COMPREHENSIVE RN EXIT-LEVEL PRACTICE EXAMINATION
HESI RN EXIT EXAM V1
2026/2027 Edition - Aligned with 2026-2027 HESI Testing Standards and the NCLEX-RN
Test Plan
QUESTIONS SECTIONS ITEM FORMAT COGNITIVE LEVELS
4 options, one best 25% recall / 50%
165 9 (Q1-Q165)
answer application / 25% analysis
CANDIDATE INSTRUCTIONS
1. This examination contains exactly 165 multiple-choice questions divided into nine blueprint sections, mirroring
the length and category weighting of the actual HESI RN Exit Examination.
2. Select the single best answer for each item. Each question is followed by the correct answer, marked
[CORRECT], and a detailed HESI-specific rationale that explains why the correct option is right and why each
distractor is wrong.
3. Content is weighted per the NCLEX-RN test plan: Management of Care and Pharmacology carry the heaviest
load, and Section 9 integrates NGN-style case studies built on the Clinical Judgment Measurement Model.
4. Recommended pacing: no more than 1.5 minutes per item during a first pass (about 4 hours total); review
rationales on a second pass, focusing on missed prioritization, delegation, and calculation items.
5. Rationales cite the governing safety principle - ABCs, least restrictive intervention, standard of care, or
evidence-based guidelines - so every missed item becomes a targeted study point.
SECTION 1
SAFE AND EFFECTIVE CARE ENVIRONMENT - Questions 1-30
MANAGEMENT OF CARE
Legal and ethical practice, informed consent, advance directives, HIPAA, mandatory reporting, delegation and supervision,
priority-setting frameworks, client rights, advocacy, case management, and continuity of care.
Q1. A client is scheduled for an open cholecystectomy in the morning. The surgeon has discussed the
procedure and its risks with the client, and the client states, "I understand they will take out my gallbladder
through a cut in my belly." Which action should the nurse take next?
A. Explain the risks of anesthesia because the surgeon is busy
B. Witness the client's signature on the consent form [CORRECT]
C. Hold the consent form until the client's family arrives
D. Cancel the procedure because the client is confused
Correct Answer: B
Rationale: The nurse's legal role in informed consent is to verify and document that the client understands the
procedure, and then witness the client's signature. The client restated the procedure accurately, which confirms
1
,HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
understanding, so witnessing the signature is the appropriate next step. Explaining the risks is the provider's
responsibility, and the nurse who explains the procedure assumes legal liability for the consent. Holding the form for
family is unnecessary because a competent adult client signs his or her own consent. There is no indication of
confusion; the client restated the procedure correctly, so cancellation is unwarranted.
Q2. A preoperative client who received midazolam 20 minutes ago states to the nurse, "I never really
understood what the surgeon said about my operation, but I signed the form anyway." Which action should
the nurse take?
A. Reassure the client that the form already signed is legally valid
B. Teach the client about the procedure and document the teaching
C. Ask the circulating nurse to explain the procedure instead
D. Contact the surgeon to return and re-explain the procedure [CORRECT]
Correct Answer: D
Rationale: Informed consent obtained from a client who has received sedation is not legally valid, and the client has
now voiced a lack of understanding, which indicates informed consent was never truly given. The nurse must notify
the surgeon, because only the person performing the procedure may provide the explanation and obtain valid
consent. Reassuring the client that the signed form is valid ignores both the sedation and the client's statement,
creating serious legal risk. The nurse may reinforce, but not replace, the provider's explanation, and teaching does
not substitute for the surgeon's informed-consent discussion. Delegating the explanation to another nurse does not
meet the legal requirement that the provider performing the procedure obtains the consent.
Q3. A client with progressive dementia completed a durable power of attorney for health care (healthcare
proxy) three years ago while still competent. The client is now unable to make decisions and requires
emergency surgery. Who should provide consent for the procedure?
A. The person named as healthcare proxy in the advance directive [CORRECT]
B. The client's oldest adult child who lives in another state
C. The client's primary care provider who knows the history
D. The court-appointed public guardian for the county
Correct Answer: A
Rationale: A durable power of attorney for health care designates an agent who legally assumes decision-making
authority when the client loses capacity, and this document remains in effect despite the client's current dementia.
