HESI RN Exit Exam | NGN Nursing Questions | 2026 HESI
Nursing Exit Exam Questions Latest PDF Update |
Comprehensive Practice Bank
This guide provides an extensive collection of Next Generation NCLEX (NGN)-style questions for the
2026 HESI RN Exit Exam, organized by clinical domain with detailed rationales. Questions are formatted
to reflect current exam blueprints including SATA (Select All That Apply), case scenarios, matrix/grid,
drag-and-drop, and prioritization items .
QUICK REFERENCE: KEY UPDATES FOR 2026 HESI EXIT EXAM
Feature 2026 Update
NGN Integration Clinical judgment cases required; traditional multiple-choice reduced
Item Types Matrix/grid, drag-and-drop, dropdown, highlighting, SATA, bowtie, enhanced hotspots
Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, Evaluate
Clinical Judgment
Outcomes
Content
Pharmacology (+15%), Delegation/Prioritization (+20%), NGN Cases (+30%)
Emphasis
Scoring Partial credit for SATA (no all-or-nothing)
Exam Versions V1, V2, V3, V4, V5, V6, V7, plus CAT adaptive format
DOMAIN 1: MEDICAL-SURGICAL NURSING (25 Questions)
Question 1
A nurse is assessing a client with heart failure who reports sudden onset of dyspnea and coughing up
pink, frothy sputum. Which action should the nurse take first?
A. Place the client in high-Fowler's position
B. Administer furosemide IV push
,C. Apply a non-rebreather mask at 100% oxygen
D. Check the client's oxygen saturation
Answer: A. Place the client in high-Fowler's position
Rationale: High-Fowler's position decreases venous return (preload) and reduces pulmonary congestion,
making it the priority intervention for pulmonary edema. Oxygen administration is also critical, but
positioning comes first in immediate management. Furosemide and checking SpO2 are important but
not the initial action .
Question 2
A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which statement
by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables."
B. "I will use a soft toothbrush to brush my teeth."
C. "I will take ibuprofen if I get a headache."
D. "I will have my blood checked regularly as ordered."
Answer: C. "I will take ibuprofen if I get a headache."
Rationale: Ibuprofen (NSAID) increases bleeding risk when combined with warfarin. Clients should use
acetaminophen instead for pain or headache. The other statements demonstrate correct
understanding .
Question 3
A nurse on a medical-surgical unit is caring for four clients. Which client should the nurse assess first?
A. A client with diabetes mellitus and a blood glucose of 60 mg/dL who is awake and alert
B. A client with pneumonia who has an oxygen saturation of 89% on room air
C. A client with a hip fracture who reports pain of 8 on a 0-10 scale
D. A client with chronic kidney disease who has a potassium level of 5.1 mEq/L
Answer: B. Client with pneumonia and SpO2 of 89%
Rationale: Hypoxia (SpO2 <90%) is life-threatening and requires immediate intervention. The nurse
should provide oxygen and notify the provider. A blood glucose of 60 mg/dL can be treated with oral
carbohydrates in an awake, alert client; pain is important but not priority over oxygenation; potassium
5.1 mEq/L is borderline but not critical .
Question 4
A client with acute pancreatitis is admitted with severe, piercing abdominal pain and an elevated serum
amylase. Which additional information is the client most likely to report?
,A. Abdominal pain decreases when lying supine
B. Pain lasts an hour and leaves the abdomen tender
C. Right upper quadrant pain refers to right scapula
D. Drinks alcohol until intoxicated at least twice weekly
Answer: D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Alcohol use is a leading cause of acute pancreatitis. The pain of pancreatitis is typically
epigastric, may radiate to the back, and is often worse when lying supine (not relieved) .
Question 5
The nurse is caring for a client with pneumonia who now develops initial signs of septic shock and multi-
organ failure. The healthcare provider prescribes a sepsis protocol. Which intervention is most
important for the nurse to include in the plan of care?
A. Maintain strict intake and output
B. Keep head of bed raised 45°
C. Monitor for warmth of extremities
D. Monitor blood glucose level
Answer: A. Maintain strict intake and output
Rationale: In septic shock, maintaining adequate fluid volume and monitoring renal perfusion is critical.
Accurate intake and output monitoring guides fluid resuscitation and helps detect acute kidney injury .
Question 6
A client who is scheduled for a bronchoscopy in the morning is anxious and asking the nurse numerous
questions about the procedure. In preparing the client for the procedure, which intervention has
the highest priority?
A. Allow client to gargle with warm salt water
B. Administer a sedative to alleviate anxiety
C. Instruct client to write down the questions
D. Deny client's request for a midnight snack
Answer: D. Deny client's request for a midnight snack
Rationale: NPO status (nothing by mouth) is essential before bronchoscopy to prevent aspiration. This is
the highest priority safety intervention, regardless of client anxiety .
