HESI RN Exit Exam NGN Version B Practice Questions:
100+ Next Generation NCLEX Case Studies, Priority &
Delegation, SATA with Expert Rationales (2026)
CASE STUDY 1: Older Adult with Cataracts & Vision Changes
Client Profile: Mrs. Eleanor Vance, 78-year-old female, lives independently,
diagnosed with bilateral cataracts. She reports gradual vision loss over 18
months. Today she calls the clinic stating, "I woke up seeing a dark curtain
with spiderweb lines across my right eye, and colors look washed out."
Vital Signs Display:
Table
Parameter Value
Blood Pressure 142/88 mm Hg
Heart Rate 88 beats/min
Respiratory Rate 18 breaths/min
Temperature 98.4°F (36.9°C)
SpO₂ 96% on room air
Pain 0/10
Question 1 (Highlight/Identify): Which assessment finding in Mrs. Vance's
report requires immediate notification to the ophthalmologist?
,A. Gradual vision loss over 18 months
B. Washed-out color perception
C. Opacity of the lens noted on previous exam
D. Visualization of a cobweb- or hairnet-type structure with a dark curtain
Correct Answer: D
Rationale:
Visualization of a cobweb- or hairnet-type structure with a dark curtain is a
hallmark sign of retinal detachment, which constitutes a medical emergency.
Clients with cataracts are at increased risk for retinal detachment due to
changes in the vitreous humor. Options A, B, and C are expected
manifestations of cataracts: gradual vision loss, distorted color perception, and
lens opacity do not require immediate intervention. Retinal detachment
requires surgical repair within 24-48 hours to preserve vision. The nurse must
instruct the client to avoid strenuous activity, bending, or rubbing the eye and
arrange emergent ophthalmologic evaluation.
CASE STUDY 2: Guillain-Barré Syndrome – Progressive Neuromuscular
Decline
Client Profile: Mr. James Chen, 45-year-old male, hospitalized with Guillain-
Barré syndrome (GBS) following a recent Campylobacter infection. He is on
day 7 of illness. Current assessment reveals progressive ascending weakness,
areflexia in lower extremities, and stable vital signs.
Clinical Progression Timeline:
Table
Day Assessment Findings
Day Bilateral lower extremity weakness, difficulty climbing stairs
3
, Day Assessment Findings
Day Ascending paralysis to waist level, absent DTRs in legs
5
Day Weakness at shoulder girdle, respiratory rate 22, slight dyspnea on
7 exertion
Question 2 (Priority/Action): When caring for Mr. Chen, which information is
most important for the nurse to report to the primary health care provider
immediately?
A. Bilateral lower extremity weakness progressing to waist level
B. Decrease in cognitive status with confusion to time and place
C. Absent deep tendon reflexes in bilateral lower extremities
D. Reports of paresthesia in fingertips and toes
Correct Answer: B
Rationale:
A decline in cognitive status in a client with GBS is indicative of hypoxia
secondary to respiratory muscle weakness and a possible need for mechanical
ventilation. GBS can progress to respiratory failure due to diaphragm and
intercostal muscle involvement. Cognitive changes (confusion, lethargy) signal
impending respiratory compromise before overt signs like cyanosis appear.
Options A, C, and D are expected findings in GBS: progressive ascending
weakness, areflexia, and paresthesias should be monitored and documented
but are not as critical as signs of hypoxia. The nurse must perform serial
respiratory assessments including vital capacity, negative inspiratory force, and
continuous pulse oximetry.
CASE STUDY 3: Leukemia – Multisystem Assessment
, Client Profile: Ms. Rosa Martinez, 34-year-old female, admitted with newly
diagnosed acute myelogenous leukemia (AML). She reports 3-month history of
fatigue, recurrent infections, and easy bruising. Laboratory results pending.
Laboratory Results Display:
Table
Parameter Value Normal Range
WBC 85,000/mm³ 4,500-11,000/mm³
Hemoglobin 7.2 g/dL 12-16 g/dL
Platelets 45,000/mm³ 150,000-400,000/mm³
Absolute Neutrophil Count (ANC) 800/mm³ >1,500/mm³
Question 3 (Select All That Apply): Which findings should the nurse include in
the plan of care for Ms. Martinez? Select all that apply.
A. Hyperplastic, swollen gums
B. Elevated platelet count
C. Unexplained weight loss of 15 lbs over 2 months
D. Elevated white blood cell count
E. Generalized weakness and fatigue
F. Petechiae and ecchymoses on extremities
Correct Answers: A, C, D, E, F
Rationale:
Classic signs of leukemia include: hyperplastic gums (especially in AML with
monocytic differentiation), weight loss (due to hypermetabolic state and
cytokine release), elevated WBC (often with immature blasts),
weakness/fatigue (anemia-related), and thrombocytopenia manifestations
(petechiae, ecchymoses). Option B (elevated platelets) is incorrect—
100+ Next Generation NCLEX Case Studies, Priority &
Delegation, SATA with Expert Rationales (2026)
CASE STUDY 1: Older Adult with Cataracts & Vision Changes
Client Profile: Mrs. Eleanor Vance, 78-year-old female, lives independently,
diagnosed with bilateral cataracts. She reports gradual vision loss over 18
months. Today she calls the clinic stating, "I woke up seeing a dark curtain
with spiderweb lines across my right eye, and colors look washed out."
