RN HESI Exit Exam V1 2026-2027 | Comprehensive
Nursing Actual Exam
150 Verified Questions & Answers | Based on the 2026/2027 Elsevier HESI RN Exit Exam
Blueprint and Next Generation NCLEX (NGN) Standards
___________________________________________________________________
____________________________
Abstract
This actual exam document provides 150 verified questions and answers aligned to the
2026/2027 Elsevier HESI RN Exit Exam blueprint and current Next Generation NCLEX (NGN)
standards. It integrates clinical judgment, evidence-based standards, and interdisciplinary care
across the lifespan in five comprehensive domains: Medical-Surgical Nursing, Maternal-
Newborn and Pediatric Nursing, Mental Health and Psychosocial Nursing, Leadership,
Management and Community Health, and Fundamentals, Pharmacology and NGN Clinical
Judgment. Each item is structured to mirror the cognitive demand of the actual exam, with
rationales, distractor analysis, and textbook references designed to reinforce safe entry into
professional nursing care and NCLEX-RN readiness. The content reflects current clinical
standards, prioritization principles, pharmacologic safety, and the six-step NGN clinical
judgment measurement model (Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate
Solutions, Take Action, Evaluate Outcomes). This resource supports the development of clinical
reasoning essential for competent, client-centered, and ethically sound nursing care.
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular, Respiratory,
Medical-Surgical Nursing 1-45 (45) Neurologic, GI, Renal, Endocrine, 30%
Immune, Musculoskeletal
Pregnancy complications, Labor &
Maternal-Newborn &
46-83 (38) delivery, Newborn care, Pediatric 25%
Pediatric Nursing
acute and chronic conditions
Anxiety, Mood disorders,
Mental Health & Psychosocial
84-105 (22) Psychosis, Substance use, 15%
Nursing
Personality disorders, Dementia
Delegation, Prioritization, Ethics,
Leadership, Management &
106-127 (22) Public health, Cultural 15%
Community Health
competence, Quality improvement
Medication safety, IV therapy,
Fundamentals, Pharmacology
128-150 (23) NGN case scenarios, Clinical 15%
& NGN Clinical Judgment
judgment measurement model
Comprehensive Nursing
TOTAL 150 100%
Across the Lifespan
,Examination Questions
Domain: Medical-Surgical Nursing
1. A 68-year-old client with heart failure reports sudden weight gain of 2.3 kg (5 lb)
over 3 days. Which finding should the nurse anticipate?
A. Decreased jugular venous distension
B. Bilateral crackles in lung bases
C. Hypotension with supine positioning
D. Bradycardia with premature ventricular contractions
Correct Answer: B
Rationale: Rapid weight gain in heart failure indicates fluid retention and worsening volume
overload, which commonly presents as bilateral basilar crackles due to pulmonary venous
congestion.
Why Wrong:
• JVD would increase, not decrease, with fluid overload.
• Hypotension is not the hallmark of fluid overload; crackles are typical.
• Bradycardia and PVCs are not classic signs of fluid overload.
Reference: 2026 HESI RN Exit Exam Blueprint – Medical-Surgical Nursing: Cardiovascular;
Lewis Medical-Surgical Nursing, Ch. 33.
2. A client receiving IV heparin for deep vein thrombosis has an aPTT of 110 seconds
(control 30–40 sec). Which action should the nurse take first?
A. Increase the heparin infusion rate
B. Notify the prescriber to adjust the dose
C. Administer protamine sulfate immediately
D. Document the finding as expected
Correct Answer: B
Rationale: An aPTT of 110 seconds is above the therapeutic range (1.5–2.0 times control). The
nurse should notify the prescriber for dose adjustment; protamine is reserved for critical
bleeding.
Why Wrong:
• Increasing the rate worsens anticoagulation.
• Protamine is the antidote but is used for severe bleeding or significant overdose, not as
first-line adjustment.
• The finding is not expected; it is supratherapeutic.
Reference: HESI Pharmacology Assessment – Anticoagulants; Lewis Medical-Surgical Nursing,
Ch. 38.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. The client becomes lethargic and the SpO2 is 92%.
What is the priority nursing action?
A. Increase oxygen to 6 L/min
B. Assess arterial blood gases (ABGs)
C. Encourage coughing and deep breathing
D. Lower the oxygen to 1 L/min
Correct Answer: B
Rationale: In COPD clients, lethargy with adequate SpO2 may signal CO2 narcica (rising
PaCO2). ABGs are essential to evaluate hypercapnia before changing oxygen therapy.
Why Wrong:
• Increasing oxygen may worsen hypercapnia by suppressing hypoxic drive.
• Coughing is helpful but not the priority when neurologic status changes.
, • Lowering oxygen without assessment may cause hypoxemia.
Reference: HESI RN Exit Blueprint – Med-Surg: Respiratory; Lewis Medical-Surgical Nursing,
Ch. 28.
4. A client with a chest tube attached to a water-seal drainage system has continuous
bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally
B. There is a leak in the system or at the insertion site
C. The drainage system needs to be replaced
D. The suction pressure is too high
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent
bubbling is normal with exhalation, but continuous bubbling requires assessment for system or
insertion-site leaks.
Why Wrong:
• Intermittent bubbling is normal, not continuous.
• Replacement is not the first action; locate the leak first.
• Suction control chamber bubbling is normal, but water-seal continuous bubbling indicates
a leak.
Reference: HESI Med-Surg – Respiratory; Lewis Medical-Surgical Nursing, Ch. 28.
5. A client with diabetes mellitus has a fasting blood glucose of 58 mg/dL and is
diaphoretic and confused. Which action should the nurse take first?
A. Administer 50% dextrose IV push
B. Give 4 oz of fruit juice
C. Recheck the glucose in 15 minutes
D. Notify the healthcare provider
Correct Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to provide a fast-acting
oral carbohydrate (15 g) such as 4 oz of fruit juice. IV dextrose is reserved for severe or
unresponsive clients.
Why Wrong:
• IV dextrose is for severe/unconscious hypoglycemia.
• Waiting 15 minutes without treatment worsens hypoglycemia.
• The nurse should treat first, then notify the provider.
Reference: HESI Pharmacology – Endocrine; Lewis Medical-Surgical Nursing, Ch. 49.
6. A client with cirrhosis develops asterixis. The nurse recognizes this as a sign of
which condition?
A. Hepatic encephalopathy
B. Spontaneous bacterial peritonitis
C. Hepatorenal syndrome
D. Esophageal varices
Correct Answer: A
Rationale: Asterixis (flapping tremor of the hand) is a classic sign of hepatic encephalopathy
due to elevated serum ammonia affecting cerebral function.
Why Wrong:
• SBP presents with fever and abdominal pain, not asterixis.
• Hepatorenal syndrome presents with oliguria and rising creatinine.
• Esophageal varices present with hematemesis.
Reference: HESI Med-Surg – Gastrointestinal; Lewis Medical-Surgical Nursing, Ch. 43.
, 7. A client with a suspected myocardial infarction reports chest pain rated 8/10.
Which intervention should the nurse implement first?
A. Administer morphine 4 mg IV
B. Assess vital signs and attach cardiac monitor
C. Administer aspirin 325 mg chewable
D. Administer nitroglycerin sublingual
Correct Answer: B
Rationale: The nurse must first assess vital signs and rhythm before administering
medications such as nitroglycerin (which can cause hypotension) or morphine.
Why Wrong:
• Morphine is given after assessment and per protocol.
• Aspirin is given early but only after initial assessment.
• Nitroglycerin requires BP assessment first.
Reference: HESI Med-Surg – Cardiovascular; Lewis Medical-Surgical Nursing, Ch. 34.
8. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
ECG finding should the nurse anticipate?
A. Peaked T waves
B. Flattened P waves
C. Shortened QT interval
D. Narrow QRS complex
Correct Answer: A
Rationale: Hyperkalemia causes characteristic peaked (tented) T waves, prolonged PR
interval, and widened QRS complex on ECG.
Why Wrong:
• Flattened P waves occur with hyperkalemia in late stages, but peaked T waves are the
earliest sign.
• QT interval is prolonged, not shortened.
• QRS widens, not narrows, with hyperkalemia.
Reference: HESI Med-Surg – Renal/Urinary; Lewis Medical-Surgical Nursing, Ch. 47.
9. A client post-thyroidectomy reports tingling around the mouth and muscle
twitching. Which finding should the nurse assess next?
A. Serum calcium level
B. Respiratory rate
C. Incisional drainage
D. Body temperature
Correct Answer: A
Rationale: Tingling (perioral) and muscle twitching (Chvostek sign) suggest hypocalcemia
from accidental parathyroid removal during thyroidectomy. Calcium level should be assessed.
Why Wrong:
• Respiratory rate is important but not specific to these symptoms.
• Incisional drainage is monitored but does not explain tetany.
• Temperature is not relevant to hypocalcemia signs.
Reference: HESI Med-Surg – Endocrine; Lewis Medical-Surgical Nursing, Ch. 49.
10. A client with a peptic ulcer develops sudden severe epigastric pain and a rigid,
board-like abdomen. Which complication should the nurse suspect?
A. Gastric perforation
B. Pyloric obstruction
C. Hemorrhage
Nursing Actual Exam
150 Verified Questions & Answers | Based on the 2026/2027 Elsevier HESI RN Exit Exam
Blueprint and Next Generation NCLEX (NGN) Standards
___________________________________________________________________
____________________________
Abstract
This actual exam document provides 150 verified questions and answers aligned to the
2026/2027 Elsevier HESI RN Exit Exam blueprint and current Next Generation NCLEX (NGN)
standards. It integrates clinical judgment, evidence-based standards, and interdisciplinary care
across the lifespan in five comprehensive domains: Medical-Surgical Nursing, Maternal-
Newborn and Pediatric Nursing, Mental Health and Psychosocial Nursing, Leadership,
Management and Community Health, and Fundamentals, Pharmacology and NGN Clinical
Judgment. Each item is structured to mirror the cognitive demand of the actual exam, with
rationales, distractor analysis, and textbook references designed to reinforce safe entry into
professional nursing care and NCLEX-RN readiness. The content reflects current clinical
standards, prioritization principles, pharmacologic safety, and the six-step NGN clinical
judgment measurement model (Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate
Solutions, Take Action, Evaluate Outcomes). This resource supports the development of clinical
reasoning essential for competent, client-centered, and ethically sound nursing care.
Content Area Overview
Content Area Questions Key Topics Weight
Cardiovascular, Respiratory,
Medical-Surgical Nursing 1-45 (45) Neurologic, GI, Renal, Endocrine, 30%
Immune, Musculoskeletal
Pregnancy complications, Labor &
Maternal-Newborn &
46-83 (38) delivery, Newborn care, Pediatric 25%
Pediatric Nursing
acute and chronic conditions
Anxiety, Mood disorders,
Mental Health & Psychosocial
84-105 (22) Psychosis, Substance use, 15%
Nursing
Personality disorders, Dementia
Delegation, Prioritization, Ethics,
Leadership, Management &
106-127 (22) Public health, Cultural 15%
Community Health
competence, Quality improvement
Medication safety, IV therapy,
Fundamentals, Pharmacology
128-150 (23) NGN case scenarios, Clinical 15%
& NGN Clinical Judgment
judgment measurement model
Comprehensive Nursing
TOTAL 150 100%
Across the Lifespan
,Examination Questions
Domain: Medical-Surgical Nursing
1. A 68-year-old client with heart failure reports sudden weight gain of 2.3 kg (5 lb)
over 3 days. Which finding should the nurse anticipate?
A. Decreased jugular venous distension
B. Bilateral crackles in lung bases
C. Hypotension with supine positioning
D. Bradycardia with premature ventricular contractions
Correct Answer: B
Rationale: Rapid weight gain in heart failure indicates fluid retention and worsening volume
overload, which commonly presents as bilateral basilar crackles due to pulmonary venous
congestion.
Why Wrong:
• JVD would increase, not decrease, with fluid overload.
• Hypotension is not the hallmark of fluid overload; crackles are typical.
• Bradycardia and PVCs are not classic signs of fluid overload.
Reference: 2026 HESI RN Exit Exam Blueprint – Medical-Surgical Nursing: Cardiovascular;
Lewis Medical-Surgical Nursing, Ch. 33.
2. A client receiving IV heparin for deep vein thrombosis has an aPTT of 110 seconds
(control 30–40 sec). Which action should the nurse take first?
A. Increase the heparin infusion rate
B. Notify the prescriber to adjust the dose
C. Administer protamine sulfate immediately
D. Document the finding as expected
Correct Answer: B
Rationale: An aPTT of 110 seconds is above the therapeutic range (1.5–2.0 times control). The
nurse should notify the prescriber for dose adjustment; protamine is reserved for critical
bleeding.
Why Wrong:
• Increasing the rate worsens anticoagulation.
• Protamine is the antidote but is used for severe bleeding or significant overdose, not as
first-line adjustment.
• The finding is not expected; it is supratherapeutic.
Reference: HESI Pharmacology Assessment – Anticoagulants; Lewis Medical-Surgical Nursing,
Ch. 38.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. The client becomes lethargic and the SpO2 is 92%.
What is the priority nursing action?
A. Increase oxygen to 6 L/min
B. Assess arterial blood gases (ABGs)
C. Encourage coughing and deep breathing
D. Lower the oxygen to 1 L/min
Correct Answer: B
Rationale: In COPD clients, lethargy with adequate SpO2 may signal CO2 narcica (rising
PaCO2). ABGs are essential to evaluate hypercapnia before changing oxygen therapy.
Why Wrong:
• Increasing oxygen may worsen hypercapnia by suppressing hypoxic drive.
• Coughing is helpful but not the priority when neurologic status changes.
, • Lowering oxygen without assessment may cause hypoxemia.
Reference: HESI RN Exit Blueprint – Med-Surg: Respiratory; Lewis Medical-Surgical Nursing,
Ch. 28.
4. A client with a chest tube attached to a water-seal drainage system has continuous
bubbling in the water-seal chamber. What does this finding indicate?
A. The system is functioning normally
B. There is a leak in the system or at the insertion site
C. The drainage system needs to be replaced
D. The suction pressure is too high
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak. Intermittent
bubbling is normal with exhalation, but continuous bubbling requires assessment for system or
insertion-site leaks.
Why Wrong:
• Intermittent bubbling is normal, not continuous.
• Replacement is not the first action; locate the leak first.
• Suction control chamber bubbling is normal, but water-seal continuous bubbling indicates
a leak.
Reference: HESI Med-Surg – Respiratory; Lewis Medical-Surgical Nursing, Ch. 28.
5. A client with diabetes mellitus has a fasting blood glucose of 58 mg/dL and is
diaphoretic and confused. Which action should the nurse take first?
A. Administer 50% dextrose IV push
B. Give 4 oz of fruit juice
C. Recheck the glucose in 15 minutes
D. Notify the healthcare provider
Correct Answer: B
Rationale: For a conscious client with hypoglycemia, the first action is to provide a fast-acting
oral carbohydrate (15 g) such as 4 oz of fruit juice. IV dextrose is reserved for severe or
unresponsive clients.
Why Wrong:
• IV dextrose is for severe/unconscious hypoglycemia.
• Waiting 15 minutes without treatment worsens hypoglycemia.
• The nurse should treat first, then notify the provider.
Reference: HESI Pharmacology – Endocrine; Lewis Medical-Surgical Nursing, Ch. 49.
6. A client with cirrhosis develops asterixis. The nurse recognizes this as a sign of
which condition?
A. Hepatic encephalopathy
B. Spontaneous bacterial peritonitis
C. Hepatorenal syndrome
D. Esophageal varices
Correct Answer: A
Rationale: Asterixis (flapping tremor of the hand) is a classic sign of hepatic encephalopathy
due to elevated serum ammonia affecting cerebral function.
Why Wrong:
• SBP presents with fever and abdominal pain, not asterixis.
• Hepatorenal syndrome presents with oliguria and rising creatinine.
• Esophageal varices present with hematemesis.
Reference: HESI Med-Surg – Gastrointestinal; Lewis Medical-Surgical Nursing, Ch. 43.
, 7. A client with a suspected myocardial infarction reports chest pain rated 8/10.
Which intervention should the nurse implement first?
A. Administer morphine 4 mg IV
B. Assess vital signs and attach cardiac monitor
C. Administer aspirin 325 mg chewable
D. Administer nitroglycerin sublingual
Correct Answer: B
Rationale: The nurse must first assess vital signs and rhythm before administering
medications such as nitroglycerin (which can cause hypotension) or morphine.
Why Wrong:
• Morphine is given after assessment and per protocol.
• Aspirin is given early but only after initial assessment.
• Nitroglycerin requires BP assessment first.
Reference: HESI Med-Surg – Cardiovascular; Lewis Medical-Surgical Nursing, Ch. 34.
8. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
ECG finding should the nurse anticipate?
A. Peaked T waves
B. Flattened P waves
C. Shortened QT interval
D. Narrow QRS complex
Correct Answer: A
Rationale: Hyperkalemia causes characteristic peaked (tented) T waves, prolonged PR
interval, and widened QRS complex on ECG.
Why Wrong:
• Flattened P waves occur with hyperkalemia in late stages, but peaked T waves are the
earliest sign.
• QT interval is prolonged, not shortened.
• QRS widens, not narrows, with hyperkalemia.
Reference: HESI Med-Surg – Renal/Urinary; Lewis Medical-Surgical Nursing, Ch. 47.
9. A client post-thyroidectomy reports tingling around the mouth and muscle
twitching. Which finding should the nurse assess next?
A. Serum calcium level
B. Respiratory rate
C. Incisional drainage
D. Body temperature
Correct Answer: A
Rationale: Tingling (perioral) and muscle twitching (Chvostek sign) suggest hypocalcemia
from accidental parathyroid removal during thyroidectomy. Calcium level should be assessed.
Why Wrong:
• Respiratory rate is important but not specific to these symptoms.
• Incisional drainage is monitored but does not explain tetany.
• Temperature is not relevant to hypocalcemia signs.
Reference: HESI Med-Surg – Endocrine; Lewis Medical-Surgical Nursing, Ch. 49.
10. A client with a peptic ulcer develops sudden severe epigastric pain and a rigid,
board-like abdomen. Which complication should the nurse suspect?
A. Gastric perforation
B. Pyloric obstruction
C. Hemorrhage
