2026 HESI RN EXIT EXAM V4
2026 HESI RN Exit Exam V4 — Complete 200-
Question NGN Practice Test with Verified
Answers and Detailed Rationales Across
Fundamentals, Medical-Surgical, Maternal-
Newborn, Pediatric, Mental Health,
Pharmacology, and Nursing Leadership
================================================================================
2026 HESI RN EXIT EXAM V4
Complete 200-Question NGN Practice Test with Verified Answers and Detailed
Rationales Across Fundamentals, Medical-Surgical, Maternal-Newborn, Pediatric,
Mental Health, Pharmacology, and Nursing Leadership
================================================================================
Document Type : Comprehensive Practice Examination
Exam Version : V4 (Next Generation NCLEX-Style)
Total Questions : 200
Format : Color-Coded Question / Answer / Rationale
Answer Key : Included with Full Rationales
--------------------------------------------------------------------------------
INSTRUCTIONS TO THE CANDIDATE
--------------------------------------------------------------------------------
1. Read each question carefully before selecting your answer.
2. Choose the BEST answer for each item unless otherwise indicated.
3. Select all that apply when the question directs you to do so.
4. Do not reveal the answer or rationale until you have answered the question.
5. Review the rationale for every item, including those you answered correctly.
6. Maintain the color-coded format: Blue = Question, Red = Answer, Purple = Rationale.
pg. 1
, 2026 HESI RN EXIT EXAM V4
--------------------------------------------------------------------------------
EXAM SECTIONS
--------------------------------------------------------------------------------
Section 1 : Fundamentals of Nursing .................... Questions 001-025
Section 2 : Medical-Surgical Nursing ................... Questions 026-070
Section 3 : Maternal-Newborn Nursing ................... Questions 071-100
Section 4 : Pediatric Nursing .......................... Questions 101-130
Section 5 : Mental Health Nursing ...................... Questions 131-155
Section 6 : Pharmacology ............................... Questions 156-185
Section 7 : Nursing Leadership and Management .......... Questions 186-200
--------------------------------------------------------------------------------
COLOR KEY
--------------------------------------------------------------------------------
[BLUE] QUESTION - The complete exam question and answer options
[RED] ANSWER - The correct answer with letter and full text
[PURPLE] RATIONALE - Detailed explanation of the correct and incorrect options
================================================================================
BEGIN EXAMINATION
================================================================================
pg. 2
, 2026 HESI RN EXIT EXAM V4
2026 HESI RN Exit Exam V4
Comprehensive Practice Examination with NGN Questions
SECTION 1: Fundamentals of Nursing (Questions 1-25)
QUESTION 1:
A nurse is caring for a client who has a prescription for a 24-hour urine collection. Which action
should the nurse take to ensure accurate collection?
A. Discard the first voiding and begin the collection after that
B. Collect all urine in a container without preservatives
C. Keep the collection container on ice throughout the collection period
D. Begin the collection at the start of the shift and end 24 hours later
ANSWER:
A. Discard the first voiding and begin the collection after that
RATIONALE:
The correct procedure for a 24-hour urine collection is to discard the first voiding and begin timing
from that point, collecting all subsequent urine for the next 24 hours. This ensures accurate
measurement of substances excreted over the full 24-hour period. Option B is incorrect because
some tests require preservatives in the container. Option C is incorrect because not all 24-hour urine
collections require ice; this depends on the specific test being performed. Option D is incorrect
because the collection should not begin at the start of a shift without discarding the first voiding; the
24-hour period begins after the first voiding is discarded.
QUESTION 2:
A client with a newly placed colostomy expresses concern about the odor from the ostomy pouch.
Which dietary recommendation should the nurse provide?
A. "Increase your intake of eggs and fish"
B. "Avoid foods like yogurt and buttermilk"
C. "Eat foods such as parsley, yogurt, and buttermilk"
D. "Increase your intake of asparagus and broccoli"
ANSWER:
C. "Eat foods such as parsley, yogurt, and buttermilk"
RATIONALE:
Foods like parsley, yogurt, and buttermilk can help reduce odor from a colostomy. These foods
contain natural deodorizing properties. Option A is incorrect because eggs and fish actually increase
odor. Option B is incorrect because yogurt and buttermilk help reduce odor, not increase it. Option D
is incorrect because asparagus and broccoli are known to increase gas and odor production.
pg. 3
, 2026 HESI RN EXIT EXAM V4
QUESTION 3:
The nurse is assessing a client who is 24 hours post-operative from abdominal surgery. Which finding
would require immediate intervention?
