HESI FINAL EXAM NSG123 (2026/2027) | UPDATED QUESTIONS & ANSWERS
NSG123: Nursing Fundamentals - HESI Final Examination | Core Domains: Nursing Process & Clinical
Judgment, Basic Care & Comfort, Safety & Infection Control, Health Promotion & Maintenance,
Psychosocial Integrity, Pharmacological & Parenteral Therapies, Reduction of Risk Potential, and
Physiological Adaptation | Foundational Nursing Competency Focus | Comprehensive HESI Final Exam
Format
Exam Structure
The NSG123 HESI Final Exam for the 2026/2027 academic cycle is a 110-question, multiple-choice
question (MCQ) examination.
Introduction
This NSG123 HESI Final Exam guide for the 2026/2027 cycle prepares nursing students for the
comprehensive predictor exam assessing mastery of fundamental nursing principles. The content
integrates knowledge across all client needs categories, emphasizing clinical judgment, safe practice,
medication administration, and the application of the nursing process to diverse patient care scenarios
essential for NCLEX-RN® readiness and clinical success.
Answer Format
All correct answers and foundational nursing interventions must be presented in bold and green,
followed by detailed rationales that apply the nursing process steps, explain core nursing concepts and
safety protocols, justify basic pharmacological principles and dosage calculations, and utilize HESI's
specific test-taking and clinical judgment strategies.
Questions (110 Total)
1. A nurse is preparing to administer a medication. Which action demonstrates adherence to the "Right
Patient" principle?
A. Checking the medication label against the MAR
B. Using two patient identifiers (e.g., name and date of birth)
C. Verifying the dose with another nurse
D. Confirming the route with the provider
Rationale: The "Right Patient" requires using two unique identifiers (e.g., name and DOB or medical
record number)—never room number or appearance. This prevents potentially fatal errors and aligns
with The Joint Commission National Patient Safety Goal NPSG.01.01.01.
2. A client reports pain as "8 out of 10." What is the nurse’s best next step?
,A. Document the number only
B. Assess location, quality, duration, and aggravating/relieving factors
C. Administer PRN medication without further assessment
D. Tell the client to relax
Rationale: Pain is subjective and multidimensional. A complete assessment includes PQRST:
Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing. This guides appropriate
intervention and evaluation of effectiveness. Never treat pain based on a number alone.
3. When performing hand hygiene, the nurse should:
A. Use soap and water only if hands are visibly soiled
B. Use alcohol-based hand rub for routine decontamination unless hands are visibly soiled
C. Rinse hands before applying soap
D. Skip hand hygiene after removing gloves
Rationale: CDC guidelines recommend alcohol-based hand rubs for routine hand hygiene—they are
more effective and less drying than soap and water. Wash with soap and water only if hands are visibly
soiled or after caring for patients with C. difficile or norovirus.
4. A client is prescribed furosemide 40 mg IV. The vial contains 10 mg/mL. How many mL should the
nurse administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 8 mL
Rationale: Desired dose = 40 mg. Concentration = 10 mg/mL. Volume = 40 ÷ 10 = 4 mL. Always
double-check calculations and have a second nurse verify high-alert medications like IV diuretics.
5. A postoperative client has a boggy uterus and heavy lochia. What should the nurse do first?
A. Administer oxytocin IV
B. Massage the fundus and assist the client to void
,C. Increase IV fluids
D. Apply ice packs to the perineum
Rationale: A displaced, boggy fundus often indicates a full bladder. Assisting the client to void may
restore uterine tone. If the fundus remains boggy, then massage and administer oxytocin as ordered.
Bladder distension is a common reversible cause of uterine atony.
6. A client with type 1 diabetes has a blood glucose of 52 mg/dL and is conscious. What should the nurse
do first?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate (e.g., 4 oz orange juice)
C. Inject regular insulin IV
D. Offer a protein snack
Rationale: For a conscious hypoglycemic client, follow the “Rule of 15”: 15 g fast-acting carb (juice,
glucose tablets), recheck in 15 minutes. Glucagon is for unconscious/unresponsive patients. Insulin
would worsen hypoglycemia. Protein slows glucose absorption and is not first-line.
