EVOLVE HESI RN FUNDAMENTALS
EXAM 2026/2027: 400 VERIFIED
QUESTIONS & ANSWERS WITH
RATIONALES | 9 CORE DOMAINS |
ELSEVIER NCLEX PREP | GRADED A+ \
(GUARANTEED PASS) NEWEST!!
Domain 1: Nursing Process & Clinical Judgment
1. A nurse is caring for four clients at the start of a shift. Which client should
the nurse assess FIRST?
A. A client who reports a pain level of 4/10 after knee surgery
B. A client with a new onset of shortness of breath and oxygen saturation of 88%
C. A client requesting a scheduled dressing change
D. A client waiting for discharge instructions
Correct Answer: B. A client with a new onset of shortness of breath and oxygen
saturation of 88%
Rationale: New-onset shortness of breath with a low oxygen saturation indicates an
acute airway/breathing problem, which takes priority over stable pain, routine
treatments, or discharge teaching using the ABC (airway, breathing, circulation)
framework.
2. A nurse is documenting in the client's electronic health record. Which
documentation is most appropriate?
A. "Client seems upset today"
B. "Client is anxious and tearful"
C. "Client is acting strange"
D. "Client is having a bad day"
Correct Answer: B. "Client is anxious and tearful"
Rationale: Documentation should be objective, factual, and specific. "Client is anxious
and tearful" describes observable behaviors, whereas the other options are subjective or
vague.
3. The nurse is prioritizing care for a client with a new tracheostomy who is
anxious and a client with a stable chronic wound needing a dressing change.
,Which action reflects correct prioritization?
A. Wait until both clients call the nurse before responding
B. Attend to the chronic wound dressing change first since it was scheduled earlier
C. Assess the tracheostomy client first because airway concerns take priority over
routine wound care
D. Delegate both tasks to the UAP simultaneously
Correct Answer: C. Assess the tracheostomy client first because airway concerns take
priority over routine wound care
Rationale: Airway management for a new tracheostomy takes priority under the ABC
framework over a scheduled, non-urgent dressing change on a stable chronic wound,
regardless of which task was scheduled first.
Domain 2: Safety & Infection Control
4. The nurse observes an unlicensed assistive personnel (UAP) securing a
client's wrist restraints to the bed side rails. Which action is most important for
the nurse to implement?
A. Report the UAP to the charge nurse
B. Instruct the UAP to attach the restraints to the bed frame
C. Document the incident in the client's chart
D. Remove the restraints immediately
Correct Answer: B. Instruct the UAP to attach the restraints to the bed frame
Rationale: Restraints must never be attached to side rails because movement of the
rails can cause injury. The nurse must immediately correct this unsafe practice by
instructing the UAP to attach restraints to the bed frame, which is a stationary part of
the bed.
5. A nurse is caring for a client with a new diagnosis of "C. Difficile." Which
infection control measure is the absolute priority?
A. Wearing an N95 respirator mask
B. Using alcohol-based hand rub after exiting the room
C. Performing hand hygiene with soap and water
D. Keeping the client's door closed at all times
Correct Answer: C. Performing hand hygiene with soap and water
Rationale: C. Diff spores are resistant to alcohol; mechanical friction with soap and
water is required to physically remove them from the skin.
,6. The nurse is preparing to delegate tasks to an unlicensed assistive personnel
(UAP). Which of the following tasks is appropriate for the nurse to delegate?
A. Administering oral medications
B. Performing a sterile dressing change
C. Assisting a patient with ambulation
D. Assessing a patient's pain level
Correct Answer: C. Assisting a patient with ambulation
Rationale: The RN can delegate tasks that do not require nursing judgment, such as
ambulation, bathing, feeding, and vital signs on stable patients. Administering
medications, performing sterile procedures, and assessment require nursing judgment
and cannot be delegated to UAP.
Domain 3: Basic Care & Comfort
7. While assessing a client's right wrist, the nurse notes that the client's right
hand is cool, with a blue tint and capillary refill greater than 3 seconds. The
right wrist restraint is in place. What action should the nurse implement first?
A. Loosen the right wrist restraint
B. Apply a pulse oximeter to the right hand
C. Compare hand color bilaterally
D. Palpate the right radial pulse
Correct Answer: A. Loosen the right wrist restraint
Rationale: The priority nursing action is to restore circulation by loosening the restraint,
because blue fingers (cyanosis) indicate decreased circulation. While comparing hand
color and palpating the pulse are also important interventions, they do not have the
priority of loosening the restraint.
