HESI COMPREHENSIVE
EXIT EXAM
NCLEX Readiness & Clinical Judgment
2026/2027 Edition
Comprehensive Nursing Review
150 Verified Questions with Detailed Rationales
EXAM SPECIFICATIONS
Time Allocation: 4 Hours
Total Questions: 150 Questions
Question Format: Multiple Choice & NGN-Style with Rationales
Minimum Competency: 900 HESI Score (Predicts NCLEX Pass)
Core Focus: Clinical Judgment, Safety, Priority Setting, Pharmacology
HESI Comprehensive Exit Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This HESI Comprehensive Exit Exam evaluates NCLEX-RN readiness and clinical judgment across
all nursing content areas. Questions mirror HESI Exit and NCLEX Next Gen format, testing
application, analysis, and priority-setting using the NCSBN Clinical Judgment Measurement Model.
CONTENT DISTRIBUTION
• Management of Care (20%) — Priority setting, delegation, triage, legal/ethical, quality improvement
• Safety & Infection Control (15%) — National Patient Safety Goals, standard precautions, error
prevention
• Health Promotion & Maintenance (10%) — Growth/development, prevention, screening, patient
education
• Psychosocial Integrity (10%) — Mental health, therapeutic communication, crisis intervention,
abuse
• Physiological Integrity: Basic Care (10%) — Mobility, nutrition, elimination, rest/sleep, comfort
• Pharmacological Therapies (15%) — Medication administration, side effects, patient teaching,
calculations
• Reduction of Risk Potential (10%) — Lab values, diagnostics, complications, monitoring
• Physiological Adaptation (10%) — Medical-surgical, pathophysiology, emergency management
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with NCLEX test-taking strategies. Target HESI score:
900+ predicts 95% NCLEX pass rate.
STUDY STRATEGY
Use ABC-Airway, Breathing, Circulation, Maslow's Hierarchy, and Acute vs. Chronic to set priorities.
Review rationales for all answers, not just correct ones. Focus on safety first.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 HESI Exit blueprint and NCLEX-RN Test Plan: Clinical Judgment, NGN
item types, and AACN Essentials.
HESI Comprehensive Exit Exam Prep 2026/2027 Page 2
,HESI Comprehensive Exit Exam Prep 2026/2027 Page 3
, SECTION I: Management of Care & Priority Setting
1. The nurse receives four patients. Which patient should be assessed first?
A. Post-op day 1 cholecystectomy, pain 6/10
✓ B. New onset chest pain and diaphoresis
C. Type 2 diabetes, blood glucose 180 mg/dL
D. COPD exacerbation, O2 sat 93% on 2L
Rationale: New chest pain with diaphoresis indicates potential MI—life-threatening. Use ABC and acute vs.
chronic. Post-op pain, stable diabetes, and stable COPD are lower priority.
2. Which task can the RN delegate to UAP?
A. Initial assessment of new admission
✓ B. Vital signs for stable patient
C. Patient teaching about insulin
D. IV push medication administration
Rationale: UAP can perform routine, stable tasks like vitals. RN must do assessments, teaching, and IV
meds. Never delegate EAT: Evaluation, Assessment, Teaching.
3. A patient with NG tube has sudden respiratory distress. The nurse should first:
✓ A. Check NG tube placement
B. Call respiratory therapy
C. Increase oxygen flow rate
D. Document the finding
Rationale: Sudden respiratory distress with NG tube suggests aspiration or tube migration to airway. Verify
placement first. Don't increase O2 without assessing cause. Document after intervention.
4. The nurse administers incorrect medication. The priority action is:
A. Complete incident report
✓ B. Assess the patient
C. Notify the physician
D. Inform the charge nurse
Rationale: Patient safety first—assess for adverse effects. Then notify MD, charge nurse, and complete
report. Assessment before reporting.
5. Which lab value requires immediate intervention?
A. Potassium 3.2 mEq/L
B. Sodium 128 mEq/L
C. Hemoglobin 9.5 g/dL
✓ D. Potassium 6.8 mEq/L
Rationale: K+ 6.8 is life-threatening hyperkalemia—risk of cardiac arrest. K+ 3.2 is low but not critical. Na
128 is hyponatremia but not emergent. Hgb 9.5 is anemia but stable.
