HESI NCLEX PRACTICE QUESTIONS
2026/2027
Comprehensive Nursing Competency Assessment for Licensure Readiness
150 MCQ Questions 180 Minutes Passing: 850 HESI / NCSBN CJMM
75–80% Aligned
Examination Domain Distribution
Domain Questions Key Topics Weight
Management of 22 Delegation, Prioritization, 15%
Care Legal/Ethical
Safety and 18 Precautions, Fall Prevention, 12%
Infection Emergency
Control
Health 10 Developmental Stages, Screening, 10%
Promotion and Prevention
Maintenance
Psychosocial 15 Communication, Mental Health, 10%
Integrity Crisis
Basic Care and 18 ADLs, Pain, Nutrition, Mobility 12%
Comfort
Pharmacological 17 Med Admin, Calculations, IV 15%
and Parenteral Therapy
Therapies
Reduction of 25 Diagnostics, Complications, 13%
Risk Potential Procedures
Physiological 25 Fluid/Electrolytes, Acid-Base, 13%
Adaptation Acute Care
,Management of Care (Q1–Q22)
1. A nurse on a medical-surgical unit is caring for four clients. Which task is most
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing the effectiveness of a new pain medication in a postoperative client
B. Measuring and recording intake and output for a client with heart failure
C. Evaluating the understanding of discharge instructions in a client newly diagnosed with
diabetes
D. Performing the initial admission assessment on a client transferred from the emergency
department
Correct Answer: B. Measuring and recording intake and output for a client with heart
failure
Rationale: Measuring and recording intake and output is a standardized, repetitive task within
the UAP's scope of practice that does not require clinical judgment. Assessment, evaluation, and
initial admission assessment are nursing responsibilities that require the RN's education and
licensure.
2. The charge nurse is making assignments for the night shift. There is one RN, one
LPN, and one UAP on the team. Which client should be assigned to the LPN?
A. A client who is 1 day postoperative following a bowel resection with a new colostomy
requiring teaching
B. A client admitted with chest pain who has new ST-segment changes on the cardiac monitor
C. A client with chronic obstructive pulmonary disease (COPD) who requires vital signs every 4
hours and oral suctioning
D. A client newly diagnosed with Guillain-Barre syndrome who is experiencing ascending
paralysis
Correct Answer: C. A client with chronic obstructive pulmonary disease (COPD) who
requires vital signs every 4 hours and oral suctioning
Rationale: An LPN can provide care for a stable client with predictable outcomes, such as a client
with COPD requiring routine vital signs and oral suctioning. Clients who are newly diagnosed,
require complex teaching, or have acute changes in condition should be assigned to the RN.
3. A nurse is caring for a client with a fresh tracheostomy. Which intervention should
the nurse delegate to the UAP?
A. Performing the first tracheostomy tube change since the procedure
B. Suctioning the tracheostomy tube when secretions are present
C. Providing oral hygiene to the client while the tracheostomy is in place
D. Assessing the stoma site for signs of infection or bleeding
Correct Answer: C. Providing oral hygiene to the client while the tracheostomy is in
place
Rationale: Oral hygiene is a routine task within the UAP's scope that does not require clinical
judgment. Suctioning, the first tracheostomy change, and stoma assessment require nursing
assessment skills and should be performed by licensed nurses.
4. A nurse receives a phone call from a laboratory technologist requesting to draw
blood from a client for a crossmatch. The nurse knows the client has a right forearm IV.
Which action demonstrates the right direction/communication in delegation?
A. Tell the technologist to draw the blood from the left arm because the IV is in the right arm.
B. Tell the technologist to draw the blood from the right arm distal to the IV site.
C. Ask the technologist to verify the client's identity and allergy status before drawing the
sample.
D. Inform the technologist that the nurse will draw the specimen to ensure correct labeling and
client identification.
Correct Answer: D. Inform the technologist that the nurse will draw the specimen to
ensure correct labeling and client identification.
HESI NCLEX Practice Exam 2026/2027 — Page 1
,Rationale: Blood drawn proximal to an IV site can be contaminated with IV fluid, leading to
inaccurate results. The nurse should ensure the correct site and verify client identification using two
identifiers. The right direction/communication means the nurse must provide clear, accurate
instructions when delegating or performing tasks affecting specimen integrity.
