,HESI RN Exit Exam Version 1 2026/2027 | 160
Verified Questions & Answers | Elsevier Next
Generation NCLEX NGN Prep | 6 Core
Domains | Instant Download | rated 100%
correct.
SECTION 1: SAFE AND EFFECTIVE CARE
ENVIRONMENT — MANAGEMENT OF CARE
(Questions 1–30)
1. A registered nurse is assigned to care for four patients on a
medical-surgical unit: a post-operative cholecystectomy patient who
is 4 hours out of surgery with stable vital signs, an elderly patient
with newly diagnosed heart failure awaiting discharge teaching, a
patient with type 2 diabetes mellitus reporting blood glucose of 65
mg/dL and feeling shaky, and a patient admitted yesterday for
pneumonia who has developed new-onset confusion and oxygen
saturation of 88% on room air. The nurse should prioritize
assessment of which patient first?
A) The post-operative cholecystectomy patient to ensure surgical site
integrity
B) The elderly heart failure patient to complete discharge education before
end of shift
C) The diabetic patient with hypoglycemia symptoms to provide rapid
glucose correction
D) The pneumonia patient with acute mental status change and hypoxemia
Correct Answer: D
Rationale: This patient demonstrates both neurological deterioration and
respiratory compromise, representing an immediate life-threatening
situation requiring urgent intervention per the ABC prioritization framework.
While hypoglycemia requires prompt treatment, the combination of altered
mental status and significant desaturation indicates potential respiratory
,failure or sepsis progression that takes precedence. HESI frequently tests
recognition of clinical deterioration patterns where multiple system
involvement elevates acuity above single-system concerns .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
2. The charge nurse on a busy telemetry unit receives report that
one RN called in sick, leaving three RNs and two LPNs to care for 24
patients. Among today's assignments are a patient receiving a fresh
blood transfusion who needs monitoring, a patient with complex
wound care requiring sterile dressing changes, a stable patient who
needs assistance with bathing and ambulation, and a patient
scheduled for discharge who requires comprehensive medication
education. Which task is most appropriate to delegate to the LPN?
A) Monitoring the patient during the blood transfusion and documenting vital
signs per protocol
B) Performing the sterile wound dressing change using aseptic technique
C) Assisting the stable patient with bathing, feeding, and progressive
ambulation
D) Providing comprehensive discharge medication education and written
instructions
Correct Answer: C
Rationale: LPN scope of practice includes assisting with activities of daily
living and basic mobility support for stable patients, which falls within routine
nursing care that does not require professional nursing judgment. Blood
transfusion monitoring involves ongoing assessment for adverse reactions
requiring RN-level critical thinking, sterile wound care demands advanced
clinical skills typically reserved for RNs, and discharge education represents
the teaching-coaching function that cannot be delegated per the Five Rights
of Delegation framework .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
, 3. A nurse is preparing to administer morning medications and
notices that the pharmacy sent furosemide 80 mg IV push instead of
the prescribed furosemide 40 mg oral tablet for a patient with
chronic heart failure. The nurse calls the pharmacy to clarify and is
told the physician changed the order yesterday evening but it was
not updated in the electronic health record. What is the nurse's best
initial action?
A) Administer the IV furosemide as sent since the pharmacy confirmed the
order change
B) Hold the medication and contact the prescribing physician to verify the
current order
C) Give the oral dose from the unit's automated dispensing cabinet while
waiting for clarification
D) Document the discrepancy and proceed with administration after noting
the communication
Correct Answer: B
Rationale: The nurse must verify any medication discrepancy directly with
the prescriber before administration because the Right Drug and Right Dose
principles require confirmation when orders conflict or seem inconsistent.
Administering a different route and dose without prescriber verification
violates medication safety standards. The pharmacy's verbal confirmation
does not substitute for direct prescriber verification in this scenario .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
4. A nurse witnesses a colleague documenting medications as given
that were not actually administered. Which action by the nurse is
MOST appropriate FIRST?
A) Report the colleague to the state Board of Nursing immediately
B) Discuss the observation directly with the colleague and encourage self-
reporting
C) Ignore the observation because it is not the nurse's responsibility
D) Document the discrepancy in the patient's chart and notify the provider
Correct Answer: B
Rationale: The most appropriate first step is to address the issue directly
with the colleague and encourage self-reporting through the chain of
Verified Questions & Answers | Elsevier Next
Generation NCLEX NGN Prep | 6 Core
Domains | Instant Download | rated 100%
correct.
