HESI RN EXIT NGN-STYLE AND CASE SCENARIOS V3
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. The nurse is reviewing home care for quality improvement after repeated falls. Which teaching is
correct?
A. A safe discharge plan accounts for clinical needs and practical barriers in the home setting
B. Quality improvement uses data to test system changes rather than relying on assumptions
C. Incident reporting is used for safety improvement and is not a substitute for factual chart documentation
D. Disaster triage aims for the greatest benefit across the affected population
Correct Answer: B. Quality improvement uses data to test system changes rather than relying on assumptions
Rationale: Quality improvement is iterative and data driven, focusing on safer systems and measurable outcomes.
2. Which guidance most accurately reflects safe practice for vancomycin therapy?
A. Keep vitamin K intake reasonably consistent and check before adding NSAIDs or herbal products
B. Do not stop chronic corticosteroids suddenly; follow taper and stress-dose instructions
C. Maintain oral hygiene and do not stop antiseizure therapy abruptly
D. Report hearing changes, severe rash, or decreased urine output
Correct Answer: D. Report hearing changes, severe rash, or decreased urine output
Rationale: Vancomycin requires appropriate exposure monitoring and careful infusion to reduce toxicity and
infusion reactions.
3. Which teaching point about structured handoff communication should the nurse emphasize?
A. Palliative care can be integrated with serious-illness treatment; hospice emphasizes comfort when eligibility
and goals align
B. Handoff should include information the receiving clinician needs to safely continue care
C. A safe discharge plan accounts for clinical needs and practical barriers in the home setting
D. Disaster triage aims for the greatest benefit across the affected population
Correct Answer: B. Handoff should include information the receiving clinician needs to safely continue care
Rationale: Structured handoff reduces omissions and supports continuity of care.
4. Which guidance most accurately reflects safe practice for eclampsia?
A. Report severe headache, visual change, right-upper-quadrant pain, dyspnea, or markedly increased swelling
promptly
B. Seek urgent care for sudden dyspnea, pleuritic chest pain, hemoptysis, or unexplained tachycardia
C. Carry prescribed epinephrine and seek emergency care after use because symptoms may recur
D. Call for emergency help immediately if a cord is seen or felt after membrane rupture
Correct Answer: A. Report severe headache, visual change, right-upper-quadrant pain, dyspnea, or markedly
increased swelling promptly
Rationale: Eclampsia is seizure activity in the setting of hypertensive pregnancy disease and requires rapid
maternal stabilization and magnesium therapy.
5. Which teaching point about ACE inhibitor therapy should the nurse emphasize?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Do not stop chronic corticosteroids suddenly; follow taper and stress-dose instructions
C. Avoid dehydration and check before starting interacting drugs such as NSAIDs or certain diuretics
D. Report unusual bleeding, black stools, severe headache, or signs of thrombosis
Correct Answer: A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless
prescribed
Rationale: ACE inhibitors can cause hyperkalemia, kidney function changes, cough, and rare life-threatening
angioedema.
6. For discharge teaching related to restraints and least-restrictive care, which point is most important?
A. The provider performing the procedure explains risks, benefits, alternatives, and answers procedure-specific
questions
B. Palliative care can be integrated with serious-illness treatment; hospice emphasizes comfort when eligibility
and goals align
C. Handoff should include information the receiving clinician needs to safely continue care
D. Restraints never replace observation, treatment of causes, or safer alternatives
,Correct Answer: D. Restraints never replace observation, treatment of causes, or safer alternatives
Rationale: Restraints carry physical and psychological risk and require strict indication, monitoring, and repeated
reassessment.
7. Which instruction best supports safe self-management of rapid-acting insulin?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Carry a rapid glucose source and follow the individualized hypoglycemia plan
C. Avoid combining opioids with alcohol or nonprescribed sedatives and keep naloxone available when indicated
D. Report increasing dyspnea, profound weakness, or decreased urine output while receiving magnesium
Correct Answer: B. Carry a rapid glucose source and follow the individualized hypoglycemia plan
Rationale: Rapid-acting insulin has a quick onset; timing with meals and prompt treatment of hypoglycemia are
essential.
