HESI-Style Comprehensive Practice Exam 2026–
2027
(Original Practice Questions – Not Actual HESI
Items)
Instructions:
One best answer per question.
Correct answer: bold.
Rationale: italics.
Fundamentals & Nursing Process (1–20)
1. A nurse is assessing a client’s understanding of informed consent. Which statement
by the client indicates a correct understanding?
A. “The doctor will decide what’s best for me.”
B. “I can change my mind about the procedure at any time before it starts.”
C. “Once I sign, I can’t ask any more questions.”
D. “My family can sign for me even if I’m alert and oriented.”
Answer: B
Rationale: Informed consent is voluntary and can be withdrawn at any time before the
procedure if the client is competent.
2. Which action best demonstrates the implementation step of the nursing process?
A. Reviewing lab results to identify abnormalities
B. Setting a goal for the client to ambulate 50 feet by day 2
C. Administering prescribed insulin before breakfast
D. Asking the client to rate pain on a 0–10 scale
Answer: C
Rationale: Implementation involves carrying out planned interventions such as medication
administration.
3. For an IM injection in the ventrogluteal site, which landmarking is correct?
A. Heel of hand on greater trochanter, index finger to anterior superior iliac spine,
, inject in triangle
B. Upper outer quadrant of the buttock
C. Midpoint between acromion and olecranon
D. Two inches below the iliac crest in the midline
Answer: A
Rationale: This technique identifies the ventrogluteal site, avoiding major nerves and
vessels.
4. Which task is appropriate to delegate to UAP?
A. Teaching incentive spirometer use
B. Assessing a postoperative incision
C. Assisting a stable client with ambulation
D. Evaluating pain medication effectiveness
Answer: C
Rationale: UAP can perform routine tasks on stable clients; teaching, assessment, and
evaluation require RN judgment.
5. An IV site is cool, pale, swollen, and the infusion has slowed. Priority action?
A. Increase the IV flow rate
B. Apply a warm compress and continue infusion
C. Stop the infusion and assess for infiltration
D. Elevate the extremity and document
Answer: C
Rationale: These are classic signs of infiltration; stopping the infusion prevents further tissue
injury.
6. Which finding requires immediate provider notification in a post-op hip arthroplasty
client?
A. Mild incisional pain relieved by analgesics
B. Sudden shortness of breath and chest pain
C. Small serosanguinous drainage
D. Ability to dorsiflex and plantarflex toes
Answer: B
Rationale: Suggests possible pulmonary embolism, a life-threatening complication.
7. Best initial oxygen device for a COPD client needing controlled FiO₂?
A. Non-rebreather at 15 L/min
, B. Nasal cannula at 6 L/min
C. Simple face mask at 8 L/min
D. Venturi mask
Answer: D
Rationale: Venturi masks deliver precise oxygen concentrations, important in COPD to
avoid suppressing respiratory drive.
8. Most important lab to monitor for a client on warfarin?
A. Platelet count
B. Hemoglobin
C. INR
D. Serum potassium
Answer: C
Rationale: INR reflects warfarin’s anticoagulant effect and guides dosing.
9. A type 1 diabetic has glucose 420 mg/dL, nausea, vomiting, fruity breath. Most likely
condition?
A. Hypoglycemia
B. HHS
C. DKA
D. Somogyi phenomenon
Answer: C
Rationale: Hyperglycemia, ketosis (fruity breath), and GI symptoms are classic for DKA.
10. ECG finding most indicative of acute MI?
A. Peaked T waves
B. ST-segment elevation in contiguous leads
C. Prolonged PR interval
D. U waves
Answer: B
Rationale: ST elevation in contiguous leads indicates STEMI.
11. Which assessment would cause the nurse to hold metoprolol?
A. BP 138/86
B. HR 52
C. RR 18
D. Temp 37.2°C
, Answer: B
Rationale: Beta-blockers lower HR; many protocols require holding for HR < 60 and
notifying the provider.
12. Which statement shows need for further teaching for a client starting lisinopril?
A. “I will report lip/tongue swelling immediately.”
B. “I may feel dizzy at first.”
C. “I can use salt substitutes freely.”
D. “I’ll have kidney function checked periodically.”
Answer: C
Rationale: Many salt substitutes contain potassium; ACE inhibitors can cause hyperkalemia.
13. Most important action when giving IV push morphine?
A. Dilute in 50 mL NS
B. Inject rapidly over 5 seconds
C. Monitor respiratory rate before and after
D. Encourage immediate ambulation
Answer: C
Rationale: Opioids can cause respiratory depression; monitoring RR is critical.
14. Which drug combined with an SSRI requires monitoring for serotonin syndrome?
A. Acetaminophen
B. Tramadol
C. Omeprazole
D. Levothyroxine
Answer: B
Rationale: Tramadol has serotonergic activity and can precipitate serotonin syndrome with
SSRIs.
15. Most important lab to monitor for vancomycin toxicity?
A. Serum creatinine
B. Liver enzymes
C. Hematocrit
D. Sodium
Answer: A
Rationale: Vancomycin is nephrotoxic; renal function must be monitored.
