RN HESI Exit Exam V1 with NGN Questions
and Verified Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response
Client Scenario:
A 68-year-old male is admitted to the progressive care unit with a 2-day history of
increasing dyspnea and orthopnea. PMH: heart failure with reduced ejection fraction
(30%), type 2 diabetes, stage 3 CKD. On arrival he is alert but mildly agitated. Vital
signs: BP 162/94, HR 118 irregularly irregular, RR 28, O2 sat 88% on room air, temp
37°C. ABG on 6 L nasal cannula: pH 7.28, PaCO2 58 mmHg, HCO3 26 mEq/L, PaO2 62
mmHg. Lung auscultation reveals bilateral crackles to mid-fields and scattered wheezes.
Chest X-ray shows pulmonary venous congestion. Current meds: metformin 1000 mg PO
BID, furosemide 40 mg PO daily, digoxin 0.25 mg PO daily, carvedilol 6.25 mg PO BID.
Nurse’s shift assessment notes 3+ pitting edema to knees.
Question Stem:
Which findings require immediate follow-up? (Select all that apply.)
Options/Response Fields:
1. Oxygen saturation 88% on 6 L NC
2. PaCO2 58 mmHg with pH 7.28
3. Heart rate 118 irregularly irregular
, 4. Digoxin level pending (last dose 8 h ago)
5. BNP 350 pg/mL (reference <100)
(Correct Answer: 1, 2, 3)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3
● Clinical Judgment Rationalization: Step 1—Recognize Cues: acute hypoxemic
respiratory failure with hypercapnic component (1, 2) and rapid atrial fibrillation
(3) are life-threatening. Step 2—Analyze Cues: combo of acidotic hypercapnea +
hypoxia signals impending respiratory arrest; uncontrolled AF risks rapid
decompensation. Step 3—Prioritize Hypotheses: airway/oxygenation first, then
rate control.
● Distractor Justification: 4 is important but not immediate without toxicity signs; 5
confirms HF but is not an emergent cue.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario:
A 34-year-old G2P1 at 39 weeks is admitted in active labor. Cervix 8 cm/90%/0 station.
FHR baseline 155 bpm, minimal variability, recurrent late decelerations with 4
contractions in 10 min. Maternal temp 38.1°C, BP 130/78, HR 96, RR 22. She is
receiving lactated Ringer’s 125 mL/hr and O2 8 L via face mask. Last Hgb 10.8 g/dL.
Question Stem:
For each nursing action, indicate whether it is indicated, non-essential, or contraindicated
at this time.
Options/Response Fields:
,Action:
1. Increase IV fluid rate to 250 mL/hr
2. Administer terbutaline 0.25 mg SQ
3. Place client in left-lateral position
4. Prepare for immediate cesarean delivery
5. Perform fetal scalp stimulation
Matrix:
1. Indicated | Non-essential | Contraindicated
2. Indicated | Non-essential | Contraindicated
3. Indicated | Non-essential | Contraindicated
4. Indicated | Non-essential | Contraindicated
5. Indicated | Non-essential | Contraindicated
(Correct Answer: 1-Indicated, 2-Non-essential, 3-Indicated, 4-Indicated,
5-Contraindicated)
Rationale (Verified & Rationalized | 2026):
● Correct Answer: As above.
● Clinical Judgment Rationalization: Late decels + minimal variability = fetal
hypoxemia. Step 1—Recognize Cues: uteroplacental insufficiency. Step
2—Analyze: maternal fever + tachycardia possible chorioamnionitis → fetal
stress. Step 3—Generate Solutions: improve uterine blood flow (position, fluids)
and expedite delivery. Terbutaline slows contractions but is not priority; scalp
stimulation inappropriate with late decels.
● Distractor Justification: Terbutaline could relax uterus but does not address
primary issue; scalp stimulation may worsen acidosis.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie
Client Scenario:
, A 56-year-old female post right hemicolectomy day 2 is on hydromorphone PCA (basal
0.2 mg/hr, demand 0.2 mg q10 min). She has not had a bowel movement since surgery,
last flatus this morning. Abdomen distended, hypoactive bowel sounds, pain 6/10. Vital
signs: BP 118/72, HR 88, RR 18, O2 sat 96% on room air, temp 37.4°C. Labs: Na 138, K
3.2 mEq/L, Mg 1.4 mg/dL, Hct 32%, WBC 9.8 k. Nurse notes absent PCA dosing button
presses in last 4 h.
Question Stem:
Complete the bow-tie by placing an X on the priority problem, one on the best action to
address that problem, and one on the parameter to monitor effectiveness.
