ELSEVIER HESI TESTING STANDARDS
Aligned with NCLEX-RN Test Plan & NGN Clinical Judgment Framework
HESI RN Exit Exam
Complete 200-Question Test Bank
NEWEST EDITION
Q & A with Detailed Rationales
Clinical Judgment • Prioritization • Delegation
Pharmacology • NGN Case Studies • Leadership
Section 1: Management of Care (Q1–35)
Section 2: Safety & Infection Control (Q36–50)
Section 3: Health Promotion & Maintenance (Q51–65)
Section 4: Psychosocial Integrity (Q66–85)
Section 5: Basic Care & Comfort (Q86–100)
Section 6: Pharmacological & Parenteral Therapies (Q101–120)
Section 7: Reduction of Risk Potential (Q121–140)
Section 8: Physiological Adaptation (Q141–165)
Section 9: Integrated Clinical Judgment / NGN (Q166–185)
Section 10: Leadership, Ethics & Professional Practice (Q186–200)
Complete Document for HESI Preparation
200 Questions | 10 Sections | Detailed Rationales
,HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 2
Section 1: Safe and Effective Care Environment -
Management of Care
Q1 - Q35 | Legal/Ethical Issues, Delegation, Client Rights, Advocacy, Case
Management, & Continuity of Care
Q1: A 78-year-old client with a terminal diagnosis signs a do-not-resuscitate
(DNR) order. Two days later, the client's spouse demands the nurse perform
CPR if the client arrests. Which action by the nurse reflects correct application
of client rights and ethical practice?
A. Contact the provider to rescind the DNR because the spouse is the legal next of kin.
B. Honor the client's signed DNR and explain to the spouse that the client's
autonomous decision takes precedence. [CORRECT]
C. Initiate a code and call ethics committee afterward to resolve the conflict.
D. Ask the spouse to sign a countermanding form to override the client's DNR.
Correct Answer: B
Rationale:
A competent adult client's autonomous, informed decision to enact a DNR is legally and
ethically binding and supersedes family preferences. The nurse must honor the documented
DNR, provide therapeutic communication to the spouse, and involve palliative care or
chaplaincy as needed. Rescinding the DNR without the client's consent violates autonomy;
initiating CPR despite a valid DNR constitutes battery. Ethics consults are appropriate when
true ethical dilemmas exist, but here the path is clear: the client's documented wishes
govern.
Q2: An RN on a med-surg unit is assigned one LPN and one unlicensed assistive
personnel (UAP). Which task is most appropriate for the RN to delegate to the
LPN?
A. Reinforcing teaching for a newly diagnosed diabetic client on insulin
injection technique. [CORRECT]
B. Initial admission assessment of a client transferred from the ICU.
C. Developing the plan of care for a client with new-onset heart failure.
D. Receiving report on a freshly admitted post-op client.
Correct Answer: A
Rationale:
LPNs may reinforce existing teaching but cannot perform initial teaching, initial
assessments, or develop plans of care—these remain within the RN scope. Reinforcing insulin
injection technique is a stable, predictable task appropriate for LPN scope under RN
supervision. The RN must perform initial admission assessments and care plan development
because they require clinical judgment and synthesis of comprehensive data. Receiving the
Confidential — For Educational Use Aligned with NCLEX-RN Test Plan & HESI Standards
,HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 3
initial shift/handoff report on a newly admitted unstable client also requires RN-level
assessment.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the
surgical consent, stating, 'I'm just not sure about this.' What is the nurse's
most appropriate response?
