HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
HESI PN EXIT V2 EXAM
Practical Nursing Comprehensive Exit Examination
2026/2027 Edition | Elsevier Assessment Technologies Institute | NCLEX-PN Aligned
• Total Questions: 150 (multiple-choice, SATA, ordered response, and NGN clinical judgment items)
• Testing Time: Approximately 3–4 hours (computer-based, proctored format)
• Passing Score: 850–900+ scaled score or 85–90% benchmark (institutional policies vary)
• Answer Format: Select the single best answer unless otherwise indicated. For SATA items, select all
correct responses. For ordered response items, arrange in the correct sequence.
• Focus Areas: NCSBN Clinical Judgment Measurement Model (CJMM) — Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes
• Correct answers are displayed in bold green. Rationales are provided in italics for each question.
Domain Questions Points
Fundamental Nursing 1–15 15
Skills
Medical-Surgical: 16–25 10
Cardiovascular
Medical-Surgical: 26–35 10
Respiratory
Medical-Surgical: GI/GU 36–45 10
Medical-Surgical: 46–55 10
Neurological
Medical-Surgical: 56–65 10
Endocrine/Musculoskeletal
Medical-Surgical: 66–75 10
Immune/Hematologic
Maternal-Newborn 76–95 20
Nursing
Pediatric Nursing 96–115 20
Mental Health Nursing 116–130 15
Leadership & Management 131–137 7
Community Health 138–142 5
Nursing
Pharmacology 143–148 6
Pathophysiology/NGN 149–150 2
Clinical Judgment
TOTAL 150 150
1
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
SECTION: FUNDAMENTAL NURSING SKILLS & CONCEPTS (Questions 1–15)
1. A practical nurse (PN) is preparing to transfer a patient from the bed to a wheelchair.
Which action demonstrates the correct use of proper body mechanics?
A) Bend at the waist with knees straight to lower the B) Keep the load close to the body and bend
patient at the knees and hips
C) Twist the torso while lifting to position the D) Stand with feet close together for a narrow base
patient in the chair of support
Rationale: Keeping the load close to the body and bending at the knees and hips (not the waist) is the
correct body mechanics technique. This uses the large muscles of the legs and reduces strain on the lower
back. Bending at the waist (A) shifts strain to the lumbar spine and risks injury. Twisting while lifting (C) is
the most common cause of back injury in healthcare workers; the nurse should pivot with the feet instead.
A narrow base of support (D) decreases stability; a wide base (feet shoulder-width apart) is recommended.
[Select All That Apply] 2. A patient has been placed on airborne precautions due to suspected
tuberculosis. Which interventions should the nurse include in the plan of care? Select all that
apply.
A) A) Place the patient in a negative-pressure airborne infection isolation room (AIIR)
B) B) Wear an N95 respirator mask when entering the room
C) C) Don a gown and gloves for all contact with the patient
D) D) Keep the door to the patient's room closed at all times
E) E) Instruct the patient to wear a surgical mask during transport outside the room
Correct Answers: A, B, D, E
Rationale: Airborne precautions for tuberculosis require an AIIR with negative pressure (A), an N95
respirator for anyone entering the room (B), the door kept closed to maintain negative pressure (D), and a
surgical mask on the patient during transport (E). Gown and gloves (C) are required for contact
precautions, not airborne precautions alone. However, if contact precautions are also indicated, they
would be added.
3. A nurse obtains the following vital signs on an adult patient: BP 98/60 mmHg, HR 112 bpm,
RR 22 breaths/min, and SpO2 93% on room air. Which finding should the nurse report to the
charge nurse first?
A) Heart rate of 112 bpm B) Blood pressure of 98/60 mmHg
C) Respiratory rate of 22 breaths/min D) SpO2 of 93% on room air
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, oxygen saturation
of 93% on room air is the most concerning finding because it indicates hypoxemia. Normal SpO2 is 95–
100%. While the heart rate of 112 bpm (A) is tachycardic and the BP of 98/60 mmHg (B) is borderline low,
these are secondary to the oxygenation deficit. A respiratory rate of 22 (C) is within the normal elevated
range for an adult (12–20 is textbook; 22 may be a compensatory response to hypoxemia). The nurse must
address oxygenation first.
4. A nurse is providing perineal care to an uncircumcised male patient. Which technique is
correct?
