2026 HESI RN Exit Exam | NGN Nursing Questions | 2026 HESI
Nursing Exit Exam Questions (Latest PDF Update) - 190
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Nursing
Description This exam assesses readiness for RN licensure, covering advanced clinical
reasoning, pharmacology, pathophysiology, and nursing interventions across
diverse patient populations. Questions integrate NGN (Next Generation NCLEX)
style with high-level analysis.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Apply critical thinking to complex clinical scenarios
2. Interpret laboratory and diagnostic data for clinical decision-making
3. Prioritize nursing interventions using evidence-based practice
4. Analyze pharmacological principles and adverse effects
5. Synthesize pathophysiology with nursing care across the lifespan
Accreditation Aligns with AACN Baccalaureate Essentials and NCLEX-RN test plan
Page 1
,1. A patient with a history of chronic heart failure is admitted with acute dyspnea,
jugular venous distention, and a new S3 heart sound. The nurse notes that the
patient's urine output has been <30 mL/hr for the past 4 hours. Which intervention
should the nurse prioritize first?
Answer: Place the patient in high Fowler's position
High Fowler's position reduces preload and improves ventilation, addressing acute
dyspnea immediately. While furosemide is indicated, positioning is a
non-pharmacologic priority. Foley catheter and BNP are secondary.
2. A nurse is reviewing a patient's arterial blood gas results: pH 7.32, PaCO2 48 mm
Hg, HCO3- 24 mEq/L. Which compensation mechanism is the body most likely
utilizing?
Answer: Renal excretion of hydrogen ions
The ABG shows respiratory acidosis (low pH, high PaCO2). The body compensates
renally by excreting H+ and retaining HCO3-, but here HCO3- is normal, indicating no
compensation yet. Renal excretion of H+ is the expected compensatory mechanism over
hours to days.
3. A patient receiving vancomycin develops red man syndrome during the infusion.
Which nursing action is most appropriate?
Answer: Slow the infusion rate and notify the prescriber
Red man syndrome is a histamine-mediated reaction, not anaphylaxis. Slowing the
infusion rate often resolves symptoms; diphenhydramine may be given prophylactically
but stopping is not first-line. Epinephrine is for anaphylaxis.
4. A patient with acute pancreatitis has a serum calcium level of 7.2 mg/dL. Which
finding should the nurse monitor most closely?
Answer: Trousseau's sign and prolonged QT interval
Hypocalcemia (normal 8.5-10.5 mg/dL) causes neuromuscular irritability, including
Trousseau's sign and prolonged QT interval. Bradycardia is associated with
hypercalcemia. Polyuria suggests hyperglycemia. Hyperactive reflexes are seen in
hypomagnesemia.
Page 2
,5. A nurse is caring for a patient with a chest tube connected to a dry suction water
seal system. The nurse observes continuous bubbling in the water seal chamber.
What is the priority action?
Answer: Tighten all connections and apply tape
Continuous bubbling in the water seal indicates an air leak, usually from a loose
connection. Tightening connections is the first step. Increasing suction or clamping may
worsen a pneumothorax. Replacement is needed if the leak persists.
6. A patient with type 1 diabetes is scheduled for surgery. The nurse reviews the
order for an insulin infusion. Which intravenous fluid should be administered
concurrently to prevent ketosis?
Answer: 5% dextrose in 0.45% normal saline
During surgery, insulin infusion requires concurrent dextrose to prevent hypoglycemia
and ketosis. 5% dextrose in 0.45% normal saline provides glucose and maintenance
fluid. Lactated Ringer's contains lactate which may be problematic in liver disease.
7. A patient with a history of deep vein thrombosis is receiving warfarin. The INR is
4.5. The patient has no signs of bleeding. What should the nurse do?
Answer: Hold the next dose and notify the prescriber
INR >4.5 without bleeding requires holding warfarin and notifying the prescriber.
Vitamin K is given for significant bleeding. Fresh frozen plasma is for life-threatening
bleeding. Continuing the dose risks hemorrhage.
8. A nurse is assessing a patient with suspected meningitis. Which finding is most
indicative of meningeal irritation?
Answer: Brudzinski's sign
Brudzinski's sign (neck flexion causes hip/knee flexion) is a classic sign of meningeal
irritation. Babinski is upper motor neuron. Decorticate posturing indicates brain
injury. Nuchal rigidity alone is less specific without fever.
Page 3
, 9. A patient with chronic kidney disease (stage 4) is prescribed sevelamer carbonate.
The nurse understands that this medication works by:
Answer: Binding dietary phosphate in the gastrointestinal tract
Sevelamer is a phosphate binder that reduces serum phosphate by binding dietary
phosphate in the GI tract, preventing absorption. It does not affect calcium absorption
or vitamin D. It is used to manage hyperphosphatemia in CKD.
10. A nurse is preparing to administer a blood transfusion. The patient's vital signs
are: BP 90/60, HR 110, RR 22, temp 37.0°C. Which action is most important to
prevent a transfusion reaction?
Answer: Verify the patient's identity and blood product with two nurses
The most common cause of transfusion reactions is human error. Verification with two
nurses reduces risk. Premedication is not routine. Lactated Ringer's can cause clotting.
Warming is only for massive transfusions.
11. A patient with a history of chronic kidney disease (stage 4) is admitted for
management of hyperkalemia (serum potassium 6.8 mEq/L). The electrocardiogram
shows peaked T waves. Which intervention should the nurse anticipate first?
Answer: Intravenous calcium gluconate
In life-threatening hyperkalemia with ECG changes, intravenous calcium gluconate is
the first-line intervention to stabilize the cardiac membrane. Insulin with dextrose shifts
potassium into cells but takes longer, while sodium polystyrene sulfonate and
bicarbonate are slower and less emergent. Calcium gluconate provides immediate
cardioprotection.
12. A nurse is caring for a patient receiving a continuous infusion of norepinephrine
for septic shock. The patient's blood pressure is now 90/50 mm Hg, and the nurse
notes extravasation at the IV site. What is the priority nursing action?
Answer: Administer phentolamine locally via intradermal injection
Extravasation of vasopressors like norepinephrine causes severe vasoconstriction and
tissue necrosis. The priority is to stop the infusion and administer phentolamine, an
alpha-adrenergic blocker, locally to reverse vasoconstriction. Warm compresses are
contraindicated (cold compresses are recommended initially). Simply restarting the IV
does not address the extravasation injury.
Page 4
Nursing Exit Exam Questions (Latest PDF Update) - 190
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Nursing
Description This exam assesses readiness for RN licensure, covering advanced clinical
reasoning, pharmacology, pathophysiology, and nursing interventions across
diverse patient populations. Questions integrate NGN (Next Generation NCLEX)
style with high-level analysis.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Apply critical thinking to complex clinical scenarios
2. Interpret laboratory and diagnostic data for clinical decision-making
3. Prioritize nursing interventions using evidence-based practice
4. Analyze pharmacological principles and adverse effects
5. Synthesize pathophysiology with nursing care across the lifespan
Accreditation Aligns with AACN Baccalaureate Essentials and NCLEX-RN test plan
Page 1
,1. A patient with a history of chronic heart failure is admitted with acute dyspnea,
jugular venous distention, and a new S3 heart sound. The nurse notes that the
patient's urine output has been <30 mL/hr for the past 4 hours. Which intervention
should the nurse prioritize first?
Answer: Place the patient in high Fowler's position
High Fowler's position reduces preload and improves ventilation, addressing acute
dyspnea immediately. While furosemide is indicated, positioning is a
non-pharmacologic priority. Foley catheter and BNP are secondary.
2. A nurse is reviewing a patient's arterial blood gas results: pH 7.32, PaCO2 48 mm
Hg, HCO3- 24 mEq/L. Which compensation mechanism is the body most likely
utilizing?
Answer: Renal excretion of hydrogen ions
The ABG shows respiratory acidosis (low pH, high PaCO2). The body compensates
renally by excreting H+ and retaining HCO3-, but here HCO3- is normal, indicating no
compensation yet. Renal excretion of H+ is the expected compensatory mechanism over
hours to days.
3. A patient receiving vancomycin develops red man syndrome during the infusion.
Which nursing action is most appropriate?
Answer: Slow the infusion rate and notify the prescriber
Red man syndrome is a histamine-mediated reaction, not anaphylaxis. Slowing the
infusion rate often resolves symptoms; diphenhydramine may be given prophylactically
but stopping is not first-line. Epinephrine is for anaphylaxis.