A. Notify the surgeon so consent can be obtained after the client is premedicated.
B. Explain the risks of delaying surgery and ask the client to sign anyway.
C. Notify the surgeon that the client has questions and ensure consent is
obtained without coercion before surgery. [CORRECT]
D. Document the refusal and proceed with preoperative preparation.
Correct Answer: C
Rationale:
Informed consent requires capacity, voluntariness, disclosure, comprehension, and
agreement. A client expressing doubt does not have adequate voluntariness or
comprehension to consent. The nurse must notify the surgeon so the surgeon can answer
questions and re-obtain consent without coercion. Premedicating before consent invalidates
it because sedation impairs capacity. Pressuring the client to sign is coercion, and
proceeding without consent is battery. The nurse's role is patient advocacy—protecting the
right to informed refusal.
Q4: A nurse discovers a colleague diverting narcotics from the Pyxis machine.
Which action demonstrates correct legal and ethical obligation?
A. Confront the colleague privately and ask them to seek treatment.
B. Report the observation to the nurse manager and document objectively.
[CORRECT]
C. Wait until a second incident occurs to confirm the pattern before reporting.
D. Notify the state board of nursing directly without informing facility leadership.
Correct Answer: B
Rationale:
Nurses have a legal and ethical duty to report impaired practice and diversion through the
chain of command, beginning with the nurse manager, while documenting factual, objective
observations. Immediate reporting protects patient safety and the impaired colleague from
harm. Confronting privately may enable continued diversion; waiting for repeated incidents
endangers patients. Direct reporting to the board without internal reporting bypasses
institutional due process—the board typically expects internal reporting first, though
mandatory reporting laws vary by state.
Q5: A client with metastatic cancer is confused and disoriented. The family
asks the nurse to withhold the diagnosis from the client, saying, 'It will only
upset them.' Which nursing action is most appropriate?
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, HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 4
A. Honor the family's request because the client is confused and family knows best.
B. Withhold information until the client is lucid, then assess what they want to know.
C. Tell the family the client has a right to know and disclose the diagnosis immediately.
D. Facilitate a family meeting with the provider and ethics committee to clarify
goals and disclosure preferences. [CORRECT]
Correct Answer: D
Rationale:
When capacity is in question and family requests nondisclosure, the nurse advocates by
facilitating a structured conversation involving the provider and, if needed, the ethics
committee. This respects cultural values, clarifies the client's decisional capacity, and aligns
with ethical principles of autonomy, beneficence, and nonmaleficence. Unilaterally honoring
the family's request violates autonomy if the client has moments of lucidity; immediate
disclosure without assessment may cause harm and ignores cultural context. The nurse's role
is coordination and advocacy, not unilateral disclosure decisions.
Q6: An RN is caring for four clients. Using the ABC priority framework, which
client should the nurse assess first?
A. A client with a blood pressure of 160/90 mmHg reporting a headache.
B. A client with COPD whose pulse oximetry reads 88% on room air.
[CORRECT]
C. A client with diabetes whose blood glucose is 250 mg/dL and is anxious.
D. A client with a urinary catheter producing cloudy, foul-smelling urine.
Correct Answer: B
Rationale:
The ABC framework prioritizes Airway, Breathing, and Circulation. An SpO2 of 88% indicates
severe hypoxemia requiring immediate intervention—apply oxygen, assess respiratory status,
and notify the provider. While the hypertensive client with headache is concerning (possible
hypertensive crisis), breathing takes precedence. Hyperglycemia with anxiety and a
suspected UTI are important but lower priority than acute respiratory compromise. The
nurse addresses life-threatening oxygenation issues first, then moves to circulation and other
concerns.
Q7: A nurse is preparing to discharge a client with heart failure. The client
lives alone and states, 'I can't afford my medications.' Which action best
demonstrates case management and continuity of care?
