2026 HESI RN EXIT EXAM
2026 HESI RN Exit Exam Version 1 with Next
Generation NCLEX (NGN) Case Studies: 200-Question
Comprehensive Practice Examination with Verified
Rationalized Answers and Detailed Answer
Explanations for Guaranteed Exam Success
================================================================================
2026 HESI RN EXIT EXAM VERSION 1
WITH NEXT GENERATION NCLEX (NGN) CASE STUDIES
================================================================================
200-QUESTION COMPREHENSIVE PRACTICE EXAMINATION
WITH VERIFIED RATIONALIZED ANSWERS AND DETAILED EXPLANATIONS
--------------------------------------------------------------------------------
DOCUMENT TITLE:
2026 HESI RN Exit Exam Version 1 with Next Generation NCLEX (NGN) Case
Studies: 200-Question Comprehensive Practice Examination with Verified
Rationalized Answers and Detailed Answer Explanations for Guaranteed
Exam Success
--------------------------------------------------------------------------------
EXAM DETAILS:
Total Questions: 200
Question Types: Multiple-Choice, Select-All-That-Apply,
True/False, Case Studies, Scenario-Based,
Prioritization, and Clinical Judgment
Color-Coded Format: BLUE = Question
RED = Answer
PURPLE = Rationale
Answer Key Included: Yes (Every Question)
pg. 1
, 2026 HESI RN EXIT EXAM
Rationale Included: Yes (Every Question)
--------------------------------------------------------------------------------
CONTENT SECTIONS:
Section 1: Medical-Surgical Nursing ................. Questions 001–040
Section 2: Maternity/Obstetrics .................... Questions 041–065
Section 3: Pediatrics .............................. Questions 066–090
Section 4: Psychiatric/Mental Health Nursing ....... Questions 091–110
Section 5: Pharmacology ............................ Questions 111–130
Section 6: NGN Case Studies ........................ Questions 131–160
Section 7: Prioritization and Clinical Judgment .... Questions 161–180
Section 8: NGN Complex Case Scenarios .............. Questions 181–200
--------------------------------------------------------------------------------
INSTRUCTIONS:
1. Read each question carefully before selecting your answer.
2. Select the BEST answer for each question.
3. For select-all-that-apply items, choose ALL answers that apply.
4. Do NOT reveal the answer or rationale until you have answered.
5. Review the rationale for every question, including ones answered
correctly, to reinforce clinical reasoning.
6. Complete the exam in one sitting to simulate real testing conditions.
--------------------------------------------------------------------------------
PREPARED FOR: HESI RN Exit Exam Candidates
PREPARATION YEAR: 2026
VERSION: 1.0
STATUS: Verified and Rationalized
================================================================================
BEGIN EXAMINATION
pg. 2
, 2026 HESI RN EXIT EXAM
================================================================================
2026 HESI RN Exit Exam V1 with NGN Questions
Comprehensive 200-Question Practice Examination
SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-40)
QUESTION 1:
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Increased jugular venous distention
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
ANSWER:
B. Decreased peripheral edema
RATIONALE:
Furosemide is a loop diuretic that works by inhibiting sodium and chloride reabsorption in the
ascending loop of Henle, promoting diuresis. The desired therapeutic effect is reduction of fluid
volume overload, which manifests as decreased peripheral edema, decreased pulmonary
congestion, and reduced jugular venous distention. Option A is incorrect because furosemide should
decrease JVD. Option C is incorrect because while blood pressure may decrease slightly, this is not
the primary therapeutic effect. Option D is incorrect because furosemide increases urine output.
QUESTION 2:
A nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory value requires
immediate intervention?
A. Serum glucose 350 mg/dL
B. Serum potassium 3.0 mEq/L
C. Serum bicarbonate 18 mEq/L
D. Arterial pH 7.25
ANSWER:
B. Serum potassium 3.0 mEq/L
RATIONALE:
In DKA, total body potassium is depleted despite normal or elevated serum levels due to acidosis
shifting potassium extracellularly. A potassium of 3.0 mEq/L indicates significant depletion and
carries risk of cardiac arrhythmias, especially with insulin therapy which drives potassium back into
cells. While all values are abnormal, the potassium level of 3.0 mEq/L represents the most
immediate life-threatening risk. Insulin administration will further decrease serum potassium,
pg. 3
, 2026 HESI RN EXIT EXAM
potentially leading to severe hypokalemia and cardiac arrest. The glucose of 350 mg/dL, bicarbonate
of 18 mEq/L, and pH of 7.25 are also concerning but require treatment after potassium is addressed.
