HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
QUESTION 1: ANTEPARTUM (PREECLAMPSIA MANAGEMENT)
A nurse is caring for a client at 36 weeks gestation who is admitted with severe preeclampsia
and is receiving a continuous intravenous infusion of magnesium sulfate. Which assessment
finding requires the nurse to stop the infusion immediately and notify the provider?
A) Deep tendon reflexes graded at 1+
B) Respirations of 9 breaths per minute
C) Urinary output of 45 mL over the past hour
D) A continuous feeling of warmth and flushing
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A respiratory rate below 12 breaths per minute is a critical sign of
magnesium sulfate toxicity due to central nervous system depression. The infusion
must be stopped immediately to prevent respiratory arrest.
Why others are incorrect: Deep tendon reflexes graded at 1+ (Option A) indicate
mild depression but are not as critically dangerous as respiratory depression (absent
reflexes would be a toxic sign). A urinary output of 45 mL/hr (Option C) is safe, as it
remains above the critical threshold of 30 mL/hr. Warmth and flushing (Option D) are
common, expected side effects of IV magnesium sulfate initiation.
Test-Taking Tip: For magnesium sulfate toxicity, remember the triad: Bradypnea
(<12), Absent DTRs, and Oliguria (<30 mL/hr). Keep the antidote, calcium gluconate,
at the bedside.
QUESTION 2: INTRAPARTUM (COMPLICATIONS OF LABOR)
A nurse in the labor and delivery unit is caring for a client at 39 weeks gestation who is
receiving an intravenous oxytocin infusion for labor induction. The nurse notes a pattern of
late decelerations on the fetal monitor strip. Which action should the nurse take first?
A) Increase the rate of the oxytocin infusion to accelerate delivery.
B) Position the client in a supine position with a wedge under the right hip.
C) Discontinue the oxytocin infusion immediately.
D) Administer oxygen at 2 L/min via a standard nasal cannula.
1
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
Correct Answer: C
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The absolute priority action is to immediately stop the oxytocin infusion to
halt uterine contractions and restore oxygenated blood flow to the placenta.
Why others are incorrect: Increasing oxytocin (Option A) will worsen uterine
hyperstimulation and fetal distress. The client should be turned to a lateral position,
not supine (Option B), to avoid vena cava compression. Oxygen should be given at 8–
10 L/min via a non-rebreather mask, not 2 L via nasal cannula (Option D).
Test-Taking Tip: For any non-reassuring fetal heart rate pattern (late or severe
variable decelerations) while oxytocin is running, the first move is ALWAYS to turn off
the pump.
QUESTION 3: POSTPARTUM (POSTPARTUM COMPLICATIONS)
A nurse is assessing a client who is two hours postpartum following a vaginal delivery of a
4.1 kg (9 lbs) infant. Upon palpation, the nurse notes that the client's fundus is boggy,
displaced to the right, and located two fingers above the umbilicus. Which action should the
nurse implement first?
A) Administer a prescribed dose of intramuscular methylergonovine.
B) Assist the client to the bathroom or bedpan to void.
C) Initiate a rapid continuous massage of the uterine fundus.
D) Notify the primary healthcare provider of suspected postpartum hemorrhage.
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A fundus that is boggy AND displaced to the right or left indicates a
distended bladder. A full bladder pushes the uterus out of place and prevents it from
contracting effectively, causing uterine atony. Emptying the bladder will allow the
uterus to return to the midline and firm up.
Why others are incorrect: Fundal massage (Option C) is done for a midline boggy
uterus, but displacement must be fixed by voiding first. Uterotonics like
methylergonovine (Option A) are used if the uterus remains boggy after the bladder
is emptied. Provider notification (Option D) is done after initial nursing interventions
2
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
fail.
Test-Taking Tip: If the question states the uterus is displaced to the side, the answer
is almost always related to bladder distension or urination.
QUESTION 4: ANTEPARTUM (ANTEPARTUM COMPLICATIONS)
A nurse is assessing a pregnant client at 34 weeks gestation who presents to the triage unit
reporting sudden-onset, severe abdominal pain and dark red vaginal bleeding. Upon
assessment, the nurse notes that the client's abdomen is rigid and board-like to palpation.
Which condition should the nurse suspect?
A) Placenta Previa
B) Abruptio Placentae
C) Uterine Rupture
D) Incompetent Cervix
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Abruptio placentae (premature separation of the placenta) is
characterized by sudden, painful vaginal bleeding and a classic rigid, board-like
abdomen due to concealed intra-uterine hemorrhage.
