HESI RN Exit Exam 2026/2027 | Practice
Questions, Answers & Detailed Rationales |
Complete Nursing Review
SECTION 1: MANAGEMENT OF CARE (Questions 1–24)
Question 1
Cognitive Level: Clinical Judgment
Difficulty: Moderate
Learning Objective: Prioritize client assessments using
Maslow's hierarchy and ABC framework.
A nurse receives shift report on four clients. Which client
should the nurse assess first?
A. A client with COPD reporting increased shortness of
breath, RR 28, SpO₂ 89% on 2 L nasal cannula
B. A client 2 days post-appendectomy requesting pain
medication for incisional pain rated 6/10
C. A client with diabetes requesting assistance with menu
selections
D. A client with a urinary tract infection awaiting discharge
prescriptions
Correct Answer: A
,Detailed Rationale:
The nurse must use airway-breathing-circulation (ABC)
prioritization. Client A demonstrates signs of respiratory
compromise: increased respiratory rate, subjective dyspnea,
and hypoxemia (SpO₂ 89% on oxygen). This is an immediate
threat to airway and breathing. The nurse must assess this
client first, likely increase oxygen and notify the provider.
Client B has acute pain, which is important but not
immediately life-threatening. Client C has a
nutritional/teaching need that can be addressed after
physiological needs. Client D is stable and awaiting
discharge—a psychosocial/resource need that is the lowest
priority.
Why Distractors Are Incorrect:
• B: Pain is a priority, but the ABC framework
supersedes comfort needs. The client is stable and not
showing signs of distress.
• C: Menu selection is a teaching/health promotion
activity that can safely wait.
• D: Discharge prescriptions are important for continuity
but do not require immediate nursing intervention.
Clinical Pearl: In prioritization questions, always ask: "Is
the client stable?" If any client has an airway, breathing, or
circulation issue, that client is the priority—regardless of
other clients' pain or discharge needs.
Question 2
,Cognitive Level: Analysis
Difficulty: Moderate
Learning Objective: Apply the five rights of delegation when
assigning tasks to unlicensed assistive personnel (UAP).
A charge nurse is delegating tasks to a UAP. Which task is
most appropriate to delegate?
A. Perform a focused respiratory assessment on a client with
new-onset dyspnea
B. Administer oral metformin to a stable client with diabetes
C. Assist a stable, post-operative client with ambulation to
the bathroom
D. Evaluate a client's understanding of a new insulin
regimen
Correct Answer: C
Detailed Rationale:
The five rights of delegation include right task, right
circumstance, right person, right direction/communication,
and right supervision. Ambulating a stable post-operative
client is a routine, predictable task within UAP scope when
the client is stable and the UAP has been given clear
instructions. Assessment, medication administration, and
patient education/evaluation are professional nursing
responsibilities that cannot be delegated to UAP.
Why Distractors Are Incorrect:
• A: Assessment is an RN responsibility and cannot be
delegated to UAP.
, • B: Medication administration requires a licensed nurse
(RN or LPN/LVN, depending on state scope).
• D: Evaluation of learning requires nursing judgment
and is not a delegated task.
Clinical Pearl: The RN never delegates assessment,
evaluation, teaching, or medication administration. UAP can
perform routine, stable, predictable tasks with supervision.
Question 3
Cognitive Level: Clinical Judgment
Difficulty: Hard
Learning Objective: Identify the priority action when a
provider's order appears unsafe.
A nurse is caring for a client with heart failure receiving
furosemide 80 mg IV push. The provider orders a second
dose of furosemide 80 mg IV push 2 hours after the first
dose. The client's most recent potassium level is 3.1 mEq/L.
What should the nurse do first?
