HESI RN Fundamentals Exam
Verified document to secure high score | Latest 2026/2027
90 Questions | 6 Content Domains | Cognitive Distribution: 25% Recall • 50% Application • 25% Analysis
Question Style: 75% Scenario-Based • 25% Direct Recall/Nursing Intervention Identification | Aligned with
Elsevier HESI testing standards
Instructions: This comprehensive study guide assesses competency across all 6 content domains of
the HESI RN Fundamentals examination aligned with Elsevier HESI testing standards and Next
Generation NCLEX (NGN) clinical judgment. Each multiple-choice item has exactly ONE correct answer
(A–D). Most items are scenario-based, requiring integration of the nursing process (ADPIE), prioritization
(ABCs, Maslow), safety principles, infection control, pharmacological therapies, and physiological
adaptation. Detailed rationales explain why each correct answer is right AND why distractors represent
common HESI Fundamentals pitfalls. Review rationales for both correct and incorrect options to build full
exam competency.
SECTION 1: Safe and Effective Care Environment (Management of Care,
Safety, Infection Control, & Legal/Ethical Issues)
Q1: A nurse on a medical-surgical unit is caring for four patients. Which patient should
the nurse assess FIRST?
A. A patient 2 days postoperative requesting pain medication for incisional pain rated 6/10.
B. A patient with chronic obstructive pulmonary disease (COPD) whose SpO2 dropped from 92% to
85% on room air. [CORRECT]
C. A patient with type 1 diabetes who is upset about dietary restrictions.
D. A patient awaiting discharge teaching who has questions about wound care.
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, the COPD patient with
acute hypoxemia (SpO2 85%) is at immediate risk for respiratory failure and must be assessed first. The
nurse should apply oxygen, assess respiratory status, and notify the provider. The other patients have
needs that are important but not immediately life-threatening: postoperative pain (Option A) is
uncomfortable but stable, dietary frustration (Option C) is psychosocial, and discharge teaching (Option D)
is important but not urgent.
Q2: A nurse is delegating tasks to a licensed practical nurse (LPN) and an unlicensed
assistive personnel (UAP). Which task is MOST appropriate to assign to the LPN?
A. Administering oral medications to stable patients with routine orders. [CORRECT]
B. Performing initial admission assessment of a newly admitted patient.
C. Developing the plan of care for a patient with complex needs.
D. Providing education to a patient newly diagnosed with heart failure.
Correct Answer: A
Rationale: The LPN scope of practice includes administering medications (oral, subcutaneous,
intramuscular) to stable patients, monitoring stable patients, performing sterile dressing changes, and
collecting data (but not the initial comprehensive assessment). Initial admission assessments (Option B),
care plan development for complex patients (Option C), and initial patient education for new diagnoses
(Option D) require RN-level assessment, judgment, and knowledge — they cannot be delegated to an LPN.
The Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction, Right
Supervision) guide these decisions.
,Q3: A nurse is preparing to don personal protective equipment (PPE) to care for a
patient with Clostridioides difficile infection. Which PPE is required, and in what order
should the nurse don the equipment?
A. Gown, mask, goggles, gloves.
B. Gown, mask, goggles, gloves — AND use soap-and-water hand hygiene (alcohol-based sanitizer
is ineffective against C. diff spores). [CORRECT]
C. Mask, goggles, gown, gloves.
D. Gloves, gown, mask, goggles.
Correct Answer: B
Rationale: C. difficile is a spore-forming bacterium transmitted via contact; CONTACT PRECAUTIONS are
required, plus soap-and-water hand hygiene (alcohol-based sanitizers do NOT kill C. diff spores). The
correct donning order is: gown first, then mask, then goggles/face shield, then gloves last (gloves over
gown cuffs). This order ensures contamination-free donning. The correct doffing order is: gloves first
(most contaminated), then goggles, then gown, then mask last. Hand hygiene is performed immediately
after removing all PPE.
Q4: A fire breaks out in a patient's room. The nurse follows the RACE protocol. What is
the correct sequence of actions?
A. Rescue patients, Activate the alarm, Contain the fire, Extinguish if safe. [CORRECT]
B. Extinguish the fire, Rescue patients, Activate alarm, Contain.
C. Activate alarm, Contain fire, Rescue patients, Extinguish.
D. Contain fire, Rescue patients, Activate alarm, Extinguish.
Correct Answer: A
Rationale: RACE stands for: R — Rescue anyone in immediate danger; A — Activate the fire alarm; C —
Contain the fire (close doors and windows); E — Extinguish the fire if it is small and safe to do so (using
PASS: Pull pin, Aim at base, Squeeze handle, Sweep side to side). The priority is rescuing patients first,
then alerting others, then containing, then extinguishing. The other sequences (B, C, D) either delay
rescue or allow the fire to spread before the alarm sounds.