Why others are incorrect: Placenta previa (Option A) presents with painless, bright
red vaginal bleeding, and the abdomen remains soft. Uterine rupture (Option C)
causes sudden chest or scapular pain and a loss of fetal station, usually during active
labor. An incompetent cervix (Option D) causes painless cervical dilation in the
second trimester.
Test-Taking Tip: Remember the classic contrast: Previa = Painless, bright red.
Abruption = Abdominal pain, dark red, rigid board.
3
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
QUESTION 5: NEONATAL (HYPOGLYCEMIA MONITORING)
A nurse is caring for a newborn who is 1 hour old and was born to a mother with poorly
controlled gestational diabetes. Which clinical manifestation should the nurse identify as an
early indicator of neonatal hypoglycemia?
A) Loud, lusty cry and hypertonicity
B) Jitteriness, tremors, and lethargy
C) High-pitched cry and skin peeling
D) Bradypnea and generalized petechiae
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Maternal glucose crosses the placenta, but maternal insulin does
not. The fetal pancreas hypertrophies to produce extra insulin. At birth, the maternal
glucose source drops instantly, but the infant's insulin remains high, causing rapid
hypoglycemia characterized by jitteriness, tremors, lethargy, poor feeding, and
hypotonia.
Why others are incorrect: A loud, lusty cry and hypertonicity (Option A) indicate a
vigorous, healthy newborn. A high-pitched cry (Option C) points toward neonatal
abstinence syndrome (NAS) or increased intracranial pressure. Petechiae (Option D)
indicate thrombocytopenia or trauma.
Test-Taking Tip: Think of Jitteriness as the universal #1 warning flag for a low blood
sugar level in newborns.
QUESTION 6: ANTEPARTUM (SCREENING SCHEDULES)
A client at 26 weeks gestation presents to the prenatal clinic for a routine checkup. Which
laboratory screening should the nurse prepare the client to undergo during this visit?
A) Group B Streptococcus (GBS) vaginal culture
B) Maternal serum alpha-fetoprotein (MSAFP) screening
C) 1-hour oral glucose tolerance test (OGTT)
D) Chorionic villus sampling (CVS)
4
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
QUESTION 1: ANTEPARTUM (PREECLAMPSIA MANAGEMENT)
A nurse is caring for a client at 36 weeks gestation who is admitted with severe preeclampsia
and is receiving a continuous intravenous infusion of magnesium sulfate. Which assessment
finding requires the nurse to stop the infusion immediately and notify the provider?
A) Deep tendon reflexes graded at 1+
B) Respirations of 9 breaths per minute
C) Urinary output of 45 mL over the past hour
D) A continuous feeling of warmth and flushing
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A respiratory rate below 12 breaths per minute is a critical sign of
magnesium sulfate toxicity due to central nervous system depression. The infusion
must be stopped immediately to prevent respiratory arrest.
Why others are incorrect: Deep tendon reflexes graded at 1+ (Option A) indicate
mild depression but are not as critically dangerous as respiratory depression (absent
reflexes would be a toxic sign). A urinary output of 45 mL/hr (Option C) is safe, as it
remains above the critical threshold of 30 mL/hr. Warmth and flushing (Option D) are
common, expected side effects of IV magnesium sulfate initiation.
Test-Taking Tip: For magnesium sulfate toxicity, remember the triad: Bradypnea
(<12), Absent DTRs, and Oliguria (<30 mL/hr). Keep the antidote, calcium gluconate,
at the bedside.
QUESTION 2: INTRAPARTUM (COMPLICATIONS OF LABOR)
A nurse in the labor and delivery unit is caring for a client at 39 weeks gestation who is
receiving an intravenous oxytocin infusion for labor induction. The nurse notes a pattern of
late decelerations on the fetal monitor strip. Which action should the nurse take first?
A) Increase the rate of the oxytocin infusion to accelerate delivery.
B) Position the client in a supine position with a wedge under the right hip.
C) Discontinue the oxytocin infusion immediately.
D) Administer oxygen at 2 L/min via a standard nasal cannula.
1
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
Correct Answer: C
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Late decelerations indicate uteroplacental insufficiency and fetal
hypoxia. The absolute priority action is to immediately stop the oxytocin infusion to
halt uterine contractions and restore oxygenated blood flow to the placenta.
Why others are incorrect: Increasing oxytocin (Option A) will worsen uterine
hyperstimulation and fetal distress. The client should be turned to a lateral position,
not supine (Option B), to avoid vena cava compression. Oxygen should be given at 8–
10 L/min via a non-rebreather mask, not 2 L via nasal cannula (Option D).
Test-Taking Tip: For any non-reassuring fetal heart rate pattern (late or severe
variable decelerations) while oxytocin is running, the first move is ALWAYS to turn off
the pump.
