HESI COMPREHENSIVE EXIT EXAM
2026/2027
150 Questions | Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
Comprehensive Nursing Competency Assessment for NCLEX-RN Readiness
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Total Testing Time: 180 Minutes | Passing Score: 850 HESI Score (75-80%)
Computer-Based, Proctored Format via Elsevier Evolve Testing Platform
Examination Overview
Domain Questions Key Topics Weight
Management of Care 22 Delegation, Supervision, Prioritization, 15%
Legal/Ethical Issues, Case Management,
Resource Allocation
Safety and Infection 18 Standard Precautions, Isolation, Fall 12%
Control Prevention, Error Prevention, Emergency
Response, Hand Hygiene
Health Promotion and 15 Developmental Stages, Screening, Prevention, 10%
Maintenance Lifestyle Counseling, Aging, Immunizations
Psychosocial Integrity 15 Therapeutic Communication, Mental Health, 10%
Crisis Intervention, Coping, Cultural
Sensitivity, Grief
Basic Care and Comfort 18 ADLs, Pain Management, Nutrition, 12%
Elimination, Mobility, Rest/Sleep, Comfort
Measures, Hygiene
Pharmacological and 22 Medication Administration, Rights of 15%
Parenteral Therapies Medication, Side Effects, Interactions, IV
Therapy, Dosage Calculations, High-Alert
Medications
Reduction of Risk 20 Diagnostic Tests, Vital Signs, Complication 13%
Potential Prevention, Therapeutic Procedures, Pre/Post-
Op Care, Lab Values
Physiological Adaptation 20 Acute/Chronic Conditions, Fluid/Electrolytes, 13%
Pathophysiology, Emergency Care, Wound
Healing, Multi-System Disorders
,Exam Structure
• Exact official question count: 150 multiple-choice questions (MCQ) per commonly cited HESI
Comprehensive Exit Exam specifications and verified Elsevier Evolve documentation.
• All questions presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format.
• Item types include: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend
recognition, matrix multiple-choice, prioritization scenarios, dosage calculation items, and clinical
judgment application questions.
• Focus on evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model
(CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan.
• Total testing time: 180 minutes (computer-based, proctored format via Elsevier Evolve testing
platform or institutional learning management system).
• Passing score: Typically 850 HESI score or 75-80% required for NCLEX-RN readiness prediction
per nursing program policy (113-120/150 correct).
Domain: Management of Care
Key Topics: Delegation, Supervision, Prioritization, Legal/Ethical Issues, Case Management,
Resource Allocation | Questions: 22 | Weight: 15%
1. The registered nurse (RN) is caring for four clients. Which client should the RN assess
first?
A. A client with a blood pressure of 160/90 mmHg
B. A client with a respiratory rate of 8 breaths/min
C. A client who is 2 days postoperative with a temperature of 100.4°F (38°C)
D. A client requesting pain medication
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, a respiratory rate
of 8 breaths/min indicates respiratory depression and is a life-threatening emergency requiring
immediate assessment and intervention. This client takes priority over hypertension, low-grade
postoperative fever, and pain management requests, as compromised breathing poses the greatest
immediate threat to survival.
2. The charge nurse is delegating tasks to a licensed practical nurse (LPN) and
unlicensed assistive personnel (UAP). Which task should the charge nurse assign to the
LPN?
A. Ambulating a client who is 1 day postoperative
B. Administering oral medications to a stable client
C. Teaching a client about a new diabetic diet
D. Developing a plan of care for a newly admitted client
Correct Answer: B
Rationale: The LPN's scope of practice includes administering oral medications to stable clients, as
this is within the LPN's licensed parameters. Ambulating a postoperative client can be delegated to
UAP with proper instruction. Teaching and developing plans of care are responsibilities that require
the RN's scope of practice, as they involve assessment, critical thinking, and clinical judgment that
exceed the LPN's licensure.
3. Which action by the nurse demonstrates adherence to the ethical principle of
autonomy?
A. Administering a blood transfusion to a client who refuses it based on religious beliefs
B. Respecting a competent client's decision to refuse treatment
C. Obtaining a court order to force medication administration
D. Administering medication without informing the client of side effects
Correct Answer: B
Rationale: Autonomy refers to respecting a client's right to make their own decisions about
healthcare, even when the nurse disagrees. Respecting a competent client's decision to refuse
,treatment upholds autonomy. Administering a transfusion against a client's wishes violates
autonomy. Obtaining a court order overrides autonomy and is only appropriate in very specific
circumstances involving incompetence or danger to self or others.
