HESI LEADERSHIP EXIT EXAM VERSION 1
Complete Practice Exam with Answer💜💜s
and Rationales 2026 LATEST UPDATED
TEST
DELEGATION & PRIORITIZATION (Questions 1-30)
Question 1
The nurse delegates vital sign measurement to a UAP. Which finding requires
immediate nurse follow-up?
A) BP 120/78 mm Hg
B) BP 88/50 mm Hg and HR 110 bpm
C) Temp 98.6°F (37°C)
D) Respirations 16 breaths/min
Answer💜💜: B
Rationale: Hypotension with tachycardia may indicate shock, bleeding, or
hypovolemia and requires prompt nurse assessment. Stable vital signs (A, C, D) do
not require immediate follow-up.
Question 2
Which client should the nurse assess first?
A) Client with pain 3/10 after surgery
B) Client reporting dizziness when standing
C) Client with sudden shortness of breath after chest tube removal
D) Client requesting pain medication
Answer💜💜: C
Rationale: Sudden shortness of breath post chest tube removal may indicate
pneumothorax, a life-threatening emergency. Using ABC (Airway, Breathing,
Circulation) priority framework, breathing problems take precedence.
,Question 3
Which client is appropriate to assign to an LPN/LVN?
A) Client newly admitted with chest pain
B) Stable postoperative client receiving oral antibiotics
C) Client with unstable vital signs
D) Client receiving IV titrated medications
Answer💜💜: B
Rationale: LPNs/LVNs can care for stable clients with predictable outcomes.
Unstable clients, new admissions, and those receiving titrated IV medications
require RN assessment and critical thinking.
Question 4
The charge nurse observes a UAP applying wrist restraints without an order. What
is the best action?
A) Praise the UAP for quick action
B) Stop the UAP and review restraint policies
C) Wait to see if restraints are effective
D) Ignore because the client is safe
Answer💜💜: B
Rationale: Restraints require a provider's order and RN assessment. Unauthorized
application is unsafe and violates policy. The nurse must intervene immediately
and provide education.
Question 5
Which task can the nurse delegate to the UAP?
A) Assessing a client's pain level
B) Administering oral medications
C) Assisting a client with ambulation
D) Teaching a client about wound care
,Answer💜💜: C
Rationale: UAPs can perform routine tasks like ambulation, hygiene, and vital
signs. Assessment, medication administration, and teaching require nursing
judgment and licensure.
Question 6
A charge nurse receives report that a client who is 2 days post-hip arthroplasty
has new onset sudden severe pain in the surgical hip. Vital signs are stable. What
should the charge nurse do first?
A) Administer a prescribed oral analgesic
B) Instruct the AP to apply a warm compress
C) Go to the client's room and assess the client
D) Notify the orthopedic surgeon
Answer💜💜: C
Rationale: The first step in the nursing process is assessment. Sudden severe
postoperative pain requires immediate direct assessment to determine the cause
(possible dislocation) before implementing interventions.
Question 7
A charge nurse is observing a newly licensed nurse prepare to administer a
medication. The new nurse states, "I think this is the right medication, but I'm not
entirely sure." Which action should the charge nurse take?
A) Tell the new nurse to go ahead and administer it
B) Instruct the new nurse to look up the medication
C) Immediately intervene and verify the medication
D) Document the uncertainty in a performance review
Answer💜💜: C
Rationale: Client safety is paramount. Any uncertainty about medication
administration poses a significant risk. The charge nurse must immediately
intervene to prevent a potential error.
, Question 8
Which of the following tasks should the charge nurse delegate to an assistive
personnel (AP)?
A) Obtaining a blood glucose reading for a client with new-onset confusion
B) Assessing a client's readiness for discharge
C) Administering a nebulizer treatment
D) Providing post-mortem care for a client who passed away 30 minutes ago
Answer💜💜: D
Rationale: Post-mortem care is within the AP's scope of practice. New-onset
confusion requires RN assessment. Discharge assessment and medication
administration are RN responsibilities.
Question 9
A charge nurse is prioritizing care for four clients. Which client should the charge
nurse assess first?
A) Client with a chronic wound scheduled for a dressing change
B) Client with blood glucose of 180 mg/dL who feels well
C) Client with sudden onset of shortness of breath and chest pain
D) Client requiring routine morning medications
Answer💜💜: C
Rationale: Using the ABC priority framework, shortness of breath and chest pain
indicate potential acute compromise of respiratory/cardiac function, which is life-
threatening and requires immediate assessment.
Question 10
What is the first action a nurse leader should take when two staff members are in
conflict that disrupts the unit?
A) Ignore the conflict and hope it resolves
B) Address the conflict directly with both staff members and mediate privately
C) Send both staff members home for the day
D) File a formal complaint against both nurses
Complete Practice Exam with Answer💜💜s
and Rationales 2026 LATEST UPDATED
TEST
DELEGATION & PRIORITIZATION (Questions 1-30)
Question 1
The nurse delegates vital sign measurement to a UAP. Which finding requires
immediate nurse follow-up?
A) BP 120/78 mm Hg
B) BP 88/50 mm Hg and HR 110 bpm
C) Temp 98.6°F (37°C)
D) Respirations 16 breaths/min
Answer💜💜: B
Rationale: Hypotension with tachycardia may indicate shock, bleeding, or
hypovolemia and requires prompt nurse assessment. Stable vital signs (A, C, D) do
not require immediate follow-up.
Question 2
Which client should the nurse assess first?
A) Client with pain 3/10 after surgery
B) Client reporting dizziness when standing
C) Client with sudden shortness of breath after chest tube removal
D) Client requesting pain medication
Answer💜💜: C
Rationale: Sudden shortness of breath post chest tube removal may indicate
pneumothorax, a life-threatening emergency. Using ABC (Airway, Breathing,
Circulation) priority framework, breathing problems take precedence.
,Question 3
Which client is appropriate to assign to an LPN/LVN?
A) Client newly admitted with chest pain
B) Stable postoperative client receiving oral antibiotics
C) Client with unstable vital signs
D) Client receiving IV titrated medications
Answer💜💜: B
Rationale: LPNs/LVNs can care for stable clients with predictable outcomes.
Unstable clients, new admissions, and those receiving titrated IV medications
require RN assessment and critical thinking.
Question 4
The charge nurse observes a UAP applying wrist restraints without an order. What
is the best action?
A) Praise the UAP for quick action
B) Stop the UAP and review restraint policies
C) Wait to see if restraints are effective
D) Ignore because the client is safe
Answer💜💜: B
Rationale: Restraints require a provider's order and RN assessment. Unauthorized
application is unsafe and violates policy. The nurse must intervene immediately
and provide education.
Question 5
Which task can the nurse delegate to the UAP?
A) Assessing a client's pain level
B) Administering oral medications
C) Assisting a client with ambulation
D) Teaching a client about wound care
,Answer💜💜: C
Rationale: UAPs can perform routine tasks like ambulation, hygiene, and vital
signs. Assessment, medication administration, and teaching require nursing
judgment and licensure.
Question 6
A charge nurse receives report that a client who is 2 days post-hip arthroplasty
has new onset sudden severe pain in the surgical hip. Vital signs are stable. What
should the charge nurse do first?
A) Administer a prescribed oral analgesic
B) Instruct the AP to apply a warm compress
C) Go to the client's room and assess the client
D) Notify the orthopedic surgeon
Answer💜💜: C
Rationale: The first step in the nursing process is assessment. Sudden severe
postoperative pain requires immediate direct assessment to determine the cause
(possible dislocation) before implementing interventions.
Question 7
A charge nurse is observing a newly licensed nurse prepare to administer a
medication. The new nurse states, "I think this is the right medication, but I'm not
entirely sure." Which action should the charge nurse take?
A) Tell the new nurse to go ahead and administer it
B) Instruct the new nurse to look up the medication
C) Immediately intervene and verify the medication
D) Document the uncertainty in a performance review
Answer💜💜: C
Rationale: Client safety is paramount. Any uncertainty about medication
administration poses a significant risk. The charge nurse must immediately
intervene to prevent a potential error.
, Question 8
Which of the following tasks should the charge nurse delegate to an assistive
personnel (AP)?
A) Obtaining a blood glucose reading for a client with new-onset confusion
B) Assessing a client's readiness for discharge
C) Administering a nebulizer treatment
D) Providing post-mortem care for a client who passed away 30 minutes ago
Answer💜💜: D
Rationale: Post-mortem care is within the AP's scope of practice. New-onset
confusion requires RN assessment. Discharge assessment and medication
administration are RN responsibilities.
Question 9
A charge nurse is prioritizing care for four clients. Which client should the charge
nurse assess first?
A) Client with a chronic wound scheduled for a dressing change
B) Client with blood glucose of 180 mg/dL who feels well
C) Client with sudden onset of shortness of breath and chest pain
D) Client requiring routine morning medications
Answer💜💜: C
Rationale: Using the ABC priority framework, shortness of breath and chest pain
indicate potential acute compromise of respiratory/cardiac function, which is life-
threatening and requires immediate assessment.
Question 10
What is the first action a nurse leader should take when two staff members are in
conflict that disrupts the unit?
A) Ignore the conflict and hope it resolves
B) Address the conflict directly with both staff members and mediate privately
C) Send both staff members home for the day
D) File a formal complaint against both nurses