A. Heart rate 88 beats/minute
B. Respiratory rate 22 breaths/minute
C. Blood pressure 98/62 mmHg
D. Temperature 99.2°F (37.3°C)
ANSWER:
C. Blood pressure 98/62 mmHg
RATIONALE:
A blood pressure of 98/62 mmHg is below normal and may indicate hypovolemia, hemorrhage, or
shock in the post-operative client. This requires immediate intervention. Option A (HR 88) is within
normal limits (60-100). Option B (RR 22) is slightly elevated but within expected post-operative
range. Option D (99.2°F) is a low-grade fever that is common in the first 24-48 hours post-operatively
and requires monitoring but not immediate intervention.
QUESTION 4:
A nurse is preparing to administer a blood transfusion to a client. Which action is most important
prior to initiating the transfusion?
A. Verify the client's blood type and crossmatch with another nurse
B. Assess the client's temperature
C. Start an IV line with normal saline
D. Obtain signed consent from the client
ANSWER:
A. Verify the client's blood type and crossmatch with another nurse
RATIONALE:
Verifying the client's blood type and crossmatch with another nurse is the most critical safety step to
prevent transfusion reactions. Two licensed nurses must verify the client's identification, blood type,
and unit number. While options B, C, and D are all important steps, option A is the priority safety
measure that directly prevents fatal transfusion reactions.
QUESTION 5:
A client receiving IV fluids at 150 mL/hr develops crackles in the lung bases, dyspnea, and jugular
vein distention. Which nursing action should be taken first?
A. Slow the IV infusion rate
B. Administer furosemide as prescribed
C. Place the client in high Fowler's position
D. Notify the healthcare provider
ANSWER:
A. Slow the IV infusion rate
pg. 4
2026 HESI RN Exit Exam V4 — Complete 200-
Question NGN Practice Test with Verified
Answers and Detailed Rationales Across
Fundamentals, Medical-Surgical, Maternal-
Newborn, Pediatric, Mental Health,
Pharmacology, and Nursing Leadership
================================================================================
2026 HESI RN EXIT EXAM V4
Complete 200-Question NGN Practice Test with Verified Answers and Detailed
Rationales Across Fundamentals, Medical-Surgical, Maternal-Newborn, Pediatric,
Mental Health, Pharmacology, and Nursing Leadership
================================================================================
Document Type : Comprehensive Practice Examination
Exam Version : V4 (Next Generation NCLEX-Style)
Total Questions : 200
Format : Color-Coded Question / Answer / Rationale
Answer Key : Included with Full Rationales
--------------------------------------------------------------------------------
INSTRUCTIONS TO THE CANDIDATE
--------------------------------------------------------------------------------
1. Read each question carefully before selecting your answer.
2. Choose the BEST answer for each item unless otherwise indicated.
3. Select all that apply when the question directs you to do so.
4. Do not reveal the answer or rationale until you have answered the question.
5. Review the rationale for every item, including those you answered correctly.
6. Maintain the color-coded format: Blue = Question, Red = Answer, Purple = Rationale.
pg. 1
, 2026 HESI RN EXIT EXAM V4
--------------------------------------------------------------------------------
EXAM SECTIONS
--------------------------------------------------------------------------------
Section 1 : Fundamentals of Nursing .................... Questions 001-025
Section 2 : Medical-Surgical Nursing ................... Questions 026-070
Section 3 : Maternal-Newborn Nursing ................... Questions 071-100
Section 4 : Pediatric Nursing .......................... Questions 101-130
Section 5 : Mental Health Nursing ...................... Questions 131-155
Section 6 : Pharmacology ............................... Questions 156-185
Section 7 : Nursing Leadership and Management .......... Questions 186-200
--------------------------------------------------------------------------------
COLOR KEY
--------------------------------------------------------------------------------
[BLUE] QUESTION - The complete exam question and answer options
[RED] ANSWER - The correct answer with letter and full text
[PURPLE] RATIONALE - Detailed explanation of the correct and incorrect options
================================================================================
BEGIN EXAMINATION
================================================================================
pg. 2
, 2026 HESI RN EXIT EXAM V4
2026 HESI RN Exit Exam V4
Comprehensive Practice Examination with NGN Questions
SECTION 1: Fundamentals of Nursing (Questions 1-25)
QUESTION 1:
A nurse is caring for a client who has a prescription for a 24-hour urine collection. Which action
should the nurse take to ensure accurate collection?
