RN HESI EXIT EXAM V1
ELSEVIER HESI RN
2026/2027 Academic Year
Comprehensive Nursing Exam
150 Verified Questions and Answers
EXAM SPECIFICATIONS
Time Allocation: 4 Hours
Total Questions: 150 Questions (130 scored + 20 pilot)
Question Format: Multiple Choice, SATA, Prioritization
Minimum Competency: 850 Recommended HESI Score
Core Focus: NCLEX-RN Blueprint: All Client Need Categories
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
Elsevier HESI RN Exit Exam V1 predicts NCLEX-RN success and assesses readiness for entry-level
nursing practice. Covers all NCLEX-RN Client Need Categories for 2026/2027 academic year. Score
of 850+ indicates 99% probability of passing NCLEX-RN.
CONTENT DISTRIBUTION
• Safe & Effective Care Environment (26-38%) — Management of care, safety/infection control,
prioritization, delegation
• Health Promotion & Maintenance (6-12%) — Growth/development, prevention, screening,
high-risk behaviors
• Psychosocial Integrity (6-12%) — Mental health, coping, crisis, therapeutic communication,
cultural competence
• Physiological Integrity (38-62%) — Basic care, pharmacology, risk reduction, physiological
adaptation
QUESTION FORMAT & SCORING
Each item presents four options or SATA. Correct answers are highlighted in green with
checkmark (✓). Every question includes detailed rationale with nursing standards. HESI score
850-900 acceptable, 900-950 recommended, >950 outstanding.
STUDY STRATEGY
Master ABCs and prioritization. Know delegation to UAP/LPN/RN. Understand pharmacology and
calculations. Review lab values and critical results. Study infection control and safety. Practice SATA
and priority questions. Review all body systems and pathophysiology.
CURRICULUM ALIGNMENT
Questions reflect 2026-2027 standards: NCLEX-RN Test Plan, Elsevier HESI, AACN Essentials,
ANA Scope and Standards, QSEN competencies, and current evidence-based nursing practice
guidelines.
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 2
, SECTION I: Safe & Effective Care Environment
1. Priority patient to see first:
A. Post-op day 2, pain 6/10
✓ B. New onset chest pain, diaphoresis, SOB
C. Discharge teaching needed
D. Family requesting update
Rationale: Prioritization: ABCs, Maslow, acute before chronic, unstable before stable, actual before
potential. Chest pain = possible MI, life-threatening. ABC: Airway, Breathing, Circulation. Use clinical
judgment. Emergent > Urgent > Non-urgent. Assess first, then life-threatening, then expected outcomes.
2. Delegation to UAP appropriate:
A. Initial assessment
✓ B. Vital signs stable patient, ambulation, ADLs, I&O;
C. IV medication
D. Patient teaching
Rationale: UAP: VS stable patients, ADLs (bath, feed, toilet), ambulate, position, I&O;, document care.
Cannot: assess, teach, meds, IVs, sterile procedures, unstable patients, evaluate. RN: assessment,
planning, evaluation, teaching. LPN: stable patients, meds except IV push, reinforce teaching. 5 Rights of
Delegation.
3. Contact precautions PPE order donning:
A. Gloves, gown, mask
✓ B. Gown, mask, goggles, gloves
C. Mask only
D. No order
Rationale: Donning: Gown, Mask, Goggles, Gloves. Doffing: Gloves, Goggles, Gown, Mask (alphabetical
except gloves first). Hand hygiene before and after, between steps if contaminated. Contact: MRSA, VRE,
C. diff, RSV. Private room. Dedicated equipment. Contact + Droplet: influenza. Contact + Airborne: varicella.
4. Fire RACE acronym:
A. Run, Alert, Call, Exit
✓ B. Rescue, Alarm, Contain, Extinguish/Evacuate
C. React, Assess, Call, Exit
D. Remove, Activate, Call, Extinguish
Rationale: RACE: Rescue patients in immediate danger, Alarm (activate fire alarm), Contain (close
doors/windows), Extinguish (if small) or Evacuate. PASS: Pull pin, Aim base, Squeeze handle, Sweep side
to side. Horizontal evacuation first, then vertical. Oxygen shut off. Elevators not used. Know facility plan.