Question 7
, The healthcare provider prescribes dalteparin 200 units per kilogram subcutaneously once daily for a
client who weighs 154 pounds. The medication is available as 25,000 units per milliliter. How many
milliliters should the nurse administer? (Round to the nearest 10th.)
Answer: 0.6 mL
Rationale: Convert pounds to kg: 154 lbs ÷ 2.2 = 70 kg. Calculate dose: 200 units/kg × 70 kg = 14,000
units. Calculate mL: (14,000 units ÷ 25,000 units/mL) = 0.56 mL → rounded to 0.6 mL .
Question 8
A client with foul-smelling drainage from an incision on the upper left arm is admitted with suspected
MRSA. Which nursing interventions should the nurse include in the plan of care? (SATA)
A. Institute contact precautions for staff and visitors
B. Use standard precautions and wear a mask
C. Send wound drainage for culture and sensitivity
D. Monitor the client's white blood cell count
E. Explain the purpose of a low bacteria diet
Answer: A, C, D
Rationale: Contact precautions are required for MRSA. Wound drainage should be cultured to confirm
MRSA. Monitoring WBC count helps track infection response. Mask is not required for MRSA (contact
precautions only). Low bacteria diet is not indicated .
Question 9
A client with heart failure becomes short of breath, anxious, and has audible crackles with pink frothy
sputum. The nurse sits the client upright and provides oxygen per nasal cannula. The nurse receives a
prescription to administer a one-time dose of morphine sulfate IV. Which action should the nurse take?
A. Administer the dose of morphine sulfate as prescribed
B. Consult with the charge nurse regarding the morphine prescription
C. Review the need for the prescription with the healthcare provider
D. Withhold the morphine until the client's dyspnea resolves
Answer: A. Administer the dose of morphine sulfate as prescribed
Rationale: Morphine sulfate is indicated in acute pulmonary edema to reduce preload, decrease anxiety,
and reduce the work of breathing. This is an appropriate prescription for this clinical presentation .
Question 10
A nurse is reviewing laboratory results for a client taking spironolactone. Which finding would the nurse
report to the provider immediately?
Nursing Exit Exam Questions Latest PDF Update |
Comprehensive Practice Bank
This guide provides an extensive collection of Next Generation NCLEX (NGN)-style questions for the
2026 HESI RN Exit Exam, organized by clinical domain with detailed rationales. Questions are formatted
to reflect current exam blueprints including SATA (Select All That Apply), case scenarios, matrix/grid,
drag-and-drop, and prioritization items .
QUICK REFERENCE: KEY UPDATES FOR 2026 HESI EXIT EXAM
Feature 2026 Update
NGN Integration Clinical judgment cases required; traditional multiple-choice reduced
Item Types Matrix/grid, drag-and-drop, dropdown, highlighting, SATA, bowtie, enhanced hotspots
Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Actions, Evaluate
Clinical Judgment
Outcomes
Content
Pharmacology (+15%), Delegation/Prioritization (+20%), NGN Cases (+30%)
Emphasis
Scoring Partial credit for SATA (no all-or-nothing)
Exam Versions V1, V2, V3, V4, V5, V6, V7, plus CAT adaptive format
DOMAIN 1: MEDICAL-SURGICAL NURSING (25 Questions)
Question 1
A nurse is assessing a client with heart failure who reports sudden onset of dyspnea and coughing up
pink, frothy sputum. Which action should the nurse take first?
A. Place the client in high-Fowler's position
B. Administer furosemide IV push
,C. Apply a non-rebreather mask at 100% oxygen
D. Check the client's oxygen saturation
Answer: A. Place the client in high-Fowler's position
Rationale: High-Fowler's position decreases venous return (preload) and reduces pulmonary congestion,
making it the priority intervention for pulmonary edema. Oxygen administration is also critical, but
positioning comes first in immediate management. Furosemide and checking SpO2 are important but
not the initial action .
Question 2
A nurse is providing discharge teaching to a client with a new prescription for warfarin. Which statement
by the client indicates a need for further teaching?
A. "I will avoid eating large amounts of leafy green vegetables."
B. "I will use a soft toothbrush to brush my teeth."
C. "I will take ibuprofen if I get a headache."
D. "I will have my blood checked regularly as ordered."
Answer: C. "I will take ibuprofen if I get a headache."
Rationale: Ibuprofen (NSAID) increases bleeding risk when combined with warfarin. Clients should use
acetaminophen instead for pain or headache. The other statements demonstrate correct
understanding .
