HESI PN EXIT EXAM WITH NGN - COMPREHENSIVE PRACTICE (2026/2027 EDITION)
Independent educational practice resource; not an official HESI/Elsevier or NCSBN examination.
Directions: Choose the best answer. NGN case-study items are labeled and assess clinical judgment
functions.
Section 1: Management of Care - Safety, Delegation, Legal/Ethical, Case Management
(25 questions)
Q1: [NGN Case Study 1-Postoperative safety, Recognize Cues] Four hours after abdominal surgery, a
client is restless, RR 28/min, SpO2 88% on room air, HR 112/min. Which finding requires immediate
follow-up?
A. SpO2 88% on room air [CORRECT]
B. Pain rated 6/10
C. Absent bowel sounds
D. Temperature 37.4 degrees C
Correct Answer: A
Rationale: Hypoxemia threatens oxygenation; pain, transient absent bowel sounds, and a mildly
elevated temperature are less urgent.
Q2: [NGN Case Study 1-Postoperative safety, Analyze Cues] Which explanation best links the client’s
restlessness and tachycardia?
A. They prove opioid withdrawal
B. They indicate normal emergence only
C. They confirm hemorrhage without other data
D. They may be early manifestations of hypoxemia [CORRECT]
Correct Answer: D
Rationale: Restlessness and tachycardia can be early hypoxemia cues; the other conclusions are
unsupported.
Q3: [NGN Case Study 1-Postoperative safety, Prioritize Hypotheses] Which problem has highest
priority?
A. Acute pain
B. Risk for constipation
C. Impaired gas exchange [CORRECT]
D. Knowledge deficit
Correct Answer: C
Rationale: Using ABCs, impaired gas exchange takes priority over comfort and teaching needs.
Q4: [NGN Case Study 1-Postoperative safety, Take Action] What should the PN do first?
A. Offer oral fluids
B. Raise the head of bed and apply oxygen per protocol [CORRECT]
C. Administer a PRN sedative
D. Document and reassess in 1 hour
Correct Answer: B
Rationale: Positioning and oxygen immediately support ventilation; the other actions delay
treatment or can worsen respiratory depression.
Q5: [NGN Case Study 1-Postoperative safety, Evaluate Outcomes] Which finding best shows the
intervention was effective?
A. SpO2 rises to 95% and restlessness resolves [CORRECT]
B. Pain decreases from 6 to 5
C. Bowel sounds remain absent
D. Urine output is 25 mL/hr
Correct Answer: A
Page 1 of 25
,Rationale: Improved saturation and mentation directly demonstrate better oxygenation.
Q6: The PN is assigning care with an experienced UAP. Which task is appropriate to delegate?
A. Assess a new pressure injury
B. Teach insulin self-injection
C. Evaluate response to analgesic
D. Obtain routine vital signs for a stable client [CORRECT]
Correct Answer: D
Rationale: A UAP may collect routine data on a stable client; assessment, teaching, and evaluation
remain nursing responsibilities.
Q7: Which client should the PN assess first?
A. A client requesting a sleep aid
B. A client with chronic arthritis pain rated 6/10
C. A client with new inspiratory stridor after thyroidectomy [CORRECT]
D. A client awaiting discharge instructions
Correct Answer: C
Rationale: Stridor signals possible airway obstruction and takes priority by ABCs.
Q8: A competent adult refuses a blood transfusion for religious reasons. What is the best response?
A. Ask the family to override the decision
B. Respect the refusal and notify the provider [CORRECT]
C. Administer blood because it is lifesaving
D. Delay documenting the refusal
Correct Answer: B
Rationale: Competent clients may refuse treatment; coercion or treatment without consent violates
autonomy.
Q9: A client falls while walking to the bathroom. Which action is appropriate regarding an incident
report?
A. Complete it objectively after assessing the client [CORRECT]
B. Chart that an incident report was filed
C. Ask the client to sign the report
D. Use it to assign blame
Correct Answer: A
Rationale: Incident reports are factual quality-improvement documents and are not referenced in the
medical record.
Q10: Which action best protects client confidentiality?
A. Share details with an off-duty nurse friend
B. Leave the electronic chart open at the desk
C. Post a de-identified story with unique details online
D. Discuss care in a private area with involved staff [CORRECT]
Correct Answer: D
Rationale: Only involved personnel should discuss information in a secure setting; unique details
can still identify a client.
Q11: A client with suspected pulmonary tuberculosis is admitted. Which precautions are required?
