HESI Fundamentals V1 Exam Sets A–D
HESI FUNDAMENTALS V1 EXAM SETS A–D
2026/2027 EDITION
Comprehensive Foundational Nursing Competency Assessment Collection
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
EXACT OFFICIAL COUNT: 100 QUESTIONS PER SET (400 TOTAL)
Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
Core Domains:
Clinical Judgment & Nursing Process • Safety & Infection Control • Basic Care & Comfort •
Pharmacological & Parenteral Therapies • Reduction of Risk Potential • Physiological
Adaptation • Care Coordination & NGN Case Studies
Format: Multiple-Choice Questions (MCQ) with Select-All-That-Apply (SATA) items
Testing Time: 120 minutes per set | Passing Score: 850 HESI or 75–80%
Delivery: Computer-based, proctored via Elsevier Evolve platform
Introduction
This HESI Fundamentals V1 Exam Sets A–D format for 2026/2027 reflects the standardized
competency assessments used to evaluate proficiency in foundational nursing principles for
pre-licensure nursing students. Each official examination set consists of exactly 100 multiple-
choice questions (MCQ) covering critical domains: clinical judgment and nursing process,
safety and infection control, basic care and comfort, pharmacological and parenteral
therapies, reduction of risk potential, physiological adaptation, care coordination, and NGN
case study application. The exams measure knowledge essential for safe, effective, and entry-
level practice in diverse healthcare settings, aligned with current NCSBN Clinical Judgment
Measurement Model (CJMM), NCSBN NCLEX-RN/PN test plans, Elsevier HESI test
blueprints, and institutional nursing program learning outcomes.
Answer Format
All correct answers are presented in bold #FF007D, each question appears in bold, and all
rationales explaining nursing interventions, clinical judgment frameworks, foundational skills
applications, and scenario-based professional reasoning are written in italic font with light
lavender background (#F5EDF9). Questions are formatted as MCQ (Multiple Choice
Questions) with four options (A, B, C, D), single-best-answer unless otherwise specified as
Select-All-That-Apply (SATA) format.
1
, HESI Fundamentals V1 Exam Sets A–D
Exam Structure
• Exact official question count: 100 multiple-choice questions (MCQ) per exam set (4 sets
total = 400 questions)
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend
recognition, matrix multiple-choice, prioritization scenarios, and foundational skills
application items
• Focus: Evidence-based foundational nursing interventions, NCSBN Clinical Judgment
Measurement Model (CJMM) application, and professional judgment aligned with NCSBN
NCLEX-RN/PN test plans
• Total testing time per set: 120 minutes (computer-based, proctored format via Elsevier
Evolve testing platform)
• Passing score per set: Typically 850 HESI score or 75–80% required for program
progression
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes,
NGN-style case studies, and clinical reasoning application items
Examination Overview (All 4 Sets)
Domain Questions/Set Key Topics Weight
Clinical Judgment & 15 Recognize Cues, Analyze Cues, 15%
Nursing Process Prioritize Hypotheses, Generate
Solutions, Take Action, Evaluate
Outcomes
Safety & Infection 14 Standard Precautions, Isolation, 14%
Control Fall Prevention, Error Prevention,
Emergency Response, Hand
Hygiene
Basic Care & Comfort 16 ADLs, Pain Management, 16%
Nutrition, Elimination, Mobility,
Rest/Sleep, Comfort Measures,
Hygiene
Pharmacological & 18 Medication Administration, Rights 18%
Parenteral Therapies of Medication, Side Effects,
Interactions, IV Therapy, Dosage
Calculations
Reduction of Risk 15 Diagnostic Tests, Vital Signs, 15%
Potential Complication Prevention,
Therapeutic Procedures, Pre/Post-
Op Care, Lab Values
Physiological 14 Acute/Chronic Conditions, 14%
Adaptation Fluid/Electrolytes,
Pathophysiology Basics, Emergency
Care, Wound Healing
Care Coordination & 8 Delegation, Interprofessional 8%
NGN Case Studies Collaboration, Discharge Planning,
NGN Bow-Tie/Trend/Matrix Items
2
, HESI Fundamentals V1 Exam Sets A–D
EXAM SET A
HESI Fundamentals V1 — 100 Multiple-Choice Questions
Testing Time: 120 Minutes | Passing Score: 850 HESI or 75–80%
Domain: Clinical Judgment & Nursing Process
1. The nurse is caring for a 72-year-old client admitted with pneumonia. On
assessment, the nurse notes the client is confused, has a respiratory rate of
28/min, oxygen saturation of 89% on room air, and a blood pressure of 90/58
mmHg. Which action should the nurse take first?
