**Theme----- HESI RN Exit Exam 2024 NGN
**The Final Hurdle: NGN Exit Readiness Blueprint**
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1. Four patients. Which to assess first?
💫RATIONALE✔️✔️: Chest pain with diaphoresis is unstable angina/MI until ruled out.
💫ANSWER✔️✔️: A. 52-year-old with chest pain radiating to jaw and nausea
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2. Patient on warfarin, INR 4.5, no bleeding. Next action?
💫RATIONALE✔️✔️: Supratherapeutic INR 4.5 requires holding warfarin and possibly vitamin K.
💫ANSWER✔️✔️: C. Hold warfarin and notify provider
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3. Post-op day 2, sudden dyspnea, tachypnea, HR 120. Priority?
💫RATIONALE✔️✔️: Suspect pulmonary embolism. High-flow oxygen, prepare for CTA.
💫ANSWER✔️✔️: D. Apply oxygen 10L via non-rebreather
---
4. Heart failure, new prescription for carvedilol. Which finding requires holding dose?
💫RATIONALE✔️✔️: HR 52 or SBP <90 contraindicates beta-blocker initiation.
💫ANSWER✔️✔️: A. Heart rate 52 and BP 88/50
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5. Newborn of diabetic mother, blood glucose 35 mg/dL at 1 hour. Action?
💫RATIONALE✔️✔️: Asymptomatic hypoglycemia: feed immediately. Recheck in 30 min.
,💫ANSWER✔️✔️: C. Feed 1 oz formula or breastfeed
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6. Abdominal pain, vomiting, rigid board-like abdomen. Priority intervention?
💫RATIONALE✔️✔️: Perforated viscus/peritonitis. NPO, IV access, surgical consult.
💫ANSWER✔️✔️: B. Insert two large-bore IVs and begin NS bolus
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7. Lithium level 1.8 mEq/L, coarse tremor, nausea. Next?
💫RATIONALE✔️✔️: Toxic level (>1.5). Hold lithium, encourage fluids, repeat level.
💫ANSWER✔️✔️: D. Withhold lithium and notify provider
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8. Patient with aphasia after stroke. Best communication strategy?
💫RATIONALE✔️✔️: Use yes/no questions, picture board, speak slowly. Do not shout.
💫ANSWER✔️✔️: A. Ask “Are you in pain?” with pointing to pain scale
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9. Chemotherapy-induced neutropenia, ANC 200. Visitor with cough. Action?
💫RATIONALE✔️✔️: Neutropenic precautions: mask visitor, or ask to leave if symptomatic.
💫ANSWER✔️✔️: C. Provide mask to visitor and limit to 10 minutes
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10. Continuous IV heparin for DVT. aPTT 110 sec (control 30). Action?
💫RATIONALE✔️✔️: Goal aPTT 60-80. Supratherapeutic, stop heparin.
💫ANSWER✔️✔️: B. Stop heparin infusion
---
, 11. Blood transfusion 15 min in, patient reports low back pain and chills. Priority?
💫RATIONALE✔️✔️: Hemolytic reaction. Stop transfusion, keep line with NS, send blood to lab.
💫ANSWER✔️✔️: A. Stop transfusion and infuse normal saline
---
12. Small bowel obstruction, NGT output 1000 mL in 4 hours. Which finding requires immediate report?
💫RATIONALE✔️✔️: High output can cause metabolic alkalosis and hypokalemia. Check electrolytes.
💫ANSWER✔️✔️: D. Serum potassium 2.9 mEq/L
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13. TPN infusion finishes, new bag not available. Next action?
💫RATIONALE✔️✔️: Hang D10W at same rate to prevent rebound hypoglycemia.
💫ANSWER✔️✔️: A. Infuse 10% dextrose in water
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14. Patient fall, found on floor, not moving. First action?
💫RATIONALE✔️✔️: Assess responsiveness and breathing. Do not move unless airway compromised.
💫ANSWER✔️✔️: B. Check for responsiveness and breathing
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15. Epidural analgesia, HR 110, BP 85/50 after bolus. Immediate action?
💫RATIONALE✔️✔️: Epidural-induced hypotension. Lateral position, IV bolus, O2, notify anesthesia.
💫ANSWER✔️✔️: C. Turn patient left lateral and increase IV rate
---
16. Magnesium sulfate for preeclampsia. Which finding indicates toxicity?
💫RATIONALE✔️✔️: Respiratory rate 10 and absent DTRs. Antidote: calcium gluconate.