8. Which teaching point about near-miss reporting should the nurse emphasize?
A. Priority is based on acuity and threat to life, not on room number or order of request
B. Incident reporting is used for safety improvement and is not a substitute for factual chart documentation
C. Near misses can reveal system vulnerabilities before harm occurs
D. A float nurse should receive assignments within verified competency, with needed orientation and support
Correct Answer: C. Near misses can reveal system vulnerabilities before harm occurs
Rationale: Near-miss data support proactive safety improvement and learning.
9. For discharge teaching related to delirium versus dementia, which point is most important?
A. Panic symptoms can mimic medical emergencies, so safety assessment comes first when the cause is uncertain
B. Eating disorders can cause life-threatening cardiovascular and electrolyte complications
C. Acute onset and fluctuating attention favor delirium, whereas dementia is usually chronic and progressive
D. The nurse can state that they do not hear the voices while recognizing that the experience feels real to the client
Correct Answer: C. Acute onset and fluctuating attention favor delirium, whereas dementia is usually chronic
and progressive
Rationale: Delirium is a medical syndrome requiring evaluation of reversible causes and supportive
environmental care.
10. Which teaching point about selective serotonin reuptake inhibitor therapy should the nurse emphasize?
A. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response develops
B. Maintain oral hygiene and do not stop antiseizure therapy abruptly
C. Report toxicity symptoms and avoid taking extra doses after a missed dose unless instructed
D. Do not stop the medication abruptly without guidance and report worsening suicidal thoughts
Correct Answer: D. Do not stop the medication abruptly without guidance and report worsening suicidal
thoughts
Rationale: SSRIs require adherence, time to benefit, safety monitoring, and attention to serotonergic interactions.
11. Which guidance most accurately reflects safe practice for assignment to an LPN/LVN?
A. Stable clients with predictable outcomes and established plans are generally appropriate LPN/LVN
assignments
B. Quality improvement uses data to test system changes rather than relying on assumptions
C. Priority is based on acuity and threat to life, not on room number or order of request
D. The RN remains responsible for evaluating outcomes of delegated care
Correct Answer: A. Stable clients with predictable outcomes and established plans are generally appropriate
LPN/LVN assignments
Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
12. Which instruction best supports safe self-management of acute ischemic stroke?
A. Call emergency services immediately for sudden facial droop, speech difficulty, weakness, or vision change
B. Avoid alcohol and follow the gallstone/lipid management plan to reduce recurrence
C. Continue basal insulin and follow sick-day glucose/ketone and hydration instructions
D. Avoid nonprescribed NSAIDs after an ulcer bleed and seek emergency care for recurrent hematemesis or
melena
Correct Answer: A. Call emergency services immediately for sudden facial droop, speech difficulty, weakness,
or vision change
Rationale: Stroke outcomes depend on rapid imaging/reperfusion evaluation and prevention of secondary
complications.
, 13. For discharge teaching related to oxytocin infusion, which point is most important?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response develops
C. Do not stop the medication abruptly without guidance and report worsening suicidal thoughts
D. Keep vitamin K intake reasonably consistent and check before adding NSAIDs or herbal products
Correct Answer: B. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response
develops
Rationale: Oxytocin requires close monitoring because excessive uterine activity can reduce uteroplacental
perfusion.
14. The nurse is reviewing home care for umbilical cord prolapse. Which teaching is correct?
A. Call for emergency help immediately if a cord is seen or felt after membrane rupture
B. Seek urgent care for fever, chest symptoms, dyspnea, or neurologic change
C. Seek urgent care for sudden dyspnea, pleuritic chest pain, hemoptysis, or unexplained tachycardia
D. Report sudden recurrent dyspnea or pleuritic chest pain immediately after discharge
Correct Answer: A. Call for emergency help immediately if a cord is seen or felt after membrane rupture
Rationale: Cord prolapse can abruptly cut fetal oxygen supply and requires immediate decompression and
expedited birth.
15. For discharge teaching related to lumbar puncture complications, which point is most important?
A. Report decreased fetal movement, vaginal bleeding, or other urgent pregnancy warning signs as instructed
B. Follow hydration and medication instructions and report reduced urine output after contrast
C. Report sudden chest pain, shortness of breath, hemoptysis, or unilateral leg swelling immediately
D. Report persistent severe headache, fever, drainage, weakness, or new neurologic symptoms after the procedure
Correct Answer: D. Report persistent severe headache, fever, drainage, weakness, or new neurologic symptoms
after the procedure
Rationale: Post-lumbar-puncture monitoring focuses on neurologic change, infection, bleeding, and significant
post-dural-puncture headache.
