HESI RN EXIT NGN V6 QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. A competent laboring client declines a proposed procedure after receiving an explanation of risks and
benefits. What should the nurse do?
A. Obtain consent from the partner instead.
B. Perform the procedure because labor is painful.
C. Respect the decision, notify the care team, and continue supportive care.
D. Document that the client is noncompliant and stop care.
Correct Answer: C. Respect the decision, notify the care team, and continue supportive care.
Explanation: Competent clients retain the right to informed refusal. The nurse supports autonomy, ensures
communication, and documents the decision and education provided.
2. A laboring client is GBS-positive and has no penicillin allergy. Which medication is commonly used for
intrapartum prophylaxis?
A. IV penicillin G.
B. Oral acyclovir.
C. Methylergonovine.
D. Magnesium sulfate.
Correct Answer: A. IV penicillin G.
Explanation: Penicillin is the preferred intrapartum antibiotic for GBS prophylaxis when no significant allergy is
present.
3. During nursing care, a client with advanced cirrhosis develops rising creatinine and oliguria without
evidence of shock, nephrotoxin exposure, or structural kidney disease. Which condition is most
concerning?
A. Acute appendicitis.
B. Simple urinary frequency.
C. Hepatorenal syndrome.
D. Stable nephrolithiasis without obstruction.
Correct Answer: C. Hepatorenal syndrome.
Explanation: Hepatorenal syndrome is a functional renal failure associated with advanced cirrhosis and profound
circulatory changes after other causes of kidney injury have been excluded.
4. Four clients arrive after an industrial explosion. Which client should be assessed first?
A. A client with a closed wrist fracture and intact pulses.
B. A client with facial burns, hoarseness, soot in the mouth, and increasing stridor.
C. A client with a superficial leg laceration and controlled bleeding.
D. A client requesting a tetanus booster for a small abrasion.
Correct Answer: B. A client with facial burns, hoarseness, soot in the mouth, and increasing stridor.
Explanation: Hoarseness, soot, facial burns, and worsening stridor indicate threatened airway obstruction from
inhalation injury. Airway compromise takes priority over stable musculoskeletal and minor wounds.
5. Which plan is safest for insulin and diabetes supplies at school?
A. Lock all supplies where the child and trained staff cannot reach them.
B. Send no fast-acting carbohydrate to school.
C. Require the child to skip lunch insulin every day.
D. Keep supplies accessible according to the child’s diabetes medical management plan and school policy.
Correct Answer: D. Keep supplies accessible according to the child’s diabetes medical management plan and
school policy.
Explanation: Children need timely access to glucose monitoring, insulin, and hypoglycemia treatment during the
school day.
6. Which condition is required before a fetal scalp electrode can be applied?
A. The membranes must be ruptured and the cervix sufficiently dilated to reach the presenting part.
B. The membranes must be intact.
C. The fetus must be transverse.
D. The client must be postpartum.
Correct Answer: A. The membranes must be ruptured and the cervix sufficiently dilated to reach the presenting
,part.
Explanation: Internal fetal heart monitoring requires ruptured membranes and access to the presenting fetal part.
7. Which ethical principle focuses on fairness in the distribution of care and resources?
A. Veracity.
B. Fidelity.
C. Autonomy.
D. Justice.
Correct Answer: D. Justice.
Explanation: Justice concerns fairness and equitable treatment. Other principles address truthfulness, promises,
and self-determination.
8. Which intervention most directly reduces the immediate risk from Controlled-substance handling?
A. Hold the medication and clarify an incomplete, illegible, or clinically unsafe order before administration.
B. Document administration accurately and complete required witness and wasting procedures at the time they
occur.
C. Compare prescription drugs, over-the-counter products, supplements, and actual use with current orders.
D. Use a new sterile needle and syringe for every injection and every vial entry.
Correct Answer: B. Document administration accurately and complete required witness and wasting procedures
at the time they occur.
Explanation: This action addresses the highest-priority risk in Controlled-substance handling. Controlled
substances require secure storage, accurate documentation, witnessed waste when required, and prompt
investigation of discrepancies to reduce diversion and dosing errors.
9. Why should a child with spina bifida be considered at increased risk for latex allergy?
A. Latex allergy occurs only in children with asthma.
B. Repeated healthcare exposures increase the likelihood of latex sensitization.
C. Spina bifida prevents all immune reactions.
D. Latex causes hydrocephalus directly.
Correct Answer: B. Repeated healthcare exposures increase the likelihood of latex sensitization.
Explanation: Children with spina bifida often have repeated surgeries and catheterizations, creating high
cumulative latex exposure and sensitization risk.
10. A hospitalized client has continuous generalized convulsive activity lasting more than 5 minutes. Which
medication class should the nurse anticipate first for rapid seizure termination?
A. A routine oral stool softener.
B. A delayed long-term vitamin supplement.
C. A topical antifungal cream.
D. A benzodiazepine given by an appropriate rapid route.
Correct Answer: D. A benzodiazepine given by an appropriate rapid route.
Explanation: Convulsive status epilepticus is a neurologic emergency. A rapidly acting benzodiazepine is
first-line for immediate seizure control, followed by longer-acting antiseizure therapy as indicated.
11. The nurse questions an order because the prescribed dose appears dangerously high. Which ethical
principle is most directly supported?
A. Fidelity only.
B. Justice only.
C. Confidentiality only.
D. Nonmaleficence - avoiding preventable harm.
Correct Answer: D. Nonmaleficence - avoiding preventable harm.
Explanation: Nonmaleficence requires avoiding or preventing harm. Questioning a potentially unsafe dose is an
important safety responsibility.
12. After hypospadias repair, which nursing priority is common?
A. Remove the stent whenever the child cries.
B. Allow straddle toys immediately.
C. Apply pressure directly over the repair.
D. Protect the urinary stent or catheter and monitor urine drainage and surgical-site swelling.
Correct Answer: D. Protect the urinary stent or catheter and monitor urine drainage and surgical-site swelling.
, Explanation: Urinary diversion protects the repair and must remain patent; trauma to the operative site is
avoided.
13. A client with Adrenal crisis requires further care. What should the nurse do next?
A. Monitor glucose, blood pressure, infection risk, skin integrity, and bone health while treating the source of
cortisol excess.
B. Give rapid isotonic fluid resuscitation and IV glucocorticoid therapy as ordered, correcting glucose and
electrolytes.
C. Minimize triggers and prepare for prescribed alpha blockade before beta blockade and surgical management.
D. Monitor potassium and blood pressure and administer prescribed mineralocorticoid antagonism or prepare for
definitive therapy.
Correct Answer: B. Give rapid isotonic fluid resuscitation and IV glucocorticoid therapy as ordered, correcting
glucose and electrolytes.
Explanation: This action addresses the highest-priority risk in Adrenal crisis. Adrenal crisis is acute cortisol
deficiency with severe hypotension, volume depletion, electrolyte abnormalities, and possible hypoglycemia.
14. A visitor asks the nurse for laboratory results of an alert adult client. What should the nurse do?
A. Give the results because the visitor says they are family.
B. Post the results at the nurses' station.
C. Discuss the results in the elevator so others can hear.
D. Obtain the client's permission before sharing protected information.
Correct Answer: D. Obtain the client's permission before sharing protected information.
Explanation: Client information is shared only with authorized individuals and for appropriate purposes. Family
relationship alone does not automatically authorize disclosure.
15. Which technique is required when inserting an indwelling urinary catheter in an acute-care setting?
A. Sterile technique for catheter insertion.
B. Clean gloves only for the entire insertion.
C. No hand hygiene if a sterile kit is used.
D. Reuse of a catheter that accidentally touches the bed linens.
Correct Answer: A. Sterile technique for catheter insertion.
Explanation: Indwelling catheter insertion is performed using aseptic sterile technique to reduce introduction of
microorganisms into the urinary tract.
16. During pediatric care, a child using an insulin pump has persistent hyperglycemia and ketones after the
infusion set becomes dislodged. What is the priority? Pump and glucose data Glucose 348 mg/dL Ketones
Moderate Pump site Dislodged Symptoms Nausea
A. Wait until the next scheduled meal.
B. Drink only water and omit insulin.
C. Follow the diabetes emergency plan to restore insulin delivery and evaluate for evolving DKA.
D. Exercise vigorously to lower glucose.
Correct Answer: C. Follow the diabetes emergency plan to restore insulin delivery and evaluate for evolving
DKA.
Explanation: Pump interruption can rapidly lead to insulin deficiency and ketosis because only rapid-acting
insulin is typically used in pumps.
17. During nursing care, a client receives oral fluids for mild dehydration. Which trend best indicates
improvement? Reassessment after oral rehydration Finding Before After Pulse 104/min 86/min Mucous
membranes Dry Moist Urine output 20 mL/hr 45 mL/hr
A. Pulse rises and urine output falls.
B. Heart rate decreases, mucous membranes become moist, and urine output increases.
C. New crackles develop with worsening dyspnea.
D. Orthostatic dizziness becomes more severe.
Correct Answer: B. Heart rate decreases, mucous membranes become moist, and urine output increases.
Explanation: Improved perfusion and hydration are reflected by a lower compensatory pulse, moist mucosa, and
increasing urine output.
18. While transporting a client by wheelchair, the nurse notices a blanket edge and one foot hanging near
the wheel. What correction should be made before continuing?
A. Feet supported on footrests with arms and clothing clear of the wheels.
WITH ANSWERS AND EXPLANATIONS
1. A competent laboring client declines a proposed procedure after receiving an explanation of risks and
benefits. What should the nurse do?
A. Obtain consent from the partner instead.
B. Perform the procedure because labor is painful.
C. Respect the decision, notify the care team, and continue supportive care.
D. Document that the client is noncompliant and stop care.
Correct Answer: C. Respect the decision, notify the care team, and continue supportive care.
Explanation: Competent clients retain the right to informed refusal. The nurse supports autonomy, ensures
communication, and documents the decision and education provided.
2. A laboring client is GBS-positive and has no penicillin allergy. Which medication is commonly used for
intrapartum prophylaxis?
A. IV penicillin G.
B. Oral acyclovir.
C. Methylergonovine.
D. Magnesium sulfate.
Correct Answer: A. IV penicillin G.
Explanation: Penicillin is the preferred intrapartum antibiotic for GBS prophylaxis when no significant allergy is
present.
3. During nursing care, a client with advanced cirrhosis develops rising creatinine and oliguria without
evidence of shock, nephrotoxin exposure, or structural kidney disease. Which condition is most
concerning?
A. Acute appendicitis.
B. Simple urinary frequency.
C. Hepatorenal syndrome.
D. Stable nephrolithiasis without obstruction.
Correct Answer: C. Hepatorenal syndrome.
Explanation: Hepatorenal syndrome is a functional renal failure associated with advanced cirrhosis and profound
circulatory changes after other causes of kidney injury have been excluded.
4. Four clients arrive after an industrial explosion. Which client should be assessed first?
A. A client with a closed wrist fracture and intact pulses.
B. A client with facial burns, hoarseness, soot in the mouth, and increasing stridor.
C. A client with a superficial leg laceration and controlled bleeding.
D. A client requesting a tetanus booster for a small abrasion.
Correct Answer: B. A client with facial burns, hoarseness, soot in the mouth, and increasing stridor.
Explanation: Hoarseness, soot, facial burns, and worsening stridor indicate threatened airway obstruction from
inhalation injury. Airway compromise takes priority over stable musculoskeletal and minor wounds.
5. Which plan is safest for insulin and diabetes supplies at school?
A. Lock all supplies where the child and trained staff cannot reach them.
B. Send no fast-acting carbohydrate to school.
C. Require the child to skip lunch insulin every day.
D. Keep supplies accessible according to the child’s diabetes medical management plan and school policy.
Correct Answer: D. Keep supplies accessible according to the child’s diabetes medical management plan and
school policy.
Explanation: Children need timely access to glucose monitoring, insulin, and hypoglycemia treatment during the
school day.
6. Which condition is required before a fetal scalp electrode can be applied?
A. The membranes must be ruptured and the cervix sufficiently dilated to reach the presenting part.
B. The membranes must be intact.
C. The fetus must be transverse.
D. The client must be postpartum.
Correct Answer: A. The membranes must be ruptured and the cervix sufficiently dilated to reach the presenting
,part.
Explanation: Internal fetal heart monitoring requires ruptured membranes and access to the presenting fetal part.
7. Which ethical principle focuses on fairness in the distribution of care and resources?
A. Veracity.
B. Fidelity.
C. Autonomy.
D. Justice.
Correct Answer: D. Justice.
Explanation: Justice concerns fairness and equitable treatment. Other principles address truthfulness, promises,
and self-determination.
8. Which intervention most directly reduces the immediate risk from Controlled-substance handling?
A. Hold the medication and clarify an incomplete, illegible, or clinically unsafe order before administration.
B. Document administration accurately and complete required witness and wasting procedures at the time they
occur.
C. Compare prescription drugs, over-the-counter products, supplements, and actual use with current orders.
D. Use a new sterile needle and syringe for every injection and every vial entry.
Correct Answer: B. Document administration accurately and complete required witness and wasting procedures
at the time they occur.
Explanation: This action addresses the highest-priority risk in Controlled-substance handling. Controlled
substances require secure storage, accurate documentation, witnessed waste when required, and prompt
investigation of discrepancies to reduce diversion and dosing errors.
9. Why should a child with spina bifida be considered at increased risk for latex allergy?
A. Latex allergy occurs only in children with asthma.
B. Repeated healthcare exposures increase the likelihood of latex sensitization.
C. Spina bifida prevents all immune reactions.
D. Latex causes hydrocephalus directly.
Correct Answer: B. Repeated healthcare exposures increase the likelihood of latex sensitization.
Explanation: Children with spina bifida often have repeated surgeries and catheterizations, creating high
cumulative latex exposure and sensitization risk.
10. A hospitalized client has continuous generalized convulsive activity lasting more than 5 minutes. Which
medication class should the nurse anticipate first for rapid seizure termination?
A. A routine oral stool softener.
B. A delayed long-term vitamin supplement.
C. A topical antifungal cream.
D. A benzodiazepine given by an appropriate rapid route.
Correct Answer: D. A benzodiazepine given by an appropriate rapid route.
Explanation: Convulsive status epilepticus is a neurologic emergency. A rapidly acting benzodiazepine is
first-line for immediate seizure control, followed by longer-acting antiseizure therapy as indicated.
11. The nurse questions an order because the prescribed dose appears dangerously high. Which ethical
principle is most directly supported?
A. Fidelity only.
B. Justice only.
C. Confidentiality only.
D. Nonmaleficence - avoiding preventable harm.
Correct Answer: D. Nonmaleficence - avoiding preventable harm.
Explanation: Nonmaleficence requires avoiding or preventing harm. Questioning a potentially unsafe dose is an
important safety responsibility.
12. After hypospadias repair, which nursing priority is common?
A. Remove the stent whenever the child cries.
B. Allow straddle toys immediately.
C. Apply pressure directly over the repair.
D. Protect the urinary stent or catheter and monitor urine drainage and surgical-site swelling.
Correct Answer: D. Protect the urinary stent or catheter and monitor urine drainage and surgical-site swelling.
, Explanation: Urinary diversion protects the repair and must remain patent; trauma to the operative site is
avoided.
13. A client with Adrenal crisis requires further care. What should the nurse do next?
A. Monitor glucose, blood pressure, infection risk, skin integrity, and bone health while treating the source of
cortisol excess.
B. Give rapid isotonic fluid resuscitation and IV glucocorticoid therapy as ordered, correcting glucose and
electrolytes.
C. Minimize triggers and prepare for prescribed alpha blockade before beta blockade and surgical management.
D. Monitor potassium and blood pressure and administer prescribed mineralocorticoid antagonism or prepare for
definitive therapy.
Correct Answer: B. Give rapid isotonic fluid resuscitation and IV glucocorticoid therapy as ordered, correcting
glucose and electrolytes.
Explanation: This action addresses the highest-priority risk in Adrenal crisis. Adrenal crisis is acute cortisol
deficiency with severe hypotension, volume depletion, electrolyte abnormalities, and possible hypoglycemia.
14. A visitor asks the nurse for laboratory results of an alert adult client. What should the nurse do?
A. Give the results because the visitor says they are family.
B. Post the results at the nurses' station.
C. Discuss the results in the elevator so others can hear.
D. Obtain the client's permission before sharing protected information.
Correct Answer: D. Obtain the client's permission before sharing protected information.
Explanation: Client information is shared only with authorized individuals and for appropriate purposes. Family
relationship alone does not automatically authorize disclosure.
15. Which technique is required when inserting an indwelling urinary catheter in an acute-care setting?
A. Sterile technique for catheter insertion.
B. Clean gloves only for the entire insertion.
C. No hand hygiene if a sterile kit is used.
D. Reuse of a catheter that accidentally touches the bed linens.
Correct Answer: A. Sterile technique for catheter insertion.
Explanation: Indwelling catheter insertion is performed using aseptic sterile technique to reduce introduction of
microorganisms into the urinary tract.
16. During pediatric care, a child using an insulin pump has persistent hyperglycemia and ketones after the
infusion set becomes dislodged. What is the priority? Pump and glucose data Glucose 348 mg/dL Ketones
Moderate Pump site Dislodged Symptoms Nausea
A. Wait until the next scheduled meal.
B. Drink only water and omit insulin.
C. Follow the diabetes emergency plan to restore insulin delivery and evaluate for evolving DKA.
D. Exercise vigorously to lower glucose.
Correct Answer: C. Follow the diabetes emergency plan to restore insulin delivery and evaluate for evolving
DKA.
Explanation: Pump interruption can rapidly lead to insulin deficiency and ketosis because only rapid-acting
insulin is typically used in pumps.
17. During nursing care, a client receives oral fluids for mild dehydration. Which trend best indicates
improvement? Reassessment after oral rehydration Finding Before After Pulse 104/min 86/min Mucous
membranes Dry Moist Urine output 20 mL/hr 45 mL/hr
A. Pulse rises and urine output falls.
B. Heart rate decreases, mucous membranes become moist, and urine output increases.
C. New crackles develop with worsening dyspnea.
D. Orthostatic dizziness becomes more severe.
Correct Answer: B. Heart rate decreases, mucous membranes become moist, and urine output increases.
Explanation: Improved perfusion and hydration are reflected by a lower compensatory pulse, moist mucosa, and
increasing urine output.
18. While transporting a client by wheelchair, the nurse notices a blanket edge and one foot hanging near
the wheel. What correction should be made before continuing?
A. Feet supported on footrests with arms and clothing clear of the wheels.
