HESI RN EXIT Exam
Questions and Answers
Latest 2026/2027 Edition
NCLEX-RN Test Plan Aligned • NGN-Style Clinical Judgment • A+ Graded Answers
160-Question Comprehensive Practice Examination
Aligned with Elsevier HESI RN Exit Examination Blueprint
NCLEX-RN Test Plan Aligned • NGN-Style Page 1 For Educational Use
,HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
About This Exam
This 160-question practice examination mirrors the length, content distribution, and cognitive complexity of
the Elsevier HESI RN Exit Examination administered to senior nursing students prior to graduation. The bank
is organized into nine sections aligned with the NCLEX-RN Test Plan categories: Management of Care, Safety
and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort,
Pharmacological and Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation, and an
Integrated Exit-Level Clinical Judgment section featuring Next Generation NCLEX (NGN) style case studies.
Each question reflects 2026/2027 HESI and NCLEX-RN standards.
Cognitive Level Distribution
The bank is calibrated to the HESI Exit cognitive blueprint: approximately 25% of items assess recall and
recognition of nursing facts, normal findings, and pharmacologic basics; approximately 50% assess application
of nursing concepts, pharmacologic principles, and prioritization frameworks to authentic clinical scenarios;
and approximately 25% require analysis and synthesis across multiple concepts, including NGN-style clinical
judgment measurement model (CJMM) items requiring the candidate to recognize cues, analyze cues,
prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Approximately 75% of items are
scenario-based and 25% are direct concept-identification questions, mirroring the live HESI Exit style.
How to Use the Rationales
Each item identifies the verified correct choice, marked [CORRECT], followed by a 3–4 sentence rationale
grounded in HESI-specific exit-level nursing reasoning. Rationales explain why the correct option is best and
why the distractors represent common HESI Exit Exam pitfalls, including prioritization errors (ABC vs.
Maslow misapplication), delegation confusion (RN vs. LPN vs. UAP scope), medication calculation mistakes,
nursing process sequencing errors, and patient education omissions. Use the rationales as a study scaffold, not
as a substitute for the official HESI Exit Exam review materials.
Disclaimer
This practice examination is an independent educational resource and is not affiliated with, endorsed by, or
sponsored by Elsevier or the HESI assessment program. HESI is a registered trademark of Elsevier, Inc.
Candidates are referred to the official HESI Exit Exam Candidate Guide and Elsevier review materials for
authoritative examination requirements.
NCLEX-RN Test Plan Aligned • NGN-Style Page 2 For Educational Use
,HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
Section 1: Safe and Effective Care Environment – Management of Care
Legal/Ethical Issues, Delegation, Client Rights, Advocacy, & Case Management • Q1–30
Q1. A registered nurse (RN) on a medical-surgical unit is caring for four clients. Which client should the RN
assess first?
A. A client 2 hours post-colonoscopy reporting mild abdominal cramping
B. A client with chronic heart failure whose weight has increased by 1 kg since yesterday and who has 1+ peripheral
edema
C. A client 4 hours post-thyroidectomy reporting a sudden sharp sensation in the back of the throat and
difficulty swallowing [CORRECT]
D. A client with type 2 diabetes mellitus who has a fasting blood glucose of 130 mg/dL and is requesting breakfast
Correct Answer: C
Rationale: Using the ABC priority framework and recognizing life-threatening complications, the post-thyroidectomy
client's difficulty swallowing and throat pain suggest possible hematoma compressing the airway—a surgical emergency
requiring immediate assessment and possible intubation. The cramping post-colonoscopy (A) is expected; the heart
failure weight gain (B) warrants attention but is not immediately life-threatening; the diabetic glucose of 130 mg/dL (D)
is within target range. This item tests prioritization using ABCs and recognition of postoperative hemorrhage.
Q2. An RN is delegating care for the shift. Which task is most appropriate to delegate to unlicensed assistive
personnel (UAP)?
