HESI RN EXIT NGN-STYLE AND CASE SCENARIOS V2
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Which change is least consistent with safe progress in restraints and least-restrictive care and needs
immediate evaluation?
A. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
B. A staff member opens the record of a neighbor who is not under their care
C. Staff are blamed individually without reviewing environment, workflow, medications, or trends
D. A nurse floated from postpartum is assigned an unstable ventilated client without critical-care training
Correct Answer: A. A restrained client develops increasing agitation, skin injury, or impaired circulation without
reassessment
Rationale: Restraints carry physical and psychological risk and require strict indication, monitoring, and repeated
reassessment.
2. The nurse reviews new data for a client with magnesium sulfate in severe preeclampsia. Which finding
demands priority attention?
A. New agitation, hyperreflexia, fever, diarrhea, or clonus appears after serotonergic drug combinations
B. Respiratory depression, absent reflexes, and oliguria develop during therapy
C. Respirations fall to 7/min with increasing somnolence after opioid administration
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: B. Respiratory depression, absent reflexes, and oliguria develop during therapy
Rationale: Magnesium sulfate prevents eclamptic seizures but can cause serious neuromuscular and respiratory
toxicity, especially with renal impairment.
3. During reassessment of quality improvement after repeated falls, which finding should be escalated
promptly?
A. Routine first-come-first-served treatment is used despite a declared mass-casualty event
B. A client comfort-focused wishes are ignored because family members request every possible intervention
C. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
D. Staff are blamed individually without reviewing environment, workflow, medications, or trends
Correct Answer: D. Staff are blamed individually without reviewing environment, workflow, medications, or
trends
Rationale: Quality improvement is iterative and data driven, focusing on safer systems and measurable outcomes.
4. Which change is least consistent with safe progress in anaphylaxis and needs immediate evaluation?
A. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
B. Stridor, wheezing, hypotension, or rapidly increasing facial/tongue swelling develops
C. Lactate rises and hypotension, mottling, oliguria, or confusion worsen despite initial treatment
D. Level of consciousness declines or new severe headache/vomiting develops after initial treatment
Correct Answer: B. Stridor, wheezing, hypotension, or rapidly increasing facial/tongue swelling develops
Rationale: Epinephrine is first-line therapy for anaphylaxis and should not be delayed for antihistamines or
steroids.
5. While monitoring a client in relation to phenytoin therapy, which finding requires the most immediate
follow-up?
A. Long-term corticosteroids are stopped abruptly and the client develops weakness, hypotension, and vomiting
B. Respirations fall to 7/min with increasing somnolence after opioid administration
C. New nystagmus, ataxia, slurred speech, or significant hypotension occurs
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: C. New nystagmus, ataxia, slurred speech, or significant hypotension occurs
Rationale: Phenytoin has nonlinear kinetics, multiple interactions, and concentration-related neurologic toxicity.
6. Which development would make the nurse most concerned about assignment to an LPN/LVN?
A. A nurse accepts an unsafe order after the first concern is dismissed
B. The nurse alters the health record to hide an incorrect dose
C. An LPN/LVN is assigned the initial assessment of a newly unstable client
D. Routine first-come-first-served treatment is used despite a declared mass-casualty event
Correct Answer: C. An LPN/LVN is assigned the initial assessment of a newly unstable client
,Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
7. During reassessment of meningococcal infection precautions, which finding should be escalated
promptly?
A. A used hollow-bore needle injury is hidden because the source client seems low risk
B. Alcohol hand rub is used as the only hand hygiene after heavy exposure to C. difficile spores
C. Close face-to-face care occurs without a mask before effective therapy has been established
D. The drainage bag is placed on the floor or tubing is disconnected routinely for cleaning
Correct Answer: C. Close face-to-face care occurs without a mask before effective therapy has been established
Rationale: Meningococcal organisms spread by respiratory droplets and require prompt droplet protection and
contact management.
