RN HESI Exit Exam V1 with NGN
Questions and Verified
Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response (EMR)
Client Scenario:
Mrs. Ava Flores, 67 y, post-op day-2 after open abdominal aortic aneurysm (AAA) repair, is
receiving 2 L O₂ via nasal cannula. PMH: HTN, T2DM, CKD stage 3. Morning vitals: BP 98/58
mmHg, HR 112 bpm, RR 28/min, SpO₂ 92%, T 38.4 °C, urine output 15 mL/h × 3 h via
indwelling catheter. Labs: Na 128 mEq/L, K 5.8 mEq/L, Cl 94 mEq/L, CO₂ 18 mEq/L, BUN 56
mg/dL, Cr 2.4 mg/dL (baseline 1.6), lactate 3.4 mmol/L, WBC 15.2 k/µL. Nurse’s note:
“Abdomen firm, hypoactive bowel sounds, patient reports ‘I feel really dizzy when I turn my
head.’”
Question Stem:
Which assessment findings require immediate follow-up by the nurse? (Select all that apply.)
Options/Response Fields:
Urine output 15 mL/h × 3 h
Serum potassium 5.8 mEq/L
SpO₂ 92 % on 2 L O₂
Temperature 38.4 °C
Serum lactate 3.4 mmol/L
Patient report of dizziness on head movement
(Correct Answer: 1, 2, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
Correct Answer: 1, 2, 5
Clinical Judgment Rationalization: Recognize Cues—oliguria (<0.5 mL/kg/h) signals developing
acute kidney injury/hypovolemia; severe hyperkalemia (>5.5 mEq/L) places patient at risk for
fatal dysrhythmia; elevated lactate >2 mmol/L indicates tissue hypoperfusion/possible
impending septic shock. These three cues together suggest evolving sepsis or graft
complications requiring rapid intervention.
Distractor Justification: SpO₂ 92 % while sub-optimal is not immediately life-threatening;
low-grade fever and orthostatic dizziness are important but not highest priority compared with
renal shutdown, hyperkalemia, and rising lactate.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid (Cloze)
Client Scenario:
,Mr. Jayden Kim, 54 y, admitted with decompensated heart failure (EF 25 %). Current meds:
carvedilol 12.5 mg PO BID, lisinopril 20 mg PO daily, furosemide 80 mg IV BID, spironolactone
25 mg PO daily. Morning weight +2.5 kg from yesterday, 3+ pitting edema to knees, JVP 10 cm
above sternal angle, lungs with scattered crackles posterior. BNP 1 250 pg/mL (up from 850).
Provider orders additional 40 mg IV furosemide now and strict I&O.
Question Stem:
Use the clinical judgment model. For each nursing action below, identify whether it is indicated,
non-essential, or contraindicated at this time.
Matrix Grid (mark one column per row):
Obtain daily serum potassium level
Restrict oral fluids to 500 mL/24 h
Administer furosemide 40 mg IV push over 2 min
Encourage 3 g sodium diet
Position in high-Fowler’s with legs dependent
(Correct Answer: Indicated: 1, 3, 5 | Non-essential: — | Contraindicated: 2, 4)
Rationale:
Correct Answer: Indicated—1, 3, 5; Contraindicated—2, 4
Clinical Judgment: Analyze Cues & Generate Solutions—patient in fluid overload; loop diuretic
escalation appropriate; high-Fowler’s reduces preload; daily K+ needed because furosemide +
spironolactone alter levels. Severe fluid restriction (<1 L) is not yet ordered and may precipitate
renal hypoperfusion; 3 g sodium is above standard 2 g limit for HF and would worsen retention.
Distractor Justification: Over-restriction without physician order can cause prerenal azotemia;
liberal sodium contradicts evidence-based HF guidelines.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie (Risk Recognition & Early Action)
Client Scenario:
Ms. Sofia Patel, 28 y, 38 wks pregnant, arrives to triage after a motor-vehicle crash. Seat-belt
sign across abdomen. Vital signs: BP 90/60 mmHg, HR 118 bpm, RR 24, SpO₂ 97 % RA, T 36.8
°C. FHR 160 bpm with minimal variability and late decelerations. Nurse places large-bore IV
and begins LR 150 mL/h.
