Evolve HESI Comprehensive Exit Actual
Exam 2026/2027 | Verified Questions
Elsevier Evolve | Verified Q&A | Professional Nursing Students
and NCLEX Candidates
Comprehensive 150-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 150-question actual exam set provides original Professional nursing questions
covering Medical-Surgical Nursing, Maternal-Newborn Nursing, Pediatric Nursing, Mental Health Nursing, and
Leadership, Management, and Professional Nursing Concepts with Next Generation NCLEX clinical judgment
scenarios. The content is designed to reinforce official HESI Exit assessment objectives for actual exam readiness
and clinical proficiency by strengthening prioritization, delegation, safety, pathophysiology, health promotion,
medication awareness, communication, care coordination, and evidence-based nursing decisions. Each item
includes Verified Questions with concise rationales grounded in Elsevier HESI Exit assessment materials,
evidence-based clinical guidelines, and current nursing standards of care.
Domain: Medical-Surgical Nursing
1. A client with chest pain has diaphoresis and recent ST elevation on the monitor. Which nursing
action has the highest priority?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Activate emergency cardiac response and obtain ordered rapid interventions.
Correct Answer: D
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion, requiring rapid
reperfusion-focused care.
2. Which finding requires immediate action for a client receiving IV heparin?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. recent severe headache with unilateral weakness.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Heparin increases bleeding risk, and acute neurologic change can indicate intracranial
hemorrhage.
3. A client with heart failure has sudden pink frothy sputum and severe dyspnea. What should the
nurse do first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Place the client upright and call for rapid assistance.
Correct Answer: D
Rationale: Pulmonary edema impairs gas exchange; upright positioning and urgent team support are
priorities.
4. Which laboratory value is most important to monitor before administering digoxin?
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
, A. Delay action until the next routine round.
B. Potassium level.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Hypokalemia increases sensitivity to digoxin and raises toxicity risk.
5. A client with atrial fibrillation reports palpitations and has a rapid irregular pulse. Which
complication is most important to prevent?
A. Embolic stroke.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Atrial fibrillation can promote atrial clot formation that may embolize to the brain.
6. Which assessment finding suggests left-sided heart failure?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Crackles in the lungs with exertional dyspnea.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Left-sided failure causes pulmonary congestion and impaired oxygen exchange.
7. A client taking furosemide reports muscle weakness. Which electrolyte imbalance is most
likely?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Hypokalemia.
Correct Answer: D
Rationale: Loop diuretics increase potassium loss and can cause weakness and dysrhythmias.
8. Which teaching is appropriate for a client with hypertension starting lifestyle changes?
A. Delay action until the next routine round.
B. Reduce sodium intake, increase activity as tolerated, and take medications consistently.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Blood pressure control combines lifestyle measures with adherence to prescribed therapy.
9. Which symptom is most concerning for a client after cardiac catheterization through the
femoral artery?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Cool pale leg with diminished pedal pulse.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Reduced distal perfusion can indicate arterial obstruction or vascular complication.
10. Which finding suggests hypovolemic shock after trauma?
A. Delay action until the next routine round.
B. Rapid weak pulse with cool clammy skin.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Volume loss causes compensatory tachycardia and peripheral vasoconstriction.
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
, 11. A client with COPD becomes drowsy after high-flow oxygen. What should the nurse assess
first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Respiratory rate and carbon dioxide retention indicators.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Some clients with COPD are vulnerable to hypercapnia, and decreased alertness can signal
ventilatory failure.
12. Which instruction is best for a client using a metered-dose inhaler with a spacer?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Inhale slowly and deeply after actuation, then hold the breath briefly.
Correct Answer: D
Rationale: Slow inhalation with a spacer improves medication delivery to lower airways.
13. Which finding indicates worsening asthma?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Silent chest with increasing respiratory effort.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Diminished airflow despite effort is an ominous sign of severe obstruction.
14. A client with pneumonia has confusion, hypotension, and tachypnea. What complication is the
nurse concerned about?
A. Sepsis.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Infection with organ dysfunction signs such as hypotension and altered mentation suggests
sepsis.
15. Which action helps prevent aspiration in a client with dysphagia?
A. Delay action until the next routine round.
B. Keep the client upright during meals and use prescribed swallowing strategies.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Upright positioning and swallowing techniques reduce aspiration risk.
16. A client with a chest tube has continuous bubbling in the water-seal chamber. What should the
nurse suspect?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Air leak in the system or from the client.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Continuous water-seal bubbling indicates air is entering the system and requires assessment.