2027
(Original Practice Questions – Not Actual HESI
Items)
Instructions:
One best answer per question.
Correct answer: bold.
Rationale: italics.
Fundamentals & Nursing Process (1–20)
1. A nurse is assessing a client’s understanding of informed consent. Which statement
by the client indicates a correct understanding?
A. “The doctor will decide what’s best for me.”
B. “I can change my mind about the procedure at any time before it starts.”
C. “Once I sign, I can’t ask any more questions.”
D. “My family can sign for me even if I’m alert and oriented.”
Answer: B
Rationale: Informed consent is voluntary and can be withdrawn at any time before the
procedure if the client is competent.
2. Which action best demonstrates the implementation step of the nursing process?
A. Reviewing lab results to identify abnormalities
B. Setting a goal for the client to ambulate 50 feet by day 2
C. Administering prescribed insulin before breakfast
D. Asking the client to rate pain on a 0–10 scale
Answer: C
Rationale: Implementation involves carrying out planned interventions such as medication
administration.
3. For an IM injection in the ventrogluteal site, which landmarking is correct?
A. Heel of hand on greater trochanter, index finger to anterior superior iliac spine,
, inject in triangle
B. Upper outer quadrant of the buttock
C. Midpoint between acromion and olecranon
D. Two inches below the iliac crest in the midline
Answer: A
Rationale: This technique identifies the ventrogluteal site, avoiding major nerves and
vessels.
4. Which task is appropriate to delegate to UAP?
A. Teaching incentive spirometer use
B. Assessing a postoperative incision
C. Assisting a stable client with ambulation
D. Evaluating pain medication effectiveness
Answer: C
Rationale: UAP can perform routine tasks on stable clients; teaching, assessment, and
evaluation require RN judgment.
5. An IV site is cool, pale, swollen, and the infusion has slowed. Priority action?
A. Increase the IV flow rate
B. Apply a warm compress and continue infusion
C. Stop the infusion and assess for infiltration
D. Elevate the extremity and document
Answer: C
Rationale: These are classic signs of infiltration; stopping the infusion prevents further tissue
injury.
6. Which finding requires immediate provider notification in a post-op hip arthroplasty
client?
A. Mild incisional pain relieved by analgesics
B. Sudden shortness of breath and chest pain
C. Small serosanguinous drainage
D. Ability to dorsiflex and plantarflex toes
Answer: B
Rationale: Suggests possible pulmonary embolism, a life-threatening complication.
7. Best initial oxygen device for a COPD client needing controlled FiO₂?
A. Non-rebreather at 15 L/min
, B. Nasal cannula at 6 L/min
C. Simple face mask at 8 L/min
D. Venturi mask
Answer: D
Rationale: Venturi masks deliver precise oxygen concentrations, important in COPD to
avoid suppressing respiratory drive.
8. Most important lab to monitor for a client on warfarin?
A. Platelet count
B. Hemoglobin
C. INR
D. Serum potassium
Answer: C
Rationale: INR reflects warfarin’s anticoagulant effect and guides dosing.
9. A type 1 diabetic has glucose 420 mg/dL, nausea, vomiting, fruity breath. Most likely
condition?
A. Hypoglycemia
B. HHS
C. DKA
D. Somogyi phenomenon
Answer: C
Rationale: Hyperglycemia, ketosis (fruity breath), and GI symptoms are classic for DKA.
10. ECG finding most indicative of acute MI?
A. Peaked T waves
B. ST-segment elevation in contiguous leads
C. Prolonged PR interval
D. U waves
Answer: B
Rationale: ST elevation in contiguous leads indicates STEMI.
11. Which assessment would cause the nurse to hold metoprolol?
A. BP 138/86
B. HR 52
C. RR 18
D. Temp 37.2°C
, Answer: B
Rationale: Beta-blockers lower HR; many protocols require holding for HR < 60 and
notifying the provider.
12. Which statement shows need for further teaching for a client starting lisinopril?
A. “I will report lip/tongue swelling immediately.”
B. “I may feel dizzy at first.”
C. “I can use salt substitutes freely.”
D. “I’ll have kidney function checked periodically.”
Answer: C
Rationale: Many salt substitutes contain potassium; ACE inhibitors can cause hyperkalemia.
13. Most important action when giving IV push morphine?
A. Dilute in 50 mL NS
B. Inject rapidly over 5 seconds
C. Monitor respiratory rate before and after
D. Encourage immediate ambulation
Answer: C
Rationale: Opioids can cause respiratory depression; monitoring RR is critical.
14. Which drug combined with an SSRI requires monitoring for serotonin syndrome?
A. Acetaminophen
B. Tramadol
C. Omeprazole
D. Levothyroxine
Answer: B
Rationale: Tramadol has serotonergic activity and can precipitate serotonin syndrome with
SSRIs.
15. Most important lab to monitor for vancomycin toxicity?
A. Serum creatinine
B. Liver enzymes
C. Hematocrit
D. Sodium
Answer: A
Rationale: Vancomycin is nephrotoxic; renal function must be monitored.
