HESI PN EXIT EXAM — FOUNDATION PN PRACTICE QUESTIONS
2026 Comprehensive Review for the NCLEX-PN Examination
EXAM INSTRUCTIONS
This examination contains 280 multiple-choice questions designed to assess foundational practical nursing knowledge in alignment with the 2026 NCLEX-
PN Test Plan and HESI PN Exit Exam (E2) standards.
Content Areas Covered:
Safe and Effective Care Environment (Coordinated Care, Safety, Infection Control) — approximately 28–40% of exam
Health Promotion and Maintenance — approximately 6–12%
Psychosocial Integrity — approximately 9–15%
Physiological Integrity (Basic Care, Pharmacological Therapies, Reduction of Risk, Physiological Adaptation) — approximately 38–52%
Question Formats: Single-answer multiple choice, Select-All-That-Apply (SATA), Ordered Response, and NGN-style clinical judgment scenarios.
Difficulty Level: Advanced / Hard — designed to challenge critical thinking and clinical judgment at the exit-exam level.
Target Audience: Practical Nursing students preparing for the NCLEX-PN and HESI E2 Exit Exam.
Scoring Benchmark: A score of 85% or higher (238/280) is associated with a HESI score of 850+, which correlates with a 95–99% probability of passing the
NCLEX-PN on the first attempt.
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE & SAFETY
Questions 1 – 40
Question 1
The practical nurse (PN) is assigned to care for four clients on a medical-surgical unit. Which client should the PN assess first?
1. A client with chronic obstructive pulmonary disease (COPD) who has an oxygen saturation of 91% on 2 L/min nasal cannula
2. A client who is 3 days post–appendectomy and reports incisional pain of 6 on a 0–10 scale
3. A client with a history of myocardial infarction who reports sudden-onset chest pressure that radiates to the jaw
4. A client with type 2 diabetes who has a blood glucose level of 210 mg/dL
Question 2
The PN is preparing to administer a blood transfusion to a client. Which action is most important to ensure client safety?
1. Verify the client's identity using two unique identifiers
2. Prime the blood tubing with normal saline
3. Obtain a baseline set of vital signs
4. Ensure the client has signed a consent form
Question 3
A client has been placed in seclusion after exhibiting violent behavior toward staff. Which intervention is essential for the PN to implement during
seclusion?
1. Assess the client's vital signs every 4 hours
2. Provide the client with a meal tray at scheduled times
3. Document the client's behavior and the reason for seclusion every 15 minutes
4. Keep the client in seclusion for a minimum of 4 hours to ensure safety
,Question 4
(Select All That Apply)
The PN is reviewing the chain of infection with a new graduate. Which components must be present for an infection to occur? (Select all that apply.)
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
Question 5
The PN is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. The PN notes that the TPN solution appears cloudy
with particles. What is the PN's immediate action?
1. Hang the TPN solution and monitor the client for fever
2. Notify the pharmacy and obtain a new bag of TPN
3. Run the TPN through an in-line filter to remove particles
4. Administer the TPN at a slower rate to minimize risk
Question 6
A client with a fractured femur is in balanced skeletal traction. The PN notes that the traction weights are resting on the floor. Which action should the PN
take first?
1. Notify the healthcare provider
2. Reapply the traction weights to their proper position
3. Assess the client's neurovascular status
4. Document the finding and continue to monitor
Question 7
The PN is delegating a task to an unlicensed assistive personnel (UAP). Which of the following tasks is appropriate for delegation to the UAP?
1. Assist a client with ambulation using a gait belt
2. Administer a sterile saline irrigation to a wound
3. Perform a sterile dressing change for a pressure injury
4. Assess a client's lung sounds and report abnormalities
Question 8
A client is being discharged with a walking boot after a foot fracture. Which statement by the client indicates a need for further teaching?
1. "I should keep the boot on at all times, even when sleeping"
2. "I can shower with the boot if I cover it with a plastic bag"
3. "I should report any numbness or tingling in my toes"
4. "I can remove the boot for skin inspection as instructed"
Question 9
The PN is caring for a client who has a nasogastric tube set to low intermittent suction. Which finding indicates that the tube may be dislodged?
