NEW HESI RN Fundamentals 2026-2027 — Exam Question Bank
HESI RN Fundamentals 2026-2027
Questions & Answers with Rationales
Question 1
A nurse is caring for four clients at the start of a shift. Which client should the nurse assess FIRST?
A. A client who reports a pain level of 4/10 after knee surgery
B. A client with a new onset of shortness of breath and oxygen saturation of 88%
C. A client requesting a scheduled dressing change
D. A client waiting for discharge instructions
Correct Answer: B. A client with a new onset of shortness of breath and oxygen saturation of 88%
Detailed Solution: New-onset shortness of breath with a low oxygen saturation indicates an acute
airway/breathing problem, which takes priority over stable pain, routine treatments, or discharge teaching using
the ABC (airway, breathing, circulation) framework.
Question 2
Which client should the charge nurse assign to the unlicensed assistive personnel (UAP)?
A. A stable client who needs assistance with ambulation and vital signs
B. A client who requires a sterile dressing change
C. A newly admitted client requiring an admission assessment
D. A client who needs teaching on a new insulin regimen
Correct Answer: A. A stable client who needs assistance with ambulation and vital signs
Detailed Solution: UAPs can perform basic, non-invasive tasks such as ambulation assistance and routine vital
signs on stable clients. Teaching, sterile procedures, and admission assessments require licensed nursing judgment
and are outside UAP scope of practice.
Question 3
A client who had abdominal surgery yesterday reports sudden, severe pain and the nurse notes the abdomen is
rigid and distended. What should the nurse do FIRST?
A. Document the finding and continue routine rounding
B. Encourage the client to ambulate to relieve gas pain
C. Administer the PRN pain medication and reassess in an hour
D. Notify the surgeon promptly and continue to monitor vital signs
Correct Answer: D. Notify the surgeon promptly and continue to monitor vital signs
Detailed Solution: Sudden severe pain with a rigid, distended abdomen after surgery suggests a possible surgical
emergency such as dehiscence, hemorrhage, or perforation. This requires prompt provider notification rather than
simply medicating and waiting, which could delay critical intervention.
Question 4
The nurse is prioritizing care for a client with a new tracheostomy who is anxious and a client with a stable
chronic wound needing a dressing change. Which action reflects correct prioritization?
A. Wait until both clients call the nurse before responding
B. Attend to the chronic wound dressing change first since it was scheduled earlier
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, NEW HESI RN Fundamentals 2026-2027 — Exam Question Bank
C. Assess the tracheostomy client first because airway concerns take priority over routine wound care
D. Delegate both tasks to the UAP simultaneously
Correct Answer: C. Assess the tracheostomy client first because airway concerns take priority over routine
wound care
Detailed Solution: Airway management for a new tracheostomy takes priority under the ABC framework over a
scheduled, non-urgent dressing change on a stable chronic wound, regardless of which task was scheduled first.
Question 5
A nurse receiving hand-off report learns that one client had a blood pressure of 90/50 with dizziness on standing,
and another client is due for a routine medication in 30 minutes. Which client should the nurse see FIRST?
A. The client due for routine medication, to stay on schedule
B. The client with hypotension and dizziness, to assess for orthostatic changes and fall risk
C. Neither, since both can wait until after report is fully completed
D. The client whose room is closest to the nurses' station
Correct Answer: B. The client with hypotension and dizziness, to assess for orthostatic changes and fall risk
Detailed Solution: Hypotension with dizziness signals a risk for falls and possible hemodynamic instability,
requiring prompt assessment, whereas a routine medication due in 30 minutes has a wider safe administration
window and does not represent an acute safety risk.
Question 6
Four clients use their call light at the same time. Which client's request should the nurse address FIRST?
A. A client asking about visiting hours
B. A client with a chest tube reporting sudden difficulty breathing
C. A client requesting a snack from the kitchen
D. A client requesting a warm blanket
Correct Answer: B. A client with a chest tube reporting sudden difficulty breathing
Detailed Solution: Sudden difficulty breathing in a client with a chest tube may indicate a tension pneumothorax
or tube malfunction, an airway/breathing emergency that must be addressed before comfort or informational
requests.
Question 7
A postpartum client reports heavy vaginal bleeding and a firm fundus is not palpable. Which action should the
nurse take FIRST?
A. Encourage the client to ambulate to the bathroom
B. Offer the client a warm beverage
C. Document the finding and reassess in 30 minutes
D. Massage the fundus and notify the provider promptly
Correct Answer: D. Massage the fundus and notify the provider promptly
Detailed Solution: A boggy, non-firm fundus with heavy bleeding suggests uterine atony, a leading cause of
postpartum hemorrhage; fundal massage is the immediate first-line nursing intervention, combined with prompt
provider notification, rather than delayed reassessment.
