HESI RN Exit (BSN) 2026 Proctored Exam 10/08/2026 with Question 129 · Pharmacological and Parenteral Therapies

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Sample questions from HESI RN Exit (BSN) 2026 Proctored Exam 10/08/2026 with Question 129 · Pharmacological and Parenteral Therapies

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.In the neonatal intensive care unit, a 2-day-old newborn receiving a continuous intravenous infusion of gentamicin has a urine output of 0.4 mL/kg/hr over 8 hours. The latest gentamicin trough is 2.4 mcg/mL, above the prescribed target of less than 1 mcg/mL. Which action should the nurse take first?

   • A.Increase the maintenance fluid rate to improve renal clearance.
   • B.Administer the dose and repeat the trough after the infusion.
   • C.Ask the pharmacist to reduce the next dose after it is administered.
   • D.Hold the next dose and notify the prescribing clinician.

   Rationale: The elevated trough and low urine output suggest impaired gentamicin clearance and an increased risk of nephrotoxicity, so the next dose should be held while the prescriber is notified. Administering the dose before clarifying the order could worsen toxicity. Increasing fluids or requesting a dose change may be considered after assessment, but neither replaces withholding the potentially unsafe dose and promptly communicating the findings.

2. 2.At a pediatric clinic, a parent of a 4-year-old with an amoxicillin prescription for otitis media says the child vomited 20 minutes after the first dose and asks whether to give another dose. The child is alert, has moist mucous membranes, and has no rash, swelling, or breathing difficulty. Which response is best?

   • A.Give half a dose now and give the next scheduled dose as prescribed.
   • B.Stop the antibiotic and give an over-the-counter antihistamine.
   • C.Do not repeat the dose; contact the pharmacist or prescriber for instructions.
   • D.Give another full dose now because the medicine was vomited.

   Rationale: It can be difficult to determine how much medication was absorbed after vomiting, so the parent should not independently repeat or alter the dose and should obtain individualized instructions. Repeating a full dose may cause an unintended overdose, while giving half a dose is not a prescribed adjustment. Stopping the antibiotic and giving an antihistamine is not indicated without signs of an allergic reaction.

3. 3.Refer to the client's chart. Which actions should the nurse take now for the 16-year-old in the emergency department? Select all that apply.

   • A.Administer the next heparin bolus because the aPTT is below the therapeutic range.
   • B.Ask the unlicensed assistive personnel to independently determine whether the heparin should be stopped.
   • C.Assess for additional bleeding, including urine, stool, skin, and neurologic changes.
   • D.Request immediate evaluation of the falling hemoglobin and new flank pain.
   • E.Hold the scheduled unfractionated heparin infusion and promptly notify the prescriber.

   Rationale: The chart shows new flank pain, a hemoglobin decline from 12.4 to 9.8 g/dL, and hypotension with tachycardia, which are concerning for bleeding despite an aPTT below the listed therapeutic range. The nurse should hold the infusion, promptly alert the prescriber, and assess for other bleeding while following emergency protocols. Giving a bolus based only on the aPTT could worsen hemorrhage, and an unlicensed assistive personnel cannot independently assess or make infusion-management decisions. The vital-sign trend reinforces the need for urgent reassessment.

4. 4.During a home visit, a 27-year-old client with type 1 diabetes reports taking the usual morning dose of rapid-acting insulin but has been unable to eat because of nausea. The client is alert, diaphoretic, and shaky; capillary glucose is 54 mg/dL, and the client can swallow safely. Which action should the nurse take first?

   • A.Give 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes.
   • B.Encourage the client to drink water and recheck glucose in 1 hour.
   • C.Give the usual lunchtime insulin dose to prevent rebound hyperglycemia.
   • D.Administer glucagon intramuscularly and place the client on the side.

   Answer and rationale are in the full material.

5. 5.A primigravida at 32 weeks is receiving magnesium sulfate for severe preeclampsia in a labor and delivery unit. She is difficult to arouse, has respirations of 10/min, absent patellar reflexes, and urine output of 20 mL/hr. The magnesium level is 8.8 mg/dL. Which action is the priority?

   • A.Administer the prescribed antihypertensive before reassessing respirations.
   • B.Stop the magnesium infusion and prepare to administer calcium gluconate.
   • C.Reduce the infusion rate and place the client in a quiet, dark room.
   • D.Continue the infusion and repeat the magnesium level in 1 hour.

   Answer and rationale are in the full material.