17. Which sign indicates tension pneumothorax?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
Exam 2026/2027 | Verified Questions
Elsevier Evolve | Verified Q&A | Professional Nursing Students
and NCLEX Candidates
Comprehensive 150-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 150-question actual exam set provides original Professional nursing questions
covering Medical-Surgical Nursing, Maternal-Newborn Nursing, Pediatric Nursing, Mental Health Nursing, and
Leadership, Management, and Professional Nursing Concepts with Next Generation NCLEX clinical judgment
scenarios. The content is designed to reinforce official HESI Exit assessment objectives for actual exam readiness
and clinical proficiency by strengthening prioritization, delegation, safety, pathophysiology, health promotion,
medication awareness, communication, care coordination, and evidence-based nursing decisions. Each item
includes Verified Questions with concise rationales grounded in Elsevier HESI Exit assessment materials,
evidence-based clinical guidelines, and current nursing standards of care.
Domain: Medical-Surgical Nursing
1. A client with chest pain has diaphoresis and recent ST elevation on the monitor. Which nursing
action has the highest priority?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Activate emergency cardiac response and obtain ordered rapid interventions.
Correct Answer: D
Rationale: ST elevation with ischemic symptoms suggests acute coronary occlusion, requiring rapid
reperfusion-focused care.
2. Which finding requires immediate action for a client receiving IV heparin?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. recent severe headache with unilateral weakness.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Heparin increases bleeding risk, and acute neurologic change can indicate intracranial
hemorrhage.
3. A client with heart failure has sudden pink frothy sputum and severe dyspnea. What should the
nurse do first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Place the client upright and call for rapid assistance.
Correct Answer: D
Rationale: Pulmonary edema impairs gas exchange; upright positioning and urgent team support are
priorities.
4. Which laboratory value is most important to monitor before administering digoxin?
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
, A. Delay action until the next routine round.
B. Potassium level.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Hypokalemia increases sensitivity to digoxin and raises toxicity risk.
5. A client with atrial fibrillation reports palpitations and has a rapid irregular pulse. Which
complication is most important to prevent?
A. Embolic stroke.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Atrial fibrillation can promote atrial clot formation that may embolize to the brain.
6. Which assessment finding suggests left-sided heart failure?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Crackles in the lungs with exertional dyspnea.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Left-sided failure causes pulmonary congestion and impaired oxygen exchange.
7. A client taking furosemide reports muscle weakness. Which electrolyte imbalance is most
likely?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Hypokalemia.
Correct Answer: D
Rationale: Loop diuretics increase potassium loss and can cause weakness and dysrhythmias.
8. Which teaching is appropriate for a client with hypertension starting lifestyle changes?
A. Delay action until the next routine round.
B. Reduce sodium intake, increase activity as tolerated, and take medications consistently.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Blood pressure control combines lifestyle measures with adherence to prescribed therapy.
9. Which symptom is most concerning for a client after cardiac catheterization through the
femoral artery?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Cool pale leg with diminished pedal pulse.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Reduced distal perfusion can indicate arterial obstruction or vascular complication.
10. Which finding suggests hypovolemic shock after trauma?
A. Delay action until the next routine round.
B. Rapid weak pulse with cool clammy skin.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Volume loss causes compensatory tachycardia and peripheral vasoconstriction.
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
, 11. A client with COPD becomes drowsy after high-flow oxygen. What should the nurse assess
first?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Respiratory rate and carbon dioxide retention indicators.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Some clients with COPD are vulnerable to hypercapnia, and decreased alertness can signal
ventilatory failure.
12. Which instruction is best for a client using a metered-dose inhaler with a spacer?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
D. Inhale slowly and deeply after actuation, then hold the breath briefly.
Correct Answer: D
Rationale: Slow inhalation with a spacer improves medication delivery to lower airways.
13. Which finding indicates worsening asthma?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Silent chest with increasing respiratory effort.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Diminished airflow despite effort is an ominous sign of severe obstruction.
14. A client with pneumonia has confusion, hypotension, and tachypnea. What complication is the
nurse concerned about?
A. Sepsis.
B. Delay action until the next routine round.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: A
Rationale: Infection with organ dysfunction signs such as hypotension and altered mentation suggests
sepsis.
15. Which action helps prevent aspiration in a client with dysphagia?
A. Delay action until the next routine round.
B. Keep the client upright during meals and use prescribed swallowing strategies.
C. Delegate the decision to family without assessment.
D. Document the finding without notifying anyone.
Correct Answer: B
Rationale: Upright positioning and swallowing techniques reduce aspiration risk.
16. A client with a chest tube has continuous bubbling in the water-seal chamber. What should the
nurse suspect?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Air leak in the system or from the client.
D. Document the finding without notifying anyone.
Correct Answer: C
Rationale: Continuous water-seal bubbling indicates air is entering the system and requires assessment.
17. Which sign indicates tension pneumothorax?
A. Delay action until the next routine round.
B. Delegate the decision to family without assessment.
C. Document the finding without notifying anyone.
Evolve HESI Comprehensive Exit Actual Exam 2026/2027 | Verified Questions
