HESI PN Exit Exam V1-7 Practice Nursing Diploma,
Vancouver Island University (2025/2026) – Actual NGN
Format with Verified Questions and 100% Correct Answer
Keys
CORE DOMAINS
Safe and Effective Care Environment: Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity: Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
NGN Case Studies & Clinical Judgment
INTRODUCTION
This comprehensive practice examination is designed for practical nursing
students preparing for the HESI PN Exit Exam at Vancouver Island
University. It contains approximately 250 original practice questions
organized across seven versions (V1–V7), aligned with the NCLEX-PN
Test Plan and the NCSBN Clinical Judgment Measurement Model (CJM).
Each version covers the nine core domains of PN practice: Management of
Care, Safety and Infection Control, Health Promotion, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction
of Risk Potential, Physiological Adaptation, and NGN Case Studies.
Questions are formatted in NGN style, including multiple-choice, select-all-
that-apply (SATA), and unfolding case studies. Every question includes a
detailed rationale grounded in evidence-based PN practice. These are
original practice questions created for study purposes and are not derived
from any proprietary examination. Emphasis is placed on clinical judgment,
prioritization, delegation, and safe decision-making in real-world practical
nursing scenarios.
VERSION 1 – QUESTIONS 1–40
,1. The practical nurse (PN) is preparing to delegate morning care for
four assigned clients. Which client should the PN retain rather than
assign to the unlicensed assistive personnel (UAP)?
A. A 72-year-old client with a stage II pressure injury requiring dressing
reinforcement
B. A client who is 2 days post-op with a PCA pump and last rated pain at
3/10
C. A stable client on contact precautions for Clostridioides difficile requiring
a linen change
D. A client with a new onset of confusion and an unwitnessed fall during the
night
D. A client with a new onset of confusion and an unwitnessed fall during
the night
RATIONALE: The PN must retain care for the client with new-onset
confusion and an unwitnessed fall because this client requires ongoing
neurological assessment, fall reassessment, and possible escalation to the
RN—tasks outside UAP scope. Option A is appropriate for UAP after the
LPN reinforces the dressing. Option B's stable PCA client can have basic
care delegated. Option C's contact-precaution client can be cared for by
UAP with proper PPE training. Delegation decisions hinge on client stability,
predictability, and required clinical judgment.
2. A client scheduled for an elective cholecystectomy refuses to sign
the operative consent after the surgeon has explained the risks. The
client states, "I want to think about it more." What is the PN's most
appropriate action?
A. Remind the client that the surgery is scheduled and encourage signing
to avoid delays
B. Notify the surgeon and document the client's verbal refusal and stated
reason
C. Explain the risks again using simpler language to ensure the client
understands
,D. Sign the consent as a witness to acknowledge the client's decision-
making capacity
B. Notify the surgeon and document the client's verbal refusal and
stated reason
RATIONALE: Informed consent is the surgeon's legal responsibility, and
the client has the absolute right to refuse even after explanation. The PN
must notify the surgeon of the refusal and document the client's verbal
refusal and stated reason. Option A is coercive. Option C exceeds the PN
scope. Option D is inappropriate—the PN should never sign consent on
behalf of the client.
3. A PN is caring for a client who has a living will that states the client
does not want CPR. The client experiences cardiac arrest. What
should the PN do?
A. Initiate CPR immediately
B. Honor the living will and withhold CPR
C. Call the family to confirm the living will
D. Consult the ethics committee before acting
B. Honor the living will and withhold CPR
RATIONALE: A living will is a legal document that specifies the client's
wishes for end-of-life care. The PN must honor the client's wishes, even if
the family disagrees. The PN should notify the provider and document the
situation.
4. A PN is assigned to care for four clients. Which client should the
PN assess FIRST using the ABCDE framework?
A. A client requesting pain medication for a headache
B. A client with new onset of drooling and difficulty swallowing
C. A client who needs assistance ambulating to the bathroom
D. A client due for a scheduled antibiotic dose
B. A client with new onset of drooling and difficulty swallowing
RATIONALE: Drooling and difficulty swallowing indicate a potential
, airway obstruction, which is an immediate threat to the airway (A in
ABCDE). This requires immediate assessment and intervention.
5. A PN is triaging clients following a mass casualty event. Which
client should be categorized as RED (immediate)?
A. A client with a simple fracture of the radius who is ambulatory
B. A client with an open pneumothorax and respiratory distress
C. A client with a minor laceration requiring sutures
D. A client with a contusion who is able to follow commands
B. A client with an open pneumothorax and respiratory distress
RATIONALE: In disaster triage, RED (immediate) clients require life-
saving intervention within minutes. Open pneumothorax with respiratory
distress is a life-threatening emergency requiring immediate chest
decompression.
6. A PN is caring for a client who is refusing a prescribed blood
transfusion. The client is competent and has been informed of the
risks. Which action should the PN take?
A. Administer the transfusion despite the client's refusal
B. Respect the client's right to refuse and document the refusal
C. Ask the family to convince the client to accept the transfusion
D. Notify the provider and request a court order
B. Respect the client's right to refuse and document the refusal
RATIONALE: A competent client has the right to refuse any treatment,
even if it is life-saving. The PN must respect the client's autonomy,
document the refusal, and notify the provider.
