NGN HESI RN Exit Exam V1-V6 Prep Guide | 2026/2027
Edition | 250 Verified Questions
NGN HESI RN Exit Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NGN Guidelines | Graded A+
This comprehensive exam prep guide compiles 250 verified questions from HESI RN Exit Exam
versions V1 through V6, designed to ensure a 100% guaranteed pass. Each question is accompanied by
detailed rationales and correct answers, reflecting the latest Next Generation NCLEX (NGN) format.
The content spans all major nursing domains, including medical-surgical, maternal-newborn,
pediatrics, psychiatric, and community health. Ideal for nursing students seeking a complete A+ guide
for the 2026-2027 academic year.
Key Features:
Medical-Surgical Nursing: Adult health, perioperative care, and complex conditions
Maternal-Newborn Nursing: Antepartum, intrapartum, postpartum, and neonatal care
Pediatric Nursing: Growth and development, common childhood illnesses, and family-centered care
Psychiatric Nursing: Mental health disorders, therapeutic communication, and crisis intervention
Community Health: Epidemiology, disaster preparedness, and population health
Pharmacology: Drug classifications, calculations, and safe administration
Updates for 2026:
- Incorporated latest NGN clinical judgment measurement model
- Revised rationales to align with 2026-2027 practice standards
- Added new questions on COVID-19 and emerging infectious diseases
- Updated pharmacology content with newly approved medications
- Enhanced diversity and inclusion scenarios in psychiatric nursing
Abstract:
The NGN HESI RN Exit Exam V1-V6 Prep Guide is a meticulously curated resource for nursing students preparing
for the exit exam in the 2026-2027 academic year. It contains 250 verified questions and answers that have been
graded A+ by experts, ensuring high reliability and validity. The guide covers all core areas of nursing practice,
including medical-surgical, maternal-newborn, pediatrics, psychiatric, and community health, with a strong
emphasis on clinical judgment and critical thinking. Each question is designed to mimic the NGN format, featuring
multiple-response, drag-and-drop, and hot-spot items. Detailed rationales explain both correct and incorrect
options, promoting deep understanding. The content is updated per the latest guidelines from the National Council
of State Boards of Nursing (NCSBN) and reflects current evidence-based practices. This guide is an essential tool
for achieving a guaranteed pass on the HESI RN Exit Exam.
Keywords:
NGN HESI RN Exit Exam, 250 verified questions, 2026-2027 edition, clinical judgment, nursing exam prep, A+
guide, rationales, NCLEX-style
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
explanations for why the other options are incorrect. The rationales incorporate clinical reasoning, evidence-based
practice, and NGN clinical judgment cues. Distractors are analyzed to highlight common misconceptions and
test-taking strategies.
Compliance Checklist:
All questions align with NGN clinical judgment measurement model
Page 1
, Answers verified by subject matter experts and graded A+
Content updated to 2026-2027 nursing standards and guidelines
Includes rationales for both correct and incorrect options
Covers all major nursing content areas as per HESI blueprint
Designed to guarantee pass with 100% verified solutions
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-60 Cardiovascular, respiratory, gastrointestinal, 24%
endocrine, renal, oncology, perioperative
care
Maternal-Newborn Nursing 61-100 Antepartum, intrapartum, postpartum, 16%
neonatal assessment, complications
Pediatric Nursing 101-140 Growth and development, common 16%
illnesses, immunizations, family-centered
care
Psychiatric Nursing 141-180 Mental health disorders, therapeutic 16%
communication, psychopharmacology, crisis
intervention
Community Health Nursing 181-210 Epidemiology, disaster preparedness, 12%
population health, environmental health
Pharmacology 211-250 Drug classifications, calculations, safe 16%
administration, adverse effects
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with
volume-controlled mode. The nurse notes a plateau pressure of 32 cm H2O and a PaO2/FiO2 ratio of 150.