7. Which finding in a newborn requires immediate intervention?
A. Weight loss of 5%
B. Caput succedaneum
C. Jaundice appearing within the first 24 hours
D. Acrocyanosis
Rationale: Jaundice in the first 24 hours is pathologic and may indicate hemolytic disease (e.g.,
Rh/ABO incompatibility), infection, or metabolic disorder. Physiologic jaundice appears after 24 hours.
Weight loss ≤7% is normal. Caput and acrocyanosis are benign transitional findings.
8. A client is placed on contact precautions. What action should the nurse take?
A. Wear a mask for all interactions
B. Wear gloves and gown when entering the room
C. Keep the door open for ventilation
D. Allow visitors without PPE
, Rationale: Contact precautions require gloves and gown for all room entry to prevent transmission of
pathogens via direct or indirect contact (e.g., MRSA, C. diff). Masks are for droplet or airborne
precautions. Door should remain closed; visitors must wear appropriate PPE.
9. A client says, “I feel like I’m going to lose control.” What is the best response?
A. "You’re fine—relax."
B. "Tell me more about what ‘losing control’ means to you."
C. "Take your meds."
D. "Go to your room."
Rationale: Therapeutic communication uses open-ended questions to explore meaning and build trust.
Dismissing feelings ("relax") or giving directives ("take meds") blocks dialogue. This approach aligns
with HESI’s emphasis on psychosocial integrity and therapeutic relationships.
10. An older adult with dementia attempts to get out of bed repeatedly. What is the safest intervention?
A. Apply bilateral wrist restraints
B. Use bed alarms and frequent toileting rounds
C. Administer sedatives PRN
D. Raise all side rails
Rationale: Restraints increase fall risk and are a last resort. Non-restrictive measures like bed alarms,
scheduled toileting, and environmental modifications address root causes (e.g., urinary urgency) while
preserving dignity and safety—core to HESI’s safety and reduction of risk potential focus.
11. The most effective way to prevent influenza is:
A. Taking vitamin C daily
B. Annual influenza vaccination
C. Avoiding all public places
D. Using antibiotics prophylactically
Rationale: Annual flu vaccine is the primary prevention strategy per CDC. Antivirals are for
treatment, not prevention; antibiotics do not affect viruses.
12. A client who is angry about a new diagnosis should be:
NSG123: Nursing Fundamentals - HESI Final Examination | Core Domains: Nursing Process & Clinical
Judgment, Basic Care & Comfort, Safety & Infection Control, Health Promotion & Maintenance,
Psychosocial Integrity, Pharmacological & Parenteral Therapies, Reduction of Risk Potential, and
Physiological Adaptation | Foundational Nursing Competency Focus | Comprehensive HESI Final Exam
Format
Exam Structure
The NSG123 HESI Final Exam for the 2026/2027 academic cycle is a 110-question, multiple-choice
question (MCQ) examination.
Introduction
This NSG123 HESI Final Exam guide for the 2026/2027 cycle prepares nursing students for the
comprehensive predictor exam assessing mastery of fundamental nursing principles. The content
integrates knowledge across all client needs categories, emphasizing clinical judgment, safe practice,
medication administration, and the application of the nursing process to diverse patient care scenarios
essential for NCLEX-RN® readiness and clinical success.
Answer Format
All correct answers and foundational nursing interventions must be presented in bold and green,
followed by detailed rationales that apply the nursing process steps, explain core nursing concepts and
safety protocols, justify basic pharmacological principles and dosage calculations, and utilize HESI's
specific test-taking and clinical judgment strategies.
Questions (110 Total)
1. A nurse is preparing to administer a medication. Which action demonstrates adherence to the "Right
Patient" principle?
A. Checking the medication label against the MAR
B. Using two patient identifiers (e.g., name and date of birth)
C. Verifying the dose with another nurse
D. Confirming the route with the provider
Rationale: The "Right Patient" requires using two unique identifiers (e.g., name and DOB or medical
record number)—never room number or appearance. This prevents potentially fatal errors and aligns
with The Joint Commission National Patient Safety Goal NPSG.01.01.01.
2. A client reports pain as "8 out of 10." What is the nurse’s best next step?
,A. Document the number only
B. Assess location, quality, duration, and aggravating/relieving factors
C. Administer PRN medication without further assessment
D. Tell the client to relax
Rationale: Pain is subjective and multidimensional. A complete assessment includes PQRST:
Provocation/Palliation, Quality, Region/Radiation, Severity, and Timing. This guides appropriate
intervention and evaluation of effectiveness. Never treat pain based on a number alone.
