HESI Fundamentals 08/26/2026
Exit Exam
HESI Fundamentals Exit Exam 4 V1, V2 & V3
RN & PN Fundamentals Test Bank 2026/2027 |
Complete Questions & Answers with
Rationales | Verified Nursing Practice
Questions | NGN Clinical Judgment Review |
Graded A+ HESI Exit Exam Prep
The nurse is teaching a client how to perform progressive muscle relaxation techniques to relieve
insomnia. A week later the client reports that he is still unable to sleep, despite following the same
routine every night. Which action should the nurse take first?
A. Instruct the client to add regular exercise as a daily routine.
B. Determine if the client has been keeping a sleep diary.
C. Encourage the client to continue the routine until sleep is achieved.
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Exit Exam
D. Ask the client to describe the routine he is currently following. –
Correct Answer :D
Rationale:
The nurse should first evaluate whether the client has been adhering to the original instructions. A
verbal report of the client's routine will provide more specific information than the client's written
diary. The nurse can then determine which changes need to be made. The routine practiced by the
client is clearly unsuccessful, so encouragement alone is insufficient.
Ten minutes after signing an operative permit for a fractured hip, an older client states, "The aliens will
be coming to get me soon!" and falls asleep. Which action should the nurse implement next?
A. Make the client comfortable and allow the client to sleep.
B. Assess the client's neurologic status.
C. Notify the surgeon about the comment.
D. Ask the client's family to co-sign the operative permit.
- Correct Answer :B
Rationale:
This statement may indicate that the client is confused. Informed consent must be provided by a
mentally competent individual, so the nurse should further assess the client's neurologic status to be
sure that the client understands and can legally provide consent for surgery. Option A does not
provide sufficient follow-up. If the nurse determines that the client is confused, the surgeon must be
notified and permission obtained from the next of kin.
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Exit Exam
A nurse is working in an occupational health clinic when an employee walks in and states that he was
struck by lightning while working in a truck bed. The client is alert but reports feeling faint. Which
assessment will the nurse perform first?
A. Pulse characteristics
B. Open airway
C. Entrance and exit wounds
D. Cervical spine injury –
Correct Answer :A
Rationale:
Lightning is a jolt of electrical current and can produce a "natural" defibrillation, so assessment of the
pulse rate and regularity is a priority. Because the client is talking, he has an open airway, so that
assessment is not necessary. Assessing for options C and D should occur after assessing for adequate
circulation.
The nurse who is preparing to give an adolescent client a prescribed antipsychotic medication notes
that parental consent has not been obtained. Which action should the nurse take?
A. Review the chart for a signed consent for hospitalization.
B. Get the health care provider's permission to give the medication.
C. Do not give the medication and document the reason.
D. Complete an incident report and notify the parents. –
Correct Answer :C
Rationale:
The nurse should not give the medication and should document the reason because the client is a
minor and needs a guardian's permission to receive medications. Permission to give medications is not
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Exit Exam
granted by a signed hospital consent or a health care provider's permission, unless conditions are met
to justify coerced treatment. Option D is not necessary unless the medication had previously been
administered.
A hospitalized client has had difficulty falling asleep for two nights and is becoming irritable and
restless. Which action by the nurse is best?
A. Determine the client's usual bedtime routine and include these rituals in the plan of care as safety
allows.
B. Instruct the UAP not to wake the client under any circumstances during the night.
C. Place a "Do Not Disturb" sign on the door and change assessments from every 4 to every 8 hours.
D. Encourage the client to avoid pain medication during the day, which might increase daytime
napping. –
Correct Answer :A
Rationale:
Including habitual rituals that do not interfere with the client's care or safety may allow the client to
go to sleep faster and increase the quality of care. Options B, C, and D decrease the client's standard
of care and compromise safety.
The nurse is assisting a client to the bathroom. When the client is 5 feet from the bathroom door, he
states, "I feel faint." Before the nurse can get the client to a chair, the client starts to fall. Which is the
priority action for the nurse to take?
A. Check the client's carotid pulse.
B. Encourage the client to get to the toilet.
C. In a loud voice, call for help.
D. Gently lower the client to the floor. - Correct Answer :D
Rationale: Option D is the most prudent intervention and is the priority nursing action to prevent injury
to the client and the nurse. Lowering the client to the floor should be done when the client cannot
support his own weight. The client should be placed in a bed or chair only when sufficient help is
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Exit Exam
HESI Fundamentals Exit Exam 4 V1, V2 & V3
RN & PN Fundamentals Test Bank 2026/2027 |
Complete Questions & Answers with
Rationales | Verified Nursing Practice
Questions | NGN Clinical Judgment Review |
Graded A+ HESI Exit Exam Prep
The nurse is teaching a client how to perform progressive muscle relaxation techniques to relieve
insomnia. A week later the client reports that he is still unable to sleep, despite following the same
routine every night. Which action should the nurse take first?
A. Instruct the client to add regular exercise as a daily routine.
B. Determine if the client has been keeping a sleep diary.
C. Encourage the client to continue the routine until sleep is achieved.
P a g e 1 | 115
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Exit Exam
D. Ask the client to describe the routine he is currently following. –
Correct Answer :D
Rationale:
The nurse should first evaluate whether the client has been adhering to the original instructions. A
verbal report of the client's routine will provide more specific information than the client's written
diary. The nurse can then determine which changes need to be made. The routine practiced by the
client is clearly unsuccessful, so encouragement alone is insufficient.
Ten minutes after signing an operative permit for a fractured hip, an older client states, "The aliens will
be coming to get me soon!" and falls asleep. Which action should the nurse implement next?
A. Make the client comfortable and allow the client to sleep.
B. Assess the client's neurologic status.
C. Notify the surgeon about the comment.
D. Ask the client's family to co-sign the operative permit.
- Correct Answer :B
Rationale:
This statement may indicate that the client is confused. Informed consent must be provided by a
mentally competent individual, so the nurse should further assess the client's neurologic status to be
sure that the client understands and can legally provide consent for surgery. Option A does not
provide sufficient follow-up. If the nurse determines that the client is confused, the surgeon must be
notified and permission obtained from the next of kin.
P a g e 2 | 115
, HESI Fundamentals 08/26/2026
Exit Exam
A nurse is working in an occupational health clinic when an employee walks in and states that he was
struck by lightning while working in a truck bed. The client is alert but reports feeling faint. Which
assessment will the nurse perform first?
A. Pulse characteristics
B. Open airway
C. Entrance and exit wounds
D. Cervical spine injury –
Correct Answer :A
Rationale:
Lightning is a jolt of electrical current and can produce a "natural" defibrillation, so assessment of the
pulse rate and regularity is a priority. Because the client is talking, he has an open airway, so that
assessment is not necessary. Assessing for options C and D should occur after assessing for adequate
circulation.
The nurse who is preparing to give an adolescent client a prescribed antipsychotic medication notes
that parental consent has not been obtained. Which action should the nurse take?
A. Review the chart for a signed consent for hospitalization.
B. Get the health care provider's permission to give the medication.
C. Do not give the medication and document the reason.
D. Complete an incident report and notify the parents. –
Correct Answer :C
Rationale:
The nurse should not give the medication and should document the reason because the client is a
minor and needs a guardian's permission to receive medications. Permission to give medications is not
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Exit Exam
granted by a signed hospital consent or a health care provider's permission, unless conditions are met
to justify coerced treatment. Option D is not necessary unless the medication had previously been
administered.
A hospitalized client has had difficulty falling asleep for two nights and is becoming irritable and
restless. Which action by the nurse is best?
A. Determine the client's usual bedtime routine and include these rituals in the plan of care as safety
allows.
B. Instruct the UAP not to wake the client under any circumstances during the night.
C. Place a "Do Not Disturb" sign on the door and change assessments from every 4 to every 8 hours.
D. Encourage the client to avoid pain medication during the day, which might increase daytime
napping. –
Correct Answer :A
Rationale:
Including habitual rituals that do not interfere with the client's care or safety may allow the client to
go to sleep faster and increase the quality of care. Options B, C, and D decrease the client's standard
of care and compromise safety.
The nurse is assisting a client to the bathroom. When the client is 5 feet from the bathroom door, he
states, "I feel faint." Before the nurse can get the client to a chair, the client starts to fall. Which is the
priority action for the nurse to take?
A. Check the client's carotid pulse.
B. Encourage the client to get to the toilet.
C. In a loud voice, call for help.
D. Gently lower the client to the floor. - Correct Answer :D
Rationale: Option D is the most prudent intervention and is the priority nursing action to prevent injury
to the client and the nurse. Lowering the client to the floor should be done when the client cannot
support his own weight. The client should be placed in a bed or chair only when sufficient help is
P a g e 4 | 115
