HESI Exit Exam V4 with NGN – 300 Questions
Next Generation NCLEX – 100% Guaranteed Pass
300 real exam-style questions · Full rationales · Why wrong explanations · 2026 updated
Abstract: This comprehensive HESI Exit Exam V4 with NGN (Next Generation NCLEX) questions review contains
300 practice questions that mirror the actual Evolve HESI Exit Exam in content, difficulty, and structure. Each
question is paired with a verified correct answer, a detailed rationale, and a "Why Wrong" breakdown for every
incorrect option. Updated for the 2026 academic year, this guide covers all core content areas tested on the
HESI Exit Exam, including management of care, safety and infection control, health promotion and maintenance,
psychosocial integrity, pharmacological and parenteral therapies, reduction of risk potential, physiological
adaptation, medical-surgical nursing, maternal-newborn, pediatrics, mental health, and Next Generation NCLEX
(NGN) clinical judgment concepts with unfolding case studies and bow-tie questions.
HESIExpertRN, DNP – 15 years Nursing Educator & Test Prep Specialist
HESI Exit Exam V4: 100% | Verified: 2026 Academic Year
Section Qs Weight
Management of Care & Delegation 35 12%
Safety & Infection Control 30 10%
Health Promotion & Maintenance 25 8%
Psychosocial Integrity 30 10%
Pharmacological & Parenteral Therapies 40 13%
Reduction of Risk Potential 35 12%
Physiological Adaptation 45 15%
Medical-Surgical Nursing 60 20%
Content Overview
Management of Care & Delegation (35 Qs - 12%): Assignment and delegation, client advocacy, ethical and legal
principles, continuity of care, informed consent, advance directives, client rights, interdisciplinary collaboration,
prioritization (ABCs, Maslow).
Safety & Infection Control (30 Qs - 10%): Standard, contact, droplet, airborne precautions; infection prevention; isolation
techniques; medical/surgical asepsis; falls prevention; restraints; fire safety (RACE, PASS); incident reporting.
Health Promotion & Maintenance (25 Qs - 8%): Growth and development across lifespan, immunizations, screening,
health education, nutrition, prenatal care, well-baby care, lifestyle modifications, disease prevention.
Psychosocial Integrity (30 Qs - 10%): Therapeutic communication, grief and loss, stress and coping, anxiety disorders,
depression, suicidal ideation, dementia, schizophrenia, substance abuse, family dynamics, cultural competence.
Pharmacological & Parenteral Therapies (40 Qs - 13%): Medication administration, dosage calculation, adverse effects,
side effects, contraindications, drug interactions, high-alert medications, pain management, IV therapy, blood transfusion.
Reduction of Risk Potential (35 Qs - 12%): Electrolyte imbalances, acid-base imbalances, ABG interpretation, risk
identification, diagnostic tests, early warning signs, post-op complications, fall risk, DVT prevention.
Physiological Adaptation (45 Qs - 15%): Cardiovascular, respiratory, neurological, renal, gastrointestinal, endocrine,
hematological, integumentary pathophysiology; shock; sepsis; wound healing; pressure injuries.
, Medical-Surgical Nursing (60 Qs - 20%): Med-surg conditions (CHF, COPD, DM, MI, CVA, pneumonia, DVT, PE, cirrhosis,
pancreatitis, cancer), pre-op/post-op care; NGN case studies; clinical judgment; prioritization.
Management of Care & Delegation (35 questions)
Q1. A charge nurse is assigning clients on a medical-surgical unit. Which client should be assigned to
the RN rather than the LPN?
A A client post-op day 2 requiring a simple dressing change
B A client requiring a straight catheterization for a post-void residual
C A client with new-onset confusion and a blood pressure of 90/60
D A client receiving a continuous tube feeding
E A client with a colostomy requiring pouch change
Correct answer: C. A client with new-onset confusion and a blood pressure of 90/60
Rationale: New-onset confusion and hypotension indicate a potential change in condition (e.g., sepsis, stroke). The
RN must assess unstable clients. LPNs can perform stable, predictable tasks like dressing changes, catheterizations,
and tube feedings.
Why wrong:
A: Simple dressing changes on a stable post-op client can be delegated to an LPN.
B: Straight catheterization is a stable, predictable task for LPNs.
