HESI COMPREHENSIVE EXIT EXAM
OFFICIAL COMPREHENSIVE EXIT
EXAM 2026/2027
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SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q13
══════════════════════════════════════
Question 1 of 50
A 78-year-old client with a history of syncope is admitted to a medical-surgical unit after a fall
at home. The nurse notes an unsteady gait, use of a walker, and an order for lorazepam 0.5
mg PO at bedtime. Which nursing action best reduces this client's risk of falling during the
hospital stay?
A. Keep all four bed rails raised continuously when the client is in bed
B. Place the call light and personal items within the client's reach and initiate hourly rounding
✓ CORRECT
C. Apply a vest restraint when the client is left unattended in the bathroom
D. Administer the lorazepam immediately after the evening meal instead of at bedtime
Correct Answer: B
Rationale: Placing essential items within reach and performing hourly rounding addresses the
primary fall risk factors of unsteady gait and environmental hazards while preserving the
client's autonomy. Keeping all four bed rails raised is considered a restraint and can increase
agitation or injury risk, while vest restraints and unnecessary sedation both violate
least-restrictive intervention principles and increase harm potential.
Question 2 of 50
A nurse on a busy oncology unit accidentally sticks herself with a needle she has just used to
administer chemotherapy to a client with hepatitis C. The unit is short-staffed and the nurse
is already behind on medication passes. What is the nurse's immediate priority?
A. Finish the remaining medication passes to avoid further delay
B. Apply a bandage and continue documenting the chemotherapy administration
C. Wash the area with soap and water and report to employee health within the required
timeframe
D. Ask the charge nurse to finish the medication pass while she goes home for the day ✓
CORRECT
,Correct Answer: D
Rationale: The nurse must immediately notify the charge nurse to assume care
responsibilities so she can promptly seek post-exposure evaluation and prophylaxis through
employee health without abandoning assigned clients. Washing the area is appropriate but
does not replace formal reporting, and continuing to work delays critical interventions such
as baseline testing and possible antiviral prophylaxis.
Question 3 of 50
During morning report, the charge nurse assigns a stable client with a peripheral IV requiring
routine antibiotics to a licensed practical nurse, and asks the registered nurse to admit a new
client with chest pain and unstable vital signs. Which principle of assignment and delegation
does this reflect?
A. Assigning clients based on acuity and scope of practice ✓ CORRECT
B. Delegating all invasive procedures to the most experienced staff member
C. Assigning the most complex client to the newest graduate nurse
D. Delegating assessment and planning responsibilities to the licensed practical nurse
Correct Answer: A
Rationale: Matching client acuity to the appropriate level of licensure ensures safe care
delivery, as the RN's advanced assessment skills are required for the unstable admission
while the LPN's scope covers stable clients with predictable outcomes. Delegating
assessments or complex procedures to an LPN exceeds that role's legal boundaries, and
intentionally burdening novice nurses with the highest acuity contradicts patient safety
principles.
Question 4 of 50
A 42-year-old construction worker arrives in the emergency department via ambulance after a
beam fell on his lower legs at the job site. He is alert, oriented, and complaining of severe
pain. His right foot is pale and cool to the touch, and pedal pulses are absent. Another client
with a suspected ankle sprain has been waiting two hours. Which client should the nurse see
first?
A. The construction worker with the suspected ankle sprain who has been waiting longest
B. The construction worker with the pale, cool foot and absent pedal pulses ✓ CORRECT
C. The client with the ankle sprain because orthopedic injuries take priority over soft tissue
D. Both clients can be seen simultaneously since the waiting room is not overcrowded
Correct Answer: B
Rationale: Absent pedal pulses with pallor and coolness strongly indicate compromised
arterial blood flow and limb-threatening ischemia, making this a higher priority than a stable
musculoskeletal injury regardless of wait time. Triage is based on acuity and potential for
, deterioration, not arrival order or convenience, and simultaneous evaluation is unsafe when
one client requires immediate vascular assessment.
