HESI RN Exit Exam NGN Version B: Complete 2026/2027
Questions and Correct Answers
HESI RN Exit Exam (Next Generation NCLEX Format) | Key Domains: Clinical Judgment (Recognize
Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes),
Management of Care, Safety & Infection Control, Health Promotion & Maintenance, Psychosocial
Integrity, Pharmacological Therapies, Physiological Adaptation, and Complex Patient Scenarios |
Expert-Aligned Structure | NGN Version B Exam Format
Introduction
This structured HESI RN Exit Exam (NGN Version B) for 2026/2027 provides a comprehensive set
of Next Generation NCLEX-style questions with correct answers and rationales. It is designed to
predict NCLEX-RN readiness by assessing clinical judgment through unfolding case studies,
extended multiple response, matrix/grid, and other innovative item types that require higher-order
thinking.
Exam Structure:
• Version B Comprehensive NGN Exam: (75 NGN-STYLE ITEMS)
Answer Format
All correct answers and selected actions must appear in bold and cyan blue, accompanied by
concise rationales explaining the specific step of the clinical judgment model utilized, the analysis of
patient data, the prioritization of nursing actions, and why alternative options or unselected actions
demonstrate flawed clinical reasoning or unsafe practice.
1. (Unfolding Case – Part 1) A 68-year-old male is admitted with acute shortness of breath.
Vital signs: T 99.2°F, HR 118 bpm, RR 28/min, BP 178/96 mm Hg, SpO₂ 88% on room air.
What is the nurse’s priority action? (Select one.)
A. Administer furosemide IV
B. Elevate the head of the bed to High Fowler’s
C. Apply oxygen via nasal cannula
D. Notify the provider immediately
,B. Elevate the head of the bed to High Fowler’s
This action addresses the immediate life threat (impaired gas exchange) by reducing venous return
and improving lung expansion—aligning with the ABCs (Airway, Breathing, Circulation). Oxygen (C) is
important but secondary to positioning in acute pulmonary distress. Medication (A) and notification
(D) follow stabilization.
1. (Unfolding Case – Part 2) The client’s SpO₂ improves to 92% with High Fowler’s position.
Lung auscultation reveals bilateral crackles. The provider orders a chest X-ray and BNP. The
X-ray shows pulmonary edema; BNP is 650 pg/mL. What is the most likely diagnosis? (Select
one.)
A. Pneumonia
B. Pulmonary embolism
C. Heart failure
D. COPD exacerbation
C. Heart failure
Pulmonary edema, elevated BNP (>100 pg/mL), crackles, and dyspnea are classic for heart failure.
Pneumonia (A) would show infiltrates and fever. PE (B) causes pleuritic pain and hypoxia without
crackles. COPD (D) presents with wheezing and prolonged expiration.
1. (Unfolding Case – Part 3) The provider prescribes furosemide 40 mg IV, lisinopril 10 mg
PO, and oxygen to keep SpO₂ >92%. Which action should the nurse take first? (Select one.)
A. Administer oxygen
B. Give furosemide IV
C. Administer lisinopril
D. Reassess lung sounds
A. Administer oxygen
,Oxygen ensures adequate tissue perfusion and supports breathing while other interventions take effect.
Furosemide (B) reduces fluid but takes time. Lisinopril (C) is for long-term management. Reassessment
(D) is ongoing but not the first action.
2. (Matrix/Grid Item) A nurse is reviewing laboratory results for four clients. Which findings
require immediate action? (Check all that apply.)
A. Client with heart failure: potassium 2.8 mEq/L
B. Client post-op day 1: WBC 11,000/µL
C. Client with diabetes: blood glucose 58 mg/dL
D. Client with DKA: pH 7.28
E. Client with cirrhosis: platelets 150,000/µL
A, C, D
A: Hypokalemia (<3.5) can cause lethal dysrhythmias—requires urgent replacement.
