**The Ultimate Nursing Accelerator: NGN,
NCLEX-RN & HESI Exit Crossover
2025/2026**
Question 1
A nurse is assessing a client who is 4 hours post-cardiac catheterization via the femoral artery. The
client’s vital signs are BP 100/60 mm Hg, HR 110 bpm, RR 22/min. The nurse notes a large, expanding
hematoma at the insertion site. What is the priority action?
A. Apply a sandbag to the site
B. Increase the IV fluid rate
C. Notify the provider immediately
D. Monitor the site every 15 minutes
---
💫RATIONALE✔️✔️: An expanding hematoma indicates active arterial bleeding; immediate provider
notification is required for potential surgical intervention.
💫ANSWER✔️✔️: C. Notify the provider immediately
---
Question 2
A client with chronic kidney disease (CKD) has a phosphate level of 6.8 mg/dL. Which medication should
the nurse anticipate administering?
A. Calcium acetate
B. Calcitriol
C. Ferrous sulfate
D. Sodium polystyrene sulfonate
---
💫RATIONALE✔️✔️: Calcium acetate is a phosphate binder given with meals to bind dietary phosphate
and reduce serum levels in CKD.
💫ANSWER✔️✔️: A. Calcium acetate
,---
Question 3
A nurse is caring for a client with a new tracheostomy. Which finding requires immediate intervention?
A. Small amount of serosanguinous drainage around the stoma
B. Client coughing and expectorating thick mucus
C. Respiratory rate of 22 breaths/min
D. Stridor on inspiration
---
💫RATIONALE✔️✔️: Stridor indicates airway obstruction from mucus plug, tube dislodgement, or edema
— a life-threatening emergency.
💫ANSWER✔️✔️: D. Stridor on inspiration
---
Question 4
A client with a new diagnosis of type 1 diabetes is learning to draw up insulin. The client needs 8 units of
regular insulin and 22 units of NPH insulin. Which action is correct?
A. Draw up the NPH insulin first, then the regular insulin
B. Draw up the regular insulin first, then the NPH insulin
C. Use two separate syringes for each insulin type
D. Shake the NPH vial vigorously before drawing up
---
💫RATIONALE✔️✔️: When mixing insulins, draw up regular (clear) first, then NPH (cloudy) to avoid
contaminating the regular vial with NPH.
💫ANSWER✔️✔️: B. Draw up the regular insulin first, then the NPH insulin
---
Question 5
A nurse is assessing a client with suspected pulmonary embolism. Which finding is most specific?
A. Hemoptysis
B. Sudden onset of dyspnea
C. Pleuritic chest pain
D. Tachycardia
, ---
💫RATIONALE✔️✔️: Sudden unexplained dyspnea is the most common (73%) and highly suggestive
symptom of PE.
💫ANSWER✔️✔️: B. Sudden onset of dyspnea
---
Question 6
A client is 2 days post-appendectomy. The nurse notes a temperature of 38.9°C (102°F), HR 115 bpm,
and abdominal pain. Which action should the nurse take first?
A. Administer acetaminophen
B. Notify the surgeon of possible intra-abdominal abscess
C. Obtain a wound culture
D. Increase the IV fluid rate
---
💫RATIONALE✔️✔️: Fever and abdominal pain post-appendectomy suggest abscess or peritonitis; notify
the surgeon for immediate evaluation.
💫ANSWER✔️✔️: B. Notify the surgeon of possible intra-abdominal abscess
---
Question 7
A nurse is providing discharge teaching to a client with a new permanent pacemaker. Which instruction
is correct?
A. “Avoid using a microwave oven.”
B. “You cannot drive a car for 6 months.”
C. “Avoid lifting the arm on the pacemaker side above shoulder level for 2–6 weeks.”
D. “You will need to have the pacemaker battery changed every 2 years.”
---
💫RATIONALE✔️✔️: Arm restriction above shoulder prevents lead dislodgement; modern microwaves are
safe, driving is restricted for 1 week typically.
💫ANSWER✔️✔️: C. “Avoid lifting the arm on the pacemaker side above shoulder level for 2–6 weeks.”
