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HESI FUNDAMENTALS EXAM QUESTIONS EXAM
LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
HESI FUNDAMENTALS EXAM
250 Practice Questions with Rationales
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (Questions 1-65)
1. A charge nurse is making shift assignments on a medical-surgical unit. Which
client should the charge nurse assign to a newly licensed registered nurse?
A. A 68-year-old client who is 2 days post-operative following a total knee replacement
and is stable
B. A 72-year-old client who has a new diagnosis of heart failure and is receiving IV
diuretics
C. A 45-year-old client who is receiving a continuous infusion of heparin for a pulmonary
embolism
D. A 58-year-old client who has a chest tube in place following a thoracotomy for lung
cancer
Correct Answer: A
Rationale: The newly licensed RN should be assigned to a stable client with predictable
outcomes and standard interventions. A post-operative total knee replacement client is
stable and requires routine post-operative care. Clients with unstable conditions, IV
titratable drips, or specialized equipment (B, C, D) are more appropriate for experienced
RNs.
2. A nurse is delegating tasks to an assistive personnel (AP). Which of the following
tasks is appropriate for the RN to delegate to the AP?
A. Performing an initial admission assessment on a newly admitted client
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B. Assisting a client with a bath and hair care
C. Developing a plan of care for a client with diabetes
D. Administering a subcutaneous injection of heparin
Correct Answer: B
Rationale: The RN can delegate activities of daily living (ADLs), such as bathing, to
assistive personnel. Initial assessments (A) and plan of care development (C) require
the RN's assessment and clinical judgment and cannot be delegated. Medication
administration (D) is not within the AP's scope of practice.
3. A charge nurse is making assignments for the shift. Which principle should guide
delegation?
A. Delegate only tasks that are within the scope of practice of the delegatee
B. Delegate the most complex tasks to the newest staff members
C. Delegate all tasks to the staff member with the most experience
D. Delegate tasks based on the staff member's personal preference
Correct Answer: A
Rationale: The first and most important principle of delegation is to ensure the task is
within the delegatee's scope of practice and competency. Delegation should be based
on the right task, right circumstance, right person, right direction/communication, and
right supervision/evaluation. Complex tasks should not be delegated to the newest staff
(B), and delegation should not be based solely on experience (C) or personal preference
(D).
4. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client who is 1 day post-operative and requesting pain medication
B. A client with diabetes who has a blood glucose level of 55 mg/dL and is diaphoretic
and confused
C. A client with pneumonia who has a temperature of 101.2°F (38.4°C)
D. A client with a new colostomy who is asking for assistance with changing the
appliance
Correct Answer: B
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Rationale: The client with a blood glucose of 55 mg/dL, diaphoresis, and confusion is
experiencing symptomatic hypoglycemia, which is an acute, potentially life-threatening
condition requiring immediate intervention. Pain management (A), fever (C), and ostomy
care education (D) are important but not immediately life-threatening.
5. A nurse is delegating tasks to a licensed practical nurse (LPN). Which of the
following tasks is appropriate for the RN to delegate to the LPN?
A. Administering a scheduled oral antibiotic to a stable client
B. Performing a comprehensive admission assessment
C. Developing the initial nursing plan of care
D. Providing discharge teaching to a client and family
Correct Answer: A
Rationale: LPNs can administer medications (including oral antibiotics) to stable
clients, as this falls within their scope of practice. Comprehensive assessments (B),
care plan development (C), and discharge teaching (D) require the RN's assessment
and clinical judgment and are not within the LPN's scope of practice.
6. A nurse manager is implementing a new scheduling system. The manager should
identify which of the following as a priority when making staffing assignments?
A. Staff members' personal preferences
B. Client acuity and staffing mix
C. Staff members' years of experience only
D. The number of staff available, regardless of skill mix
Correct Answer: B
Rationale: The priority when making staffing assignments is to match client acuity with
the appropriate staffing mix and competency levels. Client safety requires that the right
nurse with the right skills cares for the right client. While preferences (A) and experience
(C) are considerations, they are secondary to client needs. Staffing should consider skill
mix, not just numbers (D).
7. A nurse is preparing to delegate a task to an AP. Which of the following should the
nurse include in the delegation process?
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A. Provide clear, concise instructions and expected outcomes
B. Delegate the task without supervision
C. Delegate the task and leave the unit
D. Delegate the task without providing feedback
Correct Answer: A
Rationale: The five rights of delegation include the right direction/communication,
which requires providing clear, concise instructions and expected outcomes.
Supervision (B) is always required. Leaving the unit (C) without supervision is unsafe.
Feedback (D) is essential for evaluation and improvement.
8. A nurse is caring for a client who has a new tracheostomy. Which of the following
tasks is appropriate to delegate to an LPN?
A. Assessing the tracheostomy site for signs of infection
B. Suctioning the tracheostomy
C. Developing the client's plan of care
D. Performing tracheostomy tube change
Correct Answer: B
Rationale: Suctioning a tracheostomy is within the LPN's scope of practice for a stable
client. Initial assessment (A) and plan of care development (C) require RN-level
assessment and judgment. Tracheostomy tube changes (D) are typically performed by
the RN or respiratory therapist, not the LPN.
9. A charge nurse on a busy medical-surgical unit has an RN, an LPN, and an AP on
the shift. Which of the following client assignments is most appropriate for the
LPN?
