NGN HESI RN EXIT EXAM 2026–2027 | (150
QUESTIONS AND CORRECT ANSWERS) |
ALREADY GRADED A+ | 100% VERIFIED
Nursing (NGN) | Key Domains: Next Generation NCLEX (NGN) Clinical Judgment
Measurement Model, Medical-Surgical Nursing, Maternity, Pediatrics, Mental Health,
Pharmacology, Nursing Fundamentals, Leadership & Management, and Patient Safety |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NGN HESI RN Exit Exam format for 2026–2027 provides the complete
layout for generating high-quality exam-style questions with correct answers and
rationales. It emphasizes clinical judgment, patient safety, NCLEX readiness, and evidence-
based nursing principles critical to professional nursing practice and successful
comprehensive assessment preparation.
Answer Format
All correct answers must appear in bold and cyan, accompanied by concise rationales
explaining safety/clinical reasoning, code adherence, and why alternative options are less
appropriate.
,Question 1: A nurse is caring for a patient admitted with acute decompensated heart failure
(ADHF). The patient presents with severe dyspnea, orthopnea, bilateral bibasilar crackles, and
an SpO2 of 88% on room air. Which of the following is the priority nursing intervention?
A. Administer the scheduled dose of oral carvedilol
B. Insert a Foley catheter to monitor precise intake and output
C. Place the patient in a high-Fowler position and administer supplemental oxygen
D. Initiate an intravenous infusion of normal saline at 125 mL/hr
Correct Answer: C. Place the patient in a high-Fowler position and administer
supplemental oxygen
Rationale: In acute decompensated heart failure (ADHF), fluid accumulates in the pulmonary
interstitial and alveolar spaces, causing severe impairment of gas exchange (pulmonary
edema). Applying the ABCs (Airway, Breathing, Circulation) of clinical prioritization, the
immediate priority is to support breathing and oxygenation. Placing the patient in a high-
Fowler position decreases venous return (preload) to the heart and allows for maximum
diaphragmatic expansion, while supplemental oxygen corrects hypoxemia. Beta-blockers
(option A) can worsen acute uncompensated failure and should be held. Normal saline
(option D) exacerbates fluid overload. A Foley catheter (option B) is a secondary measure for
monitoring diuresis.
Question 2: A patient with chronic left-sided heart failure is prescribed daily furosemide and
digoxin. The nurse reviews the morning laboratory results: Serum potassium 2.9 mEq/L,
Sodium 138 mEq/L, Digoxin level 1.8 ng/mL, and Creatinine 1.2 mg/dL. The patient complains
of nausea, anorexia, and seeing blurred yellow halos around lights. What is the priority action
by the nurse?
A. Administer the scheduled morning doses of furosemide and digoxin
B. Hold the furosemide and digoxin, notify the healthcare provider, and prepare to administer
potassium replacement
C. Administer an antiemetic for the nausea and continue monitoring
D. Request an immediate stat echocardiogram to evaluate ejection fraction
Correct Answer: B. Hold the furosemide and digoxin, notify the healthcare provider,
and prepare to administer potassium replacement
Rationale: This patient is exhibiting classic signs of digoxin toxicity (anorexia, nausea,
blurred yellow halo vision). While the serum digoxin level of 1.8 ng/mL is near the upper
limit of the therapeutic range (0.8-2.0 ng/mL), the patient has severe hypokalemia
(potassium 2.9 mEq/L). Hypokalemia severely sensitizes the cardiac myocardium to digoxin,
precipitating clinical toxicity and lethal dysrhythmias even at normal drug levels. Furosemide
is a loop diuretic that actively depletes potassium. The nurse must immediately hold both
medications, notify the provider, and prepare to administer intravenous or oral potassium
replacement to correct the underlying electrolyte deficit.
,Question 3: A patient is admitted to the emergency department with severe substernal chest
pain radiating to the left arm, diaphoresis, and shortness of breath. The 12-lead ECG
demonstrates ST-segment elevation in leads V1 through V4. The nurse anticipates
administering which of the following immediate pharmacological interventions according to
acute coronary syndrome (ACS) protocols?
A. 162 mg to 325 mg of chewable aspirin, sublingual nitroglycerin, supplemental oxygen (if
SpO2 <90%), and intravenous morphine (if pain persists after nitroglycerin)
B. High-dose oral digoxin and an immediate intravenous bolus of diltiazem
C. Intravenous labetalol and an immediate 500 mL bolus of 0.9% normal saline
D. Subcutaneous enoxaparin and oral clopidogrel without nitroglycerin
Correct Answer: A. 162 mg to 325 mg of chewable aspirin, sublingual nitroglycerin,
supplemental oxygen (if SpO2 <90%), and intravenous morphine (if pain persists after
nitroglycerin)
Rationale: ST-segment elevation in leads V1-V4 confirms an acute anterior wall myocardial
infarction (STEMI). The foundational initial pharmacological regimen for ACS follows the
'MONA' protocol (Morphine, Oxygen, Nitroglycerin, Aspirin, administered in clinical
sequence). Chewable aspirin (162-325 mg) irreversibly inhibits platelet aggregation to
prevent thrombus propagation. Sublingual nitroglycerin causes venodilation and coronary
vasodilation to reduce preload and myocardial oxygen demand. Oxygen is administered if
SpO2 is <90%. Intravenous morphine is used for refractory pain and anxiety, which further
reduces cardiac workload. Calcium channel blockers and large saline boluses (options B and
C) are contraindicated in acute anterior MI due to the risk of inducing cardiogenic shock.
Question 4: A nurse is caring for a patient who just returned to the cardiac step-down unit
following a percutaneous coronary intervention (PCI) with stent placement via the right
femoral artery. Which of the following physical examination findings requires immediate
intervention by the nurse?
A. The patient complains of mild tenderness directly over the femoral insertion site
B. The right foot is pale and cool, with an absent dorsalis pedis pulse and a firm, expanding
hematoma palpated in the right groin
C. The blood pressure is 118/76 mmHg with a heart rate of 78 bpm
D. The patient expresses anxiety about future dietary lifestyle changes
Correct Answer: B. The right foot is pale and cool, with an absent dorsalis pedis pulse
and a firm, expanding hematoma palpated in the right groin
Rationale: Following a percutaneous coronary intervention (PCI) via the femoral artery, the
primary life-threatening complications are retroperitoneal hemorrhage, femoral artery
pseudoaneurysm, and acute arterial occlusion of the extremity. An expanding, firm hematoma
in the groin accompanied by a pale, cool foot and an absent distal pulse signifies massive
active arterial bleeding and vascular compromise. The nurse must immediately apply firm,
unyielding direct manual pressure directly over the femoral insertion site and call for
, emergency medical assistance. Mild insertion site tenderness (option A) and normal vital
signs (option C) are expected postoperative findings.
Question 5: A patient with long-standing peripheral arterial disease (PAD) is being discharged
home. Which of the following statements by the patient indicates a correct understanding of
the nurse's discharge education regarding lower extremity care?
A. 'I will elevate my legs on several pillows above the level of my heart whenever I am resting
in bed'
B. 'I will apply a hot heating pad directly to my calves and feet every night to improve blood
flow'
C. 'I will walk daily until I experience calf pain, stop and rest until the pain subsides, and then
resume walking to build up my collateral circulation'
D. 'I will wear tight elastic compression stockings continuously throughout the day'
Correct Answer: C. 'I will walk daily until I experience calf pain, stop and rest until the
pain subsides, and then resume walking to build up my collateral circulation'
Rationale: Peripheral Arterial Disease (PAD) is characterized by decreased arterial blood
flow to the lower extremities, manifesting as intermittent claudication (ischemic calf pain
with exercise). The gold standard non-surgical therapy is a structured walking program:
patients walk until claudication pain begins, rest until it subsides, and resume walking. This
cycle stimulates the development of collateral arterial circulation in the ischemic limbs.
Patients with PAD must NEVER elevate their legs above the heart (option A), as gravity
further impedes downward arterial flow. Furthermore, they must NEVER wear tight
compression stockings (option D, which are for venous insufficiency) or apply direct heat
(option B), as severe peripheral neuropathy makes them highly susceptible to silent full-
thickness thermal burns.
Question 6: A patient is admitted with severe acute deep vein thrombosis (DVT) of the left
lower extremity. The nurse initiates an intravenous infusion of unfractionated heparin. Which
laboratory test must the nurse monitor to titrate the heparin drip, and what is the therapeutic
target range?
A. Prothrombin time (PT) / INR; therapeutic target INR of 2.0 to 3.0
B. Activated partial thromboplastin time (aPTT); therapeutic target range of 1.5 to 2.5 times
the normal baseline (approximately 60 to 80 seconds)
C. Serum troponin I; therapeutic target less than 0.04 ng/mL
D. Complete blood count for white blood cells; target 5,000 to 10,000/microL
Correct Answer: B. Activated partial thromboplastin time (aPTT); therapeutic target
range of 1.5 to 2.5 times the normal baseline (approximately 60 to 80 seconds)
Rationale: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT) or the anti-Xa assay. The established therapeutic target range for
intravenous heparin in treating thromboembolic events (DVT/PE) is 1.5 to 2.5 times the
QUESTIONS AND CORRECT ANSWERS) |
ALREADY GRADED A+ | 100% VERIFIED
Nursing (NGN) | Key Domains: Next Generation NCLEX (NGN) Clinical Judgment
Measurement Model, Medical-Surgical Nursing, Maternity, Pediatrics, Mental Health,
Pharmacology, Nursing Fundamentals, Leadership & Management, and Patient Safety |
Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NGN HESI RN Exit Exam format for 2026–2027 provides the complete
layout for generating high-quality exam-style questions with correct answers and
rationales. It emphasizes clinical judgment, patient safety, NCLEX readiness, and evidence-
based nursing principles critical to professional nursing practice and successful
comprehensive assessment preparation.
