Updated HESI RN Comprehensive Predictor
Exit 2026 with NGN | Comprehensive
Questions and Answers
NGN CASE STUDY: Acute Exacerbation of COPD
Client Scenario:
A 68-year-old male client is admitted to the medical-surgical unit with an acute
exacerbation of chronic obstructive pulmonary disease (COPD). Vital signs: HR 110 bpm,
BP 148/90 mm Hg, RR 28 breaths/min, SpO2 86% on room air, temperature 37.8°C
(100°F). The client reports increased dyspnea, productive cough with thick yellow
sputum, and chest tightness.
Question 1 (NGN - Drop Down)
Select the priority nursing assessment for this client.
A. Auscultate breath sounds ✅
B. Check capillary refill
C. Measure abdominal girth
D. Assess skin turgor
Correct Answer: A
Rationale: Auscultating breath sounds provides immediate information about airway
patency, the presence of adventitious sounds (wheezes, crackles), and the effectiveness
,of ventilation. In a COPD exacerbation, airway assessment is the priority before other
assessments.
Question 2 (NGN - Select All That Apply)
Which assessment findings require immediate nursing intervention? (Select all that
apply)
A. SpO2 86% on room air ✅
B. Respiratory rate 28 breaths/min ✅
C. Temperature 37.8°C (100°F)
D. Thick yellow sputum production ✅
E. Heart rate 110 bpm
Correct Answers: A, B, D
Rationale: SpO2 <90% indicates hypoxemia requiring oxygen therapy. Tachypnea (RR
>24) indicates respiratory distress. Purulent sputum suggests an infection that may
require antibiotic therapy. While a mild fever and tachycardia are concerning, they are
compensatory responses and not the most critical findings requiring immediate action
compared to the oxygenation and respiratory status.
Question 3 (NGN - Bow-tie)
Match the priority nursing diagnosis with the correct intervention and expected
outcome.
Part A - Nursing Diagnosis:
A. Impaired Gas Exchange ✅
B. Ineffective Airway Clearance
,C. Activity Intolerance
D. Anxiety
Part B - Priority Intervention:
A. Administer bronchodilators as prescribed ✅
B. Encourage oral fluid intake
C. Provide emotional support
D. Schedule activities with rest periods
Part C - Expected Outcome:
A. SpO2 maintained at 90% or greater ✅
B. Absence of adventitious breath sounds
C. Reports decreased anxiety level
D. Performs ADLs independently
Correct Answers: A, A, A
Rationale: "Impaired Gas Exchange" is the priority diagnosis for a client with COPD and
severe hypoxemia. Administering bronchodilators helps open airways, directly improving
gas exchange. The goal is to maintain SpO2 at 90% or greater, indicating resolution of
the primary problem.
Question 4 (NGN - Multiple Choice)
The client's arterial blood gas (ABG) results show: pH 7.31, PaCO2 55 mmHg, HCO3 28
mEq/L, PaO2 65 mmHg. Which interpretation is correct?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation ✅
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
, Correct Answer: B
Rationale: The ABG shows low pH (7.31) indicating acidosis, elevated PaCO2 (55)
indicating respiratory component, and elevated HCO3 (28) indicating metabolic
compensation. This pattern is consistent with respiratory acidosis with partial metabolic
compensation, commonly seen in COPD exacerbations with CO2 retention.
Question 5 (NGN - Multiple Choice)
Which medication is most appropriate for this client's acute bronchospasm?
A. Albuterol (Salbutamol) nebulizer ✅
B. Ipratropium (Atrovent) alone
C. Fluticasone (Flovent) inhaler
D. Montelukast (Singulair) tablet
Correct Answer: A
Rationale: Albuterol is a short-acting beta-agonist (SABA) that provides rapid
bronchodilation for acute bronchospasm. Ipratropium is an anticholinergic with slower
onset. Fluticasone is a maintenance corticosteroid, not for acute symptoms. Montelukast
is a leukotriene modifier for maintenance therapy.
Question 6 (NGN - Multiple Choice)
The nurse is preparing to administer ipratropium (Atrovent) via nebulizer. Which
statement by the client indicates understanding of this medication?
