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 (EMR)
Client Scenario: A 68-year-old client is admitted to the medical unit with a diagnosis of
heart failure exacerbation. The client reports increasing dyspnea on exertion, orthopnea,
and 3 kg weight gain over the past week. Vital signs: BP 162/94 mmHg, HR 112
beats/min (irregular), RR 26 breaths/min, SpO2 89% on room air, temperature 37°C
(98.6°F). Lung auscultation reveals bilateral crackles in lower lobes and diminished
breath sounds at bases. The client has +2 pitting edema in bilateral lower extremities.
Current medications include metoprolol 50 mg PO BID, furosemide 40 mg PO daily, and
digoxin 0.25 mg PO daily. Laboratory results: BNP 1,250 pg/mL (normal <100),
potassium 3.2 mEq/L, creatinine 1.8 mg/dL, and magnesium 1.4 mg/dL. The nurse is
reviewing the client's status.
Question Stem: Which assessment findings require immediate follow-up by the nurse?
(Select all that apply.)
Options/Response Fields:
1. Heart rate of 112 beats/min with irregular rhythm
2. SpO2 of 89% on room air
3. Potassium level of 3.2 mEq/L
4. BNP level of 1,250 pg/mL
, 5. Blood pressure of 162/94 mmHg
6. Temperature of 37°C (98.6°F)
(Correct Answer: 1, 2, 3, and 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3, and 5
● Clinical Judgment Rationalization: The nurse recognizes cues indicating acute
decompensation and potential life-threatening complications. The irregular
tachycardia (1) suggests possible digoxin toxicity or atrial fibrillation, requiring
immediate ECG monitoring. The hypoxemia (2) indicates acute pulmonary
edema, necessitating oxygen therapy and possible non-invasive ventilation. The
hypokalemia (3) places the client at high risk for digoxin toxicity and lethal
dysrhythmias, requiring immediate potassium replacement. The hypertension (5)
increases cardiac workload and worsens heart failure, requiring urgent
antihypertensive management.
● Distractor Justification: While the elevated BNP (4) confirms heart failure
severity, it does not require immediate intervention but rather guides treatment
planning. The normal temperature (6) does not indicate infection or immediate
concern.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario: A 45-year-old client presents to the emergency department with acute
onset of severe chest pain described as "tearing" in nature, radiating to the back. The
,client appears diaphoretic and anxious. Vital signs: BP 180/110 mmHg (right arm) and
140/85 mmHg (left arm), HR 110 beats/min, RR 24 breaths/min, SpO2 94% on room air.
The client reports a history of hypertension and smoking. The physician suspects aortic
dissection. CT angiography confirms a Type A aortic dissection extending from the
ascending aorta to the iliac bifurcation.
Question Stem: Identify which nursing actions are indicated, contraindicated, or
non-essential for this client at this time. (Place an X in the appropriate column for each
action.)
Options/Response Fields:
TableCopy
Indicat Contraindicat Non-Essen
Nursing Action
ed ed tial
1. Administer IV esmolol bolus followed by
X
continuous infusion
2. Obtain 12-lead ECG X
3. Encourage client to perform Valsalva maneuver X
4. Administer IV morphine sulfate X
5. Prepare for emergency surgical repair X
, 6. Apply bilateral ankle restraints X
7. Insert indwelling urinary catheter X
(Correct Answer: See matrix above)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: Indicated: 1, 2, 4, 5, 7; Contraindicated: 3; Non-Essential: 6
● Clinical Judgment Rationalization: The nurse analyzes cues recognizing a
life-threatening Type A aortic dissection requiring immediate blood pressure and
heart rate control (1) to reduce shear stress. ECG (2) identifies possible coronary
involvement. Morphine (4) manages severe pain and reduces sympathetic
stimulation. Emergency surgery (5) is definitive treatment for Type A dissections.
Urinary catheter (7) monitors output during hemodynamic management. Valsalva
maneuver (3) is contraindicated as it increases intrathoracic pressure and aortic
stress. Ankle restraints (6) are unnecessary unless mental status changes occur.
● Distractor Justification: Valsalva would dangerously increase aortic pressure
gradients. Restraints without indication violate client rights and safety protocols.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie
Client Scenario: A 72-year-old client is post-operative day 2 following a total hip
replacement. The client reports sudden onset of shortness of breath and pleuritic chest
pain. Vital signs: BP 90/60 mmHg, HR 118 beats/min, RR 28 breaths/min, SpO2 86% on
4L nasal cannula, temperature 37.8°C (100°F). Physical assessment reveals diminished
Verified Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response (EMR)
Client Scenario: A 68-year-old client is admitted to the medical unit with a diagnosis of
heart failure exacerbation. The client reports increasing dyspnea on exertion, orthopnea,
and 3 kg weight gain over the past week. Vital signs: BP 162/94 mmHg, HR 112
beats/min (irregular), RR 26 breaths/min, SpO2 89% on room air, temperature 37°C
(98.6°F). Lung auscultation reveals bilateral crackles in lower lobes and diminished
breath sounds at bases. The client has +2 pitting edema in bilateral lower extremities.
Current medications include metoprolol 50 mg PO BID, furosemide 40 mg PO daily, and
digoxin 0.25 mg PO daily. Laboratory results: BNP 1,250 pg/mL (normal <100),
potassium 3.2 mEq/L, creatinine 1.8 mg/dL, and magnesium 1.4 mg/dL. The nurse is
reviewing the client's status.
Question Stem: Which assessment findings require immediate follow-up by the nurse?
(Select all that apply.)
Options/Response Fields:
1. Heart rate of 112 beats/min with irregular rhythm
2. SpO2 of 89% on room air
3. Potassium level of 3.2 mEq/L
4. BNP level of 1,250 pg/mL
, 5. Blood pressure of 162/94 mmHg
6. Temperature of 37°C (98.6°F)
(Correct Answer: 1, 2, 3, and 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 2, 3, and 5
● Clinical Judgment Rationalization: The nurse recognizes cues indicating acute
decompensation and potential life-threatening complications. The irregular
tachycardia (1) suggests possible digoxin toxicity or atrial fibrillation, requiring
immediate ECG monitoring. The hypoxemia (2) indicates acute pulmonary
edema, necessitating oxygen therapy and possible non-invasive ventilation. The
hypokalemia (3) places the client at high risk for digoxin toxicity and lethal
dysrhythmias, requiring immediate potassium replacement. The hypertension (5)
increases cardiac workload and worsens heart failure, requiring urgent
antihypertensive management.
● Distractor Justification: While the elevated BNP (4) confirms heart failure
severity, it does not require immediate intervention but rather guides treatment
planning. The normal temperature (6) does not indicate infection or immediate
concern.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario: A 45-year-old client presents to the emergency department with acute
onset of severe chest pain described as "tearing" in nature, radiating to the back. The
,client appears diaphoretic and anxious. Vital signs: BP 180/110 mmHg (right arm) and
140/85 mmHg (left arm), HR 110 beats/min, RR 24 breaths/min, SpO2 94% on room air.
The client reports a history of hypertension and smoking. The physician suspects aortic
dissection. CT angiography confirms a Type A aortic dissection extending from the
ascending aorta to the iliac bifurcation.
Question Stem: Identify which nursing actions are indicated, contraindicated, or
non-essential for this client at this time. (Place an X in the appropriate column for each
action.)
Options/Response Fields:
TableCopy
Indicat Contraindicat Non-Essen
Nursing Action
ed ed tial
1. Administer IV esmolol bolus followed by
X
continuous infusion
2. Obtain 12-lead ECG X
3. Encourage client to perform Valsalva maneuver X
4. Administer IV morphine sulfate X
5. Prepare for emergency surgical repair X
, 6. Apply bilateral ankle restraints X
7. Insert indwelling urinary catheter X
(Correct Answer: See matrix above)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: Indicated: 1, 2, 4, 5, 7; Contraindicated: 3; Non-Essential: 6
● Clinical Judgment Rationalization: The nurse analyzes cues recognizing a
life-threatening Type A aortic dissection requiring immediate blood pressure and
heart rate control (1) to reduce shear stress. ECG (2) identifies possible coronary
involvement. Morphine (4) manages severe pain and reduces sympathetic
stimulation. Emergency surgery (5) is definitive treatment for Type A dissections.
Urinary catheter (7) monitors output during hemodynamic management. Valsalva
maneuver (3) is contraindicated as it increases intrathoracic pressure and aortic
stress. Ankle restraints (6) are unnecessary unless mental status changes occur.
● Distractor Justification: Valsalva would dangerously increase aortic pressure
gradients. Restraints without indication violate client rights and safety protocols.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie
Client Scenario: A 72-year-old client is post-operative day 2 following a total hip
replacement. The client reports sudden onset of shortness of breath and pleuritic chest
pain. Vital signs: BP 90/60 mmHg, HR 118 beats/min, RR 28 breaths/min, SpO2 86% on
4L nasal cannula, temperature 37.8°C (100°F). Physical assessment reveals diminished
