NCLEX HESI EXIT
CRITICAL THINKING EXAM - COMPREHENSIVE PRACTICE
2026/2027 EDITION
This is an independent practice exam for educational study; it is not an official Elsevier HESI exit examination or NCLEX.
Section Overview
This comprehensive critical thinking practice exam contains 150 questions across seven sections, aligned with the
Elsevier/HESI testing blueprint, the current NCLEX-RN test plan, the NCSBN Clinical Judgment Measurement Model
(NCJMM), and evidence-based nursing practice standards for 2026/2027.
Sec Topic Qs
1 Management of Care - Safety, Delegation, Legal/Ethical, Prioritization 25
2 Health Promotion & Maintenance - Development, Prenatal, Screening 20
3 Psychosocial Integrity - Mental Health, Coping, Communication 18
4 Basic Care & Comfort - Hygiene, Nutrition, Mobility, Pain 15
5 Pharmacological & Parenteral Therapies - Medications, IV, Blood 22
6 Reduction of Risk Potential - Diagnostics, Vitals, Labs, Complications 22
7 Physiological Adaptation - Fluid/Electrolytes, Pathophysiology, Acute/Chronic 28
TOTAL 150
Instructions
For each question, select the single best answer. Use the answer key at the end of the exam to check your work. Each
item includes a brief rationale explaining the correct response.
Answer Key Distribution: 38 A · 38 B · 37 C · 37 D
, Section 1: Management of Care - Safety, Delegation, Legal/Ethical, Case Management,
Infection Control, and Prioritization
Q1: The nurse is prioritizing care for four clients. Which client should be seen first?
A. A client requesting a snack
B. A client due for a routine dressing change
C. A client with new-onset chest pain and diaphoresis [CORRECT]
D. A client who wants discharge papers
Correct Answer: C
Rationale: New chest pain with diaphoresis suggests a cardiac emergency and takes priority using ABCs. The others are
lower-acuity.
Q2: Which task can the RN appropriately delegate to a UAP?
A. Administering IV push medications
B. Assessing a client's new chest pain
C. Evaluating the response to treatment
D. Measuring routine vital signs on a stable client [CORRECT]
Correct Answer: D
Rationale: UAPs can measure routine vital signs on stable clients. IV push, assessment, and evaluation require licensed staff.
Q3: Which task can be delegated to an LPN?
A. Initial assessment of a new admission
B. Developing the plan of care
C. Administering oral medications to a stable client [CORRECT]
D. Evaluating client outcomes
Correct Answer: C
Rationale: LPNs can administer medications and perform routine care. Initial assessment, care planning, and evaluation are RN
responsibilities.
Q4: The nurse is using Maslow's hierarchy to prioritize care. Which need is addressed first?
A. Self-esteem needs
B. Social needs
C. Physiologic needs such as airway, breathing, and circulation [CORRECT]
D. Self-actualization
Correct Answer: C
Rationale: Maslow's hierarchy places physiologic needs (ABCs) first. The others are higher-level needs.
Q5: A client with a do-not-resuscitate (DNR) order arrests. The nurse should:
A. Begin CPR immediately
B. Call the family first
C. Provide comfort care as directed and not initiate resuscitation [CORRECT]
D. Ignore the DNR
Correct Answer: C
Rationale: A valid DNR means resuscitation should not be initiated; comfort care is provided per the order.
Q6: Which action demonstrates client advocacy?
A. Following orders without question
B. Withholding information
C. Speaking up when a client's stated wishes are not being followed [CORRECT]
D. Prioritizing the family over the client
Correct Answer: C
Rationale: Advocacy supports the client's rights and wishes. The other options are not advocacy.
Q7: The nurse is providing handoff report using SBAR. What does the 'B' stand for?
A. Breathing
NCLEX HESI Exit Critical Thinking Exam - 2026/2027 Page 2
, B. Background [CORRECT]
C. Blood pressure
D. Brief
Correct Answer: B
Rationale: SBAR = Situation, Background, Assessment, Recommendation. 'B' is Background.
Q8: Which client is at highest risk for falls?
