NGN RN HESI EXIT EXAM|QUESTIONS AND
ANSWERS|2026|2027 UPDATES|WITH
COMPLETE SOLUTIONS
1. A nurse is caring for a client with severe preeclampsia receiving IV magnesium
sulfate. Which finding indicates magnesium toxicity?
A. Respiratory rate of 14/min
B. Urine output of 40 mL/hr
C. Patellar reflex score of 2+
D. Serum magnesium level of 9.5 mEq/L
Correct Answer: D. A therapeutic magnesium level is 4-7 mEq/L. A level of 9.5
mEq/L is toxic. Loss of deep tendon reflexes (0/4) and respiratory depression
(<12/min) occur first, but a high serum level is the definitive indicator.
Rationale: Magnesium toxicity depresses the CNS and neuromuscular junction.
The nurse must monitor for loss of patellar reflexes, respiratory depression, and
oliguria (<30 mL/hr). Calcium gluconate is the antidote.
---
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value requires the most immediate intervention?
A. Serum sodium of 135 mEq/L
,B. Serum potassium of 3.0 mEq/L
C. Serum calcium of 10.2 mg/dL
D. Serum magnesium of 2.0 mEq/L
Correct Answer: B. A potassium of 3.0 mEq/L is critically low (hypokalemia).
Rationale: Furosemide is a loop diuretic that causes massive potassium wasting in
the distal tubule. Hypokalemia increases the risk of digoxin toxicity (if the client is
on digoxin) and fatal cardiac dysrhythmias like Torsades de Pointes.
---
3. A nurse is preparing to administer insulin aspart (NovoLog) to a client with type
1 diabetes. Which action is correct?
A. Inject the insulin 30 minutes before a meal.
B. Mix the insulin with NPH insulin in the same syringe.
C. Administer the insulin with the meal or immediately after.
D. Administer the insulin 5 to 15 minutes before the meal.
Correct Answer: D. Insulin aspart is a rapid-acting analog.
Rationale: Rapid-acting insulin (aspart, lispro, glulisine) has an onset of 5-15
minutes. It should be given immediately before (0-15 minutes) or right after meals
to match the postprandial glucose spike. Mixing with NPH is acceptable but must
be drawn up with clear (aspart) before cloudy (NPH).
---
,4. A client is admitted with a traumatic brain injury (TBI). The nurse notices a
widening pulse pressure (increasing systolic, decreasing diastolic). What is the
priority intervention?
A. Administer a stool softener.
B. Elevate the head of the bed to 30 degrees.
C. Place the client in a Trendelenburg position.
D. Increase the IV fluid rate.
Correct Answer: B. Widening pulse pressure indicates increasing intracranial
pressure (ICP) (Cushing's triad).
Rationale: Elevating the HOB to 30 degrees promotes venous drainage from the
brain, helping to lower ICP. Trendelenburg would increase ICP. Maintaining
cerebral perfusion pressure (CPP) is key, but lowering ICP is the immediate priority
here.
---
5. A postpartum nurse is assessing a client who delivered 6 hours ago. The client
has saturated two perineal pads in the last 15 minutes. What is the best initial
nursing action?
A. Document the findings as normal.
B. Massage the uterine fundus.
C. Increase the IV oxytocin rate.
D. Notify the healthcare provider immediately.
Correct Answer: B. Saturation of two pads in 15 minutes indicates excessive lochia
(hemorrhage).
, Rationale: The first action for postpartum hemorrhage is to massage the fundus to
stimulate uterine contraction and tone. If the fundus is boggy, massage is the
priority. Notifying the provider and increasing oxytocin are secondary steps after
the initial assessment and fundal massage.
---
6. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 4 L/min via nasal cannula. The nurse notes the client is lethargic and has a
respiratory rate of 8/min. Which action should the nurse take first?
A. Auscultate lung sounds.
B. Draw an arterial blood gas.
C. Reduce the oxygen flow rate.
D. Administer naloxone (Narcan).
Correct Answer: C. This client is showing signs of carbon dioxide (CO2) narcosis.
Rationale: Clients with COPD rely on a hypoxic drive to breathe. High-flow oxygen
(above 2-3 L/min) can eliminate this drive, causing respiratory depression. The
nurse should reduce the O2 rate to 1-2 L/min and prepare for potential ventilatory
support.
---
7. A client is on a clear liquid diet before a colonoscopy. Which item is appropriate
to include on the lunch tray?