Vital Signs Display:
Table
Parameter Value
Blood Pressure 142/88 mm Hg
Heart Rate 88 beats/min
Respiratory Rate 18 breaths/min
Temperature 98.4°F (36.9°C)
SpO₂ 96% on room air
Pain 0/10
Question 1 (Highlight/Identify): Which assessment finding in Mrs. Vance's
report requires immediate notification to the ophthalmologist?
,A. Gradual vision loss over 18 months
B. Washed-out color perception
C. Opacity of the lens noted on previous exam
D. Visualization of a cobweb- or hairnet-type structure with a dark curtain
Correct Answer: D
Rationale:
Visualization of a cobweb- or hairnet-type structure with a dark curtain is a
hallmark sign of retinal detachment, which constitutes a medical emergency.
Clients with cataracts are at increased risk for retinal detachment due to
changes in the vitreous humor. Options A, B, and C are expected
manifestations of cataracts: gradual vision loss, distorted color perception, and
lens opacity do not require immediate intervention. Retinal detachment
requires surgical repair within 24-48 hours to preserve vision. The nurse must
instruct the client to avoid strenuous activity, bending, or rubbing the eye and
arrange emergent ophthalmologic evaluation.
CASE STUDY 2: Guillain-Barré Syndrome – Progressive Neuromuscular
Decline
Client Profile: Mr. James Chen, 45-year-old male, hospitalized with Guillain-
Barré syndrome (GBS) following a recent Campylobacter infection. He is on
day 7 of illness. Current assessment reveals progressive ascending weakness,
areflexia in lower extremities, and stable vital signs.
Clinical Progression Timeline:
Table
Day Assessment Findings
Day Bilateral lower extremity weakness, difficulty climbing stairs
3
, Day Assessment Findings
Day Ascending paralysis to waist level, absent DTRs in legs
5
Day Weakness at shoulder girdle, respiratory rate 22, slight dyspnea on
7 exertion
Question 2 (Priority/Action): When caring for Mr. Chen, which information is
most important for the nurse to report to the primary health care provider
immediately?
A. Bilateral lower extremity weakness progressing to waist level
B. Decrease in cognitive status with confusion to time and place
C. Absent deep tendon reflexes in bilateral lower extremities
D. Reports of paresthesia in fingertips and toes
Correct Answer: B
Rationale:
A decline in cognitive status in a client with GBS is indicative of hypoxia
secondary to respiratory muscle weakness and a possible need for mechanical
ventilation. GBS can progress to respiratory failure due to diaphragm and
intercostal muscle involvement. Cognitive changes (confusion, lethargy) signal
impending respiratory compromise before overt signs like cyanosis appear.
Options A, C, and D are expected findings in GBS: progressive ascending
weakness, areflexia, and paresthesias should be monitored and documented
but are not as critical as signs of hypoxia. The nurse must perform serial
respiratory assessments including vital capacity, negative inspiratory force, and
continuous pulse oximetry.
CASE STUDY 3: Leukemia – Multisystem Assessment
, Client Profile: Ms. Rosa Martinez, 34-year-old female, admitted with newly
diagnosed acute myelogenous leukemia (AML). She reports 3-month history of
fatigue, recurrent infections, and easy bruising. Laboratory results pending.
Laboratory Results Display:
Table
Parameter Value Normal Range
WBC 85,000/mm³ 4,500-11,000/mm³
Hemoglobin 7.2 g/dL 12-16 g/dL
Platelets 45,000/mm³ 150,000-400,000/mm³
Absolute Neutrophil Count (ANC) 800/mm³ >1,500/mm³
Question 3 (Select All That Apply): Which findings should the nurse include in
the plan of care for Ms. Martinez? Select all that apply.
A. Hyperplastic, swollen gums
B. Elevated platelet count
C. Unexplained weight loss of 15 lbs over 2 months
D. Elevated white blood cell count
E. Generalized weakness and fatigue
F. Petechiae and ecchymoses on extremities
Correct Answers: A, C, D, E, F
Rationale:
Classic signs of leukemia include: hyperplastic gums (especially in AML with
monocytic differentiation), weight loss (due to hypermetabolic state and
cytokine release), elevated WBC (often with immature blasts),
weakness/fatigue (anemia-related), and thrombocytopenia manifestations
(petechiae, ecchymoses). Option B (elevated platelets) is incorrect—