A. Provide written medication instructions and document the client's statement.
B. Refer the client to social services for medication assistance programs before
discharge. [CORRECT]
C. Notify the provider to delay discharge until the client can afford medications.
D. Suggest the client skip doses if they cannot afford the full prescription.
Correct Answer: B
Confidential — For Educational Use Aligned with NCLEX-RN Test Plan & HESI Standards
Aligned with NCLEX-RN Test Plan & NGN Clinical Judgment Framework
HESI RN Exit Exam
Complete 200-Question Test Bank
NEWEST EDITION
Q & A with Detailed Rationales
Clinical Judgment • Prioritization • Delegation
Pharmacology • NGN Case Studies • Leadership
Section 1: Management of Care (Q1–35)
Section 2: Safety & Infection Control (Q36–50)
Section 3: Health Promotion & Maintenance (Q51–65)
Section 4: Psychosocial Integrity (Q66–85)
Section 5: Basic Care & Comfort (Q86–100)
Section 6: Pharmacological & Parenteral Therapies (Q101–120)
Section 7: Reduction of Risk Potential (Q121–140)
Section 8: Physiological Adaptation (Q141–165)
Section 9: Integrated Clinical Judgment / NGN (Q166–185)
Section 10: Leadership, Ethics & Professional Practice (Q186–200)
Complete Document for HESI Preparation
200 Questions | 10 Sections | Detailed Rationales
,HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 2
Section 1: Safe and Effective Care Environment -
Management of Care
Q1 - Q35 | Legal/Ethical Issues, Delegation, Client Rights, Advocacy, Case
Management, & Continuity of Care
Q1: A 78-year-old client with a terminal diagnosis signs a do-not-resuscitate
(DNR) order. Two days later, the client's spouse demands the nurse perform
CPR if the client arrests. Which action by the nurse reflects correct application
of client rights and ethical practice?
A. Contact the provider to rescind the DNR because the spouse is the legal next of kin.
B. Honor the client's signed DNR and explain to the spouse that the client's
autonomous decision takes precedence. [CORRECT]
C. Initiate a code and call ethics committee afterward to resolve the conflict.
D. Ask the spouse to sign a countermanding form to override the client's DNR.
Correct Answer: B
Rationale:
A competent adult client's autonomous, informed decision to enact a DNR is legally and
ethically binding and supersedes family preferences. The nurse must honor the documented
DNR, provide therapeutic communication to the spouse, and involve palliative care or
chaplaincy as needed. Rescinding the DNR without the client's consent violates autonomy;
initiating CPR despite a valid DNR constitutes battery. Ethics consults are appropriate when
true ethical dilemmas exist, but here the path is clear: the client's documented wishes
govern.
Q2: An RN on a med-surg unit is assigned one LPN and one unlicensed assistive
personnel (UAP). Which task is most appropriate for the RN to delegate to the
LPN?
A. Reinforcing teaching for a newly diagnosed diabetic client on insulin
injection technique. [CORRECT]
B. Initial admission assessment of a client transferred from the ICU.
C. Developing the plan of care for a client with new-onset heart failure.
D. Receiving report on a freshly admitted post-op client.
Correct Answer: A
Rationale:
LPNs may reinforce existing teaching but cannot perform initial teaching, initial
assessments, or develop plans of care—these remain within the RN scope. Reinforcing insulin
injection technique is a stable, predictable task appropriate for LPN scope under RN
supervision. The RN must perform initial admission assessments and care plan development
because they require clinical judgment and synthesis of comprehensive data. Receiving the
Confidential — For Educational Use Aligned with NCLEX-RN Test Plan & HESI Standards
,HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 3
initial shift/handoff report on a newly admitted unstable client also requires RN-level
assessment.
Q3: A client scheduled for an elective cholecystectomy refuses to sign the
surgical consent, stating, 'I'm just not sure about this.' What is the nurse's
most appropriate response?
A. Notify the surgeon so consent can be obtained after the client is premedicated.
B. Explain the risks of delaying surgery and ask the client to sign anyway.
C. Notify the surgeon that the client has questions and ensure consent is
obtained without coercion before surgery. [CORRECT]
D. Document the refusal and proceed with preoperative preparation.
Correct Answer: C
Rationale:
Informed consent requires capacity, voluntariness, disclosure, comprehension, and
agreement. A client expressing doubt does not have adequate voluntariness or
comprehension to consent. The nurse must notify the surgeon so the surgeon can answer
questions and re-obtain consent without coercion. Premedicating before consent invalidates
it because sedation impairs capacity. Pressuring the client to sign is coercion, and
proceeding without consent is battery. The nurse's role is patient advocacy—protecting the
right to informed refusal.