16. The nurse is reviewing home care for prioritizing multiple clients. Which teaching is correct?
A. Handoff should include information the receiving clinician needs to safely continue care
B. The RN remains responsible for evaluating outcomes of delegated care
C. A float nurse should receive assignments within verified competency, with needed orientation and support
D. Priority is based on acuity and threat to life, not on room number or order of request
Correct Answer: D. Priority is based on acuity and threat to life, not on room number or order of request
Rationale: Prioritization uses acuity, instability, time sensitivity, and risk of harm.
17. Which guidance most accurately reflects safe practice for folic acid and early pregnancy?
A. Combining counseling and approved pharmacotherapy can improve quit success for many adults
B. Folic acid helps reduce neural-tube defect risk when taken before conception and early in pregnancy
C. Fall risk rises with medication effects, sensory loss, muscle weakness, and environmental hazards
D. Room sharing without bed sharing is safer than placing the infant on an adult sleep surface
Correct Answer: B. Folic acid helps reduce neural-tube defect risk when taken before conception and early in
pregnancy
Rationale: Preconception and prenatal health promotion reduces preventable maternal and fetal risk.
18. Which teaching point about measles infection control should the nurse emphasize?
A. Postexposure management is time sensitive and should follow institutional and public-health protocols
B. Measles is highly contagious and requires airborne precautions
C. TB requires airborne precautions in an appropriate negative-pressure airborne infection isolation room
D. Oxygen accelerates combustion and must be kept away from open flames and ignition sources
Correct Answer: B. Measles is highly contagious and requires airborne precautions
Rationale: Measles can remain suspended in air and requires airborne infection-control measures.
19. For discharge teaching related to postpartum hemorrhage, which point is most important?
A. Report decreased fetal movement, vaginal bleeding, or other urgent pregnancy warning signs as instructed
B. Keep the drainage system upright and below chest level and avoid routine clamping
C. Report heavy bleeding, large clots, dizziness, fainting, or rapidly increasing weakness after discharge
D. Report sudden chest pain, shortness of breath, hemoptysis, or unilateral leg swelling immediately
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. The nurse is reviewing home care for quality improvement after repeated falls. Which teaching is
correct?
A. A safe discharge plan accounts for clinical needs and practical barriers in the home setting
B. Quality improvement uses data to test system changes rather than relying on assumptions
C. Incident reporting is used for safety improvement and is not a substitute for factual chart documentation
D. Disaster triage aims for the greatest benefit across the affected population
Correct Answer: B. Quality improvement uses data to test system changes rather than relying on assumptions
Rationale: Quality improvement is iterative and data driven, focusing on safer systems and measurable outcomes.
2. Which guidance most accurately reflects safe practice for vancomycin therapy?
A. Keep vitamin K intake reasonably consistent and check before adding NSAIDs or herbal products
B. Do not stop chronic corticosteroids suddenly; follow taper and stress-dose instructions
C. Maintain oral hygiene and do not stop antiseizure therapy abruptly
D. Report hearing changes, severe rash, or decreased urine output
Correct Answer: D. Report hearing changes, severe rash, or decreased urine output
Rationale: Vancomycin requires appropriate exposure monitoring and careful infusion to reduce toxicity and
infusion reactions.
3. Which teaching point about structured handoff communication should the nurse emphasize?
A. Palliative care can be integrated with serious-illness treatment; hospice emphasizes comfort when eligibility
and goals align
B. Handoff should include information the receiving clinician needs to safely continue care
C. A safe discharge plan accounts for clinical needs and practical barriers in the home setting
D. Disaster triage aims for the greatest benefit across the affected population
Correct Answer: B. Handoff should include information the receiving clinician needs to safely continue care
Rationale: Structured handoff reduces omissions and supports continuity of care.
4. Which guidance most accurately reflects safe practice for eclampsia?
A. Report severe headache, visual change, right-upper-quadrant pain, dyspnea, or markedly increased swelling
promptly
B. Seek urgent care for sudden dyspnea, pleuritic chest pain, hemoptysis, or unexplained tachycardia
C. Carry prescribed epinephrine and seek emergency care after use because symptoms may recur
D. Call for emergency help immediately if a cord is seen or felt after membrane rupture
Correct Answer: A. Report severe headache, visual change, right-upper-quadrant pain, dyspnea, or markedly
increased swelling promptly
Rationale: Eclampsia is seizure activity in the setting of hypertensive pregnancy disease and requires rapid
maternal stabilization and magnesium therapy.
