HESI RN Fundamentals 2026-2027: Advanced
Clinical Reasoning & Prioritization—A 100-
Question Simulated Exam
---
## QUESTION 1–10: Safe & Effective Care Environment (Management of Care)
**1. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is appropriate
for the nurse to delegate?**
A) Administer a saline lock flush.
B) Insert a Foley catheter.
C) Measure a client's intake and output.
D) Assess a client's wound for infection.
**Answer: C) Measure a client's intake and output.**
**Rationale:** UAPs can perform tasks that are routine, have a predictable outcome, and do not
require clinical judgment—such as measuring I&O, obtaining vital signs (in stable clients), and
assisting with ADLs. Administering IV flushes (A), inserting catheters (B), and performing assessments
(D) are all within the licensed nurse's scope and require nursing judgment.
---
**2. A client falls in the hallway despite bed alarms being in place. What is the nurse's priority
action?**
A) Fill out an incident report.
B) Call the healthcare provider.
C) Assess the client for injuries.
D) Notify the family.
,**Answer: C) Assess the client for injuries.**
**Rationale:** The nursing process always begins with assessment. After a fall, the nurse must first
assess the client's airway, breathing, circulation, and any potential injuries (e.g., fractures, head
trauma). Only after assessment and stabilization should the provider be notified (B) and an incident
report completed (A). Family notification (D) is important but not the priority.
---
**3. A nurse is preparing to transfer a client from a bed to a chair using a mechanical lift. Which
action is essential?**
A) Leave the client briefly to get the lift.
B) Use a sling that is one size smaller for a snug fit.
C) Ensure the lift's battery is charged before use.
D) Have two staff members operate the lift.
**Answer: C) Ensure the lift's battery is charged before use.**
**Rationale:** A mechanical lift must have a charged battery to prevent malfunction during the
transfer, which could cause the client to fall. Never leave the client unattended (A). The sling must be
the correct size, not smaller (B), to avoid skin breakdown and ensure safety. While two staff are often
recommended, one trained staff member can operate the lift if it is a single-person model—but
checking the battery is non-negotiable.
---
**4. A nurse receives a telephone prescription from a provider for morphine 4 mg IV push. Which
action should the nurse take first?**
A) Administer the medication.
B) Repeat the prescription back to the provider.
C) Ask the provider to fax the prescription.
D) Document the prescription in the client's chart.
**Answer: B) Repeat the prescription back to the provider.**
,**Rationale:** For telephone/verbal orders, the nurse must use the "read-back" or "repeat-back"
technique to verify accuracy and prevent errors. The order is then documented, and the provider
must sign it within 24 hours (usually). Administering (A) or documenting (D) comes after verification.
---
**5. A nurse is caring for a client who requires restraints. Which action is appropriate?**
A) Apply restraints for 4 hours before reassessing.
B) Tie restraints to the side rails of the bed.
C) Remove restraints every 2 hours for range-of-motion exercises.
D) Obtain a prescription from the provider within 48 hours.
**Answer: C) Remove restraints every 2 hours for range-of-motion exercises.**
**Rationale:** Restraints must be removed every 2 hours (or per facility policy) to allow for ROM
exercises, skin assessment, toileting, and hydration. Restraints must be reassessed frequently, not
left for 4 hours (A). They must be tied to a non-movable part of the bed frame, not side rails (B), to
prevent injury if the rail is lowered. A prescription must be obtained within 24 hours (or immediately
in an emergency), not 48 hours (D).
---
**6. A nurse is preparing a client for surgery. Which of the following should the nurse verify before
the client receives preoperative medication?**
A) That the client has voided.
B) That the client's family has arrived.
C) That the surgical consent is signed and witnessed.
D) That the client has eaten a light breakfast.
**Answer: C) That the surgical consent is signed and witnessed.**
**Rationale:** Before preoperative sedation is given, the client must have a valid, signed, and
witnessed informed consent. Sedation can alter mentation and invalidate the consent. Voiding (A) is
good practice but not the priority. The client should be NPO, not eating (D).
---
, **7. A nurse is discharging a client who speaks a different language. An interpreter is not available.
What should the nurse do?**
A) Use the client's adult child to translate.
B) Write instructions in English for the client to translate later.
C) Use a translation phone service approved by the facility.
D) Provide instructions using hand gestures.
**Answer: C) Use a translation phone service approved by the facility.**
**Rationale:** Facilities typically provide interpreter services (phone or video). Using family
members (A) violates confidentiality and may lead to inaccurate translation. Written materials should
be in the client's preferred language. Hand gestures (D) are insufficient for complex medical
information.
---
**8. A nurse discovers a small fire in a client's trash can. What is the correct sequence of actions
using the RACE acronym?**
A) Rescue, Alarm, Contain, Extinguish.
B) Alarm, Rescue, Contain, Extinguish.
C) Rescue, Contain, Alarm, Extinguish.
D) Contain, Rescue, Alarm, Extinguish.
**Answer: A) Rescue, Alarm, Contain, Extinguish.**
**Rationale:** RACE stands for: **R**escue anyone in immediate danger, **A**larm (activate the
fire alarm), **C**ontain the fire (close doors/windows), and **E**xtinguish (use a fire extinguisher)
or evacuate. This is the standard fire response protocol.
---
**9. A nurse is assigning care for four clients. Which client should the nurse assign to an LPN/LVN?**
A) A client with a newly placed tracheostomy requiring frequent suctioning.
B) A client with stable diabetes who needs a fingerstick glucose check and insulin administration.
