HESI PN Fundamentals Exam ( Update) | Questions & Answers
| Complete A+ Guide - 200 Questions
This exam assesses advanced understanding of nursing management of care, including delegation, prioritization,
ethical/legal issues, quality improvement, and interprofessional collaboration. It reflects current NCSBN and ANA
standards. It contains 200 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Content is organized into 8 focused sections: Management of Care,
Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and
Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning
outcomes include: Apply ethical and legal frameworks to clinical decision-making.; Prioritize nursing
interventions using evidence-based triage and acuity systems.; Delegate tasks appropriately based on scope of
practice and competency.; Analyze quality improvement data to improve patient outcomes.. Every item has been
reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 85%. Aligned with Meets US nursing accreditation standards
(NLN CNEA, ACEN) and reflects NCLEX-PN test plan. standards and reflects the question style commonly seen
on accredited program examinations. Students consistently achieving above the cut score on this bank have
Section 1: Management of Care (Questions 1-25)
1 A charge nurse on a medical-surgical unit is making assignments for the upcoming shift. Which of the following
assignments should the charge nurse assign to a licensed practical nurse (LPN) rather than a registered nurse
(RN)?
A) Administering a blood transfusion to a stable patient with anemia.
B) Performing a comprehensive admission assessment for a new patient with chest pain.
C) Administering oral medications to a stable patient with hypertension.
D) Developing the plan of care for a patient with a new diagnosis of diabetes.
Answer: C
Rationale: LPNs can administer oral medications to stable patients. Blood transfusions and admission assessments
require RN judgment, and care planning is an RN responsibility.
2 A nurse on a busy unit is caring for four patients. After receiving change-of-shift report, which patient should
the nurse assess first?
A) A patient with a fractured femur who reports sudden shortness of breath and chest pain.
B) A patient with diabetes who has a blood glucose level of 180 mg/dL and is due for insulin.
C) A patient scheduled for discharge who needs instruction on wound care.
D) A patient with a urinary tract infection who has a temperature of 38.2°C (100.8°F).
Answer: A
Rationale: Sudden shortness of breath and chest pain in a patient with a fracture suggests a pulmonary embolism,
which is life-threatening and requires immediate intervention. The other patients are stable.
3 A nurse is preparing to delegate a task to an unlicensed assistive personnel (UAP). Which of the following tasks
is appropriate for delegation?
A) Assessing the IV site for signs of infiltration.
B) Administering a tube feeding via nasogastric tube.
C) Measuring vital signs on a stable patient.
,D) Evaluating the effectiveness of pain medication.
Answer: C
Rationale: Measuring vital signs on a stable patient is a routine, non-invasive task that can be delegated to UAP.
Assessment, administration of tube feedings, and evaluation require licensed nursing judgment.
4 A nurse is reviewing the medical records of a group of patients. Which of the following situations requires the
nurse to file an incident report?
A) A patient refuses a prescribed medication after receiving an explanation.
B) A patient's blood pressure reading is 10 mmHg higher than the previous reading.
C) A patient falls while attempting to get out of bed without assistance.
D) A patient's wound culture result shows no growth.
Answer: C
Rationale: A patient fall is an adverse event that must be documented via an incident report for risk management and
quality improvement. Refusing medication, minor vital sign changes, and negative cultures are not reportable
events.
5 A nurse is providing discharge teaching to a patient with a new diagnosis of heart failure. Which of the
following statements by the patient indicates an understanding of the dietary restrictions?
A) I will limit my fluid intake to 3 liters per day.
B) I will avoid adding salt to my food and choose low-sodium options.
C) I can eat canned soups as long as I rinse them first.
D) I will increase my potassium intake by eating bananas.
Answer: B
Rationale: Heart failure management requires sodium restriction to reduce fluid retention. Limiting fluid to 3 L is
not specific; rinsing canned soups reduces some sodium but not enough; increasing potassium may be needed but is
not the primary dietary restriction.
6 A nurse is caring for a patient who is scheduled for a surgical procedure. The patient asks, "Who will be
performing the surgery?" The nurse knows that the surgeon is a licensed physician. Which of the following is
the most appropriate response?
A) The surgeon is a doctor who has completed medical school and residency training.
B) I am not sure, but I can check with the surgical scheduler.
C) The surgeon will introduce themselves before the procedure.
D) You can ask the surgeon when they come to see you.
Answer: A
Rationale: The nurse should provide accurate information to the patient to promote informed consent and trust.
Answering directly with the surgeon's qualifications is appropriate, while deflecting or deferring may increase
anxiety.
7 A nurse is participating in a quality improvement project to reduce hospital-acquired pressure injuries. Which of
the following interventions should the nurse prioritize?
A) Implementing a risk assessment tool on admission and daily.
B) Ordering specialty mattresses for all patients.
C) Repositioning patients every 4 hours.
D) Applying barrier creams to all patients.
Answer: A
,Rationale: Risk assessment is the first step in prevention, allowing targeted interventions. Ordering mattresses for all
is costly and unnecessary; repositioning every 2 hours is standard; barrier creams are for moisture-associated
damage, not pressure injury prevention.
8 A nurse is caring for a patient who has a living will that states no life-sustaining treatment. The patient develops
respiratory failure and is unable to communicate. Which of the following actions should the nurse take?
A) Initiate mechanical ventilation pending family decision.
B) Honor the living will and provide comfort measures only.
C) Contact the ethics committee for guidance.
D) Administer oxygen via non-rebreather mask.
Answer: B
Rationale: A living will is a legally binding advance directive. The nurse must honor the patient's wishes. Initiating
life support would violate the directive. Contacting ethics is unnecessary if the directive is clear; oxygen via
non-rebreather is a life-sustaining measure.
9 A nurse is reviewing a patient's medication administration record and notes that a dose of warfarin was omitted.
The nurse calls the provider to clarify the prescription. Which of the following is the nurse demonstrating?
A) Advocacy
B) Accountability
C) Delegation
D) Collaboration
Answer: B
Rationale: Accountability involves taking responsibility for one's actions and ensuring safe care. The nurse is being
accountable by addressing the omission. Advocacy is speaking for the patient, delegation is assigning tasks,
collaboration is working with others.
10 A nurse is caring for a patient who has a chest tube connected to a closed drainage system. Which of the
following findings requires immediate intervention?
A) Continuous bubbling in the water seal chamber.
B) Intermittent bubbling in the water seal chamber.
C) Drainage of 50 mL in the collection chamber over 8 hours.
D) Fluctuation of the water level with respirations.
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system, which can impair lung
re-expansion and requires immediate intervention. Intermittent bubbling is normal, 50 mL drainage over 8 hours is
acceptable, and fluctuation is expected.
11 A nurse is delegating tasks to an unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task is
appropriate for the nurse to delegate, considering the UAP's scope of practice and the patient's stability?
A) Administer a routine oral medication to a stable patient
B) Perform a sterile wound dressing change for a postoperative patient
C) Obtain a blood glucose level via fingerstick for a patient with diabetes
D) Assess the lung sounds of a patient with a history of asthma
Answer: C
Rationale: Obtaining a blood glucose level via fingerstick is a delegated task that UAPs are trained to perform, and
it does not require nursing judgment. Administering medications (A) and sterile wound care (B) require licensed
personnel. Assessment (D) is a nursing responsibility that cannot be delegated.
, 12 A charge nurse is making assignments for the upcoming shift. Which patient should be assigned to the most
experienced registered nurse (RN)?
A) A patient with a new diagnosis of diabetes requiring insulin education
B) A patient with a chest tube connected to a water seal drainage system
C) A patient with a urinary tract infection receiving intravenous antibiotics
D) A patient with a fractured femur awaiting surgical repair
Answer: B
Rationale: A patient with a chest tube requires complex monitoring and troubleshooting, best managed by an
experienced RN. Insulin education (A) can be done by a nurse with diabetes expertise, but is less critical. IV
antibiotics (C) and fracture awaiting surgery (D) are stable and can be managed by less experienced nurses.
13 During a staff meeting, a nurse expresses concern about a colleague who appears to be impaired while on duty.
Which action by the nurse is most appropriate in addressing this situation?
A) Confront the colleague directly during the meeting
B) Report the concern to the nurse manager immediately
C) Ignore the behavior unless it directly affects patient care
D) Discuss the concern with other staff members to gather opinions
Answer: B
Rationale: Reporting to the nurse manager is the appropriate chain of command to ensure patient safety and address
potential impairment. Confrontation (A) may escalate conflict. Ignoring (C) risks patient harm. Discussing with
others (D) breaches confidentiality and does not resolve the issue.
14 A nurse is reviewing informed consent forms for a surgical procedure. Which situation indicates that the
consent may be invalid?
A) The consent form is signed by the patient's spouse, who has a durable power of attorney for healthcare
B) The consent form is signed by the patient, but the patient was sedated prior to signing
C) The consent form is signed by the patient after the surgeon explained the risks and benefits
D) The consent form is signed by the patient in the presence of a witness
Answer: B
Rationale: Informed consent requires the patient to be competent and not under the influence of sedatives that impair
decision-making. A power of attorney (A) can sign if authorized. Explanation by surgeon (C) and witness (D) are
appropriate.
15 A nurse is prioritizing care for four patients after receiving shift report. Which patient should the nurse assess
first?
A) A patient with a history of heart failure who reports a weight gain of 2 kg in 24 hours
B) A patient with a cast on the lower leg who reports numbness and tingling in the toes
C) A patient with pneumonia who has a new oxygen saturation of 89% on room air
D) A patient with a surgical wound who reports pain of 6 on a 0-10 scale
Answer: C
Rationale: An oxygen saturation of 89% indicates hypoxemia, which is life-threatening and requires immediate
intervention. Weight gain (A) is important but not emergent. Numbness/tingling (B) suggests compartment
syndrome but is less acute. Pain (D) is a lower priority.
16 A nurse is preparing to discharge a patient who speaks a language different from the nurse. Which action best
ensures the patient understands discharge instructions?
A) Provide written instructions in the patient's language using a translation app
| Complete A+ Guide - 200 Questions
This exam assesses advanced understanding of nursing management of care, including delegation, prioritization,
ethical/legal issues, quality improvement, and interprofessional collaboration. It reflects current NCSBN and ANA
standards. It contains 200 multiple-choice questions, each with four distractors and a fully worked rationale that
explains why the keyed answer is correct. Content is organized into 8 focused sections: Management of Care,
Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, Basic Care and
Comfort, Pharmacological Therapies, Reduction of Risk Potential, Physiological Adaptation. Targeted learning
outcomes include: Apply ethical and legal frameworks to clinical decision-making.; Prioritize nursing
interventions using evidence-based triage and acuity systems.; Delegate tasks appropriately based on scope of
practice and competency.; Analyze quality improvement data to improve patient outcomes.. Every item has been
reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
writing time is 3 hours, with a passing score of 85%. Aligned with Meets US nursing accreditation standards
(NLN CNEA, ACEN) and reflects NCLEX-PN test plan. standards and reflects the question style commonly seen
on accredited program examinations. Students consistently achieving above the cut score on this bank have
Section 1: Management of Care (Questions 1-25)
1 A charge nurse on a medical-surgical unit is making assignments for the upcoming shift. Which of the following
assignments should the charge nurse assign to a licensed practical nurse (LPN) rather than a registered nurse
(RN)?
A) Administering a blood transfusion to a stable patient with anemia.
B) Performing a comprehensive admission assessment for a new patient with chest pain.
C) Administering oral medications to a stable patient with hypertension.
D) Developing the plan of care for a patient with a new diagnosis of diabetes.
Answer: C
Rationale: LPNs can administer oral medications to stable patients. Blood transfusions and admission assessments
require RN judgment, and care planning is an RN responsibility.
2 A nurse on a busy unit is caring for four patients. After receiving change-of-shift report, which patient should
the nurse assess first?
A) A patient with a fractured femur who reports sudden shortness of breath and chest pain.
B) A patient with diabetes who has a blood glucose level of 180 mg/dL and is due for insulin.
C) A patient scheduled for discharge who needs instruction on wound care.
D) A patient with a urinary tract infection who has a temperature of 38.2°C (100.8°F).
Answer: A
Rationale: Sudden shortness of breath and chest pain in a patient with a fracture suggests a pulmonary embolism,
which is life-threatening and requires immediate intervention. The other patients are stable.
3 A nurse is preparing to delegate a task to an unlicensed assistive personnel (UAP). Which of the following tasks
is appropriate for delegation?
A) Assessing the IV site for signs of infiltration.
B) Administering a tube feeding via nasogastric tube.
C) Measuring vital signs on a stable patient.
,D) Evaluating the effectiveness of pain medication.
Answer: C
Rationale: Measuring vital signs on a stable patient is a routine, non-invasive task that can be delegated to UAP.
Assessment, administration of tube feedings, and evaluation require licensed nursing judgment.
4 A nurse is reviewing the medical records of a group of patients. Which of the following situations requires the
nurse to file an incident report?
A) A patient refuses a prescribed medication after receiving an explanation.
B) A patient's blood pressure reading is 10 mmHg higher than the previous reading.
C) A patient falls while attempting to get out of bed without assistance.
D) A patient's wound culture result shows no growth.
Answer: C
Rationale: A patient fall is an adverse event that must be documented via an incident report for risk management and
quality improvement. Refusing medication, minor vital sign changes, and negative cultures are not reportable
events.
5 A nurse is providing discharge teaching to a patient with a new diagnosis of heart failure. Which of the
following statements by the patient indicates an understanding of the dietary restrictions?
A) I will limit my fluid intake to 3 liters per day.
B) I will avoid adding salt to my food and choose low-sodium options.
C) I can eat canned soups as long as I rinse them first.
D) I will increase my potassium intake by eating bananas.
Answer: B
Rationale: Heart failure management requires sodium restriction to reduce fluid retention. Limiting fluid to 3 L is
not specific; rinsing canned soups reduces some sodium but not enough; increasing potassium may be needed but is
not the primary dietary restriction.
6 A nurse is caring for a patient who is scheduled for a surgical procedure. The patient asks, "Who will be
performing the surgery?" The nurse knows that the surgeon is a licensed physician. Which of the following is
the most appropriate response?
A) The surgeon is a doctor who has completed medical school and residency training.
B) I am not sure, but I can check with the surgical scheduler.
C) The surgeon will introduce themselves before the procedure.
D) You can ask the surgeon when they come to see you.
Answer: A
Rationale: The nurse should provide accurate information to the patient to promote informed consent and trust.
Answering directly with the surgeon's qualifications is appropriate, while deflecting or deferring may increase
anxiety.
7 A nurse is participating in a quality improvement project to reduce hospital-acquired pressure injuries. Which of
the following interventions should the nurse prioritize?
A) Implementing a risk assessment tool on admission and daily.
B) Ordering specialty mattresses for all patients.
C) Repositioning patients every 4 hours.
D) Applying barrier creams to all patients.
Answer: A
,Rationale: Risk assessment is the first step in prevention, allowing targeted interventions. Ordering mattresses for all
is costly and unnecessary; repositioning every 2 hours is standard; barrier creams are for moisture-associated
damage, not pressure injury prevention.
8 A nurse is caring for a patient who has a living will that states no life-sustaining treatment. The patient develops
respiratory failure and is unable to communicate. Which of the following actions should the nurse take?
A) Initiate mechanical ventilation pending family decision.
B) Honor the living will and provide comfort measures only.
C) Contact the ethics committee for guidance.
D) Administer oxygen via non-rebreather mask.
Answer: B
Rationale: A living will is a legally binding advance directive. The nurse must honor the patient's wishes. Initiating
life support would violate the directive. Contacting ethics is unnecessary if the directive is clear; oxygen via
non-rebreather is a life-sustaining measure.
9 A nurse is reviewing a patient's medication administration record and notes that a dose of warfarin was omitted.
The nurse calls the provider to clarify the prescription. Which of the following is the nurse demonstrating?
A) Advocacy
B) Accountability
C) Delegation
D) Collaboration
Answer: B
Rationale: Accountability involves taking responsibility for one's actions and ensuring safe care. The nurse is being
accountable by addressing the omission. Advocacy is speaking for the patient, delegation is assigning tasks,
collaboration is working with others.
10 A nurse is caring for a patient who has a chest tube connected to a closed drainage system. Which of the
following findings requires immediate intervention?
A) Continuous bubbling in the water seal chamber.
B) Intermittent bubbling in the water seal chamber.
C) Drainage of 50 mL in the collection chamber over 8 hours.
D) Fluctuation of the water level with respirations.
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system, which can impair lung
re-expansion and requires immediate intervention. Intermittent bubbling is normal, 50 mL drainage over 8 hours is
acceptable, and fluctuation is expected.
11 A nurse is delegating tasks to an unlicensed assistive personnel (UAP) on a medical-surgical unit. Which task is
appropriate for the nurse to delegate, considering the UAP's scope of practice and the patient's stability?
A) Administer a routine oral medication to a stable patient
B) Perform a sterile wound dressing change for a postoperative patient
C) Obtain a blood glucose level via fingerstick for a patient with diabetes
D) Assess the lung sounds of a patient with a history of asthma
Answer: C
Rationale: Obtaining a blood glucose level via fingerstick is a delegated task that UAPs are trained to perform, and
it does not require nursing judgment. Administering medications (A) and sterile wound care (B) require licensed
personnel. Assessment (D) is a nursing responsibility that cannot be delegated.
, 12 A charge nurse is making assignments for the upcoming shift. Which patient should be assigned to the most
experienced registered nurse (RN)?
A) A patient with a new diagnosis of diabetes requiring insulin education
B) A patient with a chest tube connected to a water seal drainage system
C) A patient with a urinary tract infection receiving intravenous antibiotics
D) A patient with a fractured femur awaiting surgical repair
Answer: B
Rationale: A patient with a chest tube requires complex monitoring and troubleshooting, best managed by an
experienced RN. Insulin education (A) can be done by a nurse with diabetes expertise, but is less critical. IV
antibiotics (C) and fracture awaiting surgery (D) are stable and can be managed by less experienced nurses.
13 During a staff meeting, a nurse expresses concern about a colleague who appears to be impaired while on duty.
Which action by the nurse is most appropriate in addressing this situation?
A) Confront the colleague directly during the meeting
B) Report the concern to the nurse manager immediately
C) Ignore the behavior unless it directly affects patient care
D) Discuss the concern with other staff members to gather opinions
Answer: B
Rationale: Reporting to the nurse manager is the appropriate chain of command to ensure patient safety and address
potential impairment. Confrontation (A) may escalate conflict. Ignoring (C) risks patient harm. Discussing with
others (D) breaches confidentiality and does not resolve the issue.
14 A nurse is reviewing informed consent forms for a surgical procedure. Which situation indicates that the
consent may be invalid?
A) The consent form is signed by the patient's spouse, who has a durable power of attorney for healthcare
B) The consent form is signed by the patient, but the patient was sedated prior to signing
C) The consent form is signed by the patient after the surgeon explained the risks and benefits
D) The consent form is signed by the patient in the presence of a witness
Answer: B
Rationale: Informed consent requires the patient to be competent and not under the influence of sedatives that impair
decision-making. A power of attorney (A) can sign if authorized. Explanation by surgeon (C) and witness (D) are
appropriate.
15 A nurse is prioritizing care for four patients after receiving shift report. Which patient should the nurse assess
first?
A) A patient with a history of heart failure who reports a weight gain of 2 kg in 24 hours
B) A patient with a cast on the lower leg who reports numbness and tingling in the toes
C) A patient with pneumonia who has a new oxygen saturation of 89% on room air
D) A patient with a surgical wound who reports pain of 6 on a 0-10 scale
Answer: C
Rationale: An oxygen saturation of 89% indicates hypoxemia, which is life-threatening and requires immediate
intervention. Weight gain (A) is important but not emergent. Numbness/tingling (B) suggests compartment
syndrome but is less acute. Pain (D) is a lower priority.
16 A nurse is preparing to discharge a patient who speaks a language different from the nurse. Which action best
ensures the patient understands discharge instructions?
A) Provide written instructions in the patient's language using a translation app
