Elsevier HESI | Practical Nursing Exit Examination
HESI Practical Nursing Exit
Comprehensive Examination 2026/2027
| Verified Questions
Elsevier HESI | Practical Nursing Exit Examination | University-Level Practical Nursing Students
150 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Elsevier HESI | Practical Nursing Exit Examination
Comprehensive Exit Examination Actual Exam | Academic Year 2026/2027
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This comprehensive examination contains 150 original verified questions designed for university-level
practical nursing students preparing for the HESI Practical Nursing Exit Examination. The questions are
distributed across four core domains aligned with official HESI PN Exit content outlines: Safe and
Effective Care Environment (38 questions), Health Promotion and Maintenance (38 questions),
Psychosocial Integrity (37 questions), and Physiological Integrity (37 questions). Content is original and
structured to reinforce official Elsevier HESI Practical Nursing Exit Examination course objectives for
actual exam readiness and clinical proficiency for the 2026/2027 academic year. Each question includes a
correct answer and a clinical rationale grounded in foundational practical nursing methodology and
patient safety principles.
ACTUAL QUESTIONS
Domain 1: Safe and Effective Care Environment
Question 1. A licensed practical nurse is preparing to administer a unit of packed red blood
cells to a client. Which action is the priority before initiating the transfusion?
A. Verify the client's blood type and Rh factor with another licensed nurse
B. Prime the tubing with normal saline and hang the blood immediately
C. Obtain a full set of vital signs after the transfusion begins
D. Document the start time of the transfusion in the medical record
Correct Answer: B
Rationale: Two licensed nurses must independently verify the client's identity, blood type, Rh factor,
and unit numbers against the blood product label before initiating a transfusion to prevent ABO
incompatibility reactions, a foundational safety requirement in blood administration protocols.
Question 2. When caring for a client in contact isolation for methicillin-resistant
Staphylococcus aureus, which personal protective equipment is required for all direct
care?
A. N95 respirator and face shield
B. Gown and gloves
C. Surgical mask only
D. Sterile gloves and shoe covers
Correct Answer: A
Rationale: Contact precautions require a gown and gloves for all interactions involving the client or the
client's environment to prevent transmission of MRSA via direct contact or contaminated surfaces.
Question 3. A client reports sudden onset of chest pain and shortness of breath after a
central line dressing change. What is the nurse's immediate action?
A. Administer prescribed analgesic medication
B. Place the client in Trendelenburg position on the left side
C. Clamp the central line and obtain a chest radiograph
D. Reassure the client that the symptoms will resolve
Correct Answer: B
Rationale: Sudden chest pain and dyspnea after central line manipulation suggest possible air
embolism or pneumothorax; clamping the line and obtaining a chest radiograph are priority
interventions to confirm and manage the complication.
Question 4. Which action demonstrates correct sterile technique when inserting an
indwelling urinary catheter?
A. Opening the sterile kit and placing it on the client's bed
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
, B. Donning sterile gloves after opening the sterile kit
C. Cleaning the meatus with the dominant hand
D. Allowing the sterile field to become damp with antiseptic
Correct Answer: D
Rationale: Sterile gloves must be applied after the sterile field is established and before any contact with
sterile supplies to maintain asepsis throughout the catheterization procedure.
Question 5. A nurse discovers a medication error in which a client received double the
prescribed dose of digoxin. What is the first action?
A. Notify the health care provider immediately
B. Document the error in the client's medical record
C. Assess the client's apical pulse and clinical status
D. Complete an incident report for the facility
Correct Answer: C
Rationale: Client safety requires immediate assessment of vital signs and clinical status after a digoxin
overdose, focusing on apical pulse and signs of toxicity before notification or documentation.
Question 6. When prioritising care for four clients, which client should the nurse assess
first?
A. A client with a blood pressure of 148/92 mm Hg requesting pain medication
B. A client reporting new onset of unilateral weakness and facial droop
C. A client with a blood glucose of 180 mg/dL awaiting scheduled insulin
D. A client with a temperature of 100.4°F (38°C) requesting a blanket
Correct Answer: B
Rationale: New unilateral weakness and facial droop are classic signs of acute stroke requiring
immediate assessment and intervention under time-sensitive stroke protocols.
Question 7. A nurse is preparing a sterile field for a wound dressing change. Which action
contaminates the field?
A. Turning away from the field for 10 seconds to obtain additional supplies
B. Placing sterile items within the one-inch border of the sterile drape
C. Keeping hands above the waist after applying sterile gloves
D. Opening sterile packages so that the first edge is directed away from the nurse
Correct Answer: D
Rationale: Turning away from a sterile field allows potential contamination; the field must remain in
continuous view, and any interruption requires re-establishment of sterility.
Question 8. Which statement by a newly licensed nurse indicates understanding of the
rights of medication administration?
A. I will check the medication label once before giving the drug
B. I will confirm the client's identity using the room number only
C. I will verify the medication against the provider order and the client's allergy list
D. I will administer medications prepared by another nurse if they look correct
Correct Answer: B
Rationale: The rights of medication administration require verification of the medication against the
current provider order and review of allergies before administration to prevent adverse events.
