HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
HESI Fundamentals Exit Exam V1, V2 & V3
RN & PN Fundamentals Test Bank 2026/2027 | Complete Questions & Answers with
Rationales
Aligned with 2026-2027 HESI Fundamentals Exit Exam Standards
NGN Clinical Judgment Components Integrated | Graded A+ Preparation
This comprehensive 225-question examination bank is organized across three progressive versions (V1, V2,
V3) aligned with the 2026-2027 HESI Fundamentals Exit Exam blueprint. V1 covers foundational nursing
concepts; V2 addresses intermediate fundamentals including fluid/electrolyte balance and physiological
adaptation; and V3 integrates Next Generation NCLEX (NGN) clinical judgment measurement model
components, including extended case studies with layered data. Each item includes a verified correct answer
and a detailed rationale that incorporates nursing process application, prioritization (ABCs, Maslow's hierarchy,
safety), RN/LPN scope-of-practice considerations, and current evidence-based practice standards. Cognitive
level distribution targets 25% recall, 50% application, and 25% analysis. Use this bank for graded A+ exit-exam
preparation, content remediation, and NGN clinical reasoning practice.
Version Questions Focus Sections
V1 Q1-Q75 Foundational Fundamentals 1-5
V2 Q76-Q150 Intermediate Fundamentals 6-10
V3 Q151-Q225 Advanced NGN Integration 11-14
V1 — Foundational Fundamentals (Q1–Q75)
Section 1: Basic Nursing Concepts and Principles
Q1: A newly licensed nurse is using the nursing process to care for a client admitted with pneumonia.
Which step of the nursing process involves establishing measurable, client-centered outcomes?
A. Assessment
B. Diagnosis
C. Planning [CORRECT]
D. Implementation
Correct Answer: C — Planning
Page 1 | Graded A+ HESI Exit Exam Prep | Z.ai
,HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: Planning is the third step of the nursing process (ADPIE) and involves establishing measurable,
client-centered goals and outcomes along with selecting evidence-based nursing interventions. Assessment involves
systematic data collection, diagnosis involves clinical judgment to identify actual or potential health problems, and
implementation involves executing the planned interventions. Outcomes must be SMART (specific, measurable,
achievable, relevant, time-bound) so the nurse can objectively evaluate whether care was effective. HESI frequently
tests the distinction between planning (goal-setting) and implementation (action-taking) because confusing them
undermines the evaluation phase.
Q2: A nurse documents that a client's pain was 8/10 and that an analgesic was administered. Which
documentation principle is most accurately reflected by this entry?
A. Subjective data only
B. Objective data only
C. Both subjective and objective data with intervention [CORRECT]
D. Evaluation data only
Correct Answer: C — Both subjective and objective data with intervention
Rationale: The pain rating of 8/10 is subjective data reported by the client, while the administration of an analgesic is
an objective, observable nursing intervention. Complete documentation includes the subjective complaint, the objective
assessment, the intervention performed, and later the evaluation of effectiveness. HESI tests the principle that
documentation must be timely, accurate, complete, and legally defensible. The entry must be signed, dated, and timed;
corrections must be made via single-line strikethrough with initials, never obliterated. Documenting only subjective or
only objective data fails to capture the full clinical picture and is a common HESI pitfall.
Q3: A client states, "I don't want to take this medication because it made me sick last time." Which
response by the nurse demonstrates active listening and a therapeutic communication technique?
A. "You have to take it; the provider ordered it."
B. "Tell me more about what happened when you took it last time." [CORRECT]
C. "Don't worry, the side effects won't happen again."
D. "I'll just document your refusal and move on."
Correct Answer: B — "Tell me more about what happened when you took it last time."
Rationale: Asking the client to elaborate uses the therapeutic technique of exploring and active listening, which builds
trust and gathers assessment data needed for safe care. The other options are non-therapeutic: giving false reassurance
minimizes the client's concern, threatening with provider authority blocks communication, and passive documentation
ignores the opportunity to assess and intervene. HESI emphasizes that therapeutic communication is client-centered,
nonjudgmental, and uses open-ended questions to encourage expression. The nurse should also explore side effects,
notify the provider if needed, and document the refusal and teaching using the nursing process. Communication is a
high-yield HESI topic.
Q4: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and then asks the nurse to obtain the client's signature on the consent form. Which action by
the nurse is most appropriate?