---
Question 8
NCLEX-RN & HESI Exit Crossover
2025/2026**
Question 1
A nurse is assessing a client who is 4 hours post-cardiac catheterization via the femoral artery. The
client’s vital signs are BP 100/60 mm Hg, HR 110 bpm, RR 22/min. The nurse notes a large, expanding
hematoma at the insertion site. What is the priority action?
A. Apply a sandbag to the site
B. Increase the IV fluid rate
C. Notify the provider immediately
D. Monitor the site every 15 minutes
---
💫RATIONALE✔️✔️: An expanding hematoma indicates active arterial bleeding; immediate provider
notification is required for potential surgical intervention.
💫ANSWER✔️✔️: C. Notify the provider immediately
---
Question 2
A client with chronic kidney disease (CKD) has a phosphate level of 6.8 mg/dL. Which medication should
the nurse anticipate administering?
A. Calcium acetate
B. Calcitriol
C. Ferrous sulfate
D. Sodium polystyrene sulfonate
---
💫RATIONALE✔️✔️: Calcium acetate is a phosphate binder given with meals to bind dietary phosphate
and reduce serum levels in CKD.
💫ANSWER✔️✔️: A. Calcium acetate
,---
Question 3
A nurse is caring for a client with a new tracheostomy. Which finding requires immediate intervention?
A. Small amount of serosanguinous drainage around the stoma
B. Client coughing and expectorating thick mucus
C. Respiratory rate of 22 breaths/min
D. Stridor on inspiration
---
💫RATIONALE✔️✔️: Stridor indicates airway obstruction from mucus plug, tube dislodgement, or edema
— a life-threatening emergency.
💫ANSWER✔️✔️: D. Stridor on inspiration
---
Question 4
A client with a new diagnosis of type 1 diabetes is learning to draw up insulin. The client needs 8 units of
regular insulin and 22 units of NPH insulin. Which action is correct?
A. Draw up the NPH insulin first, then the regular insulin
B. Draw up the regular insulin first, then the NPH insulin
C. Use two separate syringes for each insulin type
D. Shake the NPH vial vigorously before drawing up
---
💫RATIONALE✔️✔️: When mixing insulins, draw up regular (clear) first, then NPH (cloudy) to avoid
contaminating the regular vial with NPH.
💫ANSWER✔️✔️: B. Draw up the regular insulin first, then the NPH insulin
---
Question 5
A nurse is assessing a client with suspected pulmonary embolism. Which finding is most specific?
A. Hemoptysis
B. Sudden onset of dyspnea
C. Pleuritic chest pain
D. Tachycardia
, ---
💫RATIONALE✔️✔️: Sudden unexplained dyspnea is the most common (73%) and highly suggestive
symptom of PE.
💫ANSWER✔️✔️: B. Sudden onset of dyspnea
---
Question 6
A client is 2 days post-appendectomy. The nurse notes a temperature of 38.9°C (102°F), HR 115 bpm,
and abdominal pain. Which action should the nurse take first?
A. Administer acetaminophen
B. Notify the surgeon of possible intra-abdominal abscess
C. Obtain a wound culture
D. Increase the IV fluid rate
---
💫RATIONALE✔️✔️: Fever and abdominal pain post-appendectomy suggest abscess or peritonitis; notify
the surgeon for immediate evaluation.
💫ANSWER✔️✔️: B. Notify the surgeon of possible intra-abdominal abscess
---
Question 7
A nurse is providing discharge teaching to a client with a new permanent pacemaker. Which instruction
is correct?
A. “Avoid using a microwave oven.”
B. “You cannot drive a car for 6 months.”
C. “Avoid lifting the arm on the pacemaker side above shoulder level for 2–6 weeks.”
D. “You will need to have the pacemaker battery changed every 2 years.”
---
💫RATIONALE✔️✔️: Arm restriction above shoulder prevents lead dislodgement; modern microwaves are
safe, driving is restricted for 1 week typically.
💫ANSWER✔️✔️: C. “Avoid lifting the arm on the pacemaker side above shoulder level for 2–6 weeks.”
---
Question 8