Answer Format
All correct answers must appear in bold and cyan, accompanied by concise rationales
explaining safety/clinical reasoning, code adherence, and why alternative options are less
appropriate.
,Question 1: A nurse is caring for a patient admitted with acute decompensated heart failure
(ADHF). The patient presents with severe dyspnea, orthopnea, bilateral bibasilar crackles, and
an SpO2 of 88% on room air. Which of the following is the priority nursing intervention?
A. Administer the scheduled dose of oral carvedilol
B. Insert a Foley catheter to monitor precise intake and output
C. Place the patient in a high-Fowler position and administer supplemental oxygen
D. Initiate an intravenous infusion of normal saline at 125 mL/hr
Correct Answer: C. Place the patient in a high-Fowler position and administer
supplemental oxygen
Rationale: In acute decompensated heart failure (ADHF), fluid accumulates in the pulmonary
interstitial and alveolar spaces, causing severe impairment of gas exchange (pulmonary
edema). Applying the ABCs (Airway, Breathing, Circulation) of clinical prioritization, the
immediate priority is to support breathing and oxygenation. Placing the patient in a high-
Fowler position decreases venous return (preload) to the heart and allows for maximum
diaphragmatic expansion, while supplemental oxygen corrects hypoxemia. Beta-blockers
(option A) can worsen acute uncompensated failure and should be held. Normal saline
(option D) exacerbates fluid overload. A Foley catheter (option B) is a secondary measure for
monitoring diuresis.
Question 2: A patient with chronic left-sided heart failure is prescribed daily furosemide and
digoxin. The nurse reviews the morning laboratory results: Serum potassium 2.9 mEq/L,
Sodium 138 mEq/L, Digoxin level 1.8 ng/mL, and Creatinine 1.2 mg/dL. The patient complains
of nausea, anorexia, and seeing blurred yellow halos around lights. What is the priority action
by the nurse?
A. Administer the scheduled morning doses of furosemide and digoxin
B. Hold the furosemide and digoxin, notify the healthcare provider, and prepare to administer
potassium replacement
C. Administer an antiemetic for the nausea and continue monitoring
D. Request an immediate stat echocardiogram to evaluate ejection fraction
Correct Answer: B. Hold the furosemide and digoxin, notify the healthcare provider,
and prepare to administer potassium replacement
Rationale: This patient is exhibiting classic signs of digoxin toxicity (anorexia, nausea,
blurred yellow halo vision). While the serum digoxin level of 1.8 ng/mL is near the upper
limit of the therapeutic range (0.8-2.0 ng/mL), the patient has severe hypokalemia
(potassium 2.9 mEq/L). Hypokalemia severely sensitizes the cardiac myocardium to digoxin,
precipitating clinical toxicity and lethal dysrhythmias even at normal drug levels. Furosemide
is a loop diuretic that actively depletes potassium. The nurse must immediately hold both
medications, notify the provider, and prepare to administer intravenous or oral potassium
replacement to correct the underlying electrolyte deficit.
,Question 3: A patient is admitted to the emergency department with severe substernal chest
pain radiating to the left arm, diaphoresis, and shortness of breath. The 12-lead ECG
demonstrates ST-segment elevation in leads V1 through V4. The nurse anticipates
administering which of the following immediate pharmacological interventions according to
acute coronary syndrome (ACS) protocols?