The appointed proxy, not family members by birth order, holds the legal authority to consent, so the adult child has
no automatic standing over the designated agent. The primary care provider provides medical information but
cannot legally consent on the client's behalf. A court-appointed guardian is used only when no valid advance
directive or surrogate exists, and activating that process would cause dangerous treatment delays in an emergency.
Q4. A nurse on a medical unit receives a phone call from a person who says, "I am the neighbor of Jane Doe,
who I heard was admitted here after her fall. Can you tell me her room number and how she is doing?"
Which response by the nurse is correct?
A. Confirm the admission but state that the room number is confidential
B. Provide only general information about the client's condition
C. State that the nurse cannot confirm whether the client is admitted [CORRECT]
D. Transfer the call to the client's room so they can speak directly
Correct Answer: C
NCLEX-RN Test Plan Aligned 2
,HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
Rationale: HIPAA prohibits disclosing any information, including the mere fact of admission, to callers who cannot
be verified as authorized to receive protected health information. The correct action is to neither confirm nor deny
the admission and to offer to take a message or transfer the caller to the appropriate business office where
authorization can be verified. Admitting the client is hospitalized, even without giving details, is a breach of
confidentiality. Sharing a general condition statement such as stable or critical is permitted only through a formally
established facility code system with verified callers, not to an unverified caller. Transferring the call to the room
would allow an unauthorized person to reach the client's bedside, violating privacy and creating a safety risk.
Q5. A nurse observes a colleague using a personal smartphone to photograph a client's extensive sacral
wound, and later sees the image posted on a public social media account. Which action should the nurse take
first?
A. Ignore the post because the image did not include the client's name
B. Report the colleague's actions to the nurse manager immediately [CORRECT]
C. Confront the colleague and demand the post be deleted at once
D. Wait to see whether anyone comments on the post before acting
Correct Answer: B
Rationale: Photographing a client with a personal device and posting the image on social media is a serious HIPAA
violation even when the name is not visible, because wounds, room details, and identifiers may still be recognized.
The obligation to protect client privacy requires immediate escalation to the nurse manager so the facility can begin
its investigation and mitigate harm. Ignoring the post makes the observing nurse complicit in the breach, since the
violation is objectively present regardless of comments. While direct confrontation is tempting, the priority is formal
reporting so that authorized personnel can secure removal of the image and preserve evidence. Delaying action to
monitor the post allows continued exposure of protected health information and undermines the culture of safety.
Q6. While bathing a 4-year-old, a home health nurse notes bruises of various ages on the child's back and
buttocks, and the parent's explanation of the injury is inconsistent with the findings. Which action should the
nurse take?
A. Notify the supervising physician of the findings only
B. Ask the parent to sign a statement denying any abuse
C. Report the suspected abuse to the designated state agency [CORRECT]
D. Schedule a follow-up visit to monitor the child at home
Correct Answer: C
Rationale: Nurses are mandated reporters, and state law requires a direct report of suspected child abuse to the
child protective services agency or state hotline when assessment findings and an inconsistent history raise suspicion.
The legal duty to report is independent of certainty; the nurse needs only reasonable suspicion, not proof, and does
not need parental permission. Notifying only the physician does not fulfill the nurse's personal legal obligation,
because responsibility cannot be transferred to another professional. Obtaining a denial statement is inappropriate
and may intimidate the family, and waiting for a follow-up visit leaves a potentially endangered child in an unsafe
environment.
NCLEX-RN Test Plan Aligned 3
, HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
Q7. A visiting nurse finds a 78-year-old client with severe dehydration, multiple bruises in various stages of
healing, and poor hygiene. The client's caregiver, who is present, answers all questions for the client and
refuses to leave the room. Which action should the nurse take first?
A. Confront the caregiver privately about possible mistreatment
B. Contact adult protective services to report suspected elder abuse [CORRECT]
C. Leave contact information and return next week to reassess
D. Administer IV fluids before pursuing any further action
Correct Answer: B
Rationale: The clinical picture of dehydration, multiple bruises of different ages, poor hygiene, caregiver control of
communication, and refusal to allow private conversation constitutes reasonable suspicion of elder abuse, which
triggers the nurse's mandatory duty to report to adult protective services. Reporting must occur promptly because the
client remains in the potentially abusive environment. Confronting the caregiver may escalate danger for the client
and compromise the investigation, which is conducted by trained protective services personnel. Delaying the report
until a return visit abandons the client to continued risk, and although treatment of dehydration is needed, the
mandatory report is the priority nursing action that legal statutes impose regardless of medical care.