Clinical Reasoning & Prioritization—A 100-
Question Simulated Exam
---
## QUESTION 1–10: Safe & Effective Care Environment (Management of Care)
**1. A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is appropriate
for the nurse to delegate?**
A) Administer a saline lock flush.
B) Insert a Foley catheter.
C) Measure a client's intake and output.
D) Assess a client's wound for infection.
**Answer: C) Measure a client's intake and output.**
**Rationale:** UAPs can perform tasks that are routine, have a predictable outcome, and do not
require clinical judgment—such as measuring I&O, obtaining vital signs (in stable clients), and
assisting with ADLs. Administering IV flushes (A), inserting catheters (B), and performing assessments
(D) are all within the licensed nurse's scope and require nursing judgment.
---
**2. A client falls in the hallway despite bed alarms being in place. What is the nurse's priority
action?**
A) Fill out an incident report.
B) Call the healthcare provider.
C) Assess the client for injuries.
D) Notify the family.
,**Answer: C) Assess the client for injuries.**
**Rationale:** The nursing process always begins with assessment. After a fall, the nurse must first
assess the client's airway, breathing, circulation, and any potential injuries (e.g., fractures, head
trauma). Only after assessment and stabilization should the provider be notified (B) and an incident
report completed (A). Family notification (D) is important but not the priority.
---
**3. A nurse is preparing to transfer a client from a bed to a chair using a mechanical lift. Which
action is essential?**
A) Leave the client briefly to get the lift.
B) Use a sling that is one size smaller for a snug fit.
C) Ensure the lift's battery is charged before use.
D) Have two staff members operate the lift.
**Answer: C) Ensure the lift's battery is charged before use.**
**Rationale:** A mechanical lift must have a charged battery to prevent malfunction during the
transfer, which could cause the client to fall. Never leave the client unattended (A). The sling must be
the correct size, not smaller (B), to avoid skin breakdown and ensure safety. While two staff are often
recommended, one trained staff member can operate the lift if it is a single-person model—but
checking the battery is non-negotiable.
---
**4. A nurse receives a telephone prescription from a provider for morphine 4 mg IV push. Which
action should the nurse take first?**
A) Administer the medication.
B) Repeat the prescription back to the provider.
C) Ask the provider to fax the prescription.
D) Document the prescription in the client's chart.
**Answer: B) Repeat the prescription back to the provider.**
,**Rationale:** For telephone/verbal orders, the nurse must use the "read-back" or "repeat-back"
technique to verify accuracy and prevent errors. The order is then documented, and the provider
must sign it within 24 hours (usually). Administering (A) or documenting (D) comes after verification.
---
**5. A nurse is caring for a client who requires restraints. Which action is appropriate?**
A) Apply restraints for 4 hours before reassessing.
B) Tie restraints to the side rails of the bed.
C) Remove restraints every 2 hours for range-of-motion exercises.
D) Obtain a prescription from the provider within 48 hours.
**Answer: C) Remove restraints every 2 hours for range-of-motion exercises.**
**Rationale:** Restraints must be removed every 2 hours (or per facility policy) to allow for ROM
exercises, skin assessment, toileting, and hydration. Restraints must be reassessed frequently, not
left for 4 hours (A). They must be tied to a non-movable part of the bed frame, not side rails (B), to
prevent injury if the rail is lowered. A prescription must be obtained within 24 hours (or immediately
in an emergency), not 48 hours (D).
---
**6. A nurse is preparing a client for surgery. Which of the following should the nurse verify before
the client receives preoperative medication?**
A) That the client has voided.
B) That the client's family has arrived.
C) That the surgical consent is signed and witnessed.
D) That the client has eaten a light breakfast.
**Answer: C) That the surgical consent is signed and witnessed.**
**Rationale:** Before preoperative sedation is given, the client must have a valid, signed, and
witnessed informed consent. Sedation can alter mentation and invalidate the consent. Voiding (A) is
good practice but not the priority. The client should be NPO, not eating (D).
---
, **7. A nurse is discharging a client who speaks a different language. An interpreter is not available.
What should the nurse do?**
A) Use the client's adult child to translate.
B) Write instructions in English for the client to translate later.
C) Use a translation phone service approved by the facility.
D) Provide instructions using hand gestures.
**Answer: C) Use a translation phone service approved by the facility.**
**Rationale:** Facilities typically provide interpreter services (phone or video). Using family
members (A) violates confidentiality and may lead to inaccurate translation. Written materials should
be in the client's preferred language. Hand gestures (D) are insufficient for complex medical
information.
---
**8. A nurse discovers a small fire in a client's trash can. What is the correct sequence of actions
using the RACE acronym?**
A) Rescue, Alarm, Contain, Extinguish.
B) Alarm, Rescue, Contain, Extinguish.
C) Rescue, Contain, Alarm, Extinguish.
D) Contain, Rescue, Alarm, Extinguish.
**Answer: A) Rescue, Alarm, Contain, Extinguish.**
**Rationale:** RACE stands for: **R**escue anyone in immediate danger, **A**larm (activate the
fire alarm), **C**ontain the fire (close doors/windows), and **E**xtinguish (use a fire extinguisher)
or evacuate. This is the standard fire response protocol.
---
**9. A nurse is assigning care for four clients. Which client should the nurse assign to an LPN/LVN?**
A) A client with a newly placed tracheostomy requiring frequent suctioning.
B) A client with stable diabetes who needs a fingerstick glucose check and insulin administration.