A. Droplet precautions with a surgical mask only
B. Contact precautions with gown and gloves only
C. Airborne precautions in a negative-pressure room with a fit-tested respirator [CORRECT]
D. Protective isolation with positive pressure
Correct Answer: C
Rationale: Tuberculosis requires airborne isolation and respiratory protection.
Page 2 of 25
, Q12: Which client may the PN appropriately assign to a UAP?
A. A newly admitted client needing baseline assessment
B. A stable client needing assistance with bathing [CORRECT]
C. A client learning colostomy care
D. A client with chest pain needing reassessment
Correct Answer: B
Rationale: Routine ADLs for a stable client are delegable; assessment and teaching are not.
Q13: A nurse discovers a medication error immediately after administration. What is the first
action?
A. Assess the client [CORRECT]
B. Call risk management
C. Complete an incident report
D. Notify the pharmacy
Correct Answer: A
Rationale: Client assessment and safety come first, followed by notification and reporting.
Q14: Which statement about informed consent is correct?
A. The nurse may obtain consent after giving sedatives
B. A family member may sign for any competent adult
C. Consent is valid even when the client cannot ask questions
D. The provider explains risks and alternatives; the nurse may witness the signature [CORRECT]
Correct Answer: D
Rationale: The provider obtains informed consent; the nurse verifies voluntariness and witnesses as
permitted.
Q15: A fire starts in a wastebasket in a client room. According to RACE, what comes first?
A. Activate the alarm
B. Contain the fire
C. Rescue anyone in immediate danger [CORRECT]
D. Extinguish the fire
Correct Answer: C
Rationale: RACE begins with Rescue, then Alarm, Contain, and Extinguish/Evacuate.
Q16: Which restraint action requires correction?
A. Obtaining a time-limited order
B. Applying restraints before trying less restrictive measures [CORRECT]
C. Checking circulation frequently
D. Removing restraints for care as prescribed
Correct Answer: B
Rationale: Restraints are a last resort after less restrictive interventions fail.
Q17: A client has a durable power of attorney for health care. When does the agent generally make
decisions?
A. When the client lacks decision-making capacity [CORRECT]
B. Whenever the agent disagrees with the client
C. Only after the client’s death
D. Only for financial matters
Correct Answer: A
Rationale: A health-care agent acts when the client cannot make health decisions, according to
applicable law and documents.
Q18: Which handoff statement best uses SBAR?
A. The client does not look right; please come sometime
B. Room 4 has many problems
Page 3 of 25
Independent educational practice resource; not an official HESI/Elsevier or NCSBN examination.
Directions: Choose the best answer. NGN case-study items are labeled and assess clinical judgment
functions.
Section 1: Management of Care - Safety, Delegation, Legal/Ethical, Case Management
(25 questions)
Q1: [NGN Case Study 1-Postoperative safety, Recognize Cues] Four hours after abdominal surgery, a
client is restless, RR 28/min, SpO2 88% on room air, HR 112/min. Which finding requires immediate
follow-up?
A. SpO2 88% on room air [CORRECT]
B. Pain rated 6/10
C. Absent bowel sounds
D. Temperature 37.4 degrees C
Correct Answer: A
Rationale: Hypoxemia threatens oxygenation; pain, transient absent bowel sounds, and a mildly
elevated temperature are less urgent.
Q2: [NGN Case Study 1-Postoperative safety, Analyze Cues] Which explanation best links the client’s
restlessness and tachycardia?
A. They prove opioid withdrawal
B. They indicate normal emergence only
C. They confirm hemorrhage without other data
D. They may be early manifestations of hypoxemia [CORRECT]
Correct Answer: D
Rationale: Restlessness and tachycardia can be early hypoxemia cues; the other conclusions are
unsupported.
Q3: [NGN Case Study 1-Postoperative safety, Prioritize Hypotheses] Which problem has highest
priority?
A. Acute pain
B. Risk for constipation
C. Impaired gas exchange [CORRECT]
D. Knowledge deficit
Correct Answer: C
Rationale: Using ABCs, impaired gas exchange takes priority over comfort and teaching needs.
Q4: [NGN Case Study 1-Postoperative safety, Take Action] What should the PN do first?
A. Offer oral fluids
B. Raise the head of bed and apply oxygen per protocol [CORRECT]
C. Administer a PRN sedative
D. Document and reassess in 1 hour
Correct Answer: B
Rationale: Positioning and oxygen immediately support ventilation; the other actions delay
treatment or can worsen respiratory depression.
Q5: [NGN Case Study 1-Postoperative safety, Evaluate Outcomes] Which finding best shows the
intervention was effective?
