2026/2027 HESI EXIT RN V1 EXAM WITH 160
NGN QUESTIONS AND REVISED CORRECT
ANSWERS (VERIFIED 100% GUARANTEE PASS )
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 50 mm Hg, HCO3- 26 mEq/L. The nurse prepares to initiate noninvasive positive pressure
ventilation (NPPV). Which finding would most likely indicate a need for immediate endotracheal
intubation?
A. Patient develops a heart rate of 110 beats per minute and blood pressure 100/60 mm Hg.
B. Patient becomes increasingly agitated and attempts to remove the mask.
C. PaCO2 increases to 68 mm Hg after 30 minutes of NPPV.
D. Patient has a respiratory rate of 24 breaths per minute with use of accessory muscles.
Answer: B
Rationale: Agitation and inability to tolerate the mask often indicate worsening hypoxemia or
hypercapnia and can lead to ineffective ventilation. This is a sign of impending respiratory arrest,
necessitating intubation. Option C (PaCO2 increase) is expected initially and does not alone mandate
intubation if the patient is improving clinically. Options A and D are common in respiratory distress but
not absolute indications for intubation if the patient is stable.
2. A patient receiving vancomycin 1 g intravenously every 12 hours develops red man syndrome
during the infusion. The nurse should take which action first?
A. Administer diphenhydramine 50 mg intravenously.
B. Decrease the infusion rate and notify the prescriber.
C. Stop the infusion immediately and maintain IV access.
D. Increase the infusion rate to complete the dose quickly.
Answer: C
Rationale: Red man syndrome is an infusion-related reaction caused by rapid vancomycin
administration. The first action is to stop the infusion to prevent further histamine release. After
stopping, the nurse can decrease the rate and administer antihistamines if ordered. Option B is
appropriate after stopping the infusion; option A is a subsequent intervention; option D would worsen
the reaction.
3. A patient with schizophrenia is prescribed clozapine. The nurse monitors for which potentially
life-threatening adverse effect that requires immediate discontinuation of the medication?
A. Weight gain of 5 kg over 2 months.
B. White blood cell count of 2,500/mm³.
C. Drowsiness that persists for 2 weeks.
Page 1
,D. Constipation that is relieved with laxatives.
Answer: B
Rationale: Clozapine can cause agranulocytosis, a severe decrease in white blood cells (WBC <
3,000/mm³) that increases infection risk. The drug must be stopped immediately. Weight gain (A) is
common but not life-threatening; drowsiness (C) is common initially; constipation (D) is manageable
and not an indication for discontinuation.
4. A nurse is caring for a patient with a central venous catheter who develops sudden dyspnea,
chest pain, and hypotension. The nurse suspects an air embolism. Which immediate action is most
appropriate?
A. Place the patient in Trendelenburg position on the left side.
B. Place the patient in high Fowler's position.
C. Administer oxygen via nasal cannula at 2 L/min.
D. Clamp the catheter and notify the provider.
Answer: A
Rationale: For suspected air embolism, the patient should be placed in Trendelenburg position on the left
side (Durant's maneuver) to trap air in the right atrium and prevent it from entering the pulmonary
circulation. High Fowler's (B) may worsen the condition. Oxygen should be given at high flow (C).
Clamping the catheter (D) is appropriate after positioning to prevent further air entry.
5. A nurse is assessing a patient with suspected compartment syndrome after a tibial fracture.
Which assessment finding is most indicative of compartment syndrome?
A. Pallor and coolness of the distal extremity.
B. Pain that is out of proportion to the injury and increases with passive stretch.
C. Capillary refill less than 2 seconds.
D. Palpable dorsalis pedis pulse.
Answer: B
Rationale: Pain out of proportion and pain with passive stretch is the earliest and most reliable sign of
compartment syndrome. Pallor and coolness (A) occur later due to vascular compromise. Capillary refill
(C) and palpable pulse (D) may be present even with elevated compartment pressure, so they are not
reliable indicators.
6. A patient with heart failure is receiving furosemide 40 mg intravenously. The nurse notes that
the patient's urine output over the past hour is 50 mL. Which laboratory value should the nurse
monitor most closely?
A. Serum potassium.
B. Serum sodium.
C. Serum magnesium.
D. Serum calcium.
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading to hypokalemia.
Hypokalemia increases the risk of cardiac dysrhythmias, especially in patients with heart failure who
may also be on digoxin. Sodium (B) and magnesium (C) can be affected but are less critical; calcium (D)
Page 2
,is minimally affected by loop diuretics.
