2026
HESI RN Exit Exam 2026 Targeted
Review and Test Bank: Clinical
Reasoning, Priority Setting, and NCLEX-
Style Scenarios
In planning care for a 6 month-old infant, what must the nurse provide to assist in the
development of trust?
A) Food
B) Warmth
Correct Answer: C) Security
D) Comfort
Rationale
Security promotes trust during Erikson’s stage of trust versus mistrust by ensuring consistent
care and meeting the infant’s needs reliably. Food, warmth, and comfort are important physical
needs, but they contribute to trust only when delivered consistently as part of a secure
environment.
A nurse has just received a medication order which is not legible. Which statement best reflects
assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
Correct Answer: B) "Would you please clarify what you have written so I am sure I am
reading it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would be
more careful."
D) "Please print in the future so I do not have to spend extra time attempting to read your
writing."
Rationale
Assertive communication is respectful, clear, and focused on patient safety. Option B seeks
clarification without blaming or being aggressive. The other options sound confrontational or
passive-aggressive and may hinder professional collaboration.
What is the most important consideration when teaching parents how to reduce risks in the
home?
,2026
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
Correct Answer: D) Age of children in the home
Rationale
Safety risks are directly related to the developmental stage of the child. The age of the children
determines appropriate safety teaching. The other factors are secondary considerations.
A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters
the room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
Correct Answer: C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control
Rationale
Sickle cell crisis causes severe pain and requires prompt analgesic treatment. Fluids and
relaxation may help but do not replace pain medication. Placebos are unethical and
inappropriate.
While caring for a toddler with croup, which initial sign of croup requires the nurse's immediate
attention?
Correct Answer: A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions
Rationale
An elevated respiratory rate indicates respiratory distress and potential airway compromise,
which is critical in croup. The other findings are less immediately life-threatening.
A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial assessment,
the nurse would anticipate which of the following assessment findings?
Correct Answer: A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions
,2026
Rationale
Low thyroid hormone levels indicate hypothyroidism, which causes fatigue and lethargy. Heat
intolerance and diarrhea are associated with hyperthyroidism.
The emergency room nurse admits a child who experienced a seizure at school. The father
comments that this is the first occurrence and denies any family history of epilepsy. What is the
best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
Correct Answer: B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures."
Rationale
One seizure does not confirm epilepsy. Option B provides accurate, reassuring information
without making assumptions. The other responses either minimize or prematurely diagnose the
condition.
Alcohol and drug abuse impairs judgment and increases risk taking behavior. What nursing
diagnosis best applies?
Correct Answer: A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem
Rationale
Impaired judgment and risky behaviors increase the likelihood of injury. The other diagnoses
may be relevant but do not directly address the primary safety concern.
Which of these findings would the nurse more closely associate with anemia in a 10 month-old
infant?
A) Hemoglobin level of 12 g/dL
Correct Answer: B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160
Rationale
Pallor is a classic sign of anemia. A hemoglobin of 12 g/dL is normal for an infant. Hypoactivity
and heart rate changes are nonspecific.
, 2026
The nurse is caring for a client in hypertensive crisis in an intensive care unit. The priority
assessment in the first hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
Correct Answer: D) Pupil responses
Rationale
Hypertensive crisis can cause acute neurological damage. Assessing pupil response helps detect
early signs of increased intracranial pressure or stroke.
Which of these clients who are all in the terminal stage of cancer is least appropriate to suggest
the use of patient-controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on the hands
Correct Answer: D) A preschooler with intermittent episodes of alertness
Rationale
PCA requires cognitive ability and consistent alertness to use safely. A preschooler with
fluctuating alertness cannot reliably operate the device.
The nurse is about to assess a 6 month-old child with nonorganic failure-to-thrive (NOFTT).
Upon entering the room, the nurse would expect the baby to be
A) Irritable and colicky with no attempts to pull to standing
B) Alert, laughing and playing with a rattle, sitting with support
C) Skin color dusky with poor skin turgor over abdomen
Correct Answer: D) Pale, thin arms and legs, uninterested in surroundings
Rationale
NOFTT is associated with poor weight gain, muscle wasting, and lack of social engagement. The
other options describe normal or unrelated findings.
As the nurse is speaking with a group of teens, which of these side effects of chemotherapy for
cancer would the nurse expect this group to be more interested in during the discussion?
