HESI Exit PN Exam V4 with
NGN Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
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1. A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal
cannula. The client reports feeling drowsy. Which action should the
nurse take first?
A. Increase the oxygen flow to 4 L/min.
B. Assess the client's oxygen saturation and respiratory rate.
C. Document the finding as an expected response to therapy.
D. Notify the healthcare provider immediately.
Answer: B
Rationale: Clients with COPD rely on a hypoxic drive to breathe.
Drowsiness can be an early sign of CO2 retention and respiratory
depression. The nurse must first assess the client's oxygenation
status (SpO2 and respiratory rate) before making changes to oxygen
therapy or notifying the provider. Increasing the oxygen (A) could
worsen CO2 narcosis.
2. The nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding should prompt the nurse to hold
the medication and notify the provider?
A. Heart rate of 62 beats/min.
B. Blood pressure of 118/76 mmHg.
C. Serum potassium level of 3.0 mEq/L.
D. Respiratory rate of 18 breaths/min.
Answer: C
Rationale: Hypokalemia (normal: 3.5-5.0 mEq/L) increases the risk
of digoxin toxicity. The nurse should hold the medication and notify
the provider. A heart rate of 62 bpm is above the typical hold
parameter of 60 bpm for adults.
,3. A postpartum client who delivered 4 hours ago has a boggy
fundus that is deviated to the right of the umbilicus. Despite
massage, the uterus remains boggy. What is the nurse's priority
action?
A. Administer prescribed oxytocin.
B. Assist the client to the bathroom to void.
C. Assess the client's perineal pad for clots.
D. Perform fundal massage every 15 minutes.
Answer: B
Rationale: A deviated and boggy fundus is most commonly caused
by a full bladder, which prevents the uterus from contracting
properly. Assisting the client to void is the priority intervention.
Once the bladder is empty, the uterus should firm up.
4. A client with type 1 diabetes mellitus presents with deep, rapid
respirations (Kussmaul breathing), a fruity breath odor, and
confusion. Which arterial blood gas (ABG) finding does the nurse
anticipate?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 28, HCO3 18
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 50, HCO3 28
Answer: B
Rationale: The client is exhibiting signs of Diabetic Ketoacidosis
(DKA), which causes metabolic acidosis. In metabolic acidosis, the
pH is low (<7.35), and the HCO3 is low (<22). The respiratory
system compensates by blowing off CO2, resulting in a low PaCO2
(Kussmaul respirations).
5. A 6-month-old infant is brought to the clinic with severe diarrhea
and vomiting for 24 hours. Which assessment finding indicates
severe dehydration?
A. Capillary refill of 2 seconds.
B. Anterior fontanelle is flat.
, C. Tearing during crying.
D. Tenting of skin turgor.
Answer: D
Rationale: Tenting of skin turgor (when pinched skin stays standing
up like a tent) is a hallmark sign of severe dehydration in infants. A
flat fontanelle, capillary refill under 3 seconds, and tearing are signs
of normal or mild dehydration.
6. During a mental health shift, a client with schizophrenia tells the
nurse, "The CIA is monitoring my thoughts through the television."
Which response by the nurse is most appropriate?
A. "The CIA does not monitor televisions; you are safe here."
B. "I understand you are frightened, but I don't see the CIA here."
C. "Let's turn off the TV and talk about your favorite hobbies."
D. "Why do you think the CIA is interested in your thoughts?"
Answer: B
Rationale: This is an example of a delusion of persecution. The
nurse should not argue with the delusion (A) or reinforce it (D), nor
should they merely change the subject (C) without addressing the
client's feelings. Validating the feeling while presenting reality (B) is
the most therapeutic communication.
7. A nurse is prioritizing care for four clients. Which client should
the nurse assess first?
A. A client with asthma reporting wheezing after a nebulizer
treatment.
B. A client with a femur fracture who is in a long leg cast and reports
pruritus.
C. A client with pneumonia whose pulse oximetry reads 88% on
room air.
D. A client with diabetes who has a fasting blood glucose of 140
mg/dL.