A. SpO2 rises to 95% and restlessness resolves [CORRECT]
B. Pain decreases from 6 to 5
C. Bowel sounds remain absent
D. Urine output is 25 mL/hr
Correct Answer: A
Page 1 of 25
,Rationale: Improved saturation and mentation directly demonstrate better oxygenation.
Q6: The PN is assigning care with an experienced UAP. Which task is appropriate to delegate?
A. Assess a new pressure injury
B. Teach insulin self-injection
C. Evaluate response to analgesic
D. Obtain routine vital signs for a stable client [CORRECT]
Correct Answer: D
Rationale: A UAP may collect routine data on a stable client; assessment, teaching, and evaluation
remain nursing responsibilities.
Q7: Which client should the PN assess first?
A. A client requesting a sleep aid
B. A client with chronic arthritis pain rated 6/10
C. A client with new inspiratory stridor after thyroidectomy [CORRECT]
D. A client awaiting discharge instructions
Correct Answer: C
Rationale: Stridor signals possible airway obstruction and takes priority by ABCs.
Q8: A competent adult refuses a blood transfusion for religious reasons. What is the best response?
A. Ask the family to override the decision
B. Respect the refusal and notify the provider [CORRECT]
C. Administer blood because it is lifesaving
D. Delay documenting the refusal
Correct Answer: B
Rationale: Competent clients may refuse treatment; coercion or treatment without consent violates
autonomy.
Q9: A client falls while walking to the bathroom. Which action is appropriate regarding an incident
report?
A. Complete it objectively after assessing the client [CORRECT]
B. Chart that an incident report was filed
C. Ask the client to sign the report
D. Use it to assign blame
Correct Answer: A
Rationale: Incident reports are factual quality-improvement documents and are not referenced in the
medical record.
Q10: Which action best protects client confidentiality?
A. Share details with an off-duty nurse friend
B. Leave the electronic chart open at the desk
C. Post a de-identified story with unique details online
D. Discuss care in a private area with involved staff [CORRECT]
Correct Answer: D
Rationale: Only involved personnel should discuss information in a secure setting; unique details
can still identify a client.
Q11: A client with suspected pulmonary tuberculosis is admitted. Which precautions are required?
A. Droplet precautions with a surgical mask only
B. Contact precautions with gown and gloves only
C. Airborne precautions in a negative-pressure room with a fit-tested respirator [CORRECT]
D. Protective isolation with positive pressure
Correct Answer: C
Rationale: Tuberculosis requires airborne isolation and respiratory protection.
Page 2 of 25
, Q12: Which client may the PN appropriately assign to a UAP?
A. A newly admitted client needing baseline assessment
B. A stable client needing assistance with bathing [CORRECT]
C. A client learning colostomy care
D. A client with chest pain needing reassessment
Correct Answer: B
Rationale: Routine ADLs for a stable client are delegable; assessment and teaching are not.
Q13: A nurse discovers a medication error immediately after administration. What is the first
action?
A. Assess the client [CORRECT]
B. Call risk management
C. Complete an incident report
D. Notify the pharmacy
Correct Answer: A
Rationale: Client assessment and safety come first, followed by notification and reporting.
Q14: Which statement about informed consent is correct?
A. The nurse may obtain consent after giving sedatives
B. A family member may sign for any competent adult
C. Consent is valid even when the client cannot ask questions
D. The provider explains risks and alternatives; the nurse may witness the signature [CORRECT]
Correct Answer: D
Rationale: The provider obtains informed consent; the nurse verifies voluntariness and witnesses as
permitted.
Q15: A fire starts in a wastebasket in a client room. According to RACE, what comes first?
A. Activate the alarm
B. Contain the fire
C. Rescue anyone in immediate danger [CORRECT]
D. Extinguish the fire
Correct Answer: C
Rationale: RACE begins with Rescue, then Alarm, Contain, and Extinguish/Evacuate.
Q16: Which restraint action requires correction?
A. Obtaining a time-limited order
B. Applying restraints before trying less restrictive measures [CORRECT]
C. Checking circulation frequently
D. Removing restraints for care as prescribed
Correct Answer: B
Rationale: Restraints are a last resort after less restrictive interventions fail.
Q17: A client has a durable power of attorney for health care. When does the agent generally make
decisions?
A. When the client lacks decision-making capacity [CORRECT]
B. Whenever the agent disagrees with the client
C. Only after the client’s death
D. Only for financial matters
Correct Answer: A
Rationale: A health-care agent acts when the client cannot make health decisions, according to
applicable law and documents.
Q18: Which handoff statement best uses SBAR?
A. The client does not look right; please come sometime
B. Room 4 has many problems
Page 3 of 25