A. Sign as a witness after confirming the client's identity and voluntary consent [CORRECT]
B. Explain the surgical risks in greater detail before signing
C. Refuse to participate because only the surgeon may obtain consent
D. Have a family member sign on the client's behalf
Correct Answer: A — Sign as a witness after confirming the client's identity and voluntary consent
Page 2 | Graded A+ HESI Exit Exam Prep | Z.ai
,HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: The nurse's role in informed consent is to witness the client's signature and verify that consent is voluntary,
that the client has decision-making capacity, and that the provider has explained the procedure, risks, benefits, and
alternatives. The nurse does not obtain consent or provide in-depth surgical explanations; this is the provider's legal
responsibility. If the client has unanswered questions, the nurse must notify the provider before witnessing the
signature. Having a family member sign is inappropriate unless the client lacks capacity and a legal surrogate is
designated. HESI frequently tests the boundaries of informed consent and the nurse's witnessing role.
Q5: An older adult client tells the nurse, "I don't want my daughter to know I have cancer." The
daughter then asks the nurse about her mother's diagnosis. Which action by the nurse best complies with
HIPAA regulations?
A. Share the diagnosis because the daughter is a family member
B. Decline to share the information without the client's permission [CORRECT]
C. Share only the prognosis, not the diagnosis
D. Ask the charge nurse to decide what to disclose
Correct Answer: B — Decline to share the information without the client's permission
Rationale: Under HIPAA, protected health information (PHI) may not be disclosed to family members without the
client's explicit permission unless the client is incapacitated and disclosure is in the client's best interest. The client has
the right to confidentiality, and the nurse must respect this right even when family members press for information. The
nurse should encourage the client to discuss the diagnosis with her daughter, document the client's request, and inform
the care team. Sharing partial information or deferring to the charge nurse does not resolve the legal/ethical issue. HESI
frequently tests HIPAA principles, client autonomy, and confidentiality.
Q6: A nurse is caring for a client who is angry and refuses to ambulate after surgery. The nurse states,
"If you don't walk, I'll have to put restraints on you so you don't fall." This statement represents which
legal tort?
A. Assault [CORRECT]
B. Battery
C. Negligence
D. Defamation
Correct Answer: A — Assault
Rationale: Assault is the intentional threat of harmful or offensive touching that creates a reasonable fear of harm; no
actual contact is required. Threatening to apply restraints as punishment is assault. Battery requires actual harmful or
offensive contact. Negligence is the failure to meet the standard of care causing unintentional harm. Defamation
involves false communication that damages reputation. HESI tests the nurse's ability to distinguish torts and to avoid
coercive, threatening communication. The correct response is to explore the client's concerns, educate about benefits of
ambulation, and document the refusal and teaching. Restraints require a provider order, least-restrictive trials, and strict
documentation; they are never a punitive measure.
Q7: A nurse is assigned to care for four clients. Which task can the nurse safely delegate to unlicensed
assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about insulin administration
B. Assessing a surgical incision for signs of infection
C. Ambulating a stable postoperative client who has ambulated previously without difficulty [CORRECT]
D. Administering oral analgesics to a client with chronic pain
Correct Answer: C — Ambulating a stable postoperative client who has ambulated previously without difficulty
Page 3 | Graded A+ HESI Exit Exam Prep | Z.ai
, HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: Ambulating a stable, previously mobile postoperative client is within the UAP scope of practice because it is
a routine, noninvasive task with predictable outcomes. Teaching, assessment, and medication administration are the
RN's responsibility and cannot be delegated to UAP under the Five Rights of Delegation (right task, right circumstance,
right person, right direction and communication, right supervision and evaluation). HESI tests the nurse's ability to
delegate safely using these principles. The RN retains accountability for the outcome even when a task is delegated.
Stable clients with predictable needs are appropriate candidates for UAP delegation.
Q8: A client is brought to the emergency department unconscious and without identification. Emergency
surgery is needed. Which legal principle permits the surgeon to proceed without informed consent?
A. Living will
B. Implied consent [CORRECT]
C. Informed refusal
D. Durable power of attorney
Correct Answer: B — Implied consent
Rationale: Implied consent applies in emergencies when a client is unable to give consent and immediate treatment is
necessary to preserve life or prevent serious harm. The law presumes that a reasonable person would consent to
lifesaving treatment. A living will and durable power of attorney are advance directives that require prior client
execution. Informed refusal applies when a competent client declines recommended treatment after being informed.