5. Incident report completed when:
A. Patient satisfied
✓ B. Medication error, fall, injury, near miss
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 3
, C. Routine care
D. Never
Rationale: Incident report: Medication errors, falls, injuries, equipment malfunction, near misses, visitor
incidents, AMA discharge. Purpose: quality improvement, risk management, trending. Not part of medical
record, not for punishment. Complete objectively, factual only, no opinions/blame. Notify supervisor.
Document in chart: facts only.
6. Infant developmental milestone 6 months:
A. Walks independently
✓ B. Sits unsupported, rolls over, transfers objects
C. Speaks in sentences
D. Rides tricycle
Rationale: 6 months: Sits unsupported, rolls both ways, transfers objects hand-to-hand, stranger anxiety
begins, babbles, turns to voice. 2 months: lifts head, social smile. 4 months: rolls front to back, laughs. 9
months: crawls, pincer grasp, stranger/separation anxiety. 12 months: walks, first words. Denver II
screening.
7. Mammogram screening USPSTF:
A. Age 30 annually
✓ B. Age 50-74 biennial
C. Never recommended
D. Age 20 start
Rationale: USPSTF: Age 50-74 biennial mammogram Grade B. Age 40-49 individual decision Grade C. Age
≥75 insufficient evidence. ACS: 45-54 annual, 55+ biennial or annual. High risk: MRI + mammogram.
Clinical breast exam insufficient evidence. Self-exam not recommended. Discuss benefits/harms of
screening.
8. Therapeutic communication for anxiety:
A. 'Don't worry'
✓ B. 'Tell me more about what you're feeling'
C. 'I know how you feel'
D. Change subject
Rationale: Therapeutic: Open-ended questions, active listening, reflection, restating, clarification, silence,
offering self, summarizing. Non-therapeutic: false reassurance, giving advice, approval/disapproval, why
questions, changing subject, defensive responses. Anxiety: stay calm, reduce stimuli, breathing techniques,
validate feelings.
9. Major depression priority nursing diagnosis:
A. Imbalanced nutrition
✓ B. Risk for suicide
C. Social isolation
D. Disturbed sleep
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 4
ELSEVIER HESI RN
2026/2027 Academic Year
Comprehensive Nursing Exam
150 Verified Questions and Answers
EXAM SPECIFICATIONS
Time Allocation: 4 Hours
Total Questions: 150 Questions (130 scored + 20 pilot)
Question Format: Multiple Choice, SATA, Prioritization
Minimum Competency: 850 Recommended HESI Score
Core Focus: NCLEX-RN Blueprint: All Client Need Categories
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
Elsevier HESI RN Exit Exam V1 predicts NCLEX-RN success and assesses readiness for entry-level
nursing practice. Covers all NCLEX-RN Client Need Categories for 2026/2027 academic year. Score
of 850+ indicates 99% probability of passing NCLEX-RN.
CONTENT DISTRIBUTION
• Safe & Effective Care Environment (26-38%) — Management of care, safety/infection control,
prioritization, delegation
• Health Promotion & Maintenance (6-12%) — Growth/development, prevention, screening,
high-risk behaviors
• Psychosocial Integrity (6-12%) — Mental health, coping, crisis, therapeutic communication,
cultural competence
• Physiological Integrity (38-62%) — Basic care, pharmacology, risk reduction, physiological
adaptation
QUESTION FORMAT & SCORING
Each item presents four options or SATA. Correct answers are highlighted in green with
checkmark (✓). Every question includes detailed rationale with nursing standards. HESI score
850-900 acceptable, 900-950 recommended, >950 outstanding.
STUDY STRATEGY
Master ABCs and prioritization. Know delegation to UAP/LPN/RN. Understand pharmacology and
calculations. Review lab values and critical results. Study infection control and safety. Practice SATA
and priority questions. Review all body systems and pathophysiology.
CURRICULUM ALIGNMENT
Questions reflect 2026-2027 standards: NCLEX-RN Test Plan, Elsevier HESI, AACN Essentials,
ANA Scope and Standards, QSEN competencies, and current evidence-based nursing practice
guidelines.