A) Retract the foreskin during cleansing and leave it B) Retract the foreskin during cleansing and
retracted afterward return it to its natural position after cleaning
C) Cleanse from the rectal area toward the pubic D) Use hot water to improve the cleansing process
area
Rationale: The foreskin must be retracted to expose the glans for thorough cleaning, but it must always
be returned to its natural position after cleaning to prevent paraphimosis (swelling and constriction of the
glans). Leaving the foreskin retracted (A) can impair circulation and cause tissue damage. Cleaning from
rectal area toward the pubic area (C) is incorrect; perineal care should always proceed from least
2
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
contaminated to most contaminated area (front to back for females; for males, cleanse the meatus first,
then the shaft, then the scrotum). Hot water (D) can cause burns and is unnecessary; warm water is
appropriate.
[Ordered Response] 5. A nurse is using the nursing process to care for a patient with a new
diagnosis of hypertension. Place the steps of the nursing process in the correct order (1 = first
step, 5 = last step).
Correct Order:
1. A) Assess the patient's current blood pressure, medications, and lifestyle habits
2. B) Diagnose the patient with 'Ineffective health maintenance related to lack of
knowledge about hypertension management'
3. C) Plan interventions including medication education, dietary modifications (DASH
diet), and exercise counseling
4. D) Implement the planned interventions and teach the patient about antihypertensive
medications
5. E) Evaluate the patient's blood pressure at the next visit and determine if goals have
been met
Rationale: The nursing process follows ADPIE: Assessment (0) involves collecting data about the
patient's BP, medications, and lifestyle. Diagnosis (1) is the nursing judgment phase. Planning (2) involves
designing interventions. Implementation (3) is carrying out the plan. Evaluation (4) determines the
effectiveness of the interventions. The nursing process is continuous and cyclical.
6. A patient who had abdominal surgery yesterday is experiencing difficulty breathing. Which
position should the nurse place the patient in to promote optimal lung expansion?
A) Supine with the head of bed flat B) High Fowler's position
C) Left lateral Sims' position D) Prone position
Rationale: High Fowler's position (head of bed elevated 60–90 degrees) allows maximum diaphragm
descent and lung expansion, making it the best choice for a postoperative patient with breathing difficulty.
Supine (A) restricts diaphragm movement, especially in abdominal surgery patients. Sims' position (C) is
used for enemas and rectal examinations, not respiratory optimization. Prone position (D) is used for
patients with ARDS and is contraindicated immediately after abdominal surgery.
7. Which action by the nurse demonstrates the principle of surgical asepsis rather than
medical asepsis?
A) Wearing clean gloves when emptying a urinary B) Using sterile gloves and a sterile field
drainage bag when inserting a urinary catheter
C) Washing hands with soap and water before and D) Disinfecting a bedside table with an alcohol-
after patient contact based wipe between patients
Rationale: Surgical asepsis (sterile technique) eliminates all microorganisms and is required for invasive
procedures like urinary catheter insertion. This includes using sterile gloves and maintaining a sterile field.
Medical asepsis (clean technique) reduces the number of microorganisms and includes actions like clean
gloves for drainage bag emptying (A), hand hygiene (C), and surface disinfection (D). The key distinction is
that surgical asepsis aims for a sterile (microorganism-free) environment.
8. A nurse is documenting patient care in the electronic health record (EHR). Which
documentation entry follows the recommended practice?
A) 'Patient seems to be in pain but refuses B) 'Patient states pain is 4/10 in right knee
medication' after ambulation; declined prescribed
analgesic at 0800; instructed to request
medication if needed; will reevaluate at
1000'
C) 'Looks better than yesterday' D) 'Medication given as ordered'
3
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
Rationale: Option B is correct because it is specific, objective, uses the patient's own words where
possible, documents the assessment finding, the intervention (or lack thereof), the patient's response, and
the follow-up plan. Vague or subjective entries (A, C) do not provide clear clinical information and can lead
to misinterpretation. Option D lacks essential details such as which medication, dose, route, time, and site
of administration. Documentation should follow the SBAR format and be thorough, accurate, and timely.
[Select All That Apply] 9. A nurse educator is teaching student nurses about the chain of
infection. Which components of the chain are correct? Select all that apply.
A) A) Infectious agent (causative organism)
B) B) Reservoir (place where the organism grows and multiplies)
C) C) Portal of exit (the way the organism leaves the reservoir)
D) D) Mode of transmission (the way the organism is carried from reservoir to host)
E) E) Portal of entry (the way the organism enters the new host)
F) F) Susceptible host (a person at risk for infection)
Correct Answers: A, B, C, D, E, F
Rationale: All six options represent the six links in the chain of infection. The chain consists of (1) the
infectious agent, (2) the reservoir, (3) the portal of exit, (4) the mode of transmission, (5) the portal of
entry, and (6) the susceptible host. Breaking any one of these links prevents the spread of infection.
