2024 HESI EXIT RN V4 EXAM WITH
NGN
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted to the hospital for worsening shortness of breath. Which nursing
intervention is the priority?
A. Administer a bronchodilator.
B. Provide supplemental oxygen at 6 L/min.
C. Encourage pursed-lip breathing.
D. Administer a corticosteroid.
Answer: A
Rationale: The priority intervention for a patient with COPD and worsening shortness
of breath is to administer a bronchodilator to open the airways. Oxygen therapy
should be titrated carefully (low-flow oxygen) to avoid depressing the respiratory
drive in these patients.
2. The nurse is caring for a patient who had a stroke. Which of the following
assessment findings should be reported immediately to the healthcare provider?
A. Increased drowsiness.
B. Difficulty swallowing.
C. Blood pressure of 180/95 mmHg.
D. Slurred speech.
Answer: A
Rationale: Increased drowsiness in a stroke patient could indicate a worsening
neurological status, potentially due to increased intracranial pressure, which
requires immediate intervention.
3. A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). What
is the nurse's first action?
A. Administer regular insulin IV.
B. Start an IV of normal saline.
C. Check the patient’s potassium level.
,D. Obtain a urine sample for ketones.
Answer: B
Rationale: The first priority in treating DKA is fluid resuscitation with IV normal saline
to correct dehydration.
4. A 30-year-old patient presents with severe abdominal pain and a suspected bowel
obstruction. Which diagnostic test should the nurse expect to be ordered first?
A. Abdominal ultrasound.
B. CT scan of the abdomen.
C. MRI of the abdomen.
D. Abdominal X-ray.
Answer: D
Rationale: An abdominal X-ray is often the first diagnostic test ordered to identify a
bowel obstruction, as it can quickly reveal air-fluid levels or dilated bowel loops.
5. A patient is receiving a blood transfusion and begins to develop chills, fever, and
back pain. What should the nurse do first?
A. Stop the transfusion.
B. Administer acetaminophen.
C. Slow the rate of infusion.
D. Notify the physician.
Answer: A
Rationale: The nurse should stop the transfusion immediately as these symptoms
suggest a transfusion reaction, which can be life-threatening.
6. A patient with pneumonia is receiving antibiotics and IV fluids. Which laboratory
result would be most concerning to the nurse?
A. White blood cell count of 15,000/mm³.
B. Serum creatinine of 2.2 mg/dL.
C. Blood glucose of 200 mg/dL.
D. Potassium level of 3.5 mEq/L.
Answer: B
,Rationale: A serum creatinine level of 2.2 mg/dL indicates impaired kidney function,
which is concerning especially if the patient is receiving IV fluids and antibiotics, as it
may suggest acute kidney injury or drug toxicity.
7. The nurse is caring for a patient who had surgery for a hip fracture. The patient is
prescribed enoxaparin for deep vein thrombosis (DVT) prophylaxis. Which action
should the nurse take when administering the medication?
A. Administer the injection into the deltoid muscle.
B. Inject the medication into a 90-degree angle into the abdominal fat.
C. Aspirate for blood return before injecting the medication.
D. Massage the injection site after administration.
Answer: B
Rationale: Enoxaparin should be administered as a subcutaneous injection at a 90-
degree angle into the abdominal fat. It is not injected into muscle, nor should the
site be massaged.
8. A patient has been prescribed warfarin for the prevention of blood clots. Which
dietary instruction should the nurse provide?
A. Increase the intake of leafy green vegetables.
B. Avoid foods high in vitamin K.
C. Increase protein-rich foods.
D. Decrease the intake of dairy products.
Answer: B
Rationale: Vitamin K can interfere with the effectiveness of warfarin, so patients
should avoid consuming large amounts of foods high in vitamin K, such as leafy green
vegetables.
9. A patient diagnosed with heart failure is prescribed furosemide. Which of the
following assessment findings should the nurse monitor for as a potential side
effect?
A. Hyperkalemia.
B. Hypotension.
, C. Bradycardia.
D. Hypernatremia.
Answer: B
Rationale: Furosemide, a loop diuretic, can cause significant fluid loss, leading to
hypotension.
10. A patient with a history of atrial fibrillation is being discharged on warfarin. What
should the nurse include in the patient’s discharge instructions?
A. "You will need regular blood tests to check your INR levels."
B. "You can take aspirin as needed for headaches."
C. "You should eat plenty of spinach and broccoli."
D. "If you miss a dose, double the next dose."
Answer: A
Rationale: Warfarin requires regular monitoring of INR to ensure therapeutic levels.
Aspirin is contraindicated unless specifically prescribed, as it can increase the risk of
bleeding.11. A patient with newly diagnosed hypertension is started on lisinopril.
Which of the following is the most important to monitor during the initial
treatment?
A. Serum calcium levels.
B. Urine output.
C. Blood pressure.
D. Heart rate.
Answer: C
Rationale: The primary purpose of lisinopril is to lower blood pressure, so it’s crucial
to monitor the patient's blood pressure closely, especially during initial treatment.
12. A patient receiving chemotherapy for breast cancer reports nausea and vomiting
after treatment. What is the best action by the nurse?
A. Administer ondansetron 30 minutes before chemotherapy.
B. Offer high-protein snacks after chemotherapy.
C. Encourage oral fluid intake during chemotherapy.
D. Delay chemotherapy until nausea subsides.
NGN
1. A patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted to the hospital for worsening shortness of breath. Which nursing
intervention is the priority?
A. Administer a bronchodilator.
B. Provide supplemental oxygen at 6 L/min.
C. Encourage pursed-lip breathing.
D. Administer a corticosteroid.
Answer: A
Rationale: The priority intervention for a patient with COPD and worsening shortness
of breath is to administer a bronchodilator to open the airways. Oxygen therapy
should be titrated carefully (low-flow oxygen) to avoid depressing the respiratory
drive in these patients.
2. The nurse is caring for a patient who had a stroke. Which of the following
assessment findings should be reported immediately to the healthcare provider?
A. Increased drowsiness.
B. Difficulty swallowing.
C. Blood pressure of 180/95 mmHg.
D. Slurred speech.
Answer: A
Rationale: Increased drowsiness in a stroke patient could indicate a worsening
neurological status, potentially due to increased intracranial pressure, which
requires immediate intervention.
3. A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). What
is the nurse's first action?
A. Administer regular insulin IV.
B. Start an IV of normal saline.
C. Check the patient’s potassium level.
,D. Obtain a urine sample for ketones.
Answer: B
Rationale: The first priority in treating DKA is fluid resuscitation with IV normal saline
to correct dehydration.
4. A 30-year-old patient presents with severe abdominal pain and a suspected bowel
obstruction. Which diagnostic test should the nurse expect to be ordered first?
A. Abdominal ultrasound.
B. CT scan of the abdomen.
C. MRI of the abdomen.
D. Abdominal X-ray.
Answer: D
Rationale: An abdominal X-ray is often the first diagnostic test ordered to identify a
bowel obstruction, as it can quickly reveal air-fluid levels or dilated bowel loops.
5. A patient is receiving a blood transfusion and begins to develop chills, fever, and
back pain. What should the nurse do first?
A. Stop the transfusion.
B. Administer acetaminophen.
C. Slow the rate of infusion.
D. Notify the physician.
Answer: A
Rationale: The nurse should stop the transfusion immediately as these symptoms
suggest a transfusion reaction, which can be life-threatening.
6. A patient with pneumonia is receiving antibiotics and IV fluids. Which laboratory
result would be most concerning to the nurse?
A. White blood cell count of 15,000/mm³.
B. Serum creatinine of 2.2 mg/dL.
C. Blood glucose of 200 mg/dL.
D. Potassium level of 3.5 mEq/L.
Answer: B
,Rationale: A serum creatinine level of 2.2 mg/dL indicates impaired kidney function,
which is concerning especially if the patient is receiving IV fluids and antibiotics, as it
may suggest acute kidney injury or drug toxicity.
7. The nurse is caring for a patient who had surgery for a hip fracture. The patient is
prescribed enoxaparin for deep vein thrombosis (DVT) prophylaxis. Which action
should the nurse take when administering the medication?
A. Administer the injection into the deltoid muscle.
B. Inject the medication into a 90-degree angle into the abdominal fat.
C. Aspirate for blood return before injecting the medication.
D. Massage the injection site after administration.
Answer: B
Rationale: Enoxaparin should be administered as a subcutaneous injection at a 90-
degree angle into the abdominal fat. It is not injected into muscle, nor should the
site be massaged.
8. A patient has been prescribed warfarin for the prevention of blood clots. Which
dietary instruction should the nurse provide?
A. Increase the intake of leafy green vegetables.
B. Avoid foods high in vitamin K.
C. Increase protein-rich foods.
D. Decrease the intake of dairy products.
Answer: B
Rationale: Vitamin K can interfere with the effectiveness of warfarin, so patients
should avoid consuming large amounts of foods high in vitamin K, such as leafy green
vegetables.
9. A patient diagnosed with heart failure is prescribed furosemide. Which of the
following assessment findings should the nurse monitor for as a potential side
effect?
A. Hyperkalemia.
B. Hypotension.
, C. Bradycardia.
D. Hypernatremia.
Answer: B
Rationale: Furosemide, a loop diuretic, can cause significant fluid loss, leading to
hypotension.
10. A patient with a history of atrial fibrillation is being discharged on warfarin. What
should the nurse include in the patient’s discharge instructions?
A. "You will need regular blood tests to check your INR levels."
B. "You can take aspirin as needed for headaches."
C. "You should eat plenty of spinach and broccoli."
D. "If you miss a dose, double the next dose."
Answer: A
Rationale: Warfarin requires regular monitoring of INR to ensure therapeutic levels.
Aspirin is contraindicated unless specifically prescribed, as it can increase the risk of
bleeding.11. A patient with newly diagnosed hypertension is started on lisinopril.
Which of the following is the most important to monitor during the initial
treatment?
A. Serum calcium levels.
B. Urine output.
C. Blood pressure.
D. Heart rate.
Answer: C
Rationale: The primary purpose of lisinopril is to lower blood pressure, so it’s crucial
to monitor the patient's blood pressure closely, especially during initial treatment.
12. A patient receiving chemotherapy for breast cancer reports nausea and vomiting
after treatment. What is the best action by the nurse?
A. Administer ondansetron 30 minutes before chemotherapy.
B. Offer high-protein snacks after chemotherapy.
C. Encourage oral fluid intake during chemotherapy.
D. Delay chemotherapy until nausea subsides.
