Evolve HESI Fundamentals Exit Exam
ACTUAL EXAM 2026/2027 | Elsevier Evolve
NCSBN Standards Alignment | Verified
Q&A | Pass Guaranteed - A+ Graded
[Section 1: Prioritization, Delegation & Management of Care — 20 Questions]
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse assess
first?
A. A patient who received pain medication 30 minutes ago and reports pain is now 3/10
B. A patient with a respiratory rate of 8 breaths/min and oxygen saturation of 84% on 2 L nasal cannula
C. A patient who needs discharge teaching before going home in 2 hours
D. A patient requesting a bedside commode
Correct Answer: B
Rationale: The patient with respiratory rate of 8 and SpO2 84% has compromised airway and breathing,
which are priority using the ABC framework. Pain at 3/10, discharge teaching, and toileting are
important but not immediately life-threatening. Respiratory depression and hypoxemia require
immediate intervention.
Q2: A nurse is delegating tasks to a nursing assistant. Which task is appropriate to delegate?
A. Assessing a postoperative patient's surgical incision for signs of infection
B. Measuring and recording the intake and output of a stable patient
C. Administering oral medications to a patient with dysphagia
D. Evaluating the effectiveness of a patient's pain management plan
Correct Answer: B
Rationale: Measuring and recording intake and output is within the nursing assistant's scope for stable
patients. Assessment of incisions, medication administration with dysphagia risk, and evaluation of care
plans require nursing judgment and remain with the RN.
Q3: A nurse is caring for a group of patients. Which action should the nurse perform first?
,A. Administer a scheduled antibiotic to a patient with a urinary tract infection
B. Change the dressing on a patient with a stage 2 pressure ulcer
C. Respond to a patient who is unresponsive and not breathing
D. Provide a bed bath for a patient who was incontinent
Correct Answer: C
Rationale: An unresponsive, non-breathing patient requires immediate intervention for airway and
breathing per the ABC priority framework. Scheduled medications, dressing changes, and hygiene care
are important but not emergent when a patient is in respiratory arrest.
Q4: A nurse is reviewing the morning assignments. Which task should the nurse prioritize?
A. A patient with a potassium level of 3.2 mEq/L who has a scheduled dose of potassium
B. A patient with a blood glucose of 245 mg/dL who needs insulin coverage
C. A patient with a heart rate of 52 beats/min who is asymptomatic
D. A patient with a hemoglobin of 7.8 g/dL who has a unit of blood to transfuse
Correct Answer: A
Rationale: A potassium level of 3.2 mEq/L is below normal and places the patient at risk for cardiac
dysrhythmias, requiring prompt replacement. While elevated glucose and low hemoglobin need
attention, hypokalemia poses more immediate cardiac risk. Asymptomatic bradycardia does not require
immediate intervention.
Q5: A nurse is caring for a patient who reports chest pain rated 9/10. The patient is diaphoretic and has
a blood pressure of 88/52 mmHg. Which action should the nurse take first?
A. Administer the prescribed nitroglycerin sublingually
B. Obtain a 12-lead ECG
C. Place the patient in a supine position and elevate the legs
D. Call the patient's family to inform them of the situation
Correct Answer: C
Rationale: The patient is hypotensive and likely in shock, so placing them supine with legs elevated
improves venous return and perfusion. Nitroglycerin would further lower blood pressure and is
contraindicated. ECG is important but secondary to hemodynamic stabilization. Calling family is not a
priority during an emergency.
Q6: A nurse is working with an LPN and a nursing assistant. Which task is most appropriate to assign to
the LPN?
,A. Developing a plan of care for a newly admitted patient
B. Administering enteral tube feedings to a stable patient
C. Performing the initial head-to-toe assessment on a postoperative patient
D. Teaching a patient about diabetes self-management
Correct Answer: B
Rationale: Administering enteral feedings to stable patients is within the LPN scope of practice. Care
plan development, initial comprehensive assessments, and patient education require registered nursing
judgment and scope. The LPN can reinforce teaching but not provide initial education.
Q7: A nurse is caring for multiple patients. Which patient should the nurse see first after receiving
report?
A. A patient who is 2 hours post-op and has not voided since surgery
B. A patient with a new onset of confusion and a temperature of 101.8°F
C. A patient who needs assistance to the bathroom
D. A patient requesting a snack before bedtime
Correct Answer: B
Rationale: New onset confusion with fever suggests possible infection or sepsis, requiring immediate
assessment. Postoperative urinary retention needs attention but is not immediately life-threatening.
Bathroom assistance and snack requests are routine care needs.
Q8: A nurse is delegating morning care. Which task should the nurse perform rather than delegate?