Bowtie Format:
Left (Potential Complications) | Center (Primary Problem) | Right (Immediate Nursing Actions)
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Hypovolemic shock
E. Gestational hypertension
(Correct Answer: Left—A, D | Center—A | Right—Insert second large-bore IV, Increase LR to
wide-open, Notify obstetrician & anesthesia now, Prepare for stat cesarean)
Rationale:
Correct Answer: As above
Clinical Judgment: Recognize Cues—maternal tachycardia + hypotension + late FHR
decelerations + seat-belt sign = concealed abruption with maternal hypovolemia. Center bowtie
,= abruption (source of bleeding). Immediate actions restore circulating volume and expedite
delivery.
Distractor Justification: Uterine rupture usually presents with fetal bradycardia; gestational HTN
not supported by current data; preterm labor is not the priority over hemorrhage.
Item ID: HESI-EXIT-V1-004
Item Type: Complex Stand-Alone
Client Scenario:
A 19 y college freshman is brought to ED by roommate after taking 20 tablets of 500 mg
acetaminophen 4 h ago following romantic breakup. Patient alert, complains of nausea. Initial
acetaminophen level 210 µg/mL.
Question Stem:
Which intervention is most important for the nurse to implement next?
Options:
Administer syrup of ipecac to induce vomiting
Start N-acetylcysteine 140 mg/kg PO loading dose now
Insert nasogastric tube for gastric lavage
Obtain stat pregnancy test and serum salicylate level
(Correct Answer: 2)
Rationale:
Correct Answer: 2
Clinical Judgment: Acetaminophen level >150 µg/mL at 4 h places patient above
Rumack-Matthew nomogram treatment line; N-acetylcysteine prevents hepatotoxicity if given
within 8 h.
Distractor Justification: Ipecac no longer recommended; lavage ineffective 4 h post ingestion;
salicylate level irrelevant to acetaminophen overdose.
Item ID: HESI-EXIT-V1-005
Item Type: NGN - Drag-and-Drop Sequencing
Client Scenario:
Mr. Luis Ortega, 72 y, is 6 h post right total hip replacement. He presses the call bell reporting
sudden shortness of breath. SpO₂ drops from 96 % to 87 % on room air. Breath sounds clear to
auscultation bilaterally; calf pain noted; HR 104 bpm; BP 160/90 mmHg. Nurse suspects
pulmonary embolism.
Question Stem:
Arrange the following nursing actions in the order they should be performed. (Drag tiles into
correct sequence.)
Tiles:
A. Apply high-flow oxygen via non-rebreather
B. Notify rapid-response team/physician
C. Obtain stat V/Q scan or CT-PE protocol
D. Start IV access with large-bore catheter
E. Administer heparin bolus 80 units/kg
(Correct Answer: Sequence—A, B, D, C, E)
Rationale:
, Correct Answer: Oxygen first to correct hypoxemia; then alert team for orders; establish IV
access before imaging; confirm diagnosis prior to anticoagulation per 2026 AHA guidelines.
Distractor Justification: Anticoagulation before imaging risks bleeding if alternate diagnosis
exists; oxygen must precede diagnostic work-up to stabilize patient.
Item ID: HESI-EXIT-V1-006
Item Type: NGN - Enhanced Hot Spot (Text Identification)
Client Scenario:
Ms. Faith Johnson, 41 y, newly diagnosed Graves’ disease, started on methimazole 15 mg PO
TID yesterday. This morning she reports “my throat hurts a lot” and points to anterior neck.
Temp 38.9 °C; WBC 2.8 k/µL (baseline 6.0), neutrophils 18 %.
Question Stem:
Click on the phrase in the nurse’s note that most clearly indicates a life-threatening adverse
effect of methimazole.
