, HESI Fundamentals Exit Exam 2026/2027 | 150 Verified Questions & Answers | Elsevier
Evolve Nursing Prep | 7 Core Domains | just released .
INTRODUCTION
This comprehensive study guide contains 150 verified questions designed for
professional nursing candidates preparing for the Evolve HESI Fundamentals Exit
Examination, administered by Elsevier/HESI. The questions are organized across seven
core domains: Priority Setting & Clinical Judgment (25 questions), Patient Safety,
Mobility & Positioning (25 questions), Infection Control & Asepsis (20 questions),
Medication Administration & Dosage Calculations (25 questions), Vital Signs & Physical
Assessment (20 questions), Nursing Process & Communication (20 questions), and
Fluid, Electrolyte & Elimination (15 questions). All content is aligned to the 2026/2027
testing cycle and reflects the NGN-style format of the actual examination. Each item
includes a correct answer and a detailed rationale grounded in evidence-based nursing
fundamentals .
DOMAIN 1: PRIORITY SETTING & CLINICAL JUDGMENT (25 QUESTIONS)
Question 1
A client with congestive heart failure reports shortness of breath and increasing fatigue.
The nurse notes bilateral crackles and 2+ pitting edema. Which action should the nurse
take first?
A) Encourage the client to increase fluid intake
B) Administer the prescribed diuretic
C) Place the client in high-Fowler's position
D) Document the findings and reassess in 2 hours
Correct Answer: C ✓
Rationale: High-Fowler's position improves ventilation and oxygenation immediately by
allowing maximum lung expansion. This is the priority because respiratory distress is
life-threatening. Diuretics can be administered next, but positioning is the priority to
relieve respiratory distress .
Question 2
The nurse comes upon a multi-vehicle automobile accident on a remote highway. As the
sole healthcare provider on the scene, which victim must the nurse attend to first?
A) A victim who is completely pulseless, apneic, and exhibits fixed, dilated pupils
B) A victim exhibiting a blank stare with bright red blood draining from the nose, ears,
,and mouth
C) A victim with an open thigh wound that is actively hemorrhaging bright red, spurting
blood
D) A crying victim who is alert and oriented, complaining of severe right arm and
shoulder pain
Correct Answer: C ✓
Rationale: In a mass casualty scenario with a single rescuer, triage principles shift to
doing the greatest good for the greatest number of people who have a high chance of
survival. A client with an arterial thigh hemorrhage (bright red, spurting blood) can bleed
to death within minutes, but this can be stopped quickly with direct pressure or a
tourniquet. The pulseless/apneic victim is considered deceased; the victim bleeding from
ears and nose likely has a fatal basilar skull fracture; the crying victim is stable .
Question 3
A nurse is ambulating a client down the hallway. When they are approximately 5 feet
from the bathroom door, the client suddenly stops, becomes pale, and states, "I feel
faint." Before a chair can be pulled over, the client's knees buckle and he begins to fall.
Which action should the nurse perform first?
A) Immediately check the client's carotid pulse to assess for cardiac arrest
B) Firmly encourage the client to take a few quick steps forward to reach the toilet
C) Shout loudly down the hallway to alert other staff members to bring a wheelchair
D) Extend your leg, pull the client close, and gently lower him to the floor
Correct Answer: D ✓
Rationale: When a client experiences syncope or becomes unable to bear weight while
ambulating, the priority is to prevent injury to both the client and the nurse. The nurse
should step behind the client, support him under the axillae or around the waist, widen
their base of support, and use their own leg to gently slide the client down to the floor.
Checking a pulse or calling for help is done after the client is in a secure, flat position on
the floor .
Question 4
The nurse is called to the waiting room of a pediatric clinic. The frantic mother states, "I
think my 4-month-old baby is choking!" What steps will the nurse take? (Select all that
apply.)
