The Ultimate and Complete HESI Fundamentals Exit Exam V1, V2 & V3 RN and PN Study
Guide 2026–2027, Covering Fundamentals of Nursing, Nursing Process, Clinical
Judgment, Patient Assessment, Vital Signs, Safety and Fall Prevention, Infection
Prevention and Control, Standard and Transmission-Based Precautions, Medication
Administration and Medication Safety, Dosage Calculations, Fluid and Electrolyte
Balance, Oxygenation and Respiratory Care, Pain Management, Mobility and
Positioning, Hygiene and Basic Care, Nutrition and Elimination, Wound Care, Skin
Integrity, Pressure Injury Prevention, Perioperative Nursing, Sterile and Aseptic
Technique, Enteral and Parenteral Therapies, Tubes and Drains, NG and PEG Tubes,
Central Lines, Chest Tubes, Diabetes and Hypoglycemia, Patient Education,
Communication, Documentation, Delegation and Prioritization, Legal and Ethical
Nursing Practice, Emergency Care, RN and PN Scope of Practice, NGN-Style Clinical
Judgment, Case-Based Scenarios, Practice Questions With Detailed Rationales, and
Comprehensive HESI Fundamentals Exit Exam Preparation
Question 1: A nurse is preparing to administer an enteral feeding through a nasogastric tube.
Which of the following actions should the nurse take first to verify the tube's placement?
A. Aspirate gastric contents and check the pH.
B. Auscultate over the epigastric area while injecting air.
C. Obtain an abdominal x-ray.
D. Measure the length of the tube from the nose to the ear.
CORRECT ANSWER: C. Obtain an abdominal x-ray.
Rationale: An abdominal x-ray is the most reliable method to confirm the placement of a
nasogastric tube before initiating feedings, as it provides visual confirmation that the tube is in
the stomach. While aspirating for pH and auscultation are used in ongoing assessments, they
are not definitive for initial placement verification. Measuring the tube's external length is a
basic check but does not confirm gastric placement.
Question 2: A client with a new diagnosis of type 1 diabetes mellitus is learning to self-
administer insulin. Which statement indicates that the client understands the correct
injection technique?
A. "I will inject the insulin into my thigh muscle for faster absorption."
B. "I should rotate injection sites within the same anatomical region to prevent lipodystrophy."
C. "I will always use a 90-degree angle of insertion regardless of my body weight."
D. "I can use the same needle up to three times to save costs."
CORRECT ANSWER: B. "I should rotate injection sites within the same anatomical region to
prevent lipodystrophy."
,Rationale: Rotating injection sites within the same region (e.g., abdomen) is crucial to prevent
lipodystrophy, which can affect insulin absorption. Insulin should be injected into subcutaneous
tissue, not muscle. The angle of insertion is typically 90 degrees for average-weight individuals
but may be pinched at 45 degrees for thin clients to avoid intramuscular injection. Needles are
for single-use only to prevent infection and tissue damage.
Question 3: A nurse is caring for a client who has a prescription for a 24-hour urine collection.
Which of the following actions is most important for the nurse to take?
A. Instruct the client to discard the first voided specimen.
B. Keep the collection container at room temperature.
C. Ensure the client is NPO for 8 hours before the collection.
D. Ask the client to increase fluid intake to 3 liters during the collection.
CORRECT ANSWER: A. Instruct the client to discard the first voided specimen.
Rationale: For a 24-hour urine collection, the client should void and discard the first specimen
to mark the start time. All subsequent urine for the next 24 hours is collected. The container
should be kept refrigerated or on ice, not at room temperature. NPO status is not required, and
fluid intake is not typically increased to a specific amount unless ordered.
Question 4: A postoperative client reports severe pain and nausea. The nurse notes that the
client's blood pressure is 90/60 mmHg and heart rate is 110 bpm. Which action should the
nurse take first?
A. Administer the prescribed antiemetic.
B. Notify the healthcare provider.
C. Reassess the client's pain level in 30 minutes.
D. Administer the prescribed opioid analgesic.
CORRECT ANSWER: B. Notify the healthcare provider.
Rationale: The client is exhibiting signs of possible shock or hemorrhage (hypotension and
tachycardia) postoperatively. The nurse's priority is to notify the provider immediately because
the client's hemodynamic instability contraindicates the administration of an opioid, which
could further lower blood pressure. While pain and nausea are concerns, the physiological
instability takes precedence.
Question 5: A nurse is teaching a client about a low-sodium diet. Which of the following food
choices by the client indicates a correct understanding of the teaching?
A. Grilled chicken breast with a side of steamed broccoli.
B. A ham and cheese sandwich on white bread.
C. Canned vegetable soup with crackers.
D. Soy sauce marinated salmon with rice.
,CORRECT ANSWER: A. Grilled chicken breast with a side of steamed broccoli.
Rationale: Fresh, unprocessed foods like grilled chicken and steamed broccoli are naturally low
in sodium. Ham, canned soups, soy sauce, and processed cheeses are all high in sodium and
should be avoided on a low-sodium diet.
Question 6: A nurse is assessing a client's skin and notes a stage 3 pressure injury on the
sacrum. What characteristic is most consistent with this stage?
A. Non-blanchable erythema of intact skin.
B. A partial-thickness loss of skin with a pink, moist wound bed.
C. Full-thickness tissue loss with visible bone, tendon, or muscle.
D. Full-thickness tissue loss with visible subcutaneous fat but not bone.
CORRECT ANSWER: D. Full-thickness tissue loss with visible subcutaneous fat but not bone.
Rationale: A Stage 3 pressure injury involves full-thickness skin loss with damage to or necrosis
of subcutaneous tissue that may extend down to, but not through, underlying fascia. The
wound may have undermining and tunneling. Non-blanchable erythema is Stage 1, partial-
thickness loss is Stage 2, and full-thickness loss with exposed bone, tendon, or muscle is Stage
4.
Question 7: A client is receiving a blood transfusion and develops chills, fever, and a
headache 15 minutes after the infusion begins. What is the nurse's priority action?
A. Slow the infusion rate to 50 mL/hr.
B. Administer an antihistamine as a PRN order.
C. Stop the transfusion and maintain a patent IV line with normal saline.
D. Notify the healthcare provider immediately after assessing vital signs.
CORRECT ANSWER: C. Stop the transfusion and maintain a patent IV line with normal saline.
Rationale: These symptoms indicate a possible febrile or allergic transfusion reaction. The
nurse's priority is to stop the transfusion immediately to prevent further complications, keep
the IV line open with normal saline, and then notify the provider. Slowing the infusion or
waiting to notify the provider could allow the reaction to worsen.
Question 8: A nurse is performing a sterile dressing change for a surgical wound. Which
action, if performed by the nurse, would contaminate the sterile field?
A. Placing sterile supplies within the 1-inch border of the sterile field.
B. Opening the outermost flap of the sterile kit away from the body.
C. Holding a sterile object below the waist level.
D. Pouring sterile solution into a sterile basin from a bottle.
CORRECT ANSWER: C. Holding a sterile object below the waist level.
, Rationale: The sterile field is considered contaminated if it is held below the waist or above the
chest. The 1-inch border of the sterile field is considered contaminated, so placing supplies
there would contaminate them. Opening the outermost flap away from the body is a correct
technique.
Question 9: A client with heart failure is prescribed furosemide. The nurse should monitor for
which of the following adverse effects?
A. Hyperkalemia.
B. Hypokalemia.
C. Hypernatremia.
D. Hypoglycemia.
CORRECT ANSWER: B. Hypokalemia.
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to increased potassium excretion in the distal tubules. This
commonly results in hypokalemia. Other adverse effects include hyponatremia, hypocalcemia,
and hypomagnesemia.
Question 10: A nurse is providing discharge teaching to a client who had a stroke and has
unilateral neglect. Which of the following interventions is most appropriate to include in the
plan of care?
A. Place the client's belongings on the unaffected side.
B. Stand on the client's unaffected side when speaking.
C. Approach the client from the affected side to increase awareness.
D. Instruct the family to speak loudly and clearly.
CORRECT ANSWER: C. Approach the client from the affected side to increase awareness.
Rationale: To help the client with unilateral neglect become more aware of the affected side,
the nurse should approach the client from the affected side, place objects on that side, and
encourage the client to turn their head and scan that area. Placing belongings on the
unaffected side would reinforce neglect. Speaking loudly is for hearing impairment, not for
neglect.
Question 11: A nurse is calculating the intake and output for a client over an 8-hour shift. The
client received 150 mL of IV fluid, 1 cup of ice chips (200 mL), 1 cup of coffee (240 mL), and a
240 mL bowl of soup. Which of the following is the total fluid intake in mL?
