HESI RN EXIT EXAM COMPREHENSIVE REVIEW
2026/2027 WITH NGN
Predictive Exit Exam | 75 Questions | Next-Generation
NCLEX Integrated
SECTION 1: Fundamentals & Management of Care (15 Questions)
Q1: A charge nurse is making assignments. Which patient is most appropriate for a float RN who has
never worked on the unit?
A. Post-op craniotomy with ICP monitoring
B. Stable patient awaiting discharge after laparoscopic cholecystectomy
C. Newly admitted chest-pain rule-out MI
D. Tracheostomy patient requiring frequent suctioning
Correct Answer: B
Rationale: Clinical Judgment: Match nurse competency to patient acuity. Float nurse gets stable,
predictable patients. Discharge teaching is within scope of any RN.
HESI Strategy: “Most appropriate” = least complex, stable outcomes.
Priority Framework: Safety & assignment appropriateness.
Q2: A nurse notes a LPN preparing to give PO digoxin to a patient whose apical pulse is 52. The nurse’s
first action is to:
A. Administer the medication anyway
B. Tell the LPN to hold the dose and recheck the pulse in 5 minutes
C. Notify the physician immediately
D. Document the finding
Correct Answer: B
Rationale: Delegation & Supervision: LPN cannot override hold parameters. Pulse <60 = hold digoxin
(adult). First action = prevent administration.
Clinical Judgment: Generate Solution → stop unsafe action.
HESI Tip: “First action” = immediate safety intervention.
Q3: A patient asks the nurse to witness a living will. The nurse’s best response is:
A. “I’ll sign as soon as I finish my meds.”
B. “I cannot witness; I’ll call the social worker.”
C. “I can witness if no family is available.”
D. “Let me page the chaplain.”
Correct Answer: B
Rationale: Legal/Ethical: Nurse is inappropriate witness – may be perceived as coercive while patient is
dependent.
HESI Focus: Know professional boundaries.
Q4: Which action by the nurse violates HIPAA?
A. Giving report to on-coming nurse in private
B. Discussing patient condition in the elevator with other staff
C. Logging off the computer after charting
D. Using patient initials in the hallway
, Correct Answer: B
Rationale: Confidentiality: Public areas = no PHI disclosure.
HESI Strategy: HIPAA violations = public conversations, unsecured records.
Q5: A patient on contact precautions for C. difficile needs a chest X-ray. Transport protocol requires:
A. Surgical mask on patient, staff wears gown/gloves
B. Clean gown/gloves on staff, sheet over stretcher, notify receiving department
C. N95 respirator on patient
D. Remove precautions for transport
Correct Answer: B
Rationale: Infection Control: Maintain contact precautions during transport – gown/gloves, minimize
contamination.
HESI Tip: C. diff = spore-forming; bleach wipes, soap-water hand wash.
Q6: A new graduate RN makes a medication error. The nurse manager’s priority is:
A. Complete incident report
B. Ensure patient safety and assess for harm
C. Counsel the nurse
D. Notify risk management
Correct Answer: B
Rationale: Priority Framework: Patient safety first – assess patient, then process.
Clinical Judgment: Take Action → mitigate harm.
Q7: A patient refuses a blood transfusion for religious reasons. The nurse should:
A. Obtain a court order
B. Respect the refusal and notify the provider
C. Ask family to convince the patient
D. Administer anyway if life-threatening
Correct Answer: B
Rationale: Ethics: Autonomy trumps beneficence. Notify provider for alternatives.
HESI Focus: Patient rights.
Q8: During a code blue, the nurse not trained in ACLS should:
A. Leave the room
B. Start compressions until help arrives
C. Wait for code team
D. Check the crash cart
Correct Answer: B
Rationale: Emergency: Any RN can initiate high-quality CPR (CAB).
HESI Strategy: “Not trained” still allows basic life support.
Q9: A nursing student documents a medication given by another student. The nurse preceptor should:
A. Add a late entry
B. Inform instructor and have student follow agency policy for error
C. Delete the entry
D. Ignore it if medication was given
Correct Answer: B
Rationale: Legal: Falsification of record. Must follow policy.
HESI Tip: Students work under instructor license.
2026/2027 WITH NGN
Predictive Exit Exam | 75 Questions | Next-Generation
NCLEX Integrated
SECTION 1: Fundamentals & Management of Care (15 Questions)
Q1: A charge nurse is making assignments. Which patient is most appropriate for a float RN who has
never worked on the unit?
A. Post-op craniotomy with ICP monitoring
B. Stable patient awaiting discharge after laparoscopic cholecystectomy
C. Newly admitted chest-pain rule-out MI
D. Tracheostomy patient requiring frequent suctioning
Correct Answer: B
Rationale: Clinical Judgment: Match nurse competency to patient acuity. Float nurse gets stable,
predictable patients. Discharge teaching is within scope of any RN.
HESI Strategy: “Most appropriate” = least complex, stable outcomes.
Priority Framework: Safety & assignment appropriateness.
Q2: A nurse notes a LPN preparing to give PO digoxin to a patient whose apical pulse is 52. The nurse’s
first action is to:
A. Administer the medication anyway
B. Tell the LPN to hold the dose and recheck the pulse in 5 minutes
C. Notify the physician immediately
D. Document the finding
Correct Answer: B
Rationale: Delegation & Supervision: LPN cannot override hold parameters. Pulse <60 = hold digoxin
(adult). First action = prevent administration.
Clinical Judgment: Generate Solution → stop unsafe action.
HESI Tip: “First action” = immediate safety intervention.
Q3: A patient asks the nurse to witness a living will. The nurse’s best response is:
A. “I’ll sign as soon as I finish my meds.”
B. “I cannot witness; I’ll call the social worker.”
C. “I can witness if no family is available.”
D. “Let me page the chaplain.”
Correct Answer: B
Rationale: Legal/Ethical: Nurse is inappropriate witness – may be perceived as coercive while patient is
dependent.
HESI Focus: Know professional boundaries.
Q4: Which action by the nurse violates HIPAA?
A. Giving report to on-coming nurse in private
B. Discussing patient condition in the elevator with other staff
C. Logging off the computer after charting
D. Using patient initials in the hallway
, Correct Answer: B
Rationale: Confidentiality: Public areas = no PHI disclosure.
HESI Strategy: HIPAA violations = public conversations, unsecured records.
Q5: A patient on contact precautions for C. difficile needs a chest X-ray. Transport protocol requires:
A. Surgical mask on patient, staff wears gown/gloves
B. Clean gown/gloves on staff, sheet over stretcher, notify receiving department
C. N95 respirator on patient
D. Remove precautions for transport
Correct Answer: B
Rationale: Infection Control: Maintain contact precautions during transport – gown/gloves, minimize
contamination.
HESI Tip: C. diff = spore-forming; bleach wipes, soap-water hand wash.
Q6: A new graduate RN makes a medication error. The nurse manager’s priority is:
A. Complete incident report
B. Ensure patient safety and assess for harm
C. Counsel the nurse
D. Notify risk management
Correct Answer: B
Rationale: Priority Framework: Patient safety first – assess patient, then process.
Clinical Judgment: Take Action → mitigate harm.
Q7: A patient refuses a blood transfusion for religious reasons. The nurse should:
A. Obtain a court order
B. Respect the refusal and notify the provider
C. Ask family to convince the patient
D. Administer anyway if life-threatening
Correct Answer: B
Rationale: Ethics: Autonomy trumps beneficence. Notify provider for alternatives.
HESI Focus: Patient rights.
Q8: During a code blue, the nurse not trained in ACLS should:
A. Leave the room
B. Start compressions until help arrives
C. Wait for code team
D. Check the crash cart
Correct Answer: B
Rationale: Emergency: Any RN can initiate high-quality CPR (CAB).
HESI Strategy: “Not trained” still allows basic life support.
Q9: A nursing student documents a medication given by another student. The nurse preceptor should:
A. Add a late entry
B. Inform instructor and have student follow agency policy for error
C. Delete the entry
D. Ignore it if medication was given
Correct Answer: B
Rationale: Legal: Falsification of record. Must follow policy.
HESI Tip: Students work under instructor license.
