HESI Exit Exam 2026

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Sample questions from HESI Exit Exam 2026

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 72-year-old client is admitted to the emergency department with sudden dyspnea, pink frothy sputum, crackles, and an oxygen saturation of 84% on room air. Blood pressure is 188/102 mm Hg. Which action should the nurse take first?

   • A.Place the client in high-Fowler position and apply oxygen
   • B.Obtain a sputum specimen for culture
   • C.Encourage the client to drink 500 mL of water
   • D.Prepare the client for ambulation

   Rationale: High-Fowler positioning and oxygen support ventilation in suspected acute pulmonary edema, an immediate threat to life. A sputum culture may be obtained later but does not stabilize breathing. Fluids can worsen pulmonary congestion, and ambulation is unsafe during severe dyspnea.

2. 2.A 68-year-old client with heart failure is being discharged from a medical unit. The client has new prescriptions, stable vital signs, and correctly describes daily weights and a low-sodium diet. Which task is appropriate for the RN to delegate to unlicensed assistive personnel (UAP)?

   • A.Teach the client how to adjust diuretic doses
   • B.Assess the client's understanding of warning signs
   • C.Obtain and record the client's daily weight
   • D.Evaluate the client's response to prescribed medication

   Rationale: Obtaining and recording a weight is a routine, predictable task that can be delegated to trained UAP. Medication teaching and assessment of understanding require nursing judgment and remain the RN's responsibility. Evaluating a medication response also requires assessment and cannot be delegated.

3. 3.A 59-year-old client with type 1 diabetes arrives at the emergency department with vomiting, abdominal pain, and deep rapid respirations. Glucose is 486 mg/dL, potassium is 5.2 mEq/L, and arterial pH is 7.18. Which prescription should the nurse implement first?

   • A.Begin an isotonic intravenous fluid bolus
   • B.Administer intravenous sodium bicarbonate
   • C.Give subcutaneous long-acting insulin
   • D.Restrict fluids until the glucose decreases

   Rationale: Initial isotonic fluid replacement treats severe dehydration and supports circulation in diabetic ketoacidosis. Bicarbonate is not routinely used at this pH and may cause complications. Subcutaneous long-acting insulin is not the initial treatment for DKA, and fluid restriction worsens hypovolemia.

4. 4.A 74-year-old client with pneumonia is admitted to a medical unit. The client is newly confused, temperature is 39.1 C (102.4 F), heart rate is 124/min, blood pressure is 82/48 mm Hg, and lactate is 4.1 mmol/L. Which action has the highest priority?

   • A.Obtain a full medication history
   • B.Initiate the prescribed sepsis protocol, including rapid IV fluid resuscitation
   • C.Administer an antipyretic and reassess in 1 hour
   • D.Collect a urine specimen before notifying the provider

   Answer and rationale are in the full material.

5. 5.A 24-year-old client is admitted to the emergency department after a motorcycle crash. The client has facial burns, singed nasal hair, hoarseness, and a respiratory rate of 28/min; oxygen saturation is 93% on room air. Which action should the nurse anticipate first?

   • A.Prepare for early endotracheal intubation
   • B.Apply an ice pack to the burned face
   • C.Offer oral fluids to prevent dehydration
   • D.Wait for stridor before notifying the provider

   Answer and rationale are in the full material.