A. 830 mL
B. 740 mL
C. 630 mL
D. 880 mL
Guide 2026–2027, Covering Fundamentals of Nursing, Nursing Process, Clinical
Judgment, Patient Assessment, Vital Signs, Safety and Fall Prevention, Infection
Prevention and Control, Standard and Transmission-Based Precautions, Medication
Administration and Medication Safety, Dosage Calculations, Fluid and Electrolyte
Balance, Oxygenation and Respiratory Care, Pain Management, Mobility and
Positioning, Hygiene and Basic Care, Nutrition and Elimination, Wound Care, Skin
Integrity, Pressure Injury Prevention, Perioperative Nursing, Sterile and Aseptic
Technique, Enteral and Parenteral Therapies, Tubes and Drains, NG and PEG Tubes,
Central Lines, Chest Tubes, Diabetes and Hypoglycemia, Patient Education,
Communication, Documentation, Delegation and Prioritization, Legal and Ethical
Nursing Practice, Emergency Care, RN and PN Scope of Practice, NGN-Style Clinical
Judgment, Case-Based Scenarios, Practice Questions With Detailed Rationales, and
Comprehensive HESI Fundamentals Exit Exam Preparation
Question 1: A nurse is preparing to administer an enteral feeding through a nasogastric tube.
Which of the following actions should the nurse take first to verify the tube's placement?
A. Aspirate gastric contents and check the pH.
B. Auscultate over the epigastric area while injecting air.
C. Obtain an abdominal x-ray.
D. Measure the length of the tube from the nose to the ear.
CORRECT ANSWER: C. Obtain an abdominal x-ray.
Rationale: An abdominal x-ray is the most reliable method to confirm the placement of a
nasogastric tube before initiating feedings, as it provides visual confirmation that the tube is in
the stomach. While aspirating for pH and auscultation are used in ongoing assessments, they
are not definitive for initial placement verification. Measuring the tube's external length is a
basic check but does not confirm gastric placement.
Question 2: A client with a new diagnosis of type 1 diabetes mellitus is learning to self-
administer insulin. Which statement indicates that the client understands the correct
injection technique?
A. "I will inject the insulin into my thigh muscle for faster absorption."
B. "I should rotate injection sites within the same anatomical region to prevent lipodystrophy."
C. "I will always use a 90-degree angle of insertion regardless of my body weight."
D. "I can use the same needle up to three times to save costs."
CORRECT ANSWER: B. "I should rotate injection sites within the same anatomical region to
prevent lipodystrophy."
,Rationale: Rotating injection sites within the same region (e.g., abdomen) is crucial to prevent
lipodystrophy, which can affect insulin absorption. Insulin should be injected into subcutaneous
tissue, not muscle. The angle of insertion is typically 90 degrees for average-weight individuals
but may be pinched at 45 degrees for thin clients to avoid intramuscular injection. Needles are
for single-use only to prevent infection and tissue damage.
Question 3: A nurse is caring for a client who has a prescription for a 24-hour urine collection.
Which of the following actions is most important for the nurse to take?
A. Instruct the client to discard the first voided specimen.
B. Keep the collection container at room temperature.
C. Ensure the client is NPO for 8 hours before the collection.
D. Ask the client to increase fluid intake to 3 liters during the collection.
CORRECT ANSWER: A. Instruct the client to discard the first voided specimen.
Rationale: For a 24-hour urine collection, the client should void and discard the first specimen
to mark the start time. All subsequent urine for the next 24 hours is collected. The container
should be kept refrigerated or on ice, not at room temperature. NPO status is not required, and
fluid intake is not typically increased to a specific amount unless ordered.
Question 4: A postoperative client reports severe pain and nausea. The nurse notes that the
client's blood pressure is 90/60 mmHg and heart rate is 110 bpm. Which action should the
nurse take first?
A. Administer the prescribed antiemetic.
B. Notify the healthcare provider.
C. Reassess the client's pain level in 30 minutes.
D. Administer the prescribed opioid analgesic.
CORRECT ANSWER: B. Notify the healthcare provider.
Rationale: The client is exhibiting signs of possible shock or hemorrhage (hypotension and
tachycardia) postoperatively. The nurse's priority is to notify the provider immediately because
the client's hemodynamic instability contraindicates the administration of an opioid, which
could further lower blood pressure. While pain and nausea are concerns, the physiological
instability takes precedence.
Question 5: A nurse is teaching a client about a low-sodium diet. Which of the following food
choices by the client indicates a correct understanding of the teaching?
