HESI RN Exit Exam NGN Version B 2026 Complete Next
Generation NCLEX Questions and Answers with Expert
Rationales - 140 Questions with Answers
Page 1
,Q1. A client with septic shock is receiving norepinephrine and has a mean arterial
pressure (MAP) of 55 mm Hg despite escalating doses. Which action demonstrates the
most appropriate next step in management?
A. Add a second vasopressor such as vasopressin
B. Increase norepinephrine to a maximum of 30 mcg/min
C. Switch to phenylephrine to avoid arrhythmias
D. Administer a fluid bolus of 500 mL normal saline
Correct Answer: A. Add a second vasopressor such as vasopressin
Rationale: In septic shock, when norepinephrine fails to achieve MAP "e65 mm Hg, adding
vasopressin is recommended as second-line therapy due to its synergistic effect and
catecholamine-sparing benefit. Further increasing norepinephrine beyond moderate doses
is less effective and increases adverse effects. Phenylephrine is not preferred unless
norepinephrine is contraindicated. Fluid resuscitation is important but is not the primary
next step if the client is already on vasopressors and MAP remains low.
Why Wrong:
B - Maximizing norepinephrine alone is not optimal; adding a second agent is
preferred.
C - Phenylephrine is less effective than norepinephrine and is reserved for specific
cases.
D - Fluid bolus may be considered, but the immediate priority is to add a second
vasopressor to achieve MAP.
Reference: Marino, P. (2026). The ICU Book, 5th Ed., Ch. 14
Q2. In a patient with acute decompensated heart failure and pulmonary edema,
which finding indicates that continuous positive airway pressure (CPAP) is most
likely to improve outcomes?
A. Systolic blood pressure of 90 mm Hg
B. Arterial pH of 7.28 with PaCO2 of 55 mm Hg
C. Respiratory rate of 24 breaths/min
D. Jugular venous distention with peripheral edema
Correct Answer: B. Arterial pH of 7.28 with PaCO2 of 55 mm Hg
Rationale: CPAP is indicated for acute cardiogenic pulmonary edema with respiratory
acidosis (elevated PaCO2) because it improves ventilation and reduces preload/afterload.
Hypotension (SBP <90 mm Hg) is a relative contraindication to CPAP. Mild tachypnea
and JVD are common but do not specifically indicate the need for CPAP.
Why Wrong:
A - Hypotension is a relative contraindication to CPAP.
C - Mild tachypnea does not necessarily indicate respiratory failure requiring CPAP.
D - JVD and edema are signs of heart failure but not specific indications for CPAP.
Page 2
,Reference: American Heart Association. (2026). Heart Failure Guidelines, Section 4.2
Q3. A nurse is using the Situation, Background, Assessment, Recommendation
(SBAR) framework to communicate with a provider about a deteriorating client.
Which component is correctly aligned with the 'Recommendation' element?
A. The client's blood pressure dropped from 120/80 to 90/60 over the last hour.
B. The client is a 72-year-old male with a history of hypertension.
C. I suggest you come to evaluate the client and consider an arterial blood gas.
D. The client's urine output has been less than 30 mL/hr for 2 hours.
Correct Answer: C. I suggest you come to evaluate the client and consider an arterial
blood gas.
Rationale: SBAR: Situation (what is happening now), Background (relevant history),
Assessment (what you think is going on), Recommendation (what you want done). Option
C clearly states a suggestion for action. Option A is Assessment, B is Background, D is
Assessment (or Situation) - all are not recommendations.
Why Wrong:
A - This is assessment data, not a recommendation.
B - This is background information.
D - This is assessment data, not a recommendation.
Reference: Institute for Healthcare Improvement. (2026). SBAR Toolkit
Q4. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 65 mm Hg, HCO3- 32
mEq/L. What is the client's acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Chronic respiratory acidosis with metabolic compensation
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3- is elevated
(metabolic compensation). In chronic respiratory acidosis, the kidneys retain bicarbonate
to compensate; the HCO3- is typically elevated by 4 mEq/L for each 10 mm Hg increase in
PaCO2. Here, the expected HCO3- would be about 30-32, matching the given value,
indicating compensation rather than acute acidosis.
Why Wrong:
A - Acute respiratory acidosis would not have such a high HCO3-.
C - The primary disorder is respiratory acidosis, not metabolic alkalosis.
D - There is no evidence of a mixed disorder; the elevated HCO3- is compensatory.
Page 3
, Reference: Porth, C. (2026). Pathophysiology, 10th Ed., Ch. 5
Q5. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 65 mm Hg, HCO3- 32
mEq/L. What is the client's acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Chronic respiratory acidosis with metabolic compensation
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3- is elevated
(metabolic compensation). In chronic respiratory acidosis, the kidneys retain bicarbonate
to compensate; the HCO3- is typically elevated by 4 mEq/L for each 10 mm Hg increase in
PaCO2. Here, the expected HCO3- would be about 30-32, matching the given value,
indicating compensation rather than acute acidosis.
Why Wrong:
A - Acute respiratory acidosis would not have such a high HCO3-.
C - The primary disorder is respiratory acidosis, not metabolic alkalosis.
D - There is no evidence of a mixed disorder; the elevated HCO3- is compensatory.
Reference: Porth, C. (2026). Pathophysiology, 10th Ed., Ch. 5
Q6. A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water-seal chamber
B. Constant bubbling in the water-seal chamber
C. Drainage of 50 mL in the first hour
D. Fluctuation of the water level with respirations
Correct Answer: B. Constant bubbling in the water-seal chamber
Rationale: Constant bubbling in the water-seal chamber indicates an air leak in the
system (e.g., loose connections or a leak in the tubing), which requires immediate
assessment and intervention. Intermittent bubbling is normal when the client exhales,
indicating air removal. Fluctuation is expected until lung re-expansion. Drainage of 50
mL in the first hour is acceptable.
Why Wrong:
A - Intermittent bubbling is normal.
C - 50 mL in the first hour is not excessive.
D - Fluctuation is expected and indicates the system is patent.
Reference: Ignatavicius, D. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 22
Page 4
Generation NCLEX Questions and Answers with Expert
Rationales - 140 Questions with Answers
Page 1
,Q1. A client with septic shock is receiving norepinephrine and has a mean arterial
pressure (MAP) of 55 mm Hg despite escalating doses. Which action demonstrates the
most appropriate next step in management?
A. Add a second vasopressor such as vasopressin
B. Increase norepinephrine to a maximum of 30 mcg/min
C. Switch to phenylephrine to avoid arrhythmias
D. Administer a fluid bolus of 500 mL normal saline
Correct Answer: A. Add a second vasopressor such as vasopressin
Rationale: In septic shock, when norepinephrine fails to achieve MAP "e65 mm Hg, adding
vasopressin is recommended as second-line therapy due to its synergistic effect and
catecholamine-sparing benefit. Further increasing norepinephrine beyond moderate doses
is less effective and increases adverse effects. Phenylephrine is not preferred unless
norepinephrine is contraindicated. Fluid resuscitation is important but is not the primary
next step if the client is already on vasopressors and MAP remains low.
Why Wrong:
B - Maximizing norepinephrine alone is not optimal; adding a second agent is
preferred.
C - Phenylephrine is less effective than norepinephrine and is reserved for specific
cases.
D - Fluid bolus may be considered, but the immediate priority is to add a second
vasopressor to achieve MAP.
Reference: Marino, P. (2026). The ICU Book, 5th Ed., Ch. 14
Q2. In a patient with acute decompensated heart failure and pulmonary edema,
which finding indicates that continuous positive airway pressure (CPAP) is most
likely to improve outcomes?
A. Systolic blood pressure of 90 mm Hg
B. Arterial pH of 7.28 with PaCO2 of 55 mm Hg
C. Respiratory rate of 24 breaths/min
D. Jugular venous distention with peripheral edema
Correct Answer: B. Arterial pH of 7.28 with PaCO2 of 55 mm Hg
Rationale: CPAP is indicated for acute cardiogenic pulmonary edema with respiratory
acidosis (elevated PaCO2) because it improves ventilation and reduces preload/afterload.
Hypotension (SBP <90 mm Hg) is a relative contraindication to CPAP. Mild tachypnea
and JVD are common but do not specifically indicate the need for CPAP.
Why Wrong:
A - Hypotension is a relative contraindication to CPAP.
C - Mild tachypnea does not necessarily indicate respiratory failure requiring CPAP.
D - JVD and edema are signs of heart failure but not specific indications for CPAP.
Page 2
,Reference: American Heart Association. (2026). Heart Failure Guidelines, Section 4.2
Q3. A nurse is using the Situation, Background, Assessment, Recommendation
(SBAR) framework to communicate with a provider about a deteriorating client.
Which component is correctly aligned with the 'Recommendation' element?
A. The client's blood pressure dropped from 120/80 to 90/60 over the last hour.
B. The client is a 72-year-old male with a history of hypertension.
C. I suggest you come to evaluate the client and consider an arterial blood gas.
D. The client's urine output has been less than 30 mL/hr for 2 hours.
Correct Answer: C. I suggest you come to evaluate the client and consider an arterial
blood gas.
Rationale: SBAR: Situation (what is happening now), Background (relevant history),
Assessment (what you think is going on), Recommendation (what you want done). Option
C clearly states a suggestion for action. Option A is Assessment, B is Background, D is
Assessment (or Situation) - all are not recommendations.
Why Wrong:
A - This is assessment data, not a recommendation.
B - This is background information.
D - This is assessment data, not a recommendation.
Reference: Institute for Healthcare Improvement. (2026). SBAR Toolkit
Q4. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 65 mm Hg, HCO3- 32
mEq/L. What is the client's acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Chronic respiratory acidosis with metabolic compensation
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3- is elevated
(metabolic compensation). In chronic respiratory acidosis, the kidneys retain bicarbonate
to compensate; the HCO3- is typically elevated by 4 mEq/L for each 10 mm Hg increase in
PaCO2. Here, the expected HCO3- would be about 30-32, matching the given value,
indicating compensation rather than acute acidosis.
Why Wrong:
A - Acute respiratory acidosis would not have such a high HCO3-.
C - The primary disorder is respiratory acidosis, not metabolic alkalosis.
D - There is no evidence of a mixed disorder; the elevated HCO3- is compensatory.
Page 3
, Reference: Porth, C. (2026). Pathophysiology, 10th Ed., Ch. 5
Q5. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic
obstructive pulmonary disease (COPD): pH 7.32, PaCO2 65 mm Hg, HCO3- 32
mEq/L. What is the client's acid-base status?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Chronic respiratory acidosis with metabolic compensation
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory), and HCO3- is elevated
(metabolic compensation). In chronic respiratory acidosis, the kidneys retain bicarbonate
to compensate; the HCO3- is typically elevated by 4 mEq/L for each 10 mm Hg increase in
PaCO2. Here, the expected HCO3- would be about 30-32, matching the given value,
indicating compensation rather than acute acidosis.
Why Wrong:
A - Acute respiratory acidosis would not have such a high HCO3-.
C - The primary disorder is respiratory acidosis, not metabolic alkalosis.
D - There is no evidence of a mixed disorder; the elevated HCO3- is compensatory.
Reference: Porth, C. (2026). Pathophysiology, 10th Ed., Ch. 5
Q6. A nurse is caring for a client with a chest tube connected to a water-seal drainage
system. Which finding requires immediate intervention?
A. Intermittent bubbling in the water-seal chamber
B. Constant bubbling in the water-seal chamber
C. Drainage of 50 mL in the first hour
D. Fluctuation of the water level with respirations
Correct Answer: B. Constant bubbling in the water-seal chamber
Rationale: Constant bubbling in the water-seal chamber indicates an air leak in the
system (e.g., loose connections or a leak in the tubing), which requires immediate
assessment and intervention. Intermittent bubbling is normal when the client exhales,
indicating air removal. Fluctuation is expected until lung re-expansion. Drainage of 50
mL in the first hour is acceptable.
Why Wrong:
A - Intermittent bubbling is normal.
C - 50 mL in the first hour is not excessive.
D - Fluctuation is expected and indicates the system is patent.
Reference: Ignatavicius, D. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 22
Page 4
