RN HESI Exit Exam 2026/2027 Latest NGN Version
with 130 Verified Questions and Answers for RN Exit
Exam Success
1. A patient with a history of chronic kidney disease (stage 4) is admitted with hyperkalemia (6.8
mEq/L) and ECG changes showing peaked T waves. The provider prescribes intravenous calcium
gluconate, insulin with dextrose, and albuterol nebulization. Which of the following actions by the
nurse is MOST critical to perform before administering these medications?
A. Obtain a serum potassium level to confirm the lab value.
B. Assess the patient's respiratory rate and oxygen saturation.
C. Verify the patient's serum calcium level to ensure it is not elevated.
D. Place the patient on a cardiac monitor and obtain a 12-lead ECG.
Answer: D
Rationale: In hyperkalemia with ECG changes, cardiac monitoring is essential before treatment to detect
dysrhythmias and guide therapy. While confirming potassium level is important, the ECG changes
indicate acute need; monitoring allows immediate identification of worsening rhythm. Calcium
gluconate stabilizes the cardiac membrane, but monitoring must be in place. Respiratory assessment and
calcium level are secondary.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for treatment of
pulmonary embolism. The activated partial thromboplastin time (aPTT) result is 120 seconds, and
the patient has new onset of hematuria and epistaxis. Which of the following actions should the
nurse take FIRST?
A. Stop the heparin infusion immediately.
B. Administer protamine sulfate as prescribed.
C. Notify the healthcare provider of the aPTT and bleeding.
D. Decrease the heparin infusion rate by 50% per protocol.
Answer: A
Rationale: With a critically elevated aPTT (therapeutic range ~60-80 seconds) and active bleeding, the
priority is to stop the heparin infusion to prevent further anticoagulation. Protamine sulfate is the
antidote but should be given after stopping the infusion and notifying the provider. Decreasing the rate is
insufficient. Notifying the provider is important but the immediate action is to stop the infusion.
3. A patient with severe sepsis is receiving norepinephrine via central line for hypotension
refractory to fluid resuscitation. The nurse notes that the patient's blood pressure remains low
(82/44 mm Hg) despite increasing the dose. Which of the following additional interventions should
the nurse anticipate as MOST appropriate?
A. Administer a fluid bolus of 500 mL normal saline.
Page 1
,B. Start an infusion of vasopressin as a second vasopressor.
C. Increase the norepinephrine rate to the maximum safe dose.
D. Obtain a serum lactate level to assess tissue perfusion.
Answer: B
Rationale: In septic shock with norepinephrine-resistant hypotension, adding vasopressin is
recommended by guidelines to achieve target MAP. Fluid resuscitation should have been optimized;
additional bolus may be considered but vasopressin is a specific second-line agent. Increasing
norepinephrine further may cause excessive vasoconstriction. Lactate is important but does not address
the immediate hypotension.
4. A nurse is teaching a patient with a new diagnosis of type 2 diabetes mellitus about
self-management. The patient asks, "Why do I need to check my blood sugar before meals and at
bedtime?" Which of the following responses by the nurse is MOST accurate?
A. It helps to determine if your insulin dose needs adjustment.
B. It allows us to see how well your pancreas is producing insulin.
C. It provides information about your average blood glucose over the past 24 hours.
D. It helps to identify patterns of hyperglycemia and hypoglycemia related to meals and activity.
Answer: D
Rationale: Pre-meal and bedtime glucose monitoring helps identify patterns influenced by meals, activity,
and medications, enabling adjustments to treatment. Option A is too narrow (insulin not always used).
Option B is inaccurate; CGM or A1C provides average glucose. Option D is the most comprehensive
and patient-centered explanation.
5. A patient with advanced liver cirrhosis is admitted with acute variceal hemorrhage. After initial
resuscitation, the provider prescribes octreotide and endoscopic variceal ligation. Which of the
following findings would be MOST concerning during the procedure?