5. A nurse on the cardiac step-down unit receives the morning report on four clients.
Which client should the nurse assess first?
A. A client with heart failure who has gained 2 pounds since yesterday and has bilateral ankle
edema
B. A client with atrial fibrillation who reports feeling dizzy and has an apical pulse of 148 bpm
C. A client with angina who requests pain medication 30 minutes early because of chest
discomfort at a level of 4/10
D. A client recovering from cardiac catheterization whose dressing has a small amount of serous
drainage
Correct Answer: B. A client with atrial fibrillation who reports feeling dizzy and has an
apical pulse of 148 bpm
Rationale: Using the ABC (Airway, Breathing, Circulation) approach, the client with a rapid
apical pulse of 148 bpm and dizziness is at highest risk for hemodynamic instability, decreased
cardiac output, and potential thromboembolic events. This client requires immediate assessment
and intervention.
6. The nurse is caring for multiple clients on a medical unit. After receiving the shift
report, which client should the nurse prioritize to see first?
A. A client with type 2 diabetes whose pre-lunch blood glucose is 210 mg/dL
B. A client with pneumonia who has a temperature of 100.4°F (38°C) and a productive cough
C. A client with deep vein thrombosis who reports new-onset shortness of breath and calf pain
D. A client with hypertension whose blood pressure is 158/92 mmHg after receiving morning
medications
Correct Answer: C. A client with deep vein thrombosis who reports new-onset shortness
of breath and calf pain
Rationale: New-onset shortness of breath in a client with deep vein thrombosis is a classic sign of a
pulmonary embolism, which is a life-threatening emergency requiring immediate intervention.
Using Maslow's hierarchy, physiologic needs related to oxygenation take precedence over other
client concerns.
7. A nurse receives a shift report on four postoperative clients. Which client is most
stable and can be seen last?
A. A client 2 hours post-cholecystectomy who has not voided and reports abdominal pain at 7/10
B. A client 1 day post-hip replacement who is scheduled for the first physical therapy session at
10:00 AM
C. A client 4 hours post-appendectomy whose vital signs are BP 110/70, HR 88, RR 18, and is
tolerating clear liquids
D. A client 6 hours post-thyroidectomy who reports tingling around the mouth and fingertips
Correct Answer: C. A client 4 hours post-appendectomy whose vital signs are BP 110/70,
HR 88, RR 18, and is tolerating clear liquids
Rationale: This client has stable vital signs and is progressing as expected postoperatively, making
them the most appropriate to be seen last. The client who has not voided (risk of urinary retention),
the client with thyroidectomy reporting tingling (risk of hypocalcemia), and the client needing pre-
procedure assessment all require more urgent attention.
8. A triage nurse in the emergency department receives four clients at the same time.
Which client should be triaged as emergent (Level 1)?
A. A 35-year-old with a laceration to the left hand that is actively bleeding and requires sutures
B. A 22-year-old with a 2-day history of fever, sore throat, and difficulty swallowing
C. A 60-year-old with crushing substernal chest pain that radiates to the left arm and jaw,
diaphoretic
D. A 45-year-old with a sprained right ankle sustained during a basketball game, with moderate
swelling
HESI NCLEX Practice Exam 2026/2027 — Page 2
, Correct Answer: C. A 60-year-old with crushing substernal chest pain that radiates to
the left arm and jaw, diaphoretic
Rationale: The client with crushing substernal chest pain radiating to the arm and jaw, along with
diaphoresis, is exhibiting classic signs of an acute myocardial infarction. This is a life-threatening
condition requiring immediate intervention and is classified as emergent (Level 1) using the
Emergency Severity Index.
9. A client scheduled for an elective hernia repair tells the nurse, 'I changed my mind
and I do not want the surgery anymore.' What is the nurse's best response?
A. You should discuss this with your surgeon because the surgery has already been scheduled.
B. I will cancel the surgery. You have the right to refuse any treatment, including surgery.
C. Let me get your family involved so they can help you make the right decision.
D. Are you sure? This surgery will prevent the hernia from getting worse and causing
complications.
Correct Answer: B. I will cancel the surgery. You have the right to refuse any treatment,
including surgery.
