HESI Exam Flashcards

Q: What is a good HESI exit exam score?

HESI scores range from 0-1000+. Most nursing programs set a benchmark of 850-900 for the exit exam. Scoring 900+ is considered excellent and strongly correlates with NCLEX-RN success. Scoring 850-899 is acceptable at most programs. Below 750 indicates significant review is needed. The HESI conversion score predicts NCLEX pass probability: 900+ = 96-99% predicted NCLEX pass rate.

Q: What is the difference between HESI A2 and HESI Exit Exam?

HESI A2 (Admission Assessment) is taken BEFORE nursing school for program admission. It covers: math, reading, vocabulary, grammar, anatomy, biology, chemistry. The HESI Exit Exam is taken at the END of nursing school to predict NCLEX readiness. It covers clinical nursing content: med-surg, pharmacology, fundamentals, maternity, pediatrics, psychiatric nursing. Different exams, different purposes.

Q: How many times can I take the HESI?

HESI retake policies are set by individual nursing programs, not by Elsevier. Most programs allow 2-3 attempts. Some charge additional fees for retakes ($50-100). Some programs require remediation before retaking. A few programs dismiss students who fail to meet the benchmark after all attempts. Check your specific program's policy. The exam is computer-based and results are typically available immediately.

Q: Does HESI score affect graduation?

This depends entirely on your nursing program. Some programs require meeting the HESI benchmark to graduate. Others use it as a predictor but don't require a minimum score. Some count it as a percentage of your final course grade. Many programs now require both HESI and ATI scores. Always check your program handbook for specific HESI requirements and consequences.

Q: How should I study for the HESI exit exam?

Effective HESI study strategies: (1) Use the Elsevier Adaptive Quizzing platform (if your program provides it), (2) Focus on pharmacology and med-surg (heaviest content areas), (3) Review Saunders Comprehensive Review for NCLEX, (4) Practice HESI-style questions (application and analysis level), (5) Study lab values and normal ranges, (6) Review delegation and priority-setting frameworks. Start studying 4-6 weeks before the exam.

Q: Does the HESI predict NCLEX success?

Yes, HESI is designed to predict NCLEX-RN pass probability. Research shows: HESI Exit scores of 900+ correlate with 96-99% NCLEX first-time pass rates. Scores of 850-899 correlate with ~90% pass rates. Scores below 750 correlate with significantly lower NCLEX pass rates. However, HESI is just a predictor—students who score lower can still pass NCLEX with additional preparation.

Question 1

Maslow's Hierarchy of Needs (Nursing Priority)

Accepted Answer

From base to top: Physiological (airway, breathing, food, water), Safety & Security (fall prevention, infection control), Love & Belonging (family, support), Esteem (independence, dignity), Self-Actualization (growth). Always address lower levels first when prioritizing nursing care.

Question 2

Nursing Process (ADPIE)

Accepted Answer

A = Assessment (collect data), D = Diagnosis (identify problems), P = Planning (set goals, expected outcomes), I = Implementation (carry out interventions), E = Evaluation (determine if goals met). Continuous, cyclical process. Assessment is always the first step.

Question 3

Delegation: The Five Rights

Accepted Answer

Right Task (appropriate to delegate), Right Circumstance (stable patient), Right Person (competent delegate), Right Direction/Communication (clear instructions), Right Supervision/Evaluation (follow up). RNs cannot delegate assessment, planning, evaluation, or teaching.

Question 4

Standard Precautions

Accepted Answer

Applied to ALL patients regardless of diagnosis. Includes: hand hygiene, gloves (contact with body fluids), gowns (if splashing expected), masks/eye protection (aerosol-generating procedures), safe needle disposal, respiratory hygiene/cough etiquette.

Question 5

Isolation Precautions: Contact, Droplet, Airborne

Accepted Answer

Contact (MRSA, C. diff): gown + gloves, dedicated equipment. Droplet (flu, pertussis, meningitis): surgical mask within 3 feet, private room. Airborne (TB, measles, chickenpox): N95 respirator, negative pressure room, keep door closed.

Question 6

Informed Consent Requirements

Accepted Answer

Must include: procedure explanation, risks, benefits, alternatives, right to refuse. Patient must be competent, voluntary, and informed. Physician obtains consent; nurse witnesses the signature. Nurse ensures patient understanding and can notify MD if patient has questions.