8. Which observation related to near-miss reporting is the strongest warning sign?
A. A dangerous dispensing error is corrected before administration and therefore never reported
B. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
C. An assistive person reports a new abnormal finding but the RN does not reassess the client
D. An LPN/LVN is assigned the initial assessment of a newly unstable client
Correct Answer: A. A dangerous dispensing error is corrected before administration and therefore never
reported
Rationale: Near-miss data support proactive safety improvement and learning.
9. During reassessment of acute coronary syndrome, which finding should be escalated promptly?
A. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
B. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant dysrhythmia
C. Level of consciousness declines or new severe headache/vomiting develops after initial treatment
D. Syncope, hypotension, increasing oxygen need, or right-heart strain develops
Correct Answer: B. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant
dysrhythmia
Rationale: ACS care is time sensitive and focuses on rapid diagnosis, antiplatelet/anti-ischemic therapy,
reperfusion when indicated, and complication monitoring.
10. While monitoring a client in relation to aminoglycoside therapy, which finding requires the most
immediate follow-up?
A. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
B. The client has a markedly supratherapeutic INR with active bleeding
C. Respirations fall to 7/min with increasing somnolence after opioid administration
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: A. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
Rationale: Aminoglycosides can cause nephrotoxicity and ototoxicity, especially with accumulation or
interacting nephrotoxins.
11. During reassessment of prioritizing multiple clients, which finding should be escalated promptly?
A. A staff member opens the record of a neighbor who is not under their care
B. A newly unstable client is deferred while routine discharge paperwork is completed
C. Routine first-come-first-served treatment is used despite a declared mass-casualty event
D. Staff are blamed individually without reviewing environment, workflow, medications, or trends
Correct Answer: B. A newly unstable client is deferred while routine discharge paperwork is completed
Rationale: Prioritization uses acuity, instability, time sensitivity, and risk of harm.
12. The nurse reviews new data for a client with acute pancreatitis. Which finding demands priority
attention?
A. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant dysrhythmia
B. Lactate rises and hypotension, mottling, oliguria, or confusion worsen despite initial treatment
C. Hypoxemia, hypotension, oliguria, or increasing abdominal rigidity develops
D. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
Correct Answer: C. Hypoxemia, hypotension, oliguria, or increasing abdominal rigidity develops
Rationale: Pancreatitis can progress to systemic organ failure; supportive care and complication monitoring are
central.
13. Which observation related to smoking cessation is the strongest warning sign?
, A. The newborn has poor transfer, fewer wet diapers, and increasing lethargy but no feeding assessment is
performed
B. Cleaning chemicals are stored in beverage bottles within reach of a toddler
C. A pregnant client reports taking a medication or supplement known to be teratogenic without discussing it with
the prescriber
D. A client with COPD who wants to quit is advised to rely only on willpower despite prior failed attempts
Correct Answer: D. A client with COPD who wants to quit is advised to rely only on willpower despite prior
failed attempts
Rationale: Tobacco cessation is one of the highest-yield preventive interventions and benefits from structured
support.
14. Which development would make the nurse most concerned about panic attack?
A. A client with a specific suicide plan and access to lethal means is left alone
B. A client reports voices commanding self-harm and the nurse does not assess the content
C. Severe chest pain or hypoxemia is assumed to be anxiety without medical assessment
D. A withdrawing client develops hallucinations, severe autonomic hyperactivity, or a seizure
Correct Answer: C. Severe chest pain or hypoxemia is assumed to be anxiety without medical assessment
Rationale: During acute panic, calm presence and simple communication are more effective than detailed
teaching.
15. While monitoring a client in relation to delegation to assistive personnel, which finding requires the
most immediate follow-up?
A. Routine first-come-first-served treatment is used despite a declared mass-casualty event
B. An assistive person reports a new abnormal finding but the RN does not reassess the client
C. The nurse alters the health record to hide an incorrect dose
D. The nurse witnesses a signature after sedating medication has impaired decision-making
Correct Answer: B. An assistive person reports a new abnormal finding but the RN does not reassess the client
Rationale: Delegation transfers performance of a task, not nursing accountability; unstable clients, assessment,
teaching, and evaluation remain RN responsibilities.