1. The client reports mild nausea
2. The tube's external length has increased by 6 cm
3. The gastric aspirate has a pH of 4.0
4. The suction machine is making a gurgling sound
,Question 10
A client with a history of falls is at risk for injury. Which intervention is most effective to prevent falls in the hospital setting?
1. Apply a bed alarm and place the client in a room near the nurses' station
2. Keep all side rails up and the bed in the lowest position
3. Restrict the client's ambulation without assistance
4. Administer a sedative to reduce restlessness
Question 11
(Select All That Apply)
The PN is teaching a client about home fire safety. Which of the following instructions should the PN include? (Select all that apply.)
1. Install smoke detectors on every level of the home
2. Change smoke detector batteries annually
3. Keep a fire extinguisher in the kitchen
4. Plan and practice a home fire escape route
5. Use space heaters with automatic shut-off features
Question 12
The PN is preparing to administer a tuberculin skin test (PPD). After injecting the antigen, the PN observes a wheal of 5 mm. What is the correct
interpretation?
1. The test is negative; no further action is needed
2. The test is positive; the client has active tuberculosis
3. The test should be read in 48–72 hours for interpretation
4. The injection was given incorrectly and must be repeated
Question 13
A client is on contact precautions for a methicillin-resistant Staphylococcus aureus (MRSA) wound infection. Which personal protective equipment (PPE) is
required when entering the client's room?
1. Gloves and gown only
2. Gloves, gown, and mask
3. Gloves, gown, mask, and eye protection
4. Gown and mask only
Question 14
The PN is caring for a client who has a do-not-resuscitate (DNR) order. The client's family member demands that the PN perform CPR if the client stops
breathing. What is the PN's best response?
1. "I will honor your request and perform CPR if needed"
2. "The DNR order is a legal document and must be followed"
3. "I will contact the healthcare provider to discuss your concerns"
4. "I will document your request but I cannot perform CPR against the order"
Question 15
A client is post-operative day 2 after a total knee replacement. The PN is assisting the client with the use of a continuous passive motion (CPM) machine.
Which action is correct when using the CPM?
1. Set the machine to 90 degrees of flexion initially
2. Ensure the machine's range of motion does not exceed the prescribed limits
3. Keep the CPM machine running continuously without breaks
4. Place the client's operative leg in the machine without a pillow for support
, Question 16
(Select All That Apply)
The PN is preparing to discharge a client with a new colostomy. Which teaching points should the PN reinforce? (Select all that apply.)
1. Change the ostomy appliance when the seal begins to leak
2. Clean the peristomal skin with mild soap and water
3. Apply stoma powder to weeping skin before applying the wafer
4. Notify the healthcare provider if the stoma becomes dark or purplish
5. Limit fluid intake to reduce output
Question 17
The PN is caring for a client with a Pacemaker who is about to undergo a magnetic resonance imaging (MRI) scan. What is the PN's priority action?
1. Ensure the client has signed the MRI consent form
2. Notify the MRI technician that the client has a pacemaker
3. Place the client on a cardiac monitor during the MRI
4. Remove the client's clothing and jewelry
Question 18
A client is receiving chemotherapy via an implanted port. The PN notes that the port site is red, swollen, and warm to the touch. What is the
PN's priority action?
1. Apply a cold compress to the site
2. Notify the healthcare provider and prepare to obtain a blood culture
3. Flush the port with heparinized saline
4. Document the finding as a localized skin reaction
Question 19
The PN is educating a client about fall prevention in the home. Which statement by the client indicates correct understanding?
1. "I will use throw rugs to prevent slipping on hardwood floors"
2. "I should wear slippers with smooth soles to avoid tripping"
3. "I will install grab bars in the bathroom near the toilet and shower"
4. "I can keep my medications on a high shelf to keep them out of reach"
Question 20
The PN is caring for a client who has a urinary retention and is scheduled for a straight catheterization. What is the maximum volume of urine that should
be drained from the bladder at one time?
1. 500 mL
2. 750 mL
3. 1000 mL
4. 1500 mL
Question 21
(Ordered Response)
Place the following steps in the correct order for performing a sterile dressing change. (Rank from first to last.)
