HESI RN EXIT EXAM
NGN VERSION B 2025-2026
COMPREHENSIVE STUDY GUIDE
SECTION 1: NEUROLOGICAL & INCREASED ICP
QUESTION 1
A 3-year-old is admitted with bacterial meningitis and hydrocephalus. Which finding indicates
increased ICP?
ANSWER
B. Sluggish and unequal pupillary responses
RATIONALE / EXPLANATION
Sluggish/unequal pupils indicate brainstem compression from increased ICP. Bulging fontanels
occur in infants (fontanels close by 18 months). Tachycardia/tachypnea are late signs.
QUESTION 2
A client with bacterial meningitis is receiving phenytoin. Which finding indicates therapeutic
response?
ANSWER
B. Normal electroencephalogram after drug administration
RATIONALE / EXPLANATION
Phenytoin is an anticonvulsant. A normal EEG indicates seizure activity is controlled, which is the
therapeutic goal.
QUESTION 3
A client fell at home with sudden onset confusion. Using SBAR, what should the nurse report
FIRST?
ANSWER
C. Increasing confusion of the client
Page 1 of 37
,RATIONALE / EXPLANATION
In SBAR, Situation comes first - the immediate problem (confusion) is the priority before
background information like medications or fall history.
QUESTION 4
In an ICP patient, what does one pupil bigger than the other indicate?
ANSWER
The brain is being compressed on THAT SIDE (ipsilateral to the dilated pupil)
RATIONALE / EXPLANATION
Unilateral pupil dilation indicates herniation - a neurosurgical emergency requiring immediate
intervention.
QUESTION 5
A client after a fall requests something for severe headache. Why offer acetaminophen
instead of narcotics?
ANSWER
B. Explain the reason for using only non-narcotics
RATIONALE / EXPLANATION
Narcotics mask neurological signs and cause pupil changes. Until head injury is ruled out by CT,
avoid narcotics to allow accurate neuro assessment.
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, SECTION 2: RESPIRATORY & OXYGEN THERAPY
QUESTION 6
A teenager is anxious, fearful, and hyperventilating after vaping. Which acid-base imbalance
is expected?
ANSWER
D. Respiratory alkalosis
RATIONALE / EXPLANATION
Hyperventilation blows off CO2, causing respiratory alkalosis. Signs include anxiety, numbness,
tingling, and palpitations.
QUESTION 7
A client with dyspnea is being admitted. What bed position should the nurse prepare?
ANSWER
Fowler's position
RATIONALE / EXPLANATION
Fowler's (head elevated 45-90°) promotes lung expansion and reduces dyspnea. Never place a
dyspneic client supine.
QUESTION 8
Which intervention requires GREATEST caution in a COPD client with chest pain?
ANSWER
C. Administering narcotics for pain relief
RATIONALE / EXPLANATION
Narcotics are respiratory depressants. COPD patients already have compromised respiratory
function - narcotics can cause respiratory failure.
QUESTION 9
Page 3 of 37
, Prolonged high-concentration oxygen can cause which pathophysiological effect?
ANSWER
A. Disrupted surfactant production
RATIONALE / EXPLANATION
High O2 concentrations cause oxygen toxicity, damaging alveolar cells that produce surfactant.
This leads to atelectasis and ARDS.
QUESTION 10
A preterm newborn has nasal flaring, grunting, and sternal retractions. After giving
surfactant, what is MOST important to monitor?
ANSWER
A. Arterial blood gases
RATIONALE / EXPLANATION
ABGs provide the most accurate assessment of oxygenation and ventilation status - more
accurate than pulse ox alone.
QUESTION 11
A child with tetanus - which intervention should the nurse include?
ANSWER
B. Minimize the amount of stimuli in the room
RATIONALE / EXPLANATION
Tetanus causes muscle spasms triggered by stimulation. Keep the environment dark, quiet, and
minimize handling to prevent spasms.