7. A PN is reviewing a client's medical record and discovers that the
client has a documented allergy to penicillin. The provider has
prescribed amoxicillin. Which action should the PN take?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
Vancouver Island University (2025/2026) – Actual NGN
Format with Verified Questions and 100% Correct Answer
Keys
CORE DOMAINS
Safe and Effective Care Environment: Management of Care
Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity: Basic Care and Comfort
Pharmacological and Parenteral Therapies
Reduction of Risk Potential
Physiological Adaptation
NGN Case Studies & Clinical Judgment
INTRODUCTION
This comprehensive practice examination is designed for practical nursing
students preparing for the HESI PN Exit Exam at Vancouver Island
University. It contains approximately 250 original practice questions
organized across seven versions (V1–V7), aligned with the NCLEX-PN
Test Plan and the NCSBN Clinical Judgment Measurement Model (CJM).
Each version covers the nine core domains of PN practice: Management of
Care, Safety and Infection Control, Health Promotion, Psychosocial
Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction
of Risk Potential, Physiological Adaptation, and NGN Case Studies.
Questions are formatted in NGN style, including multiple-choice, select-all-
that-apply (SATA), and unfolding case studies. Every question includes a
detailed rationale grounded in evidence-based PN practice. These are
original practice questions created for study purposes and are not derived
from any proprietary examination. Emphasis is placed on clinical judgment,
prioritization, delegation, and safe decision-making in real-world practical
nursing scenarios.
VERSION 1 – QUESTIONS 1–40
,1. The practical nurse (PN) is preparing to delegate morning care for
four assigned clients. Which client should the PN retain rather than
assign to the unlicensed assistive personnel (UAP)?
A. A 72-year-old client with a stage II pressure injury requiring dressing
reinforcement
B. A client who is 2 days post-op with a PCA pump and last rated pain at
3/10
C. A stable client on contact precautions for Clostridioides difficile requiring
a linen change
D. A client with a new onset of confusion and an unwitnessed fall during the
night
D. A client with a new onset of confusion and an unwitnessed fall during
the night
RATIONALE: The PN must retain care for the client with new-onset
confusion and an unwitnessed fall because this client requires ongoing
neurological assessment, fall reassessment, and possible escalation to the
RN—tasks outside UAP scope. Option A is appropriate for UAP after the
LPN reinforces the dressing. Option B's stable PCA client can have basic
care delegated. Option C's contact-precaution client can be cared for by
UAP with proper PPE training. Delegation decisions hinge on client stability,
predictability, and required clinical judgment.
2. A client scheduled for an elective cholecystectomy refuses to sign
the operative consent after the surgeon has explained the risks. The
client states, "I want to think about it more." What is the PN's most
appropriate action?
A. Remind the client that the surgery is scheduled and encourage signing
to avoid delays
B. Notify the surgeon and document the client's verbal refusal and stated
reason
C. Explain the risks again using simpler language to ensure the client
understands
,D. Sign the consent as a witness to acknowledge the client's decision-
making capacity
B. Notify the surgeon and document the client's verbal refusal and
stated reason
RATIONALE: Informed consent is the surgeon's legal responsibility, and
the client has the absolute right to refuse even after explanation. The PN
must notify the surgeon of the refusal and document the client's verbal
refusal and stated reason. Option A is coercive. Option C exceeds the PN
scope. Option D is inappropriate—the PN should never sign consent on
behalf of the client.
3. A PN is caring for a client who has a living will that states the client
does not want CPR. The client experiences cardiac arrest. What
should the PN do?
A. Initiate CPR immediately
B. Honor the living will and withhold CPR
C. Call the family to confirm the living will
D. Consult the ethics committee before acting
B. Honor the living will and withhold CPR
RATIONALE: A living will is a legal document that specifies the client's
wishes for end-of-life care. The PN must honor the client's wishes, even if
the family disagrees. The PN should notify the provider and document the
situation.
4. A PN is assigned to care for four clients. Which client should the
PN assess FIRST using the ABCDE framework?
A. A client requesting pain medication for a headache
B. A client with new onset of drooling and difficulty swallowing
C. A client who needs assistance ambulating to the bathroom
D. A client due for a scheduled antibiotic dose
B. A client with new onset of drooling and difficulty swallowing
RATIONALE: Drooling and difficulty swallowing indicate a potential
, airway obstruction, which is an immediate threat to the airway (A in
ABCDE). This requires immediate assessment and intervention.
5. A PN is triaging clients following a mass casualty event. Which
client should be categorized as RED (immediate)?
A. A client with a simple fracture of the radius who is ambulatory
B. A client with an open pneumothorax and respiratory distress
C. A client with a minor laceration requiring sutures
D. A client with a contusion who is able to follow commands
B. A client with an open pneumothorax and respiratory distress
RATIONALE: In disaster triage, RED (immediate) clients require life-
saving intervention within minutes. Open pneumothorax with respiratory
distress is a life-threatening emergency requiring immediate chest
decompression.
6. A PN is caring for a client who is refusing a prescribed blood
transfusion. The client is competent and has been informed of the
risks. Which action should the PN take?
A. Administer the transfusion despite the client's refusal
B. Respect the client's right to refuse and document the refusal
C. Ask the family to convince the client to accept the transfusion
D. Notify the provider and request a court order
B. Respect the client's right to refuse and document the refusal
RATIONALE: A competent client has the right to refuse any treatment,
even if it is life-saving. The PN must respect the client's autonomy,
document the refusal, and notify the provider.
7. A PN is reviewing a client's medical record and discovers that the
client has a documented allergy to penicillin. The provider has
prescribed amoxicillin. Which action should the PN take?
A. Administer the medication as prescribed
B. Hold the medication and notify the provider
