HESI RN EXIT NGN-STYLE AND CASE SCENARIOS V5
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Which finding is most consistent with successful management of assignment to an LPN/LVN?
A. The LPN/LVN completes routine care and promptly reports a change in condition
B. The highest-acuity problem is addressed before stable routine needs
C. The client can accurately explain the plan in their preferred language
D. A responsible clinician reviews the unresolved concern and a safer plan is established
Correct Answer: A. The LPN/LVN completes routine care and promptly reports a change in condition
Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
2. After interventions for rapid-acting insulin, which finding most strongly suggests improvement?
A. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
B. Congestion improves while blood pressure, renal function, and electrolytes remain acceptable
C. Blood pressure improves without hyperkalemia, renal deterioration, or angioedema
D. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
Correct Answer: D. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
Rationale: Rapid-acting insulin has a quick onset; timing with meals and prompt treatment of hypoglycemia are
essential.
3. Which evaluation finding supports that care for medication error response is achieving its goal?
A. Limited resources are directed to the highest-priority salvageable needs
B. The client is assessed and protected, and the event is reported through the safety system
C. The LPN/LVN completes routine care and promptly reports a change in condition
D. The receiving nurse can identify current priorities and unresolved issues
Correct Answer: B. The client is assessed and protected, and the event is reported through the safety system
Rationale: After an error, client safety is first; documentation remains factual and incident reporting supports
system learning.
4. Which outcome would the nurse expect when care for diabetic ketoacidosis is effective?
A. The anion gap closes and acidosis/ketosis resolve with stable potassium
B. Bleeding stops and perfusion stabilizes without recurrent shock
C. Dyspnea and hypoxemia improve without recurrent embolism or major bleeding
D. Work of breathing and crackles decrease while oxygenation and perfusion improve
Correct Answer: A. The anion gap closes and acidosis/ketosis resolve with stable potassium
Rationale: DKA treatment corrects dehydration and ketosis while carefully managing potassium and the
precipitating illness.
5. After interventions for confidentiality and electronic health information, which finding most strongly
suggests improvement?
A. Only authorized team members can access the information needed for care
B. Fall rates or relevant process measures improve after the intervention
C. The plan of care reflects the client stated goals and symptom priorities
D. The client can describe the procedure in general terms and chooses voluntarily
Correct Answer: A. Only authorized team members can access the information needed for care
Rationale: Privacy standards require appropriate access, minimum necessary disclosure, and secure handling of
health information.
6. Which finding is most consistent with successful management of digoxin therapy?
A. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid complications
B. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
C. Blood pressure improves without hyperkalemia, renal deterioration, or angioedema
D. Seizures remain controlled without neurologic toxicity or major infusion complications
Correct Answer: B. Heart rate and symptoms improve without toxicity while the dose remains appropriate for
renal function
Rationale: Digoxin has a narrow therapeutic index and toxicity risk rises with renal impairment and electrolyte
abnormalities.
,7. After interventions for advance directives and surrogate decision-making, which finding most strongly
suggests improvement?
A. The highest-acuity problem is addressed before stable routine needs
B. The client can describe the procedure in general terms and chooses voluntarily
C. The client is assessed and protected, and the event is reported through the safety system
D. Care decisions remain aligned with the client expressed goals and designated surrogate authority
Correct Answer: D. Care decisions remain aligned with the client expressed goals and designated surrogate
authority
Rationale: Client autonomy guides care; advance directives and authorized surrogates support the client
preferences when capacity is absent.
8. Which evaluation finding supports that care for loop diuretic therapy is achieving its goal?
A. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
B. Congestion improves while blood pressure, renal function, and electrolytes remain acceptable
C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
D. The infection improves with target exposure and no significant nephrotoxicity or infusion reaction
Correct Answer: B. Congestion improves while blood pressure, renal function, and electrolytes remain
acceptable
Rationale: Loop diuretics relieve fluid overload but can cause volume depletion and electrolyte loss.