7. A patient with a history of bipolar disorder is admitted with acute mania. The patient has not
slept for 3 days, is talking rapidly, and is physically aggressive. Which nursing intervention is most
appropriate initially?
A. Place the patient in a private room with minimal stimulation.
B. Encourage the patient to participate in group therapy.
C. Administer a prescribed sedative-hypnotic medication.
D. Allow the patient to pace in the hallway to expend energy.
Answer: A
Rationale: In acute mania, the priority is to reduce environmental stimuli to prevent escalation of
agitation. A private, quiet room helps decrease sensory input. Group therapy (B) may overstimulate the
patient. Sedatives (C) may be needed but are not the first intervention; the nurse should first try
nonpharmacological measures. Pacing (D) may be allowed but in a controlled environment, not the
hallway.
8. A patient with end-stage renal disease is scheduled for hemodialysis. The nurse reviews the
medication administration record. Which medication should be withheld prior to dialysis?
A. Epoetin alfa (Epogen).
B. Calcium acetate (PhosLo).
C. Lisinopril (Prinivil).
D. Sevelamer (Renagel).
Answer: C
Rationale: Lisinopril, an ACE inhibitor, can cause hypotension during dialysis due to volume removal
and vasodilation. It is often withheld on dialysis days. Epoetin alfa (A) is given to stimulate red blood
cell production and is not held. Calcium acetate (B) and sevelamer (D) are phosphate binders given with
meals, not typically held for dialysis.
9. A nurse is providing discharge teaching to a patient who had a mechanical mitral valve
replacement. The patient is prescribed warfarin. Which statement by the patient indicates a need
for further teaching?
A. I will use an electric razor when shaving.
B. I will avoid taking aspirin unless prescribed by my doctor.
C. I will check my blood pressure daily.
D. I will increase my intake of green leafy vegetables.
Answer: D
Rationale: Green leafy vegetables are high in vitamin K, which can antagonize warfarin and reduce its
effectiveness. Patients should maintain a consistent intake of vitamin K, not increase it. Using an electric
razor (A) reduces bleeding risk; avoiding aspirin (B) is correct because it increases bleeding risk;
checking blood pressure (C) is appropriate but not directly related to warfarin.
Page 3
, 10. A patient with a third-degree burn over 40% total body surface area is admitted. During the
first 24 hours, the nurse expects which intravenous fluid to be administered?
A. 5% dextrose in water.
B. Lactated Ringer's solution.
C. 0.9% normal saline.
D. 5% dextrose in 0.45% normal saline.
Answer: B
Rationale: Lactated Ringer's solution is the recommended fluid for initial burn resuscitation because its
electrolyte composition closely resembles plasma and it helps correct metabolic acidosis. 5% dextrose in
water (A) is not used for volume resuscitation. 0.9% normal saline (C) can cause hyperchloremic
acidosis if given in large volumes. 5% dextrose in 0.45% normal saline (D) is not appropriate for burn
shock.
11. A patient with end-stage renal disease on hemodialysis develops hyperkalemia (K+ 6.8 mEq/L).
The nurse reviews the medication administration record. Which combination of medications is
most likely contributing to this electrolyte disturbance?
A. Spironolactone and digoxin
B. Furosemide and metoprolol
C. Lisinopril and insulin
D. Calcium acetate and sevelamer
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in
renal failure. Digoxin toxicity is potentiated by hyperkalemia. Furosemide causes hypokalemia.
Lisinopril can increase potassium but insulin lowers it. Calcium acetate and sevelamer are phosphate
binders that do not affect potassium.
12. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory acidosis (pH 7.25, PaCO2 60 mm Hg, HCO3- 26 mEq/L). The nurse anticipates
which intervention as most appropriate to correct the acid-base imbalance?
A. Administer intravenous sodium bicarbonate
B. Increase the fraction of inspired oxygen (FiO2) to 100%
C. Initiate noninvasive positive pressure ventilation (NIPPV)
D. Administer intravenous acetazolamide
Answer: C
Rationale: Acute respiratory acidosis is due to hypoventilation. NIPPV (BiPAP or CPAP) improves
ventilation and reduces PaCO2. Sodium bicarbonate is not recommended for acute respiratory acidosis
as it can worsen hypercapnia. High FiO2 may suppress respiratory drive in COPD. Acetazolamide is
used for metabolic alkalosis or altitude sickness.
13. A nurse is assessing a patient receiving a blood transfusion. Fifteen minutes after initiation, the
patient develops chills, low back pain, and hypotension. The nurse suspects a transfusion reaction.
What is the priority action?