A. Administer the prescribed antibiotic
B. Apply supplemental oxygen as prescribed
C. Notify the healthcare provider of the assessment findings
D. Obtain a blood culture before initiating antibiotic therapy
Correct Answer: B
Rationale: Using the ABC (Airway-Breathing-Circulation) priority framework and the
NCSBN Clinical Judgment Measurement Model, the nurse must first address the client's
oxygenation deficit. The oxygen saturation of 89% and tachypnea indicate hypoxemia,
which is the most immediate threat to life. Applying supplemental oxygen addresses the
breathing priority before other interventions. While antibiotics and blood cultures are
important for treating the underlying infection, and notifying the provider is necessary,
oxygenation takes precedence. Obtaining a blood culture before antibiotics is best practice
but does not supersede the immediate need to correct hypoxemia.
2. A nurse is using the nursing process to care for a client who is 2 days
postoperative following a total hip arthroplasty. The client reports pain of 8 on a
scale of 0-10 in the surgical hip and refuses to participate in physical therapy.
Which step of the nursing process should the nurse implement first to address
this situation?
A. Reassess the client's pain level and characteristics
B. Modify the nursing care plan to include alternative pain management strategies
C. Implement guided imagery as a complementary pain intervention
D. Evaluate the effectiveness of the current analgesic regimen
Correct Answer: A
Rationale: The nursing process follows a sequential and iterative approach: assessment,
diagnosis, planning, implementation, and evaluation. When a client's condition changes or
interventions are not effective, the nurse must first reassess to gather new data before
modifying the plan. Reassessing the pain characteristics (location, quality,
aggravating/relieving factors, timing) provides the information needed to determine
whether the current plan requires modification. Modifying the care plan, implementing new
interventions, or evaluating current medications all come after comprehensive
reassessment.
3. The nurse receives a client with chest pain from the emergency department.
The client's vital signs are: heart rate 112/min, blood pressure 148/92 mmHg,
respiratory rate 22/min, and oxygen saturation 93%. The client states, 'I feel like
an elephant is sitting on my chest.' Which nursing diagnosis should receive the
highest priority?
A. Anxiety related to fear of death
B. Acute Pain related to myocardial ischemia
C. Decreased Cardiac Output related to impaired myocardial function
D. Ineffective Breathing Pattern related to chest pain
Correct Answer: C
3
, HESI Fundamentals V1 Exam Sets A–D
Rationale: According to Maslow's hierarchy of needs and the ABC priority framework,
physiological needs that threaten survival take precedence. Decreased Cardiac Output is the
most life-threatening diagnosis because myocardial ischemia can rapidly progress to
cardiac arrest. While acute pain is significant and the client's description is classic for
myocardial infarction, the underlying problem of decreased cardiac output poses the
greatest threat. Anxiety and ineffective breathing pattern, while relevant, are secondary to
the immediate risk of cardiovascular collapse. Prioritization must focus on the most life-
threatening condition first.
4. The nurse is developing a plan of care for a 68-year-old client with heart
failure who has been readmitted twice in the past month for exacerbation.
Which assessment findings should the nurse identify as indicators of worsening
heart failure? (Select all that apply.) (Select All That Apply)
A. Weight gain of 3 lbs over 2 days
B. Decreased jugular venous distension
C. Crackles in bilateral lung bases
D. Increased fatigue with activity
E. Peripheral edema of 2+ in lower extremities
F. Bounding peripheral pulses
Correct Answer: A,C,D,E
Rationale: Weight gain of 3 lbs over 2 days (A) indicates fluid retention, a hallmark of
worsening heart failure; patients are instructed to report weight gains of 2-3 lbs in 24 hours
or 5 lbs in 1 week. Crackles in bilateral lung bases (C) indicate pulmonary congestion from
left-sided heart failure. Increased fatigue with activity (D) reflects decreased cardiac output
and tissue perfusion. Peripheral edema of 2+ (E) indicates right-sided heart failure with
systemic venous congestion. Decreased jugular venous distension (B) is incorrect because
JVD increases, not decreases, with worsening right-sided heart failure. Bounding peripheral
pulses (F) are associated with conditions like aortic regurgitation or sepsis, not typically
with worsening heart failure, where pulses are usually weak.
5. A client with type 2 diabetes mellitus presents with a blood glucose level of 412
mg/dL, deep rapid respirations (Kussmaul breathing), and a fruity breath odor.
The nurse recognizes these findings are consistent with which condition?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin resistance syndrome
Correct Answer: B
Rationale: The triad of Kussmaul respirations, fruity breath odor, and significantly
elevated blood glucose are classic manifestations of diabetic ketoacidosis (DKA). Kussmaul
respirations are the body's compensatory mechanism to blow off excess carbon dioxide and
correct metabolic acidosis caused by ketone accumulation. The fruity breath odor results
from acetone exhalation, a byproduct of fat metabolism and ketone production. While
hyperosmolar hyperglycemic state (HHS) also presents with hyperglycemia, it typically
does not present with Kussmaul respirations or fruity breath because significant ketosis is
absent. Hypoglycemia presents with low blood glucose and sympathetic nervous system
responses.
6. The night shift nurse is caring for four clients. Which client should the nurse
assess first?
A. A client requesting pain medication for postoperative incisional pain rated 6/10
B. A client with a new onset of atrial fibrillation with a ventricular rate of 152/min
C. A client with diabetes who has a blood glucose level of 210 mg/dL before breakfast
D. A client with chronic obstructive pulmonary disease who has an oxygen saturation
of 92%
Correct Answer: B
Rationale: The client with new-onset atrial fibrillation and a ventricular rate of 152/min is
the highest priority because uncontrolled tachyarrhythmia can lead to hemodynamic
4
HESI FUNDAMENTALS V1 EXAM SETS A–D
2026/2027 EDITION
Comprehensive Foundational Nursing Competency Assessment Collection
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
EXACT OFFICIAL COUNT: 100 QUESTIONS PER SET (400 TOTAL)
Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
Core Domains:
Clinical Judgment & Nursing Process • Safety & Infection Control • Basic Care & Comfort •
Pharmacological & Parenteral Therapies • Reduction of Risk Potential • Physiological
Adaptation • Care Coordination & NGN Case Studies
Format: Multiple-Choice Questions (MCQ) with Select-All-That-Apply (SATA) items
Testing Time: 120 minutes per set | Passing Score: 850 HESI or 75–80%
Delivery: Computer-based, proctored via Elsevier Evolve platform
Introduction
This HESI Fundamentals V1 Exam Sets A–D format for 2026/2027 reflects the standardized
competency assessments used to evaluate proficiency in foundational nursing principles for
pre-licensure nursing students. Each official examination set consists of exactly 100 multiple-
choice questions (MCQ) covering critical domains: clinical judgment and nursing process,
safety and infection control, basic care and comfort, pharmacological and parenteral
therapies, reduction of risk potential, physiological adaptation, care coordination, and NGN
case study application. The exams measure knowledge essential for safe, effective, and entry-
level practice in diverse healthcare settings, aligned with current NCSBN Clinical Judgment
Measurement Model (CJMM), NCSBN NCLEX-RN/PN test plans, Elsevier HESI test
blueprints, and institutional nursing program learning outcomes.
Answer Format
All correct answers are presented in bold #FF007D, each question appears in bold, and all
rationales explaining nursing interventions, clinical judgment frameworks, foundational skills
applications, and scenario-based professional reasoning are written in italic font with light
lavender background (#F5EDF9). Questions are formatted as MCQ (Multiple Choice
Questions) with four options (A, B, C, D), single-best-answer unless otherwise specified as
Select-All-That-Apply (SATA) format.