9. The nurse evaluates the response to care for delegation to assistive personnel. Which result is most
favorable?
A. Only authorized team members can access the information needed for care
B. The highest-acuity problem is addressed before stable routine needs
C. The client is assessed and protected, and the event is reported through the safety system
D. The task is completed correctly and unexpected findings are promptly communicated
Correct Answer: D. The task is completed correctly and unexpected findings are promptly communicated
Rationale: Delegation transfers performance of a task, not nursing accountability; unstable clients, assessment,
teaching, and evaluation remain RN responsibilities.
10. Which finding is most consistent with successful management of systemic corticosteroid therapy?
A. INR remains in the individualized target range without thromboembolism or major bleeding
B. Contractions become effective without tachysystole and fetal status remains reassuring
C. Heart rate and blood pressure are controlled without symptomatic bradycardia
D. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid complications
Correct Answer: D. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid
complications
Rationale: Chronic corticosteroids suppress the hypothalamic-pituitary-adrenal axis and require careful tapering
and complication monitoring.
11. Which outcome best indicates that management of alcohol withdrawal is effective?
A. Tremor and autonomic symptoms resolve without seizure or delirium
B. Immediate safety is maintained and a collaborative follow-up/safety plan is established
C. Attention and cognition improve as the precipitating illness resolves
D. The client can express feelings and identify supports or next steps without being rushed
Correct Answer: A. Tremor and autonomic symptoms resolve without seizure or delirium
Rationale: Withdrawal treatment prevents complications while supporting nutrition, hydration, and longer-term
recovery planning.
12. After interventions for acute ischemic stroke, which finding most strongly suggests improvement?
A. Neurologic deficits stabilize or improve without hemorrhagic transformation or aspiration
B. Mean arterial pressure, urine output, mental status, and lactate trend improve
C. Work of breathing decreases and the child maintains age-appropriate oxygenation and interaction
D. Bleeding stops and perfusion stabilizes without recurrent shock
Correct Answer: A. Neurologic deficits stabilize or improve without hemorrhagic transformation or aspiration
Rationale: Stroke outcomes depend on rapid imaging/reperfusion evaluation and prevention of secondary
complications.
13. Which outcome best indicates that management of informed consent for a procedure is effective?
A. The client has medications, equipment, follow-up, and a feasible plan for self-care
, B. The client can explain the decision and remains free of coercion
C. Limited resources are directed to the highest-priority salvageable needs
D. The client can describe the procedure in general terms and chooses voluntarily
Correct Answer: D. The client can describe the procedure in general terms and chooses voluntarily
Rationale: Informed consent requires capacity, adequate information, understanding, and voluntariness; the nurse
witnesses and advocates rather than replacing the provider explanation.
14. Which evaluation finding supports that care for adolescent sexual health is achieving its goal?
A. Falls decrease and mobility confidence improves without unnecessary restriction
B. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows how to obtain care
C. Tobacco use decreases or stops and the client uses relapse-prevention strategies
D. The caregiver consistently uses a separate firm sleep surface and supine position
Correct Answer: B. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows
how to obtain care
Rationale: Effective adolescent health promotion combines confidentiality, risk assessment, vaccination,
screening, and harm-reduction counseling.
15. The nurse evaluates the response to care for sickle cell acute chest syndrome. Which result is most
favorable?
A. Oxygenation and respiratory symptoms improve without progressive lung injury
B. Pain and nausea improve with stable oxygenation, renal function, and hemodynamics
C. Mean arterial pressure, urine output, mental status, and lactate trend improve
D. Fetal heart rate improves while definitive delivery proceeds without delay
Correct Answer: A. Oxygenation and respiratory symptoms improve without progressive lung injury
Rationale: Acute chest syndrome is a life-threatening sickle cell complication requiring rapid respiratory and
hematologic management.
