RN HESI Exit Exam V1 with NGN Questions and
Verified Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response
Client Scenario: A 68-year-old male client with a history of chronic obstructive
pulmonary disease (COPD) and coronary artery disease is admitted to the
medical-surgical unit with community-acquired pneumonia. He is alert, oriented, and
reports increasing shortness of breath, productive cough with yellow sputum, and
pleuritic chest pain. Vital signs: Temperature 38.9°C, HR 118, RR 28, BP 148/92, SpO2
88% on room air. Lung sounds reveal crackles in right lower lobe with diminished breath
sounds. He is receiving oxygen via nasal cannula at 2 L/min, IV fluids NS at 75 mL/hr,
and ceftriaxone 1 g IV every 24 hours. The nurse notes the client is using accessory
muscles and appears anxious. ABG results: pH 7.32, PaCO2 68 mmHg, PaO2 58 mmHg,
HCO3- 34 mEq/L.
Question Stem: Which assessment findings require immediate follow-up by the nurse?
(Select all that apply)
1. SpO2 88% on 2 L/min nasal cannula
2. Temperature 38.9°C
3. Client using accessory muscles
4. Heart rate 118 beats/min
5. PaO2 58 mmHg on ABG
6. Blood pressure 148/92 mmHg
(Correct Answer: 1, 3, 5)
,Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 3, and 5
● Clinical Judgment Rationalization: This scenario demonstrates the "Recognize
Cues" and "Analyze Cues" phases of the Clinical Judgment Measurement Model.
The nurse must identify data that signals life-threatening respiratory compromise.
An SpO2 of 88% indicates severe hypoxemia despite supplemental oxygen,
requiring immediate escalation per 2026 AARC guidelines (target SpO2 92-98%
for COPD patients). Accessory muscle use is a critical cue indicating impending
respiratory failure and increased work of breathing. A PaO2 of 58 mmHg confirms
acute hypoxemic respiratory failure (PaO2 <60 mmHg). These three findings
cluster to form a pattern of deteriorating gas exchange requiring urgent
intervention. The nurse must analyze these cues as priority over isolated findings
like fever or tachycardia, which are expected responses to infection but not
immediately life-threatening.
● Distractor Justification: Option 2 (Temperature 38.9°C) and Option 4 (HR 118) are
expected physiologic responses to infection and pneumonia. While they require
monitoring, they do not represent immediate threats to
airway/breathing/circulation. Option 6 (BP 148/92) is elevated but not in a
hypertensive crisis range requiring immediate intervention. These distractors test
the nurse's ability to differentiate between expected inflammatory responses versus
life-threatening respiratory decompensation cues that demand immediate action.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario: A 45-year-old female client is admitted with diabetic ketoacidosis
(DKA). She has type 1 diabetes mellitus for 22 years. Current vital signs: HR 122, RR 32
(deep, rapid respirations), BP 98/52, Temp 36.8°C, SpO2 97% on room air. She is
lethargic but arousable. Labs: Glucose 688 mg/dL, BUN 38 mg/dL, Creatinine 1.4
mg/dL, K+ 3.2 mEq/L, Na+ 132 mEq/L, Cl- 98 mEq/L, HCO3- 12 mEq/L, pH 7.18.
Urine positive for ketones and glucose. Physician orders: NS 1 L bolus, then NS at 250
,mL/hr, regular insulin infusion 0.1 units/kg/hr, potassium chloride 20 mEq in 1 L NS,
hourly blood glucose checks, hourly neuro checks.
Question Stem: For each nursing action, determine if it is an Immediate Priority, a
Subsequent Priority, or Not a Priority at this time.
TableCopy
Immediate Subsequent Not a
Nursing Action
Priority Priority Priority
Initiate insulin infusion at 0.1 units/kg/hr ☐ ☐ ☐
Establish second peripheral IV line ☐ ☐ ☐
Administer potassium chloride 20 mEq
☐ ☐ ☐
in 1 L NS
Call physician to clarify fluid rate ☐ ☐ ☐
Obtain 12-lead ECG ☐ ☐ ☐
Insert indwelling urinary catheter ☐ ☐ ☐
(Correct Answer: Immediate Priority = Initiate insulin infusion at 0.1 units/kg/hr,
Establish second peripheral IV line; Subsequent Priority = Administer potassium
chloride 20 mEq in 1 L NS, Obtain 12-lead ECG; Not a Priority = Call physician to
clarify fluid rate, Insert indwelling urinary catheter)
, Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: Immediate Priority: Initiate insulin infusion at 0.1 units/kg/hr,
Establish second peripheral IV line. Subsequent Priority: Administer potassium
chloride 20 mEq in 1 L NS, Obtain 12-lead ECG. Not a Priority: Call physician to
clarify fluid rate, Insert indwelling urinary catheter.
