HESI Exit Exam

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Sample questions from HESI Exit Exam

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

1. 1.In the emergency department, a client with pneumonia becomes restless and says, "I can't catch my breath." The client has a temperature of 39.1 C, HR 124/min, RR 30/min, BP 86/50 mm Hg, and SpO2 89% on room air. Which action should the nurse take first?

   • A.Obtain a sputum specimen before antimicrobial therapy is started
   • B.Encourage oral fluids to support hydration
   • C.Administer the prescribed antipyretic and reassess in 30 minutes
   • D.Apply supplemental oxygen and initiate the facility's sepsis response

   Rationale: Hypotension, tachycardia, hypoxemia, and new restlessness suggest worsening oxygenation and possible septic shock, so oxygen and prompt sepsis-response actions take priority. Obtaining a sputum specimen is appropriate if it does not delay stabilization or time-sensitive treatment. An antipyretic and oral fluids do not address the immediate instability, and oral intake may be unsafe in a client with respiratory distress.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the change in the client's respiratory status? Select all that apply.

   • A.Withhold the prescribed bronchodilator until the chest radiograph is reviewed
   • B.Reassess respiratory effort, mental status, and oxygen saturation after intervention
   • C.Coach the client to breathe into a paper bag to reduce anxiety
   • D.Raise the head of the bed and apply oxygen as prescribed
   • E.Notify the rapid response team because the client is acutely worsening

   Rationale: At 1000, the client's SpO2 has fallen to 86% with increased work of breathing and new confusion, so positioning, prescribed oxygen, and prompt reassessment are indicated. The rapid response team should be notified because the trend shows acute deterioration despite initial treatment. Paper-bag breathing can worsen hypoxemia, and delaying the prescribed bronchodilator for imaging is not appropriate during respiratory distress.

3. 3.After a total hip arthroplasty, a client suddenly reports shortness of breath and sharp chest pain. The client is anxious, HR is 132/min, RR is 30/min, and SpO2 is 84%. Which action should the nurse take first?

   • A.Assist the client to ambulate to improve venous return
   • B.Massage the operative leg to reduce discomfort
   • C.Apply oxygen and activate the rapid response system
   • D.Place the client in Trendelenburg position

   Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia after joint surgery are concerning for pulmonary embolism, requiring immediate oxygenation and emergency escalation. Ambulation is unsafe during acute respiratory compromise, and Trendelenburg does not treat the cause and can impair breathing. Massaging the operative leg is contraindicated when venous thromboembolism is possible.

4. 4.A client's potassium is 6.2 mEq/L (reference 3.5-5.0), and the electrocardiogram shows peaked T waves. The client has chronic kidney disease and takes lisinopril. Which prescribed medication should the nurse anticipate administering first?

   • A.Calcium gluconate IV
   • B.Sodium polystyrene sulfonate orally
   • C.Furosemide orally
   • D.Patiromer orally

   Answer and rationale are in the full material.

5. 5.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client with heart failure who gained 1 kg in 24 hours and has bilateral ankle edema
   • B.A client 6 hours after thyroidectomy who reports tingling around the mouth and has a hoarse voice
   • C.A client with a urinary tract infection who reports burning with urination
   • D.A client with diabetes whose premeal glucose is 238 mg/dL and who is due for insulin

   Answer and rationale are in the full material.