D: Continuous tube feeding on a stable client can be managed by an LPN.
E: Colostomy pouch changes are within LPN scope for stable clients.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q2. A charge nurse is assigning rooms for four clients. Which client should be placed in a private
room?
A Client with pneumonia
B Client with MRSA
C Client with a diabetic foot ulcer
D Client with COPD
E Client with urinary tract infection
Correct answer: B. Client with MRSA
Rationale: MRSA requires contact isolation. A private room is essential to prevent transmission to other clients.
While pneumonia may require droplet precautions, MRSA is the priority for a single room assignment.
Why wrong:
A: Pneumonia requires droplet precautions, but a private room is not always required.
C: Diabetic foot ulcers require standard precautions.
D: COPD does not require isolation precautions.
E: UTI requires standard precautions.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
,Q3. A nurse is delegating tasks to an assistive personnel (AP). Which task is appropriate to delegate?
A Assess a postoperative incision
B Teach a client how to use a walker
C Obtain a capillary blood glucose level
D Evaluate a client's pain level
E Change a sterile wound dressing
Correct answer: C. Obtain a capillary blood glucose level
Rationale: APs can perform capillary blood glucose testing. Assessment, teaching, and evaluation all require
nursing judgment. Sterile dressing changes require sterile technique and assessment, which are RN/LPN
responsibilities.
Why wrong:
A: Assessment requires RN-level clinical judgment.
B: Teaching requires RN-level education.
D: Evaluation of pain requires RN-level clinical judgment.
E: Sterile dressing changes require sterile technique and assessment.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q4. A nurse is caring for a client who just signed a DNR order. The family member says, "I don't care
what the paper says; you will do CPR if I see him stop breathing." What is the nurse's priority
response?
A "I will have to follow the DNR order, as the client has the right to make that decision."
B "I understand you are upset, but you need to leave the room."
C "Let's call for an ethics committee meeting right now."
D "Okay, I will do CPR if you insist."
E "This must be very difficult for you. Let me call the provider to talk with you."
Correct answer: A. "I will have to follow the DNR order, as the client has the right to make that decision."
Rationale: The client's autonomous decision (DNR) supersedes the family's wishes. The nurse must advocate for
the client's choice and explain the legal and ethical obligation to follow the DNR order.
Why wrong:
B: Asking the family to leave is dismissive.
C: An ethics committee is not necessary for a clear DNR order.
D: Following the family's wishes violates the client's autonomy.
E: While empathetic, the nurse must also uphold the DNR order.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
, Q5. A nurse is caring for four clients. Which client should be seen first?
A Client with COPD and SpO₂ 89% on 2L nasal cannula
B Client post-appendectomy day 2 with temperature 38.3°C (101°F)
C Client with heart failure and 3+ pitting edema
D Client with new onset confusion and bounding pulse
E Client with diabetes and blood glucose 180 mg/dL
Correct answer: D. Client with new onset confusion and bounding pulse
Rationale: New onset confusion with bounding pulse suggests hypercapnia or fluid overload affecting cerebral
perfusion. This is a change in neurological status, which is always the priority. Option A is expected in COPD
patients (target SpO₂ 88-92%).
Why wrong:
A: SpO₂ 89% is expected in COPD patients (target 88-92%).
B: Low-grade fever is expected post-operatively.
C: 3+ pitting edema is a chronic finding in heart failure.
E: Blood glucose 180 mg/dL is elevated but not immediately life-threatening.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q6. A charge nurse is evaluating a newly licensed nurse's understanding of client advocacy. Which
action demonstrates advocacy?
A Telling the family the client's diagnosis before the client has been told
B Referring a client with a language barrier to a medical interpreter
C Changing the client's wound care order without consulting the provider
D Encouraging a client to stop cancer treatment because it is painful
E Providing a client with all options and letting them choose independently
Correct answer: B. Referring a client with a language barrier to a medical interpreter
Rationale: Advocacy involves ensuring the client's rights are respected, including the right to understand and
communicate. Referring to a medical interpreter enables the client to participate in their own care decisions.
Why wrong:
A: The client should be told first.
C: Changing orders without consulting the provider is beyond scope.
D: Encouraging treatment cessation undermines informed decision-making.