Q8. The nurse is planning care for a stable postoperative client on a surgical unit. Which task is appropriate
for the nurse to delegate to the unlicensed assistive personnel (UAP)?
A. Evaluate the client's pain after receiving the first dose of morphine
B. Teach the client how to perform incentive spirometry correctly
C. Ambulate the client in the hallway twice during the shift [CORRECT]
D. Assess the client's surgical incision for signs of infection
Correct Answer: C
Rationale: Ambulating a stable client is a routine, noninvasive activity with predictable outcomes that falls within
the UAP's scope when the nurse has determined the client is stable and provided clear directions about distance and
reporting parameters. Evaluating pain responses requires nursing judgment because assessment and interpretation of
findings are RN responsibilities that cannot be delegated. Client teaching is an RN function, although the LPN may
reinforce previously taught content. Incision assessment involves clinical interpretation of wound findings, which
requires licensed nursing assessment and is outside the UAP's legal scope of practice.
Q9. A registered nurse (RN) is working with a licensed practical nurse (LPN) and a nursing assistant on a
busy medical-surgical unit. Which client should the RN assign to the LPN?
A. A client admitted 2 hours ago with unexplained syncope
B. A stable client who needs scheduled oral antibiotics and wound care [CORRECT]
C. A client newly diagnosed with diabetes who needs discharge teaching
D. A client returned from the post-anesthesia unit 1 hour ago
Correct Answer: B
Rationale: The LPN's scope includes administering scheduled oral medications and performing stable wound care
under RN supervision, making the stable client with predictable needs the correct assignment. The client with
unexplained syncope requires initial assessment, diagnostic interpretation, and clinical judgment, all of which are
RN responsibilities. Discharge teaching for a new diagnosis is an RN function because it requires evaluation of
learning needs and outcomes, although the LPN may later reinforce the content. A client just returned from the
post-anesthesia unit requires ongoing assessments and detection of unstable postoperative complications, which must
remain with the RN.
NCLEX-RN Test Plan Aligned 4
HESI RN EXIT EXAM V1
2026/2027 Edition - Aligned with 2026-2027 HESI Testing Standards and the NCLEX-RN
Test Plan
QUESTIONS SECTIONS ITEM FORMAT COGNITIVE LEVELS
4 options, one best 25% recall / 50%
165 9 (Q1-Q165)
answer application / 25% analysis
CANDIDATE INSTRUCTIONS
1. This examination contains exactly 165 multiple-choice questions divided into nine blueprint sections, mirroring
the length and category weighting of the actual HESI RN Exit Examination.
2. Select the single best answer for each item. Each question is followed by the correct answer, marked
[CORRECT], and a detailed HESI-specific rationale that explains why the correct option is right and why each
distractor is wrong.
3. Content is weighted per the NCLEX-RN test plan: Management of Care and Pharmacology carry the heaviest
load, and Section 9 integrates NGN-style case studies built on the Clinical Judgment Measurement Model.
4. Recommended pacing: no more than 1.5 minutes per item during a first pass (about 4 hours total); review
rationales on a second pass, focusing on missed prioritization, delegation, and calculation items.
5. Rationales cite the governing safety principle - ABCs, least restrictive intervention, standard of care, or
evidence-based guidelines - so every missed item becomes a targeted study point.
SECTION 1
SAFE AND EFFECTIVE CARE ENVIRONMENT - Questions 1-30
MANAGEMENT OF CARE
Legal and ethical practice, informed consent, advance directives, HIPAA, mandatory reporting, delegation and supervision,
priority-setting frameworks, client rights, advocacy, case management, and continuity of care.
Q1. A client is scheduled for an open cholecystectomy in the morning. The surgeon has discussed the
procedure and its risks with the client, and the client states, "I understand they will take out my gallbladder
through a cut in my belly." Which action should the nurse take next?
