HESI RN Exit Exam – Next Generation Actual
Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Total Questions: 160 | Time: 240 min | Pass: 850 scaled (75%)
TABLE OF CONTENTS
Section 1 | Safe & Effective Care Environment | Q1 – Q25
Section 2 | Health Promotion & Maintenance | Q26 – Q50
Section 3 | Psychosocial Integrity | Q51 – Q70
Section 4 | Basic Care & Comfort | Q71 – Q88
Section 5 | Pharmacological & Parenteral Therapies | Q89 – Q106
Section 6 | Reduction of Risk Potential | Q107 – Q126
Section 7 | Physiological Adaptation | Q127 – Q146
Section 8 | Clinical Judgment & Next Gen NCLEX Style Questions | Q147 – Q160
Instructions: Choose the single best answer. Pass: 850 scaled (75%) in 240 minutes.
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q25
══════════════════════════════════════
Question 1 of 160
A 68-year-old man is admitted to the medical-surgical unit after a fall at home. During
the initial safety assessment, the nurse notes he uses a walker, has bilateral cataracts,
and takes metoprolol for hypertension. His wife states he "got up too fast" before the
fall. The nurse's priority intervention is:
A. Place a bedside commode to reduce nighttime ambulation
B. Ensure all four side rails are raised when the patient is in bed
C. Keep the call light within reach and educate on rising slowly ✓ CORRECT
D. Apply a vest restraint during hours when staffing is low
,Correct Answer: C
Rationale: Orthostatic hypotension from rapid position changes, compounded by
beta-blocker use and visual impairment, is the most modifiable fall risk factor here;
patient education and accessible communication tools address the root cause. Option
B is incorrect because raised side rails can actually increase fall injury risk if the patient
climbs over them and may be considered a restraint. Fall prevention should prioritize
autonomy and education over restrictive measures whenever possible.
Question 2 of 160
A charge nurse on a busy telemetry unit receives a call from the lab about a critical
potassium level of 2.8 mEq/L for a patient with heart failure on furosemide. The charge
nurse's first action is to:
A. Notify the patient's primary nurse to assess the patient immediately
B. Call the prescribing provider with the critical value and await orders
C. Verify the result, check the patient for ECG changes, and notify the provider ✓
CORRECT
D. Administer a potassium supplement from the floor stock per protocol
Correct Answer: C
Rationale: Critical values require immediate patient assessment for clinical correlation
before or concurrent with provider notification; hypokalemia at this level can precipitate
life-threatening arrhythmias that need identification first. Option B delays direct patient
care; option D is unsafe without an order and assessment. The nurse must always
correlate lab data with the patient's clinical presentation before intervention.
Question 3 of 160
A 42-year-old woman is scheduled for an elective cholecystectomy. During preoperative
verification, the nurse notes the consent form lists "laparoscopic cholecystectomy" but
the surgeon's orders indicate "open cholecystectomy." The nurse's appropriate action is:
,A. Proceed with preoperative preparation and clarify the approach in the operating room
B. Ask the patient which procedure she understood she was having
C. Stop the preparation process and contact the surgeon to resolve the discrepancy ✓
CORRECT
D. Call the operating room scheduler to determine which procedure was booked
Correct Answer: C
Rationale: The Universal Protocol requires resolution of any discrepancies in procedure,
site, or patient identification before proceeding; the nurse has a duty to halt the process
until the correct procedure is confirmed with the surgeon. Option A risks a
wrong-procedure event; option B places responsibility on the patient that belongs to the
surgical team. Patient safety depends on assertive communication to prevent never
events.
Question 4 of 160
A nursing student is preparing to administer morning medications to a group of
patients. The clinical instructor observes the student comparing each medication to the
MAR but not checking patient identification. The instructor's best response is:
A. Praise the student for careful medication verification and remind them about the final
patient ID check
B. Stop the student immediately and require them to start the entire process over
C. Ask the student what they believe is missing from the rights of medication
administration ✓ CORRECT
D. Allow the student to proceed and discuss the omission during post-conference
Correct Answer: C
Rationale: Socratic questioning promotes critical thinking and self-correction, helping
the student recognize the gap in their own practice rather than simply receiving external
correction. Option A misses the teaching moment; option B may be unnecessarily
punitive and delay patient care. Effective clinical instruction balances patient safety with
the development of independent clinical reasoning.
, Question 5 of 160
A 78-year-old patient with advanced dementia is admitted from a skilled nursing facility
with a stage 3 pressure injury on the sacrum. The admitting nurse's priority action is:
A. Document the wound thoroughly and notify the wound care team
B. Perform a head-to-toe skin assessment and implement a pressure redistribution plan
✓ CORRECT
C. Contact the nursing facility to report a suspected case of neglect
D. Place the patient on a low-air-loss mattress and turn every four hours
Correct Answer: B
Rationale: A comprehensive skin assessment and immediate pressure redistribution
address both the known injury and the risk of additional skin breakdown, which is the
priority on admission. Option A is important but secondary to immediate intervention;
option C is premature without a full assessment and may be adversarial. Pressure injury
management requires systematic prevention alongside treatment of existing wounds.
Question 6 of 160
A nurse on a pediatric unit discovers that a vial of morphine is missing from the
controlled substance drawer. The nurse's first action is to:
A. Search the medication room thoroughly to ensure it was not misplaced
B. Notify the charge nurse and complete an incident report per facility policy ✓
CORRECT
C. Review the automated dispensing system records to identify who last accessed the
drawer
D. Call pharmacy to request an immediate replacement vial
Correct Answer: B
Rationale: Controlled substance discrepancies require immediate notification of the
charge nurse and formal documentation to initiate the facility's diversion investigation
protocol; this preserves chain of custody and regulatory compliance. Option A may
Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Total Questions: 160 | Time: 240 min | Pass: 850 scaled (75%)
TABLE OF CONTENTS
Section 1 | Safe & Effective Care Environment | Q1 – Q25
Section 2 | Health Promotion & Maintenance | Q26 – Q50
Section 3 | Psychosocial Integrity | Q51 – Q70
Section 4 | Basic Care & Comfort | Q71 – Q88
Section 5 | Pharmacological & Parenteral Therapies | Q89 – Q106
Section 6 | Reduction of Risk Potential | Q107 – Q126
Section 7 | Physiological Adaptation | Q127 – Q146
Section 8 | Clinical Judgment & Next Gen NCLEX Style Questions | Q147 – Q160
Instructions: Choose the single best answer. Pass: 850 scaled (75%) in 240 minutes.
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q25
══════════════════════════════════════
Question 1 of 160
A 68-year-old man is admitted to the medical-surgical unit after a fall at home. During
the initial safety assessment, the nurse notes he uses a walker, has bilateral cataracts,
and takes metoprolol for hypertension. His wife states he "got up too fast" before the
fall. The nurse's priority intervention is:
A. Place a bedside commode to reduce nighttime ambulation
B. Ensure all four side rails are raised when the patient is in bed
C. Keep the call light within reach and educate on rising slowly ✓ CORRECT
D. Apply a vest restraint during hours when staffing is low
,Correct Answer: C
Rationale: Orthostatic hypotension from rapid position changes, compounded by
beta-blocker use and visual impairment, is the most modifiable fall risk factor here;
patient education and accessible communication tools address the root cause. Option
B is incorrect because raised side rails can actually increase fall injury risk if the patient
climbs over them and may be considered a restraint. Fall prevention should prioritize
autonomy and education over restrictive measures whenever possible.
Question 2 of 160
A charge nurse on a busy telemetry unit receives a call from the lab about a critical
potassium level of 2.8 mEq/L for a patient with heart failure on furosemide. The charge
nurse's first action is to:
A. Notify the patient's primary nurse to assess the patient immediately
B. Call the prescribing provider with the critical value and await orders
C. Verify the result, check the patient for ECG changes, and notify the provider ✓
CORRECT
D. Administer a potassium supplement from the floor stock per protocol
Correct Answer: C
Rationale: Critical values require immediate patient assessment for clinical correlation
before or concurrent with provider notification; hypokalemia at this level can precipitate
life-threatening arrhythmias that need identification first. Option B delays direct patient
care; option D is unsafe without an order and assessment. The nurse must always
correlate lab data with the patient's clinical presentation before intervention.
Question 3 of 160
A 42-year-old woman is scheduled for an elective cholecystectomy. During preoperative
verification, the nurse notes the consent form lists "laparoscopic cholecystectomy" but
the surgeon's orders indicate "open cholecystectomy." The nurse's appropriate action is:
,A. Proceed with preoperative preparation and clarify the approach in the operating room
B. Ask the patient which procedure she understood she was having
C. Stop the preparation process and contact the surgeon to resolve the discrepancy ✓
CORRECT
D. Call the operating room scheduler to determine which procedure was booked
Correct Answer: C
Rationale: The Universal Protocol requires resolution of any discrepancies in procedure,
site, or patient identification before proceeding; the nurse has a duty to halt the process
until the correct procedure is confirmed with the surgeon. Option A risks a
wrong-procedure event; option B places responsibility on the patient that belongs to the
surgical team. Patient safety depends on assertive communication to prevent never
events.
Question 4 of 160
A nursing student is preparing to administer morning medications to a group of
patients. The clinical instructor observes the student comparing each medication to the
MAR but not checking patient identification. The instructor's best response is:
A. Praise the student for careful medication verification and remind them about the final
patient ID check
B. Stop the student immediately and require them to start the entire process over
C. Ask the student what they believe is missing from the rights of medication
administration ✓ CORRECT
D. Allow the student to proceed and discuss the omission during post-conference
Correct Answer: C
Rationale: Socratic questioning promotes critical thinking and self-correction, helping
the student recognize the gap in their own practice rather than simply receiving external
correction. Option A misses the teaching moment; option B may be unnecessarily
punitive and delay patient care. Effective clinical instruction balances patient safety with
the development of independent clinical reasoning.
, Question 5 of 160
A 78-year-old patient with advanced dementia is admitted from a skilled nursing facility
with a stage 3 pressure injury on the sacrum. The admitting nurse's priority action is:
A. Document the wound thoroughly and notify the wound care team
B. Perform a head-to-toe skin assessment and implement a pressure redistribution plan
✓ CORRECT
C. Contact the nursing facility to report a suspected case of neglect
D. Place the patient on a low-air-loss mattress and turn every four hours
Correct Answer: B
Rationale: A comprehensive skin assessment and immediate pressure redistribution
address both the known injury and the risk of additional skin breakdown, which is the
priority on admission. Option A is important but secondary to immediate intervention;
option C is premature without a full assessment and may be adversarial. Pressure injury
management requires systematic prevention alongside treatment of existing wounds.
Question 6 of 160
A nurse on a pediatric unit discovers that a vial of morphine is missing from the
controlled substance drawer. The nurse's first action is to:
A. Search the medication room thoroughly to ensure it was not misplaced
B. Notify the charge nurse and complete an incident report per facility policy ✓
CORRECT
C. Review the automated dispensing system records to identify who last accessed the
drawer
D. Call pharmacy to request an immediate replacement vial
Correct Answer: B
Rationale: Controlled substance discrepancies require immediate notification of the
charge nurse and formal documentation to initiate the facility's diversion investigation
protocol; this preserves chain of custody and regulatory compliance. Option A may