A) Mouth sores
B) Fatigue
C) Diarrhea
Correct Answer: D) Hair loss
HESI RN Exit Exam 2026 Targeted
Review and Test Bank: Clinical
Reasoning, Priority Setting, and NCLEX-
Style Scenarios
In planning care for a 6 month-old infant, what must the nurse provide to assist in the
development of trust?
A) Food
B) Warmth
Correct Answer: C) Security
D) Comfort
Rationale
Security promotes trust during Erikson’s stage of trust versus mistrust by ensuring consistent
care and meeting the infant’s needs reliably. Food, warmth, and comfort are important physical
needs, but they contribute to trust only when delivered consistently as part of a secure
environment.
A nurse has just received a medication order which is not legible. Which statement best reflects
assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
Correct Answer: B) "Would you please clarify what you have written so I am sure I am
reading it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would be
more careful."
D) "Please print in the future so I do not have to spend extra time attempting to read your
writing."
Rationale
Assertive communication is respectful, clear, and focused on patient safety. Option B seeks
clarification without blaming or being aggressive. The other options sound confrontational or
passive-aggressive and may hinder professional collaboration.
What is the most important consideration when teaching parents how to reduce risks in the
home?
,2026
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
Correct Answer: D) Age of children in the home
Rationale
Safety risks are directly related to the developmental stage of the child. The age of the children
determines appropriate safety teaching. The other factors are secondary considerations.
A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters
the room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
Correct Answer: C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control
Rationale
Sickle cell crisis causes severe pain and requires prompt analgesic treatment. Fluids and
relaxation may help but do not replace pain medication. Placebos are unethical and
inappropriate.
While caring for a toddler with croup, which initial sign of croup requires the nurse's immediate
attention?
Correct Answer: A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions
Rationale
An elevated respiratory rate indicates respiratory distress and potential airway compromise,
which is critical in croup. The other findings are less immediately life-threatening.
A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial assessment,
the nurse would anticipate which of the following assessment findings?
Correct Answer: A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions
,2026
Rationale
Low thyroid hormone levels indicate hypothyroidism, which causes fatigue and lethargy. Heat
intolerance and diarrhea are associated with hyperthyroidism.
The emergency room nurse admits a child who experienced a seizure at school. The father
comments that this is the first occurrence and denies any family history of epilepsy. What is the
best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
Correct Answer: B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures."
Rationale
One seizure does not confirm epilepsy. Option B provides accurate, reassuring information
without making assumptions. The other responses either minimize or prematurely diagnose the
condition.
Alcohol and drug abuse impairs judgment and increases risk taking behavior. What nursing
diagnosis best applies?
Correct Answer: A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem
Rationale
Impaired judgment and risky behaviors increase the likelihood of injury. The other diagnoses
may be relevant but do not directly address the primary safety concern.
Which of these findings would the nurse more closely associate with anemia in a 10 month-old
infant?
A) Hemoglobin level of 12 g/dL
Correct Answer: B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160
Rationale
Pallor is a classic sign of anemia. A hemoglobin of 12 g/dL is normal for an infant. Hypoactivity
and heart rate changes are nonspecific.
, 2026
The nurse is caring for a client in hypertensive crisis in an intensive care unit. The priority
assessment in the first hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
Correct Answer: D) Pupil responses
Rationale
Hypertensive crisis can cause acute neurological damage. Assessing pupil response helps detect
early signs of increased intracranial pressure or stroke.
Which of these clients who are all in the terminal stage of cancer is least appropriate to suggest
the use of patient-controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on the hands
Correct Answer: D) A preschooler with intermittent episodes of alertness
Rationale
PCA requires cognitive ability and consistent alertness to use safely. A preschooler with
fluctuating alertness cannot reliably operate the device.
The nurse is about to assess a 6 month-old child with nonorganic failure-to-thrive (NOFTT).
Upon entering the room, the nurse would expect the baby to be
A) Irritable and colicky with no attempts to pull to standing
B) Alert, laughing and playing with a rattle, sitting with support
C) Skin color dusky with poor skin turgor over abdomen
Correct Answer: D) Pale, thin arms and legs, uninterested in surroundings
Rationale
NOFTT is associated with poor weight gain, muscle wasting, and lack of social engagement. The
other options describe normal or unrelated findings.
As the nurse is speaking with a group of teens, which of these side effects of chemotherapy for
cancer would the nurse expect this group to be more interested in during the discussion?
A) Mouth sores
B) Fatigue
C) Diarrhea
Correct Answer: D) Hair loss