1. ______ Apply sterile gloves
2. ______ Remove old dressing and discard
3. ______ Clean the wound with sterile solution
4. ______ Apply new sterile dressing
5. ______ Open sterile supplies and set up sterile field
2026 Comprehensive Review for the NCLEX-PN Examination
EXAM INSTRUCTIONS
This examination contains 280 multiple-choice questions designed to assess foundational practical nursing knowledge in alignment with the 2026 NCLEX-
PN Test Plan and HESI PN Exit Exam (E2) standards.
Content Areas Covered:
Safe and Effective Care Environment (Coordinated Care, Safety, Infection Control) — approximately 28–40% of exam
Health Promotion and Maintenance — approximately 6–12%
Psychosocial Integrity — approximately 9–15%
Physiological Integrity (Basic Care, Pharmacological Therapies, Reduction of Risk, Physiological Adaptation) — approximately 38–52%
Question Formats: Single-answer multiple choice, Select-All-That-Apply (SATA), Ordered Response, and NGN-style clinical judgment scenarios.
Difficulty Level: Advanced / Hard — designed to challenge critical thinking and clinical judgment at the exit-exam level.
Target Audience: Practical Nursing students preparing for the NCLEX-PN and HESI E2 Exit Exam.
Scoring Benchmark: A score of 85% or higher (238/280) is associated with a HESI score of 850+, which correlates with a 95–99% probability of passing the
NCLEX-PN on the first attempt.
SECTION 1: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE & SAFETY
Questions 1 – 40
Question 1
The practical nurse (PN) is assigned to care for four clients on a medical-surgical unit. Which client should the PN assess first?
1. A client with chronic obstructive pulmonary disease (COPD) who has an oxygen saturation of 91% on 2 L/min nasal cannula
2. A client who is 3 days post–appendectomy and reports incisional pain of 6 on a 0–10 scale
3. A client with a history of myocardial infarction who reports sudden-onset chest pressure that radiates to the jaw
4. A client with type 2 diabetes who has a blood glucose level of 210 mg/dL
Question 2
The PN is preparing to administer a blood transfusion to a client. Which action is most important to ensure client safety?
1. Verify the client's identity using two unique identifiers
2. Prime the blood tubing with normal saline
3. Obtain a baseline set of vital signs
4. Ensure the client has signed a consent form
Question 3
A client has been placed in seclusion after exhibiting violent behavior toward staff. Which intervention is essential for the PN to implement during
seclusion?
1. Assess the client's vital signs every 4 hours
2. Provide the client with a meal tray at scheduled times
3. Document the client's behavior and the reason for seclusion every 15 minutes
4. Keep the client in seclusion for a minimum of 4 hours to ensure safety
,Question 4
(Select All That Apply)
The PN is reviewing the chain of infection with a new graduate. Which components must be present for an infection to occur? (Select all that apply.)
1. Infectious agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
Question 5
The PN is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. The PN notes that the TPN solution appears cloudy
with particles. What is the PN's immediate action?
1. Hang the TPN solution and monitor the client for fever
2. Notify the pharmacy and obtain a new bag of TPN
3. Run the TPN through an in-line filter to remove particles
4. Administer the TPN at a slower rate to minimize risk
Question 6
A client with a fractured femur is in balanced skeletal traction. The PN notes that the traction weights are resting on the floor. Which action should the PN
take first?
1. Notify the healthcare provider
2. Reapply the traction weights to their proper position
3. Assess the client's neurovascular status
4. Document the finding and continue to monitor
Question 7
The PN is delegating a task to an unlicensed assistive personnel (UAP). Which of the following tasks is appropriate for delegation to the UAP?
1. Assist a client with ambulation using a gait belt
2. Administer a sterile saline irrigation to a wound
3. Perform a sterile dressing change for a pressure injury
4. Assess a client's lung sounds and report abnormalities
Question 8
A client is being discharged with a walking boot after a foot fracture. Which statement by the client indicates a need for further teaching?
1. "I should keep the boot on at all times, even when sleeping"
2. "I can shower with the boot if I cover it with a plastic bag"
3. "I should report any numbness or tingling in my toes"
4. "I can remove the boot for skin inspection as instructed"
Question 9
The PN is caring for a client who has a nasogastric tube set to low intermittent suction. Which finding indicates that the tube may be dislodged?
