,HESI RN Exit Exam — 2026/2027
Comprehensive Practice Test + NGN Case
Studies & Rationales
1. A nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client 2 days post-appendectomy requesting pain medication
B. A client with COPD reporting increased shortness of breath
C. A client with a urinary tract infection requesting assistance to the bathroom
D. A client 1 day post-hip replacement asking about discharge planning
Correct Answer: B. The client with COPD reporting increased shortness of breath requires
immediate assessment for potential respiratory decompensation. Airway and breathing take
priority over pain management, elimination needs, and discharge planning.
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, respiratory
compromise is the highest priority. A client with COPD is at high risk for acute exacerbation. The
other clients have stable, non-urgent needs.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate for the nurse to delegate?
A. Administering a scheduled oral medication
,B. Assessing a client's surgical wound
C. Measuring and recording a client's intake and output
D. Teaching a client about a new low-sodium diet
Correct Answer: C. Measuring and recording intake and output is a routine, non-invasive task
within the UAP's scope of practice. Medication administration, assessment, and client teaching
all require the licensed nurse's clinical judgment and are not delegable to UAP.
Rationale: The nurse must follow the five rights of delegation: right task, right circumstance,
right person, right direction/communication, and right supervision. I&O measurement is a
standard UAP task.
3. A nurse is reviewing a client's advance directives. The client states, "I want my daughter to
make decisions for me if I can't." Which document should the nurse ensure is in the chart?
A. Living will
B. Durable power of attorney for health care
C. Do-not-resuscitate order
D. Organ donation consent form
Correct Answer: B. A durable power of attorney for health care designates a specific person
(health care proxy) to make medical decisions on the client's behalf if the client becomes
incapacitated. A living will specifies treatment preferences but does not designate a decision-
maker.
Rationale: The client is specifically naming a person to act as surrogate decision-maker. This
requires a durable power of attorney for health care, not a living will.
, 4. A charge nurse is making assignments for the shift. Which client should be assigned to the
most experienced RN?
A. A client with a stable gastrointestinal bleed receiving blood transfusion
B. A client 4 hours post-cardiac catheterization with a sandbag on the femoral site
C. A client with pneumonia receiving IV antibiotics
D. A client awaiting discharge following uncomplicated laparoscopic surgery
Correct Answer: B. A client who is 4 hours post-cardiac catheterization requires frequent
monitoring for bleeding, hematoma, and cardiac complications. This client has the highest
acuity and requires the most experienced nurse.
Rationale: Assignment should match client acuity with nurse competency. Post-cardiac
catheterization clients are at risk for femoral artery bleeding, retroperitoneal hemorrhage, and
arrhythmias.
5. A nurse is preparing to administer a blood transfusion. Which action should the nurse take
first?
A. Obtain the client's vital signs
B. Verify the blood product with a second nurse
C. Initiate the transfusion at a slow rate
D. Assess the client's IV site
Comprehensive Practice Test + NGN Case
Studies & Rationales
1. A nurse is caring for four clients on a medical-surgical unit. Which client should the nurse
assess first?
A. A client 2 days post-appendectomy requesting pain medication
B. A client with COPD reporting increased shortness of breath
C. A client with a urinary tract infection requesting assistance to the bathroom
D. A client 1 day post-hip replacement asking about discharge planning
Correct Answer: B. The client with COPD reporting increased shortness of breath requires
immediate assessment for potential respiratory decompensation. Airway and breathing take
priority over pain management, elimination needs, and discharge planning.
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, respiratory
compromise is the highest priority. A client with COPD is at high risk for acute exacerbation. The
other clients have stable, non-urgent needs.
2. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate for the nurse to delegate?
A. Administering a scheduled oral medication
,B. Assessing a client's surgical wound
C. Measuring and recording a client's intake and output
D. Teaching a client about a new low-sodium diet
Correct Answer: C. Measuring and recording intake and output is a routine, non-invasive task
within the UAP's scope of practice. Medication administration, assessment, and client teaching
all require the licensed nurse's clinical judgment and are not delegable to UAP.
Rationale: The nurse must follow the five rights of delegation: right task, right circumstance,
right person, right direction/communication, and right supervision. I&O measurement is a
standard UAP task.
3. A nurse is reviewing a client's advance directives. The client states, "I want my daughter to
make decisions for me if I can't." Which document should the nurse ensure is in the chart?
A. Living will
B. Durable power of attorney for health care
C. Do-not-resuscitate order
D. Organ donation consent form
Correct Answer: B. A durable power of attorney for health care designates a specific person
(health care proxy) to make medical decisions on the client's behalf if the client becomes
incapacitated. A living will specifies treatment preferences but does not designate a decision-
maker.
Rationale: The client is specifically naming a person to act as surrogate decision-maker. This
requires a durable power of attorney for health care, not a living will.
, 4. A charge nurse is making assignments for the shift. Which client should be assigned to the
most experienced RN?
A. A client with a stable gastrointestinal bleed receiving blood transfusion
B. A client 4 hours post-cardiac catheterization with a sandbag on the femoral site
C. A client with pneumonia receiving IV antibiotics
D. A client awaiting discharge following uncomplicated laparoscopic surgery
Correct Answer: B. A client who is 4 hours post-cardiac catheterization requires frequent
monitoring for bleeding, hematoma, and cardiac complications. This client has the highest
acuity and requires the most experienced nurse.
Rationale: Assignment should match client acuity with nurse competency. Post-cardiac
catheterization clients are at risk for femoral artery bleeding, retroperitoneal hemorrhage, and
arrhythmias.
5. A nurse is preparing to administer a blood transfusion. Which action should the nurse take
first?
A. Obtain the client's vital signs
B. Verify the blood product with a second nurse
C. Initiate the transfusion at a slow rate
D. Assess the client's IV site