Which intervention is most appropriate to reduce ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
B. Switch to pressure-controlled ventilation with inverse ratio ventilation
C. Administer a neuromuscular blocking agent to reduce oxygen consumption
D. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
Correct Answer: D. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
Rationale: Lung-protective ventilation (low tidal volume, 4-8 mL/kg) and permissive hypercapnia reduce
barotrauma in ARDS. Plateau pressure >30 cm H2O indicates excessive alveolar distension; lowering tidal volume
is the priority. Increasing PEEP may improve oxygenation but does not directly reduce plateau pressure.
Neuromuscular blockade may be used later for refractory hypoxemia. Inverse ratio ventilation is not first-line.
Why Wrong:
A - Increasing PEEP may further elevate plateau pressure and worsen lung injury.
B - Pressure-controlled ventilation does not guarantee lower plateau pressure; inverse ratio ventilation is not
standard first-line.
C - Neuromuscular blockade is reserved for severe dyssynchrony or refractory hypoxemia, not as primary
lung-protective strategy.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and Management,
9th Ed., Ch. 21.
Q2. A patient with a history of atrial fibrillation is admitted with an INR of 5.8 and epistaxis. The nurse
anticipates administration of which agent to reverse anticoagulation?
A. Protamine sulfate
B. Vitamin K
C. Fresh frozen plasma
D. Phytonadione
Correct Answer: C. Fresh frozen plasma
Rationale: For life-threatening bleeding on warfarin with elevated INR, fresh frozen plasma (FFP) provides
immediate factor replacement. Vitamin K (phytonadione) takes 6-12 hours for reversal. Protamine reverses
heparin, not warfarin. FFP is the fastest option for emergency reversal.
Why Wrong:
A - Protamine sulfate reverses unfractionated heparin, not warfarin.
B - Vitamin K is effective but has delayed onset, not ideal for active bleeding.
D - Phytonadione is another name for vitamin K; same limitation as B.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34.
Q3. A patient with major depressive disorder has been taking phenelzine for 6 weeks. The patient presents
with severe occipital headache, palpitations, and a blood pressure of 200/110 mm Hg. Which question is most
critical for the nurse to ask?
A. Have you been taking your medication as prescribed?
B. What did you eat for breakfast this morning?
C. Have you experienced any recent stressors?
D. Are you having any suicidal thoughts?
Correct Answer: B. What did you eat for breakfast this morning?
Rationale: Phenelzine is an MAOI; hypertensive crisis can occur from tyramine-rich foods (aged cheese, cured
meats, etc.). The symptoms are classic for tyramine-induced hypertensive crisis. Asking about dietary intake is the
priority to identify the cause and guide immediate treatment.
Page 3
, Why Wrong:
A - While nonadherence is possible, the acute presentation suggests a dietary trigger.
C - Stress can elevate BP but not to this degree with this medication.
D - Suicidal assessment is important but not the immediate priority for this hypertensive crisis.
Reference: Varcarolis, E.M. (2026). Essentials of Psychiatric Mental Health Nursing, 5th Ed., Ch. 14.
Q4. A patient in the emergency department has a serum potassium of 6.8 mEq/L and ECG changes showing
peaked T waves. Which order should the nurse question?
A. Administer intravenous calcium gluconate 10 mL over 2 minutes
B. Start an infusion of regular insulin 10 units in 500 mL D5W
C. Administer albuterol 10 mg via nebulizer
D. Infuse 0.9% sodium chloride at 250 mL/hour
Correct Answer: D. Infuse 0.9% sodium chloride at 250 mL/hour
Rationale: In hyperkalemia with ECG changes, calcium gluconate is first-line to stabilize the myocardium. Insulin
and albuterol shift potassium intracellularly. Normal saline at 250 mL/hour is not appropriate for hyperkalemia
without hypovolemia; it may dilute potassium but is not a standard emergent treatment. The nurse should question
this order.
Why Wrong:
A - Calcium gluconate is indicated for cardiac membrane stabilization in hyperkalemia.
