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 client is admitted to the cardiac unit with a diagnosis of heart failure with
reduced ejection fraction (HFrEF). The client reports increasing shortness of breath,
weight gain of 3 kg in 3 days, and uses two pillows at night to breathe. Vital signs: BP
98/62 mmHg, HR 104 beats/min (irregular), RR 24 breaths/min, SpO₂ 90% on 2 L nasal
cannula. Laboratory results: Na 132 mEq/L, K 3.2 mEq/L, BUN 38 mg/dL, creatinine 1.5
mg/dL (baseline 1.0), BNP 950 pg/mL. Current medications include furosemide 40 mg
PO daily, lisinopril 10 mg PO daily, digoxin 0.25 mg PO daily, and warfarin 5 mg PO daily.
The nurse notes bibasilar crackles and +2 pitting ankle edema.
Question Stem:
Which assessment findings require immediate follow-up by the nurse? (Select all that
apply.)
Options/Response Fields:
1. Heart rate irregularity
2. Serum potassium 3.2 mEq/L
3. SpO₂ 90% on 2 L nasal cannula
4. BNP 950 pg/mL
, 5. Weight gain of 3 kg in 3 days
6. Digoxin level pending
(Correct Answer: 1, 2, 3, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3, 5
● Clinical Judgment Rationalization:
○ Recognize Cues: Irregular HR suggests atrial fibrillation, increasing risk for
thromboembolism and poor perfusion. Hypokalemia (K 3.2) potentiates
digoxin toxicity and ventricular arrhythmias. Hypoxemia (SpO₂ 90%)
indicates pulmonary congestion requiring oxygen titration. Rapid weight
gain signals fluid retention and worsening HF.
○ Analyze Cues: These findings cluster to suggest acute decompensated HF
with electrolyte imbalance and respiratory compromise.
○ Prioritize Actions: Immediate notification of provider for electrolyte
repletion, oxygen optimization, and potential diuretic adjustment is
warranted.
● Distractor Justification:
○ BNP 950 pg/mL is elevated but expected in chronic HFrEF and not an
immediate action trigger.
○ Pending digoxin level is important but not an immediate cue without signs
of toxicity.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario:
A 34-year-old primigravida at 38 weeks gestation presents to labor and delivery
reporting severe headache, blurred vision, and epigastric pain. Vital signs: BP 158/102
mmHg, HR 92 beats/min, RR 20 breaths/min, SpO₂ 97% on room air. Nursing notes: +2
proteinuria, hyperreflexia, and right upper quadrant tenderness. Laboratory results:
,Platelet count 92,000/mm³, AST 98 U/L, ALT 110 U/L, LDH 420 U/L, creatinine 1.1
mg/dL.
Question Stem:
Identify the priority nursing actions for each clinical finding. (Matrix: Match each finding
with the correct priority action.)
Matrix Rows (Findings):
A. BP 158/102 mmHg
B. Platelet count 92,000/mm³
C. AST/ALT elevation
D. Hyperreflexia
Matrix Columns (Actions):
1. Administer IV labetalol per protocol
2. Prepare for emergency delivery
3. Start magnesium sulfate loading dose
4. Obtain type and screen, crossmatch 2 units PRBC
(Correct Answer: A-1, B-4, C-2, D-3)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: A-1, B-4, C-2, D-3
● Clinical Judgment Rationalization:
○ Recognize Cues: Findings indicate severe preeclampsia with HELLP
features.
○ Analyze Cues: Hypertension requires antihypertensive control to prevent
maternal stroke. Thrombocytopenia risks hemorrhage; blood bank
readiness is essential. Elevated liver enzymes signal HELLP, necessitating
, delivery planning. Hyperreflexia predicts seizure risk; magnesium sulfate
is neuroprotective.
○ Prioritize Actions: Control BP, prevent seizure, prepare for delivery, and
ensure blood availability.
● Distractor Justification:
○ Administering labetalol for hyperreflexia does not address seizure risk.
○ Immediate delivery without seizure prophylaxis is unsafe.
Item ID: HESI-EXIT-V1-003
Item Type: Complex Stand-Alone
Client Scenario:
A 56-year-old client with a history of COPD is admitted with acute exacerbation. The
client is receiving oxygen via Venturi mask at 40% FiO₂. ABG results: pH 7.28, PaCO₂ 68
mmHg, PaO₂ 58 mmHg, HCO₃ 32 mEq/L. The client is drowsy but arousable and using
accessory muscles to breathe.
Question Stem:
Which intervention should the nurse anticipate next?
