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HESI RN Exit Exam V3 (2025/2026) – 160 Real Exam-Based NGN
Questions with Correct Answers & Rationales | Med-Surg, OB,
Pharmacology, Psych, SATA"
Question 1: (OB – Case-Based NGN)
A 26-year-old primigravida at 38 weeks' gestation presents to the labor unit with contractions
occurring every 3–4 minutes. Vaginal exam shows cervix 5 cm dilated, 80% effaced, and -1
station. Fetal heart tracing shows moderate variability with occasional early decelerations.
Which nursing intervention is most appropriate at this stage?
A. Position the client on her back and apply fundal pressure
B. Administer oxygen via non-rebreather mask
C. Continue to monitor and provide comfort measures
D. Initiate emergency cesarean delivery
Correct Answer: C. Continue to monitor and provide comfort measures
Rationale: This patient is in the active phase of labor with reassuring FHR tracing. Early
decelerations are benign and linked to head compression during labor.
, 2
Question 2: (Med-Surg – SATA)
A nurse is caring for a client with chronic kidney disease. Which of the following findings should
the nurse expect? (Select all that apply.)
A. Hyperkalemia
B. Hypophosphatemia
C. Anemia
D. Decreased creatinine
E. Hypertension
Correct Answers: A, C, E
Rationale: CKD causes decreased erythropoietin (→ anemia), fluid retention (→ hypertension),
and poor potassium excretion (→ hyperkalemia). Phosphate increases; creatinine increases.
Question 3: (Pharmacology – NGN)
A nurse is reviewing medications for a client diagnosed with heart failure and prescribed
digoxin, furosemide, and lisinopril. The client reports nausea and blurred vision. Vital signs:
HR 52 bpm, BP 118/74, RR 16.
What is the nurse’s best action?
A. Hold the digoxin and notify the provider
B. Administer ondansetron and reassess in 1 hour
C. Check potassium levels and give the next digoxin dose
D. Increase fluid intake to flush out toxins
, 3
Correct Answer: A. Hold the digoxin and notify the provider
Rationale: Classic digoxin toxicity signs = nausea, visual changes, bradycardia. HR < 60
indicates need to hold medication.
Question 4: (OB – SATA)
A nurse is assessing a newborn immediately after delivery. Which of the following findings
should be reported to the provider? (Select all that apply.)
A. Respiratory rate 72
B. Heart rate 150
C. Nasal flaring
D. Grunting
E. Acrocyanosis
Correct Answers: C, D
Rationale: Nasal flaring and grunting indicate respiratory distress. RR of 72 is high but expected
for first hour of life. Acrocyanosis is normal initially.
Question 5: (Med-Surg – Priority NGN)
A nurse is caring for four clients. Who should be assessed first?
A. A client with pneumonia reporting increased sputum
B. A client with a potassium level of 6.2 mEq/L and ECG changes
C. A client receiving a blood transfusion started 3 hours ago
D. A client with chronic back pain requesting medication
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Correct Answer: B. A client with a potassium level of 6.2 mEq/L and ECG changes
Rationale: Hyperkalemia with ECG changes is life-threatening and requires immediate
treatment due to risk of arrhythmias.
Question 6: (Pharmacology – SATA)
A nurse is reviewing medications that increase the risk of bleeding. Which of the following drugs
should the nurse identify? (Select all that apply.)
A. Clopidogrel
B. Warfarin
C. Ibuprofen
D. Acetaminophen
E. Enoxaparin
Correct Answers: A, B, C, E
Rationale: Clopidogrel (antiplatelet), warfarin (anticoagulant), NSAIDs (ibuprofen), and
enoxaparin (LMWH) increase bleeding risk. Acetaminophen does not.
Question 7: (OB – Priority NGN)
A pregnant client at 32 weeks presents with painless vaginal bleeding. The fetal heart rate is 140
bpm and regular. The nurse suspects placenta previa.
What is the priority nursing action?
A. Perform a vaginal exam
B. Obtain IV access and monitor blood loss
HESI RN Exit Exam V3 (2025/2026) – 160 Real Exam-Based NGN
Questions with Correct Answers & Rationales | Med-Surg, OB,
Pharmacology, Psych, SATA"
Question 1: (OB – Case-Based NGN)
A 26-year-old primigravida at 38 weeks' gestation presents to the labor unit with contractions
occurring every 3–4 minutes. Vaginal exam shows cervix 5 cm dilated, 80% effaced, and -1
station. Fetal heart tracing shows moderate variability with occasional early decelerations.
Which nursing intervention is most appropriate at this stage?
A. Position the client on her back and apply fundal pressure
B. Administer oxygen via non-rebreather mask
C. Continue to monitor and provide comfort measures
D. Initiate emergency cesarean delivery
Correct Answer: C. Continue to monitor and provide comfort measures
Rationale: This patient is in the active phase of labor with reassuring FHR tracing. Early
decelerations are benign and linked to head compression during labor.
, 2
Question 2: (Med-Surg – SATA)
A nurse is caring for a client with chronic kidney disease. Which of the following findings should
the nurse expect? (Select all that apply.)
A. Hyperkalemia
B. Hypophosphatemia
C. Anemia
D. Decreased creatinine
E. Hypertension
Correct Answers: A, C, E
Rationale: CKD causes decreased erythropoietin (→ anemia), fluid retention (→ hypertension),
and poor potassium excretion (→ hyperkalemia). Phosphate increases; creatinine increases.
Question 3: (Pharmacology – NGN)
A nurse is reviewing medications for a client diagnosed with heart failure and prescribed
digoxin, furosemide, and lisinopril. The client reports nausea and blurred vision. Vital signs:
HR 52 bpm, BP 118/74, RR 16.
What is the nurse’s best action?
A. Hold the digoxin and notify the provider
B. Administer ondansetron and reassess in 1 hour
C. Check potassium levels and give the next digoxin dose
D. Increase fluid intake to flush out toxins
, 3
Correct Answer: A. Hold the digoxin and notify the provider
Rationale: Classic digoxin toxicity signs = nausea, visual changes, bradycardia. HR < 60
indicates need to hold medication.
Question 4: (OB – SATA)
A nurse is assessing a newborn immediately after delivery. Which of the following findings
should be reported to the provider? (Select all that apply.)
A. Respiratory rate 72
B. Heart rate 150
C. Nasal flaring
D. Grunting
E. Acrocyanosis
Correct Answers: C, D
Rationale: Nasal flaring and grunting indicate respiratory distress. RR of 72 is high but expected
for first hour of life. Acrocyanosis is normal initially.
Question 5: (Med-Surg – Priority NGN)
A nurse is caring for four clients. Who should be assessed first?
A. A client with pneumonia reporting increased sputum
B. A client with a potassium level of 6.2 mEq/L and ECG changes
C. A client receiving a blood transfusion started 3 hours ago
D. A client with chronic back pain requesting medication
, 4
Correct Answer: B. A client with a potassium level of 6.2 mEq/L and ECG changes
Rationale: Hyperkalemia with ECG changes is life-threatening and requires immediate
treatment due to risk of arrhythmias.
Question 6: (Pharmacology – SATA)
A nurse is reviewing medications that increase the risk of bleeding. Which of the following drugs
should the nurse identify? (Select all that apply.)
A. Clopidogrel
B. Warfarin
C. Ibuprofen
D. Acetaminophen
E. Enoxaparin
Correct Answers: A, B, C, E
Rationale: Clopidogrel (antiplatelet), warfarin (anticoagulant), NSAIDs (ibuprofen), and
enoxaparin (LMWH) increase bleeding risk. Acetaminophen does not.
Question 7: (OB – Priority NGN)
A pregnant client at 32 weeks presents with painless vaginal bleeding. The fetal heart rate is 140
bpm and regular. The nurse suspects placenta previa.
What is the priority nursing action?
A. Perform a vaginal exam
B. Obtain IV access and monitor blood loss