Question 7

Six Rights of Medication Administration

Accepted Answer

Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation. Additional rights: right reason, right to refuse, right assessment, right education. Verify with two patient identifiers (name + DOB). Three checks: when pulling, preparing, and administering.

Question 8

Therapeutic Drug Levels: Digoxin

Accepted Answer

Therapeutic range: 0.5-2.0 ng/mL. Toxicity signs: nausea, vomiting, anorexia, visual disturbances (yellow-green halos), bradycardia, dysrhythmias. Check apical pulse for 1 full minute before administering. Hold if HR <60 bpm (adult). Monitor potassium—hypokalemia increases toxicity risk.

Question 9

Therapeutic Drug Levels: Lithium

Accepted Answer

Therapeutic range: 0.6-1.2 mEq/L. Toxicity signs: coarse tremors, confusion, seizures, oliguria. Draw levels 8-12 hours after last dose. Patient must maintain adequate sodium and fluid intake. Toxicity is medical emergency—no antidote, supportive care + possible dialysis.

Question 10

Anticoagulant Comparison: Heparin vs. Warfarin

Accepted Answer

Heparin: IV/SubQ, rapid onset, monitor aPTT (target 1.5-2.5× control), antidote = protamine sulfate. Warfarin (Coumadin): oral, delayed onset (3-5 days), monitor INR (target 2-3), antidote = vitamin K. Both increase bleeding risk. Avoid IM injections.

Question 11

ACE Inhibitors (-pril medications)

Accepted Answer

Examples: lisinopril, enalapril, captopril. Used for HTN, heart failure, diabetic nephropathy. Side effects: dry cough (most common), hyperkalemia, angioedema (rare but serious), first-dose hypotension. Contraindicated in pregnancy. Monitor potassium and renal function.

Question 12

Heart Failure: Left-Sided vs. Right-Sided

Accepted Answer

Left-sided: pulmonary congestion—dyspnea, orthopnea, crackles, pink frothy sputum, fatigue, S3 gallop. Right-sided: systemic congestion—peripheral edema, JVD, hepatomegaly, weight gain, ascites. Right failure often caused by left failure. Treatment: diuretics, ACE inhibitors, monitor daily weights.

Question 13

Myocardial Infarction (MI) Nursing Care

Accepted Answer

MONA: Morphine (pain), Oxygen (if SpO2 <94%), Nitroglycerin (vasodilation), Aspirin (antiplatelet). Elevate HOB 45°. Continuous cardiac monitoring. Serial troponins and 12-lead ECG. Pain rated 0-10. Goal: door-to-balloon time <90 min for STEMI. Monitor for dysrhythmias.

Question 14

Diabetes: Type 1 vs. Type 2

Accepted Answer

Type 1: autoimmune destruction of beta cells, no insulin production, requires exogenous insulin, younger onset, DKA risk. Type 2: insulin resistance ± decreased production, managed with lifestyle + oral meds ± insulin, older onset, HHS risk. Both: monitor A1C (goal <7%), blood glucose, complications.

Question 15

DKA vs. HHS (Hyperosmolar Hyperglycemic State)

Accepted Answer

DKA: Type 1, BG 300-800, ketones present, Kussmaul breathing, fruity breath, pH <7.35, rapid onset. HHS: Type 2, BG >600 (often >1000), no ketones, severe dehydration, altered mental status, gradual onset. Both: IV fluids first, then insulin drip, monitor potassium closely.

Question 16

Thyroid Disorders: Hypo vs. Hyper

Accepted Answer

Hypothyroid: fatigue, weight gain, cold intolerance, constipation, bradycardia, dry skin, low T3/T4, high TSH. Treat with levothyroxine. Hyperthyroid: anxiety, weight loss, heat intolerance, diarrhea, tachycardia, exophthalmos, high T3/T4, low TSH. Treat with methimazole/PTU.

Question 17

Chronic Kidney Disease (CKD) Nursing Care

Accepted Answer

Monitor I&O, daily weights, electrolytes (hyperkalemia!), BUN/creatinine. Diet: restrict sodium, potassium, phosphorus, protein, fluids. Medications: phosphate binders, erythropoietin (anemia), vitamin D. Avoid nephrotoxic drugs (NSAIDs, aminoglycosides). Prepare for dialysis when GFR <15.

