RN HESI Exit Exam 2026 Advanced Prep:
Master Clinical Judgment & NGN Practice
Questions
Subject: Comprehensive Critical Care, Pharmacology, and
Physiological Adaptation
Question 1: A client is admitted with septic shock. The healthcare provider orders a fluid bolus
of 500 mL of 0.9% Normal Saline over 30 minutes, followed by the initiation of norepinephrine.
Which assessment finding is the most reliable indicator that the client is responding
appropriately to the fluid resuscitation?
A) Mean Arterial Pressure (MAP) increase from 55 mmHg to 68 mmHg.
B) Urine output increase from 5 mL/hour to 25 mL/hour.
C) Reduction in serum lactate levels from 4.2 mmol/L to 3.8 mmol/L.
D) Decrease in heart rate from 115 bpm to 105 bpm.
Correct Answer: A) Mean Arterial Pressure (MAP) increase from 55 mmHg to 68 mmHg.
Explanation: In the management of septic shock, hemodynamic stabilization is the primary goal
of fluid resuscitation. A MAP of at least 65 mmHg is the standard threshold for ensuring
adequate end-organ perfusion. While urine output and lactate levels are important, they are
lagging indicators. An immediate, sustained improvement in MAP directly reflects the efficacy of
the fluid volume in increasing stroke volume and systemic vascular resistance in the early
resuscitation phase.
Question 2: A nurse is caring for a client who is 48 hours post-craniotomy for a supratentorial
tumor. The client suddenly develops polyuria (800 mL in the last hour), serum sodium of 152
mEq/L, and a serum osmolality of 310 mOsm/kg. Which intervention is the priority for the nurse
to implement?
A) Increase the rate of intravenous 0.45% Normal Saline.
B) Administer a dose of IV furosemide as prescribed.
C) Obtain an order for Desmopressin (DDAVP) acetate.
D) Restrict oral fluid intake to prevent fluid overload.
Correct Answer: C) Obtain an order for Desmopressin (DDAVP) acetate.
,Explanation: The client is exhibiting classic signs of Diabetes Insipidus (DI), a common
complication following pituitary or hypothalamic trauma. The high serum sodium and high
serum osmolality, combined with massive polyuria and low urine specific gravity (implied),
indicate a deficiency in Antidiuretic Hormone (ADH). Desmopressin is a synthetic analog of
ADH and is the definitive treatment to restore water balance.
Question 3: A client with severe acute pancreatitis is receiving total parenteral nutrition (TPN)
through a central venous catheter. The nurse notes the TPN solution is empty, and the new bag
has not yet arrived from the pharmacy. What is the most appropriate action by the nurse?
A) Infuse 0.9% Normal Saline at the same rate until the TPN arrives.
B) Hang a bag of Dextrose 5% in Water (D5W) to maintain patency.
C) Infuse Dextrose 10% in Water (D10W) at the same rate as the TPN.
D) Notify the healthcare provider and flush the line with heparin.
Correct Answer: C) Infuse Dextrose 10% in Water (D10W) at the same rate as the TPN.
Explanation: Abrupt cessation of TPN can lead to severe rebound hypoglycemia because the
pancreas has been conditioned to secrete high levels of insulin to compensate for the high
glucose content of the TPN. To prevent this, the nurse must substitute the TPN with a solution of
similar glucose concentration (usually D10W or D20W depending on facility protocol) to
maintain a stable blood glucose level until the next bag is prepared.
Question 4: A 65-year-old client with chronic heart failure presents with an acute exacerbation.
The current medication list includes lisinopril, carvedilol, and furosemide. The client’s
laboratory results show a Potassium level of 5.8 mEq/L. Which medication is the most likely
contributor to this finding?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Digoxin
Correct Answer: A) Lisinopril
Explanation: Lisinopril is an ACE inhibitor, which works by inhibiting the conversion of
Angiotensin I to Angiotensin II. This process also decreases aldosterone secretion, which
promotes potassium retention in the kidneys. In the presence of impaired renal function or other
contributing factors, this can lead to life-threatening hyperkalemia. Furosemide is a loop
,diuretic that typically causes potassium excretion, while carvedilol and digoxin have minimal
effects on potassium levels.
Question 5: A nurse is assessing a client with suspected Myasthenia Gravis who is undergoing an
edrophonium (Tensilon) test. During the test, the client suddenly experiences bradycardia,
sweating, and cramping. What is the nurse's priority action?
A) Administer a dose of epinephrine immediately.
B) Administer atropine sulfate.
C) Stop the infusion and notify the healthcare provider.
D) Monitor the client for respiratory distress.
Correct Answer: B) Administer atropine sulfate.
Explanation: The client is experiencing a cholinergic crisis triggered by the edrophonium, which
is a rapid-acting acetylcholinesterase inhibitor. Atropine is the specific antidote for the
muscarinic side effects (bradycardia, secretions, cramps) of cholinergic drugs. While assessing
for respiratory status is important, the immediate pharmacological reversal of the
overstimulation is the priority action.
Question 6: A client with a spinal cord injury at the T4 level suddenly complains of a throbbing
headache and blurred vision. The blood pressure is 210/110 mmHg. What is the first action the
nurse should take?
A) Administer an antihypertensive medication.
B) Elevate the head of the bed to 90 degrees.
C) Check for bladder distention.
D) Notify the healthcare provider.
Correct Answer: B) Elevate the head of the bed to 90 degrees.
Explanation: The client is exhibiting symptoms of autonomic dysreflexia, a life-threatening
medical emergency. Placing the client in a high-Fowler's position (or elevating the head of the
bed) is the immediate first step to facilitate venous pooling and reduce blood pressure. Once the
head is elevated, the nurse would then immediately assess and eliminate the stimulus (e.g.,
kinked catheter).
Question 7: A nurse is caring for a client with Hemophilia A who is scheduled for a minor
surgical procedure. The nurse reviews the lab results and notes the factor VIII activity level is
15%. What is the nurse's interpretation?
, A) The client has severe hemophilia and is at high risk for spontaneous bleeding.
B) The client has moderate hemophilia and requires prophylactic factor VIII replacement.
C) The client has mild hemophilia and may require factor VIII for surgery.
D) The client’s coagulation profile is within normal limits.
Correct Answer: C) The client has mild hemophilia and may require factor VIII for surgery.
Explanation: Factor VIII activity levels define the severity of Hemophilia A: Severe is <1%,
Moderate is 1–5%, and Mild is 5–40%. A level of 15% indicates mild disease. While
spontaneous bleeding is less common, bleeding is highly likely with trauma or surgical
intervention, necessitating pre-procedural replacement therapy.
Question 8: A client with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation. The low-pressure alarm on the ventilator begins to sound. What is the nurse’s first
action?
A) Suction the client's airway.
B) Check the ventilator tubing for disconnections.
C) Increase the FIO2 on the ventilator.
D) Manually ventilate the client with an ambu-bag.
Correct Answer: B) Check the ventilator tubing for disconnections.
Explanation: A low-pressure alarm indicates a loss of resistance in the circuit, most commonly
caused by a disconnected tube or an inadequately inflated endotracheal tube cuff. The nurse
must first ensure the circuit is intact. If no disconnection is found, then further investigation for a
leak or assessing the client is required. Manually ventilating is the backup if the equipment fails
or the client becomes unstable.
Question 9: A client is receiving an infusion of Vancomycin. The nurse notices the client's face,
neck, and upper chest have developed a bright red, maculopapular rash. Which nursing
intervention is most appropriate?
A) Stop the infusion immediately and notify the healthcare provider.
B) Slow the rate of the infusion.
C) Administer diphenhydramine as ordered.
D) Continue the infusion but monitor for airway compromise.
