Version 2 – 2026 HESI RN EXIT EXAM V4 (NGN Integrated, 160
Questions) Latest Actual Exam | Verified Questions and
Correct Answers | Updated NGN Edition | Graded A+
1. A nurse is caring for a client with heart failure who is receiving furosemide.
Which finding indicates a therapeutic response?
A) Decreased urine output
B) Increased crackles
C) Weight loss of 1 kg in 24 hours
D) Increased peripheral edema
Answer: C
Explanation: Furosemide promotes diuresis; weight loss indicates fluid removal.
Other options indicate worsening failure.
2. A client with COPD is on oxygen at 2 L/min. The nurse notes the client is
drowsy with a respiratory rate of 10. What is the priority action?
A) Increase oxygen to 4 L/min
B) Reduce oxygen flow and notify provider
C) Administer naloxone
D) Encourage deep breathing
Answer: B
Explanation: High oxygen can suppress hypoxic drive in COPD, causing CO₂
retention. Reduce oxygen and notify provider.
3. A client with type 1 diabetes has blood glucose 580 mg/dL, Kussmaul
respirations, and fruity breath. Which IV fluid is most appropriate initially?
A) Dextrose 5%
B) 0.9% sodium chloride
,C) 0.45% sodium chloride
D) Lactated Ringer's
Answer: B
Explanation: DKA requires initial isotonic fluid (0.9% NaCl) to restore perfusion.
4. A client with cirrhosis has hematemesis. What is the priority action?
A) Administer lactulose
B) Start IV fluids and prepare for endoscopy
C) Give propranolol
D) Insert a nasogastric tube for lavage
Answer: B
Explanation: Variceal bleeding is an emergency; volume resuscitation and
endoscopic intervention are priorities.
5. A client has a chest tube for pneumothorax. The water seal chamber has
continuous bubbling. What does this indicate?
A) Normal function
B) Air leak
C) Tube occlusion
D) Lung re-expansion
Answer: B
Explanation: Continuous bubbling indicates an air leak in the system or from the
lung.
6. A client receiving a blood transfusion develops fever, chills, and flank pain.
What is the first action?
A) Slow the transfusion
B) Stop transfusion and infuse normal saline
C) Administer acetaminophen
D) Notify blood bank only
,Answer: B
Explanation: Signs suggest hemolytic reaction; stop transfusion, infuse NS, notify
provider.
7. A client with acute pancreatitis reports severe epigastric pain. Which lab is
most specific?
A) Amylase
B) Lipase
C) AST
D) Alkaline phosphatase
Answer: B
Explanation: Lipase is more specific and remains elevated longer.
8. A client with a head injury has a fixed, dilated right pupil and decreasing LOC.
What is the priority?
A) Administer mannitol
B) Notify provider immediately and prepare for herniation
C) Place in Trendelenburg
D) Reassess in 30 min
Answer: B
Explanation: Fixed dilated pupil with decreased LOC indicates herniation;
immediate intervention needed.
9. A client with chronic kidney disease has potassium 6.8 mEq/L. Which ECG
finding is expected?
A) Prominent U waves
B) Peaked T waves and widened QRS
C) Prolonged QT
D) ST depression
, Answer: B
Explanation: Hyperkalemia causes peaked T waves, wide QRS.
10. A client with asthma is having an acute exacerbation. Which finding
indicates impending respiratory failure?
A) Loud wheezing
B) Bradycardia and decreased respiratory effort
C) Tachypnea
D) Cough with clear sputum
Answer: B
Explanation: Fatigue leading to bradycardia and decreased effort is a late sign of
respiratory failure.
11. A client has full-thickness burns with no pain at the site. What is the burn
depth?
A) Superficial partial-thickness
B) Deep partial-thickness
C) Full-thickness
D) First-degree
Answer: C
Explanation: Full-thickness burns destroy nerve endings, causing no pain.
12. A client with hypovolemic shock has urine output 20 mL/hr. What is the next
priority?
