HESI Fundamentals
Practice Examination
Comprehensive Foundational Nursing Competency Assessment
Evolve Nursing Education / Elsevier — 2026/2027
60 Multiple-Choice Questions | 90 Minutes
Passing Score: 75–80% (45–48/60 Correct)
Computer-Based Practice Format (Evolve Platform / Institutional LMS)
NCLEX-RN Readiness Prediction Assessment
,Abstract
This document presents the HESI Fundamentals Practice Examination for 2026/2027, a
standardized competency assessment designed to evaluate proficiency in foundational nursing
principles for pre-licensure nursing students. The examination consists of exactly 60 multiple-
choice questions spanning nine core domains: Nursing Process and Clinical Judgment, Safety and
Infection Control, Basic Care and Comfort, Pharmacological Foundations, Psychosocial Integrity
and Therapeutic Communication, Health Promotion and Maintenance, Legal Ethical and
Professional Practice, Vital Signs and Assessment Fundamentals, and Scenario-Based
Application. The exam measures knowledge essential for safe, effective, and entry-level nursing
practice in diverse healthcare settings, aligned with the NCSBN Clinical Judgment Measurement
Model (CJMM), AACN Essentials, Evolve HESI curriculum frameworks, and institutional nursing
program learning outcomes. The 90-minute computer-based assessment is delivered via the
Evolve testing platform or institutional learning management system, with a recommended
passing score of 75–80% for NCLEX-RN readiness prediction.
Keywords: HESI Fundamentals, NCLEX-RN, clinical judgment, CJMM, nursing process, patient
safety, pharmacological foundations, therapeutic communication, health promotion
Examination Overview
Parameter Details
Examination Title HESI Fundamentals Practice Examination
Governing Authority Evolve Nursing Education / Elsevier
Question Count 60 Multiple-Choice Questions (MCQ)
Testing Time 90 Minutes
Delivery Format Computer-Based (Evolve Platform /
Institutional LMS)
Passing Score 75–80% (45–48/60 Correct) for NCLEX-RN
Readiness
Item Types Standard MCQ, SATA, Prioritization
Scenarios,
Clinical Judgment Vignettes (NGN-style),
Calculation Items, Concept Integration
Questions
Regulatory Alignment NCSBN CJMM, AACN Essentials, HESI
Concept-Based Curriculum
Certification HESI Fundamentals Competency / NCLEX-
RN Readiness Prediction
Domain Distribution
Domain Questions Percentage
1. Nursing Process & Clinical 9 (Q1–Q9) 15%
Judgment
2. Safety & Infection Control 9 (Q10–Q18) 15%
3. Basic Care & Comfort 8 (Q19–Q26) 13%
4. Pharmacological 8 (Q27–Q34) 13%
Foundations
5. Psychosocial Integrity & 6 (Q35–Q40) 10%
Therapeutic Communication
6. Health Promotion & 6 (Q41–Q46) 10%
Maintenance
7. Legal, Ethical & 5 (Q47–Q51) 8%
Professional Practice
8. Vital Signs & Assessment 6 (Q52–Q57) 10%
, Fundamentals
9. Scenario-Based Application 3 (Q58–Q60) 6%
Total 60 100%
Introduction
The HESI Fundamentals Practice Examination evaluates foundational nursing competency across
the essential knowledge domains required for safe and effective entry-level practice. This
examination is aligned with the NCSBN Clinical Judgment Measurement Model (CJMM), which
structures clinical reasoning into six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Additionally, the exam
incorporates AACN Essentials competencies and the Evolve HESI concept-based curriculum
framework. Successful performance on this assessment predicts NCLEX-RN readiness and
demonstrates the candidate's ability to apply nursing process principles, prioritize care using the
ABC and Maslow frameworks, implement evidence-based safety practices, perform accurate
assessments, administer medications safely, communicate therapeutically, and apply legal and
ethical principles in clinical decision-making. The examination emphasizes integration of
knowledge across domains through clinical judgment vignettes and scenario-based items that
reflect the complexity of contemporary nursing practice.
Examination Questions
Domain: Nursing Process & Clinical Judgment
Q1: A nurse is caring for a client with heart failure who reports increased shortness
of breath and has new crackles bilaterally in the lung bases. Which step of the
nursing process is the nurse performing when identifying that the client's fluid
volume is excessive?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
Correct Answer: B
Rationale: When the nurse interprets assessment data to identify a client's health problem — in
this case, analyzing the cue of bilateral crackles and dyspnea to determine the diagnosis of Fluid
Volume Excess — the nurse is in the Diagnosis phase (Step 2 of ADPIE). Assessment (A) involves
collecting subjective and objective data. Planning (C) involves setting goals and selecting
interventions. Implementation (D) involves carrying out the planned interventions. The key
distinction is that Diagnosis involves clinical judgment to identify the human response to the
health condition, moving beyond mere data collection to data interpretation and problem
identification.
Q2: Using the NCSBN Clinical Judgment Measurement Model (CJMM), which
cognitive skill is the nurse demonstrating when recognizing that a postoperative
client's heart rate of 120 bpm, blood pressure of 88/52 mmHg, and cool, clammy
skin indicate potential hemorrhage?