HESI tests the nurse's understanding of consent types and when each applies. Once the client regains capacity, formal
consent should be obtained for ongoing treatment.
Q9: A nurse completes a head-to-toe assessment on a newly admitted client. Which finding should the
nurse document as subjective data?
A. Blood pressure 148/92 mm Hg
B. Client reports "feeling nauseated for two days" [CORRECT]
C. Bowel sounds hyperactive in all four quadrants
D. 2+ pitting edema bilateral lower extremities
Correct Answer: B — Client reports "feeling nauseated for two days"
Rationale: Subjective data are what the client states or feels and cannot be directly observed or measured by the nurse;
"feeling nauseated for two days" is the client's verbal report. Blood pressure, bowel sounds, and pitting edema are
objective data that can be observed, measured, or auscultated by the nurse. HESI tests the distinction between subjective
and objective data because accurate assessment and documentation form the foundation of the nursing process. Both
types of data are essential for complete assessment and should be documented using the client's exact words when
possible, with quotation marks for direct quotes.
Q10: A client with a terminal illness asks the nurse, "Am I dying?" The family has requested that the
staff not reveal the prognosis. Which response by the nurse is most appropriate?
A. "Your family doesn't want me to discuss that with you."
B. "What have your doctors told you about your condition?" [CORRECT]
C. "You're going to be fine; don't worry about it."
D. "I'll have the chaplain come speak with you."
Correct Answer: B — "What have your doctors told you about your condition?"
Rationale: The nurse should assess what the client already knows and encourage further discussion with the provider;
this respects client autonomy and honesty while acknowledging the family's request. Blaming the family, giving false
reassurance, or deflecting to the chaplain is non-therapeutic and violates the ethical principle of veracity. The nurse
Page 4 | Graded A+ HESI Exit Exam Prep | Z.ai
HESI Fundamentals Exit Exam V1, V2 & V3
RN & PN Fundamentals Test Bank 2026/2027 | Complete Questions & Answers with
Rationales
Aligned with 2026-2027 HESI Fundamentals Exit Exam Standards
NGN Clinical Judgment Components Integrated | Graded A+ Preparation
This comprehensive 225-question examination bank is organized across three progressive versions (V1, V2,
V3) aligned with the 2026-2027 HESI Fundamentals Exit Exam blueprint. V1 covers foundational nursing
concepts; V2 addresses intermediate fundamentals including fluid/electrolyte balance and physiological
adaptation; and V3 integrates Next Generation NCLEX (NGN) clinical judgment measurement model
components, including extended case studies with layered data. Each item includes a verified correct answer
and a detailed rationale that incorporates nursing process application, prioritization (ABCs, Maslow's hierarchy,
safety), RN/LPN scope-of-practice considerations, and current evidence-based practice standards. Cognitive
level distribution targets 25% recall, 50% application, and 25% analysis. Use this bank for graded A+ exit-exam
preparation, content remediation, and NGN clinical reasoning practice.
Version Questions Focus Sections
V1 Q1-Q75 Foundational Fundamentals 1-5
V2 Q76-Q150 Intermediate Fundamentals 6-10
V3 Q151-Q225 Advanced NGN Integration 11-14
V1 — Foundational Fundamentals (Q1–Q75)
Section 1: Basic Nursing Concepts and Principles
Q1: A newly licensed nurse is using the nursing process to care for a client admitted with pneumonia.
Which step of the nursing process involves establishing measurable, client-centered outcomes?
A. Assessment
B. Diagnosis
C. Planning [CORRECT]
D. Implementation
Correct Answer: C — Planning
Page 1 | Graded A+ HESI Exit Exam Prep | Z.ai
,HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: Planning is the third step of the nursing process (ADPIE) and involves establishing measurable,
client-centered goals and outcomes along with selecting evidence-based nursing interventions. Assessment involves
systematic data collection, diagnosis involves clinical judgment to identify actual or potential health problems, and
implementation involves executing the planned interventions. Outcomes must be SMART (specific, measurable,
achievable, relevant, time-bound) so the nurse can objectively evaluate whether care was effective. HESI frequently
tests the distinction between planning (goal-setting) and implementation (action-taking) because confusing them
undermines the evaluation phase.