Rationale: Every client has the legal and ethical right to refuse treatment, even if the treatment is
recommended for their well-being. The nurse must respect the client's autonomy and facilitate the
cancellation of the procedure. The nurse should also ensure the client understands the consequences
of refusal.
10. A nurse is preparing a client for a colonoscopy. The client asks, 'What are the risks
of this procedure?' The nurse notices that the informed consent form has been signed.
What is the nurse's best action?
A. Tell the client that the risks were already explained when the consent was signed.
B. Explain the common risks of the procedure, including bleeding and perforation.
C. Notify the physician that the client still has questions about the procedure.
D. Direct the client to read the educational brochure provided during the pre-procedure visit.
Correct Answer: C. Notify the physician that the client still has questions about the
procedure.
Rationale: The physician performing the procedure is responsible for obtaining informed consent,
which includes explaining the risks, benefits, and alternatives. If the client still has questions, the
nurse should notify the physician to return and address them. The nurse should not provide the
explanation, as this is the physician's responsibility.
11. A nurse is caring for a client who is on a ventilator. The client's spouse asks the
nurse, 'How did my husband end up on life support?' Which response by the nurse is
most appropriate?
A. Your husband had a cardiac arrest, and we initiated life-saving measures. I can have the
physician explain further.
B. Your husband was intubated because he went into respiratory failure due to his pneumonia.
C. I am not at liberty to discuss his medical condition without his written consent.
D. I can provide you with a copy of his medical records so you can review everything yourself.
Correct Answer: C. I am not at liberty to discuss his medical condition without his
written consent.
Rationale: Under HIPAA, the nurse must protect the client's protected health information (PHI).
Although the spouse may be the next of kin, the nurse should verify whether the client has authorized
disclosure of information to the spouse. The nurse should encourage the spouse to speak with the
client or obtain proper authorization.
12. A nurse receives an order from a physician to administer a medication via the
intrathecal route. The nurse has never performed this procedure before. What is the
nurse's best action?
A. Administer the medication as ordered after reviewing the procedure in the nursing reference
manual.
B. Ask a more experienced nurse to supervise the medication administration.
C. Refuse to administer the medication and notify the charge nurse and physician.
HESI NCLEX Practice Exam 2026/2027 — Page 3
2026/2027
Comprehensive Nursing Competency Assessment for Licensure Readiness
150 MCQ Questions 180 Minutes Passing: 850 HESI / NCSBN CJMM
75–80% Aligned
Examination Domain Distribution
Domain Questions Key Topics Weight
Management of 22 Delegation, Prioritization, 15%
Care Legal/Ethical
Safety and 18 Precautions, Fall Prevention, 12%
Infection Emergency
Control
Health 10 Developmental Stages, Screening, 10%
Promotion and Prevention
Maintenance
Psychosocial 15 Communication, Mental Health, 10%
Integrity Crisis
Basic Care and 18 ADLs, Pain, Nutrition, Mobility 12%
Comfort
Pharmacological 17 Med Admin, Calculations, IV 15%
and Parenteral Therapy
Therapies
Reduction of 25 Diagnostics, Complications, 13%
Risk Potential Procedures
Physiological 25 Fluid/Electrolytes, Acid-Base, 13%
Adaptation Acute Care
,Management of Care (Q1–Q22)
1. A nurse on a medical-surgical unit is caring for four clients. Which task is most
appropriate to delegate to an unlicensed assistive personnel (UAP)?
A. Assessing the effectiveness of a new pain medication in a postoperative client
B. Measuring and recording intake and output for a client with heart failure
C. Evaluating the understanding of discharge instructions in a client newly diagnosed with
diabetes
D. Performing the initial admission assessment on a client transferred from the emergency
department
Correct Answer: B. Measuring and recording intake and output for a client with heart
failure
Rationale: Measuring and recording intake and output is a standardized, repetitive task within
the UAP's scope of practice that does not require clinical judgment. Assessment, evaluation, and
initial admission assessment are nursing responsibilities that require the RN's education and
licensure.
2. The charge nurse is making assignments for the night shift. There is one RN, one
LPN, and one UAP on the team. Which client should be assigned to the LPN?