Master Clinical Judgment & NGN Practice
Questions
Subject: Comprehensive Critical Care, Pharmacology, and
Physiological Adaptation
Question 1: A client is admitted with septic shock. The healthcare provider orders a fluid bolus
of 500 mL of 0.9% Normal Saline over 30 minutes, followed by the initiation of norepinephrine.
Which assessment finding is the most reliable indicator that the client is responding
appropriately to the fluid resuscitation?
A) Mean Arterial Pressure (MAP) increase from 55 mmHg to 68 mmHg.
B) Urine output increase from 5 mL/hour to 25 mL/hour.
C) Reduction in serum lactate levels from 4.2 mmol/L to 3.8 mmol/L.
D) Decrease in heart rate from 115 bpm to 105 bpm.
Correct Answer: A) Mean Arterial Pressure (MAP) increase from 55 mmHg to 68 mmHg.
Explanation: In the management of septic shock, hemodynamic stabilization is the primary goal
of fluid resuscitation. A MAP of at least 65 mmHg is the standard threshold for ensuring
adequate end-organ perfusion. While urine output and lactate levels are important, they are
lagging indicators. An immediate, sustained improvement in MAP directly reflects the efficacy of
the fluid volume in increasing stroke volume and systemic vascular resistance in the early
resuscitation phase.
Question 2: A nurse is caring for a client who is 48 hours post-craniotomy for a supratentorial
tumor. The client suddenly develops polyuria (800 mL in the last hour), serum sodium of 152
mEq/L, and a serum osmolality of 310 mOsm/kg. Which intervention is the priority for the nurse
to implement?
A) Increase the rate of intravenous 0.45% Normal Saline.
B) Administer a dose of IV furosemide as prescribed.
C) Obtain an order for Desmopressin (DDAVP) acetate.
D) Restrict oral fluid intake to prevent fluid overload.
Correct Answer: C) Obtain an order for Desmopressin (DDAVP) acetate.
,Explanation: The client is exhibiting classic signs of Diabetes Insipidus (DI), a common
complication following pituitary or hypothalamic trauma. The high serum sodium and high
serum osmolality, combined with massive polyuria and low urine specific gravity (implied),
indicate a deficiency in Antidiuretic Hormone (ADH). Desmopressin is a synthetic analog of
ADH and is the definitive treatment to restore water balance.
Question 3: A client with severe acute pancreatitis is receiving total parenteral nutrition (TPN)
through a central venous catheter. The nurse notes the TPN solution is empty, and the new bag
has not yet arrived from the pharmacy. What is the most appropriate action by the nurse?
A) Infuse 0.9% Normal Saline at the same rate until the TPN arrives.
B) Hang a bag of Dextrose 5% in Water (D5W) to maintain patency.
C) Infuse Dextrose 10% in Water (D10W) at the same rate as the TPN.
D) Notify the healthcare provider and flush the line with heparin.
Correct Answer: C) Infuse Dextrose 10% in Water (D10W) at the same rate as the TPN.
Explanation: Abrupt cessation of TPN can lead to severe rebound hypoglycemia because the
pancreas has been conditioned to secrete high levels of insulin to compensate for the high
glucose content of the TPN. To prevent this, the nurse must substitute the TPN with a solution of
similar glucose concentration (usually D10W or D20W depending on facility protocol) to
maintain a stable blood glucose level until the next bag is prepared.
Question 4: A 65-year-old client with chronic heart failure presents with an acute exacerbation.
The current medication list includes lisinopril, carvedilol, and furosemide. The client’s
laboratory results show a Potassium level of 5.8 mEq/L. Which medication is the most likely
contributor to this finding?