16. Which outcome best indicates that management of high-alert medication administration is effective?
A. No unprotected exposure occurs while diagnostic evaluation and treatment proceed
B. Exposed susceptible persons are identified and managed promptly
C. The medication is delivered at the intended dose and rate without preventable error
D. The client remains free from injury and maintains adequate oxygenation
Correct Answer: C. The medication is delivered at the intended dose and rate without preventable error
Rationale: High-alert medications warrant extra verification because errors can cause severe harm.
17. Which evaluation finding supports that care for unfractionated heparin infusion is achieving its goal?
A. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
B. Mood stabilizes while lithium level, renal function, and thyroid status remain appropriate
C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
D. Depressive symptoms improve over weeks without severe activation, suicidality, or serotonin toxicity
Correct Answer: C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
Rationale: Heparin therapy requires dose monitoring, bleeding assessment, and vigilance for heparin-induced
thrombocytopenia.
18. Which outcome would the nurse expect when care for newborn safe sleep is effective?
A. Tobacco use decreases or stops and the client uses relapse-prevention strategies
B. The caregiver consistently uses a separate firm sleep surface and supine position
C. The home environment removes common poisoning, fall, drowning, and transport hazards
D. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows how to obtain care
Correct Answer: B. The caregiver consistently uses a separate firm sleep surface and supine position
Rationale: Safe-sleep practices reduce sleep-related infant deaths and avoid suffocation hazards.
19. The nurse evaluates the response to care for tension pneumothorax. Which result is most favorable?
A. Breath sounds and hemodynamics improve after decompression and chest-tube treatment
B. The anion gap closes and acidosis/ketosis resolve with stable potassium
C. Airway swelling, wheezing, hives, and hypotension resolve without biphasic deterioration
D. Bleeding stops and perfusion stabilizes without recurrent shock
Correct Answer: A. Breath sounds and hemodynamics improve after decompression and chest-tube treatment
Rationale: Tension pneumothorax causes obstructive shock and requires immediate pressure relief.
EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Which finding is most consistent with successful management of assignment to an LPN/LVN?
A. The LPN/LVN completes routine care and promptly reports a change in condition
B. The highest-acuity problem is addressed before stable routine needs
C. The client can accurately explain the plan in their preferred language
D. A responsible clinician reviews the unresolved concern and a safer plan is established
Correct Answer: A. The LPN/LVN completes routine care and promptly reports a change in condition
Rationale: Assignment should match scope, competence, client stability, and predictability of outcomes.
2. After interventions for rapid-acting insulin, which finding most strongly suggests improvement?
A. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
B. Congestion improves while blood pressure, renal function, and electrolytes remain acceptable
C. Blood pressure improves without hyperkalemia, renal deterioration, or angioedema
D. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
Correct Answer: D. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
Rationale: Rapid-acting insulin has a quick onset; timing with meals and prompt treatment of hypoglycemia are
essential.
3. Which evaluation finding supports that care for medication error response is achieving its goal?
A. Limited resources are directed to the highest-priority salvageable needs
B. The client is assessed and protected, and the event is reported through the safety system
C. The LPN/LVN completes routine care and promptly reports a change in condition
D. The receiving nurse can identify current priorities and unresolved issues
Correct Answer: B. The client is assessed and protected, and the event is reported through the safety system
Rationale: After an error, client safety is first; documentation remains factual and incident reporting supports
system learning.
4. Which outcome would the nurse expect when care for diabetic ketoacidosis is effective?
A. The anion gap closes and acidosis/ketosis resolve with stable potassium
B. Bleeding stops and perfusion stabilizes without recurrent shock
C. Dyspnea and hypoxemia improve without recurrent embolism or major bleeding
D. Work of breathing and crackles decrease while oxygenation and perfusion improve
Correct Answer: A. The anion gap closes and acidosis/ketosis resolve with stable potassium
Rationale: DKA treatment corrects dehydration and ketosis while carefully managing potassium and the
precipitating illness.
5. After interventions for confidentiality and electronic health information, which finding most strongly
suggests improvement?
