HESI RN Exit Exam V1 — NGN Test Bank 2026/2027
Next Generation NCLEX (NGN) Case Studies & MCQ |
Questions & Verified Answers | 100% Guaranteed
Pass
Complete A+ Study Guide | Updated 2026/2027 | Walden Exam Vault (WEV)
Covers: Cardiac • Pulmonary Embolism • Diabetic Ketoacidosis • NGN Recognize Cues • Analyze Cues
• Prioritize Hypotheses • Generate Solutions • Take Action • Evaluate Outcomes
NGN QUESTION FORMAT LEGEND:
NGN Prioritize Hypotheses 🟣🟦
Multiple Choice (MCQ)
NGN Generate Solutions 🟣🟣NGNNGNTakeRecognize Cues 🟣 NGN Analyze Cues 🟣
Action 🟣 NGN Evaluate Outcomes
CASE STUDY 1: Acute Coronary Syndrome / Myocardial Infarction
A 67-year-old male presents to the emergency department with a complaint of substernal chest pressure that began 3
hours ago while shoveling snow. He rates the pain as 8/10, describing it as "an elephant sitting on my chest." The pain
radiates to his left jaw. He is diaphoretic, pale, and nauseated.
BP 158/96 mmHg
HR 112 bpm, regular
RR 22 breaths/min
Temp 37.0°C (98.6°F)
SpO2 94% on room air
PMH Hypertension (10 yrs), Type 2 Diabetes (7 yrs), Hyperlipidemia
Medications Lisinopril 10 mg daily, Metformin 1000 mg BID, Atorvastatin 40 mg daily
Q1 [NGN — Recognize Cues] Case 1: ACS/MI — Select the 5 assessment findings that require
immediate follow-up.
A. Chest pressure rating 8/10
B. Radiation to left jaw
C. Blood pressure 158/96
D. Heart rate 112 bpm
E. Respiratory rate 22 breaths/min
F. Temperature 37.0°C
G. Oxygen saturation 94%
H. Diaphoresis
I. History of shoveling snow
J. Nausea
✔ CORRECT ANSWERS: A, B, D, G, H
RATIONALE
, ▸ A (Chest pressure 8/10) — Severe pain indicates possible active myocardial ischemia requiring immediate
intervention.
▸ B (Radiation to jaw) — Classic indicator of cardiac origin pain; suggests ongoing ischemia and STEMI.
▸ D (Tachycardia 112 bpm) — Sympathetic response to pain and decreased cardiac output.
▸ G (SpO2 94%) — Borderline hypoxemia requires supplemental oxygen to prevent further myocardial
damage.
▸ H (Diaphoresis) — Sympathetic stress response indicating significant physiological distress.
▸ Why others are less critical: BP 158/96 is expected in acute pain/stress; RR 22 is mild tachypnea; normal
temp not immediately concerning; history of shoveling is context but not a finding; nausea is important but lower
priority than the five selected.
Q2 [NGN — Analyze Cues] Case 1: ACS/MI — Which conditions are most consistent with these
assessment findings? Select the 3 most likely.
A. Stable angina
B. Unstable angina
C. Acute myocardial infarction
D. Pulmonary embolism
E. Aortic dissection
F. Gastroesophageal reflux disease
✔ CORRECT ANSWERS: B, C, E — Unstable angina; Acute MI; Aortic dissection
RATIONALE
▸ B (Unstable angina) — Angina at rest or with minimal exertion, radiating to jaw, with diaphoresis suggests
ACS spectrum.
▸ C (Acute MI) — Prolonged 3-hour chest pressure, radiation, diaphoresis, tachycardia, and SpO2 drop all
point to STEMI/NSTEMI.
▸ E (Aortic dissection) — Must be ruled out in this presentation due to severe chest pain, hypertension, and
radiation pattern.
▸ Why others are less likely: Stable angina would resolve with rest. PE presents with dyspnea, pleuritic pain,
and leg swelling. GERD does not cause diaphoresis, jaw pain, or hemodynamic changes.
Q3 [NGN — Prioritize Hypotheses] Case 1: ACS/MI — Which hypothesis should the nurse
prioritize as MOST consistent with this patient's presentation?
A. Stable angina
B. Unstable angina
C. Acute myocardial infarction
D. Pulmonary embolism
✔ CORRECT ANSWERS: C. Acute myocardial infarction
RATIONALE
▸ Acute MI is the most urgent hypothesis: pain duration >3 hours, radiation to jaw, diaphoresis, tachycardia,
and hypoxemia indicate active myocardial damage.
▸ Onset during physical exertion (shoveling) combined with risk factors (HTN, DM, hyperlipidemia) further
supports MI.
▸ Unstable angina is possible but less likely given the 3-hour duration without relief — typical angina lasts <20
minutes.
▸ Immediate 12-lead ECG, troponin levels, and emergent cardiology consultation are required to confirm and
manage STEMI vs NSTEMI.
Next Generation NCLEX (NGN) Case Studies & MCQ |
Questions & Verified Answers | 100% Guaranteed
Pass
Complete A+ Study Guide | Updated 2026/2027 | Walden Exam Vault (WEV)
Covers: Cardiac • Pulmonary Embolism • Diabetic Ketoacidosis • NGN Recognize Cues • Analyze Cues
• Prioritize Hypotheses • Generate Solutions • Take Action • Evaluate Outcomes
NGN QUESTION FORMAT LEGEND:
NGN Prioritize Hypotheses 🟣🟦
Multiple Choice (MCQ)
NGN Generate Solutions 🟣🟣NGNNGNTakeRecognize Cues 🟣 NGN Analyze Cues 🟣
Action 🟣 NGN Evaluate Outcomes
CASE STUDY 1: Acute Coronary Syndrome / Myocardial Infarction
A 67-year-old male presents to the emergency department with a complaint of substernal chest pressure that began 3
hours ago while shoveling snow. He rates the pain as 8/10, describing it as "an elephant sitting on my chest." The pain
radiates to his left jaw. He is diaphoretic, pale, and nauseated.
BP 158/96 mmHg
HR 112 bpm, regular
RR 22 breaths/min
Temp 37.0°C (98.6°F)
SpO2 94% on room air
PMH Hypertension (10 yrs), Type 2 Diabetes (7 yrs), Hyperlipidemia
Medications Lisinopril 10 mg daily, Metformin 1000 mg BID, Atorvastatin 40 mg daily
Q1 [NGN — Recognize Cues] Case 1: ACS/MI — Select the 5 assessment findings that require
immediate follow-up.
A. Chest pressure rating 8/10
B. Radiation to left jaw
C. Blood pressure 158/96
D. Heart rate 112 bpm
E. Respiratory rate 22 breaths/min
F. Temperature 37.0°C
G. Oxygen saturation 94%
H. Diaphoresis
I. History of shoveling snow
J. Nausea
✔ CORRECT ANSWERS: A, B, D, G, H
RATIONALE
, ▸ A (Chest pressure 8/10) — Severe pain indicates possible active myocardial ischemia requiring immediate
intervention.
▸ B (Radiation to jaw) — Classic indicator of cardiac origin pain; suggests ongoing ischemia and STEMI.
▸ D (Tachycardia 112 bpm) — Sympathetic response to pain and decreased cardiac output.
▸ G (SpO2 94%) — Borderline hypoxemia requires supplemental oxygen to prevent further myocardial
damage.
▸ H (Diaphoresis) — Sympathetic stress response indicating significant physiological distress.
▸ Why others are less critical: BP 158/96 is expected in acute pain/stress; RR 22 is mild tachypnea; normal
temp not immediately concerning; history of shoveling is context but not a finding; nausea is important but lower
priority than the five selected.
Q2 [NGN — Analyze Cues] Case 1: ACS/MI — Which conditions are most consistent with these
assessment findings? Select the 3 most likely.
A. Stable angina
B. Unstable angina
C. Acute myocardial infarction
D. Pulmonary embolism
E. Aortic dissection
F. Gastroesophageal reflux disease
✔ CORRECT ANSWERS: B, C, E — Unstable angina; Acute MI; Aortic dissection
RATIONALE
▸ B (Unstable angina) — Angina at rest or with minimal exertion, radiating to jaw, with diaphoresis suggests
ACS spectrum.
▸ C (Acute MI) — Prolonged 3-hour chest pressure, radiation, diaphoresis, tachycardia, and SpO2 drop all
point to STEMI/NSTEMI.
▸ E (Aortic dissection) — Must be ruled out in this presentation due to severe chest pain, hypertension, and
radiation pattern.
▸ Why others are less likely: Stable angina would resolve with rest. PE presents with dyspnea, pleuritic pain,
and leg swelling. GERD does not cause diaphoresis, jaw pain, or hemodynamic changes.
Q3 [NGN — Prioritize Hypotheses] Case 1: ACS/MI — Which hypothesis should the nurse
prioritize as MOST consistent with this patient's presentation?
A. Stable angina
B. Unstable angina
C. Acute myocardial infarction
D. Pulmonary embolism
✔ CORRECT ANSWERS: C. Acute myocardial infarction
RATIONALE
▸ Acute MI is the most urgent hypothesis: pain duration >3 hours, radiation to jaw, diaphoresis, tachycardia,
and hypoxemia indicate active myocardial damage.
▸ Onset during physical exertion (shoveling) combined with risk factors (HTN, DM, hyperlipidemia) further
supports MI.
▸ Unstable angina is possible but less likely given the 3-hour duration without relief — typical angina lasts <20
minutes.
▸ Immediate 12-lead ECG, troponin levels, and emergent cardiology consultation are required to confirm and
manage STEMI vs NSTEMI.