3. When performing hand hygiene, the nurse should:
A. Use soap and water only if hands are visibly soiled
B. Use alcohol-based hand rub for routine decontamination unless hands are visibly soiled
C. Rinse hands before applying soap
D. Skip hand hygiene after removing gloves
Rationale: CDC guidelines recommend alcohol-based hand rubs for routine hand hygiene—they are
more effective and less drying than soap and water. Wash with soap and water only if hands are visibly
soiled or after caring for patients with C. difficile or norovirus.
4. A client is prescribed furosemide 40 mg IV. The vial contains 10 mg/mL. How many mL should the
nurse administer?
A. 2 mL
B. 4 mL
C. 6 mL
D. 8 mL
Rationale: Desired dose = 40 mg. Concentration = 10 mg/mL. Volume = 40 ÷ 10 = 4 mL. Always
double-check calculations and have a second nurse verify high-alert medications like IV diuretics.
5. A postoperative client has a boggy uterus and heavy lochia. What should the nurse do first?
A. Administer oxytocin IV
B. Massage the fundus and assist the client to void
,C. Increase IV fluids
D. Apply ice packs to the perineum
Rationale: A displaced, boggy fundus often indicates a full bladder. Assisting the client to void may
restore uterine tone. If the fundus remains boggy, then massage and administer oxytocin as ordered.
Bladder distension is a common reversible cause of uterine atony.
6. A client with type 1 diabetes has a blood glucose of 52 mg/dL and is conscious. What should the nurse
do first?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate (e.g., 4 oz orange juice)
C. Inject regular insulin IV
D. Offer a protein snack
Rationale: For a conscious hypoglycemic client, follow the “Rule of 15”: 15 g fast-acting carb (juice,
glucose tablets), recheck in 15 minutes. Glucagon is for unconscious/unresponsive patients. Insulin
would worsen hypoglycemia. Protein slows glucose absorption and is not first-line.
7. Which finding in a newborn requires immediate intervention?
A. Weight loss of 5%
B. Caput succedaneum
C. Jaundice appearing within the first 24 hours
D. Acrocyanosis
Rationale: Jaundice in the first 24 hours is pathologic and may indicate hemolytic disease (e.g.,
Rh/ABO incompatibility), infection, or metabolic disorder. Physiologic jaundice appears after 24 hours.
Weight loss ≤7% is normal. Caput and acrocyanosis are benign transitional findings.
8. A client is placed on contact precautions. What action should the nurse take?
A. Wear a mask for all interactions
B. Wear gloves and gown when entering the room
C. Keep the door open for ventilation
D. Allow visitors without PPE
, Rationale: Contact precautions require gloves and gown for all room entry to prevent transmission of
pathogens via direct or indirect contact (e.g., MRSA, C. diff). Masks are for droplet or airborne
precautions. Door should remain closed; visitors must wear appropriate PPE.
9. A client says, “I feel like I’m going to lose control.” What is the best response?
A. "You’re fine—relax."
B. "Tell me more about what ‘losing control’ means to you."
C. "Take your meds."
D. "Go to your room."
Rationale: Therapeutic communication uses open-ended questions to explore meaning and build trust.
Dismissing feelings ("relax") or giving directives ("take meds") blocks dialogue. This approach aligns
with HESI’s emphasis on psychosocial integrity and therapeutic relationships.
10. An older adult with dementia attempts to get out of bed repeatedly. What is the safest intervention?
A. Apply bilateral wrist restraints
B. Use bed alarms and frequent toileting rounds
C. Administer sedatives PRN
D. Raise all side rails
Rationale: Restraints increase fall risk and are a last resort. Non-restrictive measures like bed alarms,
scheduled toileting, and environmental modifications address root causes (e.g., urinary urgency) while
preserving dignity and safety—core to HESI’s safety and reduction of risk potential focus.
11. The most effective way to prevent influenza is:
A. Taking vitamin C daily
B. Annual influenza vaccination
C. Avoiding all public places
D. Using antibiotics prophylactically
Rationale: Annual flu vaccine is the primary prevention strategy per CDC. Antivirals are for
treatment, not prevention; antibiotics do not affect viruses.
12. A client who is angry about a new diagnosis should be:
