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2026 HESI RN
EXIT EXAM
NGN PRACTICE QUESTIONS
(ORIGINAL NGN-STYLE QUESTIONS & CASE SCENARIOS)
Pass Your Exit Exam with Confidence
WHAT YOU WILL GET:
• Hundreds of Original NGN-Style Practice Questions
• Detailed Rationales for Every Correct Answer
• Full-Length Case Studies, Bow-Tie & Matrix Items
• High-Yield Review Points for Every Content Area
• Test-Taking Strategies for the Next Generation Format
Not affiliated with HESI, ATI or NCLEX. Original practice material for study purposes only.
, 2026 HESI RN Exit Exam
NGN Practice Edition · Original Study Material
This practice guide was created as an original study resource for nursing students preparing for
their exit examinations and the NCLEX-RN. It contains original questions written in the Next
Generation NCLEX (NGN) format, including case studies, bow-tie items, matrix/grid items, cloze
(drop-down) items, highlight items, and ordered-response items, along with multiple-choice and
select-all-that-apply questions.
The questions are organized by content area. Each question is followed immediately by the
correct answer and a rationale that explains why the answer is correct and why the other
options are not. Use the rationales as your primary learning tool: they reinforce the underlying
nursing concepts far more than the question itself.
Suggested study plan: complete one section per sitting, score yourself, then re-read every
rationale regardless of whether you answered correctly. Return to any section where you scored
below 80% after reviewing the high-yield points.
Important notice: This document is original practice material and is not affiliated with,
endorsed by, or sponsored by HESI, Elsevier, ATI, or the National Council of State Boards of
Nursing (NCSBN). It does not contain actual exam questions. It is intended for study purposes
only.
2026 HESI RN Exit Exam - NGN Practice Edition 2
,Table of Contents
How to Use This Practice Guide
High-Yield Test-Taking Strategies
Section 1: Fundamentals of Nursing (20 questions)
Section 2: Medical-Surgical Nursing (26 questions)
Section 3: Pharmacology (50 questions)
Section 4: Maternal-Newborn Nursing (50 questions)
Section 5: Pediatric Nursing (50 questions)
Section 6: Psychiatric-Mental Health Nursing (50 questions)
Section 7: Leadership, Delegation & Prioritization (50 questions)
Section 8: Community Health & Safety (50 questions)
Section 9: NGN Case Studies & Alternate Item Types (55 questions)
2026 HESI RN Exit Exam - NGN Practice Edition 3
, High-Yield Test-Taking Strategies
Master the NGN item formats before you begin
• Case studies: read the entire scenario before answering the first question.
Information in later questions often clarifies earlier ones, and each sub-question is
scored independently.
• Bow-tie items: you must place at least one answer in each of the three columns
(actions to take, parameters to monitor, potential conditions). Leave nothing blank;
partial credit is possible.
• Matrix/grid items: evaluate every cell independently. Each row-column combination
is scored on its own.
• Cloze (drop-down) items: read the full sentence before choosing. The correct phrase
must make the entire sentence clinically accurate, not just grammatically correct.
• Highlight items: select all findings that require follow-up. If a finding is normal for the
client's situation, do not select it.
• Ordered response: think about the sequence of events or the order of priority, not
just what is correct.
Prioritization and delegation heuristics
• Airway, breathing, circulation (ABC) always comes first, then safety, then comfort and
teaching.
• When asked what to do first, choose the option that is an assessment over an
intervention, unless the situation is a crisis requiring immediate action.
• Acute over chronic: a sudden change in an unstable client outranks a stable client with
a chronic problem.
• Delegate to the UAP only tasks that are routine, predictable, and do not require nursing
judgment (vital signs on stable clients, hygiene, ambulation, feeding, specimen
collection, I&O).
• Only the RN may assess, teach, initiate blood products, give IV push medications, and
perform the first dose of any medication.
Reading the question
• Identify the client first: age, diagnosis, and current status change the correct answer.
• Identify the stem's key words: "first," "best," "priority," "most important," "further
teaching needed," "expected," and "unexpected" all change what is being asked.
2026 HESI RN Exit Exam - NGN Practice Edition 4
2026 HESI RN
EXIT EXAM
NGN PRACTICE QUESTIONS
(ORIGINAL NGN-STYLE QUESTIONS & CASE SCENARIOS)
Pass Your Exit Exam with Confidence
WHAT YOU WILL GET:
• Hundreds of Original NGN-Style Practice Questions
• Detailed Rationales for Every Correct Answer
• Full-Length Case Studies, Bow-Tie & Matrix Items
• High-Yield Review Points for Every Content Area
• Test-Taking Strategies for the Next Generation Format
Not affiliated with HESI, ATI or NCLEX. Original practice material for study purposes only.
, 2026 HESI RN Exit Exam
NGN Practice Edition · Original Study Material
This practice guide was created as an original study resource for nursing students preparing for
their exit examinations and the NCLEX-RN. It contains original questions written in the Next
Generation NCLEX (NGN) format, including case studies, bow-tie items, matrix/grid items, cloze
(drop-down) items, highlight items, and ordered-response items, along with multiple-choice and
select-all-that-apply questions.
The questions are organized by content area. Each question is followed immediately by the
correct answer and a rationale that explains why the answer is correct and why the other
options are not. Use the rationales as your primary learning tool: they reinforce the underlying
nursing concepts far more than the question itself.
Suggested study plan: complete one section per sitting, score yourself, then re-read every
rationale regardless of whether you answered correctly. Return to any section where you scored
below 80% after reviewing the high-yield points.
Important notice: This document is original practice material and is not affiliated with,
endorsed by, or sponsored by HESI, Elsevier, ATI, or the National Council of State Boards of
Nursing (NCSBN). It does not contain actual exam questions. It is intended for study purposes
only.
2026 HESI RN Exit Exam - NGN Practice Edition 2
,Table of Contents
How to Use This Practice Guide
High-Yield Test-Taking Strategies
Section 1: Fundamentals of Nursing (20 questions)
Section 2: Medical-Surgical Nursing (26 questions)
Section 3: Pharmacology (50 questions)
Section 4: Maternal-Newborn Nursing (50 questions)
Section 5: Pediatric Nursing (50 questions)
Section 6: Psychiatric-Mental Health Nursing (50 questions)
Section 7: Leadership, Delegation & Prioritization (50 questions)
Section 8: Community Health & Safety (50 questions)
Section 9: NGN Case Studies & Alternate Item Types (55 questions)
2026 HESI RN Exit Exam - NGN Practice Edition 3
, High-Yield Test-Taking Strategies
Master the NGN item formats before you begin
• Case studies: read the entire scenario before answering the first question.
Information in later questions often clarifies earlier ones, and each sub-question is
scored independently.
• Bow-tie items: you must place at least one answer in each of the three columns
(actions to take, parameters to monitor, potential conditions). Leave nothing blank;
partial credit is possible.
• Matrix/grid items: evaluate every cell independently. Each row-column combination
is scored on its own.
• Cloze (drop-down) items: read the full sentence before choosing. The correct phrase
must make the entire sentence clinically accurate, not just grammatically correct.
• Highlight items: select all findings that require follow-up. If a finding is normal for the
client's situation, do not select it.
• Ordered response: think about the sequence of events or the order of priority, not
just what is correct.
Prioritization and delegation heuristics
• Airway, breathing, circulation (ABC) always comes first, then safety, then comfort and
teaching.
• When asked what to do first, choose the option that is an assessment over an
intervention, unless the situation is a crisis requiring immediate action.
• Acute over chronic: a sudden change in an unstable client outranks a stable client with
a chronic problem.
• Delegate to the UAP only tasks that are routine, predictable, and do not require nursing
judgment (vital signs on stable clients, hygiene, ambulation, feeding, specimen
collection, I&O).
• Only the RN may assess, teach, initiate blood products, give IV push medications, and
perform the first dose of any medication.
Reading the question
• Identify the client first: age, diagnosis, and current status change the correct answer.
• Identify the stem's key words: "first," "best," "priority," "most important," "further
teaching needed," "expected," and "unexpected" all change what is being asked.
2026 HESI RN Exit Exam - NGN Practice Edition 4