A. Only authorized team members can access the information needed for care
B. Fall rates or relevant process measures improve after the intervention
C. The plan of care reflects the client stated goals and symptom priorities
D. The client can describe the procedure in general terms and chooses voluntarily
Correct Answer: A. Only authorized team members can access the information needed for care
Rationale: Privacy standards require appropriate access, minimum necessary disclosure, and secure handling of
health information.
6. Which finding is most consistent with successful management of digoxin therapy?
A. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid complications
B. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
C. Blood pressure improves without hyperkalemia, renal deterioration, or angioedema
D. Seizures remain controlled without neurologic toxicity or major infusion complications
Correct Answer: B. Heart rate and symptoms improve without toxicity while the dose remains appropriate for
renal function
Rationale: Digoxin has a narrow therapeutic index and toxicity risk rises with renal impairment and electrolyte
abnormalities.
,7. After interventions for advance directives and surrogate decision-making, which finding most strongly
suggests improvement?
A. The highest-acuity problem is addressed before stable routine needs
B. The client can describe the procedure in general terms and chooses voluntarily
C. The client is assessed and protected, and the event is reported through the safety system
D. Care decisions remain aligned with the client expressed goals and designated surrogate authority
Correct Answer: D. Care decisions remain aligned with the client expressed goals and designated surrogate
authority
Rationale: Client autonomy guides care; advance directives and authorized surrogates support the client
preferences when capacity is absent.
8. Which evaluation finding supports that care for loop diuretic therapy is achieving its goal?
A. Heart rate and symptoms improve without toxicity while the dose remains appropriate for renal function
B. Congestion improves while blood pressure, renal function, and electrolytes remain acceptable
C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
D. The infection improves with target exposure and no significant nephrotoxicity or infusion reaction
Correct Answer: B. Congestion improves while blood pressure, renal function, and electrolytes remain
acceptable
Rationale: Loop diuretics relieve fluid overload but can cause volume depletion and electrolyte loss.
9. The nurse evaluates the response to care for delegation to assistive personnel. Which result is most
favorable?
A. Only authorized team members can access the information needed for care
B. The highest-acuity problem is addressed before stable routine needs
C. The client is assessed and protected, and the event is reported through the safety system
D. The task is completed correctly and unexpected findings are promptly communicated
Correct Answer: D. The task is completed correctly and unexpected findings are promptly communicated
Rationale: Delegation transfers performance of a task, not nursing accountability; unstable clients, assessment,
teaching, and evaluation remain RN responsibilities.
10. Which finding is most consistent with successful management of systemic corticosteroid therapy?
A. INR remains in the individualized target range without thromboembolism or major bleeding
B. Contractions become effective without tachysystole and fetal status remains reassuring
C. Heart rate and blood pressure are controlled without symptomatic bradycardia
D. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid complications
Correct Answer: D. Inflammatory symptoms improve without adrenal crisis or unacceptable steroid
complications
Rationale: Chronic corticosteroids suppress the hypothalamic-pituitary-adrenal axis and require careful tapering
and complication monitoring.
11. Which outcome best indicates that management of alcohol withdrawal is effective?
A. Tremor and autonomic symptoms resolve without seizure or delirium
B. Immediate safety is maintained and a collaborative follow-up/safety plan is established
C. Attention and cognition improve as the precipitating illness resolves
D. The client can express feelings and identify supports or next steps without being rushed
Correct Answer: A. Tremor and autonomic symptoms resolve without seizure or delirium
Rationale: Withdrawal treatment prevents complications while supporting nutrition, hydration, and longer-term
recovery planning.
12. After interventions for acute ischemic stroke, which finding most strongly suggests improvement?
A. Neurologic deficits stabilize or improve without hemorrhagic transformation or aspiration
B. Mean arterial pressure, urine output, mental status, and lactate trend improve
C. Work of breathing decreases and the child maintains age-appropriate oxygenation and interaction
D. Bleeding stops and perfusion stabilizes without recurrent shock
Correct Answer: A. Neurologic deficits stabilize or improve without hemorrhagic transformation or aspiration
Rationale: Stroke outcomes depend on rapid imaging/reperfusion evaluation and prevention of secondary
complications.