A. Grilled chicken breast with a side of steamed broccoli.
B. A ham and cheese sandwich on white bread.
C. Canned vegetable soup with crackers.
D. Soy sauce marinated salmon with rice.
,CORRECT ANSWER: A. Grilled chicken breast with a side of steamed broccoli.
Rationale: Fresh, unprocessed foods like grilled chicken and steamed broccoli are naturally low
in sodium. Ham, canned soups, soy sauce, and processed cheeses are all high in sodium and
should be avoided on a low-sodium diet.
Question 6: A nurse is assessing a client's skin and notes a stage 3 pressure injury on the
sacrum. What characteristic is most consistent with this stage?
A. Non-blanchable erythema of intact skin.
B. A partial-thickness loss of skin with a pink, moist wound bed.
C. Full-thickness tissue loss with visible bone, tendon, or muscle.
D. Full-thickness tissue loss with visible subcutaneous fat but not bone.
CORRECT ANSWER: D. Full-thickness tissue loss with visible subcutaneous fat but not bone.
Rationale: A Stage 3 pressure injury involves full-thickness skin loss with damage to or necrosis
of subcutaneous tissue that may extend down to, but not through, underlying fascia. The
wound may have undermining and tunneling. Non-blanchable erythema is Stage 1, partial-
thickness loss is Stage 2, and full-thickness loss with exposed bone, tendon, or muscle is Stage
4.
Question 7: A client is receiving a blood transfusion and develops chills, fever, and a
headache 15 minutes after the infusion begins. What is the nurse's priority action?
A. Slow the infusion rate to 50 mL/hr.
B. Administer an antihistamine as a PRN order.
C. Stop the transfusion and maintain a patent IV line with normal saline.
D. Notify the healthcare provider immediately after assessing vital signs.
CORRECT ANSWER: C. Stop the transfusion and maintain a patent IV line with normal saline.
Rationale: These symptoms indicate a possible febrile or allergic transfusion reaction. The
nurse's priority is to stop the transfusion immediately to prevent further complications, keep
the IV line open with normal saline, and then notify the provider. Slowing the infusion or
waiting to notify the provider could allow the reaction to worsen.
Question 8: A nurse is performing a sterile dressing change for a surgical wound. Which
action, if performed by the nurse, would contaminate the sterile field?
A. Placing sterile supplies within the 1-inch border of the sterile field.
B. Opening the outermost flap of the sterile kit away from the body.
C. Holding a sterile object below the waist level.
D. Pouring sterile solution into a sterile basin from a bottle.
CORRECT ANSWER: C. Holding a sterile object below the waist level.
, Rationale: The sterile field is considered contaminated if it is held below the waist or above the
chest. The 1-inch border of the sterile field is considered contaminated, so placing supplies
there would contaminate them. Opening the outermost flap away from the body is a correct
technique.
Question 9: A client with heart failure is prescribed furosemide. The nurse should monitor for
which of the following adverse effects?
A. Hyperkalemia.
B. Hypokalemia.
C. Hypernatremia.
D. Hypoglycemia.
CORRECT ANSWER: B. Hypokalemia.
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
ascending loop of Henle, leading to increased potassium excretion in the distal tubules. This
commonly results in hypokalemia. Other adverse effects include hyponatremia, hypocalcemia,
and hypomagnesemia.
Question 10: A nurse is providing discharge teaching to a client who had a stroke and has
unilateral neglect. Which of the following interventions is most appropriate to include in the
plan of care?
A. Place the client's belongings on the unaffected side.
B. Stand on the client's unaffected side when speaking.
C. Approach the client from the affected side to increase awareness.
D. Instruct the family to speak loudly and clearly.
CORRECT ANSWER: C. Approach the client from the affected side to increase awareness.
Rationale: To help the client with unilateral neglect become more aware of the affected side,
the nurse should approach the client from the affected side, place objects on that side, and
encourage the client to turn their head and scan that area. Placing belongings on the
unaffected side would reinforce neglect. Speaking loudly is for hearing impairment, not for
neglect.
Question 11: A nurse is calculating the intake and output for a client over an 8-hour shift. The
client received 150 mL of IV fluid, 1 cup of ice chips (200 mL), 1 cup of coffee (240 mL), and a
240 mL bowl of soup. Which of the following is the total fluid intake in mL?
A. 830 mL
B. 740 mL
C. 630 mL
D. 880 mL