E: Providing options is advocacy, but interpreter referral is a clearer example.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Next Generation NCLEX – 100% Guaranteed Pass
300 real exam-style questions · Full rationales · Why wrong explanations · 2026 updated
Abstract: This comprehensive HESI Exit Exam V4 with NGN (Next Generation NCLEX) questions review contains
300 practice questions that mirror the actual Evolve HESI Exit Exam in content, difficulty, and structure. Each
question is paired with a verified correct answer, a detailed rationale, and a "Why Wrong" breakdown for every
incorrect option. Updated for the 2026 academic year, this guide covers all core content areas tested on the
HESI Exit Exam, including management of care, safety and infection control, health promotion and maintenance,
psychosocial integrity, pharmacological and parenteral therapies, reduction of risk potential, physiological
adaptation, medical-surgical nursing, maternal-newborn, pediatrics, mental health, and Next Generation NCLEX
(NGN) clinical judgment concepts with unfolding case studies and bow-tie questions.
HESIExpertRN, DNP – 15 years Nursing Educator & Test Prep Specialist
HESI Exit Exam V4: 100% | Verified: 2026 Academic Year
Section Qs Weight
Management of Care & Delegation 35 12%
Safety & Infection Control 30 10%
Health Promotion & Maintenance 25 8%
Psychosocial Integrity 30 10%
Pharmacological & Parenteral Therapies 40 13%
Reduction of Risk Potential 35 12%
Physiological Adaptation 45 15%
Medical-Surgical Nursing 60 20%
Content Overview
Management of Care & Delegation (35 Qs - 12%): Assignment and delegation, client advocacy, ethical and legal
principles, continuity of care, informed consent, advance directives, client rights, interdisciplinary collaboration,
prioritization (ABCs, Maslow).
Safety & Infection Control (30 Qs - 10%): Standard, contact, droplet, airborne precautions; infection prevention; isolation
techniques; medical/surgical asepsis; falls prevention; restraints; fire safety (RACE, PASS); incident reporting.
Health Promotion & Maintenance (25 Qs - 8%): Growth and development across lifespan, immunizations, screening,
health education, nutrition, prenatal care, well-baby care, lifestyle modifications, disease prevention.
Psychosocial Integrity (30 Qs - 10%): Therapeutic communication, grief and loss, stress and coping, anxiety disorders,
depression, suicidal ideation, dementia, schizophrenia, substance abuse, family dynamics, cultural competence.
Pharmacological & Parenteral Therapies (40 Qs - 13%): Medication administration, dosage calculation, adverse effects,
side effects, contraindications, drug interactions, high-alert medications, pain management, IV therapy, blood transfusion.
Reduction of Risk Potential (35 Qs - 12%): Electrolyte imbalances, acid-base imbalances, ABG interpretation, risk
identification, diagnostic tests, early warning signs, post-op complications, fall risk, DVT prevention.
Physiological Adaptation (45 Qs - 15%): Cardiovascular, respiratory, neurological, renal, gastrointestinal, endocrine,
hematological, integumentary pathophysiology; shock; sepsis; wound healing; pressure injuries.
, Medical-Surgical Nursing (60 Qs - 20%): Med-surg conditions (CHF, COPD, DM, MI, CVA, pneumonia, DVT, PE, cirrhosis,
pancreatitis, cancer), pre-op/post-op care; NGN case studies; clinical judgment; prioritization.
Management of Care & Delegation (35 questions)
Q1. A charge nurse is assigning clients on a medical-surgical unit. Which client should be assigned to
the RN rather than the LPN?
A A client post-op day 2 requiring a simple dressing change
B A client requiring a straight catheterization for a post-void residual
C A client with new-onset confusion and a blood pressure of 90/60
D A client receiving a continuous tube feeding
E A client with a colostomy requiring pouch change
Correct answer: C. A client with new-onset confusion and a blood pressure of 90/60
Rationale: New-onset confusion and hypotension indicate a potential change in condition (e.g., sepsis, stroke). The
RN must assess unstable clients. LPNs can perform stable, predictable tasks like dressing changes, catheterizations,
and tube feedings.
Why wrong:
A: Simple dressing changes on a stable post-op client can be delegated to an LPN.
B: Straight catheterization is a stable, predictable task for LPNs.
D: Continuous tube feeding on a stable client can be managed by an LPN.