Question 18

Post-Operative Nursing Assessment Priority

Accepted Answer

ABCs first (airway patency, breathing, circulation). Then check: level of consciousness, vital signs, surgical site (bleeding, drainage), pain level, IV sites, urine output (≥30 mL/hr). Turn, cough, deep breathe every 2 hours. Incentive spirometry. Early ambulation to prevent DVT.

Question 19

Stages of Labor

Accepted Answer

Stage 1: Onset of contractions to full cervical dilation (10 cm). Latent phase: 0-6 cm. Active phase: 6-10 cm. Stage 2: Full dilation to delivery of baby. Stage 3: Delivery of baby to delivery of placenta (5-30 min). Stage 4: First 1-2 hours postpartum (monitor for hemorrhage).

Question 20

Preeclampsia Signs & Management

Accepted Answer

Signs: BP ≥140/90 after 20 weeks, proteinuria, edema (face/hands), headache, visual changes, epigastric pain. Severe: BP ≥160/110, HELLP syndrome. Treatment: magnesium sulfate (seizure prevention)—monitor for toxicity (decreased reflexes, respiratory depression). Antidote: calcium gluconate. Delivery is the cure.

Question 21

Newborn APGAR Scoring

Accepted Answer

Assessed at 1 and 5 minutes. Appearance (color): 0=blue, 1=acrocyanosis, 2=pink. Pulse: 0=absent, 1=<100, 2=>100. Grimace: 0=none, 1=grimace, 2=cough/cry. Activity: 0=limp, 1=some flexion, 2=active. Respirations: 0=absent, 1=slow/irregular, 2=strong cry. Score 7-10 = normal.

Question 22

Postpartum Hemorrhage

Accepted Answer

Blood loss >500 mL (vaginal) or >1000 mL (cesarean). #1 cause: uterine atony (boggy uterus). Nursing actions: fundal massage, monitor vital signs, IV oxytocin (Pitocin), empty bladder, notify provider. Other causes: lacerations, retained placenta, coagulopathy. 4 T's: Tone, Trauma, Tissue, Thrombin.

Question 23

Pediatric Vital Signs by Age

Accepted Answer

Newborn: HR 120-160, RR 30-60. Infant: HR 100-150, RR 25-50. Toddler: HR 70-110, RR 20-30. School-age: HR 65-110, RR 18-25. Adolescent: HR 55-105, RR 12-20. BP increases with age. Fever: temp >100.4°F (38°C) rectal.

Question 24

Pediatric Dehydration Assessment

Accepted Answer

Mild (3-5%): slightly dry mucous membranes, decreased tears. Moderate (6-9%): sunken fontanel, decreased skin turgor, tachycardia, oliguria. Severe (>10%): lethargy, sunken eyes, absent tears, delayed capillary refill, hypotension. Treat with oral or IV rehydration based on severity.

Question 25

Epiglottitis vs. Croup (Nursing)

Accepted Answer

Epiglottitis: bacterial, abrupt onset, high fever, drooling, tripod position, toxic appearance—do NOT examine throat (risk of complete obstruction). Croup: viral, gradual onset, barking cough, stridor, low-grade fever—treat with cool mist, racemic epinephrine, corticosteroids.

Question 26

Therapeutic Communication Techniques

Accepted Answer

Effective: open-ended questions, reflecting, restating, silence, offering self, validating feelings, summarizing. Non-therapeutic (AVOID): giving advice, false reassurance, 'why' questions, changing the subject, minimizing feelings, approving/disapproving.

Question 27

Suicide Risk Assessment

Accepted Answer

Risk factors: previous attempts (#1 predictor), plan with means, hopelessness, substance abuse, social isolation, recent loss. Warning signs: giving away possessions, sudden calmness after depression, talking about being a burden. Always ask directly about suicidal thoughts. One-to-one observation for high-risk patients.

Question 28

Antidepressant Medications: SSRIs

Accepted Answer

Examples: fluoxetine, sertraline, paroxetine, citalopram. First-line for depression and anxiety. Side effects: GI upset, sexual dysfunction, insomnia, weight changes. Black box warning: increased suicidality in ages <25. Full therapeutic effect: 4-6 weeks. Do NOT stop abruptly.