QUESTION 3:
A client diagnosed with pneumonia has a prescription for ceftriaxone (Rocephin) 1 g IV every 12
hours. Which assessment finding indicates a potential adverse reaction to this medication?
A. Diarrhea
B. Headache
C. Rash on the chest
D. Pain at the IV site
ANSWER:
C. Rash on the chest
RATIONALE:
Ceftriaxone is a third-generation cephalosporin antibiotic. A rash on the chest is a sign of a
hypersensitivity reaction, which can range from mild to severe and potentially life-threatening
(Stevens-Johnson syndrome). Diarrhea can occur with antibiotic use but is not the primary
concerning adverse reaction requiring immediate attention. Headache is a possible side effect but
less concerning than a hypersensitivity rash. Pain at the IV site indicates phlebitis or infiltration,
which requires intervention but is not a medication-specific adverse reaction.
QUESTION 4:
The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding is
consistent with the expected clinical presentation?
A. Barrel-shaped chest
B. Clubbing of the fingers
C. Pursed-lip breathing
D. All of the above
ANSWER:
D. All of the above
RATIONALE:
All of these findings are characteristic of COPD. Barrel-shaped chest results from hyperinflation of
the lungs due to air trapping. Clubbing of the fingers occurs due to chronic hypoxemia. Pursed-lip
breathing is an adaptive mechanism that increases airway pressure and keeps airways open during
exhalation. These findings collectively indicate advanced COPD and chronic respiratory compromise.
QUESTION 5:
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
indicates the medication is at a therapeutic level?
A. INR of 1.0
B. INR of 2.5
pg. 4
2026 HESI RN Exit Exam Version 1 with Next
Generation NCLEX (NGN) Case Studies: 200-Question
Comprehensive Practice Examination with Verified
Rationalized Answers and Detailed Answer
Explanations for Guaranteed Exam Success
================================================================================
2026 HESI RN EXIT EXAM VERSION 1
WITH NEXT GENERATION NCLEX (NGN) CASE STUDIES
================================================================================
200-QUESTION COMPREHENSIVE PRACTICE EXAMINATION
WITH VERIFIED RATIONALIZED ANSWERS AND DETAILED EXPLANATIONS
--------------------------------------------------------------------------------
DOCUMENT TITLE:
2026 HESI RN Exit Exam Version 1 with Next Generation NCLEX (NGN) Case
Studies: 200-Question Comprehensive Practice Examination with Verified
Rationalized Answers and Detailed Answer Explanations for Guaranteed
Exam Success
--------------------------------------------------------------------------------
EXAM DETAILS:
Total Questions: 200
Question Types: Multiple-Choice, Select-All-That-Apply,
True/False, Case Studies, Scenario-Based,
Prioritization, and Clinical Judgment
Color-Coded Format: BLUE = Question
RED = Answer
PURPLE = Rationale
Answer Key Included: Yes (Every Question)
pg. 1
, 2026 HESI RN EXIT EXAM
Rationale Included: Yes (Every Question)
--------------------------------------------------------------------------------
CONTENT SECTIONS:
Section 1: Medical-Surgical Nursing ................. Questions 001–040
Section 2: Maternity/Obstetrics .................... Questions 041–065
Section 3: Pediatrics .............................. Questions 066–090
Section 4: Psychiatric/Mental Health Nursing ....... Questions 091–110
Section 5: Pharmacology ............................ Questions 111–130
Section 6: NGN Case Studies ........................ Questions 131–160
Section 7: Prioritization and Clinical Judgment .... Questions 161–180
Section 8: NGN Complex Case Scenarios .............. Questions 181–200
--------------------------------------------------------------------------------
INSTRUCTIONS:
1. Read each question carefully before selecting your answer.
2. Select the BEST answer for each question.
3. For select-all-that-apply items, choose ALL answers that apply.
4. Do NOT reveal the answer or rationale until you have answered.
5. Review the rationale for every question, including ones answered
correctly, to reinforce clinical reasoning.