A. Explain the risks of anesthesia because the surgeon is busy
B. Witness the client's signature on the consent form [CORRECT]
C. Hold the consent form until the client's family arrives
D. Cancel the procedure because the client is confused
Correct Answer: B
Rationale: The nurse's legal role in informed consent is to verify and document that the client understands the
procedure, and then witness the client's signature. The client restated the procedure accurately, which confirms
1
,HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
understanding, so witnessing the signature is the appropriate next step. Explaining the risks is the provider's
responsibility, and the nurse who explains the procedure assumes legal liability for the consent. Holding the form for
family is unnecessary because a competent adult client signs his or her own consent. There is no indication of
confusion; the client restated the procedure correctly, so cancellation is unwarranted.
Q2. A preoperative client who received midazolam 20 minutes ago states to the nurse, "I never really
understood what the surgeon said about my operation, but I signed the form anyway." Which action should
the nurse take?
A. Reassure the client that the form already signed is legally valid
B. Teach the client about the procedure and document the teaching
C. Ask the circulating nurse to explain the procedure instead
D. Contact the surgeon to return and re-explain the procedure [CORRECT]
Correct Answer: D
Rationale: Informed consent obtained from a client who has received sedation is not legally valid, and the client has
now voiced a lack of understanding, which indicates informed consent was never truly given. The nurse must notify
the surgeon, because only the person performing the procedure may provide the explanation and obtain valid
consent. Reassuring the client that the signed form is valid ignores both the sedation and the client's statement,
creating serious legal risk. The nurse may reinforce, but not replace, the provider's explanation, and teaching does
not substitute for the surgeon's informed-consent discussion. Delegating the explanation to another nurse does not
meet the legal requirement that the provider performing the procedure obtains the consent.
Q3. A client with progressive dementia completed a durable power of attorney for health care (healthcare
proxy) three years ago while still competent. The client is now unable to make decisions and requires
emergency surgery. Who should provide consent for the procedure?
A. The person named as healthcare proxy in the advance directive [CORRECT]
B. The client's oldest adult child who lives in another state
C. The client's primary care provider who knows the history
D. The court-appointed public guardian for the county
Correct Answer: A
Rationale: A durable power of attorney for health care designates an agent who legally assumes decision-making
authority when the client loses capacity, and this document remains in effect despite the client's current dementia.
The appointed proxy, not family members by birth order, holds the legal authority to consent, so the adult child has
no automatic standing over the designated agent. The primary care provider provides medical information but
cannot legally consent on the client's behalf. A court-appointed guardian is used only when no valid advance
directive or surrogate exists, and activating that process would cause dangerous treatment delays in an emergency.
Q4. A nurse on a medical unit receives a phone call from a person who says, "I am the neighbor of Jane Doe,
who I heard was admitted here after her fall. Can you tell me her room number and how she is doing?"
Which response by the nurse is correct?
A. Confirm the admission but state that the room number is confidential
B. Provide only general information about the client's condition
C. State that the nurse cannot confirm whether the client is admitted [CORRECT]
D. Transfer the call to the client's room so they can speak directly
Correct Answer: C
NCLEX-RN Test Plan Aligned 2
,HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
Rationale: HIPAA prohibits disclosing any information, including the mere fact of admission, to callers who cannot
be verified as authorized to receive protected health information. The correct action is to neither confirm nor deny
the admission and to offer to take a message or transfer the caller to the appropriate business office where
authorization can be verified. Admitting the client is hospitalized, even without giving details, is a breach of
confidentiality. Sharing a general condition statement such as stable or critical is permitted only through a formally
established facility code system with verified callers, not to an unverified caller. Transferring the call to the room
would allow an unauthorized person to reach the client's bedside, violating privacy and creating a safety risk.
Q5. A nurse observes a colleague using a personal smartphone to photograph a client's extensive sacral
wound, and later sees the image posted on a public social media account. Which action should the nurse take
first?
A. Ignore the post because the image did not include the client's name
B. Report the colleague's actions to the nurse manager immediately [CORRECT]
C. Confront the colleague and demand the post be deleted at once
D. Wait to see whether anyone comments on the post before acting
Correct Answer: B
Rationale: Photographing a client with a personal device and posting the image on social media is a serious HIPAA
violation even when the name is not visible, because wounds, room details, and identifiers may still be recognized.
The obligation to protect client privacy requires immediate escalation to the nurse manager so the facility can begin
its investigation and mitigate harm. Ignoring the post makes the observing nurse complicit in the breach, since the
violation is objectively present regardless of comments. While direct confrontation is tempting, the priority is formal
reporting so that authorized personnel can secure removal of the image and preserve evidence. Delaying action to
monitor the post allows continued exposure of protected health information and undermines the culture of safety.