5. Which teaching point about ACE inhibitor therapy should the nurse emphasize?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Do not stop chronic corticosteroids suddenly; follow taper and stress-dose instructions
C. Avoid dehydration and check before starting interacting drugs such as NSAIDs or certain diuretics
D. Report unusual bleeding, black stools, severe headache, or signs of thrombosis
Correct Answer: A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless
prescribed
Rationale: ACE inhibitors can cause hyperkalemia, kidney function changes, cough, and rare life-threatening
angioedema.
6. For discharge teaching related to restraints and least-restrictive care, which point is most important?
A. The provider performing the procedure explains risks, benefits, alternatives, and answers procedure-specific
questions
B. Palliative care can be integrated with serious-illness treatment; hospice emphasizes comfort when eligibility
and goals align
C. Handoff should include information the receiving clinician needs to safely continue care
D. Restraints never replace observation, treatment of causes, or safer alternatives
,Correct Answer: D. Restraints never replace observation, treatment of causes, or safer alternatives
Rationale: Restraints carry physical and psychological risk and require strict indication, monitoring, and repeated
reassessment.
7. Which instruction best supports safe self-management of rapid-acting insulin?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Carry a rapid glucose source and follow the individualized hypoglycemia plan
C. Avoid combining opioids with alcohol or nonprescribed sedatives and keep naloxone available when indicated
D. Report increasing dyspnea, profound weakness, or decreased urine output while receiving magnesium
Correct Answer: B. Carry a rapid glucose source and follow the individualized hypoglycemia plan
Rationale: Rapid-acting insulin has a quick onset; timing with meals and prompt treatment of hypoglycemia are
essential.
8. Which teaching point about near-miss reporting should the nurse emphasize?
A. Priority is based on acuity and threat to life, not on room number or order of request
B. Incident reporting is used for safety improvement and is not a substitute for factual chart documentation
C. Near misses can reveal system vulnerabilities before harm occurs
D. A float nurse should receive assignments within verified competency, with needed orientation and support
Correct Answer: C. Near misses can reveal system vulnerabilities before harm occurs
Rationale: Near-miss data support proactive safety improvement and learning.
9. For discharge teaching related to delirium versus dementia, which point is most important?
A. Panic symptoms can mimic medical emergencies, so safety assessment comes first when the cause is uncertain
B. Eating disorders can cause life-threatening cardiovascular and electrolyte complications
C. Acute onset and fluctuating attention favor delirium, whereas dementia is usually chronic and progressive
D. The nurse can state that they do not hear the voices while recognizing that the experience feels real to the client
Correct Answer: C. Acute onset and fluctuating attention favor delirium, whereas dementia is usually chronic
and progressive
Rationale: Delirium is a medical syndrome requiring evaluation of reversible causes and supportive
environmental care.
10. Which teaching point about selective serotonin reuptake inhibitor therapy should the nurse emphasize?
A. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response develops
B. Maintain oral hygiene and do not stop antiseizure therapy abruptly
C. Report toxicity symptoms and avoid taking extra doses after a missed dose unless instructed
D. Do not stop the medication abruptly without guidance and report worsening suicidal thoughts
Correct Answer: D. Do not stop the medication abruptly without guidance and report worsening suicidal
thoughts
Rationale: SSRIs require adherence, time to benefit, safety monitoring, and attention to serotonergic interactions.
11. Which guidance most accurately reflects safe practice for assignment to an LPN/LVN?
A. Stable clients with predictable outcomes and established plans are generally appropriate LPN/LVN
assignments
B. Quality improvement uses data to test system changes rather than relying on assumptions
C. Priority is based on acuity and threat to life, not on room number or order of request
D. The RN remains responsible for evaluating outcomes of delegated care
Correct Answer: A. Stable clients with predictable outcomes and established plans are generally appropriate
LPN/LVN assignments
Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
12. Which instruction best supports safe self-management of acute ischemic stroke?
A. Call emergency services immediately for sudden facial droop, speech difficulty, weakness, or vision change
B. Avoid alcohol and follow the gallstone/lipid management plan to reduce recurrence
C. Continue basal insulin and follow sick-day glucose/ketone and hydration instructions
D. Avoid nonprescribed NSAIDs after an ulcer bleed and seek emergency care for recurrent hematemesis or
melena
Correct Answer: A. Call emergency services immediately for sudden facial droop, speech difficulty, weakness,
or vision change
Rationale: Stroke outcomes depend on rapid imaging/reperfusion evaluation and prevention of secondary
complications.
