HESI EXIT V3 — ORIGINAL PRACTICE EXAM WITH
RATIONALES
CORE DOMAINS
Management of Care (Delegation, Prioritization, Legal/Ethical)
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
INTRODUCTION
This original practice examination is designed for nursing students
preparing for the HESI Exit V3 exam. Questions cover all eight content
domains tested on the exam, aligned with the NCSBN Clinical Judgment
Measurement Model and the HESI Exit V3 blueprint. Each question
includes a detailed rationale. These are original questions created for study
purposes and are not derived from any proprietary examination. Emphasis
is placed on clinical judgment, prioritization, and safe nursing practice.
SECTION ONE: MANAGEMENT OF CARE
1. The RN is assigned to care for four clients. Which client should the
RN assess first?
A. A client with COPD who has an oxygen saturation of 92% on 2L nasal
cannula
B. A client with heart failure who reports increased shortness of breath and
has new crackles
C. A client with diabetes who has a blood glucose of 180 mg/dL
D. A client recovering from a total knee replacement who is requesting pain
medication
B. A client with heart failure who reports increased shortness of breath
and has new crackles
, RATIONALE: New-onset shortness of breath with crackles in a heart
failure client suggests acute pulmonary edema, a life-threatening
complication requiring immediate assessment and intervention. COPD with
SpO2 of 92% is stable. Blood glucose of 180 mg/dL is elevated but not
emergent. Post-operative pain is important but not the priority .
2. A charge nurse is delegating tasks to an LPN. Which task is
appropriate to delegate?
A. Performing an initial assessment on a newly admitted client
B. Administering oral medications to a stable client
C. Developing a care plan for a client with complex needs
D. Teaching a client about discharge instructions
B. Administering oral medications to a stable client
RATIONALE: LPNs can administer medications to stable clients under
RN supervision. Initial assessments, care plan development, and teaching
require RN-level clinical judgment and cannot be delegated .
3. A nurse is triaging clients following a mass casualty event. Which
client should be categorized as red (immediate)?
A. A client with a simple fracture of the radius who is ambulatory
B. A client with an open pneumothorax and respiratory distress
C. A client with a minor laceration requiring sutures
D. A client with a contusion who is able to follow commands
B. A client with an open pneumothorax and respiratory distress
RATIONALE: In disaster triage, red (immediate) clients require life-
saving intervention within minutes. Open pneumothorax with respiratory
distress is a life-threatening emergency requiring immediate chest
decompression. Green clients are ambulatory with minor injuries .
4. A nurse is caring for a client who refuses a prescribed blood
transfusion. The client is competent and has been informed of the
risks. Which action should the nurse take?
, A. Administer the transfusion despite the client's refusal
B. Respect the client's right to refuse and document the refusal
C. Ask the family to convince the client to accept the transfusion
D. Notify the provider and request a court order
B. Respect the client's right to refuse and document the refusal
RATIONALE: A competent client has the right to refuse any treatment,
even if it is life-saving. The nurse must respect the client's autonomy,
document the refusal, and notify the provider.
5. A nurse is prioritizing care for four clients. Which client should the
nurse see first using the ABCDE framework?
A. A client requesting pain medication for a headache
B. A client with new onset of drooling and difficulty swallowing
C. A client who needs assistance ambulating to the bathroom
D. A client due for a scheduled antibiotic dose
B. A client with new onset of drooling and difficulty swallowing
RATIONALE: Drooling and difficulty swallowing indicate potential airway
obstruction, which is an immediate threat to the airway (A in ABCDE). This
requires immediate assessment and intervention.
SECTION TWO: SAFETY AND INFECTION CONTROL
6. A nurse is preparing to administer a blood transfusion. Which
action is most important before initiating the transfusion?