A. An older adult who is unsteady and on a new sedative [CORRECT]
B. A young client in good health
C. A fully mobile client
D. A stable client who refuses assistance
Correct Answer: A
Rationale: An unsteady older adult on a sedative is at high fall risk. The others are lower risk.
Q9: A nurse observes a colleague documenting care that was not provided. The nurse should:
A. Ignore it
B. Do the same
C. Report the falsified documentation to the supervisor [CORRECT]
D. Keep it confidential
Correct Answer: C
Rationale: Falsified documentation is a serious violation that must be reported. Ignoring or participating is unacceptable.
Q10: When a fire is discovered, the nurse's first priority is to:
A. Call the family
B. Document
C. Remove clients from immediate danger (RACE) [CORRECT]
D. Gather belongings
Correct Answer: C
Rationale: RACE prioritizes Rescue/Remove clients first. Client safety is the priority.
Q11: A client on transmission-based precautions for airborne infection (e.g., TB) requires:
A. Only gloves
B. No precautions
C. A negative-pressure room and an N95 respirator [CORRECT]
D. A private room with no mask
Correct Answer: C
Rationale: Airborne precautions require a negative-pressure room and N95 respirator. The other options are insufficient.
Q12: Which infection-control precaution is used for a client with a droplet-spread infection (e.g., influenza)?
A. Airborne precautions
B. Contact precautions only
C. No precautions
D. Droplet precautions with a surgical mask [CORRECT]
Correct Answer: D
Rationale: Droplet precautions require a surgical mask. Airborne is for smaller particles; contact for skin contact.
Q13: Which of the following is a sentinel event?
A. An unexpected client death [CORRECT]
B. A near-miss caught in time
C. A routine admission
D. A scheduled discharge
Correct Answer: A
Rationale: A sentinel event is unexpected and involves death or serious injury. A near-miss is caught before harm.
Q14: A client's family asks the nurse for a copy of the client's medical record. The nurse should:
A. Explain that the client's authorization is required before releasing records [CORRECT]
NCLEX HESI Exit Critical Thinking Exam - 2026/2027 Page 3
CRITICAL THINKING EXAM - COMPREHENSIVE PRACTICE
2026/2027 EDITION
This is an independent practice exam for educational study; it is not an official Elsevier HESI exit examination or NCLEX.
Section Overview
This comprehensive critical thinking practice exam contains 150 questions across seven sections, aligned with the
Elsevier/HESI testing blueprint, the current NCLEX-RN test plan, the NCSBN Clinical Judgment Measurement Model
(NCJMM), and evidence-based nursing practice standards for 2026/2027.
Sec Topic Qs
1 Management of Care - Safety, Delegation, Legal/Ethical, Prioritization 25
2 Health Promotion & Maintenance - Development, Prenatal, Screening 20
3 Psychosocial Integrity - Mental Health, Coping, Communication 18
4 Basic Care & Comfort - Hygiene, Nutrition, Mobility, Pain 15
5 Pharmacological & Parenteral Therapies - Medications, IV, Blood 22
6 Reduction of Risk Potential - Diagnostics, Vitals, Labs, Complications 22
7 Physiological Adaptation - Fluid/Electrolytes, Pathophysiology, Acute/Chronic 28
TOTAL 150
Instructions
For each question, select the single best answer. Use the answer key at the end of the exam to check your work. Each
item includes a brief rationale explaining the correct response.
Answer Key Distribution: 38 A · 38 B · 37 C · 37 D
, Section 1: Management of Care - Safety, Delegation, Legal/Ethical, Case Management,
Infection Control, and Prioritization
Q1: The nurse is prioritizing care for four clients. Which client should be seen first?
A. A client requesting a snack
B. A client due for a routine dressing change
C. A client with new-onset chest pain and diaphoresis [CORRECT]
D. A client who wants discharge papers
Correct Answer: C
Rationale: New chest pain with diaphoresis suggests a cardiac emergency and takes priority using ABCs. The others are
lower-acuity.
Q2: Which task can the RN appropriately delegate to a UAP?
