2027 HESI RN Exit Final Exam – NGN Questions,
Case Studies & Verified Answers with Rationales
(Pass Guaranteed)
Includes: NGN clinical judgment, case studies, prioritization, SATA, matrix-style
thinking, ordered response, delegation, pharmacology, medical-surgical,
maternal-newborn, pediatrics, mental health, leadership, safety, and health
promotion.
SECTION I — MEDICAL-SURGICAL NURSING
Question 1
A client with acute pulmonary edema suddenly develops severe dyspnea,
crackles throughout both lungs, and an oxygen saturation of 82%. Which action
should the nurse take first?
A. Obtain the client's daily weight
B. Place the client in high-Fowler's position
C. Administer the prescribed oral diuretic
D. Encourage oral fluid intake
Answer: B
Rationale: High-Fowler's positioning decreases venous return and improves
lung expansion, helping reduce respiratory distress immediately. Oxygen and
prescribed emergency medications would follow. Daily weight and fluid intake
are not immediate interventions.
Question 2
A client with chronic obstructive pulmonary disease is receiving oxygen at 2
L/min by nasal cannula. The client becomes increasingly drowsy. Which
assessment is the priority?
A. Temperature
B. Blood pressure
C. Level of consciousness and respiratory status
D. Peripheral edema
Answer: C
,Rationale: Increasing drowsiness may indicate worsening carbon dioxide
retention or respiratory failure. The nurse should immediately reassess
respiratory rate, effort, oxygenation, and mental status.
Question 3
A client with suspected myocardial infarction reports crushing substernal chest
pain radiating to the left arm. Which finding requires immediate intervention?
A. Blood pressure 146/88 mmHg
B. Heart rate 104/min
C. Oxygen saturation 86%
D. Respiratory rate 22/min
Answer: C
Rationale: Severe hypoxemia threatens tissue oxygenation and requires
immediate intervention. The other findings may occur with pain and
sympathetic stimulation but are less immediately life-threatening.
Question 4
The nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory result is most important to monitor?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: B
Rationale: Unfractionated heparin therapy is monitored using the activated
partial thromboplastin time (aPTT), according to the institution's therapeutic
range. INR is primarily used for warfarin therapy.
Question 5
A client taking warfarin reports black, tarry stools. What should the nurse do
first?
,A. Document the finding as an expected effect
B. Encourage increased dietary vitamin K
C. Notify the healthcare provider
D. Administer the next dose of warfarin
Answer: C
Rationale: Melena may indicate gastrointestinal bleeding and requires prompt
evaluation. Warfarin should not simply be continued without assessment.
Question 6
A client with heart failure is prescribed furosemide. Which laboratory result is
most important for the nurse to monitor?
A. Potassium
B. Calcium
C. Hemoglobin
D. Platelets
Answer: A
Rationale: Furosemide is a loop diuretic that can cause potassium loss.
Hypokalemia can produce muscle weakness and potentially dangerous
dysrhythmias.
Question 7
A client with chronic kidney disease has a serum potassium of 6.7 mEq/L and
reports muscle weakness. Which action has the highest priority?
A. Encourage potassium-rich foods
B. Place the client on cardiac monitoring
C. Administer a potassium supplement
D. Restrict dietary calcium
Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. Continuous cardiac monitoring is a priority while emergency
treatment is initiated.
, Question 8
A client with diabetes is awake, sweating, trembling, and reports feeling weak.
The blood glucose level is 54 mg/dL. What should the nurse do?
A. Administer regular insulin
B. Give approximately 15 g of rapid-acting carbohydrate
C. Restrict oral intake
D. Administer long-acting insulin
Answer: B
Rationale: An alert client with symptomatic hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
Question 9
A client with diabetic ketoacidosis has a glucose level of 610 mg/dL, deep
respirations, and dehydration. Which prescription should the nurse anticipate
implementing first?
A. IV isotonic fluid replacement
B. Oral potassium supplementation
C. Long-acting subcutaneous insulin
D. Fluid restriction
Answer: A
Rationale: Initial DKA management focuses on restoring circulating volume
with isotonic IV fluids. Insulin is then administered according to the treatment
protocol, with careful electrolyte monitoring.
Question 10
A client with SIADH has a sodium level of 118 mEq/L. Which assessment finding
is most concerning?