Question 8
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, NEW HESI RN Fundamentals 2026-2027 — Exam Question Bank
Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
A. Administering an intravenous antibiotic
B. Assessing a new post-operative client's incision
C. Reinforcing previously taught discharge instructions
D. Recording intake and output for a stable client
Correct Answer: D. Recording intake and output for a stable client
Detailed Solution: Recording intake and output on a stable client is a routine, non-invasive task within UAP
scope. Assessment, patient teaching, and medication administration require nursing judgment and licensure, and
cannot be delegated to a UAP.
Question 9
A nurse is delegating tasks to an LPN/LVN on the team. Which task is MOST appropriate to assign to the
LPN/LVN?
A. Developing the initial plan of care for a new admission
B. Administering a scheduled oral medication to a stable client
C. Completing the discharge teaching for a client with a new colostomy
D. Performing the initial assessment of an unstable client
Correct Answer: B. Administering a scheduled oral medication to a stable client
Detailed Solution: LPNs/LVNs can administer many oral medications to stable clients under an RN's supervision.
Initial care planning, complex discharge teaching, and assessment of unstable clients require RN-level scope of
practice and clinical judgment.
Question 10
Which finding, if reported to the nurse by a UAP, requires the nurse to reprioritize care and assess the client
immediately?
A. A client's blood glucose of 45 mg/dL with new confusion
B. A client who ate 80% of a meal tray
C. A client who requests extra pillows
D. A stable client's oral temperature of 98.6°F (37°C)
Correct Answer: A. A client's blood glucose of 45 mg/dL with new confusion
Detailed Solution: A blood glucose of 45 mg/dL with new confusion indicates symptomatic hypoglycemia, a
time-sensitive emergency requiring immediate nursing assessment and intervention, unlike the other routine,
non-urgent findings.
Question 11
The nurse must decide whether to delegate ambulation of a client to a UAP. Which client is MOST appropriate for
this delegation?
A. A client who fell during the previous shift
B. A client with an unsteady gait and new sedating medication given 20 minutes ago
C. A client who is 6 hours post-op from hip replacement with orthostatic hypotension noted earlier
D. A client who is 2 days post-op, hemodynamically stable, and has ambulated without difficulty twice
already
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HESI RN Fundamentals 2026-2027
Questions & Answers with Rationales
Question 1
A nurse is caring for four clients at the start of a shift. Which client should the nurse assess FIRST?
A. A client who reports a pain level of 4/10 after knee surgery
B. A client with a new onset of shortness of breath and oxygen saturation of 88%
C. A client requesting a scheduled dressing change
D. A client waiting for discharge instructions
Correct Answer: B. A client with a new onset of shortness of breath and oxygen saturation of 88%
Detailed Solution: New-onset shortness of breath with a low oxygen saturation indicates an acute
airway/breathing problem, which takes priority over stable pain, routine treatments, or discharge teaching using
the ABC (airway, breathing, circulation) framework.
Question 2
Which client should the charge nurse assign to the unlicensed assistive personnel (UAP)?
A. A stable client who needs assistance with ambulation and vital signs
B. A client who requires a sterile dressing change
C. A newly admitted client requiring an admission assessment
D. A client who needs teaching on a new insulin regimen
Correct Answer: A. A stable client who needs assistance with ambulation and vital signs
Detailed Solution: UAPs can perform basic, non-invasive tasks such as ambulation assistance and routine vital
signs on stable clients. Teaching, sterile procedures, and admission assessments require licensed nursing judgment
and are outside UAP scope of practice.
Question 3
A client who had abdominal surgery yesterday reports sudden, severe pain and the nurse notes the abdomen is
rigid and distended. What should the nurse do FIRST?
A. Document the finding and continue routine rounding
B. Encourage the client to ambulate to relieve gas pain
C. Administer the PRN pain medication and reassess in an hour
D. Notify the surgeon promptly and continue to monitor vital signs
Correct Answer: D. Notify the surgeon promptly and continue to monitor vital signs
Detailed Solution: Sudden severe pain with a rigid, distended abdomen after surgery suggests a possible surgical
emergency such as dehiscence, hemorrhage, or perforation. This requires prompt provider notification rather than
simply medicating and waiting, which could delay critical intervention.
Question 4
The nurse is prioritizing care for a client with a new tracheostomy who is anxious and a client with a stable
chronic wound needing a dressing change. Which action reflects correct prioritization?
