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2026 HESI RN EXIT EXAM | NGN PRACTICE QUESTIONS & ANSWERS
COMPREHENSIVE STUDY GUIDE WITH VERIFIED ANSWERS AND
DETAILED RATIONALES | NEXT GENERATION NCLEX (NGN) ALIGNED |
160 QUESTIONS | A+ GRADED
Core Domains Covered:
1. Safe & Effective Care Environment – Delegation, Prioritization, Infection Control,
Legal/Ethical Issues
2. Health Promotion & Maintenance – Developmental Stages, Disease Prevention,
Patient Education
3. Psychosocial Integrity – Coping Mechanisms, Therapeutic Communication,
Mental Health Disorders
4. Physiological Integrity – Medical-Surgical Nursing, Pharmacology, Fluid &
Electrolytes, Pain Management
5. NGN Case Studies – Bow-Tie, Matrix, Drag-and-Drop, Hot Spot, Cloze, Enhanced
Hot Spot
6. Critical Care & Emergency – ARDS, Sepsis, Shock, ICP Monitoring, Trauma
7. Pharmacology – Medication Administration, Side Effects, Interactions, Dosage
Calculations
8. Maternal-Newborn & Pediatrics – OB Complications, Newborn Assessment,
Pediatric Development
Introduction:
This comprehensive 2026 HESI RN Exit Exam preparation resource is meticulously
designed for nursing students preparing for the HESI Exit Examination and NCLEX-
RN. The assessment consists of 160 Next Generation NCLEX (NGN) style questions,
including multiple-choice, select-all-that-apply (SATA), ordered response, dosage
calculations, and NGN case scenarios (bow-tie, matrix, drag-and-drop). Each
question includes a verified correct answer and a detailed rationale to reinforce
concept understanding and improve clinical judgment. Questions are aligned with
the NCSBN Clinical Judgment Measurement Model (CJMM) and designed to mirror
the actual HESI Exit Exam difficulty, format, and content distribution.
pg. 1
,2
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT
Delegation, Prioritization, and Assignment
Question 1
A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate for the nurse to delegate?
A. Assessing a client's pain level
B. Administering oral medications
C. Ambulating a stable client
D. Evaluating the effectiveness of pain medication
C. Ambulating a stable client
RATIONALE: Delegation follows the "Five Rights": right task, right
circumstance, right person, right direction/communication, and right supervision.
UAP can ambulate stable clients, assist with activities of daily living, and obtain
vital signs on stable clients. Assessment, medication administration, and
evaluation are the responsibility of the licensed nurse.
Question 2
A charge nurse is making assignments for the shift. Which client should be
assigned to an LPN?
A. Client with chest tube and continuous bubbling in water seal chamber
B. Client 1 hour post-thyroidectomy with neck swelling
C. Client with stable diabetes requiring morning insulin and foot care teaching
D. Client with new stroke and dysphagia requiring swallow evaluation
C. Client with stable diabetes requiring morning insulin and foot care teaching
RATIONALE: LPNs can administer insulin and perform routine foot care for
stable diabetic clients. The other clients require RN assessment or complex
intervention. LPN scope includes stable, predictable clients; RNs manage unstable,
new post-op, or complex assessments.
pg. 2
,3
Question 3
A nurse receives a telephone order from a provider for a client's pain medication.
What is the nurse's priority action?
A. Implement the order immediately
B. Write the order in the chart and sign "TO"
C. Read the order back to the provider for verification
D. Ask another nurse to listen to the order
C. Read the order back to the provider for verification
RATIONALE: The "read back" process is a critical safety measure that ensures
accurate communication of verbal and telephone orders. After verification, the
order should be documented and implemented.
Question 4
A nurse is caring for four clients. Which client should be assessed first?
A. Client with COPD and SpO₂ 89% on 2L nasal cannula
B. Client post-op day 1 reporting pain 6/10
C. Client with new-onset confusion and temperature 102°F (38.9°C)
D. Client requesting discharge teaching
C. Client with new-onset confusion and temperature 102°F (38.9°C)
RATIONALE: New-onset confusion with fever suggests possible sepsis or CNS
infection. ABCs (airway, breathing, circulation) are primary; however, a change in
mental status with fever indicates potential rapid deterioration. Assess first to
rule out sepsis or meningitis.
Infection Control and Safety
Question 5
The nurse is wearing personal protective equipment (PPE) while caring for a
patient. When exiting the room, which PPE should be removed first?
pg. 3
, 4
A. Gown
B. Mask
C. Gloves
D. Eye protection
C. Gloves
RATIONALE: Gloves are considered the most contaminated PPE and should be
removed first to prevent contamination of other PPE and the environment. The
order of removal is: gloves → goggles/face shield → gown → mask/respirator.
Question 6
A nurse is caring for a client who is post-operative day 2 and has a platelet count
of 20,000/mm³. Which intervention should the nurse implement?
A. Use an electric razor for shaving
B. Administer IM pain medication
C. Apply warm compresses to IV sites
D. Encourage the client to floss teeth daily
A. Use an electric razor for shaving
RATIONALE: With severe thrombocytopenia (platelets <50,000), bleeding
precautions should be implemented: electric razor (not straight razor), soft
toothbrush (no flossing), no IM injections, and avoid rectal temperatures.
Question 7
The nurse is caring for a client with a cuffed tracheostomy tube. Before
performing oral care, the nurse notes that the tracheostomy cuff is inflated. What
is the priority nursing action?
A. Deflate the cuff before oral care
B. Suction the tracheostomy before oral care
C. Verify the cuff pressure is within the recommended range
D. Position the client in a supine position
pg. 4
2026 HESI RN EXIT EXAM | NGN PRACTICE QUESTIONS & ANSWERS
COMPREHENSIVE STUDY GUIDE WITH VERIFIED ANSWERS AND
DETAILED RATIONALES | NEXT GENERATION NCLEX (NGN) ALIGNED |
160 QUESTIONS | A+ GRADED
Core Domains Covered:
1. Safe & Effective Care Environment – Delegation, Prioritization, Infection Control,
Legal/Ethical Issues
2. Health Promotion & Maintenance – Developmental Stages, Disease Prevention,
Patient Education
3. Psychosocial Integrity – Coping Mechanisms, Therapeutic Communication,
Mental Health Disorders
4. Physiological Integrity – Medical-Surgical Nursing, Pharmacology, Fluid &
Electrolytes, Pain Management
5. NGN Case Studies – Bow-Tie, Matrix, Drag-and-Drop, Hot Spot, Cloze, Enhanced
Hot Spot
6. Critical Care & Emergency – ARDS, Sepsis, Shock, ICP Monitoring, Trauma
7. Pharmacology – Medication Administration, Side Effects, Interactions, Dosage
Calculations
8. Maternal-Newborn & Pediatrics – OB Complications, Newborn Assessment,
Pediatric Development
Introduction:
This comprehensive 2026 HESI RN Exit Exam preparation resource is meticulously
designed for nursing students preparing for the HESI Exit Examination and NCLEX-
RN. The assessment consists of 160 Next Generation NCLEX (NGN) style questions,
including multiple-choice, select-all-that-apply (SATA), ordered response, dosage
calculations, and NGN case scenarios (bow-tie, matrix, drag-and-drop). Each
question includes a verified correct answer and a detailed rationale to reinforce
concept understanding and improve clinical judgment. Questions are aligned with
the NCSBN Clinical Judgment Measurement Model (CJMM) and designed to mirror
the actual HESI Exit Exam difficulty, format, and content distribution.
pg. 1
,2
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT
Delegation, Prioritization, and Assignment
Question 1
A nurse is preparing to delegate tasks to an unlicensed assistive personnel (UAP).
Which task is appropriate for the nurse to delegate?
A. Assessing a client's pain level
B. Administering oral medications
C. Ambulating a stable client
D. Evaluating the effectiveness of pain medication
C. Ambulating a stable client
RATIONALE: Delegation follows the "Five Rights": right task, right
circumstance, right person, right direction/communication, and right supervision.
UAP can ambulate stable clients, assist with activities of daily living, and obtain
vital signs on stable clients. Assessment, medication administration, and
evaluation are the responsibility of the licensed nurse.
Question 2
A charge nurse is making assignments for the shift. Which client should be
assigned to an LPN?
A. Client with chest tube and continuous bubbling in water seal chamber
B. Client 1 hour post-thyroidectomy with neck swelling
C. Client with stable diabetes requiring morning insulin and foot care teaching
D. Client with new stroke and dysphagia requiring swallow evaluation
C. Client with stable diabetes requiring morning insulin and foot care teaching
RATIONALE: LPNs can administer insulin and perform routine foot care for
stable diabetic clients. The other clients require RN assessment or complex
intervention. LPN scope includes stable, predictable clients; RNs manage unstable,
new post-op, or complex assessments.
pg. 2
,3
Question 3
A nurse receives a telephone order from a provider for a client's pain medication.
What is the nurse's priority action?
A. Implement the order immediately
B. Write the order in the chart and sign "TO"
C. Read the order back to the provider for verification
D. Ask another nurse to listen to the order
C. Read the order back to the provider for verification
RATIONALE: The "read back" process is a critical safety measure that ensures
accurate communication of verbal and telephone orders. After verification, the
order should be documented and implemented.
Question 4
A nurse is caring for four clients. Which client should be assessed first?
A. Client with COPD and SpO₂ 89% on 2L nasal cannula
B. Client post-op day 1 reporting pain 6/10
C. Client with new-onset confusion and temperature 102°F (38.9°C)
D. Client requesting discharge teaching
C. Client with new-onset confusion and temperature 102°F (38.9°C)
RATIONALE: New-onset confusion with fever suggests possible sepsis or CNS
infection. ABCs (airway, breathing, circulation) are primary; however, a change in
mental status with fever indicates potential rapid deterioration. Assess first to
rule out sepsis or meningitis.
Infection Control and Safety
Question 5
The nurse is wearing personal protective equipment (PPE) while caring for a
patient. When exiting the room, which PPE should be removed first?
pg. 3
, 4
A. Gown
B. Mask
C. Gloves
D. Eye protection
C. Gloves
RATIONALE: Gloves are considered the most contaminated PPE and should be
removed first to prevent contamination of other PPE and the environment. The
order of removal is: gloves → goggles/face shield → gown → mask/respirator.
Question 6
A nurse is caring for a client who is post-operative day 2 and has a platelet count
of 20,000/mm³. Which intervention should the nurse implement?
A. Use an electric razor for shaving
B. Administer IM pain medication
C. Apply warm compresses to IV sites
D. Encourage the client to floss teeth daily
A. Use an electric razor for shaving
RATIONALE: With severe thrombocytopenia (platelets <50,000), bleeding
precautions should be implemented: electric razor (not straight razor), soft
toothbrush (no flossing), no IM injections, and avoid rectal temperatures.
Question 7
The nurse is caring for a client with a cuffed tracheostomy tube. Before
performing oral care, the nurse notes that the tracheostomy cuff is inflated. What
is the priority nursing action?
A. Deflate the cuff before oral care
B. Suction the tracheostomy before oral care
C. Verify the cuff pressure is within the recommended range
D. Position the client in a supine position
pg. 4
