HESI PN Exit V2 Exam Study Guide 2026/2027
HESI PN EXIT V2 EXAMINATION
2026/2027 | 160 Questions | NCLEX-PN Prep | Graded A+ | Verified Answers
Core Domains: Fundamentals of Nursing, Medical-Surgical Nursing, Pharmacology,
Maternal-Newborn Nursing, Pediatric Nursing, Psychiatric-Mental Health Nursing,
Gerontology, Nutrition, Prioritization & Delegation, Safety & Infection Control,
Health Promotion & Maintenance | NCLEX-PN Test Plan Alignment
Introduction
This HESI PN Exit V2 Exam document for the 2026/2027 academic cycle reflects the official Elsevier
HESI Exit Examination blueprint for practical nursing programs. The HESI Exit Exam is a
comprehensive predictor of NCLEX-PN success, designed to evaluate students' readiness for licensure
by assessing clinical judgment, prioritization, and application of nursing knowledge across all content
areas essential for safe, entry-level practical nursing practice.
Answer Format: All correct answers are presented in bold and green. Rationales in italics
reinforce evidence-based nursing practice and clinical judgment.
FUNDAMENTALS OF NURSING
1. The nurse is preparing to administer a medication via the Z-track method. Which
action is correct?
A. Inject the medication rapidly
B. Pull the skin laterally before injection and hold until after withdrawal
C. Massage the site after injection
D. Use a 45-degree angle for injection
Correct Answer: B. Pull the skin laterally before injection and hold until after
withdrawal
Rationale: The Z-track method involves displacing the skin laterally before injection, which creates
a zigzag path that seals the medication in the muscle, preventing leakage into subcutaneous tissue
and reducing irritation.
2. A client has a prescription for oxygen at 4 L/min via nasal cannula. Which finding
indicates the therapy is effective?
A. Respiratory rate of 28/min
B. Oxygen saturation of 96%
C. Use of accessory muscles
D. Presence of cyanosis
Correct Answer: B. Oxygen saturation of 96%
Rationale: Oxygen saturation of 96% indicates adequate oxygenation. Normal SpO2 is 95-100%.
Respiratory rate of 28/min, accessory muscle use, and cyanosis indicate respiratory distress and
inadequate oxygenation.
3. The nurse is assessing a client's blood pressure. Which action will ensure an accurate
reading?
A. Take the reading immediately after the client walks into the room
B. Position the client's arm at heart level
C. Use a cuff that covers 50% of the upper arm
D. Wrap the cuff loosely around the arm
Correct Answer: B. Position the client's arm at heart level
Page 1 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Rationale: The arm should be positioned at heart level for accurate blood pressure measurement.
The cuff should cover 80% of the upper arm circumference and be wrapped snugly. The client should
rest for 5 minutes before measurement.
4. A client is on fall precautions. Which intervention should the nurse implement first?
A. Keep the bed in the lowest position
B. Apply physical restraints
C. Administer sedation
D. Keep all four side rails raised
Correct Answer: A. Keep the bed in the lowest position
Rationale: Keeping the bed in the lowest position is the first-line intervention for fall prevention.
Physical restraints require a prescription and are last resort. Four side rails may be considered a
restraint. Sedation increases fall risk.
5. The nurse is preparing to suction a client's tracheostomy. Which action is correct?
A. Apply suction while inserting the catheter
B. Suction for up to 20 seconds at a time
C. Hyperoxygenate the client before suctioning
D. Use clean technique for the procedure
Correct Answer: B. Hyperoxygenate the client before suctioning
Rationale: The client should be hyperoxygenated before suctioning to prevent hypoxia. Suction is
applied only during withdrawal, for 10-15 seconds maximum. Sterile technique is required.
Suctioning during insertion causes trauma.
6. A client has a nasogastric tube for enteral feeding. Before administering the feeding,
what should the nurse do first?
A. Flush the tube with water
B. Check the pH of aspirated contents
C. Elevate the head of the bed
D. Warm the feeding solution
Correct Answer: B. Check the pH of aspirated contents
Rationale: Checking tube placement is the priority before administering feedings. Gastric pH is
typically 1-5.5. The head of bed should be elevated 30-45 degrees during feedings to prevent
aspiration.
7. The nurse is providing care for a client who is hearing impaired. Which
communication technique is most appropriate?
A. Speak loudly and slowly
B. Stand directly in front of the client when speaking
C. Use medical terminology to be precise
D. Avoid eye contact
Correct Answer: B. Stand directly in front of the client when speaking
Rationale: Standing directly in front allows the client to see lip movements and facial expressions.
Speak at a normal volume and pace. Use simple language. Eye contact facilitates communication.
8. A postoperative client has a Jackson-Pratt drain. Which finding should the nurse
report immediately?
A. Serous drainage in the bulb
B. Sudden cessation of drainage
C. Drainage that has decreased over 24 hours
D. The bulb is compressed
Correct Answer: B. Sudden cessation of drainage
Page 2 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Rationale: Sudden cessation of drainage may indicate a blockage or kink in the drain, which could
lead to fluid accumulation and infection. The bulb should be compressed to maintain suction.
Decreasing drainage over time is expected.
9. The nurse is teaching a client about using a cane for ambulation. Which instruction is
correct?
A. Hold the cane on the weaker side
B. Move the cane and weaker leg together
C. Advance the cane 18-24 inches with each step
D. Keep the cane on the stronger side only for stairs
Correct Answer: B. Move the cane and weaker leg together
Rationale: The cane should be held on the stronger side and moved together with the weaker leg to
provide support. The cane is advanced 6-10 inches with each step. The same technique is used for
stairs.
10. A client is receiving a blood transfusion. Which finding indicates a possible
transfusion reaction?
A. Temperature of 99°F (37.2°C)
B. Blood pressure of 118/70 mm Hg
C. Flank pain and dark urine
D. Respiratory rate of 18/min
Correct Answer: B. Flank pain and dark urine
Rationale: Flank pain and dark urine indicate possible hemolytic transfusion reaction, which is a
medical emergency. Other signs include fever, chills, hypotension, and tachycardia. The transfusion
should be stopped immediately.
11. The nurse is performing a sterile dressing change. Which action breaks sterile
technique?
A. Opening the first flap of the sterile package away from the body
B. Pouring solution onto a sterile field from 4-6 inches above
C. Reaching over the sterile field to obtain supplies
D. Holding sterile items above waist level
Correct Answer: B. Reaching over the sterile field to obtain supplies
Rationale: Reaching over a sterile field breaks sterile technique because the nurse's arm passes
over the sterile area, potentially contaminating it. Supplies should be placed on the field from the
side or dropped onto the field.
12. A client is prescribed bed rest. Which intervention will help prevent complications
of immobility?
A. Keep the client in a supine position
B. Perform range-of-motion exercises every shift
C. Apply antiembolism stockings as prescribed
D. Limit fluid intake
Correct Answer: B. Apply antiembolism stockings as prescribed
Rationale: Antiembolism stockings help prevent deep vein thrombosis. Range of motion should be
performed every 4-8 hours. The client should be repositioned every 2 hours. Adequate hydration
helps prevent complications.
13. The nurse is preparing to administer an intradermal injection for a tuberculin skin
test. Which technique is correct?
A. Use a 45-degree angle for injection
B. Inject 0.1 mL of solution
C. Massage the site after injection
D. Aspirate before injecting
Page 3 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Correct Answer: B. Inject 0.1 mL of solution
Rationale: Intradermal injections for tuberculin skin tests use 0.1 mL of solution injected at a 5-15
degree angle. A small wheal should form. Do not massage or aspirate. The site is assessed 48-72
hours later.
14. A client has a prescription for an indwelling urinary catheter. Which action reduces
the risk of catheter-associated urinary tract infection (CAUTI)?
A. Keep the drainage bag on the bed
B. Clean the meatus with antiseptic solution daily
C. Maintain a closed urinary drainage system
D. Irrigate the catheter daily
Correct Answer: B. Maintain a closed urinary drainage system
Rationale: Maintaining a closed drainage system is the most important intervention to prevent
CAUTI. The drainage bag should be kept below the bladder. Routine irrigation and antiseptic
cleansing are not recommended.
15. The nurse is documenting in a client's electronic health record. Which
documentation is appropriate?
A. Documenting for another nurse who is busy
B. Using abbreviations not on the approved list
C. Documenting after completing care for multiple clients
D. Documenting objective findings only
Correct Answer: C. Documenting objective findings only
Rationale: Documentation should be objective, factual, and timely. Only approved abbreviations
should be used. Nurses document their own care. Documentation should occur as close to the time of
care as possible.
16. A client is scheduled for surgery and has a latex allergy. Which intervention is most
important?
A. Place a latex allergy sign on the door
B. Ensure latex-free supplies are available in the operating room
C. Administer diphenhydramine before surgery
D. Schedule the surgery as the last case of the day
Correct Answer: B. Ensure latex-free supplies are available in the operating room
Rationale: The priority is ensuring a latex-free environment in the OR. Signs should be posted and
the chart flagged. Premedication may be ordered but is not the priority. Scheduling first can reduce
latex exposure.
17. The nurse is caring for a client with a stage 2 pressure injury. Which dressing is
most appropriate?
A. Dry gauze dressing
B. Hydrocolloid dressing
C. Wet-to-dry dressing
D. No dressing needed
Correct Answer: B. Hydrocolloid dressing
Rationale: Stage 2 pressure injuries are partial-thickness with pink, moist wound beds.
Hydrocolloid dressings maintain a moist wound environment and protect from contamination.
They can remain in place for 3-7 days.
18. A client is receiving oxygen via a simple face mask at 6 L/min. The nurse should
monitor for which complication?
A. Carbon dioxide retention
B. Dry mucous membranes
C. Skin breakdown over ears
Page 4 of 34
HESI PN EXIT V2 EXAMINATION
2026/2027 | 160 Questions | NCLEX-PN Prep | Graded A+ | Verified Answers
Core Domains: Fundamentals of Nursing, Medical-Surgical Nursing, Pharmacology,
Maternal-Newborn Nursing, Pediatric Nursing, Psychiatric-Mental Health Nursing,
Gerontology, Nutrition, Prioritization & Delegation, Safety & Infection Control,
Health Promotion & Maintenance | NCLEX-PN Test Plan Alignment
Introduction
This HESI PN Exit V2 Exam document for the 2026/2027 academic cycle reflects the official Elsevier
HESI Exit Examination blueprint for practical nursing programs. The HESI Exit Exam is a
comprehensive predictor of NCLEX-PN success, designed to evaluate students' readiness for licensure
by assessing clinical judgment, prioritization, and application of nursing knowledge across all content
areas essential for safe, entry-level practical nursing practice.
Answer Format: All correct answers are presented in bold and green. Rationales in italics
reinforce evidence-based nursing practice and clinical judgment.
FUNDAMENTALS OF NURSING
1. The nurse is preparing to administer a medication via the Z-track method. Which
action is correct?
A. Inject the medication rapidly
B. Pull the skin laterally before injection and hold until after withdrawal
C. Massage the site after injection
D. Use a 45-degree angle for injection
Correct Answer: B. Pull the skin laterally before injection and hold until after
withdrawal
Rationale: The Z-track method involves displacing the skin laterally before injection, which creates
a zigzag path that seals the medication in the muscle, preventing leakage into subcutaneous tissue
and reducing irritation.
2. A client has a prescription for oxygen at 4 L/min via nasal cannula. Which finding
indicates the therapy is effective?
A. Respiratory rate of 28/min
B. Oxygen saturation of 96%
C. Use of accessory muscles
D. Presence of cyanosis
Correct Answer: B. Oxygen saturation of 96%
Rationale: Oxygen saturation of 96% indicates adequate oxygenation. Normal SpO2 is 95-100%.
Respiratory rate of 28/min, accessory muscle use, and cyanosis indicate respiratory distress and
inadequate oxygenation.
3. The nurse is assessing a client's blood pressure. Which action will ensure an accurate
reading?
A. Take the reading immediately after the client walks into the room
B. Position the client's arm at heart level
C. Use a cuff that covers 50% of the upper arm
D. Wrap the cuff loosely around the arm
Correct Answer: B. Position the client's arm at heart level
Page 1 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Rationale: The arm should be positioned at heart level for accurate blood pressure measurement.
The cuff should cover 80% of the upper arm circumference and be wrapped snugly. The client should
rest for 5 minutes before measurement.
4. A client is on fall precautions. Which intervention should the nurse implement first?
A. Keep the bed in the lowest position
B. Apply physical restraints
C. Administer sedation
D. Keep all four side rails raised
Correct Answer: A. Keep the bed in the lowest position
Rationale: Keeping the bed in the lowest position is the first-line intervention for fall prevention.
Physical restraints require a prescription and are last resort. Four side rails may be considered a
restraint. Sedation increases fall risk.
5. The nurse is preparing to suction a client's tracheostomy. Which action is correct?
A. Apply suction while inserting the catheter
B. Suction for up to 20 seconds at a time
C. Hyperoxygenate the client before suctioning
D. Use clean technique for the procedure
Correct Answer: B. Hyperoxygenate the client before suctioning
Rationale: The client should be hyperoxygenated before suctioning to prevent hypoxia. Suction is
applied only during withdrawal, for 10-15 seconds maximum. Sterile technique is required.
Suctioning during insertion causes trauma.
6. A client has a nasogastric tube for enteral feeding. Before administering the feeding,
what should the nurse do first?
A. Flush the tube with water
B. Check the pH of aspirated contents
C. Elevate the head of the bed
D. Warm the feeding solution
Correct Answer: B. Check the pH of aspirated contents
Rationale: Checking tube placement is the priority before administering feedings. Gastric pH is
typically 1-5.5. The head of bed should be elevated 30-45 degrees during feedings to prevent
aspiration.
7. The nurse is providing care for a client who is hearing impaired. Which
communication technique is most appropriate?
A. Speak loudly and slowly
B. Stand directly in front of the client when speaking
C. Use medical terminology to be precise
D. Avoid eye contact
Correct Answer: B. Stand directly in front of the client when speaking
Rationale: Standing directly in front allows the client to see lip movements and facial expressions.
Speak at a normal volume and pace. Use simple language. Eye contact facilitates communication.
8. A postoperative client has a Jackson-Pratt drain. Which finding should the nurse
report immediately?
A. Serous drainage in the bulb
B. Sudden cessation of drainage
C. Drainage that has decreased over 24 hours
D. The bulb is compressed
Correct Answer: B. Sudden cessation of drainage
Page 2 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Rationale: Sudden cessation of drainage may indicate a blockage or kink in the drain, which could
lead to fluid accumulation and infection. The bulb should be compressed to maintain suction.
Decreasing drainage over time is expected.
9. The nurse is teaching a client about using a cane for ambulation. Which instruction is
correct?
A. Hold the cane on the weaker side
B. Move the cane and weaker leg together
C. Advance the cane 18-24 inches with each step
D. Keep the cane on the stronger side only for stairs
Correct Answer: B. Move the cane and weaker leg together
Rationale: The cane should be held on the stronger side and moved together with the weaker leg to
provide support. The cane is advanced 6-10 inches with each step. The same technique is used for
stairs.
10. A client is receiving a blood transfusion. Which finding indicates a possible
transfusion reaction?
A. Temperature of 99°F (37.2°C)
B. Blood pressure of 118/70 mm Hg
C. Flank pain and dark urine
D. Respiratory rate of 18/min
Correct Answer: B. Flank pain and dark urine
Rationale: Flank pain and dark urine indicate possible hemolytic transfusion reaction, which is a
medical emergency. Other signs include fever, chills, hypotension, and tachycardia. The transfusion
should be stopped immediately.
11. The nurse is performing a sterile dressing change. Which action breaks sterile
technique?
A. Opening the first flap of the sterile package away from the body
B. Pouring solution onto a sterile field from 4-6 inches above
C. Reaching over the sterile field to obtain supplies
D. Holding sterile items above waist level
Correct Answer: B. Reaching over the sterile field to obtain supplies
Rationale: Reaching over a sterile field breaks sterile technique because the nurse's arm passes
over the sterile area, potentially contaminating it. Supplies should be placed on the field from the
side or dropped onto the field.
12. A client is prescribed bed rest. Which intervention will help prevent complications
of immobility?
A. Keep the client in a supine position
B. Perform range-of-motion exercises every shift
C. Apply antiembolism stockings as prescribed
D. Limit fluid intake
Correct Answer: B. Apply antiembolism stockings as prescribed
Rationale: Antiembolism stockings help prevent deep vein thrombosis. Range of motion should be
performed every 4-8 hours. The client should be repositioned every 2 hours. Adequate hydration
helps prevent complications.
13. The nurse is preparing to administer an intradermal injection for a tuberculin skin
test. Which technique is correct?
A. Use a 45-degree angle for injection
B. Inject 0.1 mL of solution
C. Massage the site after injection
D. Aspirate before injecting
Page 3 of 34
, HESI PN Exit V2 Exam Study Guide 2026/2027
Correct Answer: B. Inject 0.1 mL of solution
Rationale: Intradermal injections for tuberculin skin tests use 0.1 mL of solution injected at a 5-15
degree angle. A small wheal should form. Do not massage or aspirate. The site is assessed 48-72
hours later.
14. A client has a prescription for an indwelling urinary catheter. Which action reduces
the risk of catheter-associated urinary tract infection (CAUTI)?
A. Keep the drainage bag on the bed
B. Clean the meatus with antiseptic solution daily
C. Maintain a closed urinary drainage system
D. Irrigate the catheter daily
Correct Answer: B. Maintain a closed urinary drainage system
Rationale: Maintaining a closed drainage system is the most important intervention to prevent
CAUTI. The drainage bag should be kept below the bladder. Routine irrigation and antiseptic
cleansing are not recommended.
15. The nurse is documenting in a client's electronic health record. Which
documentation is appropriate?
A. Documenting for another nurse who is busy
B. Using abbreviations not on the approved list
C. Documenting after completing care for multiple clients
D. Documenting objective findings only
Correct Answer: C. Documenting objective findings only
Rationale: Documentation should be objective, factual, and timely. Only approved abbreviations
should be used. Nurses document their own care. Documentation should occur as close to the time of
care as possible.
16. A client is scheduled for surgery and has a latex allergy. Which intervention is most
important?
A. Place a latex allergy sign on the door
B. Ensure latex-free supplies are available in the operating room
C. Administer diphenhydramine before surgery
D. Schedule the surgery as the last case of the day
Correct Answer: B. Ensure latex-free supplies are available in the operating room
Rationale: The priority is ensuring a latex-free environment in the OR. Signs should be posted and
the chart flagged. Premedication may be ordered but is not the priority. Scheduling first can reduce
latex exposure.
17. The nurse is caring for a client with a stage 2 pressure injury. Which dressing is
most appropriate?
A. Dry gauze dressing
B. Hydrocolloid dressing
C. Wet-to-dry dressing
D. No dressing needed
Correct Answer: B. Hydrocolloid dressing
Rationale: Stage 2 pressure injuries are partial-thickness with pink, moist wound beds.
Hydrocolloid dressings maintain a moist wound environment and protect from contamination.
They can remain in place for 3-7 days.
18. A client is receiving oxygen via a simple face mask at 6 L/min. The nurse should
monitor for which complication?
A. Carbon dioxide retention
B. Dry mucous membranes
C. Skin breakdown over ears
Page 4 of 34