1. The client reports mild nausea
2. The tube's external length has increased by 6 cm
3. The gastric aspirate has a pH of 4.0
4. The suction machine is making a gurgling sound
,Question 10
A client with a history of falls is at risk for injury. Which intervention is most effective to prevent falls in the hospital setting?
1. Apply a bed alarm and place the client in a room near the nurses' station
2. Keep all side rails up and the bed in the lowest position
3. Restrict the client's ambulation without assistance
4. Administer a sedative to reduce restlessness
Question 11
(Select All That Apply)
The PN is teaching a client about home fire safety. Which of the following instructions should the PN include? (Select all that apply.)
1. Install smoke detectors on every level of the home
2. Change smoke detector batteries annually
3. Keep a fire extinguisher in the kitchen
4. Plan and practice a home fire escape route
5. Use space heaters with automatic shut-off features
Question 12
The PN is preparing to administer a tuberculin skin test (PPD). After injecting the antigen, the PN observes a wheal of 5 mm. What is the correct
interpretation?
1. The test is negative; no further action is needed
2. The test is positive; the client has active tuberculosis
3. The test should be read in 48–72 hours for interpretation
4. The injection was given incorrectly and must be repeated
Question 13
A client is on contact precautions for a methicillin-resistant Staphylococcus aureus (MRSA) wound infection. Which personal protective equipment (PPE) is
required when entering the client's room?
1. Gloves and gown only
2. Gloves, gown, and mask
3. Gloves, gown, mask, and eye protection
4. Gown and mask only
Question 14
The PN is caring for a client who has a do-not-resuscitate (DNR) order. The client's family member demands that the PN perform CPR if the client stops
breathing. What is the PN's best response?
1. "I will honor your request and perform CPR if needed"
2. "The DNR order is a legal document and must be followed"
3. "I will contact the healthcare provider to discuss your concerns"
4. "I will document your request but I cannot perform CPR against the order"
Question 15
A client is post-operative day 2 after a total knee replacement. The PN is assisting the client with the use of a continuous passive motion (CPM) machine.
Which action is correct when using the CPM?
1. Set the machine to 90 degrees of flexion initially
2. Ensure the machine's range of motion does not exceed the prescribed limits
3. Keep the CPM machine running continuously without breaks
4. Place the client's operative leg in the machine without a pillow for support
, Question 16
(Select All That Apply)
The PN is preparing to discharge a client with a new colostomy. Which teaching points should the PN reinforce? (Select all that apply.)
1. Change the ostomy appliance when the seal begins to leak
2. Clean the peristomal skin with mild soap and water
3. Apply stoma powder to weeping skin before applying the wafer
4. Notify the healthcare provider if the stoma becomes dark or purplish
5. Limit fluid intake to reduce output
Question 17
The PN is caring for a client with a Pacemaker who is about to undergo a magnetic resonance imaging (MRI) scan. What is the PN's priority action?
1. Ensure the client has signed the MRI consent form
2. Notify the MRI technician that the client has a pacemaker
3. Place the client on a cardiac monitor during the MRI
4. Remove the client's clothing and jewelry
Question 18
A client is receiving chemotherapy via an implanted port. The PN notes that the port site is red, swollen, and warm to the touch. What is the
PN's priority action?
1. Apply a cold compress to the site
2. Notify the healthcare provider and prepare to obtain a blood culture
3. Flush the port with heparinized saline
4. Document the finding as a localized skin reaction
Question 19
The PN is educating a client about fall prevention in the home. Which statement by the client indicates correct understanding?
1. "I will use throw rugs to prevent slipping on hardwood floors"
2. "I should wear slippers with smooth soles to avoid tripping"
3. "I will install grab bars in the bathroom near the toilet and shower"
4. "I can keep my medications on a high shelf to keep them out of reach"
Question 20
The PN is caring for a client who has a urinary retention and is scheduled for a straight catheterization. What is the maximum volume of urine that should
be drained from the bladder at one time?
1. 500 mL
2. 750 mL
3. 1000 mL
4. 1500 mL
Question 21
(Ordered Response)
Place the following steps in the correct order for performing a sterile dressing change. (Rank from first to last.)
1. ______ Apply sterile gloves
2. ______ Remove old dressing and discard
3. ______ Clean the wound with sterile solution
4. ______ Apply new sterile dressing
5. ______ Open sterile supplies and set up sterile field