A. "I can take this medication with my beta-blocker for my heart condition"
B. "I will avoid driving until I know how this medication affects me" ✅
Exit 2026 with NGN | Comprehensive
Questions and Answers
NGN CASE STUDY: Acute Exacerbation of COPD
Client Scenario:
A 68-year-old male client is admitted to the medical-surgical unit with an acute
exacerbation of chronic obstructive pulmonary disease (COPD). Vital signs: HR 110 bpm,
BP 148/90 mm Hg, RR 28 breaths/min, SpO2 86% on room air, temperature 37.8°C
(100°F). The client reports increased dyspnea, productive cough with thick yellow
sputum, and chest tightness.
Question 1 (NGN - Drop Down)
Select the priority nursing assessment for this client.
A. Auscultate breath sounds ✅
B. Check capillary refill
C. Measure abdominal girth
D. Assess skin turgor
Correct Answer: A
Rationale: Auscultating breath sounds provides immediate information about airway
patency, the presence of adventitious sounds (wheezes, crackles), and the effectiveness
,of ventilation. In a COPD exacerbation, airway assessment is the priority before other
assessments.
Question 2 (NGN - Select All That Apply)
Which assessment findings require immediate nursing intervention? (Select all that
apply)
A. SpO2 86% on room air ✅
B. Respiratory rate 28 breaths/min ✅
C. Temperature 37.8°C (100°F)
D. Thick yellow sputum production ✅
E. Heart rate 110 bpm
Correct Answers: A, B, D
Rationale: SpO2 <90% indicates hypoxemia requiring oxygen therapy. Tachypnea (RR
>24) indicates respiratory distress. Purulent sputum suggests an infection that may
require antibiotic therapy. While a mild fever and tachycardia are concerning, they are
compensatory responses and not the most critical findings requiring immediate action
compared to the oxygenation and respiratory status.
Question 3 (NGN - Bow-tie)
Match the priority nursing diagnosis with the correct intervention and expected
outcome.
Part A - Nursing Diagnosis:
A. Impaired Gas Exchange ✅
B. Ineffective Airway Clearance
,C. Activity Intolerance
D. Anxiety
Part B - Priority Intervention:
A. Administer bronchodilators as prescribed ✅
B. Encourage oral fluid intake
C. Provide emotional support
D. Schedule activities with rest periods
Part C - Expected Outcome:
A. SpO2 maintained at 90% or greater ✅
B. Absence of adventitious breath sounds
C. Reports decreased anxiety level
D. Performs ADLs independently
Correct Answers: A, A, A
Rationale: "Impaired Gas Exchange" is the priority diagnosis for a client with COPD and
severe hypoxemia. Administering bronchodilators helps open airways, directly improving
gas exchange. The goal is to maintain SpO2 at 90% or greater, indicating resolution of
the primary problem.
Question 4 (NGN - Multiple Choice)
The client's arterial blood gas (ABG) results show: pH 7.31, PaCO2 55 mmHg, HCO3 28
mEq/L, PaO2 65 mmHg. Which interpretation is correct?
A. Respiratory alkalosis with metabolic compensation
B. Respiratory acidosis with metabolic compensation ✅
C. Metabolic acidosis with respiratory compensation
D. Metabolic alkalosis with respiratory compensation
, Correct Answer: B
Rationale: The ABG shows low pH (7.31) indicating acidosis, elevated PaCO2 (55)
indicating respiratory component, and elevated HCO3 (28) indicating metabolic
compensation. This pattern is consistent with respiratory acidosis with partial metabolic
compensation, commonly seen in COPD exacerbations with CO2 retention.
Question 5 (NGN - Multiple Choice)
Which medication is most appropriate for this client's acute bronchospasm?
A. Albuterol (Salbutamol) nebulizer ✅
B. Ipratropium (Atrovent) alone
C. Fluticasone (Flovent) inhaler
D. Montelukast (Singulair) tablet
Correct Answer: A
Rationale: Albuterol is a short-acting beta-agonist (SABA) that provides rapid
bronchodilation for acute bronchospasm. Ipratropium is an anticholinergic with slower
onset. Fluticasone is a maintenance corticosteroid, not for acute symptoms. Montelukast
is a leukotriene modifier for maintenance therapy.
Question 6 (NGN - Multiple Choice)
The nurse is preparing to administer ipratropium (Atrovent) via nebulizer. Which
statement by the client indicates understanding of this medication?
A. "I can take this medication with my beta-blocker for my heart condition"
B. "I will avoid driving until I know how this medication affects me" ✅