QUESTION 3: POSTPARTUM (POSTPARTUM COMPLICATIONS)
A nurse is assessing a client who is two hours postpartum following a vaginal delivery of a
4.1 kg (9 lbs) infant. Upon palpation, the nurse notes that the client's fundus is boggy,
displaced to the right, and located two fingers above the umbilicus. Which action should the
nurse implement first?
A) Administer a prescribed dose of intramuscular methylergonovine.
B) Assist the client to the bathroom or bedpan to void.
C) Initiate a rapid continuous massage of the uterine fundus.
D) Notify the primary healthcare provider of suspected postpartum hemorrhage.
Correct Answer: B
HESI Category: Reduction of Risk Potential / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: A fundus that is boggy AND displaced to the right or left indicates a
distended bladder. A full bladder pushes the uterus out of place and prevents it from
contracting effectively, causing uterine atony. Emptying the bladder will allow the
uterus to return to the midline and firm up.
Why others are incorrect: Fundal massage (Option C) is done for a midline boggy
uterus, but displacement must be fixed by voiding first. Uterotonics like
methylergonovine (Option A) are used if the uterus remains boggy after the bladder
is emptied. Provider notification (Option D) is done after initial nursing interventions
2
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
fail.
Test-Taking Tip: If the question states the uterus is displaced to the side, the answer
is almost always related to bladder distension or urination.
QUESTION 4: ANTEPARTUM (ANTEPARTUM COMPLICATIONS)
A nurse is assessing a pregnant client at 34 weeks gestation who presents to the triage unit
reporting sudden-onset, severe abdominal pain and dark red vaginal bleeding. Upon
assessment, the nurse notes that the client's abdomen is rigid and board-like to palpation.
Which condition should the nurse suspect?
A) Placenta Previa
B) Abruptio Placentae
C) Uterine Rupture
D) Incompetent Cervix
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Abruptio placentae (premature separation of the placenta) is
characterized by sudden, painful vaginal bleeding and a classic rigid, board-like
abdomen due to concealed intra-uterine hemorrhage.
Why others are incorrect: Placenta previa (Option A) presents with painless, bright
red vaginal bleeding, and the abdomen remains soft. Uterine rupture (Option C)
causes sudden chest or scapular pain and a loss of fetal station, usually during active
labor. An incompetent cervix (Option D) causes painless cervical dilation in the
second trimester.
Test-Taking Tip: Remember the classic contrast: Previa = Painless, bright red.
Abruption = Abdominal pain, dark red, rigid board.
3
, HESI RN EXIT EXAM MASTER TEST BANK (2026/2027)
Next-Gen NCJMM All-In-One Pass Pack: Volumes 1–4 Complete
ID: HESI-RN-MASTER-BUNDLE | 180+ Questions, Rationales & Tips
QUESTION 5: NEONATAL (HYPOGLYCEMIA MONITORING)
A nurse is caring for a newborn who is 1 hour old and was born to a mother with poorly
controlled gestational diabetes. Which clinical manifestation should the nurse identify as an
early indicator of neonatal hypoglycemia?
A) Loud, lusty cry and hypertonicity
B) Jitteriness, tremors, and lethargy
C) High-pitched cry and skin peeling
D) Bradypnea and generalized petechiae
Correct Answer: B
HESI Category: Physiological Adaptation / Maternal-Newborn
Next-Gen NCJMM Rationale:
Why it's correct: Maternal glucose crosses the placenta, but maternal insulin does
not. The fetal pancreas hypertrophies to produce extra insulin. At birth, the maternal
glucose source drops instantly, but the infant's insulin remains high, causing rapid
hypoglycemia characterized by jitteriness, tremors, lethargy, poor feeding, and
hypotonia.
Why others are incorrect: A loud, lusty cry and hypertonicity (Option A) indicate a
vigorous, healthy newborn. A high-pitched cry (Option C) points toward neonatal
abstinence syndrome (NAS) or increased intracranial pressure. Petechiae (Option D)
indicate thrombocytopenia or trauma.
Test-Taking Tip: Think of Jitteriness as the universal #1 warning flag for a low blood
sugar level in newborns.
QUESTION 6: ANTEPARTUM (SCREENING SCHEDULES)
A client at 26 weeks gestation presents to the prenatal clinic for a routine checkup. Which
laboratory screening should the nurse prepare the client to undergo during this visit?
A) Group B Streptococcus (GBS) vaginal culture
B) Maternal serum alpha-fetoprotein (MSAFP) screening
C) 1-hour oral glucose tolerance test (OGTT)
D) Chorionic villus sampling (CVS)
4