A. Wait until both clients call the nurse before responding
B. Attend to the chronic wound dressing change first since it was scheduled earlier
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, NEW HESI RN Fundamentals 2026-2027 — Exam Question Bank
C. Assess the tracheostomy client first because airway concerns take priority over routine wound care
D. Delegate both tasks to the UAP simultaneously
Correct Answer: C. Assess the tracheostomy client first because airway concerns take priority over routine
wound care
Detailed Solution: Airway management for a new tracheostomy takes priority under the ABC framework over a
scheduled, non-urgent dressing change on a stable chronic wound, regardless of which task was scheduled first.
Question 5
A nurse receiving hand-off report learns that one client had a blood pressure of 90/50 with dizziness on standing,
and another client is due for a routine medication in 30 minutes. Which client should the nurse see FIRST?
A. The client due for routine medication, to stay on schedule
B. The client with hypotension and dizziness, to assess for orthostatic changes and fall risk
C. Neither, since both can wait until after report is fully completed
D. The client whose room is closest to the nurses' station
Correct Answer: B. The client with hypotension and dizziness, to assess for orthostatic changes and fall risk
Detailed Solution: Hypotension with dizziness signals a risk for falls and possible hemodynamic instability,
requiring prompt assessment, whereas a routine medication due in 30 minutes has a wider safe administration
window and does not represent an acute safety risk.
Question 6
Four clients use their call light at the same time. Which client's request should the nurse address FIRST?
A. A client asking about visiting hours
B. A client with a chest tube reporting sudden difficulty breathing
C. A client requesting a snack from the kitchen
D. A client requesting a warm blanket
Correct Answer: B. A client with a chest tube reporting sudden difficulty breathing
Detailed Solution: Sudden difficulty breathing in a client with a chest tube may indicate a tension pneumothorax
or tube malfunction, an airway/breathing emergency that must be addressed before comfort or informational
requests.
Question 7
A postpartum client reports heavy vaginal bleeding and a firm fundus is not palpable. Which action should the
nurse take FIRST?
A. Encourage the client to ambulate to the bathroom
B. Offer the client a warm beverage
C. Document the finding and reassess in 30 minutes
D. Massage the fundus and notify the provider promptly
Correct Answer: D. Massage the fundus and notify the provider promptly
Detailed Solution: A boggy, non-firm fundus with heavy bleeding suggests uterine atony, a leading cause of
postpartum hemorrhage; fundal massage is the immediate first-line nursing intervention, combined with prompt
provider notification, rather than delayed reassessment.
Question 8
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, NEW HESI RN Fundamentals 2026-2027 — Exam Question Bank
Which task is appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?
A. Administering an intravenous antibiotic
B. Assessing a new post-operative client's incision
C. Reinforcing previously taught discharge instructions
D. Recording intake and output for a stable client
Correct Answer: D. Recording intake and output for a stable client
Detailed Solution: Recording intake and output on a stable client is a routine, non-invasive task within UAP
scope. Assessment, patient teaching, and medication administration require nursing judgment and licensure, and
cannot be delegated to a UAP.
Question 9
A nurse is delegating tasks to an LPN/LVN on the team. Which task is MOST appropriate to assign to the
LPN/LVN?
A. Developing the initial plan of care for a new admission
B. Administering a scheduled oral medication to a stable client
C. Completing the discharge teaching for a client with a new colostomy
D. Performing the initial assessment of an unstable client
Correct Answer: B. Administering a scheduled oral medication to a stable client
Detailed Solution: LPNs/LVNs can administer many oral medications to stable clients under an RN's supervision.
Initial care planning, complex discharge teaching, and assessment of unstable clients require RN-level scope of
practice and clinical judgment.
Question 10
Which finding, if reported to the nurse by a UAP, requires the nurse to reprioritize care and assess the client
immediately?
A. A client's blood glucose of 45 mg/dL with new confusion
B. A client who ate 80% of a meal tray
C. A client who requests extra pillows
D. A stable client's oral temperature of 98.6°F (37°C)
Correct Answer: A. A client's blood glucose of 45 mg/dL with new confusion
Detailed Solution: A blood glucose of 45 mg/dL with new confusion indicates symptomatic hypoglycemia, a
time-sensitive emergency requiring immediate nursing assessment and intervention, unlike the other routine,
non-urgent findings.
Question 11
The nurse must decide whether to delegate ambulation of a client to a UAP. Which client is MOST appropriate for
this delegation?
A. A client who fell during the previous shift
B. A client with an unsteady gait and new sedating medication given 20 minutes ago
C. A client who is 6 hours post-op from hip replacement with orthostatic hypotension noted earlier
D. A client who is 2 days post-op, hemodynamically stable, and has ambulated without difficulty twice
already
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