NCLEX-RN / HESI EXIT EXAM
Prioritization, Delegation & Management of Care
NCLEX-RN Prioritization, Delegation & Management of
Care Exam Pack | 180 Questions with Rationales | ABCs,
Maslow, Triage, Scope of Practice & Clinical Judgment |
HESI ATI Nursing Exit Exam Study Guide | 2026
Question 1
The nurse receives the change-of-shift report for four clients on a medical-surgical unit.
Which client should the nurse assess FIRST?
☐ A. A 72-year-old client with chronic heart failure who has gained 2 pounds since
yesterday and reports mild ankle swelling.
☑ B. A 60-year-old client who underwent a thyroidectomy 1 hour ago and is now
experiencing audible stridor and difficulty speaking.
☐ C. A 45-year-old client with type 2 diabetes mellitus whose blood glucose level is 245
mg/dL before breakfast.
☐ D. A 30-year-old client recovering from appendectomy who reports incisional pain
rated 6/10.
RATIONALE
The correct answer is B. Stridor following thyroid surgery is an emergency because it
indicates possible airway obstruction caused by swelling, hematoma formation, or
laryngeal edema. According to the ABC framework, airway concerns always take priority
over circulation, pain, or chronic conditions. Immediate intervention is necessary to
prevent respiratory arrest.
KEY TERMS EXPLAINED
Stridor = High-pitched breathing sound caused by airway narrowing.
Airway Obstruction = Partial or complete blockage of airflow.
,Thyroidectomy = Surgical removal of all or part of the thyroid gland.
ABC Framework = Airway, Breathing, Circulation prioritization method.
Question 2
A nurse is assigned four clients in the emergency department. Which client should be
seen FIRST?
☐ A. A 22-year-old client with a closed wrist fracture and pain rated 8/10.
☐ B. A 40-year-old client with nausea and vomiting for 12 hours.
☑ C. A 68-year-old client with sudden onset chest pain, diaphoresis, and shortness of
breath.
☐ D. A 15-year-old client with a temperature of 101.4°F (38.6°C) and sore throat.
RATIONALE
The correct answer is C. Sudden chest pain accompanied by diaphoresis and dyspnea
suggests an acute myocardial infarction. This condition can rapidly progress to cardiac
arrest and requires immediate evaluation and intervention. The other clients are stable
and can safely wait.
KEY TERMS EXPLAINED
Diaphoresis = Excessive sweating.
Myocardial Infarction = Heart attack caused by interrupted blood flow.
Dyspnea = Difficulty breathing.
Cardiac Arrest = Sudden cessation of effective heart function.
Question 3
The nurse is caring for four clients. Which client should be assessed FIRST?
☐ A. A client who reports anxiety about an upcoming surgical procedure.
,☐ B. A client requesting assistance to the bathroom.
☐ C. A client who has not had a bowel movement in 3 days.
☑ D. A client who is drooling and unable to swallow secretions.
RATIONALE
The correct answer is D. Drooling and inability to swallow indicate a compromised
airway. Physiological needs must be addressed before psychological or comfort needs
according to Maslow's hierarchy and ABC prioritization principles.
KEY TERMS EXPLAINED
Drooling = Inability to manage oral secretions.
Compromised Airway = Condition that threatens normal breathing.
Maslow's Hierarchy = Framework used to prioritize human needs.
Physiological Needs = Basic survival requirements.
Question 4
The nurse is reviewing laboratory results and assessment findings for four clients. Which
client requires immediate intervention?
☐ A. A client with potassium level 3.8 mEq/L.
☐ B. A client with chronic kidney disease and creatinine level 2.4 mg/dL.
☑ C. A client with potassium level 6.8 mEq/L and peaked T waves on ECG.
☐ D. A client with hemoglobin level 11.5 g/dL.
RATIONALE
The correct answer is C. Severe hyperkalemia can cause fatal cardiac dysrhythmias.
Peaked T waves indicate that cardiac conduction is already affected. Immediate treatment
is necessary to prevent cardiac arrest.
KEY TERMS EXPLAINED
, Hyperkalemia = Elevated serum potassium level.
Peaked T Waves = ECG finding associated with hyperkalemia.
Dysrhythmia = Abnormal heart rhythm.
ECG = Electrocardiogram.
Question 5
A nurse receives report on four postoperative clients. Which client should the nurse
assess FIRST?
☐ A. A client reporting nausea after receiving opioid medication.
☑ B. A client whose surgical dressing became saturated with bright red blood within 15
minutes.
☐ C. A client requesting assistance with ambulation.
☐ D. A client with pain rated 7/10.
RATIONALE
The correct answer is B. Rapid saturation of a dressing with bright red blood indicates
active hemorrhage. Circulation problems can quickly become life-threatening and require
immediate assessment and intervention.
KEY TERMS EXPLAINED
Hemorrhage = Excessive bleeding.
Surgical Dressing = Protective covering placed over a wound.
Circulation = Movement of blood throughout the body.
Hypovolemic Shock = Shock caused by significant blood loss.
Question 6
Prioritization, Delegation & Management of Care
NCLEX-RN Prioritization, Delegation & Management of
Care Exam Pack | 180 Questions with Rationales | ABCs,
Maslow, Triage, Scope of Practice & Clinical Judgment |
HESI ATI Nursing Exit Exam Study Guide | 2026
Question 1
The nurse receives the change-of-shift report for four clients on a medical-surgical unit.
Which client should the nurse assess FIRST?
☐ A. A 72-year-old client with chronic heart failure who has gained 2 pounds since
yesterday and reports mild ankle swelling.
☑ B. A 60-year-old client who underwent a thyroidectomy 1 hour ago and is now
experiencing audible stridor and difficulty speaking.
☐ C. A 45-year-old client with type 2 diabetes mellitus whose blood glucose level is 245
mg/dL before breakfast.
☐ D. A 30-year-old client recovering from appendectomy who reports incisional pain
rated 6/10.
RATIONALE
The correct answer is B. Stridor following thyroid surgery is an emergency because it
indicates possible airway obstruction caused by swelling, hematoma formation, or
laryngeal edema. According to the ABC framework, airway concerns always take priority
over circulation, pain, or chronic conditions. Immediate intervention is necessary to
prevent respiratory arrest.
KEY TERMS EXPLAINED
Stridor = High-pitched breathing sound caused by airway narrowing.
Airway Obstruction = Partial or complete blockage of airflow.
,Thyroidectomy = Surgical removal of all or part of the thyroid gland.
ABC Framework = Airway, Breathing, Circulation prioritization method.
Question 2
A nurse is assigned four clients in the emergency department. Which client should be
seen FIRST?
☐ A. A 22-year-old client with a closed wrist fracture and pain rated 8/10.
☐ B. A 40-year-old client with nausea and vomiting for 12 hours.
☑ C. A 68-year-old client with sudden onset chest pain, diaphoresis, and shortness of
breath.
☐ D. A 15-year-old client with a temperature of 101.4°F (38.6°C) and sore throat.
RATIONALE
The correct answer is C. Sudden chest pain accompanied by diaphoresis and dyspnea
suggests an acute myocardial infarction. This condition can rapidly progress to cardiac
arrest and requires immediate evaluation and intervention. The other clients are stable
and can safely wait.
KEY TERMS EXPLAINED
Diaphoresis = Excessive sweating.
Myocardial Infarction = Heart attack caused by interrupted blood flow.
Dyspnea = Difficulty breathing.
Cardiac Arrest = Sudden cessation of effective heart function.
Question 3
The nurse is caring for four clients. Which client should be assessed FIRST?
☐ A. A client who reports anxiety about an upcoming surgical procedure.
,☐ B. A client requesting assistance to the bathroom.
☐ C. A client who has not had a bowel movement in 3 days.
☑ D. A client who is drooling and unable to swallow secretions.
RATIONALE
The correct answer is D. Drooling and inability to swallow indicate a compromised
airway. Physiological needs must be addressed before psychological or comfort needs
according to Maslow's hierarchy and ABC prioritization principles.
KEY TERMS EXPLAINED
Drooling = Inability to manage oral secretions.
Compromised Airway = Condition that threatens normal breathing.
Maslow's Hierarchy = Framework used to prioritize human needs.
Physiological Needs = Basic survival requirements.
Question 4
The nurse is reviewing laboratory results and assessment findings for four clients. Which
client requires immediate intervention?
☐ A. A client with potassium level 3.8 mEq/L.
☐ B. A client with chronic kidney disease and creatinine level 2.4 mg/dL.
☑ C. A client with potassium level 6.8 mEq/L and peaked T waves on ECG.
☐ D. A client with hemoglobin level 11.5 g/dL.
RATIONALE
The correct answer is C. Severe hyperkalemia can cause fatal cardiac dysrhythmias.
Peaked T waves indicate that cardiac conduction is already affected. Immediate treatment
is necessary to prevent cardiac arrest.
KEY TERMS EXPLAINED
, Hyperkalemia = Elevated serum potassium level.
Peaked T Waves = ECG finding associated with hyperkalemia.
Dysrhythmia = Abnormal heart rhythm.
ECG = Electrocardiogram.
Question 5
A nurse receives report on four postoperative clients. Which client should the nurse
assess FIRST?
☐ A. A client reporting nausea after receiving opioid medication.
☑ B. A client whose surgical dressing became saturated with bright red blood within 15
minutes.
☐ C. A client requesting assistance with ambulation.
☐ D. A client with pain rated 7/10.
RATIONALE
The correct answer is B. Rapid saturation of a dressing with bright red blood indicates
active hemorrhage. Circulation problems can quickly become life-threatening and require
immediate assessment and intervention.
KEY TERMS EXPLAINED
Hemorrhage = Excessive bleeding.
Surgical Dressing = Protective covering placed over a wound.
Circulation = Movement of blood throughout the body.
Hypovolemic Shock = Shock caused by significant blood loss.
Question 6