A. Recognize Cues
B. Analyze Cues
C. Prioritize Hypotheses
D. Generate Solutions
Correct Answer: B
Practice Examination
Comprehensive Foundational Nursing Competency Assessment
Evolve Nursing Education / Elsevier — 2026/2027
60 Multiple-Choice Questions | 90 Minutes
Passing Score: 75–80% (45–48/60 Correct)
Computer-Based Practice Format (Evolve Platform / Institutional LMS)
NCLEX-RN Readiness Prediction Assessment
,Abstract
This document presents the HESI Fundamentals Practice Examination for 2026/2027, a
standardized competency assessment designed to evaluate proficiency in foundational nursing
principles for pre-licensure nursing students. The examination consists of exactly 60 multiple-
choice questions spanning nine core domains: Nursing Process and Clinical Judgment, Safety and
Infection Control, Basic Care and Comfort, Pharmacological Foundations, Psychosocial Integrity
and Therapeutic Communication, Health Promotion and Maintenance, Legal Ethical and
Professional Practice, Vital Signs and Assessment Fundamentals, and Scenario-Based
Application. The exam measures knowledge essential for safe, effective, and entry-level nursing
practice in diverse healthcare settings, aligned with the NCSBN Clinical Judgment Measurement
Model (CJMM), AACN Essentials, Evolve HESI curriculum frameworks, and institutional nursing
program learning outcomes. The 90-minute computer-based assessment is delivered via the
Evolve testing platform or institutional learning management system, with a recommended
passing score of 75–80% for NCLEX-RN readiness prediction.
Keywords: HESI Fundamentals, NCLEX-RN, clinical judgment, CJMM, nursing process, patient
safety, pharmacological foundations, therapeutic communication, health promotion
Examination Overview
Parameter Details
Examination Title HESI Fundamentals Practice Examination
Governing Authority Evolve Nursing Education / Elsevier
Question Count 60 Multiple-Choice Questions (MCQ)
Testing Time 90 Minutes
Delivery Format Computer-Based (Evolve Platform /
Institutional LMS)
Passing Score 75–80% (45–48/60 Correct) for NCLEX-RN
Readiness
Item Types Standard MCQ, SATA, Prioritization
Scenarios,
Clinical Judgment Vignettes (NGN-style),
Calculation Items, Concept Integration
Questions
Regulatory Alignment NCSBN CJMM, AACN Essentials, HESI
Concept-Based Curriculum
Certification HESI Fundamentals Competency / NCLEX-
RN Readiness Prediction
Domain Distribution
Domain Questions Percentage
1. Nursing Process & Clinical 9 (Q1–Q9) 15%
Judgment
2. Safety & Infection Control 9 (Q10–Q18) 15%
3. Basic Care & Comfort 8 (Q19–Q26) 13%
4. Pharmacological 8 (Q27–Q34) 13%
Foundations
5. Psychosocial Integrity & 6 (Q35–Q40) 10%
Therapeutic Communication
6. Health Promotion & 6 (Q41–Q46) 10%
Maintenance
7. Legal, Ethical & 5 (Q47–Q51) 8%
Professional Practice
8. Vital Signs & Assessment 6 (Q52–Q57) 10%
, Fundamentals
9. Scenario-Based Application 3 (Q58–Q60) 6%
Total 60 100%
Introduction
The HESI Fundamentals Practice Examination evaluates foundational nursing competency across
the essential knowledge domains required for safe and effective entry-level practice. This
examination is aligned with the NCSBN Clinical Judgment Measurement Model (CJMM), which
structures clinical reasoning into six cognitive skills: Recognize Cues, Analyze Cues, Prioritize
Hypotheses, Generate Solutions, Take Action, and Evaluate Outcomes. Additionally, the exam
incorporates AACN Essentials competencies and the Evolve HESI concept-based curriculum
framework. Successful performance on this assessment predicts NCLEX-RN readiness and
demonstrates the candidate's ability to apply nursing process principles, prioritize care using the
ABC and Maslow frameworks, implement evidence-based safety practices, perform accurate
assessments, administer medications safely, communicate therapeutically, and apply legal and
ethical principles in clinical decision-making. The examination emphasizes integration of
knowledge across domains through clinical judgment vignettes and scenario-based items that
reflect the complexity of contemporary nursing practice.
Examination Questions
Domain: Nursing Process & Clinical Judgment
Q1: A nurse is caring for a client with heart failure who reports increased shortness
of breath and has new crackles bilaterally in the lung bases. Which step of the
nursing process is the nurse performing when identifying that the client's fluid
volume is excessive?
A. Assessment
B. Diagnosis
C. Planning
D. Implementation
Correct Answer: B
Rationale: When the nurse interprets assessment data to identify a client's health problem — in
this case, analyzing the cue of bilateral crackles and dyspnea to determine the diagnosis of Fluid
Volume Excess — the nurse is in the Diagnosis phase (Step 2 of ADPIE). Assessment (A) involves
collecting subjective and objective data. Planning (C) involves setting goals and selecting
interventions. Implementation (D) involves carrying out the planned interventions. The key
distinction is that Diagnosis involves clinical judgment to identify the human response to the
health condition, moving beyond mere data collection to data interpretation and problem
identification.
Q2: Using the NCSBN Clinical Judgment Measurement Model (CJMM), which
cognitive skill is the nurse demonstrating when recognizing that a postoperative
client's heart rate of 120 bpm, blood pressure of 88/52 mmHg, and cool, clammy
skin indicate potential hemorrhage?
A. Recognize Cues
B. Analyze Cues
C. Prioritize Hypotheses
D. Generate Solutions
Correct Answer: B