C: Hypoglycemia (<70) in a conscious patient requires immediate fast-acting carbohydrate.
D: pH 7.28 indicates severe acidosis in DKA—needs IV fluids and insulin.
WBC 11,000 (B) is normal post-op. Platelets 150,000 (E) are within normal limits (150–400k).
3. (Bowtie Item) A client with septic shock is on norepinephrine. Which assessment findings
indicate effectiveness of treatment? (Select one best outcome on the right.)
Left (Interventions): Norepinephrine infusion, IV fluids, blood cultures, antibiotics
A. MAP ≥65 mm Hg
B. Temperature 100.4°F
C. Urine output 20 mL/hr
, D. WBC 18,000/µL
A. MAP ≥65 mm Hg
In septic shock, the primary goal of vasopressors like norepinephrine is to maintain mean arterial
pressure (MAP) ≥65 mm Hg to ensure organ perfusion. Urine output (C) should be >30 mL/hr. Fever
(B) and elevated WBC (D) indicate ongoing infection but not hemodynamic stability.
4. (Extended Multiple Response) A nurse is preparing to discharge a client with heart failure.
Which instructions are essential for self-management? (Select all that apply.)
A. “Weigh yourself daily at the same time.”
B. “Limit sodium to less than 2,000 mg per day.”
C. “Take your diuretic only when you feel swollen.”
D. “Report weight gain of 2 pounds in one day.”
E. “Stop taking ACE inhibitors if you develop a cough.”
A, B, D
A: Daily weights detect fluid retention early.
B: Sodium restriction reduces fluid retention.
D: Sudden weight gain (>2 lbs/day or >5 lbs/week) signals worsening HF.
Diuretics (C) must be taken as prescribed, not PRN. ACEi cough (E) is common but not a reason to
stop—notify provider instead.
5. (Case Study) A 24-year-old female presents with sudden onset of headache, photophobia,
and neck stiffness. Temp 102.8°F. What is the priority nursing action? (Select one.)
A. Administer acetaminophen
B. Prepare for lumbar puncture
Questions and Correct Answers
HESI RN Exit Exam (Next Generation NCLEX Format) | Key Domains: Clinical Judgment (Recognize
Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes),
Management of Care, Safety & Infection Control, Health Promotion & Maintenance, Psychosocial
Integrity, Pharmacological Therapies, Physiological Adaptation, and Complex Patient Scenarios |
Expert-Aligned Structure | NGN Version B Exam Format
Introduction
This structured HESI RN Exit Exam (NGN Version B) for 2026/2027 provides a comprehensive set
of Next Generation NCLEX-style questions with correct answers and rationales. It is designed to
predict NCLEX-RN readiness by assessing clinical judgment through unfolding case studies,
extended multiple response, matrix/grid, and other innovative item types that require higher-order
thinking.
Exam Structure:
• Version B Comprehensive NGN Exam: (75 NGN-STYLE ITEMS)
Answer Format
All correct answers and selected actions must appear in bold and cyan blue, accompanied by
concise rationales explaining the specific step of the clinical judgment model utilized, the analysis of
patient data, the prioritization of nursing actions, and why alternative options or unselected actions
demonstrate flawed clinical reasoning or unsafe practice.
1. (Unfolding Case – Part 1) A 68-year-old male is admitted with acute shortness of breath.
Vital signs: T 99.2°F, HR 118 bpm, RR 28/min, BP 178/96 mm Hg, SpO₂ 88% on room air.
What is the nurse’s priority action? (Select one.)
A. Administer furosemide IV
B. Elevate the head of the bed to High Fowler’s
C. Apply oxygen via nasal cannula
D. Notify the provider immediately
,B. Elevate the head of the bed to High Fowler’s
This action addresses the immediate life threat (impaired gas exchange) by reducing venous return
and improving lung expansion—aligning with the ABCs (Airway, Breathing, Circulation). Oxygen (C) is
important but secondary to positioning in acute pulmonary distress. Medication (A) and notification
(D) follow stabilization.
