HESI RN EXIT EXAM NGN 2026–2027 |
COMPREHENSIVE NURSING STUDY GUIDE |
VERIFIED QUESTIONS & ANSWERS | NEXT
GENERATION NCLEX PREP PDF
HESI RN EXIT EXAM NGN 2026–2027
COMPREHENSIVE NURSING STUDY GUIDE | VERIFIED QUESTIONS & ANSWERS
DOCUMENT OVERVIEW
• Comprehensive Next Generation NCLEX (NGN) preparation with strategically
designed questions covering all essential nursing domains
• Study approach: Utilize this material for rigorous self-assessment, identify
knowledge gaps across clinical areas, and build confidence through detailed
EXPERT RATIONALE that explain correct and alternative options
1. A 45-year-old client with hypertension is prescribed lisinopril 10 mg daily.
Which of the following adverse effects should the nurse instruct the client to
report immediately?
A) Increased appetite
B) Dry persistent cough
C) Mild headache
D) Slight dizziness upon standing
E) Yellow discoloration of skin and sclera
CORRECT ANSWER: E) Yellow discoloration of skin and sclera
EXPERT RATIONALE: Yellow discoloration of skin and sclera indicates jaundice
and suggests liver dysfunction or hepatotoxicity, which is a serious adverse effect
requiring immediate medical attention. While ACE inhibitors like lisinopril can cause
a dry cough (B), this is common and annoying but not immediately dangerous.
,Increased appetite (A) is not an adverse effect of lisinopril. Mild headache (C) and
dizziness (D) are common side effects that typically resolve with continued use and
do not require immediate intervention.
2. A nurse is caring for a client receiving IV potassium replacement therapy.
Which nursing action is MOST important to prevent complications?
A) Administer the potassium through a peripheral IV at any available site
B) Infuse potassium rapidly to increase serum levels quickly
C) Verify the IV site is patent and ensure it is administered through a large bore IV in
a peripheral vein
D) Mix potassium with normal saline and administer over 30 minutes
E) Encourage the client to void frequently during infusion
CORRECT ANSWER: C) Verify the IV site is patent and ensure it is administered
through a large bore IV in a peripheral vein
EXPERT RATIONALE: Potassium is highly irritating to vessel walls and can cause
serious complications including thrombophlebitis, phlebitis, and tissue necrosis. A
large bore IV (18-20 gauge) in a peripheral vein allows proper dilution and flow rate.
A patent line must be verified to prevent extravasation. Potassium should NEVER be
given rapidly (B) as this causes hyperkalemia and cardiac dysrhythmias. Mixing with
normal saline (D) is correct but incomplete without emphasizing the importance of
line assessment. Frequent voiding (E) is unrelated to potassium infusion safety.
3. A 72-year-old client with chronic kidney disease (CKD) stage 3 has a serum
creatinine of 2.1 mg/dL. The nurse knows that which of the following
medications should be avoided or used with extreme caution in this client?
A) Metformin
B) Lisinopril
C) Amlodipine
,D) Omeprazole
E) Aspirin
CORRECT ANSWER: A) Metformin
EXPERT RATIONALE: Metformin is contraindicated in CKD because it can
accumulate to toxic levels when renal function is impaired, increasing the risk of
lactic acidosis, a life-threatening complication. With a creatinine of 2.1 mg/dL
indicating moderate renal impairment, metformin should be avoided. Lisinopril (B)
may be used cautiously and is actually beneficial in CKD for renoprotection.
Amlodipine (C) and omeprazole (D) are metabolized by the liver and are generally
safe in renal disease. Aspirin (E) is safe at therapeutic doses in CKD.
4. A client is diagnosed with acute respiratory distress syndrome (ARDS). The
nurse observes the client has a respiratory rate of 32 breaths/minute, SpO2 of
88% on 100% oxygen via non-rebreather mask, and bilateral crackles. Which
nursing intervention is the PRIORITY?
A) Place the client in a supine position to decrease work of breathing
B) Prepare for intubation and mechanical ventilation
C) Administer IV fluid bolus to improve oxygenation
D) Initiate prone positioning therapy
E) Encourage deep breathing and coughing exercises
CORRECT ANSWER: B) Prepare for intubation and mechanical ventilation
EXPERT RATIONALE: This client is in severe respiratory distress with signs of
ARDS (high RR, low SpO2 despite high oxygen, bilateral crackles). The SpO2 of 88%
on 100% oxygen indicates severe hypoxemia refractory to supplemental oxygen,
which is a hallmark of ARDS. Mechanical ventilation is the priority intervention to
support oxygenation and ventilation. Supine position (A) would worsen
oxygenation. IV fluids (C) are contraindicated in ARDS as they worsen pulmonary
edema. Prone positioning (D) may be beneficial but only AFTER intubation. Deep
breathing (E) is inadequate for this severity.
, 5. A client with sepsis has a lactate level of 4.2 mmol/L (normal <2). The nurse
recognizes this indicates:
A) Adequate tissue oxygenation and perfusion
B) Inadequate tissue oxygenation causing anaerobic metabolism
C) Hyperventilation and respiratory alkalosis
D) Successful antibiotic therapy
E) Early recovery phase of sepsis
CORRECT ANSWER: B) Inadequate tissue oxygenation causing anaerobic
metabolism
EXPERT RATIONALE: Elevated lactate (>2 mmol/L) indicates tissue hypoxia and
anaerobic metabolism, which produces lactate as a byproduct. This is a sign of
inadequate tissue perfusion and is associated with poor prognosis in sepsis. It
reflects cellular dysfunction at the mitochondrial level. Option A is incorrect—
elevated lactate indicates poor oxygenation, not adequate. Option C confuses
lactate with acid-base status. Option D is incorrect—lactate levels are independent
of antibiotic response. Option E is false—elevated lactate indicates worsening
sepsis, not recovery.
6. A nurse is preparing to administer digoxin to a client with atrial fibrillation.
Before administration, which finding would be MOST concerning?
A) Apical heart rate of 68 bpm
B) Apical heart rate of 45 bpm with irregular rhythm
C) Serum potassium of 3.8 mEq/L
D) Blood pressure of 118/76 mmHg
E) Respiratory rate of 18 breaths/minute
CORRECT ANSWER: B) Apical heart rate of 45 bpm with irregular rhythm
COMPREHENSIVE NURSING STUDY GUIDE |
VERIFIED QUESTIONS & ANSWERS | NEXT
GENERATION NCLEX PREP PDF
HESI RN EXIT EXAM NGN 2026–2027
COMPREHENSIVE NURSING STUDY GUIDE | VERIFIED QUESTIONS & ANSWERS
DOCUMENT OVERVIEW
• Comprehensive Next Generation NCLEX (NGN) preparation with strategically
designed questions covering all essential nursing domains
• Study approach: Utilize this material for rigorous self-assessment, identify
knowledge gaps across clinical areas, and build confidence through detailed
EXPERT RATIONALE that explain correct and alternative options
1. A 45-year-old client with hypertension is prescribed lisinopril 10 mg daily.
Which of the following adverse effects should the nurse instruct the client to
report immediately?
A) Increased appetite
B) Dry persistent cough
C) Mild headache
D) Slight dizziness upon standing
E) Yellow discoloration of skin and sclera
CORRECT ANSWER: E) Yellow discoloration of skin and sclera
EXPERT RATIONALE: Yellow discoloration of skin and sclera indicates jaundice
and suggests liver dysfunction or hepatotoxicity, which is a serious adverse effect
requiring immediate medical attention. While ACE inhibitors like lisinopril can cause
a dry cough (B), this is common and annoying but not immediately dangerous.
,Increased appetite (A) is not an adverse effect of lisinopril. Mild headache (C) and
dizziness (D) are common side effects that typically resolve with continued use and
do not require immediate intervention.
2. A nurse is caring for a client receiving IV potassium replacement therapy.
Which nursing action is MOST important to prevent complications?
A) Administer the potassium through a peripheral IV at any available site
B) Infuse potassium rapidly to increase serum levels quickly
C) Verify the IV site is patent and ensure it is administered through a large bore IV in
a peripheral vein
D) Mix potassium with normal saline and administer over 30 minutes
E) Encourage the client to void frequently during infusion
CORRECT ANSWER: C) Verify the IV site is patent and ensure it is administered
through a large bore IV in a peripheral vein
EXPERT RATIONALE: Potassium is highly irritating to vessel walls and can cause
serious complications including thrombophlebitis, phlebitis, and tissue necrosis. A
large bore IV (18-20 gauge) in a peripheral vein allows proper dilution and flow rate.
A patent line must be verified to prevent extravasation. Potassium should NEVER be
given rapidly (B) as this causes hyperkalemia and cardiac dysrhythmias. Mixing with
normal saline (D) is correct but incomplete without emphasizing the importance of
line assessment. Frequent voiding (E) is unrelated to potassium infusion safety.
3. A 72-year-old client with chronic kidney disease (CKD) stage 3 has a serum
creatinine of 2.1 mg/dL. The nurse knows that which of the following
medications should be avoided or used with extreme caution in this client?
A) Metformin
B) Lisinopril
C) Amlodipine
,D) Omeprazole
E) Aspirin
CORRECT ANSWER: A) Metformin
EXPERT RATIONALE: Metformin is contraindicated in CKD because it can
accumulate to toxic levels when renal function is impaired, increasing the risk of
lactic acidosis, a life-threatening complication. With a creatinine of 2.1 mg/dL
indicating moderate renal impairment, metformin should be avoided. Lisinopril (B)
may be used cautiously and is actually beneficial in CKD for renoprotection.
Amlodipine (C) and omeprazole (D) are metabolized by the liver and are generally
safe in renal disease. Aspirin (E) is safe at therapeutic doses in CKD.
4. A client is diagnosed with acute respiratory distress syndrome (ARDS). The
nurse observes the client has a respiratory rate of 32 breaths/minute, SpO2 of
88% on 100% oxygen via non-rebreather mask, and bilateral crackles. Which
nursing intervention is the PRIORITY?
A) Place the client in a supine position to decrease work of breathing
B) Prepare for intubation and mechanical ventilation
C) Administer IV fluid bolus to improve oxygenation
D) Initiate prone positioning therapy
E) Encourage deep breathing and coughing exercises
CORRECT ANSWER: B) Prepare for intubation and mechanical ventilation
EXPERT RATIONALE: This client is in severe respiratory distress with signs of
ARDS (high RR, low SpO2 despite high oxygen, bilateral crackles). The SpO2 of 88%
on 100% oxygen indicates severe hypoxemia refractory to supplemental oxygen,
which is a hallmark of ARDS. Mechanical ventilation is the priority intervention to
support oxygenation and ventilation. Supine position (A) would worsen
oxygenation. IV fluids (C) are contraindicated in ARDS as they worsen pulmonary
edema. Prone positioning (D) may be beneficial but only AFTER intubation. Deep
breathing (E) is inadequate for this severity.
, 5. A client with sepsis has a lactate level of 4.2 mmol/L (normal <2). The nurse
recognizes this indicates:
A) Adequate tissue oxygenation and perfusion
B) Inadequate tissue oxygenation causing anaerobic metabolism
C) Hyperventilation and respiratory alkalosis
D) Successful antibiotic therapy
E) Early recovery phase of sepsis
CORRECT ANSWER: B) Inadequate tissue oxygenation causing anaerobic
metabolism
EXPERT RATIONALE: Elevated lactate (>2 mmol/L) indicates tissue hypoxia and
anaerobic metabolism, which produces lactate as a byproduct. This is a sign of
inadequate tissue perfusion and is associated with poor prognosis in sepsis. It
reflects cellular dysfunction at the mitochondrial level. Option A is incorrect—
elevated lactate indicates poor oxygenation, not adequate. Option C confuses
lactate with acid-base status. Option D is incorrect—lactate levels are independent
of antibiotic response. Option E is false—elevated lactate indicates worsening
sepsis, not recovery.
6. A nurse is preparing to administer digoxin to a client with atrial fibrillation.
Before administration, which finding would be MOST concerning?
A) Apical heart rate of 68 bpm
B) Apical heart rate of 45 bpm with irregular rhythm
C) Serum potassium of 3.8 mEq/L
D) Blood pressure of 118/76 mmHg
E) Respiratory rate of 18 breaths/minute
CORRECT ANSWER: B) Apical heart rate of 45 bpm with irregular rhythm