A. Bathing a patient who is on contact precautions for MRSA
B. Weighing a patient who is stable and independent
C. Assisting a patient with range-of-motion exercises
D. Evaluating a patient's response to a new pain medication
Correct Answer: D
Rationale: Evaluating medication effectiveness requires nursing assessment and clinical judgment,
which cannot be delegated. Bathing patients on precautions, weighing stable patients, and assisting with
ROM exercises can be delegated to appropriate personnel with proper instruction.
Q9: A nurse is caring for a patient who begins to seize. Which action should the nurse take first?
A. Inserting an oral airway to maintain the airway
B. Noting the time and protecting the patient from injury
, C. Administering lorazepam intravenously
D. Restraining the patient's arms and legs
Correct Answer: B
Rationale: During a seizure, the first priority is to protect the patient from injury and note the onset
time for documentation and treatment decisions. Oral airways and restraints are contraindicated during
seizure activity. Medication is administered after the seizure if it persists or recurs, not during the active
phase.
Q10: A nurse is reviewing laboratory results. Which finding requires the most immediate nursing action?
A. A sodium level of 130 mEq/L
B. A platelet count of 85,000/mm³
C. A white blood cell count of 15,000/mm³
D. A blood urea nitrogen (BUN) of 28 mg/dL
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ indicates thrombocytopenia, placing the patient at significant
risk for bleeding. This requires immediate bleeding precautions and notification of the provider. Mild
hyponatremia, elevated WBC, and elevated BUN are concerning but do not pose the same immediate
safety risk.
Q11: A nurse is caring for a patient with a tracheostomy. Which finding requires immediate
intervention?
A. The patient is able to speak with a Passy-Muir valve in place
B. The tracheostomy site has a small amount of serosanguineous drainage
C. The patient is unable to pass a suction catheter through the tracheostomy tube
D. The patient has a respiratory rate of 18 breaths/min
Correct Answer: C
Rationale: Inability to pass a suction catheter indicates a partial or complete obstruction of the
tracheostomy tube, which is a life-threatening emergency requiring immediate intervention. Speaking
with a Passy-Muir valve is expected. Minimal drainage is normal. A respiratory rate of 18 is within
normal limits.
Q12: A nurse is caring for a patient with a nasogastric (NG) tube. Which finding indicates the tube may
be displaced?
ACTUAL EXAM 2026/2027 | Elsevier Evolve
NCSBN Standards Alignment | Verified
Q&A | Pass Guaranteed - A+ Graded
[Section 1: Prioritization, Delegation & Management of Care — 20 Questions]
Q1: A nurse is caring for four patients on a medical-surgical unit. Which patient should the nurse assess
first?
A. A patient who received pain medication 30 minutes ago and reports pain is now 3/10
B. A patient with a respiratory rate of 8 breaths/min and oxygen saturation of 84% on 2 L nasal cannula
C. A patient who needs discharge teaching before going home in 2 hours
D. A patient requesting a bedside commode
Correct Answer: B
Rationale: The patient with respiratory rate of 8 and SpO2 84% has compromised airway and breathing,
which are priority using the ABC framework. Pain at 3/10, discharge teaching, and toileting are
important but not immediately life-threatening. Respiratory depression and hypoxemia require
immediate intervention.
Q2: A nurse is delegating tasks to a nursing assistant. Which task is appropriate to delegate?
A. Assessing a postoperative patient's surgical incision for signs of infection
B. Measuring and recording the intake and output of a stable patient
C. Administering oral medications to a patient with dysphagia
D. Evaluating the effectiveness of a patient's pain management plan
Correct Answer: B
Rationale: Measuring and recording intake and output is within the nursing assistant's scope for stable
patients. Assessment of incisions, medication administration with dysphagia risk, and evaluation of care
plans require nursing judgment and remain with the RN.
Q3: A nurse is caring for a group of patients. Which action should the nurse perform first?
,A. Administer a scheduled antibiotic to a patient with a urinary tract infection
B. Change the dressing on a patient with a stage 2 pressure ulcer
C. Respond to a patient who is unresponsive and not breathing
D. Provide a bed bath for a patient who was incontinent
Correct Answer: C
Rationale: An unresponsive, non-breathing patient requires immediate intervention for airway and
breathing per the ABC priority framework. Scheduled medications, dressing changes, and hygiene care
are important but not emergent when a patient is in respiratory arrest.
Q4: A nurse is reviewing the morning assignments. Which task should the nurse prioritize?