Question 3
A nurse on a medical-surgical unit is caring for four clients. Which client should the nurse assess first?
A. A client with diabetes mellitus and a blood glucose of 60 mg/dL who is awake and alert
B. A client with pneumonia who has an oxygen saturation of 89% on room air
C. A client with a hip fracture who reports pain of 8 on a 0-10 scale
D. A client with chronic kidney disease who has a potassium level of 5.1 mEq/L
Answer: B. Client with pneumonia and SpO2 of 89%
Rationale: Hypoxia (SpO2 <90%) is life-threatening and requires immediate intervention. The nurse
should provide oxygen and notify the provider. A blood glucose of 60 mg/dL can be treated with oral
carbohydrates in an awake, alert client; pain is important but not priority over oxygenation; potassium
5.1 mEq/L is borderline but not critical .
Question 4
A client with acute pancreatitis is admitted with severe, piercing abdominal pain and an elevated serum
amylase. Which additional information is the client most likely to report?
,A. Abdominal pain decreases when lying supine
B. Pain lasts an hour and leaves the abdomen tender
C. Right upper quadrant pain refers to right scapula
D. Drinks alcohol until intoxicated at least twice weekly
Answer: D. Drinks alcohol until intoxicated at least twice weekly
Rationale: Alcohol use is a leading cause of acute pancreatitis. The pain of pancreatitis is typically
epigastric, may radiate to the back, and is often worse when lying supine (not relieved) .
Question 5
The nurse is caring for a client with pneumonia who now develops initial signs of septic shock and multi-
organ failure. The healthcare provider prescribes a sepsis protocol. Which intervention is most
important for the nurse to include in the plan of care?
A. Maintain strict intake and output
B. Keep head of bed raised 45°
C. Monitor for warmth of extremities
D. Monitor blood glucose level
Answer: A. Maintain strict intake and output
Rationale: In septic shock, maintaining adequate fluid volume and monitoring renal perfusion is critical.
Accurate intake and output monitoring guides fluid resuscitation and helps detect acute kidney injury .
Question 6
A client who is scheduled for a bronchoscopy in the morning is anxious and asking the nurse numerous
questions about the procedure. In preparing the client for the procedure, which intervention has
the highest priority?
A. Allow client to gargle with warm salt water
B. Administer a sedative to alleviate anxiety
C. Instruct client to write down the questions
D. Deny client's request for a midnight snack
Answer: D. Deny client's request for a midnight snack
Rationale: NPO status (nothing by mouth) is essential before bronchoscopy to prevent aspiration. This is
the highest priority safety intervention, regardless of client anxiety .
Question 7
, The healthcare provider prescribes dalteparin 200 units per kilogram subcutaneously once daily for a
client who weighs 154 pounds. The medication is available as 25,000 units per milliliter. How many
milliliters should the nurse administer? (Round to the nearest 10th.)
Answer: 0.6 mL
Rationale: Convert pounds to kg: 154 lbs ÷ 2.2 = 70 kg. Calculate dose: 200 units/kg × 70 kg = 14,000
units. Calculate mL: (14,000 units ÷ 25,000 units/mL) = 0.56 mL → rounded to 0.6 mL .
Question 8
A client with foul-smelling drainage from an incision on the upper left arm is admitted with suspected
MRSA. Which nursing interventions should the nurse include in the plan of care? (SATA)
A. Institute contact precautions for staff and visitors
B. Use standard precautions and wear a mask
C. Send wound drainage for culture and sensitivity
D. Monitor the client's white blood cell count
E. Explain the purpose of a low bacteria diet
Answer: A, C, D
Rationale: Contact precautions are required for MRSA. Wound drainage should be cultured to confirm
MRSA. Monitoring WBC count helps track infection response. Mask is not required for MRSA (contact
precautions only). Low bacteria diet is not indicated .
Question 9
A client with heart failure becomes short of breath, anxious, and has audible crackles with pink frothy
sputum. The nurse sits the client upright and provides oxygen per nasal cannula. The nurse receives a
prescription to administer a one-time dose of morphine sulfate IV. Which action should the nurse take?
A. Administer the dose of morphine sulfate as prescribed
B. Consult with the charge nurse regarding the morphine prescription
C. Review the need for the prescription with the healthcare provider
D. Withhold the morphine until the client's dyspnea resolves
Answer: A. Administer the dose of morphine sulfate as prescribed
Rationale: Morphine sulfate is indicated in acute pulmonary edema to reduce preload, decrease anxiety,
and reduce the work of breathing. This is an appropriate prescription for this clinical presentation .
Question 10
A nurse is reviewing laboratory results for a client taking spironolactone. Which finding would the nurse
report to the provider immediately?
