HESI Nursing Prioritization &
Delegation Exam (Latest 2026)||
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Rationales/Graded A+/2026
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Section 1: Prioritization Using ABCs & Maslow (Questions 1-15)
1. A nurse receives shift report on 4 patients. Which should be assessed first?
• A) Post-op day 2 patient reporting pain 5/10
• B) Patient with new onset confusion and O2 saturation 88%
• C) Patient requesting a glass of water
• D) Patient with a scheduled wound dressing change
Rationale: ABCs – Oxygen saturation of 88% indicates hypoxia, a life-threatening
airway/breathing issue. Confusion may be due to hypoxia.
2. Which patient requires immediate nursing intervention?
• A) Heart failure patient with 2+ pitting edema
• B) Diabetic patient with blood glucose 180 mg/dL
• C) Asthmatic patient with suddenly diminished breath sounds
• D) Post-appendectomy patient with pain 3/10
Rationale: Diminished breath sounds in asthma suggest impending respiratory
failure or silent chest – critical airway/breathing priority.
3. A nurse on a medical-surgical unit has 4 patients. Who to see first?
• A) Patient with a new ileostomy who has output 150 mL in 4 hours
, • B) Patient with pneumonia requesting pain meds
• C) Patient with chest pain radiating to the jaw
• D) Patient with a fractured femur in Buck’s traction
Rationale: Chest pain radiating to jaw = possible myocardial infarction →
circulation priority (ABCs). Pain meds and output can wait.
4. Which patient is at highest risk for airway compromise?
• A) Stroke patient with mild dysphagia
• B) Patient post-tonsillectomy with frequent swallowing
• C) Laryngectomy patient with stoma
• D) COPD patient with O2 sat 91%
Rationale: Frequent swallowing post-tonsillectomy indicates bleeding into throat,
imminent airway obstruction. This is a silent but critical airway priority.
5. A nurse hears an unlicensed assistive personnel (UAP) say a patient’s
tracheostomy tube is dislodged. First action?
• A) Call respiratory therapy
• B) Go to the room immediately to assess and attempt to reinsert
• C) Page the provider
• D) Ask the UAP to hold manual pressure
Rationale: Loss of airway is #1 priority. Nurse must go immediately to maintain
airway – cannot delegate assessment or emergent airway management.
6. Which patient should be seen first after receiving change-of-shift report?
• A) Patient scheduled for MRI at 0900
• B) Patient with a fever of 38.3°C (101°F)
• C) Patient with new slurred speech and facial droop
• D) Patient requesting discharge teaching
Rationale: New neurologic deficits suggest stroke → time-sensitive circulation to
brain. Urgent assessment for tPA eligibility.
, 7. Prioritization based on Maslow: which patient need is most immediate?
• A) Low self-esteem related to body image
• B) Ineffective airway clearance
• C) Social isolation
• D) Impaired skin integrity
Rationale: Maslow’s hierarchy: physiologic needs (airway) before safety, love,
esteem.
8. A patient with traumatic brain injury has ICP 25 mm Hg and is becoming
lethargic. Next action?
• A) Notify provider immediately
• B) Administer PRN lorazepam
• C) Increase IV fluids
• D) Reposition head of bed flat
Rationale: Elevated ICP (normal <15) with neuro change = urgent; flat HOB
worsens ICP. Notification is priority.
9. Four patients call the nurse at the same time. Who to respond to first?
• A) “My IV site is red and warm”
• B) “I haven’t had a bowel movement in 3 days”
• C) “My food tray is cold”
• D) “I feel like my heart is racing and I’m dizzy”
Rationale: Palpitations + dizziness = potential dysrhythmia or hemodynamic
instability → circulation priority.
10. A nurse is caring for a patient with a chest tube. Which finding requires
immediate action?
• A) 100 mL serosanguineous drainage in 8 hours
• B) Continuous bubbling in the water seal chamber
• C) Tidaling with respiration
Delegation Exam (Latest 2026)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Section 1: Prioritization Using ABCs & Maslow (Questions 1-15)
1. A nurse receives shift report on 4 patients. Which should be assessed first?
• A) Post-op day 2 patient reporting pain 5/10
• B) Patient with new onset confusion and O2 saturation 88%
• C) Patient requesting a glass of water
• D) Patient with a scheduled wound dressing change
Rationale: ABCs – Oxygen saturation of 88% indicates hypoxia, a life-threatening
airway/breathing issue. Confusion may be due to hypoxia.
2. Which patient requires immediate nursing intervention?
• A) Heart failure patient with 2+ pitting edema
• B) Diabetic patient with blood glucose 180 mg/dL
• C) Asthmatic patient with suddenly diminished breath sounds
• D) Post-appendectomy patient with pain 3/10
Rationale: Diminished breath sounds in asthma suggest impending respiratory
failure or silent chest – critical airway/breathing priority.
3. A nurse on a medical-surgical unit has 4 patients. Who to see first?
• A) Patient with a new ileostomy who has output 150 mL in 4 hours
, • B) Patient with pneumonia requesting pain meds
• C) Patient with chest pain radiating to the jaw
• D) Patient with a fractured femur in Buck’s traction
Rationale: Chest pain radiating to jaw = possible myocardial infarction →
circulation priority (ABCs). Pain meds and output can wait.
4. Which patient is at highest risk for airway compromise?
• A) Stroke patient with mild dysphagia
• B) Patient post-tonsillectomy with frequent swallowing
• C) Laryngectomy patient with stoma
• D) COPD patient with O2 sat 91%
Rationale: Frequent swallowing post-tonsillectomy indicates bleeding into throat,
imminent airway obstruction. This is a silent but critical airway priority.
5. A nurse hears an unlicensed assistive personnel (UAP) say a patient’s
tracheostomy tube is dislodged. First action?
• A) Call respiratory therapy
• B) Go to the room immediately to assess and attempt to reinsert
• C) Page the provider
• D) Ask the UAP to hold manual pressure
Rationale: Loss of airway is #1 priority. Nurse must go immediately to maintain
airway – cannot delegate assessment or emergent airway management.
6. Which patient should be seen first after receiving change-of-shift report?
• A) Patient scheduled for MRI at 0900
• B) Patient with a fever of 38.3°C (101°F)
• C) Patient with new slurred speech and facial droop
• D) Patient requesting discharge teaching
Rationale: New neurologic deficits suggest stroke → time-sensitive circulation to
brain. Urgent assessment for tPA eligibility.
, 7. Prioritization based on Maslow: which patient need is most immediate?
• A) Low self-esteem related to body image
• B) Ineffective airway clearance
• C) Social isolation
• D) Impaired skin integrity
Rationale: Maslow’s hierarchy: physiologic needs (airway) before safety, love,
esteem.
8. A patient with traumatic brain injury has ICP 25 mm Hg and is becoming
lethargic. Next action?
• A) Notify provider immediately
• B) Administer PRN lorazepam
• C) Increase IV fluids
• D) Reposition head of bed flat
Rationale: Elevated ICP (normal <15) with neuro change = urgent; flat HOB
worsens ICP. Notification is priority.
9. Four patients call the nurse at the same time. Who to respond to first?
• A) “My IV site is red and warm”
• B) “I haven’t had a bowel movement in 3 days”
• C) “My food tray is cold”
• D) “I feel like my heart is racing and I’m dizzy”
Rationale: Palpitations + dizziness = potential dysrhythmia or hemodynamic
instability → circulation priority.
10. A nurse is caring for a patient with a chest tube. Which finding requires
immediate action?
• A) 100 mL serosanguineous drainage in 8 hours
• B) Continuous bubbling in the water seal chamber
• C) Tidaling with respiration