13. Which outcome best indicates that management of informed consent for a procedure is effective?
A. The client has medications, equipment, follow-up, and a feasible plan for self-care
, B. The client can explain the decision and remains free of coercion
C. Limited resources are directed to the highest-priority salvageable needs
D. The client can describe the procedure in general terms and chooses voluntarily
Correct Answer: D. The client can describe the procedure in general terms and chooses voluntarily
Rationale: Informed consent requires capacity, adequate information, understanding, and voluntariness; the nurse
witnesses and advocates rather than replacing the provider explanation.
14. Which evaluation finding supports that care for adolescent sexual health is achieving its goal?
A. Falls decrease and mobility confidence improves without unnecessary restriction
B. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows how to obtain care
C. Tobacco use decreases or stops and the client uses relapse-prevention strategies
D. The caregiver consistently uses a separate firm sleep surface and supine position
Correct Answer: B. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows
how to obtain care
Rationale: Effective adolescent health promotion combines confidentiality, risk assessment, vaccination,
screening, and harm-reduction counseling.
15. The nurse evaluates the response to care for sickle cell acute chest syndrome. Which result is most
favorable?
A. Oxygenation and respiratory symptoms improve without progressive lung injury
B. Pain and nausea improve with stable oxygenation, renal function, and hemodynamics
C. Mean arterial pressure, urine output, mental status, and lactate trend improve
D. Fetal heart rate improves while definitive delivery proceeds without delay
Correct Answer: A. Oxygenation and respiratory symptoms improve without progressive lung injury
Rationale: Acute chest syndrome is a life-threatening sickle cell complication requiring rapid respiratory and
hematologic management.
16. Which outcome best indicates that management of high-alert medication administration is effective?
A. No unprotected exposure occurs while diagnostic evaluation and treatment proceed
B. Exposed susceptible persons are identified and managed promptly
C. The medication is delivered at the intended dose and rate without preventable error
D. The client remains free from injury and maintains adequate oxygenation
Correct Answer: C. The medication is delivered at the intended dose and rate without preventable error
Rationale: High-alert medications warrant extra verification because errors can cause severe harm.
17. Which evaluation finding supports that care for unfractionated heparin infusion is achieving its goal?
A. Glucose returns to a safe range without recurrent neuroglycopenic symptoms
B. Mood stabilizes while lithium level, renal function, and thyroid status remain appropriate
C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
D. Depressive symptoms improve over weeks without severe activation, suicidality, or serotonin toxicity
Correct Answer: C. Anticoagulation reaches the ordered therapeutic range without bleeding or new thrombosis
Rationale: Heparin therapy requires dose monitoring, bleeding assessment, and vigilance for heparin-induced
thrombocytopenia.
18. Which outcome would the nurse expect when care for newborn safe sleep is effective?
A. Tobacco use decreases or stops and the client uses relapse-prevention strategies
B. The caregiver consistently uses a separate firm sleep surface and supine position
C. The home environment removes common poisoning, fall, drowning, and transport hazards
D. The adolescent can describe a realistic plan for STI and pregnancy prevention and knows how to obtain care
Correct Answer: B. The caregiver consistently uses a separate firm sleep surface and supine position
Rationale: Safe-sleep practices reduce sleep-related infant deaths and avoid suffocation hazards.
19. The nurse evaluates the response to care for tension pneumothorax. Which result is most favorable?
A. Breath sounds and hemodynamics improve after decompression and chest-tube treatment
B. The anion gap closes and acidosis/ketosis resolve with stable potassium
C. Airway swelling, wheezing, hives, and hypotension resolve without biphasic deterioration
D. Bleeding stops and perfusion stabilizes without recurrent shock
Correct Answer: A. Breath sounds and hemodynamics improve after decompression and chest-tube treatment
Rationale: Tension pneumothorax causes obstructive shock and requires immediate pressure relief.