Q5: A 17-year-old patient is admitted for an emergency appendectomy. The patient's
parents are not present, and the patient requires surgery. Which statement about
informed consent is MOST accurate?
A. The patient can sign their own consent because they are over 16.
B. In an emergency when a minor's parents cannot be reached, consent is implied and surgery can
proceed. [CORRECT]
C. The patient must wait until parents arrive before surgery can proceed.
D. The nurse can sign consent on the patient's behalf.
Correct Answer: B
Rationale: Under the emergency exception to informed consent, when a minor requires life- or
limb-saving treatment and parents/guardians cannot be reached, consent is IMPLIED and treatment can
proceed. For non-emergent procedures, minors generally cannot consent (except emancipated minors or
those seeking specific services like reproductive health). The nurse's role is to witness the consent, not
obtain it (Option D is incorrect). Waiting for parents (Option C) would jeopardize the patient. A 17-year-old
is generally not able to consent for surgery (Option A is incorrect) unless emancipated.
,Q6: A nurse overhears a colleague discussing a patient's diagnosis in the elevator.
Which action by the nurse is MOST appropriate?
A. Ignore the conversation to avoid conflict.
B. Privately remind the colleague about HIPAA privacy requirements and report the incident if a
pattern continues. [CORRECT]
C. Report the colleague immediately to the supervisor without discussion.
D. Join the conversation to clarify the diagnosis.
Correct Answer: B
Rationale: HIPAA (Health Insurance Portability and Accountability Act) protects all Protected Health
Information (PHI), including diagnosis, in any form (verbal, written, electronic). Discussing PHI in public
areas (elevators, cafeterias, hallways) is a violation. The professional response is to privately remind the
colleague (educational approach first), then report if the behavior persists. Ignoring (Option A) enables
continued violations. Immediate reporting without conversation (Option C) skips the educational step
appropriate for a first incident. Joining (Option D) compounds the violation.
Q7: A nurse is caring for a patient with a DNR (Do Not Resuscitate) order. The patient
goes into cardiac arrest. Which action is MOST appropriate?
A. Begin CPR immediately and call a code.
B. Do not initiate CPR; notify the provider and provide comfort measures to the patient. [CORRECT]
C. Call the family to ask if they want CPR initiated.
D. Initiate CPR and stop if the family arrives and objects.
Correct Answer: B
Rationale: A DNR order is a medical order specifying that cardiopulmonary resuscitation should NOT be
initiated in the event of cardiac or respiratory arrest. The nurse must respect the DNR, not initiate CPR,
notify the provider of the death, and provide compassionate comfort measures to the patient and
emotional support to the family. Initiating CPR (Options A and D) violates the DNR order. Calling the family
during an arrest (Option C) delays appropriate care and is inappropriate — the DNR already reflects the
patient's wishes.
Q8: Which situation requires the nurse to file an incident report?
A. A patient develops a stage 2 pressure injury despite appropriate turning and repositioning.
B. A patient refuses their scheduled medication.
C. A visitor slips and falls in the hallway but is uninjured.
D. All of the above. [CORRECT]
Correct Answer: D
Rationale: Incident reports (variance reports) must be filed for ANY unexpected event or near-miss,
including: patient injuries (pressure injuries despite appropriate care — Option A), medication refusals
(Option B — to track adherence issues), and visitor injuries (Option C — even if apparently uninjured,
documentation is needed for liability and follow-up). Incident reports are quality improvement tools,
separate from the medical record, used to identify trends and improve safety. They are factual, objective,
and completed promptly. The principle is: when in doubt, file a report.
, Q9: A nurse is applying wrist restraints to a patient who keeps pulling at their
endotracheal tube. Which action is REQUIRED after application?
A. Tie the restraint to the side rail with a square knot.
B. Ensure two fingers can fit between the restraint and the patient's wrist, secure to the bed frame
with a quick-release knot, assess circulation and skin integrity every 15 minutes (per facility policy),
and document. [CORRECT]
C. Remove the restraints only at the end of the shift.
D. Apply the restraints as tightly as possible to prevent escape.
Correct Answer: B
Rationale: Restraint application requires: (1) Two-finger fit between restraint and skin (prevents
circulatory impairment); (2) Secure to BED FRAME (not side rail — Option A — side rails move and can
cause injury) with a quick-release knot (allows rapid release in emergency); (3) Assess circulation,
sensation, movement, and skin integrity every 15 minutes (per facility policy); (4) Remove and reposition
every 2 hours at minimum; (5) Document restraint use, justification, alternatives tried, and ongoing
assessments. Restraints require a provider order within a specific timeframe, time-limited (typically 4
hours for adults), and the LEAST RESTRICTIVE alternative must be tried first.