8. The nurse is assessing the nutritional status of several clients. Which client
has the greatest nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle
B. A lactating woman nursing her 3-day-old infant
C. A school-aged child with Type 2 diabetes
D. An elderly man being treated for a peptic ulcer
Correct Answer: B. A lactating woman nursing her 3-day-old infant
Rationale: A lactating woman has the greatest nutritional need for additional protein
intake due to the demands of milk production. The other clients may have increased
needs, but lactation specifically requires a significant increase in protein.
, 9. An elderly client with a fractured left hip is on strict bedrest. Which nursing
measure is essential to the client's care?
A. Massage any reddened areas for at least five minutes
B. Encourage active range of motion exercises on extremities
C. Position the client laterally, prone, and dorsally in sequence
D. Gently lift the client when moving into a desired position
Correct Answer: D. Gently lift the client when moving into a desired position
Rationale: To avoid shearing forces when repositioning, the client should be lifted
gently across a surface. Reddened areas should not be massaged as this may increase
damage to already traumatized skin. Active range of motion may be limited on the
affected leg, and the positioning described in C is contraindicated for a client with a
fractured left hip.
Domain 4: Pharmacological Foundations
10. The nurse is administering medications through a nasogastric tube (NGT)
which is connected to suction. After ensuring correct tube placement, what
action should the nurse take next?
A. Clamp the tube for 20 minutes
B. Flush the tube with water
C. Administer the medications as prescribed
D. Crush the tablets and dissolve in sterile water
Correct Answer: B. Flush the tube with water
Rationale: The NGT should be flushed before, after, and in between each medication
administered. Once all medications are administered, the NGT should be clamped for
20 minutes. Options C and D may be implemented only after the tubing has been
flushed.
11. A nurse is preparing to administer a medication via a nasogastric (NG) tube.
What is the nurse's first action?
A. Flush the tube with 30 mL of water
B. Verify the placement of the tube
C. Crush the medication into a fine powder
D. Administer the medication via gravity
Correct Answer: B. Verify the placement of the tube
Rationale: Safety first. The nurse must confirm the tube is in the stomach (pH testing or
X-ray) before introducing any fluids to prevent aspiration.
EXAM 2026/2027: 400 VERIFIED
QUESTIONS & ANSWERS WITH
RATIONALES | 9 CORE DOMAINS |
ELSEVIER NCLEX PREP | GRADED A+ \
(GUARANTEED PASS) NEWEST!!
Domain 1: Nursing Process & Clinical Judgment
1. A nurse is caring for four clients at the start of a shift. Which client should
the nurse assess FIRST?
A. A client who reports a pain level of 4/10 after knee surgery
B. A client with a new onset of shortness of breath and oxygen saturation of 88%
C. A client requesting a scheduled dressing change
D. A client waiting for discharge instructions
Correct Answer: B. A client with a new onset of shortness of breath and oxygen
saturation of 88%
Rationale: New-onset shortness of breath with a low oxygen saturation indicates an
acute airway/breathing problem, which takes priority over stable pain, routine
treatments, or discharge teaching using the ABC (airway, breathing, circulation)
framework.
2. A nurse is documenting in the client's electronic health record. Which
documentation is most appropriate?
A. "Client seems upset today"
B. "Client is anxious and tearful"
C. "Client is acting strange"
D. "Client is having a bad day"
Correct Answer: B. "Client is anxious and tearful"
Rationale: Documentation should be objective, factual, and specific. "Client is anxious
and tearful" describes observable behaviors, whereas the other options are subjective or
vague.
3. The nurse is prioritizing care for a client with a new tracheostomy who is
anxious and a client with a stable chronic wound needing a dressing change.
,Which action reflects correct prioritization?
A. Wait until both clients call the nurse before responding
B. Attend to the chronic wound dressing change first since it was scheduled earlier
C. Assess the tracheostomy client first because airway concerns take priority over
routine wound care
D. Delegate both tasks to the UAP simultaneously
Correct Answer: C. Assess the tracheostomy client first because airway concerns take
priority over routine wound care
Rationale: Airway management for a new tracheostomy takes priority under the ABC
framework over a scheduled, non-urgent dressing change on a stable chronic wound,
regardless of which task was scheduled first.
Domain 2: Safety & Infection Control
4. The nurse observes an unlicensed assistive personnel (UAP) securing a
client's wrist restraints to the bed side rails. Which action is most important for
the nurse to implement?
A. Report the UAP to the charge nurse
B. Instruct the UAP to attach the restraints to the bed frame
C. Document the incident in the client's chart
D. Remove the restraints immediately
Correct Answer: B. Instruct the UAP to attach the restraints to the bed frame
Rationale: Restraints must never be attached to side rails because movement of the
rails can cause injury. The nurse must immediately correct this unsafe practice by
instructing the UAP to attach restraints to the bed frame, which is a stationary part of
the bed.
5. A nurse is caring for a client with a new diagnosis of "C. Difficile." Which
infection control measure is the absolute priority?
A. Wearing an N95 respirator mask
B. Using alcohol-based hand rub after exiting the room
C. Performing hand hygiene with soap and water
D. Keeping the client's door closed at all times
Correct Answer: C. Performing hand hygiene with soap and water
Rationale: C. Diff spores are resistant to alcohol; mechanical friction with soap and
water is required to physically remove them from the skin.
,6. The nurse is preparing to delegate tasks to an unlicensed assistive personnel
(UAP). Which of the following tasks is appropriate for the nurse to delegate?
A. Administering oral medications
B. Performing a sterile dressing change
C. Assisting a patient with ambulation
D. Assessing a patient's pain level
Correct Answer: C. Assisting a patient with ambulation
Rationale: The RN can delegate tasks that do not require nursing judgment, such as
ambulation, bathing, feeding, and vital signs on stable patients. Administering
medications, performing sterile procedures, and assessment require nursing judgment
and cannot be delegated to UAP.
Domain 3: Basic Care & Comfort
7. While assessing a client's right wrist, the nurse notes that the client's right
hand is cool, with a blue tint and capillary refill greater than 3 seconds. The
right wrist restraint is in place. What action should the nurse implement first?
A. Loosen the right wrist restraint
B. Apply a pulse oximeter to the right hand
C. Compare hand color bilaterally
D. Palpate the right radial pulse
Correct Answer: A. Loosen the right wrist restraint
Rationale: The priority nursing action is to restore circulation by loosening the restraint,
because blue fingers (cyanosis) indicate decreased circulation. While comparing hand
color and palpating the pulse are also important interventions, they do not have the
priority of loosening the restraint.
8. The nurse is assessing the nutritional status of several clients. Which client
has the greatest nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle
B. A lactating woman nursing her 3-day-old infant
C. A school-aged child with Type 2 diabetes
D. An elderly man being treated for a peptic ulcer
Correct Answer: B. A lactating woman nursing her 3-day-old infant
Rationale: A lactating woman has the greatest nutritional need for additional protein
intake due to the demands of milk production. The other clients may have increased
needs, but lactation specifically requires a significant increase in protein.
, 9. An elderly client with a fractured left hip is on strict bedrest. Which nursing
measure is essential to the client's care?
A. Massage any reddened areas for at least five minutes
B. Encourage active range of motion exercises on extremities
C. Position the client laterally, prone, and dorsally in sequence
D. Gently lift the client when moving into a desired position
Correct Answer: D. Gently lift the client when moving into a desired position
Rationale: To avoid shearing forces when repositioning, the client should be lifted
gently across a surface. Reddened areas should not be massaged as this may increase
damage to already traumatized skin. Active range of motion may be limited on the
affected leg, and the positioning described in C is contraindicated for a client with a
fractured left hip.
Domain 4: Pharmacological Foundations
10. The nurse is administering medications through a nasogastric tube (NGT)
which is connected to suction. After ensuring correct tube placement, what
action should the nurse take next?
A. Clamp the tube for 20 minutes
B. Flush the tube with water
C. Administer the medications as prescribed
D. Crush the tablets and dissolve in sterile water
Correct Answer: B. Flush the tube with water
Rationale: The NGT should be flushed before, after, and in between each medication
administered. Once all medications are administered, the NGT should be clamped for
20 minutes. Options C and D may be implemented only after the tubing has been
flushed.
11. A nurse is preparing to administer a medication via a nasogastric (NG) tube.
What is the nurse's first action?
A. Flush the tube with 30 mL of water
B. Verify the placement of the tube
C. Crush the medication into a fine powder
D. Administer the medication via gravity
Correct Answer: B. Verify the placement of the tube
Rationale: Safety first. The nurse must confirm the tube is in the stomach (pH testing or
X-ray) before introducing any fluids to prevent aspiration.