Q2: A nurse documents that a client's pain was 8/10 and that an analgesic was administered. Which
documentation principle is most accurately reflected by this entry?
A. Subjective data only
B. Objective data only
C. Both subjective and objective data with intervention [CORRECT]
D. Evaluation data only
Correct Answer: C — Both subjective and objective data with intervention
Rationale: The pain rating of 8/10 is subjective data reported by the client, while the administration of an analgesic is
an objective, observable nursing intervention. Complete documentation includes the subjective complaint, the objective
assessment, the intervention performed, and later the evaluation of effectiveness. HESI tests the principle that
documentation must be timely, accurate, complete, and legally defensible. The entry must be signed, dated, and timed;
corrections must be made via single-line strikethrough with initials, never obliterated. Documenting only subjective or
only objective data fails to capture the full clinical picture and is a common HESI pitfall.
Q3: A client states, "I don't want to take this medication because it made me sick last time." Which
response by the nurse demonstrates active listening and a therapeutic communication technique?
A. "You have to take it; the provider ordered it."
B. "Tell me more about what happened when you took it last time." [CORRECT]
C. "Don't worry, the side effects won't happen again."
D. "I'll just document your refusal and move on."
Correct Answer: B — "Tell me more about what happened when you took it last time."
Rationale: Asking the client to elaborate uses the therapeutic technique of exploring and active listening, which builds
trust and gathers assessment data needed for safe care. The other options are non-therapeutic: giving false reassurance
minimizes the client's concern, threatening with provider authority blocks communication, and passive documentation
ignores the opportunity to assess and intervene. HESI emphasizes that therapeutic communication is client-centered,
nonjudgmental, and uses open-ended questions to encourage expression. The nurse should also explore side effects,
notify the provider if needed, and document the refusal and teaching using the nursing process. Communication is a
high-yield HESI topic.
Q4: A client is scheduled for an elective cholecystectomy. The surgeon explains the procedure, risks, and
alternatives, and then asks the nurse to obtain the client's signature on the consent form. Which action by
the nurse is most appropriate?
A. Sign as a witness after confirming the client's identity and voluntary consent [CORRECT]
B. Explain the surgical risks in greater detail before signing
C. Refuse to participate because only the surgeon may obtain consent
D. Have a family member sign on the client's behalf
Correct Answer: A — Sign as a witness after confirming the client's identity and voluntary consent
Page 2 | Graded A+ HESI Exit Exam Prep | Z.ai
,HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: The nurse's role in informed consent is to witness the client's signature and verify that consent is voluntary,
that the client has decision-making capacity, and that the provider has explained the procedure, risks, benefits, and
alternatives. The nurse does not obtain consent or provide in-depth surgical explanations; this is the provider's legal
responsibility. If the client has unanswered questions, the nurse must notify the provider before witnessing the
signature. Having a family member sign is inappropriate unless the client lacks capacity and a legal surrogate is
designated. HESI frequently tests the boundaries of informed consent and the nurse's witnessing role.
Q5: An older adult client tells the nurse, "I don't want my daughter to know I have cancer." The
daughter then asks the nurse about her mother's diagnosis. Which action by the nurse best complies with
HIPAA regulations?
A. Share the diagnosis because the daughter is a family member
B. Decline to share the information without the client's permission [CORRECT]
C. Share only the prognosis, not the diagnosis
D. Ask the charge nurse to decide what to disclose
Correct Answer: B — Decline to share the information without the client's permission
Rationale: Under HIPAA, protected health information (PHI) may not be disclosed to family members without the
client's explicit permission unless the client is incapacitated and disclosure is in the client's best interest. The client has
the right to confidentiality, and the nurse must respect this right even when family members press for information. The
nurse should encourage the client to discuss the diagnosis with her daughter, document the client's request, and inform
the care team. Sharing partial information or deferring to the charge nurse does not resolve the legal/ethical issue. HESI
frequently tests HIPAA principles, client autonomy, and confidentiality.
Q6: A nurse is caring for a client who is angry and refuses to ambulate after surgery. The nurse states,
"If you don't walk, I'll have to put restraints on you so you don't fall." This statement represents which
legal tort?