Options/Response Fields:
1. Increase oxygen to 60% FiO₂
2. Prepare for non-invasive positive pressure ventilation (NIPPV)
3. Administer IV morphine sulfate
4. Initiate high-flow nasal cannula at 60 L/min
(Correct Answer: 2)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 2
● Clinical Judgment Rationalization:
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 client is admitted to the cardiac unit with a diagnosis of heart failure with
reduced ejection fraction (HFrEF). The client reports increasing shortness of breath,
weight gain of 3 kg in 3 days, and uses two pillows at night to breathe. Vital signs: BP
98/62 mmHg, HR 104 beats/min (irregular), RR 24 breaths/min, SpO₂ 90% on 2 L nasal
cannula. Laboratory results: Na 132 mEq/L, K 3.2 mEq/L, BUN 38 mg/dL, creatinine 1.5
mg/dL (baseline 1.0), BNP 950 pg/mL. Current medications include furosemide 40 mg
PO daily, lisinopril 10 mg PO daily, digoxin 0.25 mg PO daily, and warfarin 5 mg PO daily.
The nurse notes bibasilar crackles and +2 pitting ankle edema.
Question Stem:
Which assessment findings require immediate follow-up by the nurse? (Select all that
apply.)
Options/Response Fields:
1. Heart rate irregularity
2. Serum potassium 3.2 mEq/L
3. SpO₂ 90% on 2 L nasal cannula
4. BNP 950 pg/mL
, 5. Weight gain of 3 kg in 3 days
6. Digoxin level pending
(Correct Answer: 1, 2, 3, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3, 5
● Clinical Judgment Rationalization:
○ Recognize Cues: Irregular HR suggests atrial fibrillation, increasing risk for
thromboembolism and poor perfusion. Hypokalemia (K 3.2) potentiates
digoxin toxicity and ventricular arrhythmias. Hypoxemia (SpO₂ 90%)
indicates pulmonary congestion requiring oxygen titration. Rapid weight
gain signals fluid retention and worsening HF.
○ Analyze Cues: These findings cluster to suggest acute decompensated HF
with electrolyte imbalance and respiratory compromise.
○ Prioritize Actions: Immediate notification of provider for electrolyte
repletion, oxygen optimization, and potential diuretic adjustment is
warranted.
● Distractor Justification:
○ BNP 950 pg/mL is elevated but expected in chronic HFrEF and not an
immediate action trigger.
○ Pending digoxin level is important but not an immediate cue without signs
of toxicity.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario:
A 34-year-old primigravida at 38 weeks gestation presents to labor and delivery
reporting severe headache, blurred vision, and epigastric pain. Vital signs: BP 158/102
mmHg, HR 92 beats/min, RR 20 breaths/min, SpO₂ 97% on room air. Nursing notes: +2
proteinuria, hyperreflexia, and right upper quadrant tenderness. Laboratory results:
,Platelet count 92,000/mm³, AST 98 U/L, ALT 110 U/L, LDH 420 U/L, creatinine 1.1
mg/dL.
Question Stem:
Identify the priority nursing actions for each clinical finding. (Matrix: Match each finding
with the correct priority action.)
Matrix Rows (Findings):
A. BP 158/102 mmHg
B. Platelet count 92,000/mm³
C. AST/ALT elevation
D. Hyperreflexia
Matrix Columns (Actions):
1. Administer IV labetalol per protocol
2. Prepare for emergency delivery
3. Start magnesium sulfate loading dose
4. Obtain type and screen, crossmatch 2 units PRBC
(Correct Answer: A-1, B-4, C-2, D-3)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: A-1, B-4, C-2, D-3
● Clinical Judgment Rationalization:
○ Recognize Cues: Findings indicate severe preeclampsia with HELLP
features.
○ Analyze Cues: Hypertension requires antihypertensive control to prevent
maternal stroke. Thrombocytopenia risks hemorrhage; blood bank
readiness is essential. Elevated liver enzymes signal HELLP, necessitating
, delivery planning. Hyperreflexia predicts seizure risk; magnesium sulfate
is neuroprotective.
○ Prioritize Actions: Control BP, prevent seizure, prepare for delivery, and
ensure blood availability.
● Distractor Justification:
○ Administering labetalol for hyperreflexia does not address seizure risk.
○ Immediate delivery without seizure prophylaxis is unsafe.
Item ID: HESI-EXIT-V1-003
Item Type: Complex Stand-Alone
Client Scenario:
A 56-year-old client with a history of COPD is admitted with acute exacerbation. The
client is receiving oxygen via Venturi mask at 40% FiO₂. ABG results: pH 7.28, PaCO₂ 68
mmHg, PaO₂ 58 mmHg, HCO₃ 32 mEq/L. The client is drowsy but arousable and using
accessory muscles to breathe.
Question Stem:
Which intervention should the nurse anticipate next?
Options/Response Fields:
1. Increase oxygen to 60% FiO₂
2. Prepare for non-invasive positive pressure ventilation (NIPPV)
3. Administer IV morphine sulfate
4. Initiate high-flow nasal cannula at 60 L/min
(Correct Answer: 2)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 2
● Clinical Judgment Rationalization:
