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HESI EXIT V4 EXAM | 200+ SOLVED QUESTIONS
& RATIONALES | HIGH-YIELD CONTENT |
GRADED A+ | FIRST-TIME PASS | LATEST 2026**
## SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (Questions 1–20)
**1. The nurse receives shift report on 4 clients. Which client should be assessed
first?**
A. Client with heart failure, crackles in mid-lung fields
B. Client with diabetes mellitus, blood glucose 180 mg/dL
**C. Client with tracheostomy, oxygen saturation 86%**
D. Client with appendicitis, temperature 100.4°F (38°C)
**Rationale:** O2 sat 86% indicates severe hypoxemia, airway/breathing priority.
Crackles (A) are expected in HF; glucose 180 (B) is elevated but not critical; low-
grade fever (D) is expected.
---
**2. An LPN is assigned to care for a stable client with a colostomy. Which task
should the RN delegate to the LPN?**
A. Teaching the client how to irrigate the colostomy
**B. Performing colostomy bag change**
C. Assessing the stoma for ischemia
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D. Developing the colostomy care plan
**Rationale:** LPN can perform stable, standard procedures (bag change).
Teaching (A), assessment (C), and care planning (D) require RN scope.
---
**3. A client refuses a blood transfusion due to religious beliefs (Jehovah’s
Witness). The nurse’s best response is:**
A. “You will die without this transfusion.”
B. “Let me call your family to convince you.”
**C. “I respect your decision. I will notify your provider.”**
D. “We will give it anyway if it’s an emergency.”
**Rationale:** Client autonomy must be respected. Option C is ethical, legal, and
therapeutic. Forcing transfusion (D) is battery.
---
**4. Which client can be assigned to an RN who is pregnant?**
A. Client receiving oral acyclovir for herpes zoster
**B. Client with stable angina**
C. Client with active cytomegalovirus (CMV)
D. Client receiving IV ribavirin
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**Rationale:** Pregnant staff should avoid CMV (C – teratogenic), ribavirin (D –
teratogenic), and some antivirals (A). Stable angina (B) poses no risk.
---
**5. A nurse finds a colleague diverting fentanyl from a PCA pump. What is the
first action?**
A. Confront the colleague privately
**B. Report to the nurse manager immediately**
C. Ignore it to avoid conflict
D. Document in the colleague’s personnel file
**Rationale:** Substance diversion is illegal and unsafe. Reporting to
management is mandatory per nursing ethics and law.
---
**6. A client falls while getting out of bed. After ensuring the client is safe, which
documentation is most appropriate?**
A. “Client fell due to negligence of nursing staff.”
B. “Client climbed over side rails and fell.”
**C. “Client found on floor beside bed. Incident report completed.”**
D. “Fall was unavoidable because client is confused.”
**Rationale:** Documentation must be objective, factual, and non-accusatory.
Incident report is separate from medical record.
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---
**7. A client with terminal cancer requests no further chemotherapy. The family
insists on continued treatment. What should the nurse do?**
**A. Support the client’s decision and notify the provider**
B. Follow the family’s wishes to avoid conflict
C. Give chemotherapy as prescribed
D. Request an ethics committee meeting before acting
**Rationale:** Client autonomy overrides family wishes. Informed refusal must
be respected.
---
**8. Which task can the nurse delegate to an unlicensed assistive personnel
(UAP)?**
A. Assess a client’s post-operative incision
B. Teach a client how to use an incentive spirometer
**C. Obtain a daily weight on a client with heart failure**
D. Evaluate the effectiveness of pain medication
**Rationale:** UAP can obtain stable, routine measurements (weight). Assessment
(A), teaching (B), and evaluation (D) are RN duties.
HESI EXIT V4 EXAM | 200+ SOLVED QUESTIONS
& RATIONALES | HIGH-YIELD CONTENT |
GRADED A+ | FIRST-TIME PASS | LATEST 2026**
## SECTION 1: SAFE & EFFECTIVE CARE ENVIRONMENT (Questions 1–20)
**1. The nurse receives shift report on 4 clients. Which client should be assessed
first?**
A. Client with heart failure, crackles in mid-lung fields
B. Client with diabetes mellitus, blood glucose 180 mg/dL
**C. Client with tracheostomy, oxygen saturation 86%**
D. Client with appendicitis, temperature 100.4°F (38°C)
**Rationale:** O2 sat 86% indicates severe hypoxemia, airway/breathing priority.
Crackles (A) are expected in HF; glucose 180 (B) is elevated but not critical; low-
grade fever (D) is expected.
---
**2. An LPN is assigned to care for a stable client with a colostomy. Which task
should the RN delegate to the LPN?**
A. Teaching the client how to irrigate the colostomy
**B. Performing colostomy bag change**
C. Assessing the stoma for ischemia
,2|Page
D. Developing the colostomy care plan
**Rationale:** LPN can perform stable, standard procedures (bag change).
Teaching (A), assessment (C), and care planning (D) require RN scope.
---
**3. A client refuses a blood transfusion due to religious beliefs (Jehovah’s
Witness). The nurse’s best response is:**
A. “You will die without this transfusion.”
B. “Let me call your family to convince you.”
**C. “I respect your decision. I will notify your provider.”**
D. “We will give it anyway if it’s an emergency.”
**Rationale:** Client autonomy must be respected. Option C is ethical, legal, and
therapeutic. Forcing transfusion (D) is battery.
---
**4. Which client can be assigned to an RN who is pregnant?**
A. Client receiving oral acyclovir for herpes zoster
**B. Client with stable angina**
C. Client with active cytomegalovirus (CMV)
D. Client receiving IV ribavirin
,3|Page
**Rationale:** Pregnant staff should avoid CMV (C – teratogenic), ribavirin (D –
teratogenic), and some antivirals (A). Stable angina (B) poses no risk.
---
**5. A nurse finds a colleague diverting fentanyl from a PCA pump. What is the
first action?**
A. Confront the colleague privately
**B. Report to the nurse manager immediately**
C. Ignore it to avoid conflict
D. Document in the colleague’s personnel file
**Rationale:** Substance diversion is illegal and unsafe. Reporting to
management is mandatory per nursing ethics and law.
---
**6. A client falls while getting out of bed. After ensuring the client is safe, which
documentation is most appropriate?**
A. “Client fell due to negligence of nursing staff.”
B. “Client climbed over side rails and fell.”
**C. “Client found on floor beside bed. Incident report completed.”**
D. “Fall was unavoidable because client is confused.”
**Rationale:** Documentation must be objective, factual, and non-accusatory.
Incident report is separate from medical record.
, 4|Page
---
**7. A client with terminal cancer requests no further chemotherapy. The family
insists on continued treatment. What should the nurse do?**
**A. Support the client’s decision and notify the provider**
B. Follow the family’s wishes to avoid conflict
C. Give chemotherapy as prescribed
D. Request an ethics committee meeting before acting
**Rationale:** Client autonomy overrides family wishes. Informed refusal must
be respected.
---
**8. Which task can the nurse delegate to an unlicensed assistive personnel
(UAP)?**
A. Assess a client’s post-operative incision
B. Teach a client how to use an incentive spirometer
**C. Obtain a daily weight on a client with heart failure**
D. Evaluate the effectiveness of pain medication
**Rationale:** UAP can obtain stable, routine measurements (weight). Assessment
(A), teaching (B), and evaluation (D) are RN duties.
