HESI RN EXIT EXAM CASE SCENARIOS NGN
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
During clinical judgment review, which response best addresses Serotonin syndrome?
A. lead-pipe rigidity without clonus is the defining pattern
B. severe bradykinesia develops gradually over months
C. agitation, hyperreflexia, clonus, autonomic instability, and fever suggest serotonin
toxicity
D. serotonin syndrome is treated by increasing serotonergic drugs
Correct Answer: C. agitation, hyperreflexia, clonus, autonomic instability, and
fever suggest serotonin toxicity
Explanation: Serotonin syndrome usually develops after increased serotonergic activity
and often features neuromuscular hyperactivity such as clonus and hyperreflexia.
Autonomic instability and hyperthermia may occur. Offending agents are stopped and
supportive care is initiated. This makes “agitation, hyperreflexia, clonus, autonomic
instability, and fever suggest serotonin toxicity” the best answer for a question testing
serotonin syndrome. The other choices describe a different mechanism, an unsafe action,
or a finding that does not fit the stated clinical context.
Question 2.
The nurse recognizes a situation involving Increased ICP. Which finding or action should be
prioritized?
A. avoid activities that markedly increase intrathoracic or intra-abdominal pressure and
maintain head/neck alignment
B. encourage forceful coughing every few minutes
C. cluster all painful procedures without rest
D. place the patient flat with hips sharply flexed
Correct Answer: A. avoid activities that markedly increase intrathoracic or
intra-abdominal pressure and maintain head/neck alignment
Explanation: Measures that promote cerebral venous drainage can help limit intracranial
pressure. Neutral alignment and appropriate head elevation reduce venous obstruction.
Excessive coughing, Valsalva, or extreme flexion can increase intracranial pressure. This
makes “avoid activities that markedly increase intrathoracic or intra-abdominal pressure
and maintain head/neck alignment” the best answer for a question testing increased icp.
The other choices describe a different mechanism, an unsafe action, or a finding that does
not fit the stated clinical context.
,Question 3.
The nurse recognizes a situation involving Aortic dissection. Which finding or action should
be prioritized?
A. pain gradually improving with exercise is typical
B. sudden severe tearing chest or back pain with pulse or pressure differences is
concerning for aortic dissection
C. bilateral equal pulses exclude all dissections
D. anticoagulation is always given before imaging
Correct Answer: B. sudden severe tearing chest or back pain with pulse or
pressure differences is concerning for aortic dissection
Explanation: Aortic dissection is separation of aortic wall layers after an intimal tear.
Abrupt severe chest or back pain, pulse deficits, neurologic findings, or blood-pressure
differences can occur. Rapid diagnosis and blood-pressure/impulse control are crucial. This
makes “sudden severe tearing chest or back pain with pulse or pressure differences is
concerning for aortic dissection” the best answer for a question testing aortic dissection.
The other choices describe a different mechanism, an unsafe action, or a finding that does
not fit the stated clinical context.
Question 4.
The nurse recognizes a situation involving Fire response. Which finding or action should be
prioritized?
A. use elevators routinely during fire evacuation
B. open all doors to improve ventilation
C. collect personal belongings before alerting others
D. rescue those in immediate danger, activate the alarm, contain the fire, and extinguish
or evacuate as appropriate
Correct Answer: D. rescue those in immediate danger, activate the alarm,
contain the fire, and extinguish or evacuate as appropriate
Explanation: RACE is a common framework for fire response: Rescue, Alarm, Contain,
and Extinguish/Evacuate. Immediate life safety and notification come before nonessential
tasks. Doors are closed to contain smoke and fire, and elevators are generally avoided
unless specifically authorized. This makes “rescue those in immediate danger, activate the
alarm, contain the fire, and extinguish or evacuate as appropriate” the best answer for a
question testing fire response. The other choices describe a different mechanism, an
unsafe action, or a finding that does not fit the stated clinical context.
,Question 5.
During clinical judgment review, which response best addresses Priority ABC?
A. routine discharge paperwork is the first priority during deterioration
B. scheduled teaching outranks sudden hypoxemia
C. an acute airway or breathing threat generally takes priority over stable chronic
problems
D. chronic pain always outranks new respiratory distress
Correct Answer: C. an acute airway or breathing threat generally takes priority
over stable chronic problems
Explanation: Prioritization starts with immediate threats to life, especially airway,
breathing, and circulation. Acute instability generally outranks chronic or expected
findings. After stabilization, other needs can be addressed systematically. This makes “an
acute airway or breathing threat generally takes priority over stable chronic problems” the
best answer for a question testing priority abc. The other choices describe a different
mechanism, an unsafe action, or a finding that does not fit the stated clinical context.
Question 6.
During clinical judgment review, which response best addresses Heart failure fluid
overload?
A. daily weight is the most sensitive routine indicator of short-term fluid balance change
B. urine color alone quantifies extracellular fluid volume
C. one blood pressure reading determines total body water
D. skin turgor is the most precise measure of pulmonary congestion
Correct Answer: A. daily weight is the most sensitive routine indicator of
short-term fluid balance change
Explanation: Daily weight trends detect relatively small changes in body water before
visible edema may change. The same scale and similar timing improve comparability.
Other findings help, but they are less sensitive for day-to-day volume change. This makes
“daily weight is the most sensitive routine indicator of short-term fluid balance change”
the best answer for a question testing heart failure fluid overload. The other choices
describe a different mechanism, an unsafe action, or a finding that does not fit the stated
clinical context.
Question 7.
During clinical judgment review, which response best addresses Cushing syndrome?
A. Cushing syndrome protects against osteoporosis
B. cortisol suppresses blood glucose
C. cortisol excess causes severe weight loss with hyperpigmentation in all cases
D. excess cortisol promotes hyperglycemia, muscle wasting, skin fragility, central fat
deposition, and infection risk
Correct Answer: D. excess cortisol promotes hyperglycemia, muscle wasting,
skin fragility, central fat deposition, and infection risk
, Explanation: Chronic glucocorticoid excess has catabolic, metabolic, and
immunosuppressive effects. Patients may develop central adiposity, muscle weakness,
thin skin, osteoporosis, hypertension, and hyperglycemia. Infection and poor wound
healing are important risks. This makes “excess cortisol promotes hyperglycemia, muscle
wasting, skin fragility, central fat deposition, and infection risk” the best answer for a
question testing cushing syndrome. The other choices describe a different mechanism, an
unsafe action, or a finding that does not fit the stated clinical context.
Question 8.
Which nursing decision is most appropriate for a client experiencing Hypertensive
emergency?
A. all severe blood-pressure readings require immediate normalization within minutes
B. severe hypertension with acute target-organ injury requires controlled IV blood-pressure
reduction and close monitoring
C. target-organ injury is unrelated to urgency
D. oral lifestyle advice alone is sufficient when encephalopathy is present
Correct Answer: B. severe hypertension with acute target-organ injury requires
controlled IV blood-pressure reduction and close monitoring
Explanation: Hypertensive emergency is defined by severe blood pressure elevation with
acute organ injury such as encephalopathy, pulmonary edema, myocardial ischemia, or
aortic dissection. Treatment uses carefully titrated IV therapy. Overly rapid reduction can
impair organ perfusion. This makes “severe hypertension with acute target-organ injury
requires controlled IV blood-pressure reduction and close monitoring” the best answer for
a question testing hypertensive emergency. The other choices describe a different
mechanism, an unsafe action, or a finding that does not fit the stated clinical context.
Question 9.
Which statement best reflects safe nursing care for Placenta previa?
A. painful rigid uterus is the defining finding
B. previa causes fetal bleeding only after delivery
C. painless bright red bleeding in later pregnancy suggests placenta previa and digital
vaginal examination is avoided until placental location is known
D. vaginal examination is used immediately to confirm the diagnosis
Correct Answer: C. painless bright red bleeding in later pregnancy suggests
placenta previa and digital vaginal examination is avoided until placental
location is known
Explanation: Placenta previa classically causes painless bleeding from placental tissue
near or over the cervical os. Digital examination can provoke catastrophic hemorrhage if
previa is present. Ultrasound is used to determine placental location. This makes “painless
bright red bleeding in later pregnancy suggests placenta previa and digital vaginal
examination is avoided until placental location is known” the best answer for a question
testing placenta previa. The other choices describe a different mechanism, an unsafe
action, or a finding that does not fit the stated clinical context.
QUESTIONS WITH ANSWERS AND EXPLANATIONS
Question 1.
During clinical judgment review, which response best addresses Serotonin syndrome?
A. lead-pipe rigidity without clonus is the defining pattern
B. severe bradykinesia develops gradually over months
C. agitation, hyperreflexia, clonus, autonomic instability, and fever suggest serotonin
toxicity
D. serotonin syndrome is treated by increasing serotonergic drugs
Correct Answer: C. agitation, hyperreflexia, clonus, autonomic instability, and
fever suggest serotonin toxicity
Explanation: Serotonin syndrome usually develops after increased serotonergic activity
and often features neuromuscular hyperactivity such as clonus and hyperreflexia.
Autonomic instability and hyperthermia may occur. Offending agents are stopped and
supportive care is initiated. This makes “agitation, hyperreflexia, clonus, autonomic
instability, and fever suggest serotonin toxicity” the best answer for a question testing
serotonin syndrome. The other choices describe a different mechanism, an unsafe action,
or a finding that does not fit the stated clinical context.
Question 2.
The nurse recognizes a situation involving Increased ICP. Which finding or action should be
prioritized?
A. avoid activities that markedly increase intrathoracic or intra-abdominal pressure and
maintain head/neck alignment
B. encourage forceful coughing every few minutes
C. cluster all painful procedures without rest
D. place the patient flat with hips sharply flexed
Correct Answer: A. avoid activities that markedly increase intrathoracic or
intra-abdominal pressure and maintain head/neck alignment
Explanation: Measures that promote cerebral venous drainage can help limit intracranial
pressure. Neutral alignment and appropriate head elevation reduce venous obstruction.
Excessive coughing, Valsalva, or extreme flexion can increase intracranial pressure. This
makes “avoid activities that markedly increase intrathoracic or intra-abdominal pressure
and maintain head/neck alignment” the best answer for a question testing increased icp.
The other choices describe a different mechanism, an unsafe action, or a finding that does
not fit the stated clinical context.
,Question 3.
The nurse recognizes a situation involving Aortic dissection. Which finding or action should
be prioritized?
A. pain gradually improving with exercise is typical
B. sudden severe tearing chest or back pain with pulse or pressure differences is
concerning for aortic dissection
C. bilateral equal pulses exclude all dissections
D. anticoagulation is always given before imaging
Correct Answer: B. sudden severe tearing chest or back pain with pulse or
pressure differences is concerning for aortic dissection
Explanation: Aortic dissection is separation of aortic wall layers after an intimal tear.
Abrupt severe chest or back pain, pulse deficits, neurologic findings, or blood-pressure
differences can occur. Rapid diagnosis and blood-pressure/impulse control are crucial. This
makes “sudden severe tearing chest or back pain with pulse or pressure differences is
concerning for aortic dissection” the best answer for a question testing aortic dissection.
The other choices describe a different mechanism, an unsafe action, or a finding that does
not fit the stated clinical context.
Question 4.
The nurse recognizes a situation involving Fire response. Which finding or action should be
prioritized?
A. use elevators routinely during fire evacuation
B. open all doors to improve ventilation
C. collect personal belongings before alerting others
D. rescue those in immediate danger, activate the alarm, contain the fire, and extinguish
or evacuate as appropriate
Correct Answer: D. rescue those in immediate danger, activate the alarm,
contain the fire, and extinguish or evacuate as appropriate
Explanation: RACE is a common framework for fire response: Rescue, Alarm, Contain,
and Extinguish/Evacuate. Immediate life safety and notification come before nonessential
tasks. Doors are closed to contain smoke and fire, and elevators are generally avoided
unless specifically authorized. This makes “rescue those in immediate danger, activate the
alarm, contain the fire, and extinguish or evacuate as appropriate” the best answer for a
question testing fire response. The other choices describe a different mechanism, an
unsafe action, or a finding that does not fit the stated clinical context.
,Question 5.
During clinical judgment review, which response best addresses Priority ABC?
A. routine discharge paperwork is the first priority during deterioration
B. scheduled teaching outranks sudden hypoxemia
C. an acute airway or breathing threat generally takes priority over stable chronic
problems
D. chronic pain always outranks new respiratory distress
Correct Answer: C. an acute airway or breathing threat generally takes priority
over stable chronic problems
Explanation: Prioritization starts with immediate threats to life, especially airway,
breathing, and circulation. Acute instability generally outranks chronic or expected
findings. After stabilization, other needs can be addressed systematically. This makes “an
acute airway or breathing threat generally takes priority over stable chronic problems” the
best answer for a question testing priority abc. The other choices describe a different
mechanism, an unsafe action, or a finding that does not fit the stated clinical context.
Question 6.
During clinical judgment review, which response best addresses Heart failure fluid
overload?
A. daily weight is the most sensitive routine indicator of short-term fluid balance change
B. urine color alone quantifies extracellular fluid volume
C. one blood pressure reading determines total body water
D. skin turgor is the most precise measure of pulmonary congestion
Correct Answer: A. daily weight is the most sensitive routine indicator of
short-term fluid balance change
Explanation: Daily weight trends detect relatively small changes in body water before
visible edema may change. The same scale and similar timing improve comparability.
Other findings help, but they are less sensitive for day-to-day volume change. This makes
“daily weight is the most sensitive routine indicator of short-term fluid balance change”
the best answer for a question testing heart failure fluid overload. The other choices
describe a different mechanism, an unsafe action, or a finding that does not fit the stated
clinical context.
Question 7.
During clinical judgment review, which response best addresses Cushing syndrome?
A. Cushing syndrome protects against osteoporosis
B. cortisol suppresses blood glucose
C. cortisol excess causes severe weight loss with hyperpigmentation in all cases
D. excess cortisol promotes hyperglycemia, muscle wasting, skin fragility, central fat
deposition, and infection risk
Correct Answer: D. excess cortisol promotes hyperglycemia, muscle wasting,
skin fragility, central fat deposition, and infection risk
, Explanation: Chronic glucocorticoid excess has catabolic, metabolic, and
immunosuppressive effects. Patients may develop central adiposity, muscle weakness,
thin skin, osteoporosis, hypertension, and hyperglycemia. Infection and poor wound
healing are important risks. This makes “excess cortisol promotes hyperglycemia, muscle
wasting, skin fragility, central fat deposition, and infection risk” the best answer for a
question testing cushing syndrome. The other choices describe a different mechanism, an
unsafe action, or a finding that does not fit the stated clinical context.
Question 8.
Which nursing decision is most appropriate for a client experiencing Hypertensive
emergency?
A. all severe blood-pressure readings require immediate normalization within minutes
B. severe hypertension with acute target-organ injury requires controlled IV blood-pressure
reduction and close monitoring
C. target-organ injury is unrelated to urgency
D. oral lifestyle advice alone is sufficient when encephalopathy is present
Correct Answer: B. severe hypertension with acute target-organ injury requires
controlled IV blood-pressure reduction and close monitoring
Explanation: Hypertensive emergency is defined by severe blood pressure elevation with
acute organ injury such as encephalopathy, pulmonary edema, myocardial ischemia, or
aortic dissection. Treatment uses carefully titrated IV therapy. Overly rapid reduction can
impair organ perfusion. This makes “severe hypertension with acute target-organ injury
requires controlled IV blood-pressure reduction and close monitoring” the best answer for
a question testing hypertensive emergency. The other choices describe a different
mechanism, an unsafe action, or a finding that does not fit the stated clinical context.
Question 9.
Which statement best reflects safe nursing care for Placenta previa?
A. painful rigid uterus is the defining finding
B. previa causes fetal bleeding only after delivery
C. painless bright red bleeding in later pregnancy suggests placenta previa and digital
vaginal examination is avoided until placental location is known
D. vaginal examination is used immediately to confirm the diagnosis
Correct Answer: C. painless bright red bleeding in later pregnancy suggests
placenta previa and digital vaginal examination is avoided until placental
location is known
Explanation: Placenta previa classically causes painless bleeding from placental tissue
near or over the cervical os. Digital examination can provoke catastrophic hemorrhage if
previa is present. Ultrasound is used to determine placental location. This makes “painless
bright red bleeding in later pregnancy suggests placenta previa and digital vaginal
examination is avoided until placental location is known” the best answer for a question
testing placenta previa. The other choices describe a different mechanism, an unsafe
action, or a finding that does not fit the stated clinical context.