💫ANSWER✔️✔️: D. Respiratory rate 10 and areflexia
**The Final Hurdle: NGN Exit Readiness Blueprint**
---
1. Four patients. Which to assess first?
💫RATIONALE✔️✔️: Chest pain with diaphoresis is unstable angina/MI until ruled out.
💫ANSWER✔️✔️: A. 52-year-old with chest pain radiating to jaw and nausea
---
2. Patient on warfarin, INR 4.5, no bleeding. Next action?
💫RATIONALE✔️✔️: Supratherapeutic INR 4.5 requires holding warfarin and possibly vitamin K.
💫ANSWER✔️✔️: C. Hold warfarin and notify provider
---
3. Post-op day 2, sudden dyspnea, tachypnea, HR 120. Priority?
💫RATIONALE✔️✔️: Suspect pulmonary embolism. High-flow oxygen, prepare for CTA.
💫ANSWER✔️✔️: D. Apply oxygen 10L via non-rebreather
---
4. Heart failure, new prescription for carvedilol. Which finding requires holding dose?
💫RATIONALE✔️✔️: HR 52 or SBP <90 contraindicates beta-blocker initiation.
💫ANSWER✔️✔️: A. Heart rate 52 and BP 88/50
---
5. Newborn of diabetic mother, blood glucose 35 mg/dL at 1 hour. Action?
💫RATIONALE✔️✔️: Asymptomatic hypoglycemia: feed immediately. Recheck in 30 min.
,💫ANSWER✔️✔️: C. Feed 1 oz formula or breastfeed
---
6. Abdominal pain, vomiting, rigid board-like abdomen. Priority intervention?
💫RATIONALE✔️✔️: Perforated viscus/peritonitis. NPO, IV access, surgical consult.
💫ANSWER✔️✔️: B. Insert two large-bore IVs and begin NS bolus
---
7. Lithium level 1.8 mEq/L, coarse tremor, nausea. Next?
💫RATIONALE✔️✔️: Toxic level (>1.5). Hold lithium, encourage fluids, repeat level.
💫ANSWER✔️✔️: D. Withhold lithium and notify provider
---
8. Patient with aphasia after stroke. Best communication strategy?
💫RATIONALE✔️✔️: Use yes/no questions, picture board, speak slowly. Do not shout.
💫ANSWER✔️✔️: A. Ask “Are you in pain?” with pointing to pain scale
---
9. Chemotherapy-induced neutropenia, ANC 200. Visitor with cough. Action?
💫RATIONALE✔️✔️: Neutropenic precautions: mask visitor, or ask to leave if symptomatic.
💫ANSWER✔️✔️: C. Provide mask to visitor and limit to 10 minutes
---
10. Continuous IV heparin for DVT. aPTT 110 sec (control 30). Action?
💫RATIONALE✔️✔️: Goal aPTT 60-80. Supratherapeutic, stop heparin.
💫ANSWER✔️✔️: B. Stop heparin infusion
---
, 11. Blood transfusion 15 min in, patient reports low back pain and chills. Priority?
💫RATIONALE✔️✔️: Hemolytic reaction. Stop transfusion, keep line with NS, send blood to lab.
💫ANSWER✔️✔️: A. Stop transfusion and infuse normal saline
---
12. Small bowel obstruction, NGT output 1000 mL in 4 hours. Which finding requires immediate report?
💫RATIONALE✔️✔️: High output can cause metabolic alkalosis and hypokalemia. Check electrolytes.
💫ANSWER✔️✔️: D. Serum potassium 2.9 mEq/L
---
13. TPN infusion finishes, new bag not available. Next action?
💫RATIONALE✔️✔️: Hang D10W at same rate to prevent rebound hypoglycemia.
💫ANSWER✔️✔️: A. Infuse 10% dextrose in water
---
14. Patient fall, found on floor, not moving. First action?
💫RATIONALE✔️✔️: Assess responsiveness and breathing. Do not move unless airway compromised.
💫ANSWER✔️✔️: B. Check for responsiveness and breathing
---
15. Epidural analgesia, HR 110, BP 85/50 after bolus. Immediate action?
💫RATIONALE✔️✔️: Epidural-induced hypotension. Lateral position, IV bolus, O2, notify anesthesia.
💫ANSWER✔️✔️: C. Turn patient left lateral and increase IV rate
---
16. Magnesium sulfate for preeclampsia. Which finding indicates toxicity?
💫RATIONALE✔️✔️: Respiratory rate 10 and absent DTRs. Antidote: calcium gluconate.
💫ANSWER✔️✔️: D. Respiratory rate 10 and areflexia
