NGN HESI RN Exit
NGN HESI RN Exit Practice Exam 2026
Edition 100 Advanced Questions with
Answers and Detailed Rationales
Part 1: Questions 1–25
Advanced NCLEX/HESI-Level Clinical Judgment Questions
Question 1
A nurse is caring for a client admitted with acute ischemic stroke 2 hours after symptom onset.
Which assessment finding requires the nurse’s immediate action?
A. Blood pressure of 168/92 mmHg
B. Mild expressive aphasia
C. Oxygen saturation of 89% on room air
D. Blood glucose of 140 mg/dL
Answer: C. Oxygen saturation of 89% on room air
Rationale:
Airway and oxygenation are priority. Hypoxia worsens cerebral ischemia and must be corrected
immediately. Blood pressure may be intentionally elevated during acute stroke management to
maintain cerebral perfusion unless critically high. Aphasia is an expected neurological deficit.
Glucose is acceptable.
Question 2
A client receiving IV heparin for a pulmonary embolism has an aPTT result of 120 seconds.
What action should the nurse take first?
A. Increase the infusion rate
B. Stop the infusion temporarily
C. Administer vitamin K
D. Give protamine sulfate immediately
Answer: B. Stop the infusion temporarily
, NGN HESI RN Exit
Rationale:
An excessively elevated aPTT indicates increased bleeding risk. The nurse should follow the
heparin protocol, which commonly requires holding the infusion and notifying the provider.
Vitamin K reverses warfarin, not heparin. Protamine is used for significant heparin reversal.
Question 3
NGN Bow-Tie Style
A client with heart failure reports increasing shortness of breath. Assessment findings:
Weight gain of 3 kg in 3 days
Bilateral crackles
Elevated BNP
Peripheral edema
Select the appropriate options:
Most likely condition:
☐ Fluid volume deficit
☑ Acute fluid overload
☐ Septic shock
Priority interventions:
☑ Administer prescribed diuretics
☑ Place client in semi-Fowler position
☐ Encourage increased oral fluids
Expected outcome:
☑ Reduced respiratory distress and improved oxygenation
Rationale:
Rapid weight gain, crackles, edema, and elevated BNP indicate worsening heart failure with
fluid retention. Positioning improves lung expansion, and diuretics decrease preload.
Question 4
A postoperative client suddenly develops chest pain, tachycardia, and dyspnea. Which action
should the nurse take first?
, NGN HESI RN Exit
A. Obtain a 12-lead ECG
B. Apply oxygen
C. Administer morphine
D. Notify the surgeon
Answer: B. Apply oxygen
Rationale:
The priority is airway and oxygenation. The client may have a pulmonary embolism. Oxygen
should be applied immediately while further assessment occurs.
Question 5
A nurse is preparing discharge teaching for a client taking warfarin. Which statement indicates
correct understanding?
A. “I will avoid all foods containing vitamin K.”
B. “I will use aspirin for headaches.”
C. “I will keep my vitamin K intake consistent.”
D. “I can stop the medication when I feel better.”
Answer: C. “I will keep my vitamin K intake consistent.”
Rationale:
Warfarin effectiveness depends on consistent vitamin K intake. Clients should avoid NSAIDs
unless approved because of bleeding risk. Therapy should not be stopped without provider
direction.
Question 6
A nurse receives report on four clients. Which client should be assessed first?
A. Client with diabetes requesting a snack
B. Client with COPD with oxygen saturation of 91%
C. Client receiving chemotherapy with temperature of 38.5°C (101.3°F)
D. Client awaiting discharge instructions
Answer: C. Client receiving chemotherapy with fever
, NGN HESI RN Exit
Rationale:
A febrile chemotherapy client may have neutropenic sepsis, which is life-threatening. Immediate
assessment and intervention are required.
Question 7
A client with chronic kidney disease has an arteriovenous fistula. Which finding indicates the
fistula is functioning properly?
A. Absence of bruit
B. Palpable thrill
C. Cool fingers
D. Severe edema
Answer: B. Palpable thrill
Rationale:
A thrill and bruit indicate blood flow through the fistula. Absence suggests possible occlusion.
Question 8
A nurse is caring for a client receiving digoxin. Which finding requires withholding the
medication?
A. Apical pulse of 54/min
B. Blood pressure 130/80 mmHg
C. Potassium level 4.2 mEq/L
D. Respiratory rate 18/min
Answer: A. Apical pulse of 54/min
Rationale:
Digoxin decreases heart rate. A pulse below 60/min generally requires holding the medication
and notifying the provider.