1. (Unfolding Case – Part 2) The client’s SpO₂ improves to 92% with High Fowler’s position.
Lung auscultation reveals bilateral crackles. The provider orders a chest X-ray and BNP. The
X-ray shows pulmonary edema; BNP is 650 pg/mL. What is the most likely diagnosis? (Select
one.)
A. Pneumonia
B. Pulmonary embolism
C. Heart failure
D. COPD exacerbation
C. Heart failure
Pulmonary edema, elevated BNP (>100 pg/mL), crackles, and dyspnea are classic for heart failure.
Pneumonia (A) would show infiltrates and fever. PE (B) causes pleuritic pain and hypoxia without
crackles. COPD (D) presents with wheezing and prolonged expiration.
1. (Unfolding Case – Part 3) The provider prescribes furosemide 40 mg IV, lisinopril 10 mg
PO, and oxygen to keep SpO₂ >92%. Which action should the nurse take first? (Select one.)
A. Administer oxygen
B. Give furosemide IV
C. Administer lisinopril
D. Reassess lung sounds
A. Administer oxygen
,Oxygen ensures adequate tissue perfusion and supports breathing while other interventions take effect.
Furosemide (B) reduces fluid but takes time. Lisinopril (C) is for long-term management. Reassessment
(D) is ongoing but not the first action.
2. (Matrix/Grid Item) A nurse is reviewing laboratory results for four clients. Which findings
require immediate action? (Check all that apply.)
A. Client with heart failure: potassium 2.8 mEq/L
B. Client post-op day 1: WBC 11,000/µL
C. Client with diabetes: blood glucose 58 mg/dL
D. Client with DKA: pH 7.28
E. Client with cirrhosis: platelets 150,000/µL
A, C, D
A: Hypokalemia (<3.5) can cause lethal dysrhythmias—requires urgent replacement.
C: Hypoglycemia (<70) in a conscious patient requires immediate fast-acting carbohydrate.
D: pH 7.28 indicates severe acidosis in DKA—needs IV fluids and insulin.
WBC 11,000 (B) is normal post-op. Platelets 150,000 (E) are within normal limits (150–400k).
3. (Bowtie Item) A client with septic shock is on norepinephrine. Which assessment findings
indicate effectiveness of treatment? (Select one best outcome on the right.)
Left (Interventions): Norepinephrine infusion, IV fluids, blood cultures, antibiotics
A. MAP ≥65 mm Hg
B. Temperature 100.4°F
C. Urine output 20 mL/hr
, D. WBC 18,000/µL
A. MAP ≥65 mm Hg
In septic shock, the primary goal of vasopressors like norepinephrine is to maintain mean arterial
pressure (MAP) ≥65 mm Hg to ensure organ perfusion. Urine output (C) should be >30 mL/hr. Fever
(B) and elevated WBC (D) indicate ongoing infection but not hemodynamic stability.
4. (Extended Multiple Response) A nurse is preparing to discharge a client with heart failure.
Which instructions are essential for self-management? (Select all that apply.)
A. “Weigh yourself daily at the same time.”
B. “Limit sodium to less than 2,000 mg per day.”
C. “Take your diuretic only when you feel swollen.”
D. “Report weight gain of 2 pounds in one day.”
E. “Stop taking ACE inhibitors if you develop a cough.”
A, B, D
A: Daily weights detect fluid retention early.
B: Sodium restriction reduces fluid retention.
D: Sudden weight gain (>2 lbs/day or >5 lbs/week) signals worsening HF.
Diuretics (C) must be taken as prescribed, not PRN. ACEi cough (E) is common but not a reason to
stop—notify provider instead.
5. (Case Study) A 24-year-old female presents with sudden onset of headache, photophobia,
and neck stiffness. Temp 102.8°F. What is the priority nursing action? (Select one.)
A. Administer acetaminophen
B. Prepare for lumbar puncture