Question 29

Benzodiazepines: Nursing Considerations

Accepted Answer

Examples: lorazepam, diazepam, alprazolam, midazolam. Used for anxiety, seizures, alcohol withdrawal. CNS depressants—monitor for respiratory depression. High addiction potential. Do NOT combine with alcohol or opioids. Antidote: flumazenil. Taper slowly to discontinue.

Question 30

Hyperkalemia (K+ >5.0 mEq/L)

Accepted Answer

Causes: renal failure, acidosis, tissue damage, ACE inhibitors, potassium-sparing diuretics. ECG changes: tall peaked T waves, widened QRS, cardiac arrest. Treatment: calcium gluconate (cardiac protection), insulin + glucose, kayexalate, albuterol, dialysis. RESTRICT potassium foods.

Question 31

Hypokalemia (K+ <3.5 mEq/L)

Accepted Answer

Causes: diuretics (loop, thiazide), vomiting, diarrhea, NG suction. Symptoms: muscle weakness, leg cramps, decreased reflexes, paralytic ileus, U waves on ECG, dysrhythmias. Treatment: potassium replacement (NEVER IV push—must dilute). Monitor cardiac rhythm. High-potassium diet: bananas, oranges, potatoes.

Question 32

Hyponatremia (Na+ <135 mEq/L)

Accepted Answer

Causes: SIADH, water intoxication, diuretics, heart failure. Symptoms: confusion, headache, nausea, seizures, cerebral edema. Treatment: fluid restriction, hypertonic saline (3%) for severe cases—infuse slowly (risk of osmotic demyelination). Monitor neuro status frequently. Correct no faster than 8-12 mEq/L per 24 hours.

Question 33

IV Fluid Types: Isotonic, Hypotonic, Hypertonic

Accepted Answer

Isotonic (NS 0.9%, LR): replaces volume, stays in vascular space. Hypotonic (0.45% NS): shifts fluid INTO cells—for cellular dehydration. Hypertonic (3% NS, D10W): pulls fluid OUT of cells—for hyponatremia. Never give hypotonic to patients with increased ICP.

Question 34

Acid-Base: Respiratory vs. Metabolic

Accepted Answer

Respiratory acidosis: pH <7.35, CO2 >45 (hypoventilation). Respiratory alkalosis: pH >7.45, CO2 <35 (hyperventilation). Metabolic acidosis: pH <7.35, HCO3 <22 (DKA, renal failure). Metabolic alkalosis: pH >7.45, HCO3 >26 (vomiting, NG suction). ROME: Respiratory = Opposite, Metabolic = Equal.

Question 35

Chest Tube Nursing Care

Accepted Answer

Keep drainage system below chest level. Monitor for air leak (bubbling in water seal). Tidaling in water seal is normal (stops when lung re-expands). Never clamp a chest tube without order. If disconnected: submerge end in sterile water. If pulled out: cover site with petroleum gauze, taped on 3 sides.

Question 36

Blood Transfusion Reactions

Accepted Answer

Acute hemolytic: fever, chills, flank pain, hemoglobinuria—STOP transfusion immediately, maintain IV with NS. Febrile: most common reaction. Allergic: urticaria, itching—antihistamine. Anaphylactic: dyspnea, hypotension—epinephrine. ALWAYS verify patient ID with two nurses before starting.

Question 37

Renal Diet Restrictions

Accepted Answer

Restrict: sodium (<2g/day), potassium (<2g/day), phosphorus (<1g/day), protein (pre-dialysis), fluids. Avoid: bananas, oranges, potatoes, tomatoes, dairy, nuts, whole grains, dark colas. Protein increased once on dialysis due to losses.

Question 38

Cardiac Diet (DASH Diet)

Accepted Answer

DASH: Dietary Approaches to Stop Hypertension. Emphasize: fruits, vegetables, whole grains, lean protein, low-fat dairy. Limit: sodium (<2g/day), saturated fat, red meat, sweets, sugary beverages. Also limit caffeine and alcohol. Daily potassium, calcium, and magnesium intake helps lower BP.

Question 39

Fall Prevention Interventions

Accepted Answer

Assess fall risk on admission and each shift (Morse Fall Scale). Interventions: bed in lowest position, call light within reach, non-skid footwear, adequate lighting, assist with ambulation, toileting schedule, bed alarm for high-risk. Review medications (sedatives, antihypertensives, diuretics).