, 13. For discharge teaching related to oxytocin infusion, which point is most important?
A. Seek emergency care for facial/tongue swelling and avoid potassium supplements unless prescribed
B. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response develops
C. Do not stop the medication abruptly without guidance and report worsening suicidal thoughts
D. Keep vitamin K intake reasonably consistent and check before adding NSAIDs or herbal products
Correct Answer: B. Oxytocin is adjusted or stopped if excessive uterine activity or concerning fetal response
develops
Rationale: Oxytocin requires close monitoring because excessive uterine activity can reduce uteroplacental
perfusion.
14. The nurse is reviewing home care for umbilical cord prolapse. Which teaching is correct?
A. Call for emergency help immediately if a cord is seen or felt after membrane rupture
B. Seek urgent care for fever, chest symptoms, dyspnea, or neurologic change
C. Seek urgent care for sudden dyspnea, pleuritic chest pain, hemoptysis, or unexplained tachycardia
D. Report sudden recurrent dyspnea or pleuritic chest pain immediately after discharge
Correct Answer: A. Call for emergency help immediately if a cord is seen or felt after membrane rupture
Rationale: Cord prolapse can abruptly cut fetal oxygen supply and requires immediate decompression and
expedited birth.
15. For discharge teaching related to lumbar puncture complications, which point is most important?
A. Report decreased fetal movement, vaginal bleeding, or other urgent pregnancy warning signs as instructed
B. Follow hydration and medication instructions and report reduced urine output after contrast
C. Report sudden chest pain, shortness of breath, hemoptysis, or unilateral leg swelling immediately
D. Report persistent severe headache, fever, drainage, weakness, or new neurologic symptoms after the procedure
Correct Answer: D. Report persistent severe headache, fever, drainage, weakness, or new neurologic symptoms
after the procedure
Rationale: Post-lumbar-puncture monitoring focuses on neurologic change, infection, bleeding, and significant
post-dural-puncture headache.
16. The nurse is reviewing home care for prioritizing multiple clients. Which teaching is correct?
A. Handoff should include information the receiving clinician needs to safely continue care
B. The RN remains responsible for evaluating outcomes of delegated care
C. A float nurse should receive assignments within verified competency, with needed orientation and support
D. Priority is based on acuity and threat to life, not on room number or order of request
Correct Answer: D. Priority is based on acuity and threat to life, not on room number or order of request
Rationale: Prioritization uses acuity, instability, time sensitivity, and risk of harm.
17. Which guidance most accurately reflects safe practice for folic acid and early pregnancy?
A. Combining counseling and approved pharmacotherapy can improve quit success for many adults
B. Folic acid helps reduce neural-tube defect risk when taken before conception and early in pregnancy
C. Fall risk rises with medication effects, sensory loss, muscle weakness, and environmental hazards
D. Room sharing without bed sharing is safer than placing the infant on an adult sleep surface
Correct Answer: B. Folic acid helps reduce neural-tube defect risk when taken before conception and early in
pregnancy
Rationale: Preconception and prenatal health promotion reduces preventable maternal and fetal risk.
18. Which teaching point about measles infection control should the nurse emphasize?
A. Postexposure management is time sensitive and should follow institutional and public-health protocols
B. Measles is highly contagious and requires airborne precautions
C. TB requires airborne precautions in an appropriate negative-pressure airborne infection isolation room
D. Oxygen accelerates combustion and must be kept away from open flames and ignition sources
Correct Answer: B. Measles is highly contagious and requires airborne precautions
Rationale: Measles can remain suspended in air and requires airborne infection-control measures.
19. For discharge teaching related to postpartum hemorrhage, which point is most important?
A. Report decreased fetal movement, vaginal bleeding, or other urgent pregnancy warning signs as instructed
B. Keep the drainage system upright and below chest level and avoid routine clamping
C. Report heavy bleeding, large clots, dizziness, fainting, or rapidly increasing weakness after discharge
D. Report sudden chest pain, shortness of breath, hemoptysis, or unilateral leg swelling immediately