SECTION 1: SAFE AND EFFECTIVE CARE
ENVIRONMENT — MANAGEMENT OF CARE
(Questions 1–30)
1. A registered nurse is assigned to care for four patients on a
medical-surgical unit: a post-operative cholecystectomy patient who
is 4 hours out of surgery with stable vital signs, an elderly patient
with newly diagnosed heart failure awaiting discharge teaching, a
patient with type 2 diabetes mellitus reporting blood glucose of 65
mg/dL and feeling shaky, and a patient admitted yesterday for
pneumonia who has developed new-onset confusion and oxygen
saturation of 88% on room air. The nurse should prioritize
assessment of which patient first?
A) The post-operative cholecystectomy patient to ensure surgical site
integrity
B) The elderly heart failure patient to complete discharge education before
end of shift
C) The diabetic patient with hypoglycemia symptoms to provide rapid
glucose correction
D) The pneumonia patient with acute mental status change and hypoxemia
Correct Answer: D
Rationale: This patient demonstrates both neurological deterioration and
respiratory compromise, representing an immediate life-threatening
situation requiring urgent intervention per the ABC prioritization framework.
While hypoglycemia requires prompt treatment, the combination of altered
mental status and significant desaturation indicates potential respiratory
,failure or sepsis progression that takes precedence. HESI frequently tests
recognition of clinical deterioration patterns where multiple system
involvement elevates acuity above single-system concerns .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
2. The charge nurse on a busy telemetry unit receives report that
one RN called in sick, leaving three RNs and two LPNs to care for 24
patients. Among today's assignments are a patient receiving a fresh
blood transfusion who needs monitoring, a patient with complex
wound care requiring sterile dressing changes, a stable patient who
needs assistance with bathing and ambulation, and a patient
scheduled for discharge who requires comprehensive medication
education. Which task is most appropriate to delegate to the LPN?
A) Monitoring the patient during the blood transfusion and documenting vital
signs per protocol
B) Performing the sterile wound dressing change using aseptic technique
C) Assisting the stable patient with bathing, feeding, and progressive
ambulation
D) Providing comprehensive discharge medication education and written
instructions
Correct Answer: C
Rationale: LPN scope of practice includes assisting with activities of daily
living and basic mobility support for stable patients, which falls within routine
nursing care that does not require professional nursing judgment. Blood
transfusion monitoring involves ongoing assessment for adverse reactions
requiring RN-level critical thinking, sterile wound care demands advanced
clinical skills typically reserved for RNs, and discharge education represents
the teaching-coaching function that cannot be delegated per the Five Rights
of Delegation framework .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
, 3. A nurse is preparing to administer morning medications and
notices that the pharmacy sent furosemide 80 mg IV push instead of
the prescribed furosemide 40 mg oral tablet for a patient with
chronic heart failure. The nurse calls the pharmacy to clarify and is
told the physician changed the order yesterday evening but it was
not updated in the electronic health record. What is the nurse's best
initial action?
A) Administer the IV furosemide as sent since the pharmacy confirmed the
order change
B) Hold the medication and contact the prescribing physician to verify the
current order
C) Give the oral dose from the unit's automated dispensing cabinet while
waiting for clarification
D) Document the discrepancy and proceed with administration after noting
the communication
Correct Answer: B
Rationale: The nurse must verify any medication discrepancy directly with
the prescriber before administration because the Right Drug and Right Dose
principles require confirmation when orders conflict or seem inconsistent.
Administering a different route and dose without prescriber verification
violates medication safety standards. The pharmacy's verbal confirmation
does not substitute for direct prescriber verification in this scenario .
Source: HESI RN Exit Exam V1, Section 1: Safe and Effective Care
Environment
4. A nurse witnesses a colleague documenting medications as given
that were not actually administered. Which action by the nurse is
MOST appropriate FIRST?
A) Report the colleague to the state Board of Nursing immediately
B) Discuss the observation directly with the colleague and encourage self-
reporting
C) Ignore the observation because it is not the nurse's responsibility
D) Document the discrepancy in the patient's chart and notify the provider
Correct Answer: B
Rationale: The most appropriate first step is to address the issue directly
with the colleague and encourage self-reporting through the chain of