A) Note any obstruction or absence of breathing
B) Deliver five backslaps between the shoulder blades
C) Place the infant over the nurse's arm
D) Perform abdominal thrusts
Correct Answer: A, B, C ✓
, Rationale: The correct steps for infant (under 1 year) choking include: placing the infant
over the nurse's arm in a head-down position, delivering five back blows between the
shoulder blades, and then turning the infant over for five chest thrusts if needed. Noting
any obstruction or absence of breathing is also essential. Abdominal thrusts are NOT
used in infants under 1 year due to risk of organ damage .
Question 5
A client with pneumonia is receiving oxygen at 2 L/min via nasal cannula. The client
becomes confused and sleepy. What is the priority nursing action?
A) Increase oxygen to 4 L/min
B) Check oxygen saturation and respiratory rate
C) Document the findings and reassess in 1 hour
D) Encourage the client to cough and deep breathe
Correct Answer: B ✓
Rationale: A change in level of consciousness in a client receiving oxygen may indicate
hypoxia or carbon dioxide retention. The nurse should first assess oxygen saturation
and respiratory rate to determine the cause and guide further intervention .
Question 6
The nurse is reviewing a client's lab results from 2 hours ago. The sodium level is 128
mEq/L. The nurse should be alert for which findings? (Select all that apply.)
A) Weakness in the hands and feet
B) Diminished reflexes to the patella
C) Muscle twitching
D) Facial redness
Correct Answer: A, B ✓
Rationale: A sodium level of 128 mEq/L indicates hyponatremia (low sodium). Common
neurological and muscular signs of hyponatremia include weakness, diminished
reflexes, headache, and nausea. Muscle twitching is more commonly associated with
hypocalcemia or hypernatremia. Facial redness is not a typical sign of hyponatremia .
Question 7
A nurse is preparing to administer a high-risk medication via a newly inserted central
venous catheter. Which action best reflects the principle of independent double-check to
prevent a catastrophic error?
A) Verify the drug calculation with a second nurse before administration
B) Confirm the patient's identity using two identifiers
C) Check the medication label against the MAR three times
D) Assess the patient for allergies prior to administration
Evolve Nursing Prep | 7 Core Domains | just released .
INTRODUCTION
This comprehensive study guide contains 150 verified questions designed for
professional nursing candidates preparing for the Evolve HESI Fundamentals Exit
Examination, administered by Elsevier/HESI. The questions are organized across seven
core domains: Priority Setting & Clinical Judgment (25 questions), Patient Safety,
Mobility & Positioning (25 questions), Infection Control & Asepsis (20 questions),
Medication Administration & Dosage Calculations (25 questions), Vital Signs & Physical
Assessment (20 questions), Nursing Process & Communication (20 questions), and
Fluid, Electrolyte & Elimination (15 questions). All content is aligned to the 2026/2027
testing cycle and reflects the NGN-style format of the actual examination. Each item
includes a correct answer and a detailed rationale grounded in evidence-based nursing
fundamentals .
DOMAIN 1: PRIORITY SETTING & CLINICAL JUDGMENT (25 QUESTIONS)
Question 1
A client with congestive heart failure reports shortness of breath and increasing fatigue.
The nurse notes bilateral crackles and 2+ pitting edema. Which action should the nurse
take first?
A) Encourage the client to increase fluid intake
B) Administer the prescribed diuretic
C) Place the client in high-Fowler's position
D) Document the findings and reassess in 2 hours
Correct Answer: C ✓
Rationale: High-Fowler's position improves ventilation and oxygenation immediately by
allowing maximum lung expansion. This is the priority because respiratory distress is
life-threatening. Diuretics can be administered next, but positioning is the priority to
relieve respiratory distress .
Question 2
The nurse comes upon a multi-vehicle automobile accident on a remote highway. As the
sole healthcare provider on the scene, which victim must the nurse attend to first?