A. Discard the first voiding and begin the collection after that
B. Collect all urine in a container without preservatives
C. Keep the collection container on ice throughout the collection period
D. Begin the collection at the start of the shift and end 24 hours later
ANSWER:
A. Discard the first voiding and begin the collection after that
RATIONALE:
The correct procedure for a 24-hour urine collection is to discard the first voiding and begin timing
from that point, collecting all subsequent urine for the next 24 hours. This ensures accurate
measurement of substances excreted over the full 24-hour period. Option B is incorrect because
some tests require preservatives in the container. Option C is incorrect because not all 24-hour urine
collections require ice; this depends on the specific test being performed. Option D is incorrect
because the collection should not begin at the start of a shift without discarding the first voiding; the
24-hour period begins after the first voiding is discarded.
QUESTION 2:
A client with a newly placed colostomy expresses concern about the odor from the ostomy pouch.
Which dietary recommendation should the nurse provide?
A. "Increase your intake of eggs and fish"
B. "Avoid foods like yogurt and buttermilk"
C. "Eat foods such as parsley, yogurt, and buttermilk"
D. "Increase your intake of asparagus and broccoli"
ANSWER:
C. "Eat foods such as parsley, yogurt, and buttermilk"
RATIONALE:
Foods like parsley, yogurt, and buttermilk can help reduce odor from a colostomy. These foods
contain natural deodorizing properties. Option A is incorrect because eggs and fish actually increase
odor. Option B is incorrect because yogurt and buttermilk help reduce odor, not increase it. Option D
is incorrect because asparagus and broccoli are known to increase gas and odor production.
pg. 3
, 2026 HESI RN EXIT EXAM V4
QUESTION 3:
The nurse is assessing a client who is 24 hours post-operative from abdominal surgery. Which finding
would require immediate intervention?
A. Heart rate 88 beats/minute
B. Respiratory rate 22 breaths/minute
C. Blood pressure 98/62 mmHg
D. Temperature 99.2°F (37.3°C)
ANSWER:
C. Blood pressure 98/62 mmHg
RATIONALE:
A blood pressure of 98/62 mmHg is below normal and may indicate hypovolemia, hemorrhage, or
shock in the post-operative client. This requires immediate intervention. Option A (HR 88) is within
normal limits (60-100). Option B (RR 22) is slightly elevated but within expected post-operative
range. Option D (99.2°F) is a low-grade fever that is common in the first 24-48 hours post-operatively
and requires monitoring but not immediate intervention.
QUESTION 4:
A nurse is preparing to administer a blood transfusion to a client. Which action is most important
prior to initiating the transfusion?
A. Verify the client's blood type and crossmatch with another nurse
B. Assess the client's temperature
C. Start an IV line with normal saline
D. Obtain signed consent from the client
ANSWER:
A. Verify the client's blood type and crossmatch with another nurse
RATIONALE:
Verifying the client's blood type and crossmatch with another nurse is the most critical safety step to
prevent transfusion reactions. Two licensed nurses must verify the client's identification, blood type,
and unit number. While options B, C, and D are all important steps, option A is the priority safety
measure that directly prevents fatal transfusion reactions.
QUESTION 5:
A client receiving IV fluids at 150 mL/hr develops crackles in the lung bases, dyspnea, and jugular
vein distention. Which nursing action should be taken first?
A. Slow the IV infusion rate
B. Administer furosemide as prescribed
C. Place the client in high Fowler's position
D. Notify the healthcare provider
ANSWER:
A. Slow the IV infusion rate
pg. 4