A. Dry skin
B. Confusion and seizure activity
Case Studies & Verified Answers with Rationales
(Pass Guaranteed)
Includes: NGN clinical judgment, case studies, prioritization, SATA, matrix-style
thinking, ordered response, delegation, pharmacology, medical-surgical,
maternal-newborn, pediatrics, mental health, leadership, safety, and health
promotion.
SECTION I — MEDICAL-SURGICAL NURSING
Question 1
A client with acute pulmonary edema suddenly develops severe dyspnea,
crackles throughout both lungs, and an oxygen saturation of 82%. Which action
should the nurse take first?
A. Obtain the client's daily weight
B. Place the client in high-Fowler's position
C. Administer the prescribed oral diuretic
D. Encourage oral fluid intake
Answer: B
Rationale: High-Fowler's positioning decreases venous return and improves
lung expansion, helping reduce respiratory distress immediately. Oxygen and
prescribed emergency medications would follow. Daily weight and fluid intake
are not immediate interventions.
Question 2
A client with chronic obstructive pulmonary disease is receiving oxygen at 2
L/min by nasal cannula. The client becomes increasingly drowsy. Which
assessment is the priority?
A. Temperature
B. Blood pressure
C. Level of consciousness and respiratory status
D. Peripheral edema
Answer: C
,Rationale: Increasing drowsiness may indicate worsening carbon dioxide
retention or respiratory failure. The nurse should immediately reassess
respiratory rate, effort, oxygenation, and mental status.
Question 3
A client with suspected myocardial infarction reports crushing substernal chest
pain radiating to the left arm. Which finding requires immediate intervention?
A. Blood pressure 146/88 mmHg
B. Heart rate 104/min
C. Oxygen saturation 86%
D. Respiratory rate 22/min
Answer: C
Rationale: Severe hypoxemia threatens tissue oxygenation and requires
immediate intervention. The other findings may occur with pain and
sympathetic stimulation but are less immediately life-threatening.
Question 4
The nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory result is most important to monitor?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: B
Rationale: Unfractionated heparin therapy is monitored using the activated
partial thromboplastin time (aPTT), according to the institution's therapeutic
range. INR is primarily used for warfarin therapy.
Question 5
A client taking warfarin reports black, tarry stools. What should the nurse do
first?
,A. Document the finding as an expected effect
B. Encourage increased dietary vitamin K
C. Notify the healthcare provider
D. Administer the next dose of warfarin
Answer: C
Rationale: Melena may indicate gastrointestinal bleeding and requires prompt
evaluation. Warfarin should not simply be continued without assessment.
Question 6
A client with heart failure is prescribed furosemide. Which laboratory result is
most important for the nurse to monitor?
A. Potassium
B. Calcium
C. Hemoglobin
D. Platelets
Answer: A
Rationale: Furosemide is a loop diuretic that can cause potassium loss.
Hypokalemia can produce muscle weakness and potentially dangerous
dysrhythmias.
Question 7
A client with chronic kidney disease has a serum potassium of 6.7 mEq/L and
reports muscle weakness. Which action has the highest priority?
A. Encourage potassium-rich foods
B. Place the client on cardiac monitoring
C. Administer a potassium supplement
D. Restrict dietary calcium
Answer: B
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. Continuous cardiac monitoring is a priority while emergency
treatment is initiated.
, Question 8
A client with diabetes is awake, sweating, trembling, and reports feeling weak.
The blood glucose level is 54 mg/dL. What should the nurse do?
A. Administer regular insulin
B. Give approximately 15 g of rapid-acting carbohydrate
C. Restrict oral intake
D. Administer long-acting insulin
Answer: B
Rationale: An alert client with symptomatic hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
Question 9
A client with diabetic ketoacidosis has a glucose level of 610 mg/dL, deep
respirations, and dehydration. Which prescription should the nurse anticipate
implementing first?
A. IV isotonic fluid replacement
B. Oral potassium supplementation
C. Long-acting subcutaneous insulin
D. Fluid restriction
Answer: A
Rationale: Initial DKA management focuses on restoring circulating volume
with isotonic IV fluids. Insulin is then administered according to the treatment
protocol, with careful electrolyte monitoring.
Question 10
A client with SIADH has a sodium level of 118 mEq/L. Which assessment finding
is most concerning?
A. Dry skin
B. Confusion and seizure activity