Question 9. A client with a history of falls is admitted. Which intervention has the highest
priority for fall prevention?
A. Placing a fall-risk identification band on the client
B. Keeping the bed in the lowest position with brakes locked
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
, C. Educating the client about the call light location
D. Requesting a sitter for continuous observation
Correct Answer: A
Rationale: Maintaining the bed in the lowest position with locked brakes reduces the distance of a
potential fall and is a fundamental environmental safety measure for high-risk clients.
Question 10. When disposing of a used needle after an intramuscular injection, the correct
action is to:
A. Recap the needle using a two-handed technique
B. Place the uncapped needle directly into a puncture-resistant sharps container
C. Bend the needle before discarding it
D. Leave the needle on the medication cart for later disposal
Correct Answer: C
Rationale: Needles must never be recapped, bent, or left unattended; immediate disposal into a sharps
container prevents needlestick injuries and follows standard blood-borne pathogen precautions.
Question 11. A nurse is caring for a client who has a prescription for a clear liquid diet.
Which item is appropriate to include?
A. Cream of chicken soup
B. Gelatin dessert
C. Milkshake
D. Pureed vegetables
Correct Answer: D
Rationale: Clear liquid diets include liquids that are transparent at room temperature, such as gelatin,
broth, and clear juices, while milk-based and pureed items are restricted.
Question 12. Which nursing action is appropriate when a client refuses a prescribed
medication?
A. Document the refusal and notify the health care provider
B. Force the client to take the medication for therapeutic benefit
C. Discard the medication without documentation
D. Administer the medication with food to improve acceptance
Correct Answer: B
Rationale: Clients have the right to refuse treatment; the nurse must document the refusal, educate
regarding consequences, and notify the provider so alternative plans can be considered.
Question 13. A nurse observes another staff member failing to wash hands after removing
gloves. The most appropriate initial response is to:
A. Report the observation immediately to the nurse manager
B. Remind the staff member of hand hygiene requirements in a private conversation
C. Ignore the incident because it is a single occurrence
D. Document the event in the client's medical record
Correct Answer: D
Rationale: Peer accountability begins with a private, non-confrontational reminder of infection-control
standards; escalation occurs only if the behavior persists.
Question 14. When preparing to transfer a client from bed to wheelchair, the nurse should
first:
A. Lock the wheels of both the bed and the wheelchair
B. Place the wheelchair parallel to the bed
C. Instruct the client to stand and pivot
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
HESI Practical Nursing Exit
Comprehensive Examination 2026/2027
| Verified Questions
Elsevier HESI | Practical Nursing Exit Examination | University-Level Practical Nursing Students
150 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Elsevier HESI | Practical Nursing Exit Examination
Comprehensive Exit Examination Actual Exam | Academic Year 2026/2027
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This comprehensive examination contains 150 original verified questions designed for university-level
practical nursing students preparing for the HESI Practical Nursing Exit Examination. The questions are
distributed across four core domains aligned with official HESI PN Exit content outlines: Safe and
Effective Care Environment (38 questions), Health Promotion and Maintenance (38 questions),
Psychosocial Integrity (37 questions), and Physiological Integrity (37 questions). Content is original and
structured to reinforce official Elsevier HESI Practical Nursing Exit Examination course objectives for
actual exam readiness and clinical proficiency for the 2026/2027 academic year. Each question includes a
correct answer and a clinical rationale grounded in foundational practical nursing methodology and
patient safety principles.
ACTUAL QUESTIONS
Domain 1: Safe and Effective Care Environment
Question 1. A licensed practical nurse is preparing to administer a unit of packed red blood
cells to a client. Which action is the priority before initiating the transfusion?
A. Verify the client's blood type and Rh factor with another licensed nurse
B. Prime the tubing with normal saline and hang the blood immediately
C. Obtain a full set of vital signs after the transfusion begins
D. Document the start time of the transfusion in the medical record
Correct Answer: B
Rationale: Two licensed nurses must independently verify the client's identity, blood type, Rh factor,
and unit numbers against the blood product label before initiating a transfusion to prevent ABO
incompatibility reactions, a foundational safety requirement in blood administration protocols.
Question 2. When caring for a client in contact isolation for methicillin-resistant
Staphylococcus aureus, which personal protective equipment is required for all direct
care?
A. N95 respirator and face shield
B. Gown and gloves
C. Surgical mask only
D. Sterile gloves and shoe covers
Correct Answer: A
Rationale: Contact precautions require a gown and gloves for all interactions involving the client or the
client's environment to prevent transmission of MRSA via direct contact or contaminated surfaces.
Question 3. A client reports sudden onset of chest pain and shortness of breath after a
central line dressing change. What is the nurse's immediate action?
A. Administer prescribed analgesic medication
B. Place the client in Trendelenburg position on the left side
C. Clamp the central line and obtain a chest radiograph
D. Reassure the client that the symptoms will resolve
Correct Answer: B
Rationale: Sudden chest pain and dyspnea after central line manipulation suggest possible air
embolism or pneumothorax; clamping the line and obtaining a chest radiograph are priority
interventions to confirm and manage the complication.