Answer: C
NGN Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. A nurse is caring for a client with chronic obstructive pulmonary
disease (COPD) who is receiving oxygen at 2 L/min via nasal
cannula. The client reports feeling drowsy. Which action should the
nurse take first?
A. Increase the oxygen flow to 4 L/min.
B. Assess the client's oxygen saturation and respiratory rate.
C. Document the finding as an expected response to therapy.
D. Notify the healthcare provider immediately.
Answer: B
Rationale: Clients with COPD rely on a hypoxic drive to breathe.
Drowsiness can be an early sign of CO2 retention and respiratory
depression. The nurse must first assess the client's oxygenation
status (SpO2 and respiratory rate) before making changes to oxygen
therapy or notifying the provider. Increasing the oxygen (A) could
worsen CO2 narcosis.
2. The nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding should prompt the nurse to hold
the medication and notify the provider?
A. Heart rate of 62 beats/min.
B. Blood pressure of 118/76 mmHg.
C. Serum potassium level of 3.0 mEq/L.
D. Respiratory rate of 18 breaths/min.
Answer: C
Rationale: Hypokalemia (normal: 3.5-5.0 mEq/L) increases the risk
of digoxin toxicity. The nurse should hold the medication and notify
the provider. A heart rate of 62 bpm is above the typical hold
parameter of 60 bpm for adults.
,3. A postpartum client who delivered 4 hours ago has a boggy
fundus that is deviated to the right of the umbilicus. Despite
massage, the uterus remains boggy. What is the nurse's priority
action?
A. Administer prescribed oxytocin.
B. Assist the client to the bathroom to void.
C. Assess the client's perineal pad for clots.
D. Perform fundal massage every 15 minutes.
Answer: B
Rationale: A deviated and boggy fundus is most commonly caused
by a full bladder, which prevents the uterus from contracting
properly. Assisting the client to void is the priority intervention.
Once the bladder is empty, the uterus should firm up.
4. A client with type 1 diabetes mellitus presents with deep, rapid
respirations (Kussmaul breathing), a fruity breath odor, and
confusion. Which arterial blood gas (ABG) finding does the nurse
anticipate?
A. pH 7.50, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 28, HCO3 18
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 50, HCO3 28
Answer: B
Rationale: The client is exhibiting signs of Diabetic Ketoacidosis
(DKA), which causes metabolic acidosis. In metabolic acidosis, the
pH is low (<7.35), and the HCO3 is low (<22). The respiratory
system compensates by blowing off CO2, resulting in a low PaCO2
(Kussmaul respirations).
5. A 6-month-old infant is brought to the clinic with severe diarrhea
and vomiting for 24 hours. Which assessment finding indicates
severe dehydration?
A. Capillary refill of 2 seconds.
B. Anterior fontanelle is flat.
, C. Tearing during crying.
D. Tenting of skin turgor.
Answer: D
Rationale: Tenting of skin turgor (when pinched skin stays standing
up like a tent) is a hallmark sign of severe dehydration in infants. A
flat fontanelle, capillary refill under 3 seconds, and tearing are signs
of normal or mild dehydration.
6. During a mental health shift, a client with schizophrenia tells the
nurse, "The CIA is monitoring my thoughts through the television."
Which response by the nurse is most appropriate?
A. "The CIA does not monitor televisions; you are safe here."
B. "I understand you are frightened, but I don't see the CIA here."
C. "Let's turn off the TV and talk about your favorite hobbies."
D. "Why do you think the CIA is interested in your thoughts?"
Answer: B
Rationale: This is an example of a delusion of persecution. The
nurse should not argue with the delusion (A) or reinforce it (D), nor
should they merely change the subject (C) without addressing the
client's feelings. Validating the feeling while presenting reality (B) is
the most therapeutic communication.
7. A nurse is prioritizing care for four clients. Which client should
the nurse assess first?
A. A client with asthma reporting wheezing after a nebulizer
treatment.
B. A client with a femur fracture who is in a long leg cast and reports
pruritus.
C. A client with pneumonia whose pulse oximetry reads 88% on
room air.
D. A client with diabetes who has a fasting blood glucose of 140
mg/dL.
Answer: C