Question 9
NGN HESI RN Exit Practice Exam 2026
Edition 100 Advanced Questions with
Answers and Detailed Rationales
Part 1: Questions 1–25
Advanced NCLEX/HESI-Level Clinical Judgment Questions
Question 1
A nurse is caring for a client admitted with acute ischemic stroke 2 hours after symptom onset.
Which assessment finding requires the nurse’s immediate action?
A. Blood pressure of 168/92 mmHg
B. Mild expressive aphasia
C. Oxygen saturation of 89% on room air
D. Blood glucose of 140 mg/dL
Answer: C. Oxygen saturation of 89% on room air
Rationale:
Airway and oxygenation are priority. Hypoxia worsens cerebral ischemia and must be corrected
immediately. Blood pressure may be intentionally elevated during acute stroke management to
maintain cerebral perfusion unless critically high. Aphasia is an expected neurological deficit.
Glucose is acceptable.
Question 2
A client receiving IV heparin for a pulmonary embolism has an aPTT result of 120 seconds.
What action should the nurse take first?
A. Increase the infusion rate
B. Stop the infusion temporarily
C. Administer vitamin K
D. Give protamine sulfate immediately
Answer: B. Stop the infusion temporarily
, NGN HESI RN Exit
Rationale:
An excessively elevated aPTT indicates increased bleeding risk. The nurse should follow the
heparin protocol, which commonly requires holding the infusion and notifying the provider.
Vitamin K reverses warfarin, not heparin. Protamine is used for significant heparin reversal.
Question 3
NGN Bow-Tie Style
A client with heart failure reports increasing shortness of breath. Assessment findings:
Weight gain of 3 kg in 3 days
Bilateral crackles
Elevated BNP
Peripheral edema
Select the appropriate options:
Most likely condition:
☐ Fluid volume deficit
☑ Acute fluid overload
☐ Septic shock
Priority interventions:
☑ Administer prescribed diuretics
☑ Place client in semi-Fowler position
☐ Encourage increased oral fluids
Expected outcome:
☑ Reduced respiratory distress and improved oxygenation
Rationale:
Rapid weight gain, crackles, edema, and elevated BNP indicate worsening heart failure with
fluid retention. Positioning improves lung expansion, and diuretics decrease preload.
Question 4
A postoperative client suddenly develops chest pain, tachycardia, and dyspnea. Which action
should the nurse take first?
, NGN HESI RN Exit
A. Obtain a 12-lead ECG
B. Apply oxygen
C. Administer morphine
D. Notify the surgeon
Answer: B. Apply oxygen
Rationale:
The priority is airway and oxygenation. The client may have a pulmonary embolism. Oxygen
should be applied immediately while further assessment occurs.
Question 5
A nurse is preparing discharge teaching for a client taking warfarin. Which statement indicates
correct understanding?
A. “I will avoid all foods containing vitamin K.”
B. “I will use aspirin for headaches.”
C. “I will keep my vitamin K intake consistent.”
D. “I can stop the medication when I feel better.”
Answer: C. “I will keep my vitamin K intake consistent.”
Rationale:
Warfarin effectiveness depends on consistent vitamin K intake. Clients should avoid NSAIDs
unless approved because of bleeding risk. Therapy should not be stopped without provider
direction.
Question 6
A nurse receives report on four clients. Which client should be assessed first?
A. Client with diabetes requesting a snack
B. Client with COPD with oxygen saturation of 91%
C. Client receiving chemotherapy with temperature of 38.5°C (101.3°F)
D. Client awaiting discharge instructions
Answer: C. Client receiving chemotherapy with fever
, NGN HESI RN Exit
Rationale:
A febrile chemotherapy client may have neutropenic sepsis, which is life-threatening. Immediate
assessment and intervention are required.
Question 7
A client with chronic kidney disease has an arteriovenous fistula. Which finding indicates the
fistula is functioning properly?
A. Absence of bruit
B. Palpable thrill
C. Cool fingers
D. Severe edema
Answer: B. Palpable thrill
Rationale:
A thrill and bruit indicate blood flow through the fistula. Absence suggests possible occlusion.
Question 8
A nurse is caring for a client receiving digoxin. Which finding requires withholding the
medication?
A. Apical pulse of 54/min
B. Blood pressure 130/80 mmHg
C. Potassium level 4.2 mEq/L
D. Respiratory rate 18/min
Answer: A. Apical pulse of 54/min
Rationale:
Digoxin decreases heart rate. A pulse below 60/min generally requires holding the medication
and notifying the provider.
Question 9
