2026/2027 HESI EXIT EXAM V6 NGN Q&A | CASE-BASED SCENARIOS PDF
HESI RN Exit Examination Version 6 (V6) - Next Generation NCLEX® (NGN) Case-Based Scenarios &
Question Bank | Core Domains: Comprehensive Clinical Judgment via Advanced NGN Item Types
(Bow-Tie, Matrix, Extended Multiple Response, Cloze), Multisystem Unfolding Case Studies, Integrated
Advanced Pharmacology & Complex Pathophysiology, Prioritization in High-Acuity & Emergency
Situations, Health Promotion & Disease Prevention Across the Lifespan, Interprofessional Collaboration
& Communication in Complex Cases, and Ethical/Legal Reasoning in Evolving Clinical Dilemmas |
NCLEX-RN® Readiness Focus | Advanced Case-Based PDF Format
Exam Structure
The HESI Exit Exam V6 with NGN for the 2026/2027 academic cycle is a 150-question, multiple-choice
question (MCQ) and NGN item-type examination.
Introduction
This HESI Exit Exam V6 NGN Q&A PDF for the 2026/2027 cycle provides an advanced collection of
case-based scenarios fully aligned with the latest Next Generation NCLEX® framework. Designed for
comprehensive preparation, it challenges students with complex, evolving patient situations that require
deep clinical judgment, integrated knowledge application, and evidence-based decision-making to predict
superior performance on the updated NCLEX-RN® examination.
Answer Format
All correct answers and clinical decisions must be presented in bold and green, followed by detailed
rationales that systematically apply the NGN Clinical Judgment Measurement Model, synthesize
knowledge from all nursing specialties, justify priority actions in multisystem disorders, analyze
pharmacological and non-pharmacological interventions, and evaluate patient outcomes in complex,
unfolding case scenarios.
Questions (150 Total)
1.
A 78-year-old male with heart failure (HFrEF, EF 20%), CKD stage 3b (eGFR 32 mL/min), and atrial
fibrillation (CHA₂DS₂-VASc = 5) presents with acute pulmonary edema: BP 198/108 mm Hg, HR 132 bpm
(irregular), RR 36/min, SpO₂ 82% on room air, bilateral crackles to apices. He takes lisinopril, metoprolol,
and furosemide at home. Labs: K⁺ 3.0 mEq/L, BNP 850 pg/mL, INR 1.1.
Which action should the nurse take first?
A. Administer furosemide 80 mg IV
B. Apply high-flow oxygen via non-rebreather mask and elevate head of bed to 90°
C. Start nitroglycerin IV infusion
D. Give potassium chloride 20 mEq IV
Rationale (NGN Clinical Judgment Model):
,Recognize Cues: Severe hypoxia (SpO₂ 82%), tachypnea, crackles to apices = life-threatening
respiratory failure.
Analyze Cues: Without immediate oxygenation, other interventions (diuresis, vasodilation) will fail.
Prioritize Hypotheses: Inadequate oxygenation > fluid overload > electrolyte imbalance >
anticoagulation need.
Generate Solutions: Maximize O₂ delivery before pharmacologic intervention.
Take Action: Non-rebreather provides up to 90% FiO₂; 90° position reduces venous return and
pulmonary congestion.
Evaluate Outcomes: SpO₂ improves within 1–2 minutes; work of breathing decreases.
2.
A 3-day-old newborn with ABO incompatibility has total serum bilirubin of 19.8 mg/dL despite 24 hours
of intensive phototherapy. The infant is lethargic, feeding poorly, and has a high-pitched cry. Blood type:
mother O+, baby A+.
What is the priority intervention?
A. Continue phototherapy and recheck bilirubin in 2 hours
B. Prepare for immediate exchange transfusion
C. Administer IV immunoglobulin (IVIG) 1 g/kg
D. Increase IV hydration with D10W
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Bilirubin >19 in a 3-day-old + neurological symptoms (lethargy, high-pitched cry).
Analyze Cues: These are signs of acute bilirubin encephalopathy—precursor to kernicterus.
Prioritize Hypotheses: Permanent neurological damage is imminent without rapid intervention.
Generate Solutions: Exchange transfusion removes bilirubin and maternal antibodies faster than
IVIG alone.
Take Action: Notify neonatologist STAT; obtain consent; ensure type-specific blood is available.
Evaluate Outcomes: Bilirubin declines rapidly; neurological symptoms resolve without sequelae.
3.
,A 52-year-old female with bipolar I disorder is admitted after a manic episode. She is agitated, shouting
delusions of grandeur, and attempting to leave AMA. Lithium level is 0.1 mEq/L. Security is called due to
escalating aggression.
What is the nurse’s best initial action?
A. Apply physical restraints immediately
B. Use verbal de-escalation, offer PRN lorazepam, and involve psychiatrist for capacity
assessment
C. Administer IM haloperidol without consent
D. Discharge to avoid liability
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Mania, agitation, delusions, low lithium, AMA attempt.