A. A client who is 1 day postoperative following a bowel resection with a new colostomy
requiring teaching
B. A client admitted with chest pain who has new ST-segment changes on the cardiac monitor
C. A client with chronic obstructive pulmonary disease (COPD) who requires vital signs every 4
hours and oral suctioning
D. A client newly diagnosed with Guillain-Barre syndrome who is experiencing ascending
paralysis
Correct Answer: C. A client with chronic obstructive pulmonary disease (COPD) who
requires vital signs every 4 hours and oral suctioning
Rationale: An LPN can provide care for a stable client with predictable outcomes, such as a client
with COPD requiring routine vital signs and oral suctioning. Clients who are newly diagnosed,
require complex teaching, or have acute changes in condition should be assigned to the RN.
3. A nurse is caring for a client with a fresh tracheostomy. Which intervention should
the nurse delegate to the UAP?
A. Performing the first tracheostomy tube change since the procedure
B. Suctioning the tracheostomy tube when secretions are present
C. Providing oral hygiene to the client while the tracheostomy is in place
D. Assessing the stoma site for signs of infection or bleeding
Correct Answer: C. Providing oral hygiene to the client while the tracheostomy is in
place
Rationale: Oral hygiene is a routine task within the UAP's scope that does not require clinical
judgment. Suctioning, the first tracheostomy change, and stoma assessment require nursing
assessment skills and should be performed by licensed nurses.
4. A nurse receives a phone call from a laboratory technologist requesting to draw
blood from a client for a crossmatch. The nurse knows the client has a right forearm IV.
Which action demonstrates the right direction/communication in delegation?
A. Tell the technologist to draw the blood from the left arm because the IV is in the right arm.
B. Tell the technologist to draw the blood from the right arm distal to the IV site.
C. Ask the technologist to verify the client's identity and allergy status before drawing the
sample.
D. Inform the technologist that the nurse will draw the specimen to ensure correct labeling and
client identification.
Correct Answer: D. Inform the technologist that the nurse will draw the specimen to
ensure correct labeling and client identification.
HESI NCLEX Practice Exam 2026/2027 — Page 1
,Rationale: Blood drawn proximal to an IV site can be contaminated with IV fluid, leading to
inaccurate results. The nurse should ensure the correct site and verify client identification using two
identifiers. The right direction/communication means the nurse must provide clear, accurate
instructions when delegating or performing tasks affecting specimen integrity.
5. A nurse on the cardiac step-down unit receives the morning report on four clients.
Which client should the nurse assess first?
A. A client with heart failure who has gained 2 pounds since yesterday and has bilateral ankle
edema
B. A client with atrial fibrillation who reports feeling dizzy and has an apical pulse of 148 bpm
C. A client with angina who requests pain medication 30 minutes early because of chest
discomfort at a level of 4/10
D. A client recovering from cardiac catheterization whose dressing has a small amount of serous
drainage
Correct Answer: B. A client with atrial fibrillation who reports feeling dizzy and has an
apical pulse of 148 bpm
Rationale: Using the ABC (Airway, Breathing, Circulation) approach, the client with a rapid
apical pulse of 148 bpm and dizziness is at highest risk for hemodynamic instability, decreased
cardiac output, and potential thromboembolic events. This client requires immediate assessment
and intervention.
6. The nurse is caring for multiple clients on a medical unit. After receiving the shift
report, which client should the nurse prioritize to see first?
A. A client with type 2 diabetes whose pre-lunch blood glucose is 210 mg/dL
B. A client with pneumonia who has a temperature of 100.4°F (38°C) and a productive cough
C. A client with deep vein thrombosis who reports new-onset shortness of breath and calf pain
D. A client with hypertension whose blood pressure is 158/92 mmHg after receiving morning
medications
Correct Answer: C. A client with deep vein thrombosis who reports new-onset shortness
of breath and calf pain
Rationale: New-onset shortness of breath in a client with deep vein thrombosis is a classic sign of a
pulmonary embolism, which is a life-threatening emergency requiring immediate intervention.
Using Maslow's hierarchy, physiologic needs related to oxygenation take precedence over other
client concerns.
7. A nurse receives a shift report on four postoperative clients. Which client is most
stable and can be seen last?