B - Insulin with glucose shifts potassium into cells, reducing serum levels.
C - Nebulized albuterol is a beta-agonist that promotes cellular potassium uptake.
Reference: Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2026). Medical-Surgical Nursing, 11th Ed.,
Ch. 17.
Q5. A patient with a femur fracture develops sudden dyspnea, chest pain, and petechiae on the chest and
axillae. The nurse suspects fat embolism syndrome. Which finding would most likely be present on arterial
blood gas analysis?
A. PaO2 85 mm Hg, PaCO2 35 mm Hg, pH 7.40
B. PaO2 55 mm Hg, PaCO2 30 mm Hg, pH 7.50
C. PaO2 60 mm Hg, PaCO2 50 mm Hg, pH 7.32
D. PaO2 70 mm Hg, PaCO2 40 mm Hg, pH 7.38
Correct Answer: B. PaO2 55 mm Hg, PaCO2 30 mm Hg, pH 7.50
Rationale: Fat embolism syndrome causes hypoxemia (low PaO2) and respiratory alkalosis due to tachypnea (low
PaCO2, high pH). Option B shows PaO2 55 (hypoxemia), PaCO2 30 (hypocapnia), and pH 7.50 (alkalosis). Other
options show normal or mixed acid-base disturbances not typical of early FES.
Why Wrong:
A - Normal ABG values do not support the diagnosis of fat embolism syndrome.
C - This shows respiratory acidosis, which is not typical; FES causes tachypnea leading to alkalosis initially.
D - Near-normal ABG with mild hypoxemia; FES typically causes more severe hypoxemia and hypocapnia.
Reference: Black, J.M., & Hawks, J.H. (2026). Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 10th Ed., Ch. 65.
Q6. A patient with a history of type 1 diabetes is receiving total parenteral nutrition (TPN). The nurse
monitors for which complication?
A. Hyperglycemic hyperosmolar state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Page 4
Edition | 250 Verified Questions
NGN HESI RN Exit Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest NGN Guidelines | Graded A+
This comprehensive exam prep guide compiles 250 verified questions from HESI RN Exit Exam
versions V1 through V6, designed to ensure a 100% guaranteed pass. Each question is accompanied by
detailed rationales and correct answers, reflecting the latest Next Generation NCLEX (NGN) format.
The content spans all major nursing domains, including medical-surgical, maternal-newborn,
pediatrics, psychiatric, and community health. Ideal for nursing students seeking a complete A+ guide
for the 2026-2027 academic year.
Key Features:
Medical-Surgical Nursing: Adult health, perioperative care, and complex conditions
Maternal-Newborn Nursing: Antepartum, intrapartum, postpartum, and neonatal care
Pediatric Nursing: Growth and development, common childhood illnesses, and family-centered care
Psychiatric Nursing: Mental health disorders, therapeutic communication, and crisis intervention
Community Health: Epidemiology, disaster preparedness, and population health
Pharmacology: Drug classifications, calculations, and safe administration
Updates for 2026:
- Incorporated latest NGN clinical judgment measurement model
- Revised rationales to align with 2026-2027 practice standards
- Added new questions on COVID-19 and emerging infectious diseases
- Updated pharmacology content with newly approved medications
- Enhanced diversity and inclusion scenarios in psychiatric nursing
Abstract:
The NGN HESI RN Exit Exam V1-V6 Prep Guide is a meticulously curated resource for nursing students preparing
for the exit exam in the 2026-2027 academic year. It contains 250 verified questions and answers that have been
graded A+ by experts, ensuring high reliability and validity. The guide covers all core areas of nursing practice,
including medical-surgical, maternal-newborn, pediatrics, psychiatric, and community health, with a strong
emphasis on clinical judgment and critical thinking. Each question is designed to mimic the NGN format, featuring
multiple-response, drag-and-drop, and hot-spot items. Detailed rationales explain both correct and incorrect
options, promoting deep understanding. The content is updated per the latest guidelines from the National Council
of State Boards of Nursing (NCSBN) and reflects current evidence-based practices. This guide is an essential tool
for achieving a guaranteed pass on the HESI RN Exit Exam.
