HESI RN EXIT EXAM NGN VERSION B 2024–2025 | 160
Comprehensive Practice Questions & Detailed Rationales | Next
Generation Nursing Exam Prep
1. Question: The nurse is completing the admission assessment of a 3-year-old
who is admitted with bacterial meningitis and hydrocephalus. Which
assessment finding is evidence that the child is experiencing increased
intracranial pressure (ICP)?
• A. Tachycardia and tachypnea
• B. Sluggish and unequal pupillary responses
• C. Increased head circumference and bulging fontanels
• D. Blood pressure fluctuations and syncope
• Answer: B. Sluggish and unequal pupillary responses
• Rationale: Increased ICP can cause compression of the oculomotor nerve (cranial
nerve III), which controls pupillary response. Sluggish, unequal, or non-reactive
pupils are late but critical signs of rising ICP and potential brainstem herniation.
Tachycardia (A) is not typical; bradycardia and irregular respirations (Cushing's
triad) are more common. Increased head circumference and bulging fontanels (C)
are signs of ICP in infants whose sutures have not yet fused, not typically in a 3-
year-old. Blood pressure fluctuations (D) can occur but are less specific; syncope is
not a classic sign.
2. Question: A client with acute pancreatitis is admitted with severe, piercing
abdominal pain and an elevated serum amylase. Which additional
information is the client most likely to report to the nurse?
• A. Abdominal pain decreases when lying supine
• B. Pain lasts an hour and leaves the abdomen tender
,• C. Right upper quadrant pain refers to right scapula
• D. Drinks alcohol until intoxicated at least twice weekly.
• Answer: A. Abdominal pain decreases when lying supine
• Rationale: In acute pancreatitis, abdominal pain is often severe and piercing,
typically worsened by lying flat (supine) and relieved by leaning forward (fetal
position) or lying on the side. Option A is the only one consistent with this pattern.
Pain lasting an hour (B) is not characteristic of acute pancreatitis, which is
constant. Right upper quadrant pain referring to the right scapula (C) is classic for
gallbladder disease (biliary colic), not pancreatitis. Alcohol use (D) is a major risk
factor, but the question asks for the additional information the client is most likely
to report, which refers to the pain characteristic, not the cause.
3. Question: A client with dyspnea is being admitted to the medical unit. To
best prepare for the client's arrival, the nurse should ensure that the client's
bed is in which position?
• A. Supine
• B. Supine; feet elevated higher than head
• C. Supine; head elevated higher than feet
• D. Fowlers
• Answer: D. Fowlers
• Rationale: Fowler's position (semi-sitting) uses gravity to assist with lung
expansion and diaphragmatic excursion, which maximizes ventilation and reduces
the work of breathing for a client with dyspnea. Supine positions (A, B, C) would
worsen dyspnea by allowing the abdominal organs to press against the diaphragm.
, 4. Question: A child newly diagnosed with sickle cell anemia (SCA) is being
discharged from the hospital. Which information is most important for the
nurse to provide the parents prior to discharge?
• A. Instructions about how much fluid the child should drink daily.
• B. Signs of addiction to opioid pain medications
• C. Information about non-pharmaceutical pain relief measures
• D. Referral for social services for the child and family
• Answer: A. Instructions about how much fluid the child should drink daily.
• Rationale: Dehydration is a primary trigger for sickle cell crisis (vaso-occlusive
episodes). Ensuring adequate daily fluid intake is the most critical preventive
measure to maintain hydration, reduce blood viscosity, and prevent sickling. While
pain management (B, C) and social support (D) are important, they are secondary
to the immediate, life-threatening risk of dehydration-induced crisis.
5. Question: To auscultate for a carotid bruit, the nurse places the stethoscope
at what location? (Select the location on the image with a red dot).
• Answer: I placed the red dot on the base of the neck on the right side
• Rationale: A carotid bruit is auscultated over the carotid artery, which is located in
the neck, just lateral to the trachea, at the level of the thyroid cartilage. The base of
the neck on either side is the correct anatomical location to assess for turbulent
blood flow indicating carotid stenosis.
6. Question: After receiving report on an inpatient acute care unit, which
client should the nurse assess first?
• A. The client with an obstruction of the large intestine who is experiencing
abdominal distention
, • B. The client who had surgery yesterday and is experiencing a paralytic ileus with
absent bowel sounds
• C. The client with a small bowel obstruction who has a nasogastric tube that is
draining greenish fluid
• D. The client with a bowel obstruction due to a volvulus who is experiencing
abdominal rigidity
• Answer: D. The client with a bowel obstruction due to a volvulus who is
experiencing abdominal rigidity
• Rationale: Abdominal rigidity is a sign of peritoneal irritation and can indicate
bowel ischemia, perforation, or peritonitis, which are surgical emergencies. This
client is at the highest risk for sepsis and requires immediate assessment. The other
clients (A, B, C) have expected findings for their conditions and are stable in
comparison.
7. Question: A teenager presents to the emergency department with
palpitations after vaping at a party. The client is anxious, fearful, and
hyperventilating. The nurse anticipates the client developing which acid base
imbalance?
• A. Respiratory acidosis
• B. Metabolic alkalosis
• C. Metabolic acidosis
• D. Respiratory alkalosis
• Answer: D. Respiratory alkalosis
• Rationale: Hyperventilation causes excessive exhalation of carbon dioxide (CO2),
leading to a decrease in plasma CO2 levels and an increase in pH (alkalosis). This
is a primary respiratory cause, not metabolic. Respiratory acidosis (A) is caused by
Comprehensive Practice Questions & Detailed Rationales | Next
Generation Nursing Exam Prep
1. Question: The nurse is completing the admission assessment of a 3-year-old
who is admitted with bacterial meningitis and hydrocephalus. Which
assessment finding is evidence that the child is experiencing increased
intracranial pressure (ICP)?