A. The patient's heart rate increases from 90 to 110 beats per minute.
B. The patient's oxygen saturation drops to 88% on room air.
C. The patient has a single episode of hematemesis during the procedure.
D. The patient's blood pressure decreases from 110/70 to 95/60 mm Hg.
Answer: B
Rationale: Hypoxemia during endoscopy may indicate aspiration, airway compromise, or
sedation-related respiratory depression, requiring immediate intervention. Tachycardia and mild
hypotension can be expected from bleeding or sedation. Hematemesis may occur during ligation but is
not as immediately life-threatening as hypoxemia.
6. A nurse is evaluating a patient's arterial blood gas results: pH 7.32, PaCO2 50 mm Hg, HCO3-
24 mEq/L. The patient has a history of chronic obstructive pulmonary disease (COPD) and is
currently experiencing increased dyspnea and confusion. Which of the following is the nurse's
priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Assess the patient's respiratory rate and effort.
C. Notify the healthcare provider of the ABG results.
Page 2
,D. Prepare for noninvasive positive pressure ventilation.
Answer: B
Rationale: The ABG shows acute-on-chronic respiratory acidosis (compensated baseline COPD with
acute worsening). Before any intervention, the nurse must assess the patient's current respiratory status
to determine the severity and appropriate response. Oxygen may be needed but assessment comes first.
NPPV might be indicated but requires provider order and assessment. Notifying is important but not
priority.
7. A patient with acute pancreatitis is receiving enteral nutrition via nasojejunal tube. The nurse
notes that the patient's serum triglyceride level is 1800 mg/dL. Which of the following actions
should the nurse take?
A. Continue the enteral feeding and monitor triglycerides daily.
B. Hold the enteral feeding and notify the provider of the triglyceride level.
C. Change the formula to a low-fat, high-carbohydrate formula.
D. Administer insulin as prescribed to lower triglyceride levels.
Answer: B
Rationale: Severe hypertriglyceridemia (>1000 mg/dL) can exacerbate pancreatitis and increase risk of
complications. Enteral feeding, even low-fat, may contribute; holding and notifying the provider is
appropriate. Insulin can lower triglycerides but is not first-line without order. Changing formula may
not be sufficient.
8. A nurse is caring for a patient with a chest tube connected to a dry suction water seal drainage
system. The nurse observes continuous bubbling in the water seal chamber. Which of the following
is the MOST likely cause?
A. An air leak in the system or from the patient's pleural space.
B. The suction pressure is set too high.
C. The drainage system is not positioned below the patient's chest.
D. The chest tube is occluded by a clot.
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, either from the patient
(e.g., bronchopleural fistula) or from a disconnection/crack in the system. Suction pressure that is too
high may cause excessive bubbling in the suction chamber, not water seal. Positioning below chest is for
drainage, not bubbling. Occlusion would decrease or stop bubbling.
9. A patient with a history of atrial fibrillation is taking warfarin. The international normalized
ratio (INR) is 4.8. The patient has no signs of bleeding. Which of the following is the nurse's BEST
action?
A. Administer vitamin K 10 mg orally as prescribed.
B. Hold the next dose of warfarin and notify the provider.
C. Administer fresh frozen plasma (FFP) as prescribed.
D. Continue the warfarin as prescribed and recheck INR in 24 hours.
Answer: B
Page 3
, Rationale: An INR of 4.8 is above therapeutic range (usually 2-3) but without bleeding, the standard action is to hold
warfarin and notify the provider for dose adjustment. Vitamin K is given for significant bleeding or very high INR (>9)
without bleeding. FFP is for urgent reversal with bleeding. Continuing warfarin increases bleeding risk.
10. A nurse is assessing a patient who has just undergone a lumbar puncture. Which of the
following findings would require immediate intervention?
A. The patient reports a mild headache when sitting up.
B. The patient's blood pressure is 100/60 mm Hg.
C. The patient has clear fluid leaking from the puncture site.
D. The patient's heart rate is 56 beats per minute.
Answer: C
Rationale: Clear fluid leaking from the puncture site may indicate cerebrospinal fluid (CSF) leak, which
increases risk of infection and low pressure complications, requiring immediate intervention. Headache
is common post-LP (post-dural puncture headache) but not immediately dangerous. Mild hypotension
and bradycardia may be normal or related to positioning; however, CSF leak is critical.
11. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on
volume-controlled mechanical ventilation. The patient's plateau pressure is 32 cm H2O, and the
tidal volume is set at 6 mL/kg ideal body weight. Which of the following interventions should the
nurse anticipate to reduce the risk of ventilator-induced lung injury?
A. Increase the tidal volume to 10 mL/kg to improve oxygenation
B. Administer a neuromuscular blocking agent to reduce oxygen consumption and improve chest wall
compliance
C. Decrease the positive end-expiratory pressure (PEEP) to minimize barotrauma
D. Switch to pressure-controlled ventilation with a set inspiratory pressure of 35 cm H2O
Answer: B
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (6 mL/kg) and limiting plateau
pressure to <30 cm H2O. Administering neuromuscular blocking agents can improve chest wall
compliance, reduce oxygen consumption, and decrease ventilator dyssynchrony, thereby reducing the
risk of ventilator-induced lung injury. Increasing tidal volume would worsen lung injury. Decreasing
PEEP could lead to alveolar collapse. Pressure-controlled ventilation with high inspiratory pressure
may cause barotrauma.
12. A nurse is reviewing the laboratory results of a patient with suspected disseminated
intravascular coagulation (DIC). Which combination of findings is most consistent with acute
DIC?
A. Elevated fibrinogen, prolonged PT, normal platelet count
B. Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer, thrombocytopenia
C. Normal PT and aPTT, decreased D-dimer, increased platelet count
D. Elevated fibrinogen, shortened PT, elevated D-dimer, thrombocytosis
Answer: B
Rationale: Acute DIC is characterized by consumption of clotting factors and platelets, leading to
decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer (from fibrinolysis), and
thrombocytopenia. Option A shows elevated fibrinogen and normal platelets, which is more consistent
Page 4
with 130 Verified Questions and Answers for RN Exit
Exam Success
1. A patient with a history of chronic kidney disease (stage 4) is admitted with hyperkalemia (6.8
mEq/L) and ECG changes showing peaked T waves. The provider prescribes intravenous calcium
gluconate, insulin with dextrose, and albuterol nebulization. Which of the following actions by the
nurse is MOST critical to perform before administering these medications?
A. Obtain a serum potassium level to confirm the lab value.
B. Assess the patient's respiratory rate and oxygen saturation.
C. Verify the patient's serum calcium level to ensure it is not elevated.
D. Place the patient on a cardiac monitor and obtain a 12-lead ECG.
Answer: D
Rationale: In hyperkalemia with ECG changes, cardiac monitoring is essential before treatment to detect
dysrhythmias and guide therapy. While confirming potassium level is important, the ECG changes
indicate acute need; monitoring allows immediate identification of worsening rhythm. Calcium
gluconate stabilizes the cardiac membrane, but monitoring must be in place. Respiratory assessment and
calcium level are secondary.
2. A nurse is caring for a patient receiving a continuous infusion of heparin for treatment of
pulmonary embolism. The activated partial thromboplastin time (aPTT) result is 120 seconds, and
the patient has new onset of hematuria and epistaxis. Which of the following actions should the
nurse take FIRST?
A. Stop the heparin infusion immediately.
B. Administer protamine sulfate as prescribed.
C. Notify the healthcare provider of the aPTT and bleeding.
D. Decrease the heparin infusion rate by 50% per protocol.
Answer: A
Rationale: With a critically elevated aPTT (therapeutic range ~60-80 seconds) and active bleeding, the
priority is to stop the heparin infusion to prevent further anticoagulation. Protamine sulfate is the
antidote but should be given after stopping the infusion and notifying the provider. Decreasing the rate is
insufficient. Notifying the provider is important but the immediate action is to stop the infusion.