HESI Comprehensive Exit Exam Prep 2026/2027 Page 4
EXIT EXAM
NCLEX Readiness & Clinical Judgment
2026/2027 Edition
Comprehensive Nursing Review
150 Verified Questions with Detailed Rationales
EXAM SPECIFICATIONS
Time Allocation: 4 Hours
Total Questions: 150 Questions
Question Format: Multiple Choice & NGN-Style with Rationales
Minimum Competency: 900 HESI Score (Predicts NCLEX Pass)
Core Focus: Clinical Judgment, Safety, Priority Setting, Pharmacology
HESI Comprehensive Exit Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This HESI Comprehensive Exit Exam evaluates NCLEX-RN readiness and clinical judgment across
all nursing content areas. Questions mirror HESI Exit and NCLEX Next Gen format, testing
application, analysis, and priority-setting using the NCSBN Clinical Judgment Measurement Model.
CONTENT DISTRIBUTION
• Management of Care (20%) — Priority setting, delegation, triage, legal/ethical, quality improvement
• Safety & Infection Control (15%) — National Patient Safety Goals, standard precautions, error
prevention
• Health Promotion & Maintenance (10%) — Growth/development, prevention, screening, patient
education
• Psychosocial Integrity (10%) — Mental health, therapeutic communication, crisis intervention,
abuse
• Physiological Integrity: Basic Care (10%) — Mobility, nutrition, elimination, rest/sleep, comfort
• Pharmacological Therapies (15%) — Medication administration, side effects, patient teaching,
calculations
• Reduction of Risk Potential (10%) — Lab values, diagnostics, complications, monitoring
• Physiological Adaptation (10%) — Medical-surgical, pathophysiology, emergency management
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with NCLEX test-taking strategies. Target HESI score:
900+ predicts 95% NCLEX pass rate.
STUDY STRATEGY
Use ABC-Airway, Breathing, Circulation, Maslow's Hierarchy, and Acute vs. Chronic to set priorities.
Review rationales for all answers, not just correct ones. Focus on safety first.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 HESI Exit blueprint and NCLEX-RN Test Plan: Clinical Judgment, NGN
item types, and AACN Essentials.
HESI Comprehensive Exit Exam Prep 2026/2027 Page 2
,HESI Comprehensive Exit Exam Prep 2026/2027 Page 3
, SECTION I: Management of Care & Priority Setting
1. The nurse receives four patients. Which patient should be assessed first?
A. Post-op day 1 cholecystectomy, pain 6/10
✓ B. New onset chest pain and diaphoresis
C. Type 2 diabetes, blood glucose 180 mg/dL
D. COPD exacerbation, O2 sat 93% on 2L
Rationale: New chest pain with diaphoresis indicates potential MI—life-threatening. Use ABC and acute vs.
chronic. Post-op pain, stable diabetes, and stable COPD are lower priority.
2. Which task can the RN delegate to UAP?
A. Initial assessment of new admission
✓ B. Vital signs for stable patient
C. Patient teaching about insulin
D. IV push medication administration
Rationale: UAP can perform routine, stable tasks like vitals. RN must do assessments, teaching, and IV
meds. Never delegate EAT: Evaluation, Assessment, Teaching.
3. A patient with NG tube has sudden respiratory distress. The nurse should first:
✓ A. Check NG tube placement
B. Call respiratory therapy
C. Increase oxygen flow rate
D. Document the finding
Rationale: Sudden respiratory distress with NG tube suggests aspiration or tube migration to airway. Verify
placement first. Don't increase O2 without assessing cause. Document after intervention.
4. The nurse administers incorrect medication. The priority action is:
A. Complete incident report
✓ B. Assess the patient
C. Notify the physician
D. Inform the charge nurse
Rationale: Patient safety first—assess for adverse effects. Then notify MD, charge nurse, and complete
report. Assessment before reporting.
5. Which lab value requires immediate intervention?
A. Potassium 3.2 mEq/L
B. Sodium 128 mEq/L
C. Hemoglobin 9.5 g/dL
✓ D. Potassium 6.8 mEq/L
Rationale: K+ 6.8 is life-threatening hyperkalemia—risk of cardiac arrest. K+ 3.2 is low but not critical. Na
128 is hyponatremia but not emergent. Hgb 9.5 is anemia but stable.
HESI Comprehensive Exit Exam Prep 2026/2027 Page 4