Page 4
NGN QUESTIONS AND REVISED CORRECT
ANSWERS (VERIFIED 100% GUARANTEE PASS )
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on admission: pH 7.25, PaCO2 65 mm Hg,
PaO2 50 mm Hg, HCO3- 26 mEq/L. The nurse prepares to initiate noninvasive positive pressure
ventilation (NPPV). Which finding would most likely indicate a need for immediate endotracheal
intubation?
A. Patient develops a heart rate of 110 beats per minute and blood pressure 100/60 mm Hg.
B. Patient becomes increasingly agitated and attempts to remove the mask.
C. PaCO2 increases to 68 mm Hg after 30 minutes of NPPV.
D. Patient has a respiratory rate of 24 breaths per minute with use of accessory muscles.
Answer: B
Rationale: Agitation and inability to tolerate the mask often indicate worsening hypoxemia or
hypercapnia and can lead to ineffective ventilation. This is a sign of impending respiratory arrest,
necessitating intubation. Option C (PaCO2 increase) is expected initially and does not alone mandate
intubation if the patient is improving clinically. Options A and D are common in respiratory distress but
not absolute indications for intubation if the patient is stable.
2. A patient receiving vancomycin 1 g intravenously every 12 hours develops red man syndrome
during the infusion. The nurse should take which action first?
A. Administer diphenhydramine 50 mg intravenously.
B. Decrease the infusion rate and notify the prescriber.
C. Stop the infusion immediately and maintain IV access.
D. Increase the infusion rate to complete the dose quickly.
Answer: C
Rationale: Red man syndrome is an infusion-related reaction caused by rapid vancomycin
administration. The first action is to stop the infusion to prevent further histamine release. After
stopping, the nurse can decrease the rate and administer antihistamines if ordered. Option B is
appropriate after stopping the infusion; option A is a subsequent intervention; option D would worsen
the reaction.
3. A patient with schizophrenia is prescribed clozapine. The nurse monitors for which potentially
life-threatening adverse effect that requires immediate discontinuation of the medication?
A. Weight gain of 5 kg over 2 months.
B. White blood cell count of 2,500/mm³.
C. Drowsiness that persists for 2 weeks.
Page 1
,D. Constipation that is relieved with laxatives.
Answer: B
Rationale: Clozapine can cause agranulocytosis, a severe decrease in white blood cells (WBC <
3,000/mm³) that increases infection risk. The drug must be stopped immediately. Weight gain (A) is
common but not life-threatening; drowsiness (C) is common initially; constipation (D) is manageable
and not an indication for discontinuation.
4. A nurse is caring for a patient with a central venous catheter who develops sudden dyspnea,
chest pain, and hypotension. The nurse suspects an air embolism. Which immediate action is most
appropriate?
A. Place the patient in Trendelenburg position on the left side.
B. Place the patient in high Fowler's position.
C. Administer oxygen via nasal cannula at 2 L/min.
D. Clamp the catheter and notify the provider.
Answer: A
Rationale: For suspected air embolism, the patient should be placed in Trendelenburg position on the left
side (Durant's maneuver) to trap air in the right atrium and prevent it from entering the pulmonary
circulation. High Fowler's (B) may worsen the condition. Oxygen should be given at high flow (C).
Clamping the catheter (D) is appropriate after positioning to prevent further air entry.
5. A nurse is assessing a patient with suspected compartment syndrome after a tibial fracture.
Which assessment finding is most indicative of compartment syndrome?
A. Pallor and coolness of the distal extremity.
B. Pain that is out of proportion to the injury and increases with passive stretch.
C. Capillary refill less than 2 seconds.
D. Palpable dorsalis pedis pulse.
Answer: B
Rationale: Pain out of proportion and pain with passive stretch is the earliest and most reliable sign of
compartment syndrome. Pallor and coolness (A) occur later due to vascular compromise. Capillary refill
(C) and palpable pulse (D) may be present even with elevated compartment pressure, so they are not
reliable indicators.
6. A patient with heart failure is receiving furosemide 40 mg intravenously. The nurse notes that
the patient's urine output over the past hour is 50 mL. Which laboratory value should the nurse
monitor most closely?
A. Serum potassium.
B. Serum sodium.
C. Serum magnesium.
D. Serum calcium.
Answer: A
Rationale: Furosemide is a loop diuretic that causes potassium excretion, leading to hypokalemia.
Hypokalemia increases the risk of cardiac dysrhythmias, especially in patients with heart failure who
may also be on digoxin. Sodium (B) and magnesium (C) can be affected but are less critical; calcium (D)
Page 2
,is minimally affected by loop diuretics.