1
, HESI Fundamentals V1 Exam Sets A–D
Exam Structure
• Exact official question count: 100 multiple-choice questions (MCQ) per exam set (4 sets
total = 400 questions)
• Item types: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend
recognition, matrix multiple-choice, prioritization scenarios, and foundational skills
application items
• Focus: Evidence-based foundational nursing interventions, NCSBN Clinical Judgment
Measurement Model (CJMM) application, and professional judgment aligned with NCSBN
NCLEX-RN/PN test plans
• Total testing time per set: 120 minutes (computer-based, proctored format via Elsevier
Evolve testing platform)
• Passing score per set: Typically 850 HESI score or 75–80% required for program
progression
• Assessment delivery: Fixed-format objective assessment with clinical case vignettes,
NGN-style case studies, and clinical reasoning application items
Examination Overview (All 4 Sets)
Domain Questions/Set Key Topics Weight
Clinical Judgment & 15 Recognize Cues, Analyze Cues, 15%
Nursing Process Prioritize Hypotheses, Generate
Solutions, Take Action, Evaluate
Outcomes
Safety & Infection 14 Standard Precautions, Isolation, 14%
Control Fall Prevention, Error Prevention,
Emergency Response, Hand
Hygiene
Basic Care & Comfort 16 ADLs, Pain Management, 16%
Nutrition, Elimination, Mobility,
Rest/Sleep, Comfort Measures,
Hygiene
Pharmacological & 18 Medication Administration, Rights 18%
Parenteral Therapies of Medication, Side Effects,
Interactions, IV Therapy, Dosage
Calculations
Reduction of Risk 15 Diagnostic Tests, Vital Signs, 15%
Potential Complication Prevention,
Therapeutic Procedures, Pre/Post-
Op Care, Lab Values
Physiological 14 Acute/Chronic Conditions, 14%
Adaptation Fluid/Electrolytes,
Pathophysiology Basics, Emergency
Care, Wound Healing
Care Coordination & 8 Delegation, Interprofessional 8%
NGN Case Studies Collaboration, Discharge Planning,
NGN Bow-Tie/Trend/Matrix Items
2
, HESI Fundamentals V1 Exam Sets A–D
EXAM SET A
HESI Fundamentals V1 — 100 Multiple-Choice Questions
Testing Time: 120 Minutes | Passing Score: 850 HESI or 75–80%
Domain: Clinical Judgment & Nursing Process
1. The nurse is caring for a 72-year-old client admitted with pneumonia. On
assessment, the nurse notes the client is confused, has a respiratory rate of
28/min, oxygen saturation of 89% on room air, and a blood pressure of 90/58
mmHg. Which action should the nurse take first?
A. Administer the prescribed antibiotic
B. Apply supplemental oxygen as prescribed
C. Notify the healthcare provider of the assessment findings
D. Obtain a blood culture before initiating antibiotic therapy
Correct Answer: B
Rationale: Using the ABC (Airway-Breathing-Circulation) priority framework and the
NCSBN Clinical Judgment Measurement Model, the nurse must first address the client's
oxygenation deficit. The oxygen saturation of 89% and tachypnea indicate hypoxemia,
which is the most immediate threat to life. Applying supplemental oxygen addresses the
breathing priority before other interventions. While antibiotics and blood cultures are
important for treating the underlying infection, and notifying the provider is necessary,
oxygenation takes precedence. Obtaining a blood culture before antibiotics is best practice
but does not supersede the immediate need to correct hypoxemia.
2. A nurse is using the nursing process to care for a client who is 2 days
postoperative following a total hip arthroplasty. The client reports pain of 8 on a
scale of 0-10 in the surgical hip and refuses to participate in physical therapy.
Which step of the nursing process should the nurse implement first to address
this situation?
A. Reassess the client's pain level and characteristics
B. Modify the nursing care plan to include alternative pain management strategies
C. Implement guided imagery as a complementary pain intervention
D. Evaluate the effectiveness of the current analgesic regimen
Correct Answer: A
Rationale: The nursing process follows a sequential and iterative approach: assessment,
diagnosis, planning, implementation, and evaluation. When a client's condition changes or
interventions are not effective, the nurse must first reassess to gather new data before
modifying the plan. Reassessing the pain characteristics (location, quality,
aggravating/relieving factors, timing) provides the information needed to determine
whether the current plan requires modification. Modifying the care plan, implementing new
interventions, or evaluating current medications all come after comprehensive
reassessment.