3. A patient with severe sepsis is receiving norepinephrine via central line for hypotension
refractory to fluid resuscitation. The nurse notes that the patient's blood pressure remains low
(82/44 mm Hg) despite increasing the dose. Which of the following additional interventions should
the nurse anticipate as MOST appropriate?
A. Administer a fluid bolus of 500 mL normal saline.
Page 1
,B. Start an infusion of vasopressin as a second vasopressor.
C. Increase the norepinephrine rate to the maximum safe dose.
D. Obtain a serum lactate level to assess tissue perfusion.
Answer: B
Rationale: In septic shock with norepinephrine-resistant hypotension, adding vasopressin is
recommended by guidelines to achieve target MAP. Fluid resuscitation should have been optimized;
additional bolus may be considered but vasopressin is a specific second-line agent. Increasing
norepinephrine further may cause excessive vasoconstriction. Lactate is important but does not address
the immediate hypotension.
4. A nurse is teaching a patient with a new diagnosis of type 2 diabetes mellitus about
self-management. The patient asks, "Why do I need to check my blood sugar before meals and at
bedtime?" Which of the following responses by the nurse is MOST accurate?
A. It helps to determine if your insulin dose needs adjustment.
B. It allows us to see how well your pancreas is producing insulin.
C. It provides information about your average blood glucose over the past 24 hours.
D. It helps to identify patterns of hyperglycemia and hypoglycemia related to meals and activity.
Answer: D
Rationale: Pre-meal and bedtime glucose monitoring helps identify patterns influenced by meals, activity,
and medications, enabling adjustments to treatment. Option A is too narrow (insulin not always used).
Option B is inaccurate; CGM or A1C provides average glucose. Option D is the most comprehensive
and patient-centered explanation.
5. A patient with advanced liver cirrhosis is admitted with acute variceal hemorrhage. After initial
resuscitation, the provider prescribes octreotide and endoscopic variceal ligation. Which of the
following findings would be MOST concerning during the procedure?
A. The patient's heart rate increases from 90 to 110 beats per minute.
B. The patient's oxygen saturation drops to 88% on room air.
C. The patient has a single episode of hematemesis during the procedure.
D. The patient's blood pressure decreases from 110/70 to 95/60 mm Hg.
Answer: B
Rationale: Hypoxemia during endoscopy may indicate aspiration, airway compromise, or
sedation-related respiratory depression, requiring immediate intervention. Tachycardia and mild
hypotension can be expected from bleeding or sedation. Hematemesis may occur during ligation but is
not as immediately life-threatening as hypoxemia.
6. A nurse is evaluating a patient's arterial blood gas results: pH 7.32, PaCO2 50 mm Hg, HCO3-
24 mEq/L. The patient has a history of chronic obstructive pulmonary disease (COPD) and is
currently experiencing increased dyspnea and confusion. Which of the following is the nurse's
priority action?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Assess the patient's respiratory rate and effort.
C. Notify the healthcare provider of the ABG results.
Page 2
,D. Prepare for noninvasive positive pressure ventilation.
Answer: B
Rationale: The ABG shows acute-on-chronic respiratory acidosis (compensated baseline COPD with
acute worsening). Before any intervention, the nurse must assess the patient's current respiratory status
to determine the severity and appropriate response. Oxygen may be needed but assessment comes first.
NPPV might be indicated but requires provider order and assessment. Notifying is important but not
priority.
7. A patient with acute pancreatitis is receiving enteral nutrition via nasojejunal tube. The nurse
notes that the patient's serum triglyceride level is 1800 mg/dL. Which of the following actions
should the nurse take?
A. Continue the enteral feeding and monitor triglycerides daily.
B. Hold the enteral feeding and notify the provider of the triglyceride level.
C. Change the formula to a low-fat, high-carbohydrate formula.
D. Administer insulin as prescribed to lower triglyceride levels.
Answer: B
Rationale: Severe hypertriglyceridemia (>1000 mg/dL) can exacerbate pancreatitis and increase risk of
complications. Enteral feeding, even low-fat, may contribute; holding and notifying the provider is
appropriate. Insulin can lower triglycerides but is not first-line without order. Changing formula may
not be sufficient.