4. The nurse is acting as a client advocate. Which situation best demonstrates this role?
A. Explaining the risks and benefits of a surgical procedure to obtain informed consent
B. Informing the healthcare provider that the client wants a second opinion before
surgery
C. Documenting the client's vital signs in the electronic health record
D. Administering pain medication as prescribed by the healthcare provider
Correct Answer: B
Rationale: Client advocacy involves supporting and representing the client's wishes and best
interests, especially when the client may not be able to do so effectively. Informing the provider that
the client wants a second opinion directly advocates for the client's expressed desire. While
explaining risks and benefits is important for informed consent, the primary advocate role is
ensuring the client's voice is heard and their wishes are respected in the care process.
5. A nurse manager is resolving a conflict between two staff nurses regarding patient
assignment. Which approach is most effective?
A. Avoiding the conflict and hoping it resolves on its own
B. Accommodating one nurse's preferences to maintain harmony
C. Collaborating with both nurses to find a mutually acceptable solution
D. Forcing the nurse manager's decision without staff input
Correct Answer: C
Rationale: Collaboration is the most effective conflict resolution strategy because it addresses the
concerns of all parties and produces a solution that everyone can support. Avoiding the conflict
allows it to escalate. Accommodating one nurse creates resentment in the other. Forcing a decision
without input damages morale and does not address the root cause. Collaboration promotes
professional relationships and sustainable solutions.
6. The nurse is preparing to discharge a client with a new colostomy. Which
interprofessional team member should the nurse consult to ensure continuity of care?
A. Pharmacist
B. Enterostomal therapy nurse (ET nurse)
C. Physical therapist
D. Social worker
Correct Answer: B
Rationale: The enterostomal therapy (ET) nurse is the specialist in ostomy care, including stoma
assessment, appliance fitting, skin care, and client education. Consulting the ET nurse ensures the
client receives expert guidance for managing their colostomy at home. While other team members
may contribute to aspects of discharge, the ET nurse is the most appropriate specialist for ostomy-
specific continuity of care.
7. Which situation requires the nurse to obtain informed consent?
A. Administering a routine influenza vaccination
B. Performing a lumbar puncture
C. Drawing blood for a complete blood count (CBC)
D. Inserting a peripheral intravenous catheter
Correct Answer: B
Rationale: A lumbar puncture is an invasive diagnostic procedure that carries significant risks,
including infection, bleeding, and nerve damage, and therefore requires informed consent. Routine
vaccinations, blood draws, and peripheral IV insertions are considered routine procedures that do
not typically require formal informed consent, although clients should still be informed about what
to expect.
8. The nurse receives a telephone order from a healthcare provider. Which action
should the nurse take first?
A. Write the order on the physician order sheet
B. Read back the order to the provider for verification
C. Implement the order immediately
, D. Ask another nurse to witness the telephone order
Correct Answer: B
Rationale: The read-back verification process is the first priority after receiving a telephone order
to ensure accuracy and prevent errors. The Joint Commission and institutional policies require the
nurse to read back the complete order to the provider, who then confirms or corrects it. This step
must occur before implementing the order or writing it on the order sheet to ensure the order is
accurately transcribed.
9. A nurse is assigned to care for a client whose cultural beliefs differ from the nurse's
own. What is the best approach?
A. Explain to the client that hospital policy takes precedence over cultural beliefs
B. Assess the client's cultural preferences and incorporate them into the care plan
C. Request that another nurse be assigned to the client
D. Ignore the cultural differences and provide standard care
Correct Answer: B
Rationale: Culturally competent care requires the nurse to assess the client's cultural preferences
and integrate them into the plan of care whenever possible. This promotes trust, compliance, and
positive outcomes. Dismissing cultural beliefs, requesting reassignment, or ignoring differences
undermines therapeutic relationships and may violate the client's right to culturally sensitive care.
10. The nurse discovers that a colleague has made a medication error but did not report
it. What is the nurse's most appropriate action?
A. Report the error to the charge nurse and complete an incident report
B. Confront the colleague privately and demand they report it
C. Ignore the error since the colleague is responsible for their own actions
D. Wait to see if the client shows any adverse effects before reporting
Correct Answer: A
Rationale: Patient safety is the highest priority, and the nurse has a professional and ethical
obligation to report medication errors regardless of whether a colleague reports it. Reporting
through the chain of command (charge nurse and incident report) ensures the client is monitored for
adverse effects and that system improvements can be implemented. Ignoring or delaying reporting
puts the client at risk.
11. Which client should the charge nurse assign to a float nurse from the medical-
surgical unit?
A. A client receiving mechanical ventilation
B. A client with a chest tube who is 3 days postoperative
C. A client with diabetic ketoacidosis receiving an insulin drip
D. A client with acute myocardial infarction in the cardiac care unit
Correct Answer: B
Rationale: A client with a chest tube who is 3 days postoperative is the most stable and requires
monitoring within the skill set of a medical-surgical float nurse. Clients on mechanical ventilation,
insulin drips for DKA, or in the cardiac care unit require specialized critical care knowledge and
continuous monitoring that are beyond the typical medical-surgical nurse's expertise.
12. The nurse is caring for a client who is scheduled for surgery but expresses
uncertainty about proceeding. What should the nurse do first?
A. Notify the surgeon that the client is refusing surgery
B. Explore the client's concerns and reasons for uncertainty
C. Remind the client of the consequences of delaying surgery
D. Ask the family to convince the client to proceed
Correct Answer: B
Rationale: Exploring the client's concerns is the first step because the nurse must understand the
client's perspective before taking any action. This respects the client's autonomy and allows the nurse
to address specific fears or misinformation. Notifying the surgeon prematurely bypasses the client's
right to express concerns. Pressuring the client or involving family undermines autonomy.
13. A nurse is implementing evidence-based practice (EBP). Which step comes first?
A. Applying the evidence to clinical practice
B. Asking a clinical question using the PICO format
2026/2027
150 Questions | Complete Exam-Style Questions with Detailed Rationales
100% Verified | Graded A+
Comprehensive Nursing Competency Assessment for NCLEX-RN Readiness
Elsevier Evolve / NCSBN Clinical Judgment Measurement Model Alignment
Total Testing Time: 180 Minutes | Passing Score: 850 HESI Score (75-80%)
Computer-Based, Proctored Format via Elsevier Evolve Testing Platform
Examination Overview
Domain Questions Key Topics Weight
Management of Care 22 Delegation, Supervision, Prioritization, 15%
Legal/Ethical Issues, Case Management,
Resource Allocation
Safety and Infection 18 Standard Precautions, Isolation, Fall 12%
Control Prevention, Error Prevention, Emergency
Response, Hand Hygiene
Health Promotion and 15 Developmental Stages, Screening, Prevention, 10%
Maintenance Lifestyle Counseling, Aging, Immunizations
Psychosocial Integrity 15 Therapeutic Communication, Mental Health, 10%
Crisis Intervention, Coping, Cultural
Sensitivity, Grief
Basic Care and Comfort 18 ADLs, Pain Management, Nutrition, 12%
Elimination, Mobility, Rest/Sleep, Comfort
Measures, Hygiene
Pharmacological and 22 Medication Administration, Rights of 15%
Parenteral Therapies Medication, Side Effects, Interactions, IV
Therapy, Dosage Calculations, High-Alert
Medications
Reduction of Risk 20 Diagnostic Tests, Vital Signs, Complication 13%
Potential Prevention, Therapeutic Procedures, Pre/Post-
Op Care, Lab Values
Physiological Adaptation 20 Acute/Chronic Conditions, Fluid/Electrolytes, 13%
Pathophysiology, Emergency Care, Wound
Healing, Multi-System Disorders
,Exam Structure
• Exact official question count: 150 multiple-choice questions (MCQ) per commonly cited HESI
Comprehensive Exit Exam specifications and verified Elsevier Evolve documentation.
• All questions presented in MCQ format with four options (A, B, C, D), single-best-answer unless
otherwise specified as SATA or NGN case study format.
• Item types include: Standard MCQ, Select-All-That-Apply (SATA), NGN bow-tie items, trend
recognition, matrix multiple-choice, prioritization scenarios, dosage calculation items, and clinical
judgment application questions.