A. Teaching a client newly diagnosed with diabetes how to perform foot care
B. Measuring intake and output and reporting a urine output of less than 30 mL/hr for two consecutive hours
[CORRECT]
C. Assessing a surgical wound for signs of infection
D. Evaluating a client's response to a new morphine PCA dose
Correct Answer: B
Rationale: UAP scope of practice includes measuring vital signs, intake and output, ADLs, and reporting abnormalities
to the RN—delegation of I&O; measurement with specific reporting parameters (urine output < 30 mL/hr) is
appropriate. Teaching (A) requires RN-level knowledge; wound assessment (C) requires nursing assessment; evaluation
of medication response (D) requires nursing judgment. The Five Rights of Delegation—right task, right circumstances,
right person, right direction and communication, right supervision and evaluation—guide this decision.
NCLEX-RN Test Plan Aligned • NGN-Style Page 3 For Educational Use
, HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
Q3. A client scheduled for an elective cholecystectomy refuses to sign the consent form, stating, 'I'm not sure I
want to do this.' What is the nurse's most appropriate response?
A. Notify the surgeon so the surgeon can discuss the procedure and answer the client's questions before the
consent is signed. [CORRECT]
B. Explain the risks and benefits of the procedure and ask the client to sign anyway.
C. Have the client sign a form declining surgery against medical advice.
D. Administer the preoperative sedation as ordered to reduce the client's anxiety.
Correct Answer: A
Rationale: Informed consent requires that the client understand the procedure, alternatives, risks, and benefits, and
consent voluntarily without coercion. The physician/surgeon is responsible for explaining the procedure; the nurse
witnesses the signature and verifies understanding. Administering sedation before consent would invalidate any
subsequent consent (D). The nurse should not explain risks/benefits (B) as this is the provider's role. AMA
documentation (C) is premature when the client simply has questions.
Q4. A client with terminal cancer asks the nurse, 'I want my daughter to make decisions for me if I can't. How
do I arrange that?' The nurse's best response is:
A. 'You can complete an advance directive, such as a durable power of attorney for health care, naming your
daughter as your proxy.' [CORRECT]
B. 'Your daughter automatically becomes your decision maker if you lose capacity.'
C. 'Only a court can appoint a health care proxy for you.'
D. 'The physician will decide who makes decisions for you if you become incapacitated.'
Correct Answer: A
Rationale: The Patient Self-Determination Act requires health care facilities to inform clients of their right to complete
advance directives, including a durable power of attorney for health care (DPOA-HC) that designates a surrogate
decision maker. A daughter does not automatically become the decision maker (B); court-appointed guardianship (C) is
only needed when no advance directive exists; the physician does not decide (D). The nurse's role is to educate and refer
to social work or chaplaincy if needed.
Q5. A nursing assistant tells the RN, 'I think the client in room 4 is being abused by their spouse. The spouse
won't let anyone visit alone and the client seems afraid.' What is the nurse's priority action?
A. Confront the spouse in the hallway about the suspected abuse.
B. Document the suspicion in the client's medical record and notify the charge nurse; suspected abuse must be
reported to adult protective services per state law. [CORRECT]
C. Wait until the client discloses abuse before taking action.
D. Discuss the suspicion with the client's family members.
Correct Answer: B
Rationale: Nurses are mandated reporters of suspected abuse, neglect, or exploitation. The nurse must document
objective findings and statements, notify the charge nurse, and report to Adult Protective Services per state law.
Confronting the spouse (A) is unsafe and may endanger the client. Waiting for disclosure (C) delays mandated reporting.
Discussing with family members (D) violates confidentiality and may place the client at risk. Mandated reporting
supersedes confidentiality in abuse cases.