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NGN VERSION B 2025-2026
COMPREHENSIVE STUDY GUIDE
SECTION 1: NEUROLOGICAL & INCREASED ICP
QUESTION 1
A 3-year-old is admitted with bacterial meningitis and hydrocephalus. Which finding indicates
increased ICP?
ANSWER
B. Sluggish and unequal pupillary responses
RATIONALE / EXPLANATION
Sluggish/unequal pupils indicate brainstem compression from increased ICP. Bulging fontanels
occur in infants (fontanels close by 18 months). Tachycardia/tachypnea are late signs.
QUESTION 2
A client with bacterial meningitis is receiving phenytoin. Which finding indicates therapeutic
response?
ANSWER
B. Normal electroencephalogram after drug administration
RATIONALE / EXPLANATION
Phenytoin is an anticonvulsant. A normal EEG indicates seizure activity is controlled, which is the
therapeutic goal.
QUESTION 3
A client fell at home with sudden onset confusion. Using SBAR, what should the nurse report
FIRST?
ANSWER
C. Increasing confusion of the client
Page 1 of 37
,RATIONALE / EXPLANATION
In SBAR, Situation comes first - the immediate problem (confusion) is the priority before
background information like medications or fall history.
QUESTION 4
In an ICP patient, what does one pupil bigger than the other indicate?
ANSWER
The brain is being compressed on THAT SIDE (ipsilateral to the dilated pupil)
RATIONALE / EXPLANATION
Unilateral pupil dilation indicates herniation - a neurosurgical emergency requiring immediate
intervention.
QUESTION 5
A client after a fall requests something for severe headache. Why offer acetaminophen
instead of narcotics?
ANSWER
B. Explain the reason for using only non-narcotics
RATIONALE / EXPLANATION
Narcotics mask neurological signs and cause pupil changes. Until head injury is ruled out by CT,
avoid narcotics to allow accurate neuro assessment.
Page 2 of 37
, SECTION 2: RESPIRATORY & OXYGEN THERAPY
QUESTION 6
A teenager is anxious, fearful, and hyperventilating after vaping. Which acid-base imbalance
is expected?
ANSWER
D. Respiratory alkalosis
RATIONALE / EXPLANATION
Hyperventilation blows off CO2, causing respiratory alkalosis. Signs include anxiety, numbness,
tingling, and palpitations.
QUESTION 7
A client with dyspnea is being admitted. What bed position should the nurse prepare?
ANSWER
Fowler's position
RATIONALE / EXPLANATION
Fowler's (head elevated 45-90°) promotes lung expansion and reduces dyspnea. Never place a
dyspneic client supine.
QUESTION 8
Which intervention requires GREATEST caution in a COPD client with chest pain?
ANSWER
C. Administering narcotics for pain relief
RATIONALE / EXPLANATION
Narcotics are respiratory depressants. COPD patients already have compromised respiratory
function - narcotics can cause respiratory failure.
QUESTION 9
Page 3 of 37
, Prolonged high-concentration oxygen can cause which pathophysiological effect?
ANSWER
A. Disrupted surfactant production
RATIONALE / EXPLANATION
High O2 concentrations cause oxygen toxicity, damaging alveolar cells that produce surfactant.
This leads to atelectasis and ARDS.
QUESTION 10
A preterm newborn has nasal flaring, grunting, and sternal retractions. After giving
surfactant, what is MOST important to monitor?
ANSWER
A. Arterial blood gases
RATIONALE / EXPLANATION
ABGs provide the most accurate assessment of oxygenation and ventilation status - more
accurate than pulse ox alone.
QUESTION 11
A child with tetanus - which intervention should the nurse include?
ANSWER
B. Minimize the amount of stimuli in the room
RATIONALE / EXPLANATION
Tetanus causes muscle spasms triggered by stimulation. Keep the environment dark, quiet, and
minimize handling to prevent spasms.
Page 4 of 37