Question 4. Which action demonstrates correct sterile technique when inserting an
indwelling urinary catheter?
A. Opening the sterile kit and placing it on the client's bed
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
, B. Donning sterile gloves after opening the sterile kit
C. Cleaning the meatus with the dominant hand
D. Allowing the sterile field to become damp with antiseptic
Correct Answer: D
Rationale: Sterile gloves must be applied after the sterile field is established and before any contact with
sterile supplies to maintain asepsis throughout the catheterization procedure.
Question 5. A nurse discovers a medication error in which a client received double the
prescribed dose of digoxin. What is the first action?
A. Notify the health care provider immediately
B. Document the error in the client's medical record
C. Assess the client's apical pulse and clinical status
D. Complete an incident report for the facility
Correct Answer: C
Rationale: Client safety requires immediate assessment of vital signs and clinical status after a digoxin
overdose, focusing on apical pulse and signs of toxicity before notification or documentation.
Question 6. When prioritising care for four clients, which client should the nurse assess
first?
A. A client with a blood pressure of 148/92 mm Hg requesting pain medication
B. A client reporting new onset of unilateral weakness and facial droop
C. A client with a blood glucose of 180 mg/dL awaiting scheduled insulin
D. A client with a temperature of 100.4°F (38°C) requesting a blanket
Correct Answer: B
Rationale: New unilateral weakness and facial droop are classic signs of acute stroke requiring
immediate assessment and intervention under time-sensitive stroke protocols.
Question 7. A nurse is preparing a sterile field for a wound dressing change. Which action
contaminates the field?
A. Turning away from the field for 10 seconds to obtain additional supplies
B. Placing sterile items within the one-inch border of the sterile drape
C. Keeping hands above the waist after applying sterile gloves
D. Opening sterile packages so that the first edge is directed away from the nurse
Correct Answer: D
Rationale: Turning away from a sterile field allows potential contamination; the field must remain in
continuous view, and any interruption requires re-establishment of sterility.
Question 8. Which statement by a newly licensed nurse indicates understanding of the
rights of medication administration?
A. I will check the medication label once before giving the drug
B. I will confirm the client's identity using the room number only
C. I will verify the medication against the provider order and the client's allergy list
D. I will administer medications prepared by another nurse if they look correct
Correct Answer: B
Rationale: The rights of medication administration require verification of the medication against the
current provider order and review of allergies before administration to prevent adverse events.
Question 9. A client with a history of falls is admitted. Which intervention has the highest
priority for fall prevention?
A. Placing a fall-risk identification band on the client
B. Keeping the bed in the lowest position with brakes locked
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
, C. Educating the client about the call light location
D. Requesting a sitter for continuous observation
Correct Answer: A
Rationale: Maintaining the bed in the lowest position with locked brakes reduces the distance of a
potential fall and is a fundamental environmental safety measure for high-risk clients.
Question 10. When disposing of a used needle after an intramuscular injection, the correct
action is to:
A. Recap the needle using a two-handed technique
B. Place the uncapped needle directly into a puncture-resistant sharps container
C. Bend the needle before discarding it
D. Leave the needle on the medication cart for later disposal
Correct Answer: C
Rationale: Needles must never be recapped, bent, or left unattended; immediate disposal into a sharps
container prevents needlestick injuries and follows standard blood-borne pathogen precautions.
Question 11. A nurse is caring for a client who has a prescription for a clear liquid diet.
Which item is appropriate to include?
A. Cream of chicken soup
B. Gelatin dessert
C. Milkshake
D. Pureed vegetables
Correct Answer: D
Rationale: Clear liquid diets include liquids that are transparent at room temperature, such as gelatin,
broth, and clear juices, while milk-based and pureed items are restricted.
Question 12. Which nursing action is appropriate when a client refuses a prescribed
medication?
A. Document the refusal and notify the health care provider
B. Force the client to take the medication for therapeutic benefit
C. Discard the medication without documentation
D. Administer the medication with food to improve acceptance
Correct Answer: B
Rationale: Clients have the right to refuse treatment; the nurse must document the refusal, educate
regarding consequences, and notify the provider so alternative plans can be considered.
Question 13. A nurse observes another staff member failing to wash hands after removing
gloves. The most appropriate initial response is to:
A. Report the observation immediately to the nurse manager
B. Remind the staff member of hand hygiene requirements in a private conversation
C. Ignore the incident because it is a single occurrence
D. Document the event in the client's medical record
Correct Answer: D
Rationale: Peer accountability begins with a private, non-confrontational reminder of infection-control
standards; escalation occurs only if the behavior persists.
Question 14. When preparing to transfer a client from bed to wheelchair, the nurse should
first:
A. Lock the wheels of both the bed and the wheelchair
B. Place the wheelchair parallel to the bed
C. Instruct the client to stand and pivot
HESI Practical Nursing Exit Comprehensive Examination 2026/2027 | Verified Questions