● Clinical Judgment Rationalization: This matrix assesses "Prioritize Hypotheses"
and "Generate Solutions" steps within the Clinical Judgment Model. In DKA, the
priority is establishing insulin therapy to halt ketogenesis and close the anion
gap—this is the single most critical intervention. A second IV line is immediate
priority for concurrent fluid and electrolyte administration. Potassium is a
subsequent priority because insulin drives K+ into cells, but the K+ of 3.2 mEq/L
is above the critical threshold (<3.0) where insulin must be held; it should be given
within the first hour but after insulin initiation. An ECG is subsequent priority to
evaluate the cardiac effects of hypokalemia and acidosis. Calling to clarify the
fluid rate is not a priority because the ordered rate is standard for DKA (250 mL/hr
after bolus)—the nurse should implement standing orders unless contraindicated.
A urinary catheter is not a priority because the client is arousable and can void
spontaneously; it increases infection risk and is reserved for anuric or critically ill
patients.
● Distractor Justification: The "Call physician" option tests whether the nurse
recognizes standard DKA protocols versus unnecessary verification that delays
care. The "Urinary catheter" option tests understanding of infection prevention and
that urinary output can be measured without catheterization in a moderately ill but
alert patient.
Item ID: HESI-EXIT-V1-003
Item Type: Complex Stand-Alone
Client Scenario: A 78-year-old male client is 3 days post-op from a total hip arthroplasty.
He has a history of atrial fibrillation on warfarin (held pre-op), hypertension, and benign
prostatic hyperplasia. He reports sudden onset of chest pain and shortness of breath while
ambulating to the bathroom. Vital signs: HR 126 (irregular), RR 28, BP 148/88, SpO2
Verified Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response
Client Scenario: A 68-year-old male client with a history of chronic obstructive
pulmonary disease (COPD) and coronary artery disease is admitted to the
medical-surgical unit with community-acquired pneumonia. He is alert, oriented, and
reports increasing shortness of breath, productive cough with yellow sputum, and
pleuritic chest pain. Vital signs: Temperature 38.9°C, HR 118, RR 28, BP 148/92, SpO2
88% on room air. Lung sounds reveal crackles in right lower lobe with diminished breath
sounds. He is receiving oxygen via nasal cannula at 2 L/min, IV fluids NS at 75 mL/hr,
and ceftriaxone 1 g IV every 24 hours. The nurse notes the client is using accessory
muscles and appears anxious. ABG results: pH 7.32, PaCO2 68 mmHg, PaO2 58 mmHg,
HCO3- 34 mEq/L.
Question Stem: Which assessment findings require immediate follow-up by the nurse?
(Select all that apply)
1. SpO2 88% on 2 L/min nasal cannula
2. Temperature 38.9°C
3. Client using accessory muscles
4. Heart rate 118 beats/min
5. PaO2 58 mmHg on ABG
6. Blood pressure 148/92 mmHg
(Correct Answer: 1, 3, 5)
,Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: 1, 3, and 5
● Clinical Judgment Rationalization: This scenario demonstrates the "Recognize
Cues" and "Analyze Cues" phases of the Clinical Judgment Measurement Model.
The nurse must identify data that signals life-threatening respiratory compromise.
An SpO2 of 88% indicates severe hypoxemia despite supplemental oxygen,
requiring immediate escalation per 2026 AARC guidelines (target SpO2 92-98%
for COPD patients). Accessory muscle use is a critical cue indicating impending
respiratory failure and increased work of breathing. A PaO2 of 58 mmHg confirms
acute hypoxemic respiratory failure (PaO2 <60 mmHg). These three findings
cluster to form a pattern of deteriorating gas exchange requiring urgent
intervention. The nurse must analyze these cues as priority over isolated findings
like fever or tachycardia, which are expected responses to infection but not
immediately life-threatening.
