**HESI RN Exit Exam 2024 NGN - Capstone
Performance**
1. Nurse assesses pt 4 hr post-op abdominal surgery. Abdomen rigid, absent bowel sounds, HR 120, BP
85/50. Priority action?
💫RATIONALE✔️✔️: Peritonitis from anastomotic leak. Notify surgeon, prepare for emergency surgery.
💫ANSWER✔️✔️: C. Notify surgeon immediately.
2. Pt w/ heart failure, EF 25%, on digoxin, furosemide, lisinopril. Vomiting, yellow vision, HR 48. Digoxin
level 3.2. Action?
💫RATIONALE✔️✔️: Digoxin toxicity >2.0. Hold digoxin, check K+, prepare Digibind if severe.
💫ANSWER✔️✔️: B. Hold digoxin.
3. Pt w/ COPD, O2 sat 89% on 2L, ABG: pH 7.31, PaCO2 70, HCO3 32. Which change to O2 order?
💫RATIONALE✔️✔️: Chronic CO2 retainer. Target sat 88-92%. Increase to 3L, recheck ABG.
💫ANSWER✔️✔️: A. Increase O2 to 3L.
4. Nurse teaching pt w/ new colostomy. Which statement indicates understanding?
💫RATIONALE✔️✔️: Stoma should be pink/moist. Pale, blue, or black indicates ischemia, report
immediately.
💫ANSWER✔️✔️: D. "A dark purple stoma needs immediate medical attention."
5. Pt w/ schizophrenia, clozapine 300 mg daily, fever 39°C, sore throat, ANC 500. Action?
💫RATIONALE✔️✔️: Agranulocytosis (ANC <500). Discontinue clozapine, reverse isolation, antibiotics.
💫ANSWER✔️✔️: C. Discontinue clozapine.
, 6. Newborn, 2 hr old, respiratory rate 80, grunting, nasal flaring, O2 sat 85% on RA. History: maternal
diabetes, 36 weeks. Likely?
💫RATIONALE✔️✔️: Respiratory distress syndrome (RDS) from surfactant deficiency. CPAP, surfactant.
💫ANSWER✔️✔️: B. RDS.
7. Nurse assessing pt w/ DKA, glucose 650, anion gap 24, HCO3 10, K+ 3.0. After insulin drip started,
which electrolyte priority?
💫RATIONALE✔️✔️: Insulin shifts K+ intracellularly, worsening hypokalemia. Add K+ to IV fluids.
💫ANSWER✔️✔️: C. Potassium.
8. Pt w/ preeclampsia, MgSO4 infusion, DTR 1+, RR 12, urine output 25 mL/hr. Action?
💫RATIONALE✔️✔️: Mg toxicity (RR <12, UO <30). Stop infusion, calcium gluconate 1 g IV.
💫ANSWER✔️✔️: D. Stop MgSO4.
9. Nurse teaching pt w/ new permanent pacemaker. Which statement correct?
💫RATIONALE✔️✔️: MRI only if pacemaker labeled MRI-conditional. Avoid direct contact with magnets.
💫ANSWER✔️✔️: A. "No MRI unless specified as safe."
10. Pt w/ bipolar disorder, acute mania, agitated, not slept 3 days, refusing PO meds. IM medication?
💫RATIONALE✔️✔️: IM haloperidol 5 mg + lorazepam 2 mg for rapid tranquilization.
💫ANSWER✔️✔️: C. Haloperidol and lorazepam.
11. Newborn, 48 hr old, breastfed, jaundice to abdomen, bilirubin 16 mg/dL, direct Coombs negative,
mother A+, baby A+. Likely?
💫RATIONALE✔️✔️: Physiologic jaundice day 2-3. Continue breastfeeding Q2-3H.
💫ANSWER✔️✔️: B. Physiologic jaundice.
12. Nurse assessing pt w/ acute pancreatitis, Grey Turner sign (flank ecchymosis). Indicates?
💫RATIONALE✔️✔️: Retroperitoneal hemorrhage from necrotizing pancreatitis. High mortality.
Performance**
1. Nurse assesses pt 4 hr post-op abdominal surgery. Abdomen rigid, absent bowel sounds, HR 120, BP
85/50. Priority action?
💫RATIONALE✔️✔️: Peritonitis from anastomotic leak. Notify surgeon, prepare for emergency surgery.
💫ANSWER✔️✔️: C. Notify surgeon immediately.
2. Pt w/ heart failure, EF 25%, on digoxin, furosemide, lisinopril. Vomiting, yellow vision, HR 48. Digoxin
level 3.2. Action?
💫RATIONALE✔️✔️: Digoxin toxicity >2.0. Hold digoxin, check K+, prepare Digibind if severe.
💫ANSWER✔️✔️: B. Hold digoxin.
3. Pt w/ COPD, O2 sat 89% on 2L, ABG: pH 7.31, PaCO2 70, HCO3 32. Which change to O2 order?
💫RATIONALE✔️✔️: Chronic CO2 retainer. Target sat 88-92%. Increase to 3L, recheck ABG.
💫ANSWER✔️✔️: A. Increase O2 to 3L.
4. Nurse teaching pt w/ new colostomy. Which statement indicates understanding?
💫RATIONALE✔️✔️: Stoma should be pink/moist. Pale, blue, or black indicates ischemia, report
immediately.
💫ANSWER✔️✔️: D. "A dark purple stoma needs immediate medical attention."
5. Pt w/ schizophrenia, clozapine 300 mg daily, fever 39°C, sore throat, ANC 500. Action?
💫RATIONALE✔️✔️: Agranulocytosis (ANC <500). Discontinue clozapine, reverse isolation, antibiotics.
💫ANSWER✔️✔️: C. Discontinue clozapine.
, 6. Newborn, 2 hr old, respiratory rate 80, grunting, nasal flaring, O2 sat 85% on RA. History: maternal
diabetes, 36 weeks. Likely?
💫RATIONALE✔️✔️: Respiratory distress syndrome (RDS) from surfactant deficiency. CPAP, surfactant.
💫ANSWER✔️✔️: B. RDS.
7. Nurse assessing pt w/ DKA, glucose 650, anion gap 24, HCO3 10, K+ 3.0. After insulin drip started,
which electrolyte priority?
💫RATIONALE✔️✔️: Insulin shifts K+ intracellularly, worsening hypokalemia. Add K+ to IV fluids.
💫ANSWER✔️✔️: C. Potassium.
8. Pt w/ preeclampsia, MgSO4 infusion, DTR 1+, RR 12, urine output 25 mL/hr. Action?
💫RATIONALE✔️✔️: Mg toxicity (RR <12, UO <30). Stop infusion, calcium gluconate 1 g IV.
💫ANSWER✔️✔️: D. Stop MgSO4.
9. Nurse teaching pt w/ new permanent pacemaker. Which statement correct?
💫RATIONALE✔️✔️: MRI only if pacemaker labeled MRI-conditional. Avoid direct contact with magnets.
💫ANSWER✔️✔️: A. "No MRI unless specified as safe."
10. Pt w/ bipolar disorder, acute mania, agitated, not slept 3 days, refusing PO meds. IM medication?
💫RATIONALE✔️✔️: IM haloperidol 5 mg + lorazepam 2 mg for rapid tranquilization.
💫ANSWER✔️✔️: C. Haloperidol and lorazepam.
11. Newborn, 48 hr old, breastfed, jaundice to abdomen, bilirubin 16 mg/dL, direct Coombs negative,
mother A+, baby A+. Likely?
💫RATIONALE✔️✔️: Physiologic jaundice day 2-3. Continue breastfeeding Q2-3H.
💫ANSWER✔️✔️: B. Physiologic jaundice.
12. Nurse assessing pt w/ acute pancreatitis, Grey Turner sign (flank ecchymosis). Indicates?
💫RATIONALE✔️✔️: Retroperitoneal hemorrhage from necrotizing pancreatitis. High mortality.