Question 40

Chain of Infection

Accepted Answer

Six links: (1) Infectious agent (pathogen), (2) Reservoir (where it lives), (3) Portal of exit (how it leaves), (4) Mode of transmission (how it spreads), (5) Portal of entry (how it enters), (6) Susceptible host. Break ANY link to prevent infection. Hand hygiene is most effective measure.

Question 41

HESI Priority Question Strategy: ABCs

Accepted Answer

When multiple answer choices are correct, prioritize: Airway first (suctioning, positioning), then Breathing (oxygen, ventilation), then Circulation (bleeding control, IV fluids). Exception: in cardiac arrest, start compressions (C-A-B). Always choose the most life-threatening option first.

Question 42

Scope of Practice: RN vs. LPN vs. UAP

Accepted Answer

RN: assessment, care planning, evaluation, IV push meds, blood administration, teaching, delegation. LPN/LVN: data collection, stable patients, oral/IM meds, dressing changes, trach/vent care (experienced). UAP: vital signs, hygiene, feeding, ambulation, I&O measurement. Never delegate assessment.

Question 43

Glasgow Coma Scale (Nursing)

Accepted Answer

Eye Opening: spontaneous (4), to voice (3), to pain (2), none (1). Verbal: oriented (5), confused (4), inappropriate words (3), incomprehensible sounds (2), none (1). Motor: obeys commands (6), localizes pain (5), withdraws (4), abnormal flexion (3), extension (2), none (1). Total: 3-15. Report changes immediately.

Question 44

Skin Integrity: Pressure Injury Staging

Accepted Answer

Stage 1: non-blanchable redness, intact skin. Stage 2: partial-thickness, shallow open ulcer or blister. Stage 3: full-thickness, fat visible, no bone/tendon. Stage 4: full-thickness, bone/tendon exposed. Unstageable: covered by slough/eschar. DTPI: intact skin with deep purple/maroon discoloration.

Question 45

Pain Assessment: Numeric vs. FLACC

Accepted Answer

Numeric Rating Scale (NRS): 0-10, used for adults and children >7. Wong-Baker FACES: ages 3-7. FLACC (infants/nonverbal): Face, Legs, Activity, Cry, Consolability (0-2 each, total 0-10). Pain is the 5th vital sign. Reassess after intervention. Document pain level and response to treatment.

Question 46

Critical Lab Values to Know

Accepted Answer

Potassium: 3.5-5.0 mEq/L. Sodium: 135-145 mEq/L. Glucose: 70-100 mg/dL (fasting). BUN: 10-20 mg/dL. Creatinine: 0.7-1.3 mg/dL. Hgb: 12-16 (F), 14-18 (M). WBC: 5,000-10,000. Platelets: 150,000-400,000. INR: 2-3 (on warfarin). Report values outside these ranges immediately.

Question 47

ABG Interpretation Steps

Accepted Answer

Step 1: pH—acidosis (<7.35) or alkalosis (>7.45)? Step 2: PaCO2 (35-45)—if abnormal, matches pH? = respiratory cause. Step 3: HCO3 (22-26)—if abnormal, matches pH? = metabolic cause. Step 4: Compensation—is the other value trying to normalize pH? Normal pH with abnormal CO2 and HCO3 = fully compensated.

Question 48

Insulin Types & Onset

Accepted Answer

Rapid-acting (lispro, aspart): onset 15 min, peak 1-2 hrs, duration 3-4 hrs. Short-acting (Regular): onset 30-60 min, peak 2-4 hrs, duration 6-8 hrs. Intermediate (NPH): onset 1-2 hrs, peak 6-12 hrs, duration 18-24 hrs. Long-acting (glargine): onset 1-2 hrs, no peak, duration 24 hrs. Only Regular can be given IV.

Question 49

SBAR Communication

Accepted Answer

S = Situation (what's happening now), B = Background (relevant history, context), A = Assessment (your clinical assessment of the problem), R = Recommendation (what you think should be done). Standardized format for nurse-to-provider and nurse-to-nurse handoff communication. Reduces errors.

Question 50

Ethical Principles in Nursing

Accepted Answer

Autonomy: patient's right to make decisions. Beneficence: do good. Nonmaleficence: do no harm. Justice: fair distribution of resources. Fidelity: keep promises. Veracity: tell the truth. When principles conflict, patient autonomy generally takes precedence for competent adults.

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