8. A nurse is caring for a patient with a chest tube connected to a dry suction water seal drainage
system. The nurse observes continuous bubbling in the water seal chamber. Which of the following
is the MOST likely cause?
A. An air leak in the system or from the patient's pleural space.
B. The suction pressure is set too high.
C. The drainage system is not positioned below the patient's chest.
D. The chest tube is occluded by a clot.
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, either from the patient
(e.g., bronchopleural fistula) or from a disconnection/crack in the system. Suction pressure that is too
high may cause excessive bubbling in the suction chamber, not water seal. Positioning below chest is for
drainage, not bubbling. Occlusion would decrease or stop bubbling.
9. A patient with a history of atrial fibrillation is taking warfarin. The international normalized
ratio (INR) is 4.8. The patient has no signs of bleeding. Which of the following is the nurse's BEST
action?
A. Administer vitamin K 10 mg orally as prescribed.
B. Hold the next dose of warfarin and notify the provider.
C. Administer fresh frozen plasma (FFP) as prescribed.
D. Continue the warfarin as prescribed and recheck INR in 24 hours.
Answer: B
Page 3
, Rationale: An INR of 4.8 is above therapeutic range (usually 2-3) but without bleeding, the standard action is to hold
warfarin and notify the provider for dose adjustment. Vitamin K is given for significant bleeding or very high INR (>9)
without bleeding. FFP is for urgent reversal with bleeding. Continuing warfarin increases bleeding risk.
10. A nurse is assessing a patient who has just undergone a lumbar puncture. Which of the
following findings would require immediate intervention?
A. The patient reports a mild headache when sitting up.
B. The patient's blood pressure is 100/60 mm Hg.
C. The patient has clear fluid leaking from the puncture site.
D. The patient's heart rate is 56 beats per minute.
Answer: C
Rationale: Clear fluid leaking from the puncture site may indicate cerebrospinal fluid (CSF) leak, which
increases risk of infection and low pressure complications, requiring immediate intervention. Headache
is common post-LP (post-dural puncture headache) but not immediately dangerous. Mild hypotension
and bradycardia may be normal or related to positioning; however, CSF leak is critical.
11. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on
volume-controlled mechanical ventilation. The patient's plateau pressure is 32 cm H2O, and the
tidal volume is set at 6 mL/kg ideal body weight. Which of the following interventions should the
nurse anticipate to reduce the risk of ventilator-induced lung injury?
A. Increase the tidal volume to 10 mL/kg to improve oxygenation
B. Administer a neuromuscular blocking agent to reduce oxygen consumption and improve chest wall
compliance
C. Decrease the positive end-expiratory pressure (PEEP) to minimize barotrauma
D. Switch to pressure-controlled ventilation with a set inspiratory pressure of 35 cm H2O
Answer: B
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (6 mL/kg) and limiting plateau
pressure to <30 cm H2O. Administering neuromuscular blocking agents can improve chest wall
compliance, reduce oxygen consumption, and decrease ventilator dyssynchrony, thereby reducing the
risk of ventilator-induced lung injury. Increasing tidal volume would worsen lung injury. Decreasing
PEEP could lead to alveolar collapse. Pressure-controlled ventilation with high inspiratory pressure
may cause barotrauma.
12. A nurse is reviewing the laboratory results of a patient with suspected disseminated
intravascular coagulation (DIC). Which combination of findings is most consistent with acute
DIC?
A. Elevated fibrinogen, prolonged PT, normal platelet count
B. Decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer, thrombocytopenia
C. Normal PT and aPTT, decreased D-dimer, increased platelet count
D. Elevated fibrinogen, shortened PT, elevated D-dimer, thrombocytosis
Answer: B
Rationale: Acute DIC is characterized by consumption of clotting factors and platelets, leading to
decreased fibrinogen, prolonged PT and aPTT, elevated D-dimer (from fibrinolysis), and
thrombocytopenia. Option A shows elevated fibrinogen and normal platelets, which is more consistent
Page 4
