2026 HESI RN Exit Exam
NGN Nursing Questions | 2026 HESI Nursing Exit Exam Questions & Correct
Answers Plus Rationales (Latest PDF Update)
Question 1
A nurse is assessing a client 2 hours after a total hip arthroplasty. The client reports sudden shortness
of breath and chest pain. Vital signs: HR 122, RR 28, BP 100/70, SpO₂ 88% on 2L nasal cannula. What is
the nurse’s priority action?
A) Recheck the SpO₂ in 15 minutes
B) Administer PRN morphine for pain
C) Apply oxygen at 4L via non-rebreather and notify the provider
D) Encourage deep breathing and coughing
Answer: C
Rationale: Sudden dyspnea, tachycardia, hypoxemia post-arthroplasty suggest pulmonary embolism.
High-flow oxygen and immediate provider notification are priority.
Question 2 (Select all that apply)
A client with chronic kidney disease (CKD) has a potassium level of 6.9 mEq/L. Which ECG changes
does the nurse expect to observe? (Select all that apply)
A) Peaked T waves
B) Widened QRS complex
C) Prolonged PR interval
D) Appearance of U waves
1 SUCCESS!!!
, E) ST segment elevation
Answer: A, B, C
Rationale: Hyperkalemia causes peaked T waves, widened QRS, and prolonged PR interval. U waves
are seen in hypokalemia, and ST elevation is not typical.
Question 3 (Bowtie – fill in the blanks)
A 68-year-old client is admitted with confusion, flank pain, and fever. Urinalysis shows leukocyte
esterase and nitrites positive.
Condition: ____________________
Two priority actions: ____________________ and ____________________
One complication to monitor: ____________________
Answer: Condition: Pyelonephritis; Priority actions: Obtain urine culture and Initiate IV antibiotics;
Complication: Sepsis
Rationale: Pyelonephritis requires prompt antibiotics and cultures; sepsis is a major risk in older
adults.
Question 4
A client with type 1 diabetes mellitus is found unresponsive. Blood glucose meter reads “LO” (below
20 mg/dL). IV access is present. Which action should the nurse take first?
A) Administer 1 mg glucagon IM
B) Give 50 mL of 50% dextrose IV push
2 SUCCESS!!!
, C) Start an insulin drip at 0.1 units/kg/hour
D) Recheck blood glucose with a different meter
Answer: B
Rationale: Severe hypoglycemia with IV access requires immediate IV dextrose for rapid correction;
glucagon is for no IV access.
Question 5 (NGN Case Study – partial)
A client is admitted with acute exacerbation of heart failure. Vital signs: BP 150/90, HR 110, RR 24,
SpO₂ 89% on room air. Lung sounds: crackles bilaterally in all lobes. Weight increased 3 kg in 48 hours.
Part A: Which medication does the nurse prepare to administer first?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Spironolactone
Answer: B
Rationale: Furosemide rapidly reduces preload, relieving pulmonary congestion and improving
oxygenation.
Part B: Which two assessment findings indicate therapeutic response? (Select two)
A) Decreased crackles
B) Increased urine output
C) Weight gain of 1 kg
D) Heart rate increases to 120
3 SUCCESS!!!
, E) SpO₂ rises to 94%
Answer: A, B, E
Rationale: Diuresis should decrease crackles, increase urine output, and improve oxygenation; weight
loss (not gain) is expected.
Question 6
A client receiving a blood transfusion of packed red blood cells complains of chills, low back pain, and
feels “hot.” Vital signs: BP 90/50, HR 120. What should the nurse do first?
A) Slow the transfusion rate
B) Stop the transfusion
C) Administer acetaminophen
D) Flush the IV line with normal saline
Answer: B
Rationale: Low back pain and hypotension suggest acute hemolytic reaction; stop transfusion
immediately, then maintain line with new saline tubing.
Question 7
A nurse is caring for a client with a chest tube to water seal drainage. There is continuous bubbling in
the water seal chamber. What does this indicate?
A) Normal functioning
B) Air leak in the system
C) Tension pneumothorax
D) Tube is clamped
Answer: B
4 SUCCESS!!!
NGN Nursing Questions | 2026 HESI Nursing Exit Exam Questions & Correct
Answers Plus Rationales (Latest PDF Update)
Question 1
A nurse is assessing a client 2 hours after a total hip arthroplasty. The client reports sudden shortness
of breath and chest pain. Vital signs: HR 122, RR 28, BP 100/70, SpO₂ 88% on 2L nasal cannula. What is
the nurse’s priority action?
A) Recheck the SpO₂ in 15 minutes
B) Administer PRN morphine for pain
C) Apply oxygen at 4L via non-rebreather and notify the provider
D) Encourage deep breathing and coughing
Answer: C
Rationale: Sudden dyspnea, tachycardia, hypoxemia post-arthroplasty suggest pulmonary embolism.
High-flow oxygen and immediate provider notification are priority.
Question 2 (Select all that apply)
A client with chronic kidney disease (CKD) has a potassium level of 6.9 mEq/L. Which ECG changes
does the nurse expect to observe? (Select all that apply)
A) Peaked T waves
B) Widened QRS complex
C) Prolonged PR interval
D) Appearance of U waves
1 SUCCESS!!!
, E) ST segment elevation
Answer: A, B, C
Rationale: Hyperkalemia causes peaked T waves, widened QRS, and prolonged PR interval. U waves
are seen in hypokalemia, and ST elevation is not typical.
Question 3 (Bowtie – fill in the blanks)
A 68-year-old client is admitted with confusion, flank pain, and fever. Urinalysis shows leukocyte
esterase and nitrites positive.
Condition: ____________________
Two priority actions: ____________________ and ____________________
One complication to monitor: ____________________
Answer: Condition: Pyelonephritis; Priority actions: Obtain urine culture and Initiate IV antibiotics;
Complication: Sepsis
Rationale: Pyelonephritis requires prompt antibiotics and cultures; sepsis is a major risk in older
adults.
Question 4
A client with type 1 diabetes mellitus is found unresponsive. Blood glucose meter reads “LO” (below
20 mg/dL). IV access is present. Which action should the nurse take first?
A) Administer 1 mg glucagon IM
B) Give 50 mL of 50% dextrose IV push
2 SUCCESS!!!
, C) Start an insulin drip at 0.1 units/kg/hour
D) Recheck blood glucose with a different meter
Answer: B
Rationale: Severe hypoglycemia with IV access requires immediate IV dextrose for rapid correction;
glucagon is for no IV access.
Question 5 (NGN Case Study – partial)
A client is admitted with acute exacerbation of heart failure. Vital signs: BP 150/90, HR 110, RR 24,
SpO₂ 89% on room air. Lung sounds: crackles bilaterally in all lobes. Weight increased 3 kg in 48 hours.
Part A: Which medication does the nurse prepare to administer first?
A) Metoprolol
B) Furosemide
C) Digoxin
D) Spironolactone
Answer: B
Rationale: Furosemide rapidly reduces preload, relieving pulmonary congestion and improving
oxygenation.
Part B: Which two assessment findings indicate therapeutic response? (Select two)
A) Decreased crackles
B) Increased urine output
C) Weight gain of 1 kg
D) Heart rate increases to 120
3 SUCCESS!!!
, E) SpO₂ rises to 94%
Answer: A, B, E
Rationale: Diuresis should decrease crackles, increase urine output, and improve oxygenation; weight
loss (not gain) is expected.
Question 6
A client receiving a blood transfusion of packed red blood cells complains of chills, low back pain, and
feels “hot.” Vital signs: BP 90/50, HR 120. What should the nurse do first?
A) Slow the transfusion rate
B) Stop the transfusion
C) Administer acetaminophen
D) Flush the IV line with normal saline
Answer: B
Rationale: Low back pain and hypotension suggest acute hemolytic reaction; stop transfusion
immediately, then maintain line with new saline tubing.
Question 7
A nurse is caring for a client with a chest tube to water seal drainage. There is continuous bubbling in
the water seal chamber. What does this indicate?
A) Normal functioning
B) Air leak in the system
C) Tension pneumothorax
D) Tube is clamped
Answer: B
4 SUCCESS!!!