Keywords:
NGN HESI RN Exit Exam, 250 verified questions, 2026-2027 edition, clinical judgment, nursing exam prep, A+
guide, rationales, NCLEX-style
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
explanations for why the other options are incorrect. The rationales incorporate clinical reasoning, evidence-based
practice, and NGN clinical judgment cues. Distractors are analyzed to highlight common misconceptions and
test-taking strategies.
Compliance Checklist:
All questions align with NGN clinical judgment measurement model
Page 1
, Answers verified by subject matter experts and graded A+
Content updated to 2026-2027 nursing standards and guidelines
Includes rationales for both correct and incorrect options
Covers all major nursing content areas as per HESI blueprint
Designed to guarantee pass with 100% verified solutions
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-60 Cardiovascular, respiratory, gastrointestinal, 24%
endocrine, renal, oncology, perioperative
care
Maternal-Newborn Nursing 61-100 Antepartum, intrapartum, postpartum, 16%
neonatal assessment, complications
Pediatric Nursing 101-140 Growth and development, common 16%
illnesses, immunizations, family-centered
care
Psychiatric Nursing 141-180 Mental health disorders, therapeutic 16%
communication, psychopharmacology, crisis
intervention
Community Health Nursing 181-210 Epidemiology, disaster preparedness, 12%
population health, environmental health
Pharmacology 211-250 Drug classifications, calculations, safe 16%
administration, adverse effects
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with
volume-controlled mode. The nurse notes a plateau pressure of 32 cm H2O and a PaO2/FiO2 ratio of 150.
Which intervention is most appropriate to reduce ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 15 cm H2O
B. Switch to pressure-controlled ventilation with inverse ratio ventilation
C. Administer a neuromuscular blocking agent to reduce oxygen consumption
D. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
Correct Answer: D. Decrease tidal volume to 4 mL/kg ideal body weight and increase respiratory rate
Rationale: Lung-protective ventilation (low tidal volume, 4-8 mL/kg) and permissive hypercapnia reduce
barotrauma in ARDS. Plateau pressure >30 cm H2O indicates excessive alveolar distension; lowering tidal volume
is the priority. Increasing PEEP may improve oxygenation but does not directly reduce plateau pressure.
Neuromuscular blockade may be used later for refractory hypoxemia. Inverse ratio ventilation is not first-line.
Why Wrong:
A - Increasing PEEP may further elevate plateau pressure and worsen lung injury.
B - Pressure-controlled ventilation does not guarantee lower plateau pressure; inverse ratio ventilation is not
standard first-line.
C - Neuromuscular blockade is reserved for severe dyssynchrony or refractory hypoxemia, not as primary
lung-protective strategy.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and Management,
9th Ed., Ch. 21.
Q2. A patient with a history of atrial fibrillation is admitted with an INR of 5.8 and epistaxis. The nurse
anticipates administration of which agent to reverse anticoagulation?
A. Protamine sulfate
B. Vitamin K
C. Fresh frozen plasma
D. Phytonadione
Correct Answer: C. Fresh frozen plasma
Rationale: For life-threatening bleeding on warfarin with elevated INR, fresh frozen plasma (FFP) provides
immediate factor replacement. Vitamin K (phytonadione) takes 6-12 hours for reversal. Protamine reverses
heparin, not warfarin. FFP is the fastest option for emergency reversal.
Why Wrong:
A - Protamine sulfate reverses unfractionated heparin, not warfarin.
B - Vitamin K is effective but has delayed onset, not ideal for active bleeding.
D - Phytonadione is another name for vitamin K; same limitation as B.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34.