7. A patient with a history of bipolar disorder is admitted with acute mania. The patient has not
slept for 3 days, is talking rapidly, and is physically aggressive. Which nursing intervention is most
appropriate initially?
A. Place the patient in a private room with minimal stimulation.
B. Encourage the patient to participate in group therapy.
C. Administer a prescribed sedative-hypnotic medication.
D. Allow the patient to pace in the hallway to expend energy.
Answer: A
Rationale: In acute mania, the priority is to reduce environmental stimuli to prevent escalation of
agitation. A private, quiet room helps decrease sensory input. Group therapy (B) may overstimulate the
patient. Sedatives (C) may be needed but are not the first intervention; the nurse should first try
nonpharmacological measures. Pacing (D) may be allowed but in a controlled environment, not the
hallway.
8. A patient with end-stage renal disease is scheduled for hemodialysis. The nurse reviews the
medication administration record. Which medication should be withheld prior to dialysis?
A. Epoetin alfa (Epogen).
B. Calcium acetate (PhosLo).
C. Lisinopril (Prinivil).
D. Sevelamer (Renagel).
Answer: C
Rationale: Lisinopril, an ACE inhibitor, can cause hypotension during dialysis due to volume removal
and vasodilation. It is often withheld on dialysis days. Epoetin alfa (A) is given to stimulate red blood
cell production and is not held. Calcium acetate (B) and sevelamer (D) are phosphate binders given with
meals, not typically held for dialysis.
9. A nurse is providing discharge teaching to a patient who had a mechanical mitral valve
replacement. The patient is prescribed warfarin. Which statement by the patient indicates a need
for further teaching?
A. I will use an electric razor when shaving.
B. I will avoid taking aspirin unless prescribed by my doctor.
C. I will check my blood pressure daily.
D. I will increase my intake of green leafy vegetables.
Answer: D
Rationale: Green leafy vegetables are high in vitamin K, which can antagonize warfarin and reduce its
effectiveness. Patients should maintain a consistent intake of vitamin K, not increase it. Using an electric
razor (A) reduces bleeding risk; avoiding aspirin (B) is correct because it increases bleeding risk;
checking blood pressure (C) is appropriate but not directly related to warfarin.
Page 3
, 10. A patient with a third-degree burn over 40% total body surface area is admitted. During the
first 24 hours, the nurse expects which intravenous fluid to be administered?
A. 5% dextrose in water.
B. Lactated Ringer's solution.
C. 0.9% normal saline.
D. 5% dextrose in 0.45% normal saline.
Answer: B
Rationale: Lactated Ringer's solution is the recommended fluid for initial burn resuscitation because its
electrolyte composition closely resembles plasma and it helps correct metabolic acidosis. 5% dextrose in
water (A) is not used for volume resuscitation. 0.9% normal saline (C) can cause hyperchloremic
acidosis if given in large volumes. 5% dextrose in 0.45% normal saline (D) is not appropriate for burn
shock.
11. A patient with end-stage renal disease on hemodialysis develops hyperkalemia (K+ 6.8 mEq/L).
The nurse reviews the medication administration record. Which combination of medications is
most likely contributing to this electrolyte disturbance?
A. Spironolactone and digoxin
B. Furosemide and metoprolol
C. Lisinopril and insulin
D. Calcium acetate and sevelamer
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, especially in
renal failure. Digoxin toxicity is potentiated by hyperkalemia. Furosemide causes hypokalemia.
Lisinopril can increase potassium but insulin lowers it. Calcium acetate and sevelamer are phosphate
binders that do not affect potassium.
12. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory acidosis (pH 7.25, PaCO2 60 mm Hg, HCO3- 26 mEq/L). The nurse anticipates
which intervention as most appropriate to correct the acid-base imbalance?
A. Administer intravenous sodium bicarbonate
B. Increase the fraction of inspired oxygen (FiO2) to 100%
C. Initiate noninvasive positive pressure ventilation (NIPPV)
D. Administer intravenous acetazolamide
Answer: C
Rationale: Acute respiratory acidosis is due to hypoventilation. NIPPV (BiPAP or CPAP) improves
ventilation and reduces PaCO2. Sodium bicarbonate is not recommended for acute respiratory acidosis
as it can worsen hypercapnia. High FiO2 may suppress respiratory drive in COPD. Acetazolamide is
used for metabolic alkalosis or altitude sickness.
13. A nurse is assessing a patient receiving a blood transfusion. Fifteen minutes after initiation, the
patient develops chills, low back pain, and hypotension. The nurse suspects a transfusion reaction.
What is the priority action?
Page 4
