HESI Leadership and Management
Practice Exam ACTUAL EXAM
2026/2027 | HESI Exam Blueprint |
Verified Q&A | Pass Guaranteed - A+
Graded
CATEGORY 1: MANAGEMENT OF CARE (40
Questions)
Q1: The charge nurse is making client assignments for the medical-surgical unit. Which client
should be assigned to the most experienced RN?
A. A 45-year-old with diabetes requiring insulin administration and dietary teaching
B. A 72-year-old 2 days post-hip replacement requiring pain management and ambulation
assistance
C. A 60-year-old with new-onset atrial fibrillation on continuous cardiac monitoring and IV
amiodarone [CORRECT]
D. A 55-year-old with pneumonia receiving IV antibiotics every 8 hours and oxygen at 2 L/min
Correct Answer: C
Rationale: The client with new-onset atrial fibrillation on cardiac monitoring and IV amiodarone is
unstable and requires advanced assessment skills, continuous monitoring, and knowledge of
,antiarrhythmic medications. This client should be assigned to the most experienced RN. Options A,
B, and D are stable clients with predictable outcomes.
HESI Note: When assigning clients, prioritize acuity and stability. Unstable clients with complex
needs require experienced RNs; stable clients with predictable outcomes can be managed by less
experienced staff.
Q2: A nurse is supervising a newly licensed RN who is providing care to a client with a chest tube.
Which action by the newly licensed RN requires immediate intervention?
A. Taping the connection between the chest tube and drainage system
B. Positioning the drainage system below the level of the client's chest
C. Clamping the chest tube during transport [CORRECT]
D. Noting continuous bubbling in the water seal chamber
Correct Answer: C
Rationale: Clamping a chest tube can lead to tension pneumothorax and is contraindicated unless
specifically ordered for troubleshooting (e.g., assessing for air leak). The drainage system should
be below chest level (B) is correct. Taping connections (A) is correct. Continuous bubbling in water
seal (D) indicates an air leak that should be reported but does not require immediate intervention.
HESI Note: Remember: "Don't clamp, don't lift above chest, don't strip or milk" unless specifically
ordered.
Q3: The charge nurse is delegating tasks on a busy medical-surgical unit. Which task is
appropriate to delegate to a UAP (unlicensed assistive personnel)?
A. Assessing a postoperative client's pain level
B. Administering oral medications to a stable client
C. Measuring and recording intake and output for a client with heart failure [CORRECT]
D. Teaching a client about wound care before discharge
,Correct Answer: C
Rationale: Measuring and recording intake and output is an appropriate task for UAPs as it does
not require nursing judgment or assessment. Assessment (A), medication administration (B), and
patient education (D) cannot be delegated to UAPs as they require professional nursing knowledge
and judgment.
HESI Note: The Five Rights of Delegation: Right Task, Right Circumstance, Right Person, Right
Direction/Communication, Right Supervision/Evaluation.
Q4: An RN is caring for four clients on a medical-surgical unit. Which client should the RN see first?
A. A client with diabetes who needs a routine blood glucose check before breakfast
B. A client with pneumonia whose oxygen saturation is 92% on room air
C. A client who had abdominal surgery 2 days ago and reports incisional pain of 4/10
D. A client with COPD who is having difficulty breathing and has an oxygen saturation of 88%
[CORRECT]
Correct Answer: D
Rationale: Using the ABCs (Airway, Breathing, Circulation) prioritization framework, the client with
COPD having difficulty breathing and low oxygen saturation (88%) has the highest priority. This
client has compromised breathing and requires immediate assessment and intervention.
HESI Note: Always prioritize using ABCs first, then Maslow's hierarchy, then acute vs. chronic, then
stable vs. unstable.
Q5: A nurse manager is implementing a quality improvement project using the Plan-Do-Study-Act
(PDSA) cycle. Which action occurs during the "Study" phase?
A. Developing protocols for the new intervention
B. Implementing the intervention on a small scale
C. Analyzing data to determine if the intervention worked [CORRECT]
, D. Making changes based on results and implementing on a larger scale
Correct Answer: C
Rationale: The PDSA cycle consists of: Plan (develop the intervention), Do (implement on small
scale), Study (analyze data and results), and Act (make changes and implement broadly). The
Study phase involves evaluating the effectiveness of the intervention.
HESI Note: PDSA is a rapid-cycle improvement method. Don't confuse "Study" with "Act"—study
comes before acting on the results.
Q6: During a mass casualty incident, a nurse is performing triage using the START method. Which
client should be tagged as "Immediate" (Red)?
A. A client with a fractured arm who is ambulatory
B. A client who is not breathing and has no pulse
C. A client with respiratory rate of 30/min and capillary refill of 3 seconds [CORRECT]
D. A client with minor lacerations who can follow commands
Correct Answer: C
Rationale: The START triage method uses RPM (Respirations, Perfusion, Mental status). A client
with respiratory rate >30/min (abnormal) and capillary refill >2 seconds (abnormal) meets criteria
for Immediate (Red) category. Ambulatory clients are Minor (Green), no breathing/no pulse is
Deceased/Expectant (Black), and minor injuries with normal mental status are Delayed (Yellow).
HESI Note: START Triage: 30-2-Can Do. Respirations >30, Capillary refill >2 seconds, Can't follow
commands = Immediate (Red).
Q7: A charge nurse is determining staffing needs for the night shift. Which factor is most important
when determining nurse-to-client ratios?