Question 5 of 50
A nurse administers 10 units of regular insulin subcutaneously to a client at 0730, then
realizes the vial read 100 units/mL but the syringe was a 1-mL tuberculin syringe. The client is
asymptomatic. What is the nurse's most appropriate next action?
A. Document the error in the client's chart without notifying the provider
B. Complete an incident report and notify the charge nurse and provider per facility policy ✓
CORRECT
C. Administer 10 units of dextrose 50% prophylactically to prevent hypoglycemia
D. Reassess the client at 0900 and only report if symptoms develop
Correct Answer: B
Rationale: Completing an incident report and notifying the charge nurse and provider ensures
transparent tracking of the medication error and triggers appropriate monitoring protocols
even when the client is currently asymptomatic. Withholding disclosure violates professional
ethics and institutional policy, while prophylactic dextrose administration without an order or
indication constitutes an additional error, and delayed reporting risks missing early signs of
hypoglycemia.
Question 6 of 50
A 17-year-old client is brought to the emergency department with a suspected ruptured
appendix. Her parents are out of state and unreachable by phone. The client is alert, oriented,
and consenting to an appendectomy. Which action by the nurse is most appropriate?
A. Proceed with preoperative preparation based on the client's informed consent ✓ CORRECT
B. Delay surgery until a parent arrives to provide legal consent
C. Ask the client's 19-year-old sibling to sign the consent form instead
D. Contact a judge to obtain an emergency court order before any procedures
Correct Answer: A
Rationale: An emancipated or mature minor who demonstrates understanding of the
procedure, risks, and alternatives may provide informed consent for emergency surgery when
delay would cause significant harm, and this client is alert and oriented with a life-threatening
condition. Delaying definitive treatment for appendicitis risks perforation and sepsis, while
sibling consent carries no legal weight and court orders are unnecessary when the client
herself can consent.
Question 7 of 50
OFFICIAL COMPREHENSIVE EXIT
EXAM 2026/2027
══════════════════════════════════════
SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT Q1 – Q13
══════════════════════════════════════
Question 1 of 50
A 78-year-old client with a history of syncope is admitted to a medical-surgical unit after a fall
at home. The nurse notes an unsteady gait, use of a walker, and an order for lorazepam 0.5
mg PO at bedtime. Which nursing action best reduces this client's risk of falling during the
hospital stay?
A. Keep all four bed rails raised continuously when the client is in bed
B. Place the call light and personal items within the client's reach and initiate hourly rounding
✓ CORRECT
C. Apply a vest restraint when the client is left unattended in the bathroom
D. Administer the lorazepam immediately after the evening meal instead of at bedtime
Correct Answer: B
Rationale: Placing essential items within reach and performing hourly rounding addresses the
primary fall risk factors of unsteady gait and environmental hazards while preserving the
client's autonomy. Keeping all four bed rails raised is considered a restraint and can increase
agitation or injury risk, while vest restraints and unnecessary sedation both violate
least-restrictive intervention principles and increase harm potential.
Question 2 of 50
A nurse on a busy oncology unit accidentally sticks herself with a needle she has just used to
administer chemotherapy to a client with hepatitis C. The unit is short-staffed and the nurse
is already behind on medication passes. What is the nurse's immediate priority?
A. Finish the remaining medication passes to avoid further delay
B. Apply a bandage and continue documenting the chemotherapy administration
C. Wash the area with soap and water and report to employee health within the required
timeframe
D. Ask the charge nurse to finish the medication pass while she goes home for the day ✓
CORRECT
,Correct Answer: D
Rationale: The nurse must immediately notify the charge nurse to assume care
responsibilities so she can promptly seek post-exposure evaluation and prophylaxis through
employee health without abandoning assigned clients. Washing the area is appropriate but
does not replace formal reporting, and continuing to work delays critical interventions such
as baseline testing and possible antiviral prophylaxis.