Options/Response Fields:
Left wing (Problems):
● Hypokalemia
● Opioid-induced constipation
● PCA under-utilization
● Surgical site infection
Knot (Priority Problem):
[]
Right wing (Actions):
● Administer docusate sodium 100 mg PO daily
● Encourage increased PCA use for pain control
● Provide 40 mEq KCl IV over 4 h
● Insert nasogastric tube for decompression
Parameter to Monitor:
and Verified Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response
Client Scenario:
A 68-year-old male is admitted to the progressive care unit with a 2-day history of
increasing dyspnea and orthopnea. PMH: heart failure with reduced ejection fraction
(30%), type 2 diabetes, stage 3 CKD. On arrival he is alert but mildly agitated. Vital
signs: BP 162/94, HR 118 irregularly irregular, RR 28, O2 sat 88% on room air, temp
37°C. ABG on 6 L nasal cannula: pH 7.28, PaCO2 58 mmHg, HCO3 26 mEq/L, PaO2 62
mmHg. Lung auscultation reveals bilateral crackles to mid-fields and scattered wheezes.
Chest X-ray shows pulmonary venous congestion. Current meds: metformin 1000 mg PO
BID, furosemide 40 mg PO daily, digoxin 0.25 mg PO daily, carvedilol 6.25 mg PO BID.
Nurse’s shift assessment notes 3+ pitting edema to knees.
Question Stem:
Which findings require immediate follow-up? (Select all that apply.)
Options/Response Fields:
1. Oxygen saturation 88% on 6 L NC
2. PaCO2 58 mmHg with pH 7.28
3. Heart rate 118 irregularly irregular
, 4. Digoxin level pending (last dose 8 h ago)
5. BNP 350 pg/mL (reference <100)
(Correct Answer: 1, 2, 3)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3
● Clinical Judgment Rationalization: Step 1—Recognize Cues: acute hypoxemic
respiratory failure with hypercapnic component (1, 2) and rapid atrial fibrillation
(3) are life-threatening. Step 2—Analyze Cues: combo of acidotic hypercapnea +
hypoxia signals impending respiratory arrest; uncontrolled AF risks rapid
decompensation. Step 3—Prioritize Hypotheses: airway/oxygenation first, then
rate control.
● Distractor Justification: 4 is important but not immediate without toxicity signs; 5
confirms HF but is not an emergent cue.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario:
A 34-year-old G2P1 at 39 weeks is admitted in active labor. Cervix 8 cm/90%/0 station.
FHR baseline 155 bpm, minimal variability, recurrent late decelerations with 4
contractions in 10 min. Maternal temp 38.1°C, BP 130/78, HR 96, RR 22. She is
receiving lactated Ringer’s 125 mL/hr and O2 8 L via face mask. Last Hgb 10.8 g/dL.
Question Stem:
For each nursing action, indicate whether it is indicated, non-essential, or contraindicated
at this time.
Options/Response Fields:
,Action:
1. Increase IV fluid rate to 250 mL/hr
2. Administer terbutaline 0.25 mg SQ
3. Place client in left-lateral position
4. Prepare for immediate cesarean delivery
5. Perform fetal scalp stimulation
Matrix:
1. Indicated | Non-essential | Contraindicated
2. Indicated | Non-essential | Contraindicated
3. Indicated | Non-essential | Contraindicated
4. Indicated | Non-essential | Contraindicated
5. Indicated | Non-essential | Contraindicated
(Correct Answer: 1-Indicated, 2-Non-essential, 3-Indicated, 4-Indicated,
5-Contraindicated)
Rationale (Verified & Rationalized | 2026):
● Correct Answer: As above.
● Clinical Judgment Rationalization: Late decels + minimal variability = fetal
hypoxemia. Step 1—Recognize Cues: uteroplacental insufficiency. Step
2—Analyze: maternal fever + tachycardia possible chorioamnionitis → fetal
stress. Step 3—Generate Solutions: improve uterine blood flow (position, fluids)
and expedite delivery. Terbutaline slows contractions but is not priority; scalp
stimulation inappropriate with late decels.
● Distractor Justification: Terbutaline could relax uterus but does not address
primary issue; scalp stimulation may worsen acidosis.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie
Client Scenario:
, A 56-year-old female post right hemicolectomy day 2 is on hydromorphone PCA (basal
0.2 mg/hr, demand 0.2 mg q10 min). She has not had a bowel movement since surgery,
last flatus this morning. Abdomen distended, hypoactive bowel sounds, pain 6/10. Vital
signs: BP 118/72, HR 88, RR 18, O2 sat 96% on room air, temp 37.4°C. Labs: Na 138, K
3.2 mEq/L, Mg 1.4 mg/dL, Hct 32%, WBC 9.8 k. Nurse notes absent PCA dosing button
presses in last 4 h.
Question Stem:
Complete the bow-tie by placing an X on the priority problem, one on the best action to
address that problem, and one on the parameter to monitor effectiveness.
Options/Response Fields:
Left wing (Problems):
● Hypokalemia
● Opioid-induced constipation
● PCA under-utilization
● Surgical site infection
Knot (Priority Problem):
[]
Right wing (Actions):
● Administer docusate sodium 100 mg PO daily
● Encourage increased PCA use for pain control
● Provide 40 mEq KCl IV over 4 h
● Insert nasogastric tube for decompression
Parameter to Monitor:
