pg. 1
,Fundamentals HESI Exit Exam Practice Examination
Note: This is an original, comprehensive practice examination based on the published test blueprint
domains for the HESI Fundamentals Exit Exam. It is not an official Elsevier product, and the questions
are not sourced from any actual HESI exam or proprietary test bank. The examination covers the
seven core domains typically assessed: Management of Care; Safety and Infection Control; Health
Promotion and Maintenance; Psychosocial Integrity; Basic Care and Comfort; Pharmacological and
Parenteral Therapies; and Reduction of Risk Potential.
Section 1: Management of Care (Q1–Q20)
Q1. A registered nurse is assigning tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate for the RN to delegate to UAP?
A. Administering a PRN dose of acetaminophen
B. Performing a sterile dressing change on a surgical incision
C. Assisting a stable client with a bed bath
D. Assessing a client's new onset of chest pain
Correct Answer: C
Rationale: Assisting a stable client with hygiene is a routine, non-invasive task that does not require
nursing judgment and may be delegated to UAP. Medication administration (A), sterile procedures
(B), and assessment (D) all require the education, licensure, and clinical judgment of a nurse and
cannot be delegated.
Q2. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client scheduled for discharge in one hour who needs paperwork completed
B. A client who reports new shortness of breath and has an SpO2 of 89% on room air
C. A client requesting pain medication for a headache rated 5/10
D. A client whose family member has questions about the discharge plan
Correct Answer: B
Rationale: Using the ABC prioritization framework, a new onset of hypoxemia (SpO2 89%) and
respiratory distress takes precedence over all other needs. Discharge planning (A), stable pain
management (C), and family communication (D) are important but not immediately life-threatening.
Q3. A nurse is reviewing a client's advance directive. The client has a living will stating no heroic
measures. The client is now unresponsive and the family requests "everything be done." Which
action should the nurse take?
A. Follow the family's wishes because they are the legal decision-makers
B. Honor the living will as the client's documented wish and notify the provider
C. Ask the family to sign a waiver overriding the living will
D. Ignore the living will because the client cannot currently verbalize wishes
Correct Answer: B
pg. 2
,Rationale: A living will is a legal document expressing the client's wishes regarding life-sustaining
treatment. The nurse must advocate for the client's documented preferences. While family input is
valuable, a valid advance directive reflects the client's autonomy and should guide care. The provider
should be notified to address the conflict.
Q4. A nurse is preparing to witness a client's signature on an informed consent form. Which
statement by the client indicates a need for further intervention before the nurse witnesses the
signature?
A. "The surgeon explained the risks and benefits to me this morning."
B. "I have not had a chance to ask the doctor all my questions yet."
C. "I understand I can change my mind at any time."
D. "I read the entire form before signing."
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the signature and verify that the client
has received information and has no unanswered questions. If the client still has questions for the
provider, the consent process is incomplete. The nurse should notify the provider to address the
client's questions before witnessing the signature.
Q5. A nurse manager is evaluating staffing for the upcoming shift. Which factor is the most
important consideration when making assignments?
A. Matching nurses with their preferred shifts
B. Ensuring each nurse has a balanced number of clients
C. Matching client acuity with nurse competency and scope of practice
D. Assigning senior nurses to the most complex clients only
Correct Answer: C
Rationale: Safe delegation and assignment require that the nurse's education, experience, and
competency match the acuity and needs of the clients. While preferences (A) and balanced
workloads (B) are considered, client safety and competency alignment are paramount. Restricting
complex clients to senior nurses only (D) is not feasible or required if competency is verified.
Q6. A nurse is caring for a client who speaks limited English. An interpreter is not immediately
available. Which action is most appropriate for obtaining informed consent?
A. Use the client's adult child to interpret the consent discussion
B. Proceed with the procedure using hand gestures to explain
C. Wait for a qualified medical interpreter before obtaining consent
D. Have the client sign the form and explain it later when an interpreter arrives
Correct Answer: C
Rationale: Informed consent requires that the client fully understand the procedure, risks, and
alternatives. Using family members (A) risks inaccurate interpretation, confidentiality breaches, and
pg. 3
, coercion. Waiting for a qualified interpreter (C) is the standard of care. Proceeding without
understanding (B, D) invalidates the consent.
Q7. A charge nurse is making client assignments. Which client is most appropriate to assign to a
newly licensed practical nurse (LPN)?
A. A client receiving a new chemotherapy regimen requiring teaching
B. A stable client requiring a dressing change and oral medication administration
C. A client with a new tracheostomy requiring suctioning and assessment
D. A client in the immediate postoperative period after cardiac surgery
Correct Answer: B
Rationale: A stable client with routine care needs (dressing change, oral medications) falls within the
LPN's scope of practice. Chemotherapy teaching (A), new tracheostomy management (C), and
immediate postoperative cardiac care (D) require RN assessment, judgment, and specialized skills.
Q8. A nurse discovers that a colleague has made a medication error but did not report it. What is the
nurse's priority action?
A. Confront the colleague publicly to ensure accountability
B. Report the error through the facility's incident reporting system and ensure client safety
C. Ignore the error because it was not the nurse's own mistake
D. Document the error in the client's chart as a nursing note only
Correct Answer: B
Rationale: Client safety is the priority. The nurse must ensure the client is assessed and the error is
reported through the appropriate channels. Incident reports are non-punitive tools for system
improvement. Public confrontation (A) is unprofessional, ignoring the error (C) is unsafe, and
documenting in the chart alone (D) does not fulfill reporting obligations.
Q9. A nurse is caring for a client who requests to leave against medical advice (AMA). Which action
should the nurse take first?
A. Restrain the client to prevent leaving
B. Notify the provider and document the client's decision-making capacity
C. Ask the client to sign the AMA form immediately
D. Tell the client that leaving AMA will result in insurance denial
Correct Answer: B
Rationale: Before allowing a client to leave AMA, the nurse must assess and document the client's
understanding of the risks and their decision-making capacity. The provider should be notified.
Restraints (A) are false imprisonment. Obtaining the signature (C) is important but follows
assessment. Threatening the client (D) is coercive and inappropriate.
pg. 4
,Fundamentals HESI Exit Exam Practice Examination
Note: This is an original, comprehensive practice examination based on the published test blueprint
domains for the HESI Fundamentals Exit Exam. It is not an official Elsevier product, and the questions
are not sourced from any actual HESI exam or proprietary test bank. The examination covers the
seven core domains typically assessed: Management of Care; Safety and Infection Control; Health
Promotion and Maintenance; Psychosocial Integrity; Basic Care and Comfort; Pharmacological and
Parenteral Therapies; and Reduction of Risk Potential.
Section 1: Management of Care (Q1–Q20)
Q1. A registered nurse is assigning tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate for the RN to delegate to UAP?
A. Administering a PRN dose of acetaminophen
B. Performing a sterile dressing change on a surgical incision
C. Assisting a stable client with a bed bath
D. Assessing a client's new onset of chest pain
Correct Answer: C
Rationale: Assisting a stable client with hygiene is a routine, non-invasive task that does not require
nursing judgment and may be delegated to UAP. Medication administration (A), sterile procedures
(B), and assessment (D) all require the education, licensure, and clinical judgment of a nurse and
cannot be delegated.
Q2. A nurse is caring for four clients. Which client should the nurse assess first?
A. A client scheduled for discharge in one hour who needs paperwork completed
B. A client who reports new shortness of breath and has an SpO2 of 89% on room air
C. A client requesting pain medication for a headache rated 5/10
D. A client whose family member has questions about the discharge plan
Correct Answer: B
Rationale: Using the ABC prioritization framework, a new onset of hypoxemia (SpO2 89%) and
respiratory distress takes precedence over all other needs. Discharge planning (A), stable pain
management (C), and family communication (D) are important but not immediately life-threatening.
Q3. A nurse is reviewing a client's advance directive. The client has a living will stating no heroic
measures. The client is now unresponsive and the family requests "everything be done." Which
action should the nurse take?
A. Follow the family's wishes because they are the legal decision-makers
B. Honor the living will as the client's documented wish and notify the provider
C. Ask the family to sign a waiver overriding the living will
D. Ignore the living will because the client cannot currently verbalize wishes
Correct Answer: B
pg. 2
,Rationale: A living will is a legal document expressing the client's wishes regarding life-sustaining
treatment. The nurse must advocate for the client's documented preferences. While family input is
valuable, a valid advance directive reflects the client's autonomy and should guide care. The provider
should be notified to address the conflict.
Q4. A nurse is preparing to witness a client's signature on an informed consent form. Which
statement by the client indicates a need for further intervention before the nurse witnesses the
signature?
A. "The surgeon explained the risks and benefits to me this morning."
B. "I have not had a chance to ask the doctor all my questions yet."
C. "I understand I can change my mind at any time."
D. "I read the entire form before signing."
Correct Answer: B
Rationale: The nurse's role in informed consent is to witness the signature and verify that the client
has received information and has no unanswered questions. If the client still has questions for the
provider, the consent process is incomplete. The nurse should notify the provider to address the
client's questions before witnessing the signature.
Q5. A nurse manager is evaluating staffing for the upcoming shift. Which factor is the most
important consideration when making assignments?
A. Matching nurses with their preferred shifts
B. Ensuring each nurse has a balanced number of clients
C. Matching client acuity with nurse competency and scope of practice
D. Assigning senior nurses to the most complex clients only
Correct Answer: C
Rationale: Safe delegation and assignment require that the nurse's education, experience, and
competency match the acuity and needs of the clients. While preferences (A) and balanced
workloads (B) are considered, client safety and competency alignment are paramount. Restricting
complex clients to senior nurses only (D) is not feasible or required if competency is verified.
Q6. A nurse is caring for a client who speaks limited English. An interpreter is not immediately
available. Which action is most appropriate for obtaining informed consent?
A. Use the client's adult child to interpret the consent discussion
B. Proceed with the procedure using hand gestures to explain
C. Wait for a qualified medical interpreter before obtaining consent
D. Have the client sign the form and explain it later when an interpreter arrives
Correct Answer: C
Rationale: Informed consent requires that the client fully understand the procedure, risks, and
alternatives. Using family members (A) risks inaccurate interpretation, confidentiality breaches, and
pg. 3
, coercion. Waiting for a qualified interpreter (C) is the standard of care. Proceeding without
understanding (B, D) invalidates the consent.
Q7. A charge nurse is making client assignments. Which client is most appropriate to assign to a
newly licensed practical nurse (LPN)?
A. A client receiving a new chemotherapy regimen requiring teaching
B. A stable client requiring a dressing change and oral medication administration
C. A client with a new tracheostomy requiring suctioning and assessment
D. A client in the immediate postoperative period after cardiac surgery
Correct Answer: B
Rationale: A stable client with routine care needs (dressing change, oral medications) falls within the
LPN's scope of practice. Chemotherapy teaching (A), new tracheostomy management (C), and
immediate postoperative cardiac care (D) require RN assessment, judgment, and specialized skills.
Q8. A nurse discovers that a colleague has made a medication error but did not report it. What is the
nurse's priority action?
A. Confront the colleague publicly to ensure accountability
B. Report the error through the facility's incident reporting system and ensure client safety
C. Ignore the error because it was not the nurse's own mistake
D. Document the error in the client's chart as a nursing note only
Correct Answer: B
Rationale: Client safety is the priority. The nurse must ensure the client is assessed and the error is
reported through the appropriate channels. Incident reports are non-punitive tools for system
improvement. Public confrontation (A) is unprofessional, ignoring the error (C) is unsafe, and
documenting in the chart alone (D) does not fulfill reporting obligations.
Q9. A nurse is caring for a client who requests to leave against medical advice (AMA). Which action
should the nurse take first?
A. Restrain the client to prevent leaving
B. Notify the provider and document the client's decision-making capacity
C. Ask the client to sign the AMA form immediately
D. Tell the client that leaving AMA will result in insurance denial
Correct Answer: B
Rationale: Before allowing a client to leave AMA, the nurse must assess and document the client's
understanding of the risks and their decision-making capacity. The provider should be notified.
Restraints (A) are false imprisonment. Obtaining the signature (C) is important but follows
assessment. Threatening the client (D) is coercive and inappropriate.
pg. 4