A. 162 mg to 325 mg of chewable aspirin, sublingual nitroglycerin, supplemental oxygen (if
SpO2 <90%), and intravenous morphine (if pain persists after nitroglycerin)
B. High-dose oral digoxin and an immediate intravenous bolus of diltiazem
C. Intravenous labetalol and an immediate 500 mL bolus of 0.9% normal saline
D. Subcutaneous enoxaparin and oral clopidogrel without nitroglycerin
Correct Answer: A. 162 mg to 325 mg of chewable aspirin, sublingual nitroglycerin,
supplemental oxygen (if SpO2 <90%), and intravenous morphine (if pain persists after
nitroglycerin)
Rationale: ST-segment elevation in leads V1-V4 confirms an acute anterior wall myocardial
infarction (STEMI). The foundational initial pharmacological regimen for ACS follows the
'MONA' protocol (Morphine, Oxygen, Nitroglycerin, Aspirin, administered in clinical
sequence). Chewable aspirin (162-325 mg) irreversibly inhibits platelet aggregation to
prevent thrombus propagation. Sublingual nitroglycerin causes venodilation and coronary
vasodilation to reduce preload and myocardial oxygen demand. Oxygen is administered if
SpO2 is <90%. Intravenous morphine is used for refractory pain and anxiety, which further
reduces cardiac workload. Calcium channel blockers and large saline boluses (options B and
C) are contraindicated in acute anterior MI due to the risk of inducing cardiogenic shock.
Question 4: A nurse is caring for a patient who just returned to the cardiac step-down unit
following a percutaneous coronary intervention (PCI) with stent placement via the right
femoral artery. Which of the following physical examination findings requires immediate
intervention by the nurse?
A. The patient complains of mild tenderness directly over the femoral insertion site
B. The right foot is pale and cool, with an absent dorsalis pedis pulse and a firm, expanding
hematoma palpated in the right groin
C. The blood pressure is 118/76 mmHg with a heart rate of 78 bpm
D. The patient expresses anxiety about future dietary lifestyle changes
Correct Answer: B. The right foot is pale and cool, with an absent dorsalis pedis pulse
and a firm, expanding hematoma palpated in the right groin
Rationale: Following a percutaneous coronary intervention (PCI) via the femoral artery, the
primary life-threatening complications are retroperitoneal hemorrhage, femoral artery
pseudoaneurysm, and acute arterial occlusion of the extremity. An expanding, firm hematoma
in the groin accompanied by a pale, cool foot and an absent distal pulse signifies massive
active arterial bleeding and vascular compromise. The nurse must immediately apply firm,
unyielding direct manual pressure directly over the femoral insertion site and call for
, emergency medical assistance. Mild insertion site tenderness (option A) and normal vital
signs (option C) are expected postoperative findings.
Question 5: A patient with long-standing peripheral arterial disease (PAD) is being discharged
home. Which of the following statements by the patient indicates a correct understanding of
the nurse's discharge education regarding lower extremity care?
A. 'I will elevate my legs on several pillows above the level of my heart whenever I am resting
in bed'
B. 'I will apply a hot heating pad directly to my calves and feet every night to improve blood
flow'
C. 'I will walk daily until I experience calf pain, stop and rest until the pain subsides, and then
resume walking to build up my collateral circulation'
D. 'I will wear tight elastic compression stockings continuously throughout the day'
Correct Answer: C. 'I will walk daily until I experience calf pain, stop and rest until the
pain subsides, and then resume walking to build up my collateral circulation'
Rationale: Peripheral Arterial Disease (PAD) is characterized by decreased arterial blood
flow to the lower extremities, manifesting as intermittent claudication (ischemic calf pain
with exercise). The gold standard non-surgical therapy is a structured walking program:
patients walk until claudication pain begins, rest until it subsides, and resume walking. This
cycle stimulates the development of collateral arterial circulation in the ischemic limbs.
Patients with PAD must NEVER elevate their legs above the heart (option A), as gravity
further impedes downward arterial flow. Furthermore, they must NEVER wear tight
compression stockings (option D, which are for venous insufficiency) or apply direct heat
(option B), as severe peripheral neuropathy makes them highly susceptible to silent full-
thickness thermal burns.
Question 6: A patient is admitted with severe acute deep vein thrombosis (DVT) of the left
lower extremity. The nurse initiates an intravenous infusion of unfractionated heparin. Which
laboratory test must the nurse monitor to titrate the heparin drip, and what is the therapeutic
target range?
A. Prothrombin time (PT) / INR; therapeutic target INR of 2.0 to 3.0
B. Activated partial thromboplastin time (aPTT); therapeutic target range of 1.5 to 2.5 times
the normal baseline (approximately 60 to 80 seconds)
C. Serum troponin I; therapeutic target less than 0.04 ng/mL
D. Complete blood count for white blood cells; target 5,000 to 10,000/microL
Correct Answer: B. Activated partial thromboplastin time (aPTT); therapeutic target
range of 1.5 to 2.5 times the normal baseline (approximately 60 to 80 seconds)
Rationale: Unfractionated heparin therapy is monitored using the activated partial
thromboplastin time (aPTT) or the anti-Xa assay. The established therapeutic target range for
intravenous heparin in treating thromboembolic events (DVT/PE) is 1.5 to 2.5 times the