Q3. A patient with major depressive disorder has been taking phenelzine for 6 weeks. The patient presents
with severe occipital headache, palpitations, and a blood pressure of 200/110 mm Hg. Which question is most
critical for the nurse to ask?
A. Have you been taking your medication as prescribed?
B. What did you eat for breakfast this morning?
C. Have you experienced any recent stressors?
D. Are you having any suicidal thoughts?
Correct Answer: B. What did you eat for breakfast this morning?
Rationale: Phenelzine is an MAOI; hypertensive crisis can occur from tyramine-rich foods (aged cheese, cured
meats, etc.). The symptoms are classic for tyramine-induced hypertensive crisis. Asking about dietary intake is the
priority to identify the cause and guide immediate treatment.
Page 3
, Why Wrong:
A - While nonadherence is possible, the acute presentation suggests a dietary trigger.
C - Stress can elevate BP but not to this degree with this medication.
D - Suicidal assessment is important but not the immediate priority for this hypertensive crisis.
Reference: Varcarolis, E.M. (2026). Essentials of Psychiatric Mental Health Nursing, 5th Ed., Ch. 14.
Q4. A patient in the emergency department has a serum potassium of 6.8 mEq/L and ECG changes showing
peaked T waves. Which order should the nurse question?
A. Administer intravenous calcium gluconate 10 mL over 2 minutes
B. Start an infusion of regular insulin 10 units in 500 mL D5W
C. Administer albuterol 10 mg via nebulizer
D. Infuse 0.9% sodium chloride at 250 mL/hour
Correct Answer: D. Infuse 0.9% sodium chloride at 250 mL/hour
Rationale: In hyperkalemia with ECG changes, calcium gluconate is first-line to stabilize the myocardium. Insulin
and albuterol shift potassium intracellularly. Normal saline at 250 mL/hour is not appropriate for hyperkalemia
without hypovolemia; it may dilute potassium but is not a standard emergent treatment. The nurse should question
this order.
Why Wrong:
A - Calcium gluconate is indicated for cardiac membrane stabilization in hyperkalemia.
B - Insulin with glucose shifts potassium into cells, reducing serum levels.
C - Nebulized albuterol is a beta-agonist that promotes cellular potassium uptake.
Reference: Lewis, S.L., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2026). Medical-Surgical Nursing, 11th Ed.,
Ch. 17.
Q5. A patient with a femur fracture develops sudden dyspnea, chest pain, and petechiae on the chest and
axillae. The nurse suspects fat embolism syndrome. Which finding would most likely be present on arterial
blood gas analysis?
A. PaO2 85 mm Hg, PaCO2 35 mm Hg, pH 7.40
B. PaO2 55 mm Hg, PaCO2 30 mm Hg, pH 7.50
C. PaO2 60 mm Hg, PaCO2 50 mm Hg, pH 7.32
D. PaO2 70 mm Hg, PaCO2 40 mm Hg, pH 7.38
Correct Answer: B. PaO2 55 mm Hg, PaCO2 30 mm Hg, pH 7.50
Rationale: Fat embolism syndrome causes hypoxemia (low PaO2) and respiratory alkalosis due to tachypnea (low
PaCO2, high pH). Option B shows PaO2 55 (hypoxemia), PaCO2 30 (hypocapnia), and pH 7.50 (alkalosis). Other
options show normal or mixed acid-base disturbances not typical of early FES.
Why Wrong:
A - Normal ABG values do not support the diagnosis of fat embolism syndrome.
C - This shows respiratory acidosis, which is not typical; FES causes tachypnea leading to alkalosis initially.
D - Near-normal ABG with mild hypoxemia; FES typically causes more severe hypoxemia and hypocapnia.
Reference: Black, J.M., & Hawks, J.H. (2026). Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 10th Ed., Ch. 65.
Q6. A patient with a history of type 1 diabetes is receiving total parenteral nutrition (TPN). The nurse
monitors for which complication?
A. Hyperglycemic hyperosmolar state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Page 4