NCLEX-RN Test Plan Aligned • NGN-Style Page 4 For Educational Use
Questions and Answers
Latest 2026/2027 Edition
NCLEX-RN Test Plan Aligned • NGN-Style Clinical Judgment • A+ Graded Answers
160-Question Comprehensive Practice Examination
Aligned with Elsevier HESI RN Exit Examination Blueprint
NCLEX-RN Test Plan Aligned • NGN-Style Page 1 For Educational Use
,HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
About This Exam
This 160-question practice examination mirrors the length, content distribution, and cognitive complexity of
the Elsevier HESI RN Exit Examination administered to senior nursing students prior to graduation. The bank
is organized into nine sections aligned with the NCLEX-RN Test Plan categories: Management of Care, Safety
and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and Comfort,
Pharmacological and Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation, and an
Integrated Exit-Level Clinical Judgment section featuring Next Generation NCLEX (NGN) style case studies.
Each question reflects 2026/2027 HESI and NCLEX-RN standards.
Cognitive Level Distribution
The bank is calibrated to the HESI Exit cognitive blueprint: approximately 25% of items assess recall and
recognition of nursing facts, normal findings, and pharmacologic basics; approximately 50% assess application
of nursing concepts, pharmacologic principles, and prioritization frameworks to authentic clinical scenarios;
and approximately 25% require analysis and synthesis across multiple concepts, including NGN-style clinical
judgment measurement model (CJMM) items requiring the candidate to recognize cues, analyze cues,
prioritize hypotheses, generate solutions, take action, and evaluate outcomes. Approximately 75% of items are
scenario-based and 25% are direct concept-identification questions, mirroring the live HESI Exit style.
How to Use the Rationales
Each item identifies the verified correct choice, marked [CORRECT], followed by a 3–4 sentence rationale
grounded in HESI-specific exit-level nursing reasoning. Rationales explain why the correct option is best and
why the distractors represent common HESI Exit Exam pitfalls, including prioritization errors (ABC vs.
Maslow misapplication), delegation confusion (RN vs. LPN vs. UAP scope), medication calculation mistakes,
nursing process sequencing errors, and patient education omissions. Use the rationales as a study scaffold, not
as a substitute for the official HESI Exit Exam review materials.
Disclaimer
This practice examination is an independent educational resource and is not affiliated with, endorsed by, or
sponsored by Elsevier or the HESI assessment program. HESI is a registered trademark of Elsevier, Inc.
Candidates are referred to the official HESI Exit Exam Candidate Guide and Elsevier review materials for
authoritative examination requirements.
NCLEX-RN Test Plan Aligned • NGN-Style Page 2 For Educational Use
,HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
Section 1: Safe and Effective Care Environment – Management of Care
Legal/Ethical Issues, Delegation, Client Rights, Advocacy, & Case Management • Q1–30
Q1. A registered nurse (RN) on a medical-surgical unit is caring for four clients. Which client should the RN
assess first?
A. A client 2 hours post-colonoscopy reporting mild abdominal cramping
B. A client with chronic heart failure whose weight has increased by 1 kg since yesterday and who has 1+ peripheral
edema
C. A client 4 hours post-thyroidectomy reporting a sudden sharp sensation in the back of the throat and
difficulty swallowing [CORRECT]
D. A client with type 2 diabetes mellitus who has a fasting blood glucose of 130 mg/dL and is requesting breakfast
Correct Answer: C
Rationale: Using the ABC priority framework and recognizing life-threatening complications, the post-thyroidectomy
client's difficulty swallowing and throat pain suggest possible hematoma compressing the airway—a surgical emergency
requiring immediate assessment and possible intubation. The cramping post-colonoscopy (A) is expected; the heart
failure weight gain (B) warrants attention but is not immediately life-threatening; the diabetic glucose of 130 mg/dL (D)
is within target range. This item tests prioritization using ABCs and recognition of postoperative hemorrhage.
Q2. An RN is delegating care for the shift. Which task is most appropriate to delegate to unlicensed assistive
personnel (UAP)?