E: Colostomy pouch changes are within LPN scope for stable clients.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q2. A charge nurse is assigning rooms for four clients. Which client should be placed in a private
room?
A Client with pneumonia
B Client with MRSA
C Client with a diabetic foot ulcer
D Client with COPD
E Client with urinary tract infection
Correct answer: B. Client with MRSA
Rationale: MRSA requires contact isolation. A private room is essential to prevent transmission to other clients.
While pneumonia may require droplet precautions, MRSA is the priority for a single room assignment.
Why wrong:
A: Pneumonia requires droplet precautions, but a private room is not always required.
C: Diabetic foot ulcers require standard precautions.
D: COPD does not require isolation precautions.
E: UTI requires standard precautions.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
,Q3. A nurse is delegating tasks to an assistive personnel (AP). Which task is appropriate to delegate?
A Assess a postoperative incision
B Teach a client how to use a walker
C Obtain a capillary blood glucose level
D Evaluate a client's pain level
E Change a sterile wound dressing
Correct answer: C. Obtain a capillary blood glucose level
Rationale: APs can perform capillary blood glucose testing. Assessment, teaching, and evaluation all require
nursing judgment. Sterile dressing changes require sterile technique and assessment, which are RN/LPN
responsibilities.
Why wrong:
A: Assessment requires RN-level clinical judgment.
B: Teaching requires RN-level education.
D: Evaluation of pain requires RN-level clinical judgment.
E: Sterile dressing changes require sterile technique and assessment.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q4. A nurse is caring for a client who just signed a DNR order. The family member says, "I don't care
what the paper says; you will do CPR if I see him stop breathing." What is the nurse's priority
response?
A "I will have to follow the DNR order, as the client has the right to make that decision."
B "I understand you are upset, but you need to leave the room."
C "Let's call for an ethics committee meeting right now."
D "Okay, I will do CPR if you insist."
E "This must be very difficult for you. Let me call the provider to talk with you."
Correct answer: A. "I will have to follow the DNR order, as the client has the right to make that decision."
Rationale: The client's autonomous decision (DNR) supersedes the family's wishes. The nurse must advocate for
the client's choice and explain the legal and ethical obligation to follow the DNR order.
Why wrong:
B: Asking the family to leave is dismissive.
C: An ethics committee is not necessary for a clear DNR order.
D: Following the family's wishes violates the client's autonomy.
E: While empathetic, the nurse must also uphold the DNR order.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
, Q5. A nurse is caring for four clients. Which client should be seen first?
A Client with COPD and SpO₂ 89% on 2L nasal cannula
B Client post-appendectomy day 2 with temperature 38.3°C (101°F)
C Client with heart failure and 3+ pitting edema
D Client with new onset confusion and bounding pulse
E Client with diabetes and blood glucose 180 mg/dL
Correct answer: D. Client with new onset confusion and bounding pulse
Rationale: New onset confusion with bounding pulse suggests hypercapnia or fluid overload affecting cerebral
perfusion. This is a change in neurological status, which is always the priority. Option A is expected in COPD
patients (target SpO₂ 88-92%).
Why wrong:
A: SpO₂ 89% is expected in COPD patients (target 88-92%).
B: Low-grade fever is expected post-operatively.
C: 3+ pitting edema is a chronic finding in heart failure.
E: Blood glucose 180 mg/dL is elevated but not immediately life-threatening.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
Q6. A charge nurse is evaluating a newly licensed nurse's understanding of client advocacy. Which
action demonstrates advocacy?
A Telling the family the client's diagnosis before the client has been told
B Referring a client with a language barrier to a medical interpreter
C Changing the client's wound care order without consulting the provider
D Encouraging a client to stop cancer treatment because it is painful
E Providing a client with all options and letting them choose independently
Correct answer: B. Referring a client with a language barrier to a medical interpreter
Rationale: Advocacy involves ensuring the client's rights are respected, including the right to understand and
communicate. Referring to a medical interpreter enables the client to participate in their own care decisions.
Why wrong:
A: The client should be told first.
C: Changing orders without consulting the provider is beyond scope.
D: Encouraging treatment cessation undermines informed decision-making.
E: Providing options is advocacy, but interpreter referral is a clearer example.
Reference: HESI Exit Exam V4 · Evolve HESI · Saunders NCLEX Review · NGN Test Plan.