Question 3 of 50
During morning report, the charge nurse assigns a stable client with a peripheral IV requiring
routine antibiotics to a licensed practical nurse, and asks the registered nurse to admit a new
client with chest pain and unstable vital signs. Which principle of assignment and delegation
does this reflect?
A. Assigning clients based on acuity and scope of practice ✓ CORRECT
B. Delegating all invasive procedures to the most experienced staff member
C. Assigning the most complex client to the newest graduate nurse
D. Delegating assessment and planning responsibilities to the licensed practical nurse
Correct Answer: A
Rationale: Matching client acuity to the appropriate level of licensure ensures safe care
delivery, as the RN's advanced assessment skills are required for the unstable admission
while the LPN's scope covers stable clients with predictable outcomes. Delegating
assessments or complex procedures to an LPN exceeds that role's legal boundaries, and
intentionally burdening novice nurses with the highest acuity contradicts patient safety
principles.
Question 4 of 50
A 42-year-old construction worker arrives in the emergency department via ambulance after a
beam fell on his lower legs at the job site. He is alert, oriented, and complaining of severe
pain. His right foot is pale and cool to the touch, and pedal pulses are absent. Another client
with a suspected ankle sprain has been waiting two hours. Which client should the nurse see
first?
A. The construction worker with the suspected ankle sprain who has been waiting longest
B. The construction worker with the pale, cool foot and absent pedal pulses ✓ CORRECT
C. The client with the ankle sprain because orthopedic injuries take priority over soft tissue
D. Both clients can be seen simultaneously since the waiting room is not overcrowded
Correct Answer: B
Rationale: Absent pedal pulses with pallor and coolness strongly indicate compromised
arterial blood flow and limb-threatening ischemia, making this a higher priority than a stable
musculoskeletal injury regardless of wait time. Triage is based on acuity and potential for
, deterioration, not arrival order or convenience, and simultaneous evaluation is unsafe when
one client requires immediate vascular assessment.
Question 5 of 50
A nurse administers 10 units of regular insulin subcutaneously to a client at 0730, then
realizes the vial read 100 units/mL but the syringe was a 1-mL tuberculin syringe. The client is
asymptomatic. What is the nurse's most appropriate next action?
A. Document the error in the client's chart without notifying the provider
B. Complete an incident report and notify the charge nurse and provider per facility policy ✓
CORRECT
C. Administer 10 units of dextrose 50% prophylactically to prevent hypoglycemia
D. Reassess the client at 0900 and only report if symptoms develop
Correct Answer: B
Rationale: Completing an incident report and notifying the charge nurse and provider ensures
transparent tracking of the medication error and triggers appropriate monitoring protocols
even when the client is currently asymptomatic. Withholding disclosure violates professional
ethics and institutional policy, while prophylactic dextrose administration without an order or
indication constitutes an additional error, and delayed reporting risks missing early signs of
hypoglycemia.
Question 6 of 50
A 17-year-old client is brought to the emergency department with a suspected ruptured
appendix. Her parents are out of state and unreachable by phone. The client is alert, oriented,
and consenting to an appendectomy. Which action by the nurse is most appropriate?
A. Proceed with preoperative preparation based on the client's informed consent ✓ CORRECT
B. Delay surgery until a parent arrives to provide legal consent
C. Ask the client's 19-year-old sibling to sign the consent form instead
D. Contact a judge to obtain an emergency court order before any procedures
Correct Answer: A
Rationale: An emancipated or mature minor who demonstrates understanding of the
procedure, risks, and alternatives may provide informed consent for emergency surgery when
delay would cause significant harm, and this client is alert and oriented with a life-threatening
condition. Delaying definitive treatment for appendicitis risks perforation and sepsis, while
sibling consent carries no legal weight and court orders are unnecessary when the client
herself can consent.
Question 7 of 50