3. The nurse receives a client with chest pain from the emergency department.
The client's vital signs are: heart rate 112/min, blood pressure 148/92 mmHg,
respiratory rate 22/min, and oxygen saturation 93%. The client states, 'I feel like
an elephant is sitting on my chest.' Which nursing diagnosis should receive the
highest priority?
A. Anxiety related to fear of death
B. Acute Pain related to myocardial ischemia
C. Decreased Cardiac Output related to impaired myocardial function
D. Ineffective Breathing Pattern related to chest pain
Correct Answer: C
3
, HESI Fundamentals V1 Exam Sets A–D
Rationale: According to Maslow's hierarchy of needs and the ABC priority framework,
physiological needs that threaten survival take precedence. Decreased Cardiac Output is the
most life-threatening diagnosis because myocardial ischemia can rapidly progress to
cardiac arrest. While acute pain is significant and the client's description is classic for
myocardial infarction, the underlying problem of decreased cardiac output poses the
greatest threat. Anxiety and ineffective breathing pattern, while relevant, are secondary to
the immediate risk of cardiovascular collapse. Prioritization must focus on the most life-
threatening condition first.
4. The nurse is developing a plan of care for a 68-year-old client with heart
failure who has been readmitted twice in the past month for exacerbation.
Which assessment findings should the nurse identify as indicators of worsening
heart failure? (Select all that apply.) (Select All That Apply)
A. Weight gain of 3 lbs over 2 days
B. Decreased jugular venous distension
C. Crackles in bilateral lung bases
D. Increased fatigue with activity
E. Peripheral edema of 2+ in lower extremities
F. Bounding peripheral pulses
Correct Answer: A,C,D,E
Rationale: Weight gain of 3 lbs over 2 days (A) indicates fluid retention, a hallmark of
worsening heart failure; patients are instructed to report weight gains of 2-3 lbs in 24 hours
or 5 lbs in 1 week. Crackles in bilateral lung bases (C) indicate pulmonary congestion from
left-sided heart failure. Increased fatigue with activity (D) reflects decreased cardiac output
and tissue perfusion. Peripheral edema of 2+ (E) indicates right-sided heart failure with
systemic venous congestion. Decreased jugular venous distension (B) is incorrect because
JVD increases, not decreases, with worsening right-sided heart failure. Bounding peripheral
pulses (F) are associated with conditions like aortic regurgitation or sepsis, not typically
with worsening heart failure, where pulses are usually weak.
5. A client with type 2 diabetes mellitus presents with a blood glucose level of 412
mg/dL, deep rapid respirations (Kussmaul breathing), and a fruity breath odor.
The nurse recognizes these findings are consistent with which condition?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin resistance syndrome
Correct Answer: B
Rationale: The triad of Kussmaul respirations, fruity breath odor, and significantly
elevated blood glucose are classic manifestations of diabetic ketoacidosis (DKA). Kussmaul
respirations are the body's compensatory mechanism to blow off excess carbon dioxide and
correct metabolic acidosis caused by ketone accumulation. The fruity breath odor results
from acetone exhalation, a byproduct of fat metabolism and ketone production. While
hyperosmolar hyperglycemic state (HHS) also presents with hyperglycemia, it typically
does not present with Kussmaul respirations or fruity breath because significant ketosis is
absent. Hypoglycemia presents with low blood glucose and sympathetic nervous system
responses.
6. The night shift nurse is caring for four clients. Which client should the nurse
assess first?
A. A client requesting pain medication for postoperative incisional pain rated 6/10
B. A client with a new onset of atrial fibrillation with a ventricular rate of 152/min
C. A client with diabetes who has a blood glucose level of 210 mg/dL before breakfast
D. A client with chronic obstructive pulmonary disease who has an oxygen saturation
of 92%
Correct Answer: B
Rationale: The client with new-onset atrial fibrillation and a ventricular rate of 152/min is
the highest priority because uncontrolled tachyarrhythmia can lead to hemodynamic
4