4. A patient with acute pancreatitis has a serum calcium level of 7.2 mg/dL. Which
finding should the nurse monitor most closely?
Answer: Trousseau's sign and prolonged QT interval
Hypocalcemia (normal 8.5-10.5 mg/dL) causes neuromuscular irritability, including
Trousseau's sign and prolonged QT interval. Bradycardia is associated with
hypercalcemia. Polyuria suggests hyperglycemia. Hyperactive reflexes are seen in
hypomagnesemia.
Page 2
,5. A nurse is caring for a patient with a chest tube connected to a dry suction water
seal system. The nurse observes continuous bubbling in the water seal chamber.
What is the priority action?
Answer: Tighten all connections and apply tape
Continuous bubbling in the water seal indicates an air leak, usually from a loose
connection. Tightening connections is the first step. Increasing suction or clamping may
worsen a pneumothorax. Replacement is needed if the leak persists.
6. A patient with type 1 diabetes is scheduled for surgery. The nurse reviews the
order for an insulin infusion. Which intravenous fluid should be administered
concurrently to prevent ketosis?
Answer: 5% dextrose in 0.45% normal saline
During surgery, insulin infusion requires concurrent dextrose to prevent hypoglycemia
and ketosis. 5% dextrose in 0.45% normal saline provides glucose and maintenance
fluid. Lactated Ringer's contains lactate which may be problematic in liver disease.
7. A patient with a history of deep vein thrombosis is receiving warfarin. The INR is
4.5. The patient has no signs of bleeding. What should the nurse do?
Answer: Hold the next dose and notify the prescriber
INR >4.5 without bleeding requires holding warfarin and notifying the prescriber.
Vitamin K is given for significant bleeding. Fresh frozen plasma is for life-threatening
bleeding. Continuing the dose risks hemorrhage.
8. A nurse is assessing a patient with suspected meningitis. Which finding is most
indicative of meningeal irritation?
Answer: Brudzinski's sign
Brudzinski's sign (neck flexion causes hip/knee flexion) is a classic sign of meningeal
irritation. Babinski is upper motor neuron. Decorticate posturing indicates brain
injury. Nuchal rigidity alone is less specific without fever.
Page 3
, 9. A patient with chronic kidney disease (stage 4) is prescribed sevelamer carbonate.
The nurse understands that this medication works by:
Answer: Binding dietary phosphate in the gastrointestinal tract
Sevelamer is a phosphate binder that reduces serum phosphate by binding dietary
phosphate in the GI tract, preventing absorption. It does not affect calcium absorption
or vitamin D. It is used to manage hyperphosphatemia in CKD.
10. A nurse is preparing to administer a blood transfusion. The patient's vital signs
are: BP 90/60, HR 110, RR 22, temp 37.0°C. Which action is most important to
prevent a transfusion reaction?
Answer: Verify the patient's identity and blood product with two nurses
The most common cause of transfusion reactions is human error. Verification with two
nurses reduces risk. Premedication is not routine. Lactated Ringer's can cause clotting.
Warming is only for massive transfusions.
11. A patient with a history of chronic kidney disease (stage 4) is admitted for
management of hyperkalemia (serum potassium 6.8 mEq/L). The electrocardiogram
shows peaked T waves. Which intervention should the nurse anticipate first?
Answer: Intravenous calcium gluconate
In life-threatening hyperkalemia with ECG changes, intravenous calcium gluconate is
the first-line intervention to stabilize the cardiac membrane. Insulin with dextrose shifts
potassium into cells but takes longer, while sodium polystyrene sulfonate and
bicarbonate are slower and less emergent. Calcium gluconate provides immediate
cardioprotection.
12. A nurse is caring for a patient receiving a continuous infusion of norepinephrine
for septic shock. The patient's blood pressure is now 90/50 mm Hg, and the nurse
notes extravasation at the IV site. What is the priority nursing action?
Answer: Administer phentolamine locally via intradermal injection
Extravasation of vasopressors like norepinephrine causes severe vasoconstriction and
tissue necrosis. The priority is to stop the infusion and administer phentolamine, an
alpha-adrenergic blocker, locally to reverse vasoconstriction. Warm compresses are
contraindicated (cold compresses are recommended initially). Simply restarting the IV
does not address the extravasation injury.
Page 4
