Version 2 – 2025 HESI RN EXIT EXAM V4 (NGN
Integrated, 160 Questions) Latest Actual Exam |
Verified Questions and Correct Answers | Updated
NGN Edition | Graded A+
SECTION 1: MEDICAL-SURGICAL NURSING & PRIORITIZATION
Question 1
The nurse receives shift report on 4 clients. Which client should be assessed first?
A) Client with heart failure, crackles in mid-lung fields
B) Client with diabetes mellitus, blood glucose 180 mg/dL
C) Client with tracheostomy, oxygen saturation 86%
D) Client with appendicitis, temperature 100.4°F (38°C)
Correct Answer: C
Rationale: An oxygen saturation of 86% indicates severe hypoxemia, making
airway and breathing the priority. Crackles are expected in heart failure, glucose
180 is elevated but not critical, and low-grade fever is expected with appendicitis .
Question 2
A client with COPD has oxygen set at 6 L/min via nasal cannula. Which action
should the nurse take?
A) Keep oxygen as ordered
B) Lower oxygen to 2 L/min
C) Switch to nonrebreather mask
D) Encourage coughing and deep breathing
Correct Answer: B
,Rationale: High-flow oxygen can suppress the respiratory drive in COPD clients
who are chronic CO₂ retainers. Maintain oxygen at ≤2–3 L/min via nasal cannula .
Question 3
The nurse cares for a postoperative client with an abdominal incision. Which
assessment requires immediate attention?
A) Serosanguineous drainage
B) Separation of wound edges
C) Pink incision line
D) Mild tenderness
Correct Answer: B
Rationale: Wound edge separation (dehiscence) requires immediate action—cover
with sterile saline dressing and notify the provider. Serosanguineous drainage and
pink incision lines are normal findings .
Question 4
A client with burns covering 35% of total body surface area is anxious and reports
severe pain. What is the best nursing action?
A) Administer IV opioids
B) Provide oral pain medication
C) Encourage deep breathing
D) Reposition for comfort
Correct Answer: A
Rationale: IV opioids provide rapid and reliable pain relief for burn clients. Oral
medications are contraindicated due to GI absorption concerns, and repositioning
alone is insufficient for severe burn pain .
,Question 5
After receiving report on an inpatient acute care unit, which client should the
nurse assess first?
A) The client with obstruction of the large intestine experiencing abdominal
distention
B) The client who had surgery yesterday and is experiencing a paralytic ileus with
absent bowel sounds
C) The client with a small bowel obstruction who has an NG tube draining greenish
fluid
D) The client with a bowel obstruction due to a volvulus who is experiencing
abdominal rigidity
Correct Answer: D
Rationale: Abdominal rigidity with bowel obstruction (especially from volvulus)
may indicate strangulation or perforation—both emergencies. Distention, NG
drainage, or absent bowel sounds are serious but do not necessarily indicate the
same risk of ischemia or peritonitis .
Question 6
A client with acute pancreatitis is admitted with severe, piercing abdominal pain
and an elevated serum amylase. Which additional information is the client most
likely to report?
A) Abdominal pain decreases when lying supine
B) Pain lasts an hour and leaves the abdomen tender
C) Right upper quadrant pain refers to right scapula
D) Drinks alcohol until intoxicated at least twice weekly
Correct Answer: A
Rationale: Clients with acute pancreatitis often find pain worsens when lying flat
and improves by sitting up and leaning forward. While alcohol abuse is a major
, contributor, the immediate distinguishing factor is the positional nature of the
pain .
Question 7
A teenager presents to the emergency department with palpitations after vaping
at a party. The client is anxious, fearful, and hyperventilating. The nurse
anticipates the client developing which acid-base imbalance?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Metabolic acidosis
D) Respiratory alkalosis
Correct Answer: D
Rationale: Hyperventilation leads to excessive CO₂ exhalation, raising blood pH
and causing respiratory alkalosis. Palpitations and anxiety are common with
stimulant use (nicotine) .
Question 8
A client with dyspnea is being admitted to the medical unit. To best prepare for
the client's arrival, the nurse should ensure the client's bed is in which position?
A) Supine
B) Supine; feet elevated higher than head
C) Supine; head elevated higher than feet
D) Fowler's
Correct Answer: D
Rationale: Maintaining High Fowler's or semi-Fowler's position maximizes chest
expansion and facilitates easier breathing. Supine or Trendelenburg (feet higher
than head) worsens dyspnea .
Integrated, 160 Questions) Latest Actual Exam |
Verified Questions and Correct Answers | Updated
NGN Edition | Graded A+
SECTION 1: MEDICAL-SURGICAL NURSING & PRIORITIZATION
Question 1
The nurse receives shift report on 4 clients. Which client should be assessed first?
A) Client with heart failure, crackles in mid-lung fields
B) Client with diabetes mellitus, blood glucose 180 mg/dL
C) Client with tracheostomy, oxygen saturation 86%
D) Client with appendicitis, temperature 100.4°F (38°C)
Correct Answer: C
Rationale: An oxygen saturation of 86% indicates severe hypoxemia, making
airway and breathing the priority. Crackles are expected in heart failure, glucose
180 is elevated but not critical, and low-grade fever is expected with appendicitis .
Question 2
A client with COPD has oxygen set at 6 L/min via nasal cannula. Which action
should the nurse take?
A) Keep oxygen as ordered
B) Lower oxygen to 2 L/min
C) Switch to nonrebreather mask
D) Encourage coughing and deep breathing
Correct Answer: B
,Rationale: High-flow oxygen can suppress the respiratory drive in COPD clients
who are chronic CO₂ retainers. Maintain oxygen at ≤2–3 L/min via nasal cannula .
Question 3
The nurse cares for a postoperative client with an abdominal incision. Which
assessment requires immediate attention?
A) Serosanguineous drainage
B) Separation of wound edges
C) Pink incision line
D) Mild tenderness
Correct Answer: B
Rationale: Wound edge separation (dehiscence) requires immediate action—cover
with sterile saline dressing and notify the provider. Serosanguineous drainage and
pink incision lines are normal findings .
Question 4
A client with burns covering 35% of total body surface area is anxious and reports
severe pain. What is the best nursing action?
A) Administer IV opioids
B) Provide oral pain medication
C) Encourage deep breathing
D) Reposition for comfort
Correct Answer: A
Rationale: IV opioids provide rapid and reliable pain relief for burn clients. Oral
medications are contraindicated due to GI absorption concerns, and repositioning
alone is insufficient for severe burn pain .
,Question 5
After receiving report on an inpatient acute care unit, which client should the
nurse assess first?
A) The client with obstruction of the large intestine experiencing abdominal
distention
B) The client who had surgery yesterday and is experiencing a paralytic ileus with
absent bowel sounds
C) The client with a small bowel obstruction who has an NG tube draining greenish
fluid
D) The client with a bowel obstruction due to a volvulus who is experiencing
abdominal rigidity
Correct Answer: D
Rationale: Abdominal rigidity with bowel obstruction (especially from volvulus)
may indicate strangulation or perforation—both emergencies. Distention, NG
drainage, or absent bowel sounds are serious but do not necessarily indicate the
same risk of ischemia or peritonitis .
Question 6
A client with acute pancreatitis is admitted with severe, piercing abdominal pain
and an elevated serum amylase. Which additional information is the client most
likely to report?
A) Abdominal pain decreases when lying supine
B) Pain lasts an hour and leaves the abdomen tender
C) Right upper quadrant pain refers to right scapula
D) Drinks alcohol until intoxicated at least twice weekly
Correct Answer: A
Rationale: Clients with acute pancreatitis often find pain worsens when lying flat
and improves by sitting up and leaning forward. While alcohol abuse is a major
, contributor, the immediate distinguishing factor is the positional nature of the
pain .
Question 7
A teenager presents to the emergency department with palpitations after vaping
at a party. The client is anxious, fearful, and hyperventilating. The nurse
anticipates the client developing which acid-base imbalance?
A) Respiratory acidosis
B) Metabolic alkalosis
C) Metabolic acidosis
D) Respiratory alkalosis
Correct Answer: D
Rationale: Hyperventilation leads to excessive CO₂ exhalation, raising blood pH
and causing respiratory alkalosis. Palpitations and anxiety are common with
stimulant use (nicotine) .
Question 8
A client with dyspnea is being admitted to the medical unit. To best prepare for
the client's arrival, the nurse should ensure the client's bed is in which position?
A) Supine
B) Supine; feet elevated higher than head
C) Supine; head elevated higher than feet
D) Fowler's
Correct Answer: D
Rationale: Maintaining High Fowler's or semi-Fowler's position maximizes chest
expansion and facilitates easier breathing. Supine or Trendelenburg (feet higher
than head) worsens dyspnea .
