension and cardiovascular risk. Although green beans are healthy, the overall fat content makes this unsuitable.
D. Beef stir fry, fried rice, egg drop soup, diet coke, and pumpkin pie
This is incorrect because stir fry sauces, fried rice, and egg drop soup are typically high in sodium, which contributes to fluid retention and elevated blood pressure. Even though some vegetables are present, the sodium load makes this option poor.
The nurse is caring for a client newly diagnosed with emphysema. The nurse should prioritize which potential complication?
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Self-care deficit.
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Activity intolerance
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Impaired gas exchange
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Ineffective airway clearance
Explanation
Correct Answer:
C. Impaired gas exchange
Explanation
Emphysema is a chronic obstructive pulmonary disease (COPD) characterized by destruction of alveolar walls, decreased elastic recoil, and air trapping. This leads to impaired gas exchange, resulting in hypoxemia and hypercapnia. Because oxygenation is vital for survival, impaired gas exchange is the priority complication for the nurse to monitor and manage. Ensuring adequate oxygen levels takes precedence over other potential issues.
Why Other Options Are Wrong
A. Self-care deficit
While emphysema may eventually limit self-care due to fatigue and dyspnea, it is not the most immediate or life-threatening complication.
B. Activity intolerance
Activity intolerance is a common issue in emphysema due to dyspnea on exertion, but it stems from the underlying impaired gas exchange. Treating gas exchange issues helps reduce activity intolerance.
D. Ineffective airway clearance
Airway clearance problems are more common in chronic bronchitis than emphysema, since emphysema involves destruction of alveoli rather than mucus hypersecretion. It is not the primary complication in emphysema.
After a scheduled downtime, the computer documentation system fails to restart. Which action should the nurse take first?
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Identify information as late entry in the record
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Notify information services department of the situation.
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Print electronic medical record (EMR) from backup server
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Wait for notification that the system has been rebooted
Explanation
Correct Answer:
B. Notify information services department of the situation.
Explanation of Correct Answer
B. Notify information services department of the situation.
If the documentation system fails to restart after scheduled downtime, the priority is to report the issue promptly to the information services (IT) department. This allows technical staff to assess and address the system failure quickly so that safe, accurate, and timely documentation can resume.
In early septic shock states, what is the primary cause of hypotension
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Peripheral vasoconstriction
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Peripheral vasodilation
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Cardiac failure
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A vagal response
Explanation
Correct Answer B. Peripheral vasodilation
Explanation:
In early septic shock (the hyperdynamic or warm phase), bacterial toxins and inflammatory mediators such as cytokines and nitric oxide cause massive peripheral vasodilation. This decreases systemic vascular resistance, leading to relative hypovolemia and hypotension, even though cardiac output may initially be high. If untreated, this progresses to impaired tissue perfusion and eventually myocardial depression and multi-organ dysfunction.
Why Other Options Are Wrong:
A. Peripheral vasoconstriction
This occurs in hypovolemic and cardiogenic shock, not in the early stages of septic shock, which is characterized by vasodilation.
C. Cardiac failure
This is a late finding in septic shock when myocardial depression occurs, but not the primary cause of hypotension in the early stage.
D. A vagal response
A vagal response causes bradycardia and hypotension transiently (e.g., vasovagal syncope), but it is not related to the pathophysiology of septic shock.
What nursing assessment of a paralyzed client would indicate the probable presence of a fecal impaction?
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Presence of blood in stools
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Oozing liquid stool
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Continuous rumbling flatulence
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Absence of bowel movements
Explanation
Correct Answer B: Oozing liquid stool
Explanation:
Fecal impaction often presents with paradoxical diarrhea or oozing of liquid stool that seeps around the impacted mass. This happens because only liquid stool can bypass the obstruction, leading to frequent soiling. In a paralyzed client, impaired mobility and reduced bowel function increase the risk, making this a classic sign of impaction.
Why Other Options Are Wrong:
A) Presence of blood in stools
Blood in stool may indicate hemorrhoids, GI bleeding, or trauma but is not a hallmark of fecal impaction.
C) Continuous rumbling flatulence
Excessive gas may suggest indigestion or partial obstruction, but it is not a reliable indicator of fecal impaction.
D) Absence of bowel movements
While constipation can precede impaction, the most telling sign is oozing stool, not just absence of bowel movements.
Which client is best to assign to the practical nurse (PN) who is assisting the registered nurse (RN) with the care of a group of clients?
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An older client who is one day postoperative with a colostomy for colon cancer
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An older adult who is scheduled for foot amputation due to diabetes complications
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An adult who is one day postoperative for a laparoscopic cholecystectomy
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An adult with alcoholism, cirrhosis, and hepatic encephalopathy.
Explanation
Correct Answer:
C. An adult who is one day postoperative for a laparoscopic cholecystectomy.
Explanation of Correct Answer
C. An adult who is one day postoperative for a laparoscopic cholecystectomy.
This client is stable, and their care involves routine postoperative monitoring (vital signs, pain assessment, wound care, ambulation, intake and output). These tasks are appropriate for a PN under the supervision of an RN.
The nurse is teaching an 87 year-old client methods for maintaining regular bowel movements. The nurse would caution the client to AVOID
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Glycerine suppositories
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Fiber supplements
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Laxatives
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Stool softeners
Explanation
Correct Answer C: Laxatives
Explanation:
Older adults are prone to constipation due to reduced gastrointestinal motility, decreased fluid intake, and less physical activity. While occasional use of laxatives may be necessary, routine or frequent use should be avoided because they can cause dependence, electrolyte imbalances, and reduced bowel tone over time. Safer alternatives include increasing fiber, hydration, mobility, and occasional stool softeners or glycerine suppositories if needed.
Why Other Options Are Wrong:
A) Glycerine suppositories
These are generally safe for occasional use in older adults because they act locally, drawing water into the rectum to ease stool passage, without systemic side effects.
B) Fiber supplements
Fiber supplements such as psyllium are safe and effective in promoting bowel regularity. They bulk the stool and improve motility, provided fluid intake is adequate.
D) Stool softeners
Stool softeners (like docusate) are safe for long-term use, especially in older adults who need to avoid straining due to conditions like heart disease or hemorrhoids. They do not cause dependency.
History and Physical
The client is a 24-year-old female who fell while horseback riding. Witnesses told the paramedics who treated her in the field that the horse may have stepped on her at least once after she fell. She has a large hematoma in the abdominal area, and her abdomen is distended. She is currently intubated with a 7.5 mm endotracheal tube and has two 18 gauge peripheral intravenous (PIV) lines. The client will go to the operating room for an exploratory laparotomy.
Nurses' Notes
1600:
Admitted client.
The client's surgical dressing is clean and dry. Ecchymosis noted on the abdomen around the dressing. The client has a PIV line in the right forearm and one in the left hand. The client also has a right subclavian central venous catheter that is infusing propofol and intravenous fluids. Heart sounds are regular. The skin is pink. Capillary refill is 6 seconds. Radial pulses are equal bilaterally. Lung sounds are clear and equal bilaterally. The client has an indwelling urinary catheter in place. No urine noted. The client has no visitors at this time. The social worker is attempting to contact family members. The client opens her eyes to verbal stimuli and follows verbal commands.
Vital signs
Temperature: 96.9° F (36.1° C), internal probe via urinary catheter
Heart rate: 128 beats/minute, sinus tachycardia (ST) Respirations: 14 breaths/minute
Blood pressure: 90/79 mm Hg, pulse pressure less than 40 mm Hg
Oxygen saturation: 100% on 40% fraction of inspired oxygen (FiO2)
Orders
1600:
Admit to the trauma intensive care unit
Connect to the cardiorespiratory monitor
STAT chest x-ray post central line and ETT placement
Vital signs every hour
Ventilator settings: respiratory rate 14 breaths/minute, tidal volume 400 mL
Propofol 0.03 mg/kg/min IV infusion
0.9% sodium chloride with 5% dextrose IV infusion at 100 mL/hr.
1610:
OK to use central venous catheter
Imaging Studies
1200:
Computerized tomography (CT) scan of the abdomen: Lacerations to the liver and spleen, blood noted in the peritoneum.
1610:
Chest x-ray: Endotracheal tube and central line in place.
Laboratory Results
|
|
|
|
Laboratory Test |
1800 2000 |
|
Hemoglobin |
9.3 g/dL (93 g/L) 10 g/dL (100 g/L) |
|
Hematocrit |
30% (0.30 volume to fraction) 35% (0.35 volume to fraction) |
Exhibits
The client has started to wake up more, opening her eyes without stimulation and looking around the room.
Which should the nurse do as the client becomes more aware of her surroundings? Select all that apply
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Have the client sign consent forms for procedures already performed
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Decrease the noise and light stimuli in the room as much as possible
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Consider extubating the client
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Increase the propofol infusion
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Determine the client's decision-making ability
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Explain all procedures
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Notify the social worker the client is awake
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Assess the client's pain
Explanation
Correct Answers:
B, E, F, G, H
Explanation of Correct Answers
B. Decrease the noise and light stimuli in the room as much as possible.
Reducing sensory stimulation helps minimize agitation and confusion as the client emerges from sedation and becomes more aware.
E. Determine the client's decision-making ability.
As awareness improves, the nurse should assess orientation and decision-making capacity to know if the client can participate in care and future consents.
F. Explain all procedures.
Clients waking from sedation often feel disoriented. Explaining procedures clearly helps reassure the client, reduce anxiety, and promote cooperation.
G. Notify the social worker the client is awake.
The social worker has been trying to contact family. Notifying them that the client is awake helps facilitate family communication and psychosocial support.
H. Assess the client's pain.
Pain assessment is a critical nursing responsibility as the client regains consciousness following trauma and surgery. Managing pain supports physiologic stability and comfort.
Why Other Options Are Incorrect
A. Have the client sign consent forms for procedures already performed.
Consent cannot be obtained retroactively. Completed procedures do not require backdated consent.
C. Consider extubating the client.
Extubation requires a provider’s evaluation and order, including readiness criteria such as oxygenation, spontaneous effort, and stable hemodynamics. It is not a nurse-initiated action.
D. Increase the propofol infusion.
Increasing sedation is not indicated simply because the client is waking up. Sedation adjustments require provider input and specific clinical justification.
A 3-year-old boy with a congenital heart defect is brought to the clinic by his mother because he has a fever and an earache. During the assessment, the mother asks the nurse why her child is at the 5th percentile for weight and height for his age. Which response is best for the nurse to provide?
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"Does your child seem mentally slower than his peers also?"
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"Haven't you been feeding him according to recommended daily allowances for children?"
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"His smaller size is probably due to the heart disease."
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"You should not worry about the growth tables. They are only averages for children."
Explanation
Correct Answer:
C. "His smaller size is probably due to the heart disease."
Explanation
Children with congenital heart defects often experience growth delays due to increased metabolic demands from the heart working harder, frequent infections, decreased oxygenation, and sometimes reduced appetite or feeding difficulties. Explaining this connection helps the mother understand the medical cause of her child’s growth issues and reassures her that it is not her fault. This response is factual, empathetic, and addresses the mother’s concern directly.
Why Other Options Are Wrong
A. "Does your child seem mentally slower than his peers also?"
This response is inappropriate and judgmental. It ignores the mother’s concern about physical growth and introduces an unrelated and potentially offensive assumption about cognitive development.
B. "Haven't you been feeding him according to recommended daily allowances for children?"
This response places blame on the mother without considering the child’s medical condition. It is non-therapeutic and could make the parent feel guilty or defensive rather than supported.
D. "You should not worry about the growth tables. They are only averages for children."
While growth tables are averages, percentile rankings are important indicators of growth trends and overall health. Dismissing the concern minimizes the issue and provides no useful explanation to the parent.
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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.