HESI RN EXIT COMPREHENSIVE EXAMINATION —
NCLEX-RN READINESS PRACTICE TEST
200 ORIGINAL MULTIPLE-CHOICE QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
SECTION 1: MANAGEMENT OF CARE (1–30)
1. Four clients are assigned to the RN. Which client should be assessed
first?
A) A client requesting pain medication for a headache
B) A client with new-onset confusion and blood pressure 82/50 mm Hg
C) A client awaiting discharge teaching
D) A client with a blood glucose of 168 mg/dL
Answer: B
Rationale: New confusion with hypotension indicates possible shock and
requires immediate assessment.
2. Which task is appropriate to delegate to unlicensed assistive personnel
(UAP)?
A) Repositioning a stable client every 2 hours
B) Performing an initial admission assessment
C) Teaching a client to use an inhaler
D) Interpreting a client's report of chest pain
Answer: A
Rationale: Repositioning a stable client is a routine task within UAP scope.
3. Which finding requires immediate notification of the provider?
A) New unilateral weakness and facial droop
,B) Blood pressure 128/78 mm Hg
C) Mild incisional pain rated 3/10
D) Heart rate 88 beats/min
Answer: A
Rationale: Unilateral weakness and facial droop suggest stroke and require
emergency evaluation.
4. A competent client refuses a prescribed medication. What is the RN's
best action?
A) Administer the medication by another route
B) Explain the purpose and consequences, then respect the refusal and
document
C) Crush the medication and mix it with food
D) Ask the family to convince the client
Answer: B
Rationale: Informed refusal must be respected and documented for a
competent client.
5. Where should an incident report be filed after a medication error?
A) In the client's medical record
B) According to facility policy, separate from the medical record
C) In the shift report
D) In the client's discharge summary
Answer: B
Rationale: Incident reports are risk-management documents and are not
placed in the chart.
6. Which statement about advance directives is correct?
A) A competent client may revise them at any time
B) They cannot be revoked once signed
C) Only a physician may complete them
D) They take effect only after death
,Answer: A
Rationale: A competent client retains the right to change or revoke advance
directives.
7. A client in violent behavioral restraints requires a new order at which
interval for an adult?
A) Every 1 hour
B) Every 2 hours
C) Every 4 hours
D) Every 24 hours
Answer: C
Rationale: Violent/self-destructive restraint orders for adults must be
renewed every 4 hours, with face-to-face evaluation within 1 hour.
8. Which action best reflects the HIPAA minimum necessary standard?
A) Sharing all records with the client's employer
B) Disclosing only the information needed for the purpose
C) Discussing the client in the elevator
D) Posting the client's diagnosis at the desk
Answer: B
Rationale: Only the minimum information necessary for the purpose should
be disclosed.
9. The RN disagrees with a provider's order that appears unsafe. What
should the RN do first?
A) Follow the order as written
B) Clarify the order with the provider
C) Ask the UAP for an opinion
D) Document the concern and administer the medication
Answer: B
Rationale: The RN must clarify questionable orders with the prescriber
before acting.
, 10. Which task is within the LPN/LVN scope of practice?
A) Performing the initial assessment
B) Administering oral medications to a stable client
C) Developing the nursing care plan
D) Providing initial discharge teaching
Answer: B
Rationale: LPNs may administer medications to stable clients; initial
assessment and teaching are RN responsibilities.
11. Which task may never be delegated?
A) Obtaining vital signs on a stable client
B) Assisting with ambulation
C) Performing the initial client assessment
D) Recording intake and output
Answer: C
Rationale: Initial assessment and clinical judgment remain RN
responsibilities.
12. A competent client leaves against medical advice. What should the RN
do?
A) Physically restrain the client
B) Document the client's decision and teaching provided
C) Refuse to provide discharge instructions
D) Call security to block the exit
Answer: B
Rationale: The competent client has the right to leave; document the
decision and teaching.
13. Who is responsible for explaining the risks and benefits of a procedure
for informed consent?
A) The RN
B) The LPN
NCLEX-RN READINESS PRACTICE TEST
200 ORIGINAL MULTIPLE-CHOICE QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
SECTION 1: MANAGEMENT OF CARE (1–30)
1. Four clients are assigned to the RN. Which client should be assessed
first?
A) A client requesting pain medication for a headache
B) A client with new-onset confusion and blood pressure 82/50 mm Hg
C) A client awaiting discharge teaching
D) A client with a blood glucose of 168 mg/dL
Answer: B
Rationale: New confusion with hypotension indicates possible shock and
requires immediate assessment.
2. Which task is appropriate to delegate to unlicensed assistive personnel
(UAP)?
A) Repositioning a stable client every 2 hours
B) Performing an initial admission assessment
C) Teaching a client to use an inhaler
D) Interpreting a client's report of chest pain
Answer: A
Rationale: Repositioning a stable client is a routine task within UAP scope.
3. Which finding requires immediate notification of the provider?
A) New unilateral weakness and facial droop
,B) Blood pressure 128/78 mm Hg
C) Mild incisional pain rated 3/10
D) Heart rate 88 beats/min
Answer: A
Rationale: Unilateral weakness and facial droop suggest stroke and require
emergency evaluation.
4. A competent client refuses a prescribed medication. What is the RN's
best action?
A) Administer the medication by another route
B) Explain the purpose and consequences, then respect the refusal and
document
C) Crush the medication and mix it with food
D) Ask the family to convince the client
Answer: B
Rationale: Informed refusal must be respected and documented for a
competent client.
5. Where should an incident report be filed after a medication error?
A) In the client's medical record
B) According to facility policy, separate from the medical record
C) In the shift report
D) In the client's discharge summary
Answer: B
Rationale: Incident reports are risk-management documents and are not
placed in the chart.
6. Which statement about advance directives is correct?
A) A competent client may revise them at any time
B) They cannot be revoked once signed
C) Only a physician may complete them
D) They take effect only after death
,Answer: A
Rationale: A competent client retains the right to change or revoke advance
directives.
7. A client in violent behavioral restraints requires a new order at which
interval for an adult?
A) Every 1 hour
B) Every 2 hours
C) Every 4 hours
D) Every 24 hours
Answer: C
Rationale: Violent/self-destructive restraint orders for adults must be
renewed every 4 hours, with face-to-face evaluation within 1 hour.
8. Which action best reflects the HIPAA minimum necessary standard?
A) Sharing all records with the client's employer
B) Disclosing only the information needed for the purpose
C) Discussing the client in the elevator
D) Posting the client's diagnosis at the desk
Answer: B
Rationale: Only the minimum information necessary for the purpose should
be disclosed.
9. The RN disagrees with a provider's order that appears unsafe. What
should the RN do first?
A) Follow the order as written
B) Clarify the order with the provider
C) Ask the UAP for an opinion
D) Document the concern and administer the medication
Answer: B
Rationale: The RN must clarify questionable orders with the prescriber
before acting.
, 10. Which task is within the LPN/LVN scope of practice?
A) Performing the initial assessment
B) Administering oral medications to a stable client
C) Developing the nursing care plan
D) Providing initial discharge teaching
Answer: B
Rationale: LPNs may administer medications to stable clients; initial
assessment and teaching are RN responsibilities.
11. Which task may never be delegated?
A) Obtaining vital signs on a stable client
B) Assisting with ambulation
C) Performing the initial client assessment
D) Recording intake and output
Answer: C
Rationale: Initial assessment and clinical judgment remain RN
responsibilities.
12. A competent client leaves against medical advice. What should the RN
do?
A) Physically restrain the client
B) Document the client's decision and teaching provided
C) Refuse to provide discharge instructions
D) Call security to block the exit
Answer: B
Rationale: The competent client has the right to leave; document the
decision and teaching.
13. Who is responsible for explaining the risks and benefits of a procedure
for informed consent?
A) The RN
B) The LPN
