2025 HESI EXIT
V3 EXAM
NCLEX (NGN), Case-based Scenarios,
Actual Qs & Ans to Pass the Exam
THIS HESI EXIT CONSISTS OF
160 Questions and Answers
Multiple-choice Style
Select All That Apply (SATA), ordering, fill-in-the-blank for dosage
including Next Generation NCLEX (NGN) items
Case-based Scenarios
Expert Rationales consistent with HESI−Elsevier/Evolve standards.
,QUESTION 1 (Standard MCQ)
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A male client with stomach cancer returns to the unit following a total gastrectomy. He
has a nasogastric tube to suction and is receiving Lactated Ringer’s solution at 75
mL/hour IV. One hour after admission to the unit, the nurse notes 300 mL of blood in the
suction canister, the client’s heart rate is 155 beats/minute, and his blood pressure is
78/48 mmHg. In addition to reporting the finding to the surgeon, which action should the
nurse implement first?
A. Measure and document the client’s urinary output.
B. Request the client’s reserved unit of packed red blood cells.
C. Prepare the placement of a central venous catheter.
D. Increase the infusion rate of Lactated Ringer’s solution.
Correct Answer: D. Increase the infusion rate of Lactated Ringer’s solution.
Expert-Verified Explanation:
• Losing 300 mL of blood in an hour suggests acute blood loss.
• Tachycardia (155 bpm) and hypotension (78/48 mmHg) indicate a shocky state.
• The priority is to restore intravascular volume by increasing IV fluids.
• Reporting to the surgeon, measuring output, and obtaining RBCs are also important but
come after increasing the IV rate.
NGN/Case-Study Tip:
• An unfolding scenario could track vital signs, suction output, and labs. Test-takers
would prioritize interventions in real time.
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QUESTION 2 (Standard MCQ)
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An adult male who fell 20 feet from the roof of his home has multiple injuries, including a
right pneumothorax. Chest tubes were inserted in the emergency department before his
transfer to the ICU. The nurse notes that the suction control chamber is bubbling at the –
10 cm H2O mark, with fluctuation in the water seal; and over the past hour, 75 mL of
bright red blood was measured in the collection chamber. Which intervention should the
nurse implement?
A. Add sterile water to the suction control chamber.
B. Give blood from the collection chamber as auto-transfusion.
C. Manipulate blood in tubing to drain into chamber.
D. Increase wall suction to eliminate fluctuation in water seal.
Correct Answer: A. Add sterile water to the suction control chamber.
Expert-Verified Explanation:
• The nurse must maintain the correct water level (–10 cm H2O) to ensure appropriate
negative pressure.
• Bubbling in the suction chamber is normal, but if water level is low, refill with sterile
water.
• Tidaling in the water seal is expected; it should not be “eliminated” via excessive wall
suction.
NGN/Case-Study Tip:
, • Could present chest tube data over time (amount drained, changes in water seal, etc.)
and prompt actions based on changes.
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QUESTION 3 (Standard MCQ)
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A client who received hemodialysis yesterday is experiencing a blood pressure of
200/100 mmHg, heart rate 110 beats/minute, and respiratory rate 36 breaths/minute. The
client reports shortness of breath, has bilateral +2 pedal edema, and an oxygen
saturation on room air of 89%. Which action should the nurse take first?
A. Elevate the foot of the bed.
B. Restrict the client’s fluid.
C. Begin supplemental oxygen.
D. Prepare the client for hemodialysis.
Correct Answer: C . Begin supplemental oxygen.
Expert-Verified Explanation:
• An SpO₂ of 89%, tachypnea (36/min), and dyspnea are signs of acute respiratory
distress.
• Address “A-B-C” first by giving supplemental oxygen to improve oxygenation.
• Other interventions (fluid restriction, dialysis) are important but follow oxygen
administration.
NGN/Case-Study Tip:
V3 EXAM
NCLEX (NGN), Case-based Scenarios,
Actual Qs & Ans to Pass the Exam
THIS HESI EXIT CONSISTS OF
160 Questions and Answers
Multiple-choice Style
Select All That Apply (SATA), ordering, fill-in-the-blank for dosage
including Next Generation NCLEX (NGN) items
Case-based Scenarios
Expert Rationales consistent with HESI−Elsevier/Evolve standards.
,QUESTION 1 (Standard MCQ)
───────────────────────────────────────────────────────
─
A male client with stomach cancer returns to the unit following a total gastrectomy. He
has a nasogastric tube to suction and is receiving Lactated Ringer’s solution at 75
mL/hour IV. One hour after admission to the unit, the nurse notes 300 mL of blood in the
suction canister, the client’s heart rate is 155 beats/minute, and his blood pressure is
78/48 mmHg. In addition to reporting the finding to the surgeon, which action should the
nurse implement first?
A. Measure and document the client’s urinary output.
B. Request the client’s reserved unit of packed red blood cells.
C. Prepare the placement of a central venous catheter.
D. Increase the infusion rate of Lactated Ringer’s solution.
Correct Answer: D. Increase the infusion rate of Lactated Ringer’s solution.
Expert-Verified Explanation:
• Losing 300 mL of blood in an hour suggests acute blood loss.
• Tachycardia (155 bpm) and hypotension (78/48 mmHg) indicate a shocky state.
• The priority is to restore intravascular volume by increasing IV fluids.
• Reporting to the surgeon, measuring output, and obtaining RBCs are also important but
come after increasing the IV rate.
NGN/Case-Study Tip:
• An unfolding scenario could track vital signs, suction output, and labs. Test-takers
would prioritize interventions in real time.
,───────────────────────────────────────────────────────
─
QUESTION 2 (Standard MCQ)
───────────────────────────────────────────────────────
─
An adult male who fell 20 feet from the roof of his home has multiple injuries, including a
right pneumothorax. Chest tubes were inserted in the emergency department before his
transfer to the ICU. The nurse notes that the suction control chamber is bubbling at the –
10 cm H2O mark, with fluctuation in the water seal; and over the past hour, 75 mL of
bright red blood was measured in the collection chamber. Which intervention should the
nurse implement?
A. Add sterile water to the suction control chamber.
B. Give blood from the collection chamber as auto-transfusion.
C. Manipulate blood in tubing to drain into chamber.
D. Increase wall suction to eliminate fluctuation in water seal.
Correct Answer: A. Add sterile water to the suction control chamber.
Expert-Verified Explanation:
• The nurse must maintain the correct water level (–10 cm H2O) to ensure appropriate
negative pressure.
• Bubbling in the suction chamber is normal, but if water level is low, refill with sterile
water.
• Tidaling in the water seal is expected; it should not be “eliminated” via excessive wall
suction.
NGN/Case-Study Tip:
, • Could present chest tube data over time (amount drained, changes in water seal, etc.)
and prompt actions based on changes.
───────────────────────────────────────────────────────
─
QUESTION 3 (Standard MCQ)
───────────────────────────────────────────────────────
─
A client who received hemodialysis yesterday is experiencing a blood pressure of
200/100 mmHg, heart rate 110 beats/minute, and respiratory rate 36 breaths/minute. The
client reports shortness of breath, has bilateral +2 pedal edema, and an oxygen
saturation on room air of 89%. Which action should the nurse take first?
A. Elevate the foot of the bed.
B. Restrict the client’s fluid.
C. Begin supplemental oxygen.
D. Prepare the client for hemodialysis.
Correct Answer: C . Begin supplemental oxygen.
Expert-Verified Explanation:
• An SpO₂ of 89%, tachypnea (36/min), and dyspnea are signs of acute respiratory
distress.
• Address “A-B-C” first by giving supplemental oxygen to improve oxygenation.
• Other interventions (fluid restriction, dialysis) are important but follow oxygen
administration.
NGN/Case-Study Tip:
