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HESI PN LEADERSHIP EXIT EXAM
Newest Version 2026/2027 | 100 Real
Exam-Based Questions with Verified
Answers | 100% Accuracy Practical
Nursing Leadership Prep | Graded A+
DOMAIN 1: CLIENT PRIORITIZATION & TRIAGE (25 Questions)
Sub-Topic A: Prioritization using ABC and Maslow's hierarchy (8 questions)
Question 1 (Multiple-Choice)
The LPN is caring for four clients on a medical-surgical unit. Which client should be assessed
FIRST?
A. A client with chronic heart failure who reports increased fatigue
B. A client 2 hours post-appendectomy with a temperature of 100.2°F
C. A client with newly diagnosed diabetes who requests dietary teaching
D. A client with sudden-onset stridor and facial edema after receiving IV antibiotics
Answer: D [CORRECT]
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, a client
with sudden stridor and facial edema represents an acute allergic reaction (anaphylaxis) with
a compromised airway. Airway compromise is ALWAYS the highest priority regardless of other
client conditions. The LPN must immediately notify the RN and initiate emergency protocols,
including preparing for epinephrine administration per protocol.
Question 2 (Multiple-Choice)
An LPN receives report on four clients. Which client requires IMMEDIATE intervention?
A. A client with COPD whose oxygen saturation is 92% on 2L nasal cannula
B. A client with a new ileostomy who reports mild abdominal cramping
, 2
C. A client post-thyroidectomy with new-onset restlessness and confusion
D. A client with hypertension whose blood pressure is 158/92 mmHg
Answer: C [CORRECT]
Rationale: New-onset restlessness and confusion in a client post-thyroidectomy are classic
early signs of hypoxia and potential airway obstruction from postoperative bleeding or
hematoma formation. Per the ABC framework and Maslow's hierarchy (physiological needs
first), this client requires immediate assessment of airway patency and oxygenation status
BEFORE administering pain medication or other interventions. The LPN must immediately
notify the RN and provider.
Question 3 (Ordered Response)
The LPN is assigned four clients. Place the following clients in order of priority for assessment,
from highest to lowest priority.
Client with chest pain rated 8/10 and diaphoresis
Client with a blood glucose of 245 mg/dL scheduled for insulin
Client with a new colostomy who needs pouch teaching
Client with stable vital signs requesting a PRN sleep medication
Answer: 1, 2, 3, 4 [CORRECT]
Rationale: Using the ABC framework and clinical stability assessment: (1) Chest pain with
diaphoresis indicates potential acute coronary syndrome (circulation compromise) — highest
priority; (2) Elevated blood glucose requires intervention but is not immediately life-
threatening; (3) Teaching is important but can be delayed; (4) PRN sleep medication is lowest
priority for a stable client. The LPN must recognize that unstable clients always take priority
over stable clients.
Question 4 (Multiple-Choice)
Using Maslow's hierarchy of needs, which client need should the LPN address FIRST?
A. A client who is anxious about an upcoming diagnostic procedure
B. A client with a potassium level of 3.1 mEq/L and muscle weakness
C. A client who requests assistance contacting family members
, 3
D. A client who wants information about discharge planning
Answer: B [CORRECT]
Rationale: Maslow's hierarchy prioritizes physiological needs (safety of ABC and electrolyte
balance) before psychosocial needs. A potassium level of 3.1 mEq/L with muscle weakness
indicates hypokalemia, which can lead to life-threatening cardiac dysrhythmias. This
physiological need takes priority over anxiety (safety/psychological), social connection
(love/belonging), or discharge planning (self-actualization). The LPN must report this finding
immediately to the RN.
Question 5 (Select-All-That-Apply)
The LPN is prioritizing care for a group of clients. Which clients are considered UNSTABLE and
require priority assessment? (Select all that apply.)
A. Client with a blood pressure of 88/52 mmHg and altered mental status
B. Client 4 hours post-laparoscopic cholecystectomy with pain rated 3/10
C. Client with pneumonia whose respiratory rate increased from 18 to 32 in 1 hour
D. Client with heart failure who developed new bilateral crackles and dyspnea
E. Client with type 2 diabetes whose fasting blood glucose is 128 mg/dL
F. Client post-cataract surgery with stable vital signs and no complaints
Answer: A, C, D [CORRECT]
Rationale: Unstable clients exhibit signs of clinical deterioration or life-threatening conditions
requiring immediate intervention. (A) Hypotension with altered mental status indicates shock
— unstable; (C) Tachypnea escalation indicates respiratory compromise — unstable; (D) New
crackles and dyspnea indicate acute pulmonary edema — unstable. Stable clients (B, E, F) can
be managed with routine care. The LPN must recognize early signs of deterioration and
escalate unstable findings to the RN immediately.
Question 6 (Multiple-Choice)
The LPN is caring for a client who suddenly develops severe dyspnea, tachypnea (respiratory
rate 38), and oxygen saturation of 84% on room air. What is the FIRST action the LPN should
take?
, 4
A. Administer oxygen per protocol
B. Call the rapid response team
C. Place the client in high-Fowler's position
D. Assess the client's airway patency
Answer: D [CORRECT]
Rationale: The ABC framework mandates that airway assessment ALWAYS comes first before
any other intervention. Even before administering oxygen or positioning, the LPN must first
determine if the airway is patent, obstructed, or compromised. A patent airway is the
foundation of the ABC sequence. After confirming airway patency, the LPN would proceed to
breathing interventions (oxygen, positioning) and then notify the RN/provider.
Question 7 (Multiple-Choice)
Which client should the LPN assess FIRST based on the nursing process and prioritization
principles?
A. A client with a Stage 2 pressure injury requiring wound dressing change
B. A client with a nasogastric tube who reports nausea and has 800 mL of bilious output in 4
hours
C. A client scheduled for discharge who needs medication teaching
D. A client with osteoarthritis requesting PRN acetaminophen for knee pain
Answer: B [CORRECT]
Rationale: The client with a nasogastric tube producing 800 mL of bilious output in 4 hours
with nausea is experiencing a potential bowel obstruction or paralytic ileus — a physiological
emergency requiring immediate assessment. This represents an unstable client with a
potential complication. Per prioritization principles, assessment of potential complications
(unstable) takes precedence over scheduled procedures (A), discharge teaching (C), or comfort
measures (D). The LPN must immediately notify the RN.
Question 8 (Multiple-Choice)
The LPN is assigned to a client with multiple needs. Using Maslow's hierarchy, which
intervention should be performed FIRST?
HESI PN LEADERSHIP EXIT EXAM
Newest Version 2026/2027 | 100 Real
Exam-Based Questions with Verified
Answers | 100% Accuracy Practical
Nursing Leadership Prep | Graded A+
DOMAIN 1: CLIENT PRIORITIZATION & TRIAGE (25 Questions)
Sub-Topic A: Prioritization using ABC and Maslow's hierarchy (8 questions)
Question 1 (Multiple-Choice)
The LPN is caring for four clients on a medical-surgical unit. Which client should be assessed
FIRST?
A. A client with chronic heart failure who reports increased fatigue
B. A client 2 hours post-appendectomy with a temperature of 100.2°F
C. A client with newly diagnosed diabetes who requests dietary teaching
D. A client with sudden-onset stridor and facial edema after receiving IV antibiotics
Answer: D [CORRECT]
Rationale: Using the ABC (Airway, Breathing, Circulation) prioritization framework, a client
with sudden stridor and facial edema represents an acute allergic reaction (anaphylaxis) with
a compromised airway. Airway compromise is ALWAYS the highest priority regardless of other
client conditions. The LPN must immediately notify the RN and initiate emergency protocols,
including preparing for epinephrine administration per protocol.
Question 2 (Multiple-Choice)
An LPN receives report on four clients. Which client requires IMMEDIATE intervention?
A. A client with COPD whose oxygen saturation is 92% on 2L nasal cannula
B. A client with a new ileostomy who reports mild abdominal cramping
, 2
C. A client post-thyroidectomy with new-onset restlessness and confusion
D. A client with hypertension whose blood pressure is 158/92 mmHg
Answer: C [CORRECT]
Rationale: New-onset restlessness and confusion in a client post-thyroidectomy are classic
early signs of hypoxia and potential airway obstruction from postoperative bleeding or
hematoma formation. Per the ABC framework and Maslow's hierarchy (physiological needs
first), this client requires immediate assessment of airway patency and oxygenation status
BEFORE administering pain medication or other interventions. The LPN must immediately
notify the RN and provider.
Question 3 (Ordered Response)
The LPN is assigned four clients. Place the following clients in order of priority for assessment,
from highest to lowest priority.
Client with chest pain rated 8/10 and diaphoresis
Client with a blood glucose of 245 mg/dL scheduled for insulin
Client with a new colostomy who needs pouch teaching
Client with stable vital signs requesting a PRN sleep medication
Answer: 1, 2, 3, 4 [CORRECT]
Rationale: Using the ABC framework and clinical stability assessment: (1) Chest pain with
diaphoresis indicates potential acute coronary syndrome (circulation compromise) — highest
priority; (2) Elevated blood glucose requires intervention but is not immediately life-
threatening; (3) Teaching is important but can be delayed; (4) PRN sleep medication is lowest
priority for a stable client. The LPN must recognize that unstable clients always take priority
over stable clients.
Question 4 (Multiple-Choice)
Using Maslow's hierarchy of needs, which client need should the LPN address FIRST?
A. A client who is anxious about an upcoming diagnostic procedure
B. A client with a potassium level of 3.1 mEq/L and muscle weakness
C. A client who requests assistance contacting family members
, 3
D. A client who wants information about discharge planning
Answer: B [CORRECT]
Rationale: Maslow's hierarchy prioritizes physiological needs (safety of ABC and electrolyte
balance) before psychosocial needs. A potassium level of 3.1 mEq/L with muscle weakness
indicates hypokalemia, which can lead to life-threatening cardiac dysrhythmias. This
physiological need takes priority over anxiety (safety/psychological), social connection
(love/belonging), or discharge planning (self-actualization). The LPN must report this finding
immediately to the RN.
Question 5 (Select-All-That-Apply)
The LPN is prioritizing care for a group of clients. Which clients are considered UNSTABLE and
require priority assessment? (Select all that apply.)
A. Client with a blood pressure of 88/52 mmHg and altered mental status
B. Client 4 hours post-laparoscopic cholecystectomy with pain rated 3/10
C. Client with pneumonia whose respiratory rate increased from 18 to 32 in 1 hour
D. Client with heart failure who developed new bilateral crackles and dyspnea
E. Client with type 2 diabetes whose fasting blood glucose is 128 mg/dL
F. Client post-cataract surgery with stable vital signs and no complaints
Answer: A, C, D [CORRECT]
Rationale: Unstable clients exhibit signs of clinical deterioration or life-threatening conditions
requiring immediate intervention. (A) Hypotension with altered mental status indicates shock
— unstable; (C) Tachypnea escalation indicates respiratory compromise — unstable; (D) New
crackles and dyspnea indicate acute pulmonary edema — unstable. Stable clients (B, E, F) can
be managed with routine care. The LPN must recognize early signs of deterioration and
escalate unstable findings to the RN immediately.
Question 6 (Multiple-Choice)
The LPN is caring for a client who suddenly develops severe dyspnea, tachypnea (respiratory
rate 38), and oxygen saturation of 84% on room air. What is the FIRST action the LPN should
take?
, 4
A. Administer oxygen per protocol
B. Call the rapid response team
C. Place the client in high-Fowler's position
D. Assess the client's airway patency
Answer: D [CORRECT]
Rationale: The ABC framework mandates that airway assessment ALWAYS comes first before
any other intervention. Even before administering oxygen or positioning, the LPN must first
determine if the airway is patent, obstructed, or compromised. A patent airway is the
foundation of the ABC sequence. After confirming airway patency, the LPN would proceed to
breathing interventions (oxygen, positioning) and then notify the RN/provider.
Question 7 (Multiple-Choice)
Which client should the LPN assess FIRST based on the nursing process and prioritization
principles?
A. A client with a Stage 2 pressure injury requiring wound dressing change
B. A client with a nasogastric tube who reports nausea and has 800 mL of bilious output in 4
hours
C. A client scheduled for discharge who needs medication teaching
D. A client with osteoarthritis requesting PRN acetaminophen for knee pain
Answer: B [CORRECT]
Rationale: The client with a nasogastric tube producing 800 mL of bilious output in 4 hours
with nausea is experiencing a potential bowel obstruction or paralytic ileus — a physiological
emergency requiring immediate assessment. This represents an unstable client with a
potential complication. Per prioritization principles, assessment of potential complications
(unstable) takes precedence over scheduled procedures (A), discharge teaching (C), or comfort
measures (D). The LPN must immediately notify the RN.
Question 8 (Multiple-Choice)
The LPN is assigned to a client with multiple needs. Using Maslow's hierarchy, which
intervention should be performed FIRST?
