HESI EXIT NGN | HESI RN EXIT EXAM 2026–2027 | 75 Questions & NGN
Case Studies | Verified Correct Answer Format
HESI NGN & RN Exit Comprehensive Examination | Key Domains: Clinical Judgment,
Medical-Surgical Nursing, Pharmacology, Maternal-Newborn, Pediatrics, Mental Health,
Leadership, Delegation, Priority Setting, and Evidence-Based Practice | Structured Q&A Format
Introduction
This 2026–2027 HESI Exit NGN and HESI RN Exit Exam format includes the full exam length
of 75 items plus NGN case studies, each containing 4–6 related questions. Content aligns with
clinical reasoning expectations, safety standards, and the Clinical Judgment Measurement
Model used in Next-Generation HESI examinations.
Answer Format
All correct answers appear in bold, followed by concise rationales emphasizing patient safety,
clinical judgment, and priority nursing interventions.
CORE EXAM – 75 MULTIPLE-CHOICE QUESTIONS
1. A patient with a history of heart failure presents with a 3 kg weight gain in 2 days and
reports shortness of breath. What is the nurse’s priority action?
A. Obtain a chest X-ray
B. Auscultate lung sounds for crackles
C. Check oxygen saturation
D. Administer furosemide
Rationale: Crackles indicate pulmonary edema, a life-threatening complication
requiring immediate intervention.
2. A patient with COPD has an oxygen saturation of 82% on room air. The nurse applies 4
L/min via nasal cannula. The patient becomes lethargic. What is the likely cause?
A. Hypoxic drive suppression
B. CO₂ narcosis from excessive oxygen
C. Acute respiratory alkalosis
D. Pulmonary embolism
Rationale: High oxygen in chronic CO₂ retainers blunts hypoxic drive, leading to CO₂
narcosis.
3. A postoperative patient has a respiratory rate of 8/min after morphine administration.
What is the nurse’s first action?
A. Administer naloxone
B. Stimulate the patient and call for help
C. Apply oxygen via non-rebreather
D. Increase IV fluids
Rationale: Stimulation assesses level of consciousness while preparing for naloxone if
needed.
, 4. A patient with cirrhosis develops confusion and asterixis. What laboratory finding is
most concerning?
A. ALT 200 U/L
B. Ammonia level 120 mcg/dL
C. INR 1.3
D. Albumin 2.8 g/dL
Rationale: Elevated ammonia indicates hepatic encephalopathy, requiring lactulose
therapy.
5. A patient with a PE is started on heparin. Four hours later, the aPTT is 90 seconds
(control 30). What is the nurse’s priority?
A. Stop the infusion for 1 hour
B. Reduce the infusion rate per protocol
C. Administer protamine sulfate
D. Obtain a stat PTT
Rationale: aPTT >3× control requires rate reduction to prevent bleeding.
6. A patient with DKA has a potassium of 2.9 mEq/L. What is the priority intervention?
A. Start insulin drip
B. Administer IV potassium chloride
C. Give sodium bicarbonate
D. Begin fluid resuscitation
Rationale: Hypokalemia must be corrected before insulin to prevent fatal
dysrhythmias.
7. A patient with acute pancreatitis reports severe abdominal pain. What position provides
relief?
A. Supine
B. Fetal position
C. Prone
D. High Fowler’s
Rationale: Fetal position reduces pressure on the inflamed pancreas.
8. A patient with a chest tube has no fluctuation in the water-seal chamber. What is the
nurse’s first action?
A. Milk the tubing
B. Check for kinks or obstruction
C. Increase suction
D. Notify the surgeon
Rationale: Absence of tidaling may indicate obstruction or lung re-expansion.
9. A patient with a stroke receives tPA. What is the priority nursing action post-infusion?
A. Elevate head of bed to 90°
B. Maintain blood pressure <185/110 mmHg
C. Insert a Foley catheter
D. Start DVT prophylaxis
Rationale: Hypertension increases risk of intracranial hemorrhage after tPA.
10.A patient with a magnesium level of 3.8 mEq/L (normal 1.5–2.5) reports flushing and
lethargy. What is the antidote?