A. A client who is 1 hour post-operative and is unstable
B. A client who is stable and requires wound care and medication administration
C. A client who requires a comprehensive admission assessment
D. A client who requires discharge teaching
Correct Answer: B
HESI FUNDAMENTALS EXAM QUESTIONS EXAM
LATEST VERSION QUESTIONS AND ANSWERS
2026 EDITION
HESI FUNDAMENTALS EXAM
250 Practice Questions with Rationales
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (Questions 1-65)
1. A charge nurse is making shift assignments on a medical-surgical unit. Which
client should the charge nurse assign to a newly licensed registered nurse?
A. A 68-year-old client who is 2 days post-operative following a total knee replacement
and is stable
B. A 72-year-old client who has a new diagnosis of heart failure and is receiving IV
diuretics
C. A 45-year-old client who is receiving a continuous infusion of heparin for a pulmonary
embolism
D. A 58-year-old client who has a chest tube in place following a thoracotomy for lung
cancer
Correct Answer: A
Rationale: The newly licensed RN should be assigned to a stable client with predictable
outcomes and standard interventions. A post-operative total knee replacement client is
stable and requires routine post-operative care. Clients with unstable conditions, IV
titratable drips, or specialized equipment (B, C, D) are more appropriate for experienced
RNs.
2. A nurse is delegating tasks to an assistive personnel (AP). Which of the following
tasks is appropriate for the RN to delegate to the AP?
A. Performing an initial admission assessment on a newly admitted client
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B. Assisting a client with a bath and hair care
C. Developing a plan of care for a client with diabetes
D. Administering a subcutaneous injection of heparin
Correct Answer: B
Rationale: The RN can delegate activities of daily living (ADLs), such as bathing, to
assistive personnel. Initial assessments (A) and plan of care development (C) require
the RN's assessment and clinical judgment and cannot be delegated. Medication
administration (D) is not within the AP's scope of practice.
3. A charge nurse is making assignments for the shift. Which principle should guide
delegation?
A. Delegate only tasks that are within the scope of practice of the delegatee
B. Delegate the most complex tasks to the newest staff members
C. Delegate all tasks to the staff member with the most experience
D. Delegate tasks based on the staff member's personal preference
Correct Answer: A
Rationale: The first and most important principle of delegation is to ensure the task is
within the delegatee's scope of practice and competency. Delegation should be based
on the right task, right circumstance, right person, right direction/communication, and
right supervision/evaluation. Complex tasks should not be delegated to the newest staff
(B), and delegation should not be based solely on experience (C) or personal preference
(D).
4. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client who is 1 day post-operative and requesting pain medication
B. A client with diabetes who has a blood glucose level of 55 mg/dL and is diaphoretic
and confused
C. A client with pneumonia who has a temperature of 101.2°F (38.4°C)
D. A client with a new colostomy who is asking for assistance with changing the
appliance
Correct Answer: B
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Rationale: The client with a blood glucose of 55 mg/dL, diaphoresis, and confusion is
experiencing symptomatic hypoglycemia, which is an acute, potentially life-threatening
condition requiring immediate intervention. Pain management (A), fever (C), and ostomy
care education (D) are important but not immediately life-threatening.
5. A nurse is delegating tasks to a licensed practical nurse (LPN). Which of the
following tasks is appropriate for the RN to delegate to the LPN?
A. Administering a scheduled oral antibiotic to a stable client
B. Performing a comprehensive admission assessment
C. Developing the initial nursing plan of care
D. Providing discharge teaching to a client and family
Correct Answer: A
Rationale: LPNs can administer medications (including oral antibiotics) to stable
clients, as this falls within their scope of practice. Comprehensive assessments (B),
care plan development (C), and discharge teaching (D) require the RN's assessment
and clinical judgment and are not within the LPN's scope of practice.
6. A nurse manager is implementing a new scheduling system. The manager should
identify which of the following as a priority when making staffing assignments?
A. Staff members' personal preferences
B. Client acuity and staffing mix
C. Staff members' years of experience only
D. The number of staff available, regardless of skill mix
Correct Answer: B
Rationale: The priority when making staffing assignments is to match client acuity with
the appropriate staffing mix and competency levels. Client safety requires that the right
nurse with the right skills cares for the right client. While preferences (A) and experience
(C) are considerations, they are secondary to client needs. Staffing should consider skill
mix, not just numbers (D).
7. A nurse is preparing to delegate a task to an AP. Which of the following should the
nurse include in the delegation process?
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A. Provide clear, concise instructions and expected outcomes
B. Delegate the task without supervision
C. Delegate the task and leave the unit
D. Delegate the task without providing feedback
Correct Answer: A
Rationale: The five rights of delegation include the right direction/communication,
which requires providing clear, concise instructions and expected outcomes.
Supervision (B) is always required. Leaving the unit (C) without supervision is unsafe.
Feedback (D) is essential for evaluation and improvement.
8. A nurse is caring for a client who has a new tracheostomy. Which of the following
tasks is appropriate to delegate to an LPN?
A. Assessing the tracheostomy site for signs of infection
B. Suctioning the tracheostomy
C. Developing the client's plan of care
D. Performing tracheostomy tube change
Correct Answer: B
Rationale: Suctioning a tracheostomy is within the LPN's scope of practice for a stable
client. Initial assessment (A) and plan of care development (C) require RN-level
assessment and judgment. Tracheostomy tube changes (D) are typically performed by
the RN or respiratory therapist, not the LPN.
9. A charge nurse on a busy medical-surgical unit has an RN, an LPN, and an AP on
the shift. Which of the following client assignments is most appropriate for the
LPN?
A. A client who is 1 hour post-operative and is unstable
B. A client who is stable and requires wound care and medication administration
C. A client who requires a comprehensive admission assessment
D. A client who requires discharge teaching
Correct Answer: B