A. A client 2 hours post-cholecystectomy who has not voided and reports abdominal pain at 7/10
B. A client 1 day post-hip replacement who is scheduled for the first physical therapy session at
10:00 AM
C. A client 4 hours post-appendectomy whose vital signs are BP 110/70, HR 88, RR 18, and is
tolerating clear liquids
D. A client 6 hours post-thyroidectomy who reports tingling around the mouth and fingertips
Correct Answer: C. A client 4 hours post-appendectomy whose vital signs are BP 110/70,
HR 88, RR 18, and is tolerating clear liquids
Rationale: This client has stable vital signs and is progressing as expected postoperatively, making
them the most appropriate to be seen last. The client who has not voided (risk of urinary retention),
the client with thyroidectomy reporting tingling (risk of hypocalcemia), and the client needing pre-
procedure assessment all require more urgent attention.
8. A triage nurse in the emergency department receives four clients at the same time.
Which client should be triaged as emergent (Level 1)?
A. A 35-year-old with a laceration to the left hand that is actively bleeding and requires sutures
B. A 22-year-old with a 2-day history of fever, sore throat, and difficulty swallowing
C. A 60-year-old with crushing substernal chest pain that radiates to the left arm and jaw,
diaphoretic
D. A 45-year-old with a sprained right ankle sustained during a basketball game, with moderate
swelling
HESI NCLEX Practice Exam 2026/2027 — Page 2
, Correct Answer: C. A 60-year-old with crushing substernal chest pain that radiates to
the left arm and jaw, diaphoretic
Rationale: The client with crushing substernal chest pain radiating to the arm and jaw, along with
diaphoresis, is exhibiting classic signs of an acute myocardial infarction. This is a life-threatening
condition requiring immediate intervention and is classified as emergent (Level 1) using the
Emergency Severity Index.
9. A client scheduled for an elective hernia repair tells the nurse, 'I changed my mind
and I do not want the surgery anymore.' What is the nurse's best response?
A. You should discuss this with your surgeon because the surgery has already been scheduled.
B. I will cancel the surgery. You have the right to refuse any treatment, including surgery.
C. Let me get your family involved so they can help you make the right decision.
D. Are you sure? This surgery will prevent the hernia from getting worse and causing
complications.
Correct Answer: B. I will cancel the surgery. You have the right to refuse any treatment,
including surgery.
Rationale: Every client has the legal and ethical right to refuse treatment, even if the treatment is
recommended for their well-being. The nurse must respect the client's autonomy and facilitate the
cancellation of the procedure. The nurse should also ensure the client understands the consequences
of refusal.
10. A nurse is preparing a client for a colonoscopy. The client asks, 'What are the risks
of this procedure?' The nurse notices that the informed consent form has been signed.
What is the nurse's best action?
A. Tell the client that the risks were already explained when the consent was signed.
B. Explain the common risks of the procedure, including bleeding and perforation.
C. Notify the physician that the client still has questions about the procedure.
D. Direct the client to read the educational brochure provided during the pre-procedure visit.
Correct Answer: C. Notify the physician that the client still has questions about the
procedure.
Rationale: The physician performing the procedure is responsible for obtaining informed consent,
which includes explaining the risks, benefits, and alternatives. If the client still has questions, the
nurse should notify the physician to return and address them. The nurse should not provide the
explanation, as this is the physician's responsibility.
11. A nurse is caring for a client who is on a ventilator. The client's spouse asks the
nurse, 'How did my husband end up on life support?' Which response by the nurse is
most appropriate?
A. Your husband had a cardiac arrest, and we initiated life-saving measures. I can have the
physician explain further.
B. Your husband was intubated because he went into respiratory failure due to his pneumonia.
C. I am not at liberty to discuss his medical condition without his written consent.
D. I can provide you with a copy of his medical records so you can review everything yourself.
Correct Answer: C. I am not at liberty to discuss his medical condition without his
written consent.
Rationale: Under HIPAA, the nurse must protect the client's protected health information (PHI).
Although the spouse may be the next of kin, the nurse should verify whether the client has authorized
disclosure of information to the spouse. The nurse should encourage the spouse to speak with the
client or obtain proper authorization.
12. A nurse receives an order from a physician to administer a medication via the
intrathecal route. The nurse has never performed this procedure before. What is the
nurse's best action?
A. Administer the medication as ordered after reviewing the procedure in the nursing reference
manual.
B. Ask a more experienced nurse to supervise the medication administration.
C. Refuse to administer the medication and notify the charge nurse and physician.
HESI NCLEX Practice Exam 2026/2027 — Page 3