16. The nurse reviews new data for a client with chest-tube system monitoring. Which finding demands
priority attention?
A. A fixed dilated pupil, extensor posturing, bradycardia with widening pulse pressure, or declining
consciousness develops
B. Sudden respiratory distress occurs with a new continuous air leak, absent drainage when expected, or tube
dislodgement
C. Fever, chills, flank pain, dyspnea, hypotension, or urticaria develops during the transfusion
D. Severe positional headache is accompanied by fever, focal deficits, or altered mental status
Correct Answer: B. Sudden respiratory distress occurs with a new continuous air leak, absent drainage when
expected, or tube dislodgement
Rationale: Chest-tube assessment prioritizes the client, then system integrity, drainage, and signs of recurrent
pneumothorax or bleeding.
17. Which observation related to structured handoff communication is the strongest warning sign?
A. The nurse witnesses a signature after sedating medication has impaired decision-making
B. Routine first-come-first-served treatment is used despite a declared mass-casualty event
C. A client comfort-focused wishes are ignored because family members request every possible intervention
D. A critical laboratory result and unresolved treatment issue are omitted from report
Correct Answer: D. A critical laboratory result and unresolved treatment issue are omitted from report
Rationale: Structured handoff reduces omissions and supports continuity of care.
18. The nurse reviews new data for a client with beta-blocker therapy. Which finding demands priority
attention?
A. Respiratory depression, absent reflexes, and oliguria develop during therapy
B. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
C. Flushing and hypotension occur during a rapid infusion or renal function worsens
D. The client develops symptomatic bradycardia, hypotension, or acute decompensated shock signs
Correct Answer: D. The client develops symptomatic bradycardia, hypotension, or acute decompensated shock
signs
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Which change is least consistent with safe progress in restraints and least-restrictive care and needs
immediate evaluation?
A. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
B. A staff member opens the record of a neighbor who is not under their care
C. Staff are blamed individually without reviewing environment, workflow, medications, or trends
D. A nurse floated from postpartum is assigned an unstable ventilated client without critical-care training
Correct Answer: A. A restrained client develops increasing agitation, skin injury, or impaired circulation without
reassessment
Rationale: Restraints carry physical and psychological risk and require strict indication, monitoring, and repeated
reassessment.
2. The nurse reviews new data for a client with magnesium sulfate in severe preeclampsia. Which finding
demands priority attention?
A. New agitation, hyperreflexia, fever, diarrhea, or clonus appears after serotonergic drug combinations
B. Respiratory depression, absent reflexes, and oliguria develop during therapy
C. Respirations fall to 7/min with increasing somnolence after opioid administration
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: B. Respiratory depression, absent reflexes, and oliguria develop during therapy
Rationale: Magnesium sulfate prevents eclamptic seizures but can cause serious neuromuscular and respiratory
toxicity, especially with renal impairment.
3. During reassessment of quality improvement after repeated falls, which finding should be escalated
promptly?
A. Routine first-come-first-served treatment is used despite a declared mass-casualty event
B. A client comfort-focused wishes are ignored because family members request every possible intervention
C. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
D. Staff are blamed individually without reviewing environment, workflow, medications, or trends
Correct Answer: D. Staff are blamed individually without reviewing environment, workflow, medications, or
trends
Rationale: Quality improvement is iterative and data driven, focusing on safer systems and measurable outcomes.
4. Which change is least consistent with safe progress in anaphylaxis and needs immediate evaluation?
A. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
B. Stridor, wheezing, hypotension, or rapidly increasing facial/tongue swelling develops
C. Lactate rises and hypotension, mottling, oliguria, or confusion worsen despite initial treatment
D. Level of consciousness declines or new severe headache/vomiting develops after initial treatment
Correct Answer: B. Stridor, wheezing, hypotension, or rapidly increasing facial/tongue swelling develops
Rationale: Epinephrine is first-line therapy for anaphylaxis and should not be delayed for antihistamines or
steroids.