• Focus on evidence-based nursing interventions, NCSBN Clinical Judgment Measurement Model
(CJMM) application, and professional judgment aligned with NCSBN NCLEX-RN test plan.
• Total testing time: 180 minutes (computer-based, proctored format via Elsevier Evolve testing
platform or institutional learning management system).
• Passing score: Typically 850 HESI score or 75-80% required for NCLEX-RN readiness prediction
per nursing program policy (113-120/150 correct).
Domain: Management of Care
Key Topics: Delegation, Supervision, Prioritization, Legal/Ethical Issues, Case Management,
Resource Allocation | Questions: 22 | Weight: 15%
1. The registered nurse (RN) is caring for four clients. Which client should the RN assess
first?
A. A client with a blood pressure of 160/90 mmHg
B. A client with a respiratory rate of 8 breaths/min
C. A client who is 2 days postoperative with a temperature of 100.4°F (38°C)
D. A client requesting pain medication
Correct Answer: B
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, a respiratory rate
of 8 breaths/min indicates respiratory depression and is a life-threatening emergency requiring
immediate assessment and intervention. This client takes priority over hypertension, low-grade
postoperative fever, and pain management requests, as compromised breathing poses the greatest
immediate threat to survival.
2. The charge nurse is delegating tasks to a licensed practical nurse (LPN) and
unlicensed assistive personnel (UAP). Which task should the charge nurse assign to the
LPN?
A. Ambulating a client who is 1 day postoperative
B. Administering oral medications to a stable client
C. Teaching a client about a new diabetic diet
D. Developing a plan of care for a newly admitted client
Correct Answer: B
Rationale: The LPN's scope of practice includes administering oral medications to stable clients, as
this is within the LPN's licensed parameters. Ambulating a postoperative client can be delegated to
UAP with proper instruction. Teaching and developing plans of care are responsibilities that require
the RN's scope of practice, as they involve assessment, critical thinking, and clinical judgment that
exceed the LPN's licensure.
3. Which action by the nurse demonstrates adherence to the ethical principle of
autonomy?
A. Administering a blood transfusion to a client who refuses it based on religious beliefs
B. Respecting a competent client's decision to refuse treatment
C. Obtaining a court order to force medication administration
D. Administering medication without informing the client of side effects
Correct Answer: B
Rationale: Autonomy refers to respecting a client's right to make their own decisions about
healthcare, even when the nurse disagrees. Respecting a competent client's decision to refuse
,treatment upholds autonomy. Administering a transfusion against a client's wishes violates
autonomy. Obtaining a court order overrides autonomy and is only appropriate in very specific
circumstances involving incompetence or danger to self or others.
4. The nurse is acting as a client advocate. Which situation best demonstrates this role?
A. Explaining the risks and benefits of a surgical procedure to obtain informed consent
B. Informing the healthcare provider that the client wants a second opinion before
surgery
C. Documenting the client's vital signs in the electronic health record
D. Administering pain medication as prescribed by the healthcare provider
Correct Answer: B
Rationale: Client advocacy involves supporting and representing the client's wishes and best
interests, especially when the client may not be able to do so effectively. Informing the provider that
the client wants a second opinion directly advocates for the client's expressed desire. While
explaining risks and benefits is important for informed consent, the primary advocate role is
ensuring the client's voice is heard and their wishes are respected in the care process.
5. A nurse manager is resolving a conflict between two staff nurses regarding patient
assignment. Which approach is most effective?
A. Avoiding the conflict and hoping it resolves on its own
B. Accommodating one nurse's preferences to maintain harmony
C. Collaborating with both nurses to find a mutually acceptable solution
D. Forcing the nurse manager's decision without staff input
Correct Answer: C
Rationale: Collaboration is the most effective conflict resolution strategy because it addresses the
concerns of all parties and produces a solution that everyone can support. Avoiding the conflict
allows it to escalate. Accommodating one nurse creates resentment in the other. Forcing a decision
without input damages morale and does not address the root cause. Collaboration promotes
professional relationships and sustainable solutions.
6. The nurse is preparing to discharge a client with a new colostomy. Which
interprofessional team member should the nurse consult to ensure continuity of care?