• A. Tachycardia and tachypnea
• B. Sluggish and unequal pupillary responses
• C. Increased head circumference and bulging fontanels
• D. Blood pressure fluctuations and syncope
• Answer: B. Sluggish and unequal pupillary responses
• Rationale: Increased ICP can cause compression of the oculomotor nerve (cranial
nerve III), which controls pupillary response. Sluggish, unequal, or non-reactive
pupils are late but critical signs of rising ICP and potential brainstem herniation.
Tachycardia (A) is not typical; bradycardia and irregular respirations (Cushing's
triad) are more common. Increased head circumference and bulging fontanels (C)
are signs of ICP in infants whose sutures have not yet fused, not typically in a 3-
year-old. Blood pressure fluctuations (D) can occur but are less specific; syncope is
not a classic sign.
2. Question: A client with acute pancreatitis is admitted with severe, piercing
abdominal pain and an elevated serum amylase. Which additional
information is the client most likely to report to the nurse?
• A. Abdominal pain decreases when lying supine
• B. Pain lasts an hour and leaves the abdomen tender
,• C. Right upper quadrant pain refers to right scapula
• D. Drinks alcohol until intoxicated at least twice weekly.
• Answer: A. Abdominal pain decreases when lying supine
• Rationale: In acute pancreatitis, abdominal pain is often severe and piercing,
typically worsened by lying flat (supine) and relieved by leaning forward (fetal
position) or lying on the side. Option A is the only one consistent with this pattern.
Pain lasting an hour (B) is not characteristic of acute pancreatitis, which is
constant. Right upper quadrant pain referring to the right scapula (C) is classic for
gallbladder disease (biliary colic), not pancreatitis. Alcohol use (D) is a major risk
factor, but the question asks for the additional information the client is most likely
to report, which refers to the pain characteristic, not the cause.
3. Question: A client with dyspnea is being admitted to the medical unit. To
best prepare for the client's arrival, the nurse should ensure that the client's
bed is in which position?
• A. Supine
• B. Supine; feet elevated higher than head
• C. Supine; head elevated higher than feet
• D. Fowlers
• Answer: D. Fowlers
• Rationale: Fowler's position (semi-sitting) uses gravity to assist with lung
expansion and diaphragmatic excursion, which maximizes ventilation and reduces
the work of breathing for a client with dyspnea. Supine positions (A, B, C) would
worsen dyspnea by allowing the abdominal organs to press against the diaphragm.
, 4. Question: A child newly diagnosed with sickle cell anemia (SCA) is being
discharged from the hospital. Which information is most important for the
nurse to provide the parents prior to discharge?
• A. Instructions about how much fluid the child should drink daily.
• B. Signs of addiction to opioid pain medications
• C. Information about non-pharmaceutical pain relief measures
• D. Referral for social services for the child and family
• Answer: A. Instructions about how much fluid the child should drink daily.
• Rationale: Dehydration is a primary trigger for sickle cell crisis (vaso-occlusive
episodes). Ensuring adequate daily fluid intake is the most critical preventive
measure to maintain hydration, reduce blood viscosity, and prevent sickling. While
pain management (B, C) and social support (D) are important, they are secondary
to the immediate, life-threatening risk of dehydration-induced crisis.
5. Question: To auscultate for a carotid bruit, the nurse places the stethoscope
at what location? (Select the location on the image with a red dot).
• Answer: I placed the red dot on the base of the neck on the right side
• Rationale: A carotid bruit is auscultated over the carotid artery, which is located in
the neck, just lateral to the trachea, at the level of the thyroid cartilage. The base of
the neck on either side is the correct anatomical location to assess for turbulent
blood flow indicating carotid stenosis.
6. Question: After receiving report on an inpatient acute care unit, which
client should the nurse assess first?
• A. The client with an obstruction of the large intestine who is experiencing
abdominal distention
, • B. The client who had surgery yesterday and is experiencing a paralytic ileus with
absent bowel sounds
• C. The client with a small bowel obstruction who has a nasogastric tube that is
draining greenish fluid
• D. The client with a bowel obstruction due to a volvulus who is experiencing
abdominal rigidity
• Answer: D. The client with a bowel obstruction due to a volvulus who is
experiencing abdominal rigidity
• Rationale: Abdominal rigidity is a sign of peritoneal irritation and can indicate
bowel ischemia, perforation, or peritonitis, which are surgical emergencies. This
client is at the highest risk for sepsis and requires immediate assessment. The other
clients (A, B, C) have expected findings for their conditions and are stable in
comparison.
7. Question: A teenager presents to the emergency department with
palpitations after vaping at a party. The client is anxious, fearful, and
hyperventilating. The nurse anticipates the client developing which acid base
imbalance?
• A. Respiratory acidosis
• B. Metabolic alkalosis
• C. Metabolic acidosis
• D. Respiratory alkalosis
• Answer: D. Respiratory alkalosis
• Rationale: Hyperventilation causes excessive exhalation of carbon dioxide (CO2),
leading to a decrease in plasma CO2 levels and an increase in pH (alkalosis). This
is a primary respiratory cause, not metabolic. Respiratory acidosis (A) is caused by