5. While monitoring a client in relation to phenytoin therapy, which finding requires the most immediate
follow-up?
A. Long-term corticosteroids are stopped abruptly and the client develops weakness, hypotension, and vomiting
B. Respirations fall to 7/min with increasing somnolence after opioid administration
C. New nystagmus, ataxia, slurred speech, or significant hypotension occurs
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: C. New nystagmus, ataxia, slurred speech, or significant hypotension occurs
Rationale: Phenytoin has nonlinear kinetics, multiple interactions, and concentration-related neurologic toxicity.
6. Which development would make the nurse most concerned about assignment to an LPN/LVN?
A. A nurse accepts an unsafe order after the first concern is dismissed
B. The nurse alters the health record to hide an incorrect dose
C. An LPN/LVN is assigned the initial assessment of a newly unstable client
D. Routine first-come-first-served treatment is used despite a declared mass-casualty event
Correct Answer: C. An LPN/LVN is assigned the initial assessment of a newly unstable client
,Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
7. During reassessment of meningococcal infection precautions, which finding should be escalated
promptly?
A. A used hollow-bore needle injury is hidden because the source client seems low risk
B. Alcohol hand rub is used as the only hand hygiene after heavy exposure to C. difficile spores
C. Close face-to-face care occurs without a mask before effective therapy has been established
D. The drainage bag is placed on the floor or tubing is disconnected routinely for cleaning
Correct Answer: C. Close face-to-face care occurs without a mask before effective therapy has been established
Rationale: Meningococcal organisms spread by respiratory droplets and require prompt droplet protection and
contact management.
8. Which observation related to near-miss reporting is the strongest warning sign?
A. A dangerous dispensing error is corrected before administration and therefore never reported
B. A restrained client develops increasing agitation, skin injury, or impaired circulation without reassessment
C. An assistive person reports a new abnormal finding but the RN does not reassess the client
D. An LPN/LVN is assigned the initial assessment of a newly unstable client
Correct Answer: A. A dangerous dispensing error is corrected before administration and therefore never
reported
Rationale: Near-miss data support proactive safety improvement and learning.
9. During reassessment of acute coronary syndrome, which finding should be escalated promptly?
A. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
B. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant dysrhythmia
C. Level of consciousness declines or new severe headache/vomiting develops after initial treatment
D. Syncope, hypotension, increasing oxygen need, or right-heart strain develops
Correct Answer: B. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant
dysrhythmia
Rationale: ACS care is time sensitive and focuses on rapid diagnosis, antiplatelet/anti-ischemic therapy,
reperfusion when indicated, and complication monitoring.
10. While monitoring a client in relation to aminoglycoside therapy, which finding requires the most
immediate follow-up?
A. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
B. The client has a markedly supratherapeutic INR with active bleeding
C. Respirations fall to 7/min with increasing somnolence after opioid administration
D. Platelets fall substantially with new thrombosis several days after starting heparin
Correct Answer: A. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
Rationale: Aminoglycosides can cause nephrotoxicity and ototoxicity, especially with accumulation or
interacting nephrotoxins.
11. During reassessment of prioritizing multiple clients, which finding should be escalated promptly?
A. A staff member opens the record of a neighbor who is not under their care
B. A newly unstable client is deferred while routine discharge paperwork is completed
C. Routine first-come-first-served treatment is used despite a declared mass-casualty event
D. Staff are blamed individually without reviewing environment, workflow, medications, or trends
Correct Answer: B. A newly unstable client is deferred while routine discharge paperwork is completed
Rationale: Prioritization uses acuity, instability, time sensitivity, and risk of harm.
12. The nurse reviews new data for a client with acute pancreatitis. Which finding demands priority
attention?