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 2
, SECTION I: Safe & Effective Care Environment
1. Priority patient to see first:
A. Post-op day 2, pain 6/10
✓ B. New onset chest pain, diaphoresis, SOB
C. Discharge teaching needed
D. Family requesting update
Rationale: Prioritization: ABCs, Maslow, acute before chronic, unstable before stable, actual before
potential. Chest pain = possible MI, life-threatening. ABC: Airway, Breathing, Circulation. Use clinical
judgment. Emergent > Urgent > Non-urgent. Assess first, then life-threatening, then expected outcomes.
2. Delegation to UAP appropriate:
A. Initial assessment
✓ B. Vital signs stable patient, ambulation, ADLs, I&O;
C. IV medication
D. Patient teaching
Rationale: UAP: VS stable patients, ADLs (bath, feed, toilet), ambulate, position, I&O;, document care.
Cannot: assess, teach, meds, IVs, sterile procedures, unstable patients, evaluate. RN: assessment,
planning, evaluation, teaching. LPN: stable patients, meds except IV push, reinforce teaching. 5 Rights of
Delegation.
3. Contact precautions PPE order donning:
A. Gloves, gown, mask
✓ B. Gown, mask, goggles, gloves
C. Mask only
D. No order
Rationale: Donning: Gown, Mask, Goggles, Gloves. Doffing: Gloves, Goggles, Gown, Mask (alphabetical
except gloves first). Hand hygiene before and after, between steps if contaminated. Contact: MRSA, VRE,
C. diff, RSV. Private room. Dedicated equipment. Contact + Droplet: influenza. Contact + Airborne: varicella.
4. Fire RACE acronym:
A. Run, Alert, Call, Exit
✓ B. Rescue, Alarm, Contain, Extinguish/Evacuate
C. React, Assess, Call, Exit
D. Remove, Activate, Call, Extinguish
Rationale: RACE: Rescue patients in immediate danger, Alarm (activate fire alarm), Contain (close
doors/windows), Extinguish (if small) or Evacuate. PASS: Pull pin, Aim base, Squeeze handle, Sweep side
to side. Horizontal evacuation first, then vertical. Oxygen shut off. Elevators not used. Know facility plan.
5. Incident report completed when:
A. Patient satisfied
✓ B. Medication error, fall, injury, near miss
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 3
, C. Routine care
D. Never
Rationale: Incident report: Medication errors, falls, injuries, equipment malfunction, near misses, visitor
incidents, AMA discharge. Purpose: quality improvement, risk management, trending. Not part of medical
record, not for punishment. Complete objectively, factual only, no opinions/blame. Notify supervisor.
Document in chart: facts only.
6. Infant developmental milestone 6 months:
A. Walks independently
✓ B. Sits unsupported, rolls over, transfers objects
C. Speaks in sentences
D. Rides tricycle
Rationale: 6 months: Sits unsupported, rolls both ways, transfers objects hand-to-hand, stranger anxiety
begins, babbles, turns to voice. 2 months: lifts head, social smile. 4 months: rolls front to back, laughs. 9
months: crawls, pincer grasp, stranger/separation anxiety. 12 months: walks, first words. Denver II
screening.
7. Mammogram screening USPSTF:
A. Age 30 annually
✓ B. Age 50-74 biennial
C. Never recommended
D. Age 20 start
Rationale: USPSTF: Age 50-74 biennial mammogram Grade B. Age 40-49 individual decision Grade C. Age
≥75 insufficient evidence. ACS: 45-54 annual, 55+ biennial or annual. High risk: MRI + mammogram.
Clinical breast exam insufficient evidence. Self-exam not recommended. Discuss benefits/harms of
screening.
8. Therapeutic communication for anxiety:
A. 'Don't worry'
✓ B. 'Tell me more about what you're feeling'
C. 'I know how you feel'
D. Change subject
Rationale: Therapeutic: Open-ended questions, active listening, reflection, restating, clarification, silence,
offering self, summarizing. Non-therapeutic: false reassurance, giving advice, approval/disapproval, why
questions, changing subject, defensive responses. Anxiety: stay calm, reduce stimuli, breathing techniques,
validate feelings.
9. Major depression priority nursing diagnosis:
A. Imbalanced nutrition
✓ B. Risk for suicide
C. Social isolation
D. Disturbed sleep
RN HESI Exit Exam V1 Elsevier 2026-2027 Page 4