Analyze Cues: Restraints are last resort; least restrictive intervention preserves trust.
Prioritize Hypotheses: Safety through engagement > coercion.
Generate Solutions: Calm tone, clear boundaries, offer anxiolytic, assess decisional capacity.
Take Action: “I’m here to keep you safe. Can we talk about what’s upsetting you?”
Evaluate Outcomes: Agitation decreases; patient agrees to stay for treatment.
4.
An 82-year-old Indigenous elder with end-stage renal disease refuses dialysis, stating, “My spirit is
ready.” Family requests traditional smudging with sage during care. Hospital policy prohibits open flames
in patient rooms.
What should the nurse do?
A. Deny request due to fire code
B. Collaborate with family and risk management to implement smokeless smudging
protocol
C. Allow smudging when staff are off-unit
D. Document refusal of cultural care
Rationale (NGN Clinical Judgment Model):
, Recognize Cues: Spiritual/cultural request, safety policy, end-of-life context.
Analyze Cues: Cultural humility requires balancing respect with institutional safety.
Prioritize Hypotheses: Honor patient autonomy and cultural identity.
Generate Solutions: Many hospitals now approve smokeless alternatives (sprays, fans).
Take Action: Facilitate interdisciplinary meeting with family, chaplain, and safety officer.
Evaluate Outcomes: Ritual performed safely; family reports dignity in dying.
5.
A 7-year-old with status asthmaticus has SpO₂ 78% on 15 L/min O₂ via non-rebreather, RR 58/min, HR
168 bpm, and silent chest. Continuous albuterol, ipratropium, and IV methylprednisolone were started 45
minutes ago.
What is the priority action?
A. Administer magnesium sulfate IV
B. Call rapid response and prepare for intubation
C. Obtain ABG
D. Encourage incentive spirometry
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Silent chest = no air movement = respiratory arrest imminent.
Analyze Cues: Exhaustion has occurred; medical therapy is failing.
Prioritize Hypotheses: Airway protection is immediately life-saving.
Generate Solutions: Secure airway before cardiac arrest.
Take Action: Ensure laryngoscope, ET tubes, and bag-valve-mask are at bedside.
Evaluate Outcomes: Intubation successful; oxygenation restored.
6.
A pregnant client at 35 weeks with severe preeclampsia (BP 178/110, proteinuria 4+) develops epigastric
pain, headache, blurred vision, and vomiting. Platelets: 85,000/mm³; AST: 140 U/L; LDH elevated.
What complication is present?
HESI RN Exit Examination Version 6 (V6) - Next Generation NCLEX® (NGN) Case-Based Scenarios &
Question Bank | Core Domains: Comprehensive Clinical Judgment via Advanced NGN Item Types
(Bow-Tie, Matrix, Extended Multiple Response, Cloze), Multisystem Unfolding Case Studies, Integrated
Advanced Pharmacology & Complex Pathophysiology, Prioritization in High-Acuity & Emergency
Situations, Health Promotion & Disease Prevention Across the Lifespan, Interprofessional Collaboration
& Communication in Complex Cases, and Ethical/Legal Reasoning in Evolving Clinical Dilemmas |
NCLEX-RN® Readiness Focus | Advanced Case-Based PDF Format
Exam Structure
The HESI Exit Exam V6 with NGN for the 2026/2027 academic cycle is a 150-question, multiple-choice
question (MCQ) and NGN item-type examination.
Introduction
This HESI Exit Exam V6 NGN Q&A PDF for the 2026/2027 cycle provides an advanced collection of
case-based scenarios fully aligned with the latest Next Generation NCLEX® framework. Designed for
comprehensive preparation, it challenges students with complex, evolving patient situations that require
deep clinical judgment, integrated knowledge application, and evidence-based decision-making to predict
superior performance on the updated NCLEX-RN® examination.
Answer Format
All correct answers and clinical decisions must be presented in bold and green, followed by detailed
rationales that systematically apply the NGN Clinical Judgment Measurement Model, synthesize
knowledge from all nursing specialties, justify priority actions in multisystem disorders, analyze
pharmacological and non-pharmacological interventions, and evaluate patient outcomes in complex,
unfolding case scenarios.
Questions (150 Total)
1.
A 78-year-old male with heart failure (HFrEF, EF 20%), CKD stage 3b (eGFR 32 mL/min), and atrial
fibrillation (CHA₂DS₂-VASc = 5) presents with acute pulmonary edema: BP 198/108 mm Hg, HR 132 bpm
(irregular), RR 36/min, SpO₂ 82% on room air, bilateral crackles to apices. He takes lisinopril, metoprolol,
and furosemide at home. Labs: K⁺ 3.0 mEq/L, BNP 850 pg/mL, INR 1.1.
Which action should the nurse take first?