Q6. While bathing a 4-year-old, a home health nurse notes bruises of various ages on the child's back and
buttocks, and the parent's explanation of the injury is inconsistent with the findings. Which action should the
nurse take?
A. Notify the supervising physician of the findings only
B. Ask the parent to sign a statement denying any abuse
C. Report the suspected abuse to the designated state agency [CORRECT]
D. Schedule a follow-up visit to monitor the child at home
Correct Answer: C
Rationale: Nurses are mandated reporters, and state law requires a direct report of suspected child abuse to the
child protective services agency or state hotline when assessment findings and an inconsistent history raise suspicion.
The legal duty to report is independent of certainty; the nurse needs only reasonable suspicion, not proof, and does
not need parental permission. Notifying only the physician does not fulfill the nurse's personal legal obligation,
because responsibility cannot be transferred to another professional. Obtaining a denial statement is inappropriate
and may intimidate the family, and waiting for a follow-up visit leaves a potentially endangered child in an unsafe
environment.
NCLEX-RN Test Plan Aligned 3
, HESI RN EXIT EXAM V1 - 2026/2027 Edition 165-Question Comprehensive Practice Examination
Q7. A visiting nurse finds a 78-year-old client with severe dehydration, multiple bruises in various stages of
healing, and poor hygiene. The client's caregiver, who is present, answers all questions for the client and
refuses to leave the room. Which action should the nurse take first?
A. Confront the caregiver privately about possible mistreatment
B. Contact adult protective services to report suspected elder abuse [CORRECT]
C. Leave contact information and return next week to reassess
D. Administer IV fluids before pursuing any further action
Correct Answer: B
Rationale: The clinical picture of dehydration, multiple bruises of different ages, poor hygiene, caregiver control of
communication, and refusal to allow private conversation constitutes reasonable suspicion of elder abuse, which
triggers the nurse's mandatory duty to report to adult protective services. Reporting must occur promptly because the
client remains in the potentially abusive environment. Confronting the caregiver may escalate danger for the client
and compromise the investigation, which is conducted by trained protective services personnel. Delaying the report
until a return visit abandons the client to continued risk, and although treatment of dehydration is needed, the
mandatory report is the priority nursing action that legal statutes impose regardless of medical care.
Q8. The nurse is planning care for a stable postoperative client on a surgical unit. Which task is appropriate
for the nurse to delegate to the unlicensed assistive personnel (UAP)?
A. Evaluate the client's pain after receiving the first dose of morphine
B. Teach the client how to perform incentive spirometry correctly
C. Ambulate the client in the hallway twice during the shift [CORRECT]
D. Assess the client's surgical incision for signs of infection
Correct Answer: C
Rationale: Ambulating a stable client is a routine, noninvasive activity with predictable outcomes that falls within
the UAP's scope when the nurse has determined the client is stable and provided clear directions about distance and
reporting parameters. Evaluating pain responses requires nursing judgment because assessment and interpretation of
findings are RN responsibilities that cannot be delegated. Client teaching is an RN function, although the LPN may
reinforce previously taught content. Incision assessment involves clinical interpretation of wound findings, which
requires licensed nursing assessment and is outside the UAP's legal scope of practice.
Q9. A registered nurse (RN) is working with a licensed practical nurse (LPN) and a nursing assistant on a
busy medical-surgical unit. Which client should the RN assign to the LPN?
A. A client admitted 2 hours ago with unexplained syncope
B. A stable client who needs scheduled oral antibiotics and wound care [CORRECT]
C. A client newly diagnosed with diabetes who needs discharge teaching
D. A client returned from the post-anesthesia unit 1 hour ago
Correct Answer: B
Rationale: The LPN's scope includes administering scheduled oral medications and performing stable wound care
under RN supervision, making the stable client with predictable needs the correct assignment. The client with
unexplained syncope requires initial assessment, diagnostic interpretation, and clinical judgment, all of which are
RN responsibilities. Discharge teaching for a new diagnosis is an RN function because it requires evaluation of
learning needs and outcomes, although the LPN may later reinforce the content. A client just returned from the
post-anesthesia unit requires ongoing assessments and detection of unstable postoperative complications, which must
remain with the RN.
NCLEX-RN Test Plan Aligned 4