Q10: A nurse is caring for a patient who requires airborne precautions for pulmonary
tuberculosis. Which PPE and room placement are REQUIRED?
A. Surgical mask and private room with the door closed.
B. N95 respirator and a negative-pressure airborne infection isolation room (AIIR) with the door
closed. [CORRECT]
C. Gown and gloves in a regular private room.
D. N95 respirator in a regular semi-private room.
Correct Answer: B
Rationale: Pulmonary tuberculosis is transmitted via AIRBORNE route (small droplet nuclei that remain
suspended in air). Requirements: (1) NEGATIVE-PRESSURE airborne infection isolation room (AIIR) — air
flows INTO the room, preventing contaminated air from escaping; (2) 12+ air exchanges per hour with
HEPA filtration or direct exhaust to outside; (3) Door kept closed; (4) N95 respirator (or higher — PAPR) for
everyone entering the room (surgical masks do NOT filter airborne droplet nuclei). Option A (surgical
mask) is for droplet precautions. Option C is for contact precautions. Option D lacks the negative-pressure
room.
Q11: A nurse is caring for a patient on droplet precautions for influenza. Which PPE is
required when entering the room?
A. N95 respirator and gown.
B. Surgical mask within 3-6 feet of the patient (and gown/gloves per Standard Precautions).
[CORRECT]
C. Goggles only.
D. No PPE is required if the patient is wearing a mask.
Correct Answer: B
Rationale: Droplet precautions (for influenza, pertussis, mumps, rubella, meningococcal meningitis,
group A strep pharyngitis) require a SURGICAL MASK when within 3-6 feet of the patient (droplets travel
short distances). Standard Precautions (gown and gloves) also apply. N95 respirators (Option A) are for
AIRBORNE precautions, not droplet. The patient may also wear a mask during transport. Goggles alone
(Option C) is insufficient. Even if the patient is masked (Option D), staff must still wear PPE per Standard
and Droplet Precautions.
Verified document to secure high score | Latest 2026/2027
90 Questions | 6 Content Domains | Cognitive Distribution: 25% Recall • 50% Application • 25% Analysis
Question Style: 75% Scenario-Based • 25% Direct Recall/Nursing Intervention Identification | Aligned with
Elsevier HESI testing standards
Instructions: This comprehensive study guide assesses competency across all 6 content domains of
the HESI RN Fundamentals examination aligned with Elsevier HESI testing standards and Next
Generation NCLEX (NGN) clinical judgment. Each multiple-choice item has exactly ONE correct answer
(A–D). Most items are scenario-based, requiring integration of the nursing process (ADPIE), prioritization
(ABCs, Maslow), safety principles, infection control, pharmacological therapies, and physiological
adaptation. Detailed rationales explain why each correct answer is right AND why distractors represent
common HESI Fundamentals pitfalls. Review rationales for both correct and incorrect options to build full
exam competency.
SECTION 1: Safe and Effective Care Environment (Management of Care,
Safety, Infection Control, & Legal/Ethical Issues)
Q1: A nurse on a medical-surgical unit is caring for four patients. Which patient should
the nurse assess FIRST?
A. A patient 2 days postoperative requesting pain medication for incisional pain rated 6/10.
B. A patient with chronic obstructive pulmonary disease (COPD) whose SpO2 dropped from 92% to
85% on room air. [CORRECT]
C. A patient with type 1 diabetes who is upset about dietary restrictions.
D. A patient awaiting discharge teaching who has questions about wound care.
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, the COPD patient with
acute hypoxemia (SpO2 85%) is at immediate risk for respiratory failure and must be assessed first. The
nurse should apply oxygen, assess respiratory status, and notify the provider. The other patients have
needs that are important but not immediately life-threatening: postoperative pain (Option A) is
uncomfortable but stable, dietary frustration (Option C) is psychosocial, and discharge teaching (Option D)
is important but not urgent.
Q2: A nurse is delegating tasks to a licensed practical nurse (LPN) and an unlicensed
assistive personnel (UAP). Which task is MOST appropriate to assign to the LPN?