A. Administer furosemide 80 mg IV
B. Apply high-flow oxygen via non-rebreather mask and elevate head of bed to 90°
C. Start nitroglycerin IV infusion
D. Give potassium chloride 20 mEq IV
Rationale (NGN Clinical Judgment Model):
,Recognize Cues: Severe hypoxia (SpO₂ 82%), tachypnea, crackles to apices = life-threatening
respiratory failure.
Analyze Cues: Without immediate oxygenation, other interventions (diuresis, vasodilation) will fail.
Prioritize Hypotheses: Inadequate oxygenation > fluid overload > electrolyte imbalance >
anticoagulation need.
Generate Solutions: Maximize O₂ delivery before pharmacologic intervention.
Take Action: Non-rebreather provides up to 90% FiO₂; 90° position reduces venous return and
pulmonary congestion.
Evaluate Outcomes: SpO₂ improves within 1–2 minutes; work of breathing decreases.
2.
A 3-day-old newborn with ABO incompatibility has total serum bilirubin of 19.8 mg/dL despite 24 hours
of intensive phototherapy. The infant is lethargic, feeding poorly, and has a high-pitched cry. Blood type:
mother O+, baby A+.
What is the priority intervention?
A. Continue phototherapy and recheck bilirubin in 2 hours
B. Prepare for immediate exchange transfusion
C. Administer IV immunoglobulin (IVIG) 1 g/kg
D. Increase IV hydration with D10W
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Bilirubin >19 in a 3-day-old + neurological symptoms (lethargy, high-pitched cry).
Analyze Cues: These are signs of acute bilirubin encephalopathy—precursor to kernicterus.
Prioritize Hypotheses: Permanent neurological damage is imminent without rapid intervention.
Generate Solutions: Exchange transfusion removes bilirubin and maternal antibodies faster than
IVIG alone.
Take Action: Notify neonatologist STAT; obtain consent; ensure type-specific blood is available.
Evaluate Outcomes: Bilirubin declines rapidly; neurological symptoms resolve without sequelae.
3.
,A 52-year-old female with bipolar I disorder is admitted after a manic episode. She is agitated, shouting
delusions of grandeur, and attempting to leave AMA. Lithium level is 0.1 mEq/L. Security is called due to
escalating aggression.
What is the nurse’s best initial action?
A. Apply physical restraints immediately
B. Use verbal de-escalation, offer PRN lorazepam, and involve psychiatrist for capacity
assessment
C. Administer IM haloperidol without consent
D. Discharge to avoid liability
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Mania, agitation, delusions, low lithium, AMA attempt.
Analyze Cues: Restraints are last resort; least restrictive intervention preserves trust.
Prioritize Hypotheses: Safety through engagement > coercion.
Generate Solutions: Calm tone, clear boundaries, offer anxiolytic, assess decisional capacity.
Take Action: “I’m here to keep you safe. Can we talk about what’s upsetting you?”
Evaluate Outcomes: Agitation decreases; patient agrees to stay for treatment.
4.
An 82-year-old Indigenous elder with end-stage renal disease refuses dialysis, stating, “My spirit is
ready.” Family requests traditional smudging with sage during care. Hospital policy prohibits open flames
in patient rooms.
What should the nurse do?
A. Deny request due to fire code
B. Collaborate with family and risk management to implement smokeless smudging
protocol
C. Allow smudging when staff are off-unit
D. Document refusal of cultural care
Rationale (NGN Clinical Judgment Model):
, Recognize Cues: Spiritual/cultural request, safety policy, end-of-life context.
Analyze Cues: Cultural humility requires balancing respect with institutional safety.
Prioritize Hypotheses: Honor patient autonomy and cultural identity.
Generate Solutions: Many hospitals now approve smokeless alternatives (sprays, fans).
Take Action: Facilitate interdisciplinary meeting with family, chaplain, and safety officer.
Evaluate Outcomes: Ritual performed safely; family reports dignity in dying.
5.
A 7-year-old with status asthmaticus has SpO₂ 78% on 15 L/min O₂ via non-rebreather, RR 58/min, HR
168 bpm, and silent chest. Continuous albuterol, ipratropium, and IV methylprednisolone were started 45
minutes ago.
What is the priority action?
A. Administer magnesium sulfate IV
B. Call rapid response and prepare for intubation
C. Obtain ABG
D. Encourage incentive spirometry
Rationale (NGN Clinical Judgment Model):
Recognize Cues: Silent chest = no air movement = respiratory arrest imminent.
Analyze Cues: Exhaustion has occurred; medical therapy is failing.
Prioritize Hypotheses: Airway protection is immediately life-saving.
Generate Solutions: Secure airway before cardiac arrest.
Take Action: Ensure laryngoscope, ET tubes, and bag-valve-mask are at bedside.
Evaluate Outcomes: Intubation successful; oxygenation restored.
6.
A pregnant client at 35 weeks with severe preeclampsia (BP 178/110, proteinuria 4+) develops epigastric
pain, headache, blurred vision, and vomiting. Platelets: 85,000/mm³; AST: 140 U/L; LDH elevated.
What complication is present?
