1
HESI RN Exit Exam V1 (2025/2026) | 160 Verified NGN Questions
with Rationales | A+ Resource | Guaranteed Pass
Question 1
A 68-year-old male with a history of type 2 diabetes is admitted with confusion, dry mucous
membranes, and blood glucose of 684 mg/dL. The nurse suspects hyperosmolar hyperglycemic
syndrome (HHS). What is the priority nursing intervention?
A. Administer IV regular insulin immediately
B. Initiate seizure precautions
C. Begin aggressive IV fluid resuscitation
D. Monitor for signs of infection
Correct Answer: C
Rationale: The priority in treating HHS is rapid fluid replacement with isotonic IV fluids to
correct profound dehydration and restore perfusion. Insulin follows once volume status
improves. Seizures are not typical in HHS. (Source: Saunders 10th Ed., p. 1167)
Question 2
A nurse is caring for a postpartum client who is saturating a perineal pad every 15 minutes and
passing large clots. What is the priority nursing action?
A. Document the findings and notify the provider
B. Assess fundus and perform fundal massage
C. Administer oxytocin IV as ordered
D. Initiate emergency postpartum hemorrhage protocol
, 2
Correct Answer: D
Rationale: Saturating a pad every 15 minutes and passing clots indicates a hemorrhage
emergency. Initiating the hemorrhage protocol ensures rapid intervention including uterotonics,
labs, and IV access. (Saunders 10th Ed., p. 492)
Question 3
A client receiving IV vancomycin develops flushing, itching, and hypotension. What is the
nurse’s best action?
A. Stop the infusion immediately
B. Slow the infusion rate and monitor closely
C. Administer diphenhydramine STAT
D. Notify the provider of anaphylaxis
Correct Answer: B
Rationale: These are signs of Red Man Syndrome, a histamine reaction—not anaphylaxis—
commonly caused by rapid vancomycin infusion. Slowing the rate typically resolves symptoms.
(Saunders 10th Ed., p. 947)
Question 4
A client with COPD is receiving 6 L/min of oxygen via nasal cannula. He becomes increasingly
drowsy and confused. What is the nurse's best response?
A. Continue oxygen and reassess in 30 minutes
B. Lower oxygen to 2 L/min and notify the provider
C. Prepare for immediate intubation
D. Suction the airway to promote CO₂ clearance
Correct Answer: B
Rationale: High oxygen flow in COPD can suppress the hypoxic respiratory drive, leading to
, 3
CO₂ narcosis. The nurse should lower oxygen to safe levels and alert the provider. (Saunders
10th Ed., p. 626)
Question 5
During shift report, the nurse learns a client with heart failure has gained 3.5 lbs in 24 hours.
Which order should the nurse question?
A. Low sodium diet
B. IV fluids at 125 mL/hr
C. Daily weight monitoring
D. Administer furosemide IV as needed
Correct Answer: B
Rationale: A weight gain >2 lbs/day suggests fluid retention. IV fluids may worsen overload and
should be questioned. The other orders are appropriate heart failure management. (Saunders 10th
Ed., p. 552)
Question 6
A nurse reviews labs for a client with cirrhosis and notes: ammonia 89 mcg/dL (↑), asterixis, and
disorientation. Which medication should the nurse anticipate administering?
A. Lactulose
B. Vitamin K
C. Spironolactone
D. Furosemide
Correct Answer: A
Rationale: Lactulose reduces serum ammonia levels in hepatic encephalopathy by trapping
ammonia in stool. This improves mental status. (Saunders 10th Ed., p. 964)
Question 7
, 4
A client is admitted for stroke with right-sided weakness and facial droop. What nursing
intervention is priority during the first 24 hours?
A. Monitor for emotional lability
B. Keep NPO until swallow evaluation is complete
C. Begin physical therapy exercises
D. Reorient the client frequently
Correct Answer: B
Rationale: Stroke clients are at high risk for aspiration. Swallow evaluation is critical before any
oral intake. (Saunders 10th Ed., p. 892)
Question 8
A nurse is reviewing ECG of a client receiving digoxin and notes PR interval prolongation and
frequent PVCs. What is the priority intervention?
A. Give next dose with food
B. Obtain serum calcium level
C. Check digoxin and potassium levels
D. Administer antidysrhythmic medication
Correct Answer: C
Rationale: Digoxin toxicity can cause ECG changes such as PVCs and AV block. Hypokalemia
increases the risk. The nurse must evaluate both digoxin and potassium levels. (Saunders 10th
Ed., p. 570)
Question 9
A nurse is caring for a client post-op appendectomy. The client reports severe pain unrelieved by
opioids, a rigid abdomen, and tachycardia. What complication should the nurse suspect?
A. Peritonitis
B. Constipation
HESI RN Exit Exam V1 (2025/2026) | 160 Verified NGN Questions
with Rationales | A+ Resource | Guaranteed Pass
Question 1
A 68-year-old male with a history of type 2 diabetes is admitted with confusion, dry mucous
membranes, and blood glucose of 684 mg/dL. The nurse suspects hyperosmolar hyperglycemic
syndrome (HHS). What is the priority nursing intervention?
A. Administer IV regular insulin immediately
B. Initiate seizure precautions
C. Begin aggressive IV fluid resuscitation
D. Monitor for signs of infection
Correct Answer: C
Rationale: The priority in treating HHS is rapid fluid replacement with isotonic IV fluids to
correct profound dehydration and restore perfusion. Insulin follows once volume status
improves. Seizures are not typical in HHS. (Source: Saunders 10th Ed., p. 1167)
Question 2
A nurse is caring for a postpartum client who is saturating a perineal pad every 15 minutes and
passing large clots. What is the priority nursing action?
A. Document the findings and notify the provider
B. Assess fundus and perform fundal massage
C. Administer oxytocin IV as ordered
D. Initiate emergency postpartum hemorrhage protocol
, 2
Correct Answer: D
Rationale: Saturating a pad every 15 minutes and passing clots indicates a hemorrhage
emergency. Initiating the hemorrhage protocol ensures rapid intervention including uterotonics,
labs, and IV access. (Saunders 10th Ed., p. 492)
Question 3
A client receiving IV vancomycin develops flushing, itching, and hypotension. What is the
nurse’s best action?
A. Stop the infusion immediately
B. Slow the infusion rate and monitor closely
C. Administer diphenhydramine STAT
D. Notify the provider of anaphylaxis
Correct Answer: B
Rationale: These are signs of Red Man Syndrome, a histamine reaction—not anaphylaxis—
commonly caused by rapid vancomycin infusion. Slowing the rate typically resolves symptoms.
(Saunders 10th Ed., p. 947)
Question 4
A client with COPD is receiving 6 L/min of oxygen via nasal cannula. He becomes increasingly
drowsy and confused. What is the nurse's best response?
A. Continue oxygen and reassess in 30 minutes
B. Lower oxygen to 2 L/min and notify the provider
C. Prepare for immediate intubation
D. Suction the airway to promote CO₂ clearance
Correct Answer: B
Rationale: High oxygen flow in COPD can suppress the hypoxic respiratory drive, leading to
, 3
CO₂ narcosis. The nurse should lower oxygen to safe levels and alert the provider. (Saunders
10th Ed., p. 626)
Question 5
During shift report, the nurse learns a client with heart failure has gained 3.5 lbs in 24 hours.
Which order should the nurse question?
A. Low sodium diet
B. IV fluids at 125 mL/hr
C. Daily weight monitoring
D. Administer furosemide IV as needed
Correct Answer: B
Rationale: A weight gain >2 lbs/day suggests fluid retention. IV fluids may worsen overload and
should be questioned. The other orders are appropriate heart failure management. (Saunders 10th
Ed., p. 552)
Question 6
A nurse reviews labs for a client with cirrhosis and notes: ammonia 89 mcg/dL (↑), asterixis, and
disorientation. Which medication should the nurse anticipate administering?
A. Lactulose
B. Vitamin K
C. Spironolactone
D. Furosemide
Correct Answer: A
Rationale: Lactulose reduces serum ammonia levels in hepatic encephalopathy by trapping
ammonia in stool. This improves mental status. (Saunders 10th Ed., p. 964)
Question 7
, 4
A client is admitted for stroke with right-sided weakness and facial droop. What nursing
intervention is priority during the first 24 hours?
A. Monitor for emotional lability
B. Keep NPO until swallow evaluation is complete
C. Begin physical therapy exercises
D. Reorient the client frequently
Correct Answer: B
Rationale: Stroke clients are at high risk for aspiration. Swallow evaluation is critical before any
oral intake. (Saunders 10th Ed., p. 892)
Question 8
A nurse is reviewing ECG of a client receiving digoxin and notes PR interval prolongation and
frequent PVCs. What is the priority intervention?
A. Give next dose with food
B. Obtain serum calcium level
C. Check digoxin and potassium levels
D. Administer antidysrhythmic medication
Correct Answer: C
Rationale: Digoxin toxicity can cause ECG changes such as PVCs and AV block. Hypokalemia
increases the risk. The nurse must evaluate both digoxin and potassium levels. (Saunders 10th
Ed., p. 570)
Question 9
A nurse is caring for a client post-op appendectomy. The client reports severe pain unrelieved by
opioids, a rigid abdomen, and tachycardia. What complication should the nurse suspect?
A. Peritonitis
B. Constipation