A. Administering oral medications to stable patients with routine orders. [CORRECT]
B. Performing initial admission assessment of a newly admitted patient.
C. Developing the plan of care for a patient with complex needs.
D. Providing education to a patient newly diagnosed with heart failure.
Correct Answer: A
Rationale: The LPN scope of practice includes administering medications (oral, subcutaneous,
intramuscular) to stable patients, monitoring stable patients, performing sterile dressing changes, and
collecting data (but not the initial comprehensive assessment). Initial admission assessments (Option B),
care plan development for complex patients (Option C), and initial patient education for new diagnoses
(Option D) require RN-level assessment, judgment, and knowledge — they cannot be delegated to an LPN.
The Five Rights of Delegation (Right Task, Right Circumstance, Right Person, Right Direction, Right
Supervision) guide these decisions.
,Q3: A nurse is preparing to don personal protective equipment (PPE) to care for a
patient with Clostridioides difficile infection. Which PPE is required, and in what order
should the nurse don the equipment?
A. Gown, mask, goggles, gloves.
B. Gown, mask, goggles, gloves — AND use soap-and-water hand hygiene (alcohol-based sanitizer
is ineffective against C. diff spores). [CORRECT]
C. Mask, goggles, gown, gloves.
D. Gloves, gown, mask, goggles.
Correct Answer: B
Rationale: C. difficile is a spore-forming bacterium transmitted via contact; CONTACT PRECAUTIONS are
required, plus soap-and-water hand hygiene (alcohol-based sanitizers do NOT kill C. diff spores). The
correct donning order is: gown first, then mask, then goggles/face shield, then gloves last (gloves over
gown cuffs). This order ensures contamination-free donning. The correct doffing order is: gloves first
(most contaminated), then goggles, then gown, then mask last. Hand hygiene is performed immediately
after removing all PPE.
Q4: A fire breaks out in a patient's room. The nurse follows the RACE protocol. What is
the correct sequence of actions?
A. Rescue patients, Activate the alarm, Contain the fire, Extinguish if safe. [CORRECT]
B. Extinguish the fire, Rescue patients, Activate alarm, Contain.
C. Activate alarm, Contain fire, Rescue patients, Extinguish.
D. Contain fire, Rescue patients, Activate alarm, Extinguish.
Correct Answer: A
Rationale: RACE stands for: R — Rescue anyone in immediate danger; A — Activate the fire alarm; C —
Contain the fire (close doors and windows); E — Extinguish the fire if it is small and safe to do so (using
PASS: Pull pin, Aim at base, Squeeze handle, Sweep side to side). The priority is rescuing patients first,
then alerting others, then containing, then extinguishing. The other sequences (B, C, D) either delay
rescue or allow the fire to spread before the alarm sounds.
Q5: A 17-year-old patient is admitted for an emergency appendectomy. The patient's
parents are not present, and the patient requires surgery. Which statement about
informed consent is MOST accurate?
A. The patient can sign their own consent because they are over 16.
B. In an emergency when a minor's parents cannot be reached, consent is implied and surgery can
proceed. [CORRECT]
C. The patient must wait until parents arrive before surgery can proceed.
D. The nurse can sign consent on the patient's behalf.
Correct Answer: B
Rationale: Under the emergency exception to informed consent, when a minor requires life- or
limb-saving treatment and parents/guardians cannot be reached, consent is IMPLIED and treatment can
proceed. For non-emergent procedures, minors generally cannot consent (except emancipated minors or
those seeking specific services like reproductive health). The nurse's role is to witness the consent, not
obtain it (Option D is incorrect). Waiting for parents (Option C) would jeopardize the patient. A 17-year-old
is generally not able to consent for surgery (Option A is incorrect) unless emancipated.
,Q6: A nurse overhears a colleague discussing a patient's diagnosis in the elevator.
Which action by the nurse is MOST appropriate?
A. Ignore the conversation to avoid conflict.
B. Privately remind the colleague about HIPAA privacy requirements and report the incident if a
pattern continues. [CORRECT]
C. Report the colleague immediately to the supervisor without discussion.
D. Join the conversation to clarify the diagnosis.
Correct Answer: B
Rationale: HIPAA (Health Insurance Portability and Accountability Act) protects all Protected Health
Information (PHI), including diagnosis, in any form (verbal, written, electronic). Discussing PHI in public
areas (elevators, cafeterias, hallways) is a violation. The professional response is to privately remind the
colleague (educational approach first), then report if the behavior persists. Ignoring (Option A) enables
continued violations. Immediate reporting without conversation (Option C) skips the educational step
appropriate for a first incident. Joining (Option D) compounds the violation.
Q7: A nurse is caring for a patient with a DNR (Do Not Resuscitate) order. The patient
goes into cardiac arrest. Which action is MOST appropriate?