A) A victim who is completely pulseless, apneic, and exhibits fixed, dilated pupils
B) A victim exhibiting a blank stare with bright red blood draining from the nose, ears,
,and mouth
C) A victim with an open thigh wound that is actively hemorrhaging bright red, spurting
blood
D) A crying victim who is alert and oriented, complaining of severe right arm and
shoulder pain
Correct Answer: C ✓
Rationale: In a mass casualty scenario with a single rescuer, triage principles shift to
doing the greatest good for the greatest number of people who have a high chance of
survival. A client with an arterial thigh hemorrhage (bright red, spurting blood) can bleed
to death within minutes, but this can be stopped quickly with direct pressure or a
tourniquet. The pulseless/apneic victim is considered deceased; the victim bleeding from
ears and nose likely has a fatal basilar skull fracture; the crying victim is stable .
Question 3
A nurse is ambulating a client down the hallway. When they are approximately 5 feet
from the bathroom door, the client suddenly stops, becomes pale, and states, "I feel
faint." Before a chair can be pulled over, the client's knees buckle and he begins to fall.
Which action should the nurse perform first?
A) Immediately check the client's carotid pulse to assess for cardiac arrest
B) Firmly encourage the client to take a few quick steps forward to reach the toilet
C) Shout loudly down the hallway to alert other staff members to bring a wheelchair
D) Extend your leg, pull the client close, and gently lower him to the floor
Correct Answer: D ✓
Rationale: When a client experiences syncope or becomes unable to bear weight while
ambulating, the priority is to prevent injury to both the client and the nurse. The nurse
should step behind the client, support him under the axillae or around the waist, widen
their base of support, and use their own leg to gently slide the client down to the floor.
Checking a pulse or calling for help is done after the client is in a secure, flat position on
the floor .
Question 4
The nurse is called to the waiting room of a pediatric clinic. The frantic mother states, "I
think my 4-month-old baby is choking!" What steps will the nurse take? (Select all that
apply.)
A) Note any obstruction or absence of breathing
B) Deliver five backslaps between the shoulder blades
C) Place the infant over the nurse's arm
D) Perform abdominal thrusts
Correct Answer: A, B, C ✓
, Rationale: The correct steps for infant (under 1 year) choking include: placing the infant
over the nurse's arm in a head-down position, delivering five back blows between the
shoulder blades, and then turning the infant over for five chest thrusts if needed. Noting
any obstruction or absence of breathing is also essential. Abdominal thrusts are NOT
used in infants under 1 year due to risk of organ damage .
Question 5
A client with pneumonia is receiving oxygen at 2 L/min via nasal cannula. The client
becomes confused and sleepy. What is the priority nursing action?
A) Increase oxygen to 4 L/min
B) Check oxygen saturation and respiratory rate
C) Document the findings and reassess in 1 hour
D) Encourage the client to cough and deep breathe
Correct Answer: B ✓
Rationale: A change in level of consciousness in a client receiving oxygen may indicate
hypoxia or carbon dioxide retention. The nurse should first assess oxygen saturation
and respiratory rate to determine the cause and guide further intervention .
Question 6
The nurse is reviewing a client's lab results from 2 hours ago. The sodium level is 128
mEq/L. The nurse should be alert for which findings? (Select all that apply.)
A) Weakness in the hands and feet
B) Diminished reflexes to the patella
C) Muscle twitching
D) Facial redness
Correct Answer: A, B ✓
Rationale: A sodium level of 128 mEq/L indicates hyponatremia (low sodium). Common
neurological and muscular signs of hyponatremia include weakness, diminished
reflexes, headache, and nausea. Muscle twitching is more commonly associated with
hypocalcemia or hypernatremia. Facial redness is not a typical sign of hyponatremia .
Question 7
A nurse is preparing to administer a high-risk medication via a newly inserted central
venous catheter. Which action best reflects the principle of independent double-check to
prevent a catastrophic error?
A) Verify the drug calculation with a second nurse before administration
B) Confirm the patient's identity using two identifiers
C) Check the medication label against the MAR three times
D) Assess the patient for allergies prior to administration