● Distractor Justification: Option 2 (Temperature 38.9°C) and Option 4 (HR 118) are
expected physiologic responses to infection and pneumonia. While they require
monitoring, they do not represent immediate threats to
airway/breathing/circulation. Option 6 (BP 148/92) is elevated but not in a
hypertensive crisis range requiring immediate intervention. These distractors test
the nurse's ability to differentiate between expected inflammatory responses versus
life-threatening respiratory decompensation cues that demand immediate action.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid
Client Scenario: A 45-year-old female client is admitted with diabetic ketoacidosis
(DKA). She has type 1 diabetes mellitus for 22 years. Current vital signs: HR 122, RR 32
(deep, rapid respirations), BP 98/52, Temp 36.8°C, SpO2 97% on room air. She is
lethargic but arousable. Labs: Glucose 688 mg/dL, BUN 38 mg/dL, Creatinine 1.4
mg/dL, K+ 3.2 mEq/L, Na+ 132 mEq/L, Cl- 98 mEq/L, HCO3- 12 mEq/L, pH 7.18.
Urine positive for ketones and glucose. Physician orders: NS 1 L bolus, then NS at 250
,mL/hr, regular insulin infusion 0.1 units/kg/hr, potassium chloride 20 mEq in 1 L NS,
hourly blood glucose checks, hourly neuro checks.
Question Stem: For each nursing action, determine if it is an Immediate Priority, a
Subsequent Priority, or Not a Priority at this time.
TableCopy
Immediate Subsequent Not a
Nursing Action
Priority Priority Priority
Initiate insulin infusion at 0.1 units/kg/hr ☐ ☐ ☐
Establish second peripheral IV line ☐ ☐ ☐
Administer potassium chloride 20 mEq
☐ ☐ ☐
in 1 L NS
Call physician to clarify fluid rate ☐ ☐ ☐
Obtain 12-lead ECG ☐ ☐ ☐
Insert indwelling urinary catheter ☐ ☐ ☐
(Correct Answer: Immediate Priority = Initiate insulin infusion at 0.1 units/kg/hr,
Establish second peripheral IV line; Subsequent Priority = Administer potassium
chloride 20 mEq in 1 L NS, Obtain 12-lead ECG; Not a Priority = Call physician to
clarify fluid rate, Insert indwelling urinary catheter)
, Rationale (Verified & Rationalized | 100% Guarantee | 2026):
● Correct Answer: Immediate Priority: Initiate insulin infusion at 0.1 units/kg/hr,
Establish second peripheral IV line. Subsequent Priority: Administer potassium
chloride 20 mEq in 1 L NS, Obtain 12-lead ECG. Not a Priority: Call physician to
clarify fluid rate, Insert indwelling urinary catheter.
● Clinical Judgment Rationalization: This matrix assesses "Prioritize Hypotheses"
and "Generate Solutions" steps within the Clinical Judgment Model. In DKA, the
priority is establishing insulin therapy to halt ketogenesis and close the anion
gap—this is the single most critical intervention. A second IV line is immediate
priority for concurrent fluid and electrolyte administration. Potassium is a
subsequent priority because insulin drives K+ into cells, but the K+ of 3.2 mEq/L
is above the critical threshold (<3.0) where insulin must be held; it should be given
within the first hour but after insulin initiation. An ECG is subsequent priority to
evaluate the cardiac effects of hypokalemia and acidosis. Calling to clarify the
fluid rate is not a priority because the ordered rate is standard for DKA (250 mL/hr
after bolus)—the nurse should implement standing orders unless contraindicated.
A urinary catheter is not a priority because the client is arousable and can void
spontaneously; it increases infection risk and is reserved for anuric or critically ill
patients.
● Distractor Justification: The "Call physician" option tests whether the nurse
recognizes standard DKA protocols versus unnecessary verification that delays
care. The "Urinary catheter" option tests understanding of infection prevention and
that urinary output can be measured without catheterization in a moderately ill but
alert patient.
Item ID: HESI-EXIT-V1-003
Item Type: Complex Stand-Alone
Client Scenario: A 78-year-old male client is 3 days post-op from a total hip arthroplasty.
He has a history of atrial fibrillation on warfarin (held pre-op), hypertension, and benign
prostatic hyperplasia. He reports sudden onset of chest pain and shortness of breath while
ambulating to the bathroom. Vital signs: HR 126 (irregular), RR 28, BP 148/88, SpO2