A. Pharmacist
B. Enterostomal therapy nurse (ET nurse)
C. Physical therapist
D. Social worker
Correct Answer: B
Rationale: The enterostomal therapy (ET) nurse is the specialist in ostomy care, including stoma
assessment, appliance fitting, skin care, and client education. Consulting the ET nurse ensures the
client receives expert guidance for managing their colostomy at home. While other team members
may contribute to aspects of discharge, the ET nurse is the most appropriate specialist for ostomy-
specific continuity of care.
7. Which situation requires the nurse to obtain informed consent?
A. Administering a routine influenza vaccination
B. Performing a lumbar puncture
C. Drawing blood for a complete blood count (CBC)
D. Inserting a peripheral intravenous catheter
Correct Answer: B
Rationale: A lumbar puncture is an invasive diagnostic procedure that carries significant risks,
including infection, bleeding, and nerve damage, and therefore requires informed consent. Routine
vaccinations, blood draws, and peripheral IV insertions are considered routine procedures that do
not typically require formal informed consent, although clients should still be informed about what
to expect.
8. The nurse receives a telephone order from a healthcare provider. Which action
should the nurse take first?
A. Write the order on the physician order sheet
B. Read back the order to the provider for verification
C. Implement the order immediately
, D. Ask another nurse to witness the telephone order
Correct Answer: B
Rationale: The read-back verification process is the first priority after receiving a telephone order
to ensure accuracy and prevent errors. The Joint Commission and institutional policies require the
nurse to read back the complete order to the provider, who then confirms or corrects it. This step
must occur before implementing the order or writing it on the order sheet to ensure the order is
accurately transcribed.
9. A nurse is assigned to care for a client whose cultural beliefs differ from the nurse's
own. What is the best approach?
A. Explain to the client that hospital policy takes precedence over cultural beliefs
B. Assess the client's cultural preferences and incorporate them into the care plan
C. Request that another nurse be assigned to the client
D. Ignore the cultural differences and provide standard care
Correct Answer: B
Rationale: Culturally competent care requires the nurse to assess the client's cultural preferences
and integrate them into the plan of care whenever possible. This promotes trust, compliance, and
positive outcomes. Dismissing cultural beliefs, requesting reassignment, or ignoring differences
undermines therapeutic relationships and may violate the client's right to culturally sensitive care.
10. The nurse discovers that a colleague has made a medication error but did not report
it. What is the nurse's most appropriate action?
A. Report the error to the charge nurse and complete an incident report
B. Confront the colleague privately and demand they report it
C. Ignore the error since the colleague is responsible for their own actions
D. Wait to see if the client shows any adverse effects before reporting
Correct Answer: A
Rationale: Patient safety is the highest priority, and the nurse has a professional and ethical
obligation to report medication errors regardless of whether a colleague reports it. Reporting
through the chain of command (charge nurse and incident report) ensures the client is monitored for
adverse effects and that system improvements can be implemented. Ignoring or delaying reporting
puts the client at risk.
11. Which client should the charge nurse assign to a float nurse from the medical-
surgical unit?
A. A client receiving mechanical ventilation
B. A client with a chest tube who is 3 days postoperative
C. A client with diabetic ketoacidosis receiving an insulin drip
D. A client with acute myocardial infarction in the cardiac care unit
Correct Answer: B
Rationale: A client with a chest tube who is 3 days postoperative is the most stable and requires
monitoring within the skill set of a medical-surgical float nurse. Clients on mechanical ventilation,
insulin drips for DKA, or in the cardiac care unit require specialized critical care knowledge and
continuous monitoring that are beyond the typical medical-surgical nurse's expertise.
12. The nurse is caring for a client who is scheduled for surgery but expresses
uncertainty about proceeding. What should the nurse do first?
A. Notify the surgeon that the client is refusing surgery
B. Explore the client's concerns and reasons for uncertainty
C. Remind the client of the consequences of delaying surgery
D. Ask the family to convince the client to proceed
Correct Answer: B
Rationale: Exploring the client's concerns is the first step because the nurse must understand the
client's perspective before taking any action. This respects the client's autonomy and allows the nurse
to address specific fears or misinformation. Notifying the surgeon prematurely bypasses the client's
right to express concerns. Pressuring the client or involving family undermines autonomy.
13. A nurse is implementing evidence-based practice (EBP). Which step comes first?
A. Applying the evidence to clinical practice
B. Asking a clinical question using the PICO format