6. Complete the exam in one sitting to simulate real testing conditions.
--------------------------------------------------------------------------------
PREPARED FOR: HESI RN Exit Exam Candidates
PREPARATION YEAR: 2026
VERSION: 1.0
STATUS: Verified and Rationalized
================================================================================
BEGIN EXAMINATION
pg. 2
, 2026 HESI RN EXIT EXAM
================================================================================
2026 HESI RN Exit Exam V1 with NGN Questions
Comprehensive 200-Question Practice Examination
SECTION 1: MEDICAL-SURGICAL NURSING (Questions 1-40)
QUESTION 1:
A client with heart failure is prescribed furosemide (Lasix) 40 mg IV push. Which assessment finding
indicates the medication is having the desired therapeutic effect?
A. Increased jugular venous distention
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased urine output
ANSWER:
B. Decreased peripheral edema
RATIONALE:
Furosemide is a loop diuretic that works by inhibiting sodium and chloride reabsorption in the
ascending loop of Henle, promoting diuresis. The desired therapeutic effect is reduction of fluid
volume overload, which manifests as decreased peripheral edema, decreased pulmonary
congestion, and reduced jugular venous distention. Option A is incorrect because furosemide should
decrease JVD. Option C is incorrect because while blood pressure may decrease slightly, this is not
the primary therapeutic effect. Option D is incorrect because furosemide increases urine output.
QUESTION 2:
A nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory value requires
immediate intervention?
A. Serum glucose 350 mg/dL
B. Serum potassium 3.0 mEq/L
C. Serum bicarbonate 18 mEq/L
D. Arterial pH 7.25
ANSWER:
B. Serum potassium 3.0 mEq/L
RATIONALE:
In DKA, total body potassium is depleted despite normal or elevated serum levels due to acidosis
shifting potassium extracellularly. A potassium of 3.0 mEq/L indicates significant depletion and
carries risk of cardiac arrhythmias, especially with insulin therapy which drives potassium back into
cells. While all values are abnormal, the potassium level of 3.0 mEq/L represents the most
immediate life-threatening risk. Insulin administration will further decrease serum potassium,
pg. 3
, 2026 HESI RN EXIT EXAM
potentially leading to severe hypokalemia and cardiac arrest. The glucose of 350 mg/dL, bicarbonate
of 18 mEq/L, and pH of 7.25 are also concerning but require treatment after potassium is addressed.
QUESTION 3:
A client diagnosed with pneumonia has a prescription for ceftriaxone (Rocephin) 1 g IV every 12
hours. Which assessment finding indicates a potential adverse reaction to this medication?
A. Diarrhea
B. Headache
C. Rash on the chest
D. Pain at the IV site
ANSWER:
C. Rash on the chest
RATIONALE:
Ceftriaxone is a third-generation cephalosporin antibiotic. A rash on the chest is a sign of a
hypersensitivity reaction, which can range from mild to severe and potentially life-threatening
(Stevens-Johnson syndrome). Diarrhea can occur with antibiotic use but is not the primary
concerning adverse reaction requiring immediate attention. Headache is a possible side effect but
less concerning than a hypersensitivity rash. Pain at the IV site indicates phlebitis or infiltration,
which requires intervention but is not a medication-specific adverse reaction.
QUESTION 4:
The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding is
consistent with the expected clinical presentation?
A. Barrel-shaped chest
B. Clubbing of the fingers
C. Pursed-lip breathing
D. All of the above
ANSWER:
D. All of the above
RATIONALE:
All of these findings are characteristic of COPD. Barrel-shaped chest results from hyperinflation of
the lungs due to air trapping. Clubbing of the fingers occurs due to chronic hypoxemia. Pursed-lip
breathing is an adaptive mechanism that increases airway pressure and keeps airways open during
exhalation. These findings collectively indicate advanced COPD and chronic respiratory compromise.
QUESTION 5:
A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory value
indicates the medication is at a therapeutic level?
A. INR of 1.0
B. INR of 2.5
pg. 4
