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NGN HESI RN 2026 Exit Exam: HIGH-
STAKES EXIT EXAM: UPDATED
QUESTION POOL & VERIFIED KEYS ACE
THE FINAL: COMPLETE 3-VERSION TEST
BANK WITH 100% ACCURACY
When preparing to administer a prescribed medication to a homeless client at a community
psychiatric clinic, the client tells the nurse that their usual baseline dosage is completely
different from the dose the nurse is preparing to give. Which action should the nurse take?
• A) Inform the client that he maintains the legal right to refuse the medication and
document the refusal.
• B) Withhold the medication immediately until the dosage can be verified and confirmed
with the prescriber.
• C) Explain to the client that the dosage was likely changed by the provider during chart
review.
• D) Instruct the client to take the medication as prepared and verify the dosage at the
next interdisciplinary healthcare team meeting.
Correct Answer: B) Withhold the medication until the dosage can be confirmed.
Rationale: Patient safety is paramount. When a client reports a discrepancy in their medication
regimen, the nurse must withhold the drug until the order can be verified against the provider's
official prescription. Administering a medication under a disputed dose violates safety protocols
and increases the risk of a sentinel medication error.
Question 2
The charge nurse is determining clinical assignments for one licensed practical nurse (LPN/PN)
and three registered nurses (RNs) who are managing a cohort of neurologically compromised
clients. Which client experiencing a change in status is most appropriate to assign to the LPN?
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• A) A client with a subdural hematoma whose blood pressure widened from 150/80
mmHg to 170/60 mmHg.
• B) A client with viral meningitis whose tympanic temperature changed from 101°F to
102°F ($38.3^\circ\text{C}$ to $38.9^\circ\text{C}$).
• C) A client with diabetic ketoacidosis whose Glasgow Coma Scale (GCS) score
deteriorated from 10 to 7.
• D) A client with myxedema coma whose baseline blood pressure dropped from 80/50
mmHg to 70/40 mmHg.
Correct Answer: B) Viral meningitis whose temperature changed from 101°F to 102°F.
Rationale: The scope of practice for an LPN/PN dictates assignment to stable clients with
predictable clinical paths. A slight temperature spike is an expected, predictable finding in a
client with an active viral infection (meningitis). Options A, C, and D exhibit acute,
lifethreatening neurological and hemodynamic shifts (e.g., signs of increased intracranial
pressure/Cushing's triad, severe CNS depression, and profound shock) that demand the
advanced assessment, critical thinking, and intervention skills of an RN.
Question 3
The nurse initiate the physical procedure to safely remove a client's peripherally inserted central
catheter (PICC) when a "Code Blue" is called for another client on the unit who collapsed in the
hallway while ambulating with an unlicensed assistive person (UAP). Which action should the
nurse take?
• A) Immediately close the client's room door and run into the hallway to lead the
resuscitation.
• B) Complete the PICC line removal procedure entirely before responding.
• C) Drop the catheter line, place a loose wrap, and immediately respond to the code
scene.
• D) Pause the extraction and call out loudly into the hallway for an assistant to take over.
Correct Answer: B) Finish the procedure.
Rationale: Once an invasive procedure like a PICC line removal has commenced, the nurse
cannot abandon the client. Stopping mid-procedure leaves the central venous architecture
vulnerable to catheter embolism, air embolism, and severe hemorrhage. The nurse must finish
the extraction and apply an occlusive dressing to ensure safety before responding to
emergencies elsewhere.
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Respiratory Care & Shock Management
Question 4
The nurse is caring for a client with pneumonia who begins to demonstrate initial signs of septic
shock and multi-organ dysfunction syndrome (MODS). The healthcare provider prescribes an
emergency sepsis protocol. Which intervention is most important for the nurse to prioritize
within the acute plan of care?
• A) Maintain strict, hourly monitoring of fluid intake and output (I&O).
• B) Maintain the head of the bed (HOB) elevated precisely at 45 degrees.
• C) Repeatedly assess the tactile warmth of the client's distal extremities.
• D) Monitor serial capillary blood glucose levels.
Correct Answer: A) Maintain strict intake and output.
Rationale: In septic shock, systemic hypoperfusion leads to microvascular failure and target
organ ischemia. End-organ perfusion is most accurately measured at the bedside via hourly
urine output. Maintaining strict, hyper-accurate I&O records allows the clinical team to evaluate
renal perfusion and guide aggressive crystalloid fluid resuscitation efforts.
Question 5
A 49-year-old male presents with flu-like symptoms, an active fever, and severe chest congestion
for four days. He arrives at the emergency department exhibiting worsening respiratory distress.
Which two orders must the nurse complete first? (Select exactly two options.)
• A) Obtain a deep sputum culture and sensitivity sample.
• B) Initiate supplemental oxygen therapy at 3 L/min via nasal cannula.
• C) Place the client immediately on a continuous cardio-respiratory monitor.
• D) Transport the client to radiology for a portable chest X-ray.
• E) Administer acetaminophen 350 mg PO every six hours for antipyretic control.
• F) Infuse 0.9% Normal Saline intravenously at a rate of 150 mL/hour.
• G) Establish a secondary large-bore peripheral IV access site.
• H) Maintain strict non-per-os (NPO) status.
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Correct Answer: B) Start oxygen 3 L per minute via nasal cannula AND C) Place the client on a
cardio-respiratory monitor
Rationale: Utilizing the ABC framework (Airway, Breathing, Circulation), the nurse's immediate
priority is to correct hypoxemia by starting supplemental oxygen (Breathing). Simultaneously,
the nurse must establish continuous cardio-respiratory monitoring (Circulation) to track heart
rate, rhythm, and oxygen saturation ($SpO_2$) trends to watch for impending respiratory
failure.
Question 6
To initiate the emergency oxygen order (3 L/min via nasal cannula) for the client described
above, which items must the nurse collect from the clinical supply room? (Select all that apply.)
• A) Humidifier bottle attachment
• B) Suction canister kit
• C) Sterile water vial
• D) Standard nasal cannula
• E) Oxygen flow meter wall attachment
• F) Lamb’s wool strap cushions
• G) Medical tape
Correct Answer: D) Nasal cannula and E) Flow meter
Rationale: To deliver oxygen at a low flow rate ($3\text{ L/min}$), only a standard nasal cannula
and a wall-mounted flow meter are mandatory. Humidification (options A and C) is typically
reserved for flow rates $\ge 4\text{ L/min}$ to prevent mucosal drying, or for long-term
delivery.
Question 7
The nurse should place a client experiencing respiratory distress into a ____________ position
to promote ____________.
• Answer: Semi-Fowler’s (or High-Fowler's), lung expansion
Rationale: Elevating the head of the bed to a Semi-Fowler’s ($30^\circ\text{ to }45^\circ$) or
High-Fowler's ($60^\circ\text{ to }90^\circ$) position drops the abdominal organs away from the
diaphragm via gravity. This maximizes thoracic capacity, optimizes lung expansion, and
decreases the overall work of breathing.
NGN HESI RN 2026 Exit Exam: HIGH-
STAKES EXIT EXAM: UPDATED
QUESTION POOL & VERIFIED KEYS ACE
THE FINAL: COMPLETE 3-VERSION TEST
BANK WITH 100% ACCURACY
When preparing to administer a prescribed medication to a homeless client at a community
psychiatric clinic, the client tells the nurse that their usual baseline dosage is completely
different from the dose the nurse is preparing to give. Which action should the nurse take?
• A) Inform the client that he maintains the legal right to refuse the medication and
document the refusal.
• B) Withhold the medication immediately until the dosage can be verified and confirmed
with the prescriber.
• C) Explain to the client that the dosage was likely changed by the provider during chart
review.
• D) Instruct the client to take the medication as prepared and verify the dosage at the
next interdisciplinary healthcare team meeting.
Correct Answer: B) Withhold the medication until the dosage can be confirmed.
Rationale: Patient safety is paramount. When a client reports a discrepancy in their medication
regimen, the nurse must withhold the drug until the order can be verified against the provider's
official prescription. Administering a medication under a disputed dose violates safety protocols
and increases the risk of a sentinel medication error.
Question 2
The charge nurse is determining clinical assignments for one licensed practical nurse (LPN/PN)
and three registered nurses (RNs) who are managing a cohort of neurologically compromised
clients. Which client experiencing a change in status is most appropriate to assign to the LPN?
,vuy
• A) A client with a subdural hematoma whose blood pressure widened from 150/80
mmHg to 170/60 mmHg.
• B) A client with viral meningitis whose tympanic temperature changed from 101°F to
102°F ($38.3^\circ\text{C}$ to $38.9^\circ\text{C}$).
• C) A client with diabetic ketoacidosis whose Glasgow Coma Scale (GCS) score
deteriorated from 10 to 7.
• D) A client with myxedema coma whose baseline blood pressure dropped from 80/50
mmHg to 70/40 mmHg.
Correct Answer: B) Viral meningitis whose temperature changed from 101°F to 102°F.
Rationale: The scope of practice for an LPN/PN dictates assignment to stable clients with
predictable clinical paths. A slight temperature spike is an expected, predictable finding in a
client with an active viral infection (meningitis). Options A, C, and D exhibit acute,
lifethreatening neurological and hemodynamic shifts (e.g., signs of increased intracranial
pressure/Cushing's triad, severe CNS depression, and profound shock) that demand the
advanced assessment, critical thinking, and intervention skills of an RN.
Question 3
The nurse initiate the physical procedure to safely remove a client's peripherally inserted central
catheter (PICC) when a "Code Blue" is called for another client on the unit who collapsed in the
hallway while ambulating with an unlicensed assistive person (UAP). Which action should the
nurse take?
• A) Immediately close the client's room door and run into the hallway to lead the
resuscitation.
• B) Complete the PICC line removal procedure entirely before responding.
• C) Drop the catheter line, place a loose wrap, and immediately respond to the code
scene.
• D) Pause the extraction and call out loudly into the hallway for an assistant to take over.
Correct Answer: B) Finish the procedure.
Rationale: Once an invasive procedure like a PICC line removal has commenced, the nurse
cannot abandon the client. Stopping mid-procedure leaves the central venous architecture
vulnerable to catheter embolism, air embolism, and severe hemorrhage. The nurse must finish
the extraction and apply an occlusive dressing to ensure safety before responding to
emergencies elsewhere.
,vuy
Respiratory Care & Shock Management
Question 4
The nurse is caring for a client with pneumonia who begins to demonstrate initial signs of septic
shock and multi-organ dysfunction syndrome (MODS). The healthcare provider prescribes an
emergency sepsis protocol. Which intervention is most important for the nurse to prioritize
within the acute plan of care?
• A) Maintain strict, hourly monitoring of fluid intake and output (I&O).
• B) Maintain the head of the bed (HOB) elevated precisely at 45 degrees.
• C) Repeatedly assess the tactile warmth of the client's distal extremities.
• D) Monitor serial capillary blood glucose levels.
Correct Answer: A) Maintain strict intake and output.
Rationale: In septic shock, systemic hypoperfusion leads to microvascular failure and target
organ ischemia. End-organ perfusion is most accurately measured at the bedside via hourly
urine output. Maintaining strict, hyper-accurate I&O records allows the clinical team to evaluate
renal perfusion and guide aggressive crystalloid fluid resuscitation efforts.
Question 5
A 49-year-old male presents with flu-like symptoms, an active fever, and severe chest congestion
for four days. He arrives at the emergency department exhibiting worsening respiratory distress.
Which two orders must the nurse complete first? (Select exactly two options.)
• A) Obtain a deep sputum culture and sensitivity sample.
• B) Initiate supplemental oxygen therapy at 3 L/min via nasal cannula.
• C) Place the client immediately on a continuous cardio-respiratory monitor.
• D) Transport the client to radiology for a portable chest X-ray.
• E) Administer acetaminophen 350 mg PO every six hours for antipyretic control.
• F) Infuse 0.9% Normal Saline intravenously at a rate of 150 mL/hour.
• G) Establish a secondary large-bore peripheral IV access site.
• H) Maintain strict non-per-os (NPO) status.
, vuy
Correct Answer: B) Start oxygen 3 L per minute via nasal cannula AND C) Place the client on a
cardio-respiratory monitor
Rationale: Utilizing the ABC framework (Airway, Breathing, Circulation), the nurse's immediate
priority is to correct hypoxemia by starting supplemental oxygen (Breathing). Simultaneously,
the nurse must establish continuous cardio-respiratory monitoring (Circulation) to track heart
rate, rhythm, and oxygen saturation ($SpO_2$) trends to watch for impending respiratory
failure.
Question 6
To initiate the emergency oxygen order (3 L/min via nasal cannula) for the client described
above, which items must the nurse collect from the clinical supply room? (Select all that apply.)
• A) Humidifier bottle attachment
• B) Suction canister kit
• C) Sterile water vial
• D) Standard nasal cannula
• E) Oxygen flow meter wall attachment
• F) Lamb’s wool strap cushions
• G) Medical tape
Correct Answer: D) Nasal cannula and E) Flow meter
Rationale: To deliver oxygen at a low flow rate ($3\text{ L/min}$), only a standard nasal cannula
and a wall-mounted flow meter are mandatory. Humidification (options A and C) is typically
reserved for flow rates $\ge 4\text{ L/min}$ to prevent mucosal drying, or for long-term
delivery.
Question 7
The nurse should place a client experiencing respiratory distress into a ____________ position
to promote ____________.
• Answer: Semi-Fowler’s (or High-Fowler's), lung expansion
Rationale: Elevating the head of the bed to a Semi-Fowler’s ($30^\circ\text{ to }45^\circ$) or
High-Fowler's ($60^\circ\text{ to }90^\circ$) position drops the abdominal organs away from the
diaphragm via gravity. This maximizes thoracic capacity, optimizes lung expansion, and
decreases the overall work of breathing.