A. Calcium gluconate
Case Studies | Verified Correct Answer Format
HESI NGN & RN Exit Comprehensive Examination | Key Domains: Clinical Judgment,
Medical-Surgical Nursing, Pharmacology, Maternal-Newborn, Pediatrics, Mental Health,
Leadership, Delegation, Priority Setting, and Evidence-Based Practice | Structured Q&A Format
Introduction
This 2026–2027 HESI Exit NGN and HESI RN Exit Exam format includes the full exam length
of 75 items plus NGN case studies, each containing 4–6 related questions. Content aligns with
clinical reasoning expectations, safety standards, and the Clinical Judgment Measurement
Model used in Next-Generation HESI examinations.
Answer Format
All correct answers appear in bold, followed by concise rationales emphasizing patient safety,
clinical judgment, and priority nursing interventions.
CORE EXAM – 75 MULTIPLE-CHOICE QUESTIONS
1. A patient with a history of heart failure presents with a 3 kg weight gain in 2 days and
reports shortness of breath. What is the nurse’s priority action?
A. Obtain a chest X-ray
B. Auscultate lung sounds for crackles
C. Check oxygen saturation
D. Administer furosemide
Rationale: Crackles indicate pulmonary edema, a life-threatening complication
requiring immediate intervention.
2. A patient with COPD has an oxygen saturation of 82% on room air. The nurse applies 4
L/min via nasal cannula. The patient becomes lethargic. What is the likely cause?
A. Hypoxic drive suppression
B. CO₂ narcosis from excessive oxygen
C. Acute respiratory alkalosis
D. Pulmonary embolism
Rationale: High oxygen in chronic CO₂ retainers blunts hypoxic drive, leading to CO₂
narcosis.
3. A postoperative patient has a respiratory rate of 8/min after morphine administration.
What is the nurse’s first action?
A. Administer naloxone
B. Stimulate the patient and call for help
C. Apply oxygen via non-rebreather
D. Increase IV fluids
Rationale: Stimulation assesses level of consciousness while preparing for naloxone if
needed.
, 4. A patient with cirrhosis develops confusion and asterixis. What laboratory finding is
most concerning?
A. ALT 200 U/L
B. Ammonia level 120 mcg/dL
C. INR 1.3
D. Albumin 2.8 g/dL
Rationale: Elevated ammonia indicates hepatic encephalopathy, requiring lactulose
therapy.
5. A patient with a PE is started on heparin. Four hours later, the aPTT is 90 seconds
(control 30). What is the nurse’s priority?
A. Stop the infusion for 1 hour
B. Reduce the infusion rate per protocol
C. Administer protamine sulfate
D. Obtain a stat PTT
Rationale: aPTT >3× control requires rate reduction to prevent bleeding.
6. A patient with DKA has a potassium of 2.9 mEq/L. What is the priority intervention?
A. Start insulin drip
B. Administer IV potassium chloride
C. Give sodium bicarbonate
D. Begin fluid resuscitation
Rationale: Hypokalemia must be corrected before insulin to prevent fatal
dysrhythmias.
7. A patient with acute pancreatitis reports severe abdominal pain. What position provides
relief?
A. Supine
B. Fetal position
C. Prone
D. High Fowler’s
Rationale: Fetal position reduces pressure on the inflamed pancreas.
8. A patient with a chest tube has no fluctuation in the water-seal chamber. What is the
nurse’s first action?
A. Milk the tubing
B. Check for kinks or obstruction
C. Increase suction
D. Notify the surgeon
Rationale: Absence of tidaling may indicate obstruction or lung re-expansion.
9. A patient with a stroke receives tPA. What is the priority nursing action post-infusion?
A. Elevate head of bed to 90°
B. Maintain blood pressure <185/110 mmHg
C. Insert a Foley catheter
D. Start DVT prophylaxis
Rationale: Hypertension increases risk of intracranial hemorrhage after tPA.
10.A patient with a magnesium level of 3.8 mEq/L (normal 1.5–2.5) reports flushing and
lethargy. What is the antidote?
A. Calcium gluconate