A) Increase IV fluids as prescribed
B) Administer a diuretic
C) Restrict fluids
D) Document and reassess
Questions) Latest Actual Exam | Verified Questions and
Correct Answers | Updated NGN Edition | Graded A+
1. A nurse is caring for a client with heart failure who is receiving furosemide.
Which finding indicates a therapeutic response?
A) Decreased urine output
B) Increased crackles
C) Weight loss of 1 kg in 24 hours
D) Increased peripheral edema
Answer: C
Explanation: Furosemide promotes diuresis; weight loss indicates fluid removal.
Other options indicate worsening failure.
2. A client with COPD is on oxygen at 2 L/min. The nurse notes the client is
drowsy with a respiratory rate of 10. What is the priority action?
A) Increase oxygen to 4 L/min
B) Reduce oxygen flow and notify provider
C) Administer naloxone
D) Encourage deep breathing
Answer: B
Explanation: High oxygen can suppress hypoxic drive in COPD, causing CO₂
retention. Reduce oxygen and notify provider.
3. A client with type 1 diabetes has blood glucose 580 mg/dL, Kussmaul
respirations, and fruity breath. Which IV fluid is most appropriate initially?
A) Dextrose 5%
B) 0.9% sodium chloride
,C) 0.45% sodium chloride
D) Lactated Ringer's
Answer: B
Explanation: DKA requires initial isotonic fluid (0.9% NaCl) to restore perfusion.
4. A client with cirrhosis has hematemesis. What is the priority action?
A) Administer lactulose
B) Start IV fluids and prepare for endoscopy
C) Give propranolol
D) Insert a nasogastric tube for lavage
Answer: B
Explanation: Variceal bleeding is an emergency; volume resuscitation and
endoscopic intervention are priorities.
5. A client has a chest tube for pneumothorax. The water seal chamber has
continuous bubbling. What does this indicate?
A) Normal function
B) Air leak
C) Tube occlusion
D) Lung re-expansion
Answer: B
Explanation: Continuous bubbling indicates an air leak in the system or from the
lung.
6. A client receiving a blood transfusion develops fever, chills, and flank pain.
What is the first action?
A) Slow the transfusion
B) Stop transfusion and infuse normal saline
C) Administer acetaminophen
D) Notify blood bank only
,Answer: B
Explanation: Signs suggest hemolytic reaction; stop transfusion, infuse NS, notify
provider.
7. A client with acute pancreatitis reports severe epigastric pain. Which lab is
most specific?
A) Amylase
B) Lipase
C) AST
D) Alkaline phosphatase
Answer: B
Explanation: Lipase is more specific and remains elevated longer.
8. A client with a head injury has a fixed, dilated right pupil and decreasing LOC.
What is the priority?
A) Administer mannitol
B) Notify provider immediately and prepare for herniation
C) Place in Trendelenburg
D) Reassess in 30 min
Answer: B
Explanation: Fixed dilated pupil with decreased LOC indicates herniation;
immediate intervention needed.
9. A client with chronic kidney disease has potassium 6.8 mEq/L. Which ECG
finding is expected?
A) Prominent U waves
B) Peaked T waves and widened QRS
C) Prolonged QT
D) ST depression
, Answer: B
Explanation: Hyperkalemia causes peaked T waves, wide QRS.
10. A client with asthma is having an acute exacerbation. Which finding
indicates impending respiratory failure?
A) Loud wheezing
B) Bradycardia and decreased respiratory effort
C) Tachypnea
D) Cough with clear sputum
Answer: B
Explanation: Fatigue leading to bradycardia and decreased effort is a late sign of
respiratory failure.
11. A client has full-thickness burns with no pain at the site. What is the burn
depth?
A) Superficial partial-thickness
B) Deep partial-thickness
C) Full-thickness
D) First-degree
Answer: C
Explanation: Full-thickness burns destroy nerve endings, causing no pain.
12. A client with hypovolemic shock has urine output 20 mL/hr. What is the next
priority?
A) Increase IV fluids as prescribed
B) Administer a diuretic
C) Restrict fluids
D) Document and reassess
