HESI RN EXIT EXAM V1 NGN QUESTIONS
WITH ANSWERS AND EXPLANATIONS
Question 1.
During morning rounds, the charge nurse is planning care for a 55-year-old client. Which
action best reflects delegation to uap?
A. administer scheduled oral medications to a stable client
B. honor a valid directive even when family members disagree
C. start discharge planning early for a client with complex home-care needs
D. ambulate a stable postoperative client who has already been assessed
Correct Answer: D. ambulate a stable postoperative client who has already been
assessed
Explanation: Routine, predictable tasks can be delegated after the RN establishes
stability. In this scenario, the safest decision is to ambulate a stable postoperative client
who has already been assessed. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. This
approach follows the nursing process by addressing the most immediate cue before
lower-priority needs. Reassessment is essential because a change in response can alter
the next priority.
Question 2.
At change of shift, which set contains only therapeutic responses to a client who says,
'Nothing matters anymore'?
A. 'You should be grateful.'; 'Promise you will not hurt yourself.'; 'Others have it worse.';
'Let's not discuss suicide.'
B. 'Why would you think that?'; 'Cheer up.'; 'You need to be positive.'; 'I know exactly how
you feel.'
C. 'Tell me more about what feels hopeless.'; 'Are you thinking about killing yourself?'; 'I
can stay with you while we talk.'; 'What has helped you through crises before?'
D. 'Suicide is selfish.'; 'You are overreacting.'; 'Forget about it.'; 'I will keep this secret no
matter what.'
Correct Answer: C. 'Tell me more about what feels hopeless.'; 'Are you thinking
about killing yourself?'; 'I can stay with you while we talk.'; 'What has helped
you through crises before?'
Explanation: Therapeutic communication invites expression, directly assesses suicide
risk, communicates presence, and explores effective coping without judgment. These
actions gather essential risk information while preserving dignity and reducing escalation.
The distractors use judgment, false reassurance, secrecy, confrontation, or unsafe
proximity that can worsen risk. If imminent danger is identified, the nurse prioritizes
continuous safety measures and the least restrictive effective intervention. Clinical
judgment should connect the cue to the risk it creates rather than treating the finding in
isolation. Ongoing monitoring helps determine whether the intervention is effective or
,escalation is needed.
Question 3.
In the emergency department, the nurse is providing basic care for a client who reports
pain 8/10 while smiling and talking. Which intervention is best?
A. accept the client's self-report and assess characteristics and function
B. monitor hydration, electrolytes, and skin integrity
C. use prescribed texture modification and position upright for meals
D. anticipate a bowel regimen with fluids, fiber, activity, and prescribed laxatives as
appropriate
Correct Answer: A. accept the client's self-report and assess characteristics and
function
Explanation: Pain is subjective and behavior alone does not invalidate the report.
Accordingly, the nurse should accept the client's self-report and assess characteristics and
function. The alternative actions either ignore positioning, hydration, reassessment, or
another basic-care principle that protects function and comfort. The nurse should evaluate
tolerance and modify the plan when the client's condition or functional ability changes.
The safest answer is the one that protects airway, circulation, neurologic function, or
medication safety before routine care. After the immediate problem is managed, the nurse
should document the response and continue focused reassessment.
Question 4.
On a medical-surgical unit, the charge nurse is planning care for a 72-year-old client.
Which action best reflects delegation to lpn/vn?
A. move a hallway discussion of client details to a private area
B. administer scheduled oral medications to a stable client
C. state the immediate concern and relevant background before giving recommendations
D. perform the initial assessment of a newly admitted unstable client
Correct Answer: B. administer scheduled oral medications to a stable client
Explanation: The LPN/VN can generally perform focused care for stable clients within
jurisdictional scope. In this scenario, the safest decision is to administer scheduled oral
medications to a stable client. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. This
reasoning also avoids delaying care for a time-sensitive complication. The nurse should
compare follow-up findings with the expected outcome and revise the plan if needed.
,Question 5.
While reviewing the plan of care, a 31-year-old client has pressure-like chest discomfort
with diaphoresis. Which action has the highest priority?
A. administer rapid-acting bronchodilator and support oxygenation
B. support oxygenation and activate urgent evaluation
C. position upright and support oxygenation
D. obtain a 12-lead ECG promptly while assessing airway, breathing, and circulation
Correct Answer: D. obtain a 12-lead ECG promptly while assessing airway,
breathing, and circulation
Explanation: The findings are characteristic of acute coronary syndrome, a condition that
can deteriorate rapidly. The immediate priority is to obtain a 12-lead ECG promptly while
assessing airway, breathing, and circulation. The distractors do not provide timely
information about physiologic stability or treatment effectiveness. Definitive management
may include aspirin when not contraindicated and rapid reperfusion evaluation, depending
on the client's presentation and provider orders. The key distinction is between an urgent
threat and a finding that can be addressed after stabilization. Evaluation of the client's
trend is more useful than relying on a single isolated data point.
Question 6.
Following an assessment, the charge nurse is planning care for a 59-year-old client. Which
action best reflects rn-only assessment?
A. perform the initial assessment of a newly admitted unstable client
B. document objective clinical facts in the chart and complete the incident report
separately
C. assess the client with new stridor before a client requesting a sleep medication
D. complete time-sensitive medications and unstable-client assessments before routine
paperwork
Correct Answer: A. perform the initial assessment of a newly admitted unstable
client
Explanation: Initial comprehensive assessment and care planning require RN-level
judgment. In this scenario, the safest decision is to perform the initial assessment of a
newly admitted unstable client. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. The
correct choice uses the least risky intervention that still addresses the identified clinical
problem. If the expected response does not occur, the nurse should escalate care and
reassess the working hypothesis.
, Question 7.
During discharge teaching, the nurse reviews a new finding: Potassium 6.5 mEq/L with
peaked T waves. How should this finding be interpreted?
A. neutropenic fever requiring urgent cultures and antibiotics
B. hyperkalemia requiring urgent cardiac monitoring and treatment
C. metabolic alkalosis with respiratory compensation
D. severe symptomatic hyponatremia requiring seizure precautions and urgent evaluation
Correct Answer: B. hyperkalemia requiring urgent cardiac monitoring and
treatment
Explanation: A dangerous potassium elevation can destabilize cardiac conduction. The
data are most consistent with hyperkalemia requiring urgent cardiac monitoring and
treatment. The distractors are lower acuity or do not indicate an active threat requiring
immediate escalation. The nurse should trend the relevant vital signs, laboratory data, and
client response after intervention. This priority is consistent with safe entry-level RN
practice and the hierarchy of physiologic needs. Subsequent care should include
communication of important changes to the appropriate team member.
Question 8.
After receiving report, the nurse reviews a new finding: Sodium 118 mEq/L with confusion.
How should this finding be interpreted?
A. symptomatic hypocalcemia
B. possible deep vein thrombosis
C. severe symptomatic hyponatremia requiring seizure precautions and urgent evaluation
D. excess anticoagulation with active bleeding
Correct Answer: C. severe symptomatic hyponatremia requiring seizure
precautions and urgent evaluation
Explanation: Neurologic symptoms reflect cerebral effects of profound hyponatremia.
The data are most consistent with severe symptomatic hyponatremia requiring seizure
precautions and urgent evaluation. The distractors are lower acuity or do not indicate an
active threat requiring immediate escalation. The nurse should trend the relevant vital
signs, laboratory data, and client response after intervention. The distractors may be
reasonable in another context, but they do not best address the cue presented here. The
nurse should continue to watch for complications that would require a different or more
urgent response.
WITH ANSWERS AND EXPLANATIONS
Question 1.
During morning rounds, the charge nurse is planning care for a 55-year-old client. Which
action best reflects delegation to uap?
A. administer scheduled oral medications to a stable client
B. honor a valid directive even when family members disagree
C. start discharge planning early for a client with complex home-care needs
D. ambulate a stable postoperative client who has already been assessed
Correct Answer: D. ambulate a stable postoperative client who has already been
assessed
Explanation: Routine, predictable tasks can be delegated after the RN establishes
stability. In this scenario, the safest decision is to ambulate a stable postoperative client
who has already been assessed. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. This
approach follows the nursing process by addressing the most immediate cue before
lower-priority needs. Reassessment is essential because a change in response can alter
the next priority.
Question 2.
At change of shift, which set contains only therapeutic responses to a client who says,
'Nothing matters anymore'?
A. 'You should be grateful.'; 'Promise you will not hurt yourself.'; 'Others have it worse.';
'Let's not discuss suicide.'
B. 'Why would you think that?'; 'Cheer up.'; 'You need to be positive.'; 'I know exactly how
you feel.'
C. 'Tell me more about what feels hopeless.'; 'Are you thinking about killing yourself?'; 'I
can stay with you while we talk.'; 'What has helped you through crises before?'
D. 'Suicide is selfish.'; 'You are overreacting.'; 'Forget about it.'; 'I will keep this secret no
matter what.'
Correct Answer: C. 'Tell me more about what feels hopeless.'; 'Are you thinking
about killing yourself?'; 'I can stay with you while we talk.'; 'What has helped
you through crises before?'
Explanation: Therapeutic communication invites expression, directly assesses suicide
risk, communicates presence, and explores effective coping without judgment. These
actions gather essential risk information while preserving dignity and reducing escalation.
The distractors use judgment, false reassurance, secrecy, confrontation, or unsafe
proximity that can worsen risk. If imminent danger is identified, the nurse prioritizes
continuous safety measures and the least restrictive effective intervention. Clinical
judgment should connect the cue to the risk it creates rather than treating the finding in
isolation. Ongoing monitoring helps determine whether the intervention is effective or
,escalation is needed.
Question 3.
In the emergency department, the nurse is providing basic care for a client who reports
pain 8/10 while smiling and talking. Which intervention is best?
A. accept the client's self-report and assess characteristics and function
B. monitor hydration, electrolytes, and skin integrity
C. use prescribed texture modification and position upright for meals
D. anticipate a bowel regimen with fluids, fiber, activity, and prescribed laxatives as
appropriate
Correct Answer: A. accept the client's self-report and assess characteristics and
function
Explanation: Pain is subjective and behavior alone does not invalidate the report.
Accordingly, the nurse should accept the client's self-report and assess characteristics and
function. The alternative actions either ignore positioning, hydration, reassessment, or
another basic-care principle that protects function and comfort. The nurse should evaluate
tolerance and modify the plan when the client's condition or functional ability changes.
The safest answer is the one that protects airway, circulation, neurologic function, or
medication safety before routine care. After the immediate problem is managed, the nurse
should document the response and continue focused reassessment.
Question 4.
On a medical-surgical unit, the charge nurse is planning care for a 72-year-old client.
Which action best reflects delegation to lpn/vn?
A. move a hallway discussion of client details to a private area
B. administer scheduled oral medications to a stable client
C. state the immediate concern and relevant background before giving recommendations
D. perform the initial assessment of a newly admitted unstable client
Correct Answer: B. administer scheduled oral medications to a stable client
Explanation: The LPN/VN can generally perform focused care for stable clients within
jurisdictional scope. In this scenario, the safest decision is to administer scheduled oral
medications to a stable client. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. This
reasoning also avoids delaying care for a time-sensitive complication. The nurse should
compare follow-up findings with the expected outcome and revise the plan if needed.
,Question 5.
While reviewing the plan of care, a 31-year-old client has pressure-like chest discomfort
with diaphoresis. Which action has the highest priority?
A. administer rapid-acting bronchodilator and support oxygenation
B. support oxygenation and activate urgent evaluation
C. position upright and support oxygenation
D. obtain a 12-lead ECG promptly while assessing airway, breathing, and circulation
Correct Answer: D. obtain a 12-lead ECG promptly while assessing airway,
breathing, and circulation
Explanation: The findings are characteristic of acute coronary syndrome, a condition that
can deteriorate rapidly. The immediate priority is to obtain a 12-lead ECG promptly while
assessing airway, breathing, and circulation. The distractors do not provide timely
information about physiologic stability or treatment effectiveness. Definitive management
may include aspirin when not contraindicated and rapid reperfusion evaluation, depending
on the client's presentation and provider orders. The key distinction is between an urgent
threat and a finding that can be addressed after stabilization. Evaluation of the client's
trend is more useful than relying on a single isolated data point.
Question 6.
Following an assessment, the charge nurse is planning care for a 59-year-old client. Which
action best reflects rn-only assessment?
A. perform the initial assessment of a newly admitted unstable client
B. document objective clinical facts in the chart and complete the incident report
separately
C. assess the client with new stridor before a client requesting a sleep medication
D. complete time-sensitive medications and unstable-client assessments before routine
paperwork
Correct Answer: A. perform the initial assessment of a newly admitted unstable
client
Explanation: Initial comprehensive assessment and care planning require RN-level
judgment. In this scenario, the safest decision is to perform the initial assessment of a
newly admitted unstable client. The other choices either delay needed care, exceed
appropriate delegation, or fail to address the safety responsibility. The RN remains
accountable for follow-up, communication, and evaluation of the client's response. The
correct choice uses the least risky intervention that still addresses the identified clinical
problem. If the expected response does not occur, the nurse should escalate care and
reassess the working hypothesis.
, Question 7.
During discharge teaching, the nurse reviews a new finding: Potassium 6.5 mEq/L with
peaked T waves. How should this finding be interpreted?
A. neutropenic fever requiring urgent cultures and antibiotics
B. hyperkalemia requiring urgent cardiac monitoring and treatment
C. metabolic alkalosis with respiratory compensation
D. severe symptomatic hyponatremia requiring seizure precautions and urgent evaluation
Correct Answer: B. hyperkalemia requiring urgent cardiac monitoring and
treatment
Explanation: A dangerous potassium elevation can destabilize cardiac conduction. The
data are most consistent with hyperkalemia requiring urgent cardiac monitoring and
treatment. The distractors are lower acuity or do not indicate an active threat requiring
immediate escalation. The nurse should trend the relevant vital signs, laboratory data, and
client response after intervention. This priority is consistent with safe entry-level RN
practice and the hierarchy of physiologic needs. Subsequent care should include
communication of important changes to the appropriate team member.
Question 8.
After receiving report, the nurse reviews a new finding: Sodium 118 mEq/L with confusion.
How should this finding be interpreted?
A. symptomatic hypocalcemia
B. possible deep vein thrombosis
C. severe symptomatic hyponatremia requiring seizure precautions and urgent evaluation
D. excess anticoagulation with active bleeding
Correct Answer: C. severe symptomatic hyponatremia requiring seizure
precautions and urgent evaluation
Explanation: Neurologic symptoms reflect cerebral effects of profound hyponatremia.
The data are most consistent with severe symptomatic hyponatremia requiring seizure
precautions and urgent evaluation. The distractors are lower acuity or do not indicate an
active threat requiring immediate escalation. The nurse should trend the relevant vital
signs, laboratory data, and client response after intervention. The distractors may be
reasonable in another context, but they do not best address the cue presented here. The
nurse should continue to watch for complications that would require a different or more
urgent response.