A. Begin CPR immediately and call a code.
B. Do not initiate CPR; notify the provider and provide comfort measures to the patient. [CORRECT]
C. Call the family to ask if they want CPR initiated.
D. Initiate CPR and stop if the family arrives and objects.
Correct Answer: B
Rationale: A DNR order is a medical order specifying that cardiopulmonary resuscitation should NOT be
initiated in the event of cardiac or respiratory arrest. The nurse must respect the DNR, not initiate CPR,
notify the provider of the death, and provide compassionate comfort measures to the patient and
emotional support to the family. Initiating CPR (Options A and D) violates the DNR order. Calling the family
during an arrest (Option C) delays appropriate care and is inappropriate — the DNR already reflects the
patient's wishes.
Q8: Which situation requires the nurse to file an incident report?
A. A patient develops a stage 2 pressure injury despite appropriate turning and repositioning.
B. A patient refuses their scheduled medication.
C. A visitor slips and falls in the hallway but is uninjured.
D. All of the above. [CORRECT]
Correct Answer: D
Rationale: Incident reports (variance reports) must be filed for ANY unexpected event or near-miss,
including: patient injuries (pressure injuries despite appropriate care — Option A), medication refusals
(Option B — to track adherence issues), and visitor injuries (Option C — even if apparently uninjured,
documentation is needed for liability and follow-up). Incident reports are quality improvement tools,
separate from the medical record, used to identify trends and improve safety. They are factual, objective,
and completed promptly. The principle is: when in doubt, file a report.
, Q9: A nurse is applying wrist restraints to a patient who keeps pulling at their
endotracheal tube. Which action is REQUIRED after application?
A. Tie the restraint to the side rail with a square knot.
B. Ensure two fingers can fit between the restraint and the patient's wrist, secure to the bed frame
with a quick-release knot, assess circulation and skin integrity every 15 minutes (per facility policy),
and document. [CORRECT]
C. Remove the restraints only at the end of the shift.
D. Apply the restraints as tightly as possible to prevent escape.
Correct Answer: B
Rationale: Restraint application requires: (1) Two-finger fit between restraint and skin (prevents
circulatory impairment); (2) Secure to BED FRAME (not side rail — Option A — side rails move and can
cause injury) with a quick-release knot (allows rapid release in emergency); (3) Assess circulation,
sensation, movement, and skin integrity every 15 minutes (per facility policy); (4) Remove and reposition
every 2 hours at minimum; (5) Document restraint use, justification, alternatives tried, and ongoing
assessments. Restraints require a provider order within a specific timeframe, time-limited (typically 4
hours for adults), and the LEAST RESTRICTIVE alternative must be tried first.
Q10: A nurse is caring for a patient who requires airborne precautions for pulmonary
tuberculosis. Which PPE and room placement are REQUIRED?
A. Surgical mask and private room with the door closed.
B. N95 respirator and a negative-pressure airborne infection isolation room (AIIR) with the door
closed. [CORRECT]
C. Gown and gloves in a regular private room.
D. N95 respirator in a regular semi-private room.
Correct Answer: B
Rationale: Pulmonary tuberculosis is transmitted via AIRBORNE route (small droplet nuclei that remain
suspended in air). Requirements: (1) NEGATIVE-PRESSURE airborne infection isolation room (AIIR) — air
flows INTO the room, preventing contaminated air from escaping; (2) 12+ air exchanges per hour with
HEPA filtration or direct exhaust to outside; (3) Door kept closed; (4) N95 respirator (or higher — PAPR) for
everyone entering the room (surgical masks do NOT filter airborne droplet nuclei). Option A (surgical
mask) is for droplet precautions. Option C is for contact precautions. Option D lacks the negative-pressure
room.
Q11: A nurse is caring for a patient on droplet precautions for influenza. Which PPE is
required when entering the room?
A. N95 respirator and gown.
B. Surgical mask within 3-6 feet of the patient (and gown/gloves per Standard Precautions).
[CORRECT]
C. Goggles only.
D. No PPE is required if the patient is wearing a mask.
Correct Answer: B
Rationale: Droplet precautions (for influenza, pertussis, mumps, rubella, meningococcal meningitis,
group A strep pharyngitis) require a SURGICAL MASK when within 3-6 feet of the patient (droplets travel
short distances). Standard Precautions (gown and gloves) also apply. N95 respirators (Option A) are for
AIRBORNE precautions, not droplet. The patient may also wear a mask during transport. Goggles alone
(Option C) is insufficient. Even if the patient is masked (Option D), staff must still wear PPE per Standard
and Droplet Precautions.