Infection control measures target specific links (e.g., hand hygiene targets the mode of transmission;
vaccination targets the susceptible host).
10. A nurse is caring for four patients. According to Maslow's hierarchy of needs, which
patient should the nurse prioritize first?
A) A patient expressing anxiety about an upcoming B) A patient with a urine output of 20 mL
surgery over the past 4 hours
C) A patient who is lonely and requesting a visit D) A patient who wants to discuss career goals
from family before discharge
Rationale: Maslow's hierarchy prioritizes physiological needs first. A urine output of 20 mL in 4 hours (5
mL/hr) is critically low (normal is at least 30 mL/hr) and indicates acute kidney injury or severe
dehydration—a life-threatening physiological need requiring immediate intervention. Anxiety (A) is a
safety/psychological need. Loneliness (C) is a love and belonging need. Discussing career goals (D) is a self-
actualization need. Physiological needs always take priority over psychological and higher-level needs.
11. A patient says, 'I don't understand why I have to take all these pills. The doctors don't even
know what they're doing.' Which response by the nurse demonstrates therapeutic
communication?
A) 'You shouldn't feel that way. The doctors here are B) 'I understand your frustration. Can you
excellent.' tell me more about your concerns regarding
your medications?'
C) 'If you don't take your medications, you won't get D) 'Everyone has to take medications when they're
better.' in the hospital.'
Rationale: Option B uses the therapeutic techniques of reflection, validation, and open-ended questioning.
It acknowledges the patient's feelings without judgment and encourages further expression. Option A
minimizes the patient's feelings (nontherapeutic). Option C uses threatening language that creates fear
(nontherapeutic). Option D provides a generalization and minimizes the patient's specific concern
(nontherapeutic). Therapeutic communication builds trust and facilitates the nurse-patient relationship.
12. A nurse is caring for a patient with influenza. In addition to standard precautions, which
transmission-based precaution should be implemented?
A) Airborne precautions B) Droplet precautions
C) Contact precautions D) Protective (neutropenic) precautions
4
HESI PN EXIT V2 EXAM
Practical Nursing Comprehensive Exit Examination
2026/2027 Edition | Elsevier Assessment Technologies Institute | NCLEX-PN Aligned
• Total Questions: 150 (multiple-choice, SATA, ordered response, and NGN clinical judgment items)
• Testing Time: Approximately 3–4 hours (computer-based, proctored format)
• Passing Score: 850–900+ scaled score or 85–90% benchmark (institutional policies vary)
• Answer Format: Select the single best answer unless otherwise indicated. For SATA items, select all
correct responses. For ordered response items, arrange in the correct sequence.
• Focus Areas: NCSBN Clinical Judgment Measurement Model (CJMM) — Recognize Cues, Analyze Cues,
Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes
• Correct answers are displayed in bold green. Rationales are provided in italics for each question.
Domain Questions Points
Fundamental Nursing 1–15 15
Skills
Medical-Surgical: 16–25 10
Cardiovascular
Medical-Surgical: 26–35 10
Respiratory
Medical-Surgical: GI/GU 36–45 10
Medical-Surgical: 46–55 10
Neurological
Medical-Surgical: 56–65 10
Endocrine/Musculoskeletal
Medical-Surgical: 66–75 10
Immune/Hematologic
Maternal-Newborn 76–95 20
Nursing
Pediatric Nursing 96–115 20
Mental Health Nursing 116–130 15
Leadership & Management 131–137 7
Community Health 138–142 5
Nursing
Pharmacology 143–148 6
Pathophysiology/NGN 149–150 2
Clinical Judgment
TOTAL 150 150
1
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
SECTION: FUNDAMENTAL NURSING SKILLS & CONCEPTS (Questions 1–15)
1. A practical nurse (PN) is preparing to transfer a patient from the bed to a wheelchair.
Which action demonstrates the correct use of proper body mechanics?
A) Bend at the waist with knees straight to lower the B) Keep the load close to the body and bend
patient at the knees and hips
C) Twist the torso while lifting to position the D) Stand with feet close together for a narrow base
patient in the chair of support
Rationale: Keeping the load close to the body and bending at the knees and hips (not the waist) is the
correct body mechanics technique. This uses the large muscles of the legs and reduces strain on the lower
back. Bending at the waist (A) shifts strain to the lumbar spine and risks injury. Twisting while lifting (C) is
the most common cause of back injury in healthcare workers; the nurse should pivot with the feet instead.
A narrow base of support (D) decreases stability; a wide base (feet shoulder-width apart) is recommended.
[Select All That Apply] 2. A patient has been placed on airborne precautions due to suspected
tuberculosis. Which interventions should the nurse include in the plan of care? Select all that
apply.
A) A) Place the patient in a negative-pressure airborne infection isolation room (AIIR)
B) B) Wear an N95 respirator mask when entering the room
C) C) Don a gown and gloves for all contact with the patient
D) D) Keep the door to the patient's room closed at all times
E) E) Instruct the patient to wear a surgical mask during transport outside the room
Correct Answers: A, B, D, E
Rationale: Airborne precautions for tuberculosis require an AIIR with negative pressure (A), an N95
respirator for anyone entering the room (B), the door kept closed to maintain negative pressure (D), and a
surgical mask on the patient during transport (E). Gown and gloves (C) are required for contact
precautions, not airborne precautions alone. However, if contact precautions are also indicated, they
would be added.
3. A nurse obtains the following vital signs on an adult patient: BP 98/60 mmHg, HR 112 bpm,
RR 22 breaths/min, and SpO2 93% on room air. Which finding should the nurse report to the
charge nurse first?
A) Heart rate of 112 bpm B) Blood pressure of 98/60 mmHg
C) Respiratory rate of 22 breaths/min D) SpO2 of 93% on room air
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, oxygen saturation
of 93% on room air is the most concerning finding because it indicates hypoxemia. Normal SpO2 is 95–
100%. While the heart rate of 112 bpm (A) is tachycardic and the BP of 98/60 mmHg (B) is borderline low,
these are secondary to the oxygenation deficit. A respiratory rate of 22 (C) is within the normal elevated
range for an adult (12–20 is textbook; 22 may be a compensatory response to hypoxemia). The nurse must
address oxygenation first.
4. A nurse is providing perineal care to an uncircumcised male patient. Which technique is
correct?
A) Retract the foreskin during cleansing and leave it B) Retract the foreskin during cleansing and
retracted afterward return it to its natural position after cleaning
C) Cleanse from the rectal area toward the pubic D) Use hot water to improve the cleansing process
area
Rationale: The foreskin must be retracted to expose the glans for thorough cleaning, but it must always
be returned to its natural position after cleaning to prevent paraphimosis (swelling and constriction of the
glans). Leaving the foreskin retracted (A) can impair circulation and cause tissue damage. Cleaning from
rectal area toward the pubic area (C) is incorrect; perineal care should always proceed from least
2
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
contaminated to most contaminated area (front to back for females; for males, cleanse the meatus first,
then the shaft, then the scrotum). Hot water (D) can cause burns and is unnecessary; warm water is
appropriate.
[Ordered Response] 5. A nurse is using the nursing process to care for a patient with a new
diagnosis of hypertension. Place the steps of the nursing process in the correct order (1 = first
step, 5 = last step).
Correct Order:
1. A) Assess the patient's current blood pressure, medications, and lifestyle habits
2. B) Diagnose the patient with 'Ineffective health maintenance related to lack of
knowledge about hypertension management'
3. C) Plan interventions including medication education, dietary modifications (DASH
diet), and exercise counseling
4. D) Implement the planned interventions and teach the patient about antihypertensive
medications
5. E) Evaluate the patient's blood pressure at the next visit and determine if goals have
been met
Rationale: The nursing process follows ADPIE: Assessment (0) involves collecting data about the
patient's BP, medications, and lifestyle. Diagnosis (1) is the nursing judgment phase. Planning (2) involves
designing interventions. Implementation (3) is carrying out the plan. Evaluation (4) determines the
effectiveness of the interventions. The nursing process is continuous and cyclical.
6. A patient who had abdominal surgery yesterday is experiencing difficulty breathing. Which
position should the nurse place the patient in to promote optimal lung expansion?
A) Supine with the head of bed flat B) High Fowler's position
C) Left lateral Sims' position D) Prone position
Rationale: High Fowler's position (head of bed elevated 60–90 degrees) allows maximum diaphragm
descent and lung expansion, making it the best choice for a postoperative patient with breathing difficulty.
Supine (A) restricts diaphragm movement, especially in abdominal surgery patients. Sims' position (C) is
used for enemas and rectal examinations, not respiratory optimization. Prone position (D) is used for
patients with ARDS and is contraindicated immediately after abdominal surgery.
7. Which action by the nurse demonstrates the principle of surgical asepsis rather than
medical asepsis?
A) Wearing clean gloves when emptying a urinary B) Using sterile gloves and a sterile field
drainage bag when inserting a urinary catheter
C) Washing hands with soap and water before and D) Disinfecting a bedside table with an alcohol-
after patient contact based wipe between patients
Rationale: Surgical asepsis (sterile technique) eliminates all microorganisms and is required for invasive
procedures like urinary catheter insertion. This includes using sterile gloves and maintaining a sterile field.
Medical asepsis (clean technique) reduces the number of microorganisms and includes actions like clean
gloves for drainage bag emptying (A), hand hygiene (C), and surface disinfection (D). The key distinction is
that surgical asepsis aims for a sterile (microorganism-free) environment.
8. A nurse is documenting patient care in the electronic health record (EHR). Which
documentation entry follows the recommended practice?
A) 'Patient seems to be in pain but refuses B) 'Patient states pain is 4/10 in right knee
medication' after ambulation; declined prescribed
analgesic at 0800; instructed to request
medication if needed; will reevaluate at
1000'
C) 'Looks better than yesterday' D) 'Medication given as ordered'
3
, HESI PN Exit V2 Exam — 2026/2027 — 150 Questions — NCLEX-PN Pre
Rationale: Option B is correct because it is specific, objective, uses the patient's own words where
possible, documents the assessment finding, the intervention (or lack thereof), the patient's response, and
the follow-up plan. Vague or subjective entries (A, C) do not provide clear clinical information and can lead
to misinterpretation. Option D lacks essential details such as which medication, dose, route, time, and site
of administration. Documentation should follow the SBAR format and be thorough, accurate, and timely.
[Select All That Apply] 9. A nurse educator is teaching student nurses about the chain of
infection. Which components of the chain are correct? Select all that apply.
A) A) Infectious agent (causative organism)
B) B) Reservoir (place where the organism grows and multiplies)
C) C) Portal of exit (the way the organism leaves the reservoir)
D) D) Mode of transmission (the way the organism is carried from reservoir to host)
E) E) Portal of entry (the way the organism enters the new host)
F) F) Susceptible host (a person at risk for infection)
Correct Answers: A, B, C, D, E, F
Rationale: All six options represent the six links in the chain of infection. The chain consists of (1) the
infectious agent, (2) the reservoir, (3) the portal of exit, (4) the mode of transmission, (5) the portal of
entry, and (6) the susceptible host. Breaking any one of these links prevents the spread of infection.
Infection control measures target specific links (e.g., hand hygiene targets the mode of transmission;
vaccination targets the susceptible host).
10. A nurse is caring for four patients. According to Maslow's hierarchy of needs, which
patient should the nurse prioritize first?
A) A patient expressing anxiety about an upcoming B) A patient with a urine output of 20 mL
surgery over the past 4 hours
C) A patient who is lonely and requesting a visit D) A patient who wants to discuss career goals
from family before discharge
Rationale: Maslow's hierarchy prioritizes physiological needs first. A urine output of 20 mL in 4 hours (5
mL/hr) is critically low (normal is at least 30 mL/hr) and indicates acute kidney injury or severe
dehydration—a life-threatening physiological need requiring immediate intervention. Anxiety (A) is a
safety/psychological need. Loneliness (C) is a love and belonging need. Discussing career goals (D) is a self-
actualization need. Physiological needs always take priority over psychological and higher-level needs.
11. A patient says, 'I don't understand why I have to take all these pills. The doctors don't even
know what they're doing.' Which response by the nurse demonstrates therapeutic
communication?
A) 'You shouldn't feel that way. The doctors here are B) 'I understand your frustration. Can you
excellent.' tell me more about your concerns regarding
your medications?'
C) 'If you don't take your medications, you won't get D) 'Everyone has to take medications when they're
better.' in the hospital.'
Rationale: Option B uses the therapeutic techniques of reflection, validation, and open-ended questioning.
It acknowledges the patient's feelings without judgment and encourages further expression. Option A
minimizes the patient's feelings (nontherapeutic). Option C uses threatening language that creates fear
(nontherapeutic). Option D provides a generalization and minimizes the patient's specific concern
(nontherapeutic). Therapeutic communication builds trust and facilitates the nurse-patient relationship.
12. A nurse is caring for a patient with influenza. In addition to standard precautions, which
transmission-based precaution should be implemented?
A) Airborne precautions B) Droplet precautions
C) Contact precautions D) Protective (neutropenic) precautions
4