A) Lisinopril
B) Carvedilol
C) Furosemide
D) Digoxin
Correct Answer: A) Lisinopril
Explanation: Lisinopril is an ACE inhibitor, which works by inhibiting the conversion of
Angiotensin I to Angiotensin II. This process also decreases aldosterone secretion, which
promotes potassium retention in the kidneys. In the presence of impaired renal function or other
contributing factors, this can lead to life-threatening hyperkalemia. Furosemide is a loop
,diuretic that typically causes potassium excretion, while carvedilol and digoxin have minimal
effects on potassium levels.
Question 5: A nurse is assessing a client with suspected Myasthenia Gravis who is undergoing an
edrophonium (Tensilon) test. During the test, the client suddenly experiences bradycardia,
sweating, and cramping. What is the nurse's priority action?
A) Administer a dose of epinephrine immediately.
B) Administer atropine sulfate.
C) Stop the infusion and notify the healthcare provider.
D) Monitor the client for respiratory distress.
Correct Answer: B) Administer atropine sulfate.
Explanation: The client is experiencing a cholinergic crisis triggered by the edrophonium, which
is a rapid-acting acetylcholinesterase inhibitor. Atropine is the specific antidote for the
muscarinic side effects (bradycardia, secretions, cramps) of cholinergic drugs. While assessing
for respiratory status is important, the immediate pharmacological reversal of the
overstimulation is the priority action.
Question 6: A client with a spinal cord injury at the T4 level suddenly complains of a throbbing
headache and blurred vision. The blood pressure is 210/110 mmHg. What is the first action the
nurse should take?
A) Administer an antihypertensive medication.
B) Elevate the head of the bed to 90 degrees.
C) Check for bladder distention.
D) Notify the healthcare provider.
Correct Answer: B) Elevate the head of the bed to 90 degrees.
Explanation: The client is exhibiting symptoms of autonomic dysreflexia, a life-threatening
medical emergency. Placing the client in a high-Fowler's position (or elevating the head of the
bed) is the immediate first step to facilitate venous pooling and reduce blood pressure. Once the
head is elevated, the nurse would then immediately assess and eliminate the stimulus (e.g.,
kinked catheter).
Question 7: A nurse is caring for a client with Hemophilia A who is scheduled for a minor
surgical procedure. The nurse reviews the lab results and notes the factor VIII activity level is
15%. What is the nurse's interpretation?
, A) The client has severe hemophilia and is at high risk for spontaneous bleeding.
B) The client has moderate hemophilia and requires prophylactic factor VIII replacement.
C) The client has mild hemophilia and may require factor VIII for surgery.
D) The client’s coagulation profile is within normal limits.
Correct Answer: C) The client has mild hemophilia and may require factor VIII for surgery.
Explanation: Factor VIII activity levels define the severity of Hemophilia A: Severe is <1%,
Moderate is 1–5%, and Mild is 5–40%. A level of 15% indicates mild disease. While
spontaneous bleeding is less common, bleeding is highly likely with trauma or surgical
intervention, necessitating pre-procedural replacement therapy.
Question 8: A client with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation. The low-pressure alarm on the ventilator begins to sound. What is the nurse’s first
action?
A) Suction the client's airway.
B) Check the ventilator tubing for disconnections.
C) Increase the FIO2 on the ventilator.
D) Manually ventilate the client with an ambu-bag.
Correct Answer: B) Check the ventilator tubing for disconnections.
Explanation: A low-pressure alarm indicates a loss of resistance in the circuit, most commonly
caused by a disconnected tube or an inadequately inflated endotracheal tube cuff. The nurse
must first ensure the circuit is intact. If no disconnection is found, then further investigation for a
leak or assessing the client is required. Manually ventilating is the backup if the equipment fails
or the client becomes unstable.
Question 9: A client is receiving an infusion of Vancomycin. The nurse notices the client's face,
neck, and upper chest have developed a bright red, maculopapular rash. Which nursing
intervention is most appropriate?
A) Stop the infusion immediately and notify the healthcare provider.
B) Slow the rate of the infusion.
C) Administer diphenhydramine as ordered.
D) Continue the infusion but monitor for airway compromise.