A. Administering IV push medications
B. Assessing a client's new chest pain
C. Evaluating the response to treatment
D. Measuring routine vital signs on a stable client [CORRECT]
Correct Answer: D
Rationale: UAPs can measure routine vital signs on stable clients. IV push, assessment, and evaluation require licensed staff.
Q3: Which task can be delegated to an LPN?
A. Initial assessment of a new admission
B. Developing the plan of care
C. Administering oral medications to a stable client [CORRECT]
D. Evaluating client outcomes
Correct Answer: C
Rationale: LPNs can administer medications and perform routine care. Initial assessment, care planning, and evaluation are RN
responsibilities.
Q4: The nurse is using Maslow's hierarchy to prioritize care. Which need is addressed first?
A. Self-esteem needs
B. Social needs
C. Physiologic needs such as airway, breathing, and circulation [CORRECT]
D. Self-actualization
Correct Answer: C
Rationale: Maslow's hierarchy places physiologic needs (ABCs) first. The others are higher-level needs.
Q5: A client with a do-not-resuscitate (DNR) order arrests. The nurse should:
A. Begin CPR immediately
B. Call the family first
C. Provide comfort care as directed and not initiate resuscitation [CORRECT]
D. Ignore the DNR
Correct Answer: C
Rationale: A valid DNR means resuscitation should not be initiated; comfort care is provided per the order.
Q6: Which action demonstrates client advocacy?
A. Following orders without question
B. Withholding information
C. Speaking up when a client's stated wishes are not being followed [CORRECT]
D. Prioritizing the family over the client
Correct Answer: C
Rationale: Advocacy supports the client's rights and wishes. The other options are not advocacy.
Q7: The nurse is providing handoff report using SBAR. What does the 'B' stand for?
A. Breathing
NCLEX HESI Exit Critical Thinking Exam - 2026/2027 Page 2
, B. Background [CORRECT]
C. Blood pressure
D. Brief
Correct Answer: B
Rationale: SBAR = Situation, Background, Assessment, Recommendation. 'B' is Background.
Q8: Which client is at highest risk for falls?
A. An older adult who is unsteady and on a new sedative [CORRECT]
B. A young client in good health
C. A fully mobile client
D. A stable client who refuses assistance
Correct Answer: A
Rationale: An unsteady older adult on a sedative is at high fall risk. The others are lower risk.
Q9: A nurse observes a colleague documenting care that was not provided. The nurse should:
A. Ignore it
B. Do the same
C. Report the falsified documentation to the supervisor [CORRECT]
D. Keep it confidential
Correct Answer: C
Rationale: Falsified documentation is a serious violation that must be reported. Ignoring or participating is unacceptable.
Q10: When a fire is discovered, the nurse's first priority is to:
A. Call the family
B. Document
C. Remove clients from immediate danger (RACE) [CORRECT]
D. Gather belongings
Correct Answer: C
Rationale: RACE prioritizes Rescue/Remove clients first. Client safety is the priority.
Q11: A client on transmission-based precautions for airborne infection (e.g., TB) requires:
A. Only gloves
B. No precautions
C. A negative-pressure room and an N95 respirator [CORRECT]
D. A private room with no mask
Correct Answer: C
Rationale: Airborne precautions require a negative-pressure room and N95 respirator. The other options are insufficient.
Q12: Which infection-control precaution is used for a client with a droplet-spread infection (e.g., influenza)?
A. Airborne precautions
B. Contact precautions only
C. No precautions
D. Droplet precautions with a surgical mask [CORRECT]
Correct Answer: D
Rationale: Droplet precautions require a surgical mask. Airborne is for smaller particles; contact for skin contact.
Q13: Which of the following is a sentinel event?
A. An unexpected client death [CORRECT]
B. A near-miss caught in time
C. A routine admission
D. A scheduled discharge
Correct Answer: A
Rationale: A sentinel event is unexpected and involves death or serious injury. A near-miss is caught before harm.
Q14: A client's family asks the nurse for a copy of the client's medical record. The nurse should:
A. Explain that the client's authorization is required before releasing records [CORRECT]
NCLEX HESI Exit Critical Thinking Exam - 2026/2027 Page 3
