**HESI RN Exit Exam 2024 NGN: Critical Judgment in
Acute & Community-Based Care**
---
**Question 1**
A nurse in the emergency department is assessing a client who was involved in a motor vehicle collision.
The client is restless, diaphoretic, and has a heart rate of 124 bpm. The blood pressure is 88/52 mm Hg.
Which finding is most critical for the nurse to report to the healthcare provider immediately?
A. Heart rate of 124 bpm
B. Restlessness and diaphoresis
C. Blood pressure of 88/52 mm Hg
D. A laceration on the left forearm
💫ANSWER✔️✔️: C. Blood pressure of 88/52 mm Hg
💫RATIONALE✔️✔️: This blood pressure indicates hypovolemic shock (compensated stage transitioning to
decompensated). While tachycardia and restlessness are also signs of shock, the specific BP value below
90/60 mm Hg signifies inadequate tissue perfusion and is a priority for immediate intervention to
prevent irreversible organ damage.
---
**Question 2**
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The morning blood
glucose is 420 mg/dL, and serum potassium is 3.2 mEq/L. The nurse reviews the provider’s orders.
Which order should the nurse question?
A. Regular insulin IV continuous infusion at 0.1 unit/kg/hour
B. 0.45% normal saline IV at 250 mL/hour
C. Potassium chloride 20 mEq IV push
,D. Potassium chloride 20 mEq/L added to IV fluids
💫ANSWER✔️✔️: C. Potassium chloride 20 mEq IV push
💫RATIONALE✔️✔️: Potassium is never administered as an IV push due to the risk of fatal cardiac
arrhythmias and cardiac arrest. In DKA with hypokalemia, potassium must be added to IV fluids and
infused slowly, typically at a rate not exceeding 10 mEq/hour.
---
**Question 3**
A nurse is providing dietary teaching to a client with chronic kidney disease (CKD) stage 4. The client
asks, "Why do I need to limit dairy products?" Which response by the nurse is most accurate?
A. "Dairy products increase your risk of developing kidney stones."
B. "Dairy products contain high levels of phosphorus, which can build up in your blood."
C. "Dairy products are high in potassium and can cause dangerous heart rhythms."
D. "Dairy products contribute to fluid retention, worsening your edema."
💫ANSWER✔️✔️: B. "Dairy products contain high levels of phosphorus, which can build up in your
blood."
💫RATIONALE✔️✔️: In CKD stage 4, the kidneys cannot excrete phosphorus, leading to
hyperphosphatemia. Elevated phosphorus binds to calcium, causing hypocalcemia and stimulating PTH
release, which results in renal osteodystrophy. Dairy is a primary source of dietary phosphorus.
---
**Question 4**
A nurse is caring for a client with pneumonia who has a new prescription for ceftriaxone 1 gram IV daily.
The client reports a previous allergic reaction to penicillin. What action should the nurse take first?
A. Administer the ceftriaxone as ordered
B. Request an order for a different antibiotic
C. Assess the client's previous reaction to penicillin
,D. Apply a medical alert bracelet for penicillin allergy
💫ANSWER✔️✔️: C. Assess the client's previous reaction to penicillin
💫RATIONALE✔️✔️: Cross-sensitivity between penicillins and cephalosporins (like ceftriaxone) exists but
is lower than once believed (approx 1-2%). The nurse must first assess the type and severity of the
previous reaction (e.g., anaphylaxis vs. rash). If the reaction was severe, the provider should be notified
to change the antibiotic.
---
**Question 5**
A nurse on a medical-surgical unit receives a handoff report for four clients. Which client should the
nurse assess first?
A. A client with heart failure who has 2+ pitting edema in the lower extremities
B. A client with diabetes mellitus who has a blood glucose of 58 mg/dL and is diaphoretic
C. A client with chronic obstructive pulmonary disease who has an oxygen saturation of 90% on 2 L/min
oxygen
D. A client with a hip fracture who reports pain at a level of 6 on a 0-10 scale
💫ANSWER✔️✔️: B. A client with diabetes mellitus who has a blood glucose of 58 mg/dL and is
diaphoretic
💫RATIONALE✔️✔️: A blood glucose of 58 mg/dL with diaphoresis indicates hypoglycemia, which is a life-
threatening emergency that can rapidly progress to seizures, loss of consciousness, and brain damage.
This client requires immediate intervention (e.g., fast-acting carbohydrates or IV dextrose).
---
**Question 6**
A nurse is preparing to administer digoxin 0.25 mg orally. Prior to administration, the nurse checks the
apical pulse and notes it is 52 bpm. The client's baseline pulse is 70-80 bpm. Which action should the
nurse take?
A. Administer the digoxin as ordered
, B. Withhold the digoxin and reassess the pulse in 1 hour
C. Withhold the digoxin and notify the healthcare provider
D. Administer atropine to increase the heart rate first
💫ANSWER✔️✔️: C. Withhold the digoxin and notify the healthcare provider
💫RATIONALE✔️✔️: The general standard is to withhold digoxin if the apical pulse is less than 60 bpm in
adults (or below the prescribed parameter). A rate of 52 bpm with a significant change from baseline
suggests digoxin toxicity or worsening cardiac function. The provider must be notified for further orders,
including a possible ECG and digoxin level.
---
**Question 7**
A client is being discharged after a myocardial infarction. Which statement by the client indicates a need
for further teaching about nitroglycerin tablets?
A. "I will keep my nitroglycerin tablets in the original brown bottle."
B. "I can take up to three tablets, 5 minutes apart, for chest pain."
C. "If I have chest pain, I will take a tablet and wait 10 minutes to see if it works."
D. "I should call 911 if I still have chest pain after taking three tablets."
💫ANSWER✔️✔️: C. "If I have chest pain, I will take a tablet and wait 10 minutes to see if it works."
💫RATIONALE✔️✔️: The correct protocol for sublingual nitroglycerin is to take one tablet at the onset of
chest pain, then call 911 if pain is unrelieved after 5 minutes, and take a second tablet. Waiting 10
minutes delays potentially life-saving treatment. The client should not wait longer than 5 minutes
between doses.
---
**Question 8**
A nurse is assessing a postpartum client who gave birth 12 hours ago. The client reports a heavy, boggy
uterus that deviates to the right. What is the priority nursing action?
Acute & Community-Based Care**
---
**Question 1**
A nurse in the emergency department is assessing a client who was involved in a motor vehicle collision.
The client is restless, diaphoretic, and has a heart rate of 124 bpm. The blood pressure is 88/52 mm Hg.
Which finding is most critical for the nurse to report to the healthcare provider immediately?
A. Heart rate of 124 bpm
B. Restlessness and diaphoresis
C. Blood pressure of 88/52 mm Hg
D. A laceration on the left forearm
💫ANSWER✔️✔️: C. Blood pressure of 88/52 mm Hg
💫RATIONALE✔️✔️: This blood pressure indicates hypovolemic shock (compensated stage transitioning to
decompensated). While tachycardia and restlessness are also signs of shock, the specific BP value below
90/60 mm Hg signifies inadequate tissue perfusion and is a priority for immediate intervention to
prevent irreversible organ damage.
---
**Question 2**
A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). The morning blood
glucose is 420 mg/dL, and serum potassium is 3.2 mEq/L. The nurse reviews the provider’s orders.
Which order should the nurse question?
A. Regular insulin IV continuous infusion at 0.1 unit/kg/hour
B. 0.45% normal saline IV at 250 mL/hour
C. Potassium chloride 20 mEq IV push
,D. Potassium chloride 20 mEq/L added to IV fluids
💫ANSWER✔️✔️: C. Potassium chloride 20 mEq IV push
💫RATIONALE✔️✔️: Potassium is never administered as an IV push due to the risk of fatal cardiac
arrhythmias and cardiac arrest. In DKA with hypokalemia, potassium must be added to IV fluids and
infused slowly, typically at a rate not exceeding 10 mEq/hour.
---
**Question 3**
A nurse is providing dietary teaching to a client with chronic kidney disease (CKD) stage 4. The client
asks, "Why do I need to limit dairy products?" Which response by the nurse is most accurate?
A. "Dairy products increase your risk of developing kidney stones."
B. "Dairy products contain high levels of phosphorus, which can build up in your blood."
C. "Dairy products are high in potassium and can cause dangerous heart rhythms."
D. "Dairy products contribute to fluid retention, worsening your edema."
💫ANSWER✔️✔️: B. "Dairy products contain high levels of phosphorus, which can build up in your
blood."
💫RATIONALE✔️✔️: In CKD stage 4, the kidneys cannot excrete phosphorus, leading to
hyperphosphatemia. Elevated phosphorus binds to calcium, causing hypocalcemia and stimulating PTH
release, which results in renal osteodystrophy. Dairy is a primary source of dietary phosphorus.
---
**Question 4**
A nurse is caring for a client with pneumonia who has a new prescription for ceftriaxone 1 gram IV daily.
The client reports a previous allergic reaction to penicillin. What action should the nurse take first?
A. Administer the ceftriaxone as ordered
B. Request an order for a different antibiotic
C. Assess the client's previous reaction to penicillin
,D. Apply a medical alert bracelet for penicillin allergy
💫ANSWER✔️✔️: C. Assess the client's previous reaction to penicillin
💫RATIONALE✔️✔️: Cross-sensitivity between penicillins and cephalosporins (like ceftriaxone) exists but
is lower than once believed (approx 1-2%). The nurse must first assess the type and severity of the
previous reaction (e.g., anaphylaxis vs. rash). If the reaction was severe, the provider should be notified
to change the antibiotic.
---
**Question 5**
A nurse on a medical-surgical unit receives a handoff report for four clients. Which client should the
nurse assess first?
A. A client with heart failure who has 2+ pitting edema in the lower extremities
B. A client with diabetes mellitus who has a blood glucose of 58 mg/dL and is diaphoretic
C. A client with chronic obstructive pulmonary disease who has an oxygen saturation of 90% on 2 L/min
oxygen
D. A client with a hip fracture who reports pain at a level of 6 on a 0-10 scale
💫ANSWER✔️✔️: B. A client with diabetes mellitus who has a blood glucose of 58 mg/dL and is
diaphoretic
💫RATIONALE✔️✔️: A blood glucose of 58 mg/dL with diaphoresis indicates hypoglycemia, which is a life-
threatening emergency that can rapidly progress to seizures, loss of consciousness, and brain damage.
This client requires immediate intervention (e.g., fast-acting carbohydrates or IV dextrose).
---
**Question 6**
A nurse is preparing to administer digoxin 0.25 mg orally. Prior to administration, the nurse checks the
apical pulse and notes it is 52 bpm. The client's baseline pulse is 70-80 bpm. Which action should the
nurse take?
A. Administer the digoxin as ordered
, B. Withhold the digoxin and reassess the pulse in 1 hour
C. Withhold the digoxin and notify the healthcare provider
D. Administer atropine to increase the heart rate first
💫ANSWER✔️✔️: C. Withhold the digoxin and notify the healthcare provider
💫RATIONALE✔️✔️: The general standard is to withhold digoxin if the apical pulse is less than 60 bpm in
adults (or below the prescribed parameter). A rate of 52 bpm with a significant change from baseline
suggests digoxin toxicity or worsening cardiac function. The provider must be notified for further orders,
including a possible ECG and digoxin level.
---
**Question 7**
A client is being discharged after a myocardial infarction. Which statement by the client indicates a need
for further teaching about nitroglycerin tablets?
A. "I will keep my nitroglycerin tablets in the original brown bottle."
B. "I can take up to three tablets, 5 minutes apart, for chest pain."
C. "If I have chest pain, I will take a tablet and wait 10 minutes to see if it works."
D. "I should call 911 if I still have chest pain after taking three tablets."
💫ANSWER✔️✔️: C. "If I have chest pain, I will take a tablet and wait 10 minutes to see if it works."
💫RATIONALE✔️✔️: The correct protocol for sublingual nitroglycerin is to take one tablet at the onset of
chest pain, then call 911 if pain is unrelieved after 5 minutes, and take a second tablet. Waiting 10
minutes delays potentially life-saving treatment. The client should not wait longer than 5 minutes
between doses.
---
**Question 8**
A nurse is assessing a postpartum client who gave birth 12 hours ago. The client reports a heavy, boggy
uterus that deviates to the right. What is the priority nursing action?