A. The years of experience of the nursing staff
Practice Exam ACTUAL EXAM
2026/2027 | HESI Exam Blueprint |
Verified Q&A | Pass Guaranteed - A+
Graded
CATEGORY 1: MANAGEMENT OF CARE (40
Questions)
Q1: The charge nurse is making client assignments for the medical-surgical unit. Which client
should be assigned to the most experienced RN?
A. A 45-year-old with diabetes requiring insulin administration and dietary teaching
B. A 72-year-old 2 days post-hip replacement requiring pain management and ambulation
assistance
C. A 60-year-old with new-onset atrial fibrillation on continuous cardiac monitoring and IV
amiodarone [CORRECT]
D. A 55-year-old with pneumonia receiving IV antibiotics every 8 hours and oxygen at 2 L/min
Correct Answer: C
Rationale: The client with new-onset atrial fibrillation on cardiac monitoring and IV amiodarone is
unstable and requires advanced assessment skills, continuous monitoring, and knowledge of
,antiarrhythmic medications. This client should be assigned to the most experienced RN. Options A,
B, and D are stable clients with predictable outcomes.
HESI Note: When assigning clients, prioritize acuity and stability. Unstable clients with complex
needs require experienced RNs; stable clients with predictable outcomes can be managed by less
experienced staff.
Q2: A nurse is supervising a newly licensed RN who is providing care to a client with a chest tube.
Which action by the newly licensed RN requires immediate intervention?
A. Taping the connection between the chest tube and drainage system
B. Positioning the drainage system below the level of the client's chest
C. Clamping the chest tube during transport [CORRECT]
D. Noting continuous bubbling in the water seal chamber
Correct Answer: C
Rationale: Clamping a chest tube can lead to tension pneumothorax and is contraindicated unless
specifically ordered for troubleshooting (e.g., assessing for air leak). The drainage system should
be below chest level (B) is correct. Taping connections (A) is correct. Continuous bubbling in water
seal (D) indicates an air leak that should be reported but does not require immediate intervention.
HESI Note: Remember: "Don't clamp, don't lift above chest, don't strip or milk" unless specifically
ordered.
Q3: The charge nurse is delegating tasks on a busy medical-surgical unit. Which task is
appropriate to delegate to a UAP (unlicensed assistive personnel)?
A. Assessing a postoperative client's pain level
B. Administering oral medications to a stable client
C. Measuring and recording intake and output for a client with heart failure [CORRECT]
D. Teaching a client about wound care before discharge
,Correct Answer: C
Rationale: Measuring and recording intake and output is an appropriate task for UAPs as it does
not require nursing judgment or assessment. Assessment (A), medication administration (B), and
patient education (D) cannot be delegated to UAPs as they require professional nursing knowledge
and judgment.
HESI Note: The Five Rights of Delegation: Right Task, Right Circumstance, Right Person, Right
Direction/Communication, Right Supervision/Evaluation.
Q4: An RN is caring for four clients on a medical-surgical unit. Which client should the RN see first?
A. A client with diabetes who needs a routine blood glucose check before breakfast
B. A client with pneumonia whose oxygen saturation is 92% on room air
C. A client who had abdominal surgery 2 days ago and reports incisional pain of 4/10
D. A client with COPD who is having difficulty breathing and has an oxygen saturation of 88%
[CORRECT]
Correct Answer: D
Rationale: Using the ABCs (Airway, Breathing, Circulation) prioritization framework, the client with
COPD having difficulty breathing and low oxygen saturation (88%) has the highest priority. This
client has compromised breathing and requires immediate assessment and intervention.
HESI Note: Always prioritize using ABCs first, then Maslow's hierarchy, then acute vs. chronic, then
stable vs. unstable.
Q5: A nurse manager is implementing a quality improvement project using the Plan-Do-Study-Act
(PDSA) cycle. Which action occurs during the "Study" phase?
A. Developing protocols for the new intervention
B. Implementing the intervention on a small scale
C. Analyzing data to determine if the intervention worked [CORRECT]
, D. Making changes based on results and implementing on a larger scale
Correct Answer: C
Rationale: The PDSA cycle consists of: Plan (develop the intervention), Do (implement on small
scale), Study (analyze data and results), and Act (make changes and implement broadly). The
Study phase involves evaluating the effectiveness of the intervention.
HESI Note: PDSA is a rapid-cycle improvement method. Don't confuse "Study" with "Act"—study
comes before acting on the results.
Q6: During a mass casualty incident, a nurse is performing triage using the START method. Which
client should be tagged as "Immediate" (Red)?
A. A client with a fractured arm who is ambulatory
B. A client who is not breathing and has no pulse
C. A client with respiratory rate of 30/min and capillary refill of 3 seconds [CORRECT]
D. A client with minor lacerations who can follow commands
Correct Answer: C
Rationale: The START triage method uses RPM (Respirations, Perfusion, Mental status). A client
with respiratory rate >30/min (abnormal) and capillary refill >2 seconds (abnormal) meets criteria
for Immediate (Red) category. Ambulatory clients are Minor (Green), no breathing/no pulse is
Deceased/Expectant (Black), and minor injuries with normal mental status are Delayed (Yellow).
HESI Note: START Triage: 30-2-Can Do. Respirations >30, Capillary refill >2 seconds, Can't follow
commands = Immediate (Red).
Q7: A charge nurse is determining staffing needs for the night shift. Which factor is most important
when determining nurse-to-client ratios?
A. The years of experience of the nursing staff