Nurse’s Note (excerpt):
“Patient complains of severe sore throat, difficulty swallowing saliva, and feels feverish. No
cough or rhinorrhea. Oral mucosa dry. White patchy exudate noted on tonsils. Anterior neck
tender with mild swelling. Lungs clear. Heart rate 108 bpm regular.”
(Correct Answer: “White patchy exudate noted on tonsils”)
Rationale:
Correct Answer: White exudate plus sore throat, fever, and profound neutropenia signals
agranulocytosis—black-box warning for methimazole requiring immediate drug discontinuation
and filgrastim/antibiotics.
Clinical Judgment: Recognize Cues—identify infection in setting of drug-induced neutropenia.
Distractor Justification: Tachycardia expected in Graves’; neck swelling alone may be thyroid;
exudate is objective sign of bacterial/fungal invasion in immunocompromised state.
Item ID: HESI-EXIT-V1-007
Item Type: Complex Stand-Alone
Client Scenario:
A 6 y child is admitted with status asthmaticus. Initial ABG on 4 L O₂: pH 7.28, PaCO₂ 55 mmHg,
PaO₂ 70 mmHg, HCO₃ 24 mEq/L. After aerosolized albuterol and ipratropium, child tires; RR
40/min, accessory muscles noted.
Question Stem:
Which prescribed intervention should the nurse implement first?
Options:
Administer methylprednisolone 2 mg/kg IV
Prepare for non-invasive bilevel positive airway pressure (BiPAP)
Draw repeat ABG in 30 min
Start magnesium sulfate 50 mg/kg IV over 20 min
(Correct Answer: 2)
Rationale:
Correct Answer: 2
Clinical Judgment: Rising PaCO₂ with fatigue signals impending respiratory failure;
guideline-directed first-line escalation is NIV to decrease work of breathing.
Questions and Verified
Rationalized Answers 2026, 100%
Guarantee Pass
Item ID: HESI-EXIT-V1-001
Item Type: NGN - Extended Multiple Response (EMR)
Client Scenario:
Mrs. Ava Flores, 67 y, post-op day-2 after open abdominal aortic aneurysm (AAA) repair, is
receiving 2 L O₂ via nasal cannula. PMH: HTN, T2DM, CKD stage 3. Morning vitals: BP 98/58
mmHg, HR 112 bpm, RR 28/min, SpO₂ 92%, T 38.4 °C, urine output 15 mL/h × 3 h via
indwelling catheter. Labs: Na 128 mEq/L, K 5.8 mEq/L, Cl 94 mEq/L, CO₂ 18 mEq/L, BUN 56
mg/dL, Cr 2.4 mg/dL (baseline 1.6), lactate 3.4 mmol/L, WBC 15.2 k/µL. Nurse’s note:
“Abdomen firm, hypoactive bowel sounds, patient reports ‘I feel really dizzy when I turn my
head.’”
Question Stem:
Which assessment findings require immediate follow-up by the nurse? (Select all that apply.)
Options/Response Fields:
Urine output 15 mL/h × 3 h
Serum potassium 5.8 mEq/L
SpO₂ 92 % on 2 L O₂
Temperature 38.4 °C
Serum lactate 3.4 mmol/L
Patient report of dizziness on head movement
(Correct Answer: 1, 2, 5)
Rationale (Verified & Rationalized | 100% Guarantee | 2026):
Correct Answer: 1, 2, 5
Clinical Judgment Rationalization: Recognize Cues—oliguria (<0.5 mL/kg/h) signals developing
acute kidney injury/hypovolemia; severe hyperkalemia (>5.5 mEq/L) places patient at risk for
fatal dysrhythmia; elevated lactate >2 mmol/L indicates tissue hypoperfusion/possible
impending septic shock. These three cues together suggest evolving sepsis or graft
complications requiring rapid intervention.
Distractor Justification: SpO₂ 92 % while sub-optimal is not immediately life-threatening;
low-grade fever and orthostatic dizziness are important but not highest priority compared with
renal shutdown, hyperkalemia, and rising lactate.
Item ID: HESI-EXIT-V1-002
Item Type: NGN - Matrix/Grid (Cloze)
Client Scenario:
,Mr. Jayden Kim, 54 y, admitted with decompensated heart failure (EF 25 %). Current meds:
carvedilol 12.5 mg PO BID, lisinopril 20 mg PO daily, furosemide 80 mg IV BID, spironolactone
25 mg PO daily. Morning weight +2.5 kg from yesterday, 3+ pitting edema to knees, JVP 10 cm
above sternal angle, lungs with scattered crackles posterior. BNP 1 250 pg/mL (up from 850).
Provider orders additional 40 mg IV furosemide now and strict I&O.
Question Stem:
Use the clinical judgment model. For each nursing action below, identify whether it is indicated,
non-essential, or contraindicated at this time.
Matrix Grid (mark one column per row):
Obtain daily serum potassium level
Restrict oral fluids to 500 mL/24 h
Administer furosemide 40 mg IV push over 2 min
Encourage 3 g sodium diet
Position in high-Fowler’s with legs dependent
(Correct Answer: Indicated: 1, 3, 5 | Non-essential: — | Contraindicated: 2, 4)
Rationale:
Correct Answer: Indicated—1, 3, 5; Contraindicated—2, 4
Clinical Judgment: Analyze Cues & Generate Solutions—patient in fluid overload; loop diuretic
escalation appropriate; high-Fowler’s reduces preload; daily K+ needed because furosemide +
spironolactone alter levels. Severe fluid restriction (<1 L) is not yet ordered and may precipitate
renal hypoperfusion; 3 g sodium is above standard 2 g limit for HF and would worsen retention.
Distractor Justification: Over-restriction without physician order can cause prerenal azotemia;
liberal sodium contradicts evidence-based HF guidelines.
Item ID: HESI-EXIT-V1-003
Item Type: NGN - Bowtie (Risk Recognition & Early Action)
Client Scenario:
Ms. Sofia Patel, 28 y, 38 wks pregnant, arrives to triage after a motor-vehicle crash. Seat-belt
sign across abdomen. Vital signs: BP 90/60 mmHg, HR 118 bpm, RR 24, SpO₂ 97 % RA, T 36.8
°C. FHR 160 bpm with minimal variability and late decelerations. Nurse places large-bore IV
and begins LR 150 mL/h.
Bowtie Format:
Left (Potential Complications) | Center (Primary Problem) | Right (Immediate Nursing Actions)
A. Placental abruption
B. Uterine rupture
C. Preterm labor
D. Hypovolemic shock
E. Gestational hypertension
(Correct Answer: Left—A, D | Center—A | Right—Insert second large-bore IV, Increase LR to
wide-open, Notify obstetrician & anesthesia now, Prepare for stat cesarean)
Rationale:
Correct Answer: As above
Clinical Judgment: Recognize Cues—maternal tachycardia + hypotension + late FHR
decelerations + seat-belt sign = concealed abruption with maternal hypovolemia. Center bowtie
,= abruption (source of bleeding). Immediate actions restore circulating volume and expedite
delivery.
Distractor Justification: Uterine rupture usually presents with fetal bradycardia; gestational HTN
not supported by current data; preterm labor is not the priority over hemorrhage.
Item ID: HESI-EXIT-V1-004
Item Type: Complex Stand-Alone
Client Scenario:
A 19 y college freshman is brought to ED by roommate after taking 20 tablets of 500 mg
acetaminophen 4 h ago following romantic breakup. Patient alert, complains of nausea. Initial
acetaminophen level 210 µg/mL.
Question Stem:
Which intervention is most important for the nurse to implement next?
Options:
Administer syrup of ipecac to induce vomiting
Start N-acetylcysteine 140 mg/kg PO loading dose now
Insert nasogastric tube for gastric lavage
Obtain stat pregnancy test and serum salicylate level
(Correct Answer: 2)
Rationale:
Correct Answer: 2
Clinical Judgment: Acetaminophen level >150 µg/mL at 4 h places patient above
Rumack-Matthew nomogram treatment line; N-acetylcysteine prevents hepatotoxicity if given
within 8 h.
Distractor Justification: Ipecac no longer recommended; lavage ineffective 4 h post ingestion;
salicylate level irrelevant to acetaminophen overdose.
Item ID: HESI-EXIT-V1-005
Item Type: NGN - Drag-and-Drop Sequencing
Client Scenario:
Mr. Luis Ortega, 72 y, is 6 h post right total hip replacement. He presses the call bell reporting
sudden shortness of breath. SpO₂ drops from 96 % to 87 % on room air. Breath sounds clear to
auscultation bilaterally; calf pain noted; HR 104 bpm; BP 160/90 mmHg. Nurse suspects
pulmonary embolism.
Question Stem:
Arrange the following nursing actions in the order they should be performed. (Drag tiles into
correct sequence.)
Tiles:
A. Apply high-flow oxygen via non-rebreather
B. Notify rapid-response team/physician
C. Obtain stat V/Q scan or CT-PE protocol
D. Start IV access with large-bore catheter
E. Administer heparin bolus 80 units/kg
(Correct Answer: Sequence—A, B, D, C, E)
Rationale:
, Correct Answer: Oxygen first to correct hypoxemia; then alert team for orders; establish IV
access before imaging; confirm diagnosis prior to anticoagulation per 2026 AHA guidelines.
Distractor Justification: Anticoagulation before imaging risks bleeding if alternate diagnosis
exists; oxygen must precede diagnostic work-up to stabilize patient.
Item ID: HESI-EXIT-V1-006
Item Type: NGN - Enhanced Hot Spot (Text Identification)
Client Scenario:
Ms. Faith Johnson, 41 y, newly diagnosed Graves’ disease, started on methimazole 15 mg PO
TID yesterday. This morning she reports “my throat hurts a lot” and points to anterior neck.
Temp 38.9 °C; WBC 2.8 k/µL (baseline 6.0), neutrophils 18 %.
Question Stem:
Click on the phrase in the nurse’s note that most clearly indicates a life-threatening adverse
effect of methimazole.
Nurse’s Note (excerpt):
“Patient complains of severe sore throat, difficulty swallowing saliva, and feels feverish. No
cough or rhinorrhea. Oral mucosa dry. White patchy exudate noted on tonsils. Anterior neck
tender with mild swelling. Lungs clear. Heart rate 108 bpm regular.”
(Correct Answer: “White patchy exudate noted on tonsils”)
Rationale:
Correct Answer: White exudate plus sore throat, fever, and profound neutropenia signals
agranulocytosis—black-box warning for methimazole requiring immediate drug discontinuation
and filgrastim/antibiotics.
Clinical Judgment: Recognize Cues—identify infection in setting of drug-induced neutropenia.
Distractor Justification: Tachycardia expected in Graves’; neck swelling alone may be thyroid;
exudate is objective sign of bacterial/fungal invasion in immunocompromised state.
Item ID: HESI-EXIT-V1-007
Item Type: Complex Stand-Alone
Client Scenario:
A 6 y child is admitted with status asthmaticus. Initial ABG on 4 L O₂: pH 7.28, PaCO₂ 55 mmHg,
PaO₂ 70 mmHg, HCO₃ 24 mEq/L. After aerosolized albuterol and ipratropium, child tires; RR
40/min, accessory muscles noted.
Question Stem:
Which prescribed intervention should the nurse implement first?
Options:
Administer methylprednisolone 2 mg/kg IV
Prepare for non-invasive bilevel positive airway pressure (BiPAP)
Draw repeat ABG in 30 min
Start magnesium sulfate 50 mg/kg IV over 20 min
(Correct Answer: 2)
Rationale:
Correct Answer: 2
Clinical Judgment: Rising PaCO₂ with fatigue signals impending respiratory failure;
guideline-directed first-line escalation is NIV to decrease work of breathing.