Q4: A nurse discovers a colleague diverting narcotics from the Pyxis machine.
Which action demonstrates correct legal and ethical obligation?
A. Confront the colleague privately and ask them to seek treatment.
B. Report the observation to the nurse manager and document objectively.
[CORRECT]
C. Wait until a second incident occurs to confirm the pattern before reporting.
D. Notify the state board of nursing directly without informing facility leadership.
Correct Answer: B
Rationale:
Nurses have a legal and ethical duty to report impaired practice and diversion through the
chain of command, beginning with the nurse manager, while documenting factual, objective
observations. Immediate reporting protects patient safety and the impaired colleague from
harm. Confronting privately may enable continued diversion; waiting for repeated incidents
endangers patients. Direct reporting to the board without internal reporting bypasses
institutional due process—the board typically expects internal reporting first, though
mandatory reporting laws vary by state.
Q5: A client with metastatic cancer is confused and disoriented. The family
asks the nurse to withhold the diagnosis from the client, saying, 'It will only
upset them.' Which nursing action is most appropriate?
Confidential — For Educational Use Aligned with NCLEX-RN Test Plan & HESI Standards
, HESI RN Exit Exam 2026/2027 — Complete 200-Question Test Bank Page 4
A. Honor the family's request because the client is confused and family knows best.
B. Withhold information until the client is lucid, then assess what they want to know.
C. Tell the family the client has a right to know and disclose the diagnosis immediately.
D. Facilitate a family meeting with the provider and ethics committee to clarify
goals and disclosure preferences. [CORRECT]
Correct Answer: D
Rationale:
When capacity is in question and family requests nondisclosure, the nurse advocates by
facilitating a structured conversation involving the provider and, if needed, the ethics
committee. This respects cultural values, clarifies the client's decisional capacity, and aligns
with ethical principles of autonomy, beneficence, and nonmaleficence. Unilaterally honoring
the family's request violates autonomy if the client has moments of lucidity; immediate
disclosure without assessment may cause harm and ignores cultural context. The nurse's role
is coordination and advocacy, not unilateral disclosure decisions.
Q6: An RN is caring for four clients. Using the ABC priority framework, which
client should the nurse assess first?
A. A client with a blood pressure of 160/90 mmHg reporting a headache.
B. A client with COPD whose pulse oximetry reads 88% on room air.
[CORRECT]
C. A client with diabetes whose blood glucose is 250 mg/dL and is anxious.
D. A client with a urinary catheter producing cloudy, foul-smelling urine.
Correct Answer: B
Rationale:
The ABC framework prioritizes Airway, Breathing, and Circulation. An SpO2 of 88% indicates
severe hypoxemia requiring immediate intervention—apply oxygen, assess respiratory status,
and notify the provider. While the hypertensive client with headache is concerning (possible
hypertensive crisis), breathing takes precedence. Hyperglycemia with anxiety and a
suspected UTI are important but lower priority than acute respiratory compromise. The
nurse addresses life-threatening oxygenation issues first, then moves to circulation and other
concerns.
Q7: A nurse is preparing to discharge a client with heart failure. The client
lives alone and states, 'I can't afford my medications.' Which action best
demonstrates case management and continuity of care?
A. Provide written medication instructions and document the client's statement.
B. Refer the client to social services for medication assistance programs before
discharge. [CORRECT]
C. Notify the provider to delay discharge until the client can afford medications.
D. Suggest the client skip doses if they cannot afford the full prescription.
Correct Answer: B
Confidential — For Educational Use Aligned with NCLEX-RN Test Plan & HESI Standards