A. Persistent chest pressure is accompanied by hypotension, pulmonary edema, or malignant dysrhythmia
B. Lactate rises and hypotension, mottling, oliguria, or confusion worsen despite initial treatment
C. Hypoxemia, hypotension, oliguria, or increasing abdominal rigidity develops
D. A client with severe preeclampsia develops a generalized seizure or persistent severe neurologic symptoms
Correct Answer: C. Hypoxemia, hypotension, oliguria, or increasing abdominal rigidity develops
Rationale: Pancreatitis can progress to systemic organ failure; supportive care and complication monitoring are
central.
13. Which observation related to smoking cessation is the strongest warning sign?
, A. The newborn has poor transfer, fewer wet diapers, and increasing lethargy but no feeding assessment is
performed
B. Cleaning chemicals are stored in beverage bottles within reach of a toddler
C. A pregnant client reports taking a medication or supplement known to be teratogenic without discussing it with
the prescriber
D. A client with COPD who wants to quit is advised to rely only on willpower despite prior failed attempts
Correct Answer: D. A client with COPD who wants to quit is advised to rely only on willpower despite prior
failed attempts
Rationale: Tobacco cessation is one of the highest-yield preventive interventions and benefits from structured
support.
14. Which development would make the nurse most concerned about panic attack?
A. A client with a specific suicide plan and access to lethal means is left alone
B. A client reports voices commanding self-harm and the nurse does not assess the content
C. Severe chest pain or hypoxemia is assumed to be anxiety without medical assessment
D. A withdrawing client develops hallucinations, severe autonomic hyperactivity, or a seizure
Correct Answer: C. Severe chest pain or hypoxemia is assumed to be anxiety without medical assessment
Rationale: During acute panic, calm presence and simple communication are more effective than detailed
teaching.
15. While monitoring a client in relation to delegation to assistive personnel, which finding requires the
most immediate follow-up?
A. Routine first-come-first-served treatment is used despite a declared mass-casualty event
B. An assistive person reports a new abnormal finding but the RN does not reassess the client
C. The nurse alters the health record to hide an incorrect dose
D. The nurse witnesses a signature after sedating medication has impaired decision-making
Correct Answer: B. An assistive person reports a new abnormal finding but the RN does not reassess the client
Rationale: Delegation transfers performance of a task, not nursing accountability; unstable clients, assessment,
teaching, and evaluation remain RN responsibilities.
16. The nurse reviews new data for a client with chest-tube system monitoring. Which finding demands
priority attention?
A. A fixed dilated pupil, extensor posturing, bradycardia with widening pulse pressure, or declining
consciousness develops
B. Sudden respiratory distress occurs with a new continuous air leak, absent drainage when expected, or tube
dislodgement
C. Fever, chills, flank pain, dyspnea, hypotension, or urticaria develops during the transfusion
D. Severe positional headache is accompanied by fever, focal deficits, or altered mental status
Correct Answer: B. Sudden respiratory distress occurs with a new continuous air leak, absent drainage when
expected, or tube dislodgement
Rationale: Chest-tube assessment prioritizes the client, then system integrity, drainage, and signs of recurrent
pneumothorax or bleeding.
17. Which observation related to structured handoff communication is the strongest warning sign?
A. The nurse witnesses a signature after sedating medication has impaired decision-making
B. Routine first-come-first-served treatment is used despite a declared mass-casualty event
C. A client comfort-focused wishes are ignored because family members request every possible intervention
D. A critical laboratory result and unresolved treatment issue are omitted from report
Correct Answer: D. A critical laboratory result and unresolved treatment issue are omitted from report
Rationale: Structured handoff reduces omissions and supports continuity of care.
18. The nurse reviews new data for a client with beta-blocker therapy. Which finding demands priority
attention?
A. Respiratory depression, absent reflexes, and oliguria develop during therapy
B. New tinnitus, hearing change, rising creatinine, or reduced urine output develops
C. Flushing and hypotension occur during a rapid infusion or renal function worsens
D. The client develops symptomatic bradycardia, hypotension, or acute decompensated shock signs
Correct Answer: D. The client develops symptomatic bradycardia, hypotension, or acute decompensated shock
signs