A. A patient with a potassium level of 3.2 mEq/L who has a scheduled dose of potassium
B. A patient with a blood glucose of 245 mg/dL who needs insulin coverage
C. A patient with a heart rate of 52 beats/min who is asymptomatic
D. A patient with a hemoglobin of 7.8 g/dL who has a unit of blood to transfuse
Correct Answer: A
Rationale: A potassium level of 3.2 mEq/L is below normal and places the patient at risk for cardiac
dysrhythmias, requiring prompt replacement. While elevated glucose and low hemoglobin need
attention, hypokalemia poses more immediate cardiac risk. Asymptomatic bradycardia does not require
immediate intervention.
Q5: A nurse is caring for a patient who reports chest pain rated 9/10. The patient is diaphoretic and has
a blood pressure of 88/52 mmHg. Which action should the nurse take first?
A. Administer the prescribed nitroglycerin sublingually
B. Obtain a 12-lead ECG
C. Place the patient in a supine position and elevate the legs
D. Call the patient's family to inform them of the situation
Correct Answer: C
Rationale: The patient is hypotensive and likely in shock, so placing them supine with legs elevated
improves venous return and perfusion. Nitroglycerin would further lower blood pressure and is
contraindicated. ECG is important but secondary to hemodynamic stabilization. Calling family is not a
priority during an emergency.
Q6: A nurse is working with an LPN and a nursing assistant. Which task is most appropriate to assign to
the LPN?
,A. Developing a plan of care for a newly admitted patient
B. Administering enteral tube feedings to a stable patient
C. Performing the initial head-to-toe assessment on a postoperative patient
D. Teaching a patient about diabetes self-management
Correct Answer: B
Rationale: Administering enteral feedings to stable patients is within the LPN scope of practice. Care
plan development, initial comprehensive assessments, and patient education require registered nursing
judgment and scope. The LPN can reinforce teaching but not provide initial education.
Q7: A nurse is caring for multiple patients. Which patient should the nurse see first after receiving
report?
A. A patient who is 2 hours post-op and has not voided since surgery
B. A patient with a new onset of confusion and a temperature of 101.8°F
C. A patient who needs assistance to the bathroom
D. A patient requesting a snack before bedtime
Correct Answer: B
Rationale: New onset confusion with fever suggests possible infection or sepsis, requiring immediate
assessment. Postoperative urinary retention needs attention but is not immediately life-threatening.
Bathroom assistance and snack requests are routine care needs.
Q8: A nurse is delegating morning care. Which task should the nurse perform rather than delegate?
A. Bathing a patient who is on contact precautions for MRSA
B. Weighing a patient who is stable and independent
C. Assisting a patient with range-of-motion exercises
D. Evaluating a patient's response to a new pain medication
Correct Answer: D
Rationale: Evaluating medication effectiveness requires nursing assessment and clinical judgment,
which cannot be delegated. Bathing patients on precautions, weighing stable patients, and assisting with
ROM exercises can be delegated to appropriate personnel with proper instruction.
Q9: A nurse is caring for a patient who begins to seize. Which action should the nurse take first?
A. Inserting an oral airway to maintain the airway
B. Noting the time and protecting the patient from injury
, C. Administering lorazepam intravenously
D. Restraining the patient's arms and legs
Correct Answer: B
Rationale: During a seizure, the first priority is to protect the patient from injury and note the onset
time for documentation and treatment decisions. Oral airways and restraints are contraindicated during
seizure activity. Medication is administered after the seizure if it persists or recurs, not during the active
phase.
Q10: A nurse is reviewing laboratory results. Which finding requires the most immediate nursing action?
A. A sodium level of 130 mEq/L
B. A platelet count of 85,000/mm³
C. A white blood cell count of 15,000/mm³
D. A blood urea nitrogen (BUN) of 28 mg/dL
Correct Answer: B
Rationale: A platelet count of 85,000/mm³ indicates thrombocytopenia, placing the patient at significant
risk for bleeding. This requires immediate bleeding precautions and notification of the provider. Mild
hyponatremia, elevated WBC, and elevated BUN are concerning but do not pose the same immediate
safety risk.
Q11: A nurse is caring for a patient with a tracheostomy. Which finding requires immediate
intervention?
A. The patient is able to speak with a Passy-Muir valve in place
B. The tracheostomy site has a small amount of serosanguineous drainage
C. The patient is unable to pass a suction catheter through the tracheostomy tube
D. The patient has a respiratory rate of 18 breaths/min
Correct Answer: C
Rationale: Inability to pass a suction catheter indicates a partial or complete obstruction of the
tracheostomy tube, which is a life-threatening emergency requiring immediate intervention. Speaking
with a Passy-Muir valve is expected. Minimal drainage is normal. A respiratory rate of 18 is within
normal limits.
Q12: A nurse is caring for a patient with a nasogastric (NG) tube. Which finding indicates the tube may
be displaced?