A. Vanilla ice cream
B. Cream of mushroom soup
ANSWERS|2026|2027 UPDATES|WITH
COMPLETE SOLUTIONS
1. A nurse is caring for a client with severe preeclampsia receiving IV magnesium
sulfate. Which finding indicates magnesium toxicity?
A. Respiratory rate of 14/min
B. Urine output of 40 mL/hr
C. Patellar reflex score of 2+
D. Serum magnesium level of 9.5 mEq/L
Correct Answer: D. A therapeutic magnesium level is 4-7 mEq/L. A level of 9.5
mEq/L is toxic. Loss of deep tendon reflexes (0/4) and respiratory depression
(<12/min) occur first, but a high serum level is the definitive indicator.
Rationale: Magnesium toxicity depresses the CNS and neuromuscular junction.
The nurse must monitor for loss of patellar reflexes, respiratory depression, and
oliguria (<30 mL/hr). Calcium gluconate is the antidote.
---
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory
value requires the most immediate intervention?
A. Serum sodium of 135 mEq/L
,B. Serum potassium of 3.0 mEq/L
C. Serum calcium of 10.2 mg/dL
D. Serum magnesium of 2.0 mEq/L
Correct Answer: B. A potassium of 3.0 mEq/L is critically low (hypokalemia).
Rationale: Furosemide is a loop diuretic that causes massive potassium wasting in
the distal tubule. Hypokalemia increases the risk of digoxin toxicity (if the client is
on digoxin) and fatal cardiac dysrhythmias like Torsades de Pointes.
---
3. A nurse is preparing to administer insulin aspart (NovoLog) to a client with type
1 diabetes. Which action is correct?
A. Inject the insulin 30 minutes before a meal.
B. Mix the insulin with NPH insulin in the same syringe.
C. Administer the insulin with the meal or immediately after.
D. Administer the insulin 5 to 15 minutes before the meal.
Correct Answer: D. Insulin aspart is a rapid-acting analog.
Rationale: Rapid-acting insulin (aspart, lispro, glulisine) has an onset of 5-15
minutes. It should be given immediately before (0-15 minutes) or right after meals
to match the postprandial glucose spike. Mixing with NPH is acceptable but must
be drawn up with clear (aspart) before cloudy (NPH).
---
,4. A client is admitted with a traumatic brain injury (TBI). The nurse notices a
widening pulse pressure (increasing systolic, decreasing diastolic). What is the
priority intervention?
A. Administer a stool softener.
B. Elevate the head of the bed to 30 degrees.
C. Place the client in a Trendelenburg position.
D. Increase the IV fluid rate.
Correct Answer: B. Widening pulse pressure indicates increasing intracranial
pressure (ICP) (Cushing's triad).
Rationale: Elevating the HOB to 30 degrees promotes venous drainage from the
brain, helping to lower ICP. Trendelenburg would increase ICP. Maintaining
cerebral perfusion pressure (CPP) is key, but lowering ICP is the immediate priority
here.
---
5. A postpartum nurse is assessing a client who delivered 6 hours ago. The client
has saturated two perineal pads in the last 15 minutes. What is the best initial
nursing action?
A. Document the findings as normal.
B. Massage the uterine fundus.
C. Increase the IV oxytocin rate.
D. Notify the healthcare provider immediately.
Correct Answer: B. Saturation of two pads in 15 minutes indicates excessive lochia
(hemorrhage).
, Rationale: The first action for postpartum hemorrhage is to massage the fundus to
stimulate uterine contraction and tone. If the fundus is boggy, massage is the
priority. Notifying the provider and increasing oxytocin are secondary steps after
the initial assessment and fundal massage.
---
6. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 4 L/min via nasal cannula. The nurse notes the client is lethargic and has a
respiratory rate of 8/min. Which action should the nurse take first?
A. Auscultate lung sounds.
B. Draw an arterial blood gas.
C. Reduce the oxygen flow rate.
D. Administer naloxone (Narcan).
Correct Answer: C. This client is showing signs of carbon dioxide (CO2) narcosis.
Rationale: Clients with COPD rely on a hypoxic drive to breathe. High-flow oxygen
(above 2-3 L/min) can eliminate this drive, causing respiratory depression. The
nurse should reduce the O2 rate to 1-2 L/min and prepare for potential ventilatory
support.
---
7. A client is on a clear liquid diet before a colonoscopy. Which item is appropriate
to include on the lunch tray?
A. Vanilla ice cream
B. Cream of mushroom soup