A. Administer the medication as ordered because the
provider is aware of the potassium level
B. Hold the medication and notify the provider of the
critically low potassium level
C. Administer the medication and request a potassium
supplement
D. Ask the UAP to obtain a repeat potassium level before
administering
Questions, Answers & Detailed Rationales |
Complete Nursing Review
SECTION 1: MANAGEMENT OF CARE (Questions 1–24)
Question 1
Cognitive Level: Clinical Judgment
Difficulty: Moderate
Learning Objective: Prioritize client assessments using
Maslow's hierarchy and ABC framework.
A nurse receives shift report on four clients. Which client
should the nurse assess first?
A. A client with COPD reporting increased shortness of
breath, RR 28, SpO₂ 89% on 2 L nasal cannula
B. A client 2 days post-appendectomy requesting pain
medication for incisional pain rated 6/10
C. A client with diabetes requesting assistance with menu
selections
D. A client with a urinary tract infection awaiting discharge
prescriptions
Correct Answer: A
,Detailed Rationale:
The nurse must use airway-breathing-circulation (ABC)
prioritization. Client A demonstrates signs of respiratory
compromise: increased respiratory rate, subjective dyspnea,
and hypoxemia (SpO₂ 89% on oxygen). This is an immediate
threat to airway and breathing. The nurse must assess this
client first, likely increase oxygen and notify the provider.
Client B has acute pain, which is important but not
immediately life-threatening. Client C has a
nutritional/teaching need that can be addressed after
physiological needs. Client D is stable and awaiting
discharge—a psychosocial/resource need that is the lowest
priority.
Why Distractors Are Incorrect:
• B: Pain is a priority, but the ABC framework
supersedes comfort needs. The client is stable and not
showing signs of distress.
• C: Menu selection is a teaching/health promotion
activity that can safely wait.
• D: Discharge prescriptions are important for continuity
but do not require immediate nursing intervention.
Clinical Pearl: In prioritization questions, always ask: "Is
the client stable?" If any client has an airway, breathing, or
circulation issue, that client is the priority—regardless of
other clients' pain or discharge needs.
Question 2
,Cognitive Level: Analysis
Difficulty: Moderate
Learning Objective: Apply the five rights of delegation when
assigning tasks to unlicensed assistive personnel (UAP).
A charge nurse is delegating tasks to a UAP. Which task is
most appropriate to delegate?
A. Perform a focused respiratory assessment on a client with
new-onset dyspnea
B. Administer oral metformin to a stable client with diabetes
C. Assist a stable, post-operative client with ambulation to
the bathroom
D. Evaluate a client's understanding of a new insulin
regimen
Correct Answer: C
Detailed Rationale:
The five rights of delegation include right task, right
circumstance, right person, right direction/communication,
and right supervision. Ambulating a stable post-operative
client is a routine, predictable task within UAP scope when
the client is stable and the UAP has been given clear
instructions. Assessment, medication administration, and
patient education/evaluation are professional nursing
responsibilities that cannot be delegated to UAP.
Why Distractors Are Incorrect:
• A: Assessment is an RN responsibility and cannot be
delegated to UAP.
, • B: Medication administration requires a licensed nurse
(RN or LPN/LVN, depending on state scope).
• D: Evaluation of learning requires nursing judgment
and is not a delegated task.
Clinical Pearl: The RN never delegates assessment,
evaluation, teaching, or medication administration. UAP can
perform routine, stable, predictable tasks with supervision.
Question 3
Cognitive Level: Clinical Judgment
Difficulty: Hard
Learning Objective: Identify the priority action when a
provider's order appears unsafe.
A nurse is caring for a client with heart failure receiving
furosemide 80 mg IV push. The provider orders a second
dose of furosemide 80 mg IV push 2 hours after the first
dose. The client's most recent potassium level is 3.1 mEq/L.
What should the nurse do first?
A. Administer the medication as ordered because the
provider is aware of the potassium level
B. Hold the medication and notify the provider of the
critically low potassium level
C. Administer the medication and request a potassium
supplement
D. Ask the UAP to obtain a repeat potassium level before
administering