A. Verify the patient's identification and blood product compatibility with a
second nurse
B. Administer the transfusion rapidly to prevent clotting
C. Pre-medicate with acetaminophen
D. Obtain a baseline 12-lead EKG
A. Verify the patient's identification and blood product compatibility with
a second nurse
RATIONALE: Verification of patient identification and blood product
RATIONALES
CORE DOMAINS
Management of Care (Delegation, Prioritization, Legal/Ethical)
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
INTRODUCTION
This original practice examination is designed for nursing students
preparing for the HESI Exit V3 exam. Questions cover all eight content
domains tested on the exam, aligned with the NCSBN Clinical Judgment
Measurement Model and the HESI Exit V3 blueprint. Each question
includes a detailed rationale. These are original questions created for study
purposes and are not derived from any proprietary examination. Emphasis
is placed on clinical judgment, prioritization, and safe nursing practice.
SECTION ONE: MANAGEMENT OF CARE
1. The RN is assigned to care for four clients. Which client should the
RN assess first?
A. A client with COPD who has an oxygen saturation of 92% on 2L nasal
cannula
B. A client with heart failure who reports increased shortness of breath and
has new crackles
C. A client with diabetes who has a blood glucose of 180 mg/dL
D. A client recovering from a total knee replacement who is requesting pain
medication
B. A client with heart failure who reports increased shortness of breath
and has new crackles
, RATIONALE: New-onset shortness of breath with crackles in a heart
failure client suggests acute pulmonary edema, a life-threatening
complication requiring immediate assessment and intervention. COPD with
SpO2 of 92% is stable. Blood glucose of 180 mg/dL is elevated but not
emergent. Post-operative pain is important but not the priority .
2. A charge nurse is delegating tasks to an LPN. Which task is
appropriate to delegate?
A. Performing an initial assessment on a newly admitted client
B. Administering oral medications to a stable client
C. Developing a care plan for a client with complex needs
D. Teaching a client about discharge instructions
B. Administering oral medications to a stable client
RATIONALE: LPNs can administer medications to stable clients under
RN supervision. Initial assessments, care plan development, and teaching
require RN-level clinical judgment and cannot be delegated .
3. A nurse is triaging clients following a mass casualty event. Which
client should be categorized as red (immediate)?
A. A client with a simple fracture of the radius who is ambulatory
B. A client with an open pneumothorax and respiratory distress
C. A client with a minor laceration requiring sutures
D. A client with a contusion who is able to follow commands
B. A client with an open pneumothorax and respiratory distress
RATIONALE: In disaster triage, red (immediate) clients require life-
saving intervention within minutes. Open pneumothorax with respiratory
distress is a life-threatening emergency requiring immediate chest
decompression. Green clients are ambulatory with minor injuries .
4. A nurse is caring for a client who refuses a prescribed blood
transfusion. The client is competent and has been informed of the
risks. Which action should the nurse take?
, A. Administer the transfusion despite the client's refusal
B. Respect the client's right to refuse and document the refusal
C. Ask the family to convince the client to accept the transfusion
D. Notify the provider and request a court order
B. Respect the client's right to refuse and document the refusal
RATIONALE: A competent client has the right to refuse any treatment,
even if it is life-saving. The nurse must respect the client's autonomy,
document the refusal, and notify the provider.
5. A nurse is prioritizing care for four clients. Which client should the
nurse see first using the ABCDE framework?
A. A client requesting pain medication for a headache
B. A client with new onset of drooling and difficulty swallowing
C. A client who needs assistance ambulating to the bathroom
D. A client due for a scheduled antibiotic dose
B. A client with new onset of drooling and difficulty swallowing
RATIONALE: Drooling and difficulty swallowing indicate potential airway
obstruction, which is an immediate threat to the airway (A in ABCDE). This
requires immediate assessment and intervention.
SECTION TWO: SAFETY AND INFECTION CONTROL
6. A nurse is preparing to administer a blood transfusion. Which
action is most important before initiating the transfusion?
A. Verify the patient's identification and blood product compatibility with a
second nurse
B. Administer the transfusion rapidly to prevent clotting
C. Pre-medicate with acetaminophen
D. Obtain a baseline 12-lead EKG
A. Verify the patient's identification and blood product compatibility with
a second nurse
RATIONALE: Verification of patient identification and blood product
