2026 HESI RN Exit Exam | NGN Nursing
Questions Complete Practice Exam with
150 Questions and Detailed Rationales
SECTION 1: MEDICAL-SURGICAL NURSING
Question 1
A client with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia is a significant side effect that can lead to
cardiac arrhythmias, especially in clients with heart failure who may
also be taking digoxin. Hypokalemia potentiates digoxin toxicity. While
sodium, calcium, and magnesium levels can also be affected,
potassium monitoring is the priority due to the immediate risk of
life-threatening arrhythmias.
,Question 2
A client with angina pectoris is prescribed nitroglycerin sublingually.
Which instruction should the nurse include in the teaching?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Swallow the tablet with a full glass of water."
C) "Place the tablet under the tongue and allow it to dissolve."
D) "Chew the tablet for faster absorption."
Correct Answer: C) "Place the tablet under the tongue and allow it to
dissolve."
Rationale: Nitroglycerin sublingual tablets should be placed under the
tongue and allowed to dissolve completely. This route provides rapid
absorption through the sublingual mucosa. Clients should take one
tablet at the onset of chest pain and may take up to 3 tablets, 5
minutes apart. If pain persists after 3 tablets, they should seek
emergency medical care. The tablets should never be swallowed or
chewed.
Question 3
A client is admitted with acute decompensated heart failure. Which
finding indicates that treatment is effective?
A) Weight gain of 2 pounds in 24 hours
B) Decreased dyspnea and clear lung sounds
C) Increased jugular venous distension
D) Decreased urine output
,Correct Answer: B) Decreased dyspnea and clear lung sounds
Rationale: Effective treatment of heart failure should result in
decreased pulmonary congestion, evidenced by decreased dyspnea,
clear lung sounds, and resolution of crackles. Weight loss (not gain)
would indicate improvement. Jugular venous distension should
decrease, and urine output should increase as fluid is mobilized.
Weight gain, increased JVD, and decreased urine output indicate
worsening heart failure.
Question 4
Which medication is most commonly prescribed for a client with atrial
fibrillation to prevent stroke?
A) Aspirin
B) Clopidogrel
C) Warfarin
D) Heparin
Correct Answer: C) Warfarin
Rationale: Warfarin is an anticoagulant that is commonly prescribed
for clients with atrial fibrillation to prevent stroke. It works by inhibiting
vitamin K-dependent clotting factors. Aspirin and clopidogrel are
antiplatelet agents and are generally less effective for stroke
prevention in atrial fibrillation. Heparin is used for acute
anticoagulation but is not appropriate for long-term prophylaxis. The
choice of anticoagulation depends on the client's CHA₂DS₂-VASc
score.
, Question 5
A client with a history of myocardial infarction is prescribed a
beta-blocker. What is the primary purpose of this medication?
A) To decrease heart rate and myocardial oxygen demand
B) To increase cardiac output
C) To promote vasodilation
D) To increase blood pressure
Correct Answer: A) To decrease heart rate and myocardial oxygen
demand
Rationale: Beta-blockers reduce myocardial oxygen demand by
decreasing heart rate, contractility, and blood pressure. This is
particularly important post-MI to prevent further ischemic events.
They do not increase cardiac output, vasodilate, or increase blood
pressure. The reduction in oxygen demand helps protect the
myocardium and improve survival after MI.
Question 6
A nurse is auscultating heart sounds and hears an S3 gallop. This
finding is most commonly associated with:
A) Heart failure
B) Aortic stenosis
C) Mitral valve prolapse
D) Pericarditis
Correct Answer: A) Heart failure
Questions Complete Practice Exam with
150 Questions and Detailed Rationales
SECTION 1: MEDICAL-SURGICAL NURSING
Question 1
A client with heart failure is prescribed furosemide. Which laboratory
value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide is a loop diuretic that causes potassium
wasting. Hypokalemia is a significant side effect that can lead to
cardiac arrhythmias, especially in clients with heart failure who may
also be taking digoxin. Hypokalemia potentiates digoxin toxicity. While
sodium, calcium, and magnesium levels can also be affected,
potassium monitoring is the priority due to the immediate risk of
life-threatening arrhythmias.
,Question 2
A client with angina pectoris is prescribed nitroglycerin sublingually.
Which instruction should the nurse include in the teaching?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Swallow the tablet with a full glass of water."
C) "Place the tablet under the tongue and allow it to dissolve."
D) "Chew the tablet for faster absorption."
Correct Answer: C) "Place the tablet under the tongue and allow it to
dissolve."
Rationale: Nitroglycerin sublingual tablets should be placed under the
tongue and allowed to dissolve completely. This route provides rapid
absorption through the sublingual mucosa. Clients should take one
tablet at the onset of chest pain and may take up to 3 tablets, 5
minutes apart. If pain persists after 3 tablets, they should seek
emergency medical care. The tablets should never be swallowed or
chewed.
Question 3
A client is admitted with acute decompensated heart failure. Which
finding indicates that treatment is effective?
A) Weight gain of 2 pounds in 24 hours
B) Decreased dyspnea and clear lung sounds
C) Increased jugular venous distension
D) Decreased urine output
,Correct Answer: B) Decreased dyspnea and clear lung sounds
Rationale: Effective treatment of heart failure should result in
decreased pulmonary congestion, evidenced by decreased dyspnea,
clear lung sounds, and resolution of crackles. Weight loss (not gain)
would indicate improvement. Jugular venous distension should
decrease, and urine output should increase as fluid is mobilized.
Weight gain, increased JVD, and decreased urine output indicate
worsening heart failure.
Question 4
Which medication is most commonly prescribed for a client with atrial
fibrillation to prevent stroke?
A) Aspirin
B) Clopidogrel
C) Warfarin
D) Heparin
Correct Answer: C) Warfarin
Rationale: Warfarin is an anticoagulant that is commonly prescribed
for clients with atrial fibrillation to prevent stroke. It works by inhibiting
vitamin K-dependent clotting factors. Aspirin and clopidogrel are
antiplatelet agents and are generally less effective for stroke
prevention in atrial fibrillation. Heparin is used for acute
anticoagulation but is not appropriate for long-term prophylaxis. The
choice of anticoagulation depends on the client's CHA₂DS₂-VASc
score.
, Question 5
A client with a history of myocardial infarction is prescribed a
beta-blocker. What is the primary purpose of this medication?
A) To decrease heart rate and myocardial oxygen demand
B) To increase cardiac output
C) To promote vasodilation
D) To increase blood pressure
Correct Answer: A) To decrease heart rate and myocardial oxygen
demand
Rationale: Beta-blockers reduce myocardial oxygen demand by
decreasing heart rate, contractility, and blood pressure. This is
particularly important post-MI to prevent further ischemic events.
They do not increase cardiac output, vasodilate, or increase blood
pressure. The reduction in oxygen demand helps protect the
myocardium and improve survival after MI.
Question 6
A nurse is auscultating heart sounds and hears an S3 gallop. This
finding is most commonly associated with:
A) Heart failure
B) Aortic stenosis
C) Mitral valve prolapse
D) Pericarditis
Correct Answer: A) Heart failure