A. Teaching a client newly diagnosed with diabetes how to perform foot care
B. Measuring intake and output and reporting a urine output of less than 30 mL/hr for two consecutive hours
[CORRECT]
C. Assessing a surgical wound for signs of infection
D. Evaluating a client's response to a new morphine PCA dose
Correct Answer: B
Rationale: UAP scope of practice includes measuring vital signs, intake and output, ADLs, and reporting abnormalities
to the RN—delegation of I&O; measurement with specific reporting parameters (urine output < 30 mL/hr) is
appropriate. Teaching (A) requires RN-level knowledge; wound assessment (C) requires nursing assessment; evaluation
of medication response (D) requires nursing judgment. The Five Rights of Delegation—right task, right circumstances,
right person, right direction and communication, right supervision and evaluation—guide this decision.
NCLEX-RN Test Plan Aligned • NGN-Style Page 3 For Educational Use
, HESI RN Exit Exam • Latest 2026/2027 Edition Verified Questions & A+ Graded Answers
Q3. A client scheduled for an elective cholecystectomy refuses to sign the consent form, stating, 'I'm not sure I
want to do this.' What is the nurse's most appropriate response?
A. Notify the surgeon so the surgeon can discuss the procedure and answer the client's questions before the
consent is signed. [CORRECT]
B. Explain the risks and benefits of the procedure and ask the client to sign anyway.
C. Have the client sign a form declining surgery against medical advice.
D. Administer the preoperative sedation as ordered to reduce the client's anxiety.
Correct Answer: A
Rationale: Informed consent requires that the client understand the procedure, alternatives, risks, and benefits, and
consent voluntarily without coercion. The physician/surgeon is responsible for explaining the procedure; the nurse
witnesses the signature and verifies understanding. Administering sedation before consent would invalidate any
subsequent consent (D). The nurse should not explain risks/benefits (B) as this is the provider's role. AMA
documentation (C) is premature when the client simply has questions.
Q4. A client with terminal cancer asks the nurse, 'I want my daughter to make decisions for me if I can't. How
do I arrange that?' The nurse's best response is:
A. 'You can complete an advance directive, such as a durable power of attorney for health care, naming your
daughter as your proxy.' [CORRECT]
B. 'Your daughter automatically becomes your decision maker if you lose capacity.'
C. 'Only a court can appoint a health care proxy for you.'
D. 'The physician will decide who makes decisions for you if you become incapacitated.'
Correct Answer: A
Rationale: The Patient Self-Determination Act requires health care facilities to inform clients of their right to complete
advance directives, including a durable power of attorney for health care (DPOA-HC) that designates a surrogate
decision maker. A daughter does not automatically become the decision maker (B); court-appointed guardianship (C) is
only needed when no advance directive exists; the physician does not decide (D). The nurse's role is to educate and refer
to social work or chaplaincy if needed.
Q5. A nursing assistant tells the RN, 'I think the client in room 4 is being abused by their spouse. The spouse
won't let anyone visit alone and the client seems afraid.' What is the nurse's priority action?
A. Confront the spouse in the hallway about the suspected abuse.
B. Document the suspicion in the client's medical record and notify the charge nurse; suspected abuse must be
reported to adult protective services per state law. [CORRECT]
C. Wait until the client discloses abuse before taking action.
D. Discuss the suspicion with the client's family members.
Correct Answer: B
Rationale: Nurses are mandated reporters of suspected abuse, neglect, or exploitation. The nurse must document
objective findings and statements, notify the charge nurse, and report to Adult Protective Services per state law.
Confronting the spouse (A) is unsafe and may endanger the client. Waiting for disclosure (C) delays mandated reporting.
Discussing with family members (D) violates confidentiality and may place the client at risk. Mandated reporting
supersedes confidentiality in abuse cases.
NCLEX-RN Test Plan Aligned • NGN-Style Page 4 For Educational Use
