HESI RN EXIT EXAM (2026/2027 EDITION)
Elsevier Comprehensive Nursing Competency Assessment for NCLEX-RN Readiness
Domains: Fundamental Nursing Skills | Medical-Surgical Nursing | Pharmacology | Maternal-Newborn
Nursing | Pediatric Nursing | Mental Health Nursing | Leadership & Management | Community Health
Nursing | NGN Item Types Integration | Scenario-Based Clinical Judgment
EXAM INFORMATION
Total Questions: 150
Testing Time: 180–210 minutes
Passing Score: 850–900
Format: Multiple-Choice and NGN-Style Questions
Instructions: Select the single best answer unless otherwise indicated. For Select All That Apply questions,
choose all correct options. For ordered response questions, arrange items in the correct sequence. Read
each question carefully and apply clinical judgment frameworks (ABCs, Maslow's hierarchy, NCSBN
Clinical Judgment Measurement Model).
DOMAIN 1: FUNDAMENTAL NURSING SKILLS (Q1–Q15)
1. Which action should the nurse take first when donning personal protective equipment
(PPE) before entering the room of a client on contact precautions?
A. Put on the gown
B. Put on the mask
C. Perform hand hygiene
D. Put on gloves
Correct Answer: C
Rationale: Hand hygiene must always be performed before donning any PPE. This is the first step in the
PPE sequence to prevent contamination. After hand hygiene, the correct order is gown, mask, and finally
gloves.
2. A client has a fever of 39.2°C (102.6°F). Which vital sign change should the nurse anticipate
as a direct result of the elevated temperature?
A. Decreased pulse rate
B. Decreased respiratory rate
C. Increased pulse rate
D. Increased blood pressure
Correct Answer: C
Rationale: For every 1°C increase in body temperature above normal, the pulse rate typically increases by
10 beats per minute. This physiological response, known as tachycardia, occurs because increased
metabolic demands from fever require greater cardiac output to deliver oxygen to tissues.
3. The nurse is preparing to transfer a client from the bed to a wheelchair. Which action is
essential to ensure client safety during the transfer?
A. Position the wheelchair at a 90-degree angle to the bed
B. Place the wheelchair on the client's weaker side
C. Lock the wheels of the wheelchair and bed
D. Instruct the client to bear weight on the weaker leg first
Correct Answer: C
Rationale: Locking the wheels of both the bed and wheelchair is essential to prevent movement during the
transfer, which could cause the client to fall. The wheelchair should be positioned on the client's stronger
side, and the client should bear weight on the stronger leg.
4. Which technique should the nurse use when performing surgical hand antisepsis?
1
, A. Wash hands for 30 seconds using regular soap
B. Hold hands above elbows during and after scrubbing
C. Keep hands below elbows at all times
D. Turn off the faucet with bare hands after scrubbing
Correct Answer: B
Rationale: During surgical hand antisepsis, hands must be held above the elbows so that water flows from
the cleanest area (fingertips) downward, preventing recontamination. Hands should never be held below
elbows during or after scrubbing, as this allows water to flow from contaminated to clean areas.
5. A client is on fall precautions. Which intervention should the nurse implement to best
prevent falls?
A. Keep the bed in the highest position
B.Raise all side rails at all times
C. Keep the bed in the lowest position with brakes locked
D. Place the call light out of reach to encourage independence
Correct Answer: C
Rationale: Keeping the bed in the lowest position with brakes locked minimizes the distance a client could
fall and prevents the bed from rolling. Side rails in the up position can increase injury risk if the client
attempts to climb over them. The call light should always be within easy reach.
6. The nurse is documenting client care in the electronic health record. Which documentation
entry is most appropriate?
A. 'Client appears to be in pain'
B. 'Client grimacing and guarding right abdomen; rates pain 7/10'
C. 'Client is not doing well today'
D. 'Client probably didn't sleep well last night'
Correct Answer: B
Rationale: Documentation must be objective, specific, measurable, and based on observable data. Option B
uses concrete, measurable findings (grimacing, guarding, pain rating) rather than vague, subjective
interpretations. Options A, C, and D contain subjective interpretations without supporting objective data.
7. A client has a latex allergy. Which action should the nurse take before providing care?
A. Use latex gloves with a powder coating
B. Wear nitrile gloves instead of latex gloves
C. Apply hand lotion before wearing latex gloves
D. Use latex gloves for brief contact only
Correct Answer: B
Rationale: Nitrile gloves are the recommended alternative for clients with latex allergies because they
provide an effective barrier without containing latex proteins. Powdered latex gloves should be avoided as
the powder can aerosolize latex proteins, and even brief latex contact can trigger an allergic reaction.
8. When measuring blood pressure, the nurse obtains a reading of 160/100 mmHg. Which
action should the nurse take first?
A. Administer the prescribed antihypertensive immediately
B. Retake the blood pressure in the same arm after 1–2 minutes
C. Document the reading and notify the provider
D. Place the client in Trendelenburg position
Correct Answer: B
Rationale: When an abnormal blood pressure reading is obtained, the nurse should first verify the
accuracy by retaking the measurement after allowing the client to rest for 1–2 minutes. This helps rule out
factors such as anxiety, improper cuff size, or incorrect positioning that may have caused a falsely elevated
reading.
9. Which intervention should the nurse implement to prevent pressure injuries in a
bedridden client?
A. Reposition the client every 4 hours
B. Massage reddened bony prominences
C. Elevate the head of bed no more than 30 degrees when possible
2
, D. Apply talcum powder to skin folds
Correct Answer: C
Rationale: Elevating the head of bed no more than 30 degrees minimizes shearing forces that contribute to
pressure injury development, particularly on the sacrum. Clients should be repositioned at least every 2
hours, not 4. Massaging reddened areas further damages tissue, and talcum powder can cause moisture
retention and skin irritation.
10. The nurse is administering a cleansing enema to a client. In which position should the
nurse place the client?
A. Supine position
B. Left lateral Sims' position
C. Right lateral Sims' position
D. Prone position
Correct Answer: B
Rationale: The left lateral Sims' position allows the enