2027 HESI RN Exit Midterm Exam – NGN
Questions, Case Studies & Verified Answers
with Rationales (Pass Guaranteed)
Coverage: Medical-surgical nursing, pharmacology, maternal-newborn,
pediatrics, mental health, leadership, safety, and clinical judgment
CASE STUDY 1 — SEPSIS AND SEPTIC SHOCK
A 74-year-old client is admitted with pneumonia. The client is confused,
temperature 39.1°C (102.4°F), heart rate 126/min, respiratory rate 32/min,
blood pressure 84/46 mm Hg, and oxygen saturation 88% on room air.
Laboratory results include WBC 20,000/mm³, lactate 4.6 mmol/L, and creatinine
2.0 mg/dL.
1. Which assessment finding is the nurse's priority?
A. Temperature of 39.1°C
B. Heart rate of 126/min
C. Blood pressure of 84/46 mm Hg
D. WBC count of 20,000/mm³
Answer: C
Rationale: Severe hypotension indicates impaired systemic perfusion and
possible septic shock. Circulation is the immediate priority.
2. Which intervention should the nurse anticipate first?
A. Restrict fluids
B. Administer isotonic IV fluid
C. Encourage ambulation
D. Administer an oral antipyretic only
Answer: B
Rationale: Rapid isotonic crystalloid administration is an important early
intervention for sepsis-associated hypotension and inadequate perfusion.
,3. Which laboratory value most directly indicates tissue hypoperfusion?
A. WBC 20,000/mm³
B. Lactate 4.6 mmol/L
C. Creatinine 2.0 mg/dL
D. Temperature 39.1°C
Answer: B
Rationale: Elevated lactate reflects increased anaerobic metabolism and is an
important marker of impaired tissue perfusion.
4. Which action should occur before the first dose of antibiotics when this can
be accomplished without delaying treatment?
A. Obtain blood cultures
B. Give a sedative
C. Restrict oxygen
D. Place the client on a low-sodium diet
Answer: A
Rationale: Blood cultures help identify the causative organism and guide
antimicrobial therapy. They should be obtained promptly without causing an
unnecessary delay in treatment.
5. Which finding best indicates improved perfusion?
A. Urine output increases
B. Lactate increases
C. Blood pressure decreases
D. Mental status worsens
Answer: A
Rationale: Increasing urine output indicates improved renal perfusion and
circulating volume.
6. Which medication should the nurse anticipate if hypotension persists
despite adequate fluid resuscitation?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Diphenhydramine
Answer: A
,Rationale: Norepinephrine is commonly used as a first-line vasopressor for
persistent septic shock-related hypotension.
7. Which finding requires immediate escalation?
A. Temperature 38.8°C
B. Heart rate 104/min
C. Urine output 45 mL/hr
D. Blood pressure 76/40 mm Hg despite fluids
Answer: D
Rationale: Persistent severe hypotension despite fluid resuscitation indicates
ongoing shock and inadequate organ perfusion.
8. Which assessment finding suggests worsening neurologic perfusion?
A. Increased alertness
B. New confusion
C. Normal pupil response
D. Improved orientation
Answer: B
Rationale: New or worsening confusion may indicate inadequate cerebral
perfusion or worsening systemic illness.
9. Which intervention is appropriate for the client's oxygen saturation of 88%?
A. Administer supplemental oxygen as prescribed
B. Withhold oxygen
C. Encourage exercise
D. Place the client flat
Answer: A
Rationale: Hypoxemia requires supplemental oxygen and continued
respiratory assessment.
10. Which outcome indicates that treatment is effective?
A. Lactate falls from 4.6 to 2.0 mmol/L
B. Urine output stops
C. Blood pressure falls further
D. Mental status deteriorates
, Answer: A
Rationale: A declining lactate level suggests improved tissue perfusion and
response to treatment.
CASE STUDY 2 — ACUTE CORONARY SYNDROME
A 62-year-old client reports crushing substernal chest pressure radiating to the
left arm. The client is pale, diaphoretic, and nauseated. BP is 150/90 mm Hg, HR
110/min, and oxygen saturation 95%.
11. Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Encourage ambulation
C. Give a large meal
D. Place the client prone
Answer: A
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute
coronary syndrome to identify myocardial ischemia or infarction.
12. Which medication should the nurse anticipate if there is no
contraindication?
A. Aspirin
B. Warfarin
C. Digoxin
D. Insulin
Answer: A
Rationale: Aspirin decreases platelet aggregation and is an important early
treatment for suspected acute coronary syndrome.
13. Which laboratory test is most specific for myocardial injury?
A. Troponin
B. Sodium
C. Hemoglobin
D. Amylase
Answer: A
Questions, Case Studies & Verified Answers
with Rationales (Pass Guaranteed)
Coverage: Medical-surgical nursing, pharmacology, maternal-newborn,
pediatrics, mental health, leadership, safety, and clinical judgment
CASE STUDY 1 — SEPSIS AND SEPTIC SHOCK
A 74-year-old client is admitted with pneumonia. The client is confused,
temperature 39.1°C (102.4°F), heart rate 126/min, respiratory rate 32/min,
blood pressure 84/46 mm Hg, and oxygen saturation 88% on room air.
Laboratory results include WBC 20,000/mm³, lactate 4.6 mmol/L, and creatinine
2.0 mg/dL.
1. Which assessment finding is the nurse's priority?
A. Temperature of 39.1°C
B. Heart rate of 126/min
C. Blood pressure of 84/46 mm Hg
D. WBC count of 20,000/mm³
Answer: C
Rationale: Severe hypotension indicates impaired systemic perfusion and
possible septic shock. Circulation is the immediate priority.
2. Which intervention should the nurse anticipate first?
A. Restrict fluids
B. Administer isotonic IV fluid
C. Encourage ambulation
D. Administer an oral antipyretic only
Answer: B
Rationale: Rapid isotonic crystalloid administration is an important early
intervention for sepsis-associated hypotension and inadequate perfusion.
,3. Which laboratory value most directly indicates tissue hypoperfusion?
A. WBC 20,000/mm³
B. Lactate 4.6 mmol/L
C. Creatinine 2.0 mg/dL
D. Temperature 39.1°C
Answer: B
Rationale: Elevated lactate reflects increased anaerobic metabolism and is an
important marker of impaired tissue perfusion.
4. Which action should occur before the first dose of antibiotics when this can
be accomplished without delaying treatment?
A. Obtain blood cultures
B. Give a sedative
C. Restrict oxygen
D. Place the client on a low-sodium diet
Answer: A
Rationale: Blood cultures help identify the causative organism and guide
antimicrobial therapy. They should be obtained promptly without causing an
unnecessary delay in treatment.
5. Which finding best indicates improved perfusion?
A. Urine output increases
B. Lactate increases
C. Blood pressure decreases
D. Mental status worsens
Answer: A
Rationale: Increasing urine output indicates improved renal perfusion and
circulating volume.
6. Which medication should the nurse anticipate if hypotension persists
despite adequate fluid resuscitation?
A. Norepinephrine
B. Furosemide
C. Propranolol
D. Diphenhydramine
Answer: A
,Rationale: Norepinephrine is commonly used as a first-line vasopressor for
persistent septic shock-related hypotension.
7. Which finding requires immediate escalation?
A. Temperature 38.8°C
B. Heart rate 104/min
C. Urine output 45 mL/hr
D. Blood pressure 76/40 mm Hg despite fluids
Answer: D
Rationale: Persistent severe hypotension despite fluid resuscitation indicates
ongoing shock and inadequate organ perfusion.
8. Which assessment finding suggests worsening neurologic perfusion?
A. Increased alertness
B. New confusion
C. Normal pupil response
D. Improved orientation
Answer: B
Rationale: New or worsening confusion may indicate inadequate cerebral
perfusion or worsening systemic illness.
9. Which intervention is appropriate for the client's oxygen saturation of 88%?
A. Administer supplemental oxygen as prescribed
B. Withhold oxygen
C. Encourage exercise
D. Place the client flat
Answer: A
Rationale: Hypoxemia requires supplemental oxygen and continued
respiratory assessment.
10. Which outcome indicates that treatment is effective?
A. Lactate falls from 4.6 to 2.0 mmol/L
B. Urine output stops
C. Blood pressure falls further
D. Mental status deteriorates
, Answer: A
Rationale: A declining lactate level suggests improved tissue perfusion and
response to treatment.
CASE STUDY 2 — ACUTE CORONARY SYNDROME
A 62-year-old client reports crushing substernal chest pressure radiating to the
left arm. The client is pale, diaphoretic, and nauseated. BP is 150/90 mm Hg, HR
110/min, and oxygen saturation 95%.
11. Which action should the nurse take first?
A. Obtain a 12-lead ECG
B. Encourage ambulation
C. Give a large meal
D. Place the client prone
Answer: A
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute
coronary syndrome to identify myocardial ischemia or infarction.
12. Which medication should the nurse anticipate if there is no
contraindication?
A. Aspirin
B. Warfarin
C. Digoxin
D. Insulin
Answer: A
Rationale: Aspirin decreases platelet aggregation and is an important early
treatment for suspected acute coronary syndrome.
13. Which laboratory test is most specific for myocardial injury?
A. Troponin
B. Sodium
C. Hemoglobin
D. Amylase
Answer: A