A. Assault [CORRECT]
B. Battery
C. Negligence
D. Defamation
Correct Answer: A — Assault
Rationale: Assault is the intentional threat of harmful or offensive touching that creates a reasonable fear of harm; no
actual contact is required. Threatening to apply restraints as punishment is assault. Battery requires actual harmful or
offensive contact. Negligence is the failure to meet the standard of care causing unintentional harm. Defamation
involves false communication that damages reputation. HESI tests the nurse's ability to distinguish torts and to avoid
coercive, threatening communication. The correct response is to explore the client's concerns, educate about benefits of
ambulation, and document the refusal and teaching. Restraints require a provider order, least-restrictive trials, and strict
documentation; they are never a punitive measure.
Q7: A nurse is assigned to care for four clients. Which task can the nurse safely delegate to unlicensed
assistive personnel (UAP)?
A. Teaching a newly diagnosed diabetic client about insulin administration
B. Assessing a surgical incision for signs of infection
C. Ambulating a stable postoperative client who has ambulated previously without difficulty [CORRECT]
D. Administering oral analgesics to a client with chronic pain
Correct Answer: C — Ambulating a stable postoperative client who has ambulated previously without difficulty
Page 3 | Graded A+ HESI Exit Exam Prep | Z.ai
, HESI Fundamentals Exit Exam V1, V2 & V3 | RN & PN Test Bank 2026/2027 NGN Clinical Judgment Review
Rationale: Ambulating a stable, previously mobile postoperative client is within the UAP scope of practice because it is
a routine, noninvasive task with predictable outcomes. Teaching, assessment, and medication administration are the
RN's responsibility and cannot be delegated to UAP under the Five Rights of Delegation (right task, right circumstance,
right person, right direction and communication, right supervision and evaluation). HESI tests the nurse's ability to
delegate safely using these principles. The RN retains accountability for the outcome even when a task is delegated.
Stable clients with predictable needs are appropriate candidates for UAP delegation.
Q8: A client is brought to the emergency department unconscious and without identification. Emergency
surgery is needed. Which legal principle permits the surgeon to proceed without informed consent?
A. Living will
B. Implied consent [CORRECT]
C. Informed refusal
D. Durable power of attorney
Correct Answer: B — Implied consent
Rationale: Implied consent applies in emergencies when a client is unable to give consent and immediate treatment is
necessary to preserve life or prevent serious harm. The law presumes that a reasonable person would consent to
lifesaving treatment. A living will and durable power of attorney are advance directives that require prior client
execution. Informed refusal applies when a competent client declines recommended treatment after being informed.
HESI tests the nurse's understanding of consent types and when each applies. Once the client regains capacity, formal
consent should be obtained for ongoing treatment.
Q9: A nurse completes a head-to-toe assessment on a newly admitted client. Which finding should the
nurse document as subjective data?
A. Blood pressure 148/92 mm Hg
B. Client reports "feeling nauseated for two days" [CORRECT]
C. Bowel sounds hyperactive in all four quadrants
D. 2+ pitting edema bilateral lower extremities
Correct Answer: B — Client reports "feeling nauseated for two days"
Rationale: Subjective data are what the client states or feels and cannot be directly observed or measured by the nurse;
"feeling nauseated for two days" is the client's verbal report. Blood pressure, bowel sounds, and pitting edema are
objective data that can be observed, measured, or auscultated by the nurse. HESI tests the distinction between subjective
and objective data because accurate assessment and documentation form the foundation of the nursing process. Both
types of data are essential for complete assessment and should be documented using the client's exact words when
possible, with quotation marks for direct quotes.
Q10: A client with a terminal illness asks the nurse, "Am I dying?" The family has requested that the
staff not reveal the prognosis. Which response by the nurse is most appropriate?
A. "Your family doesn't want me to discuss that with you."
B. "What have your doctors told you about your condition?" [CORRECT]
C. "You're going to be fine; don't worry about it."
D. "I'll have the chaplain come speak with you."
Correct Answer: B — "What have your doctors told you about your condition?"
Rationale: The nurse should assess what the client already knows and encourage further discussion with the provider;
this respects client autonomy and honesty while acknowledging the family's request. Blaming the family, giving false
reassurance, or deflecting to the chaplain is non-therapeutic and violates the ethical principle of veracity. The nurse
Page 4 | Graded A+ HESI Exit Exam Prep | Z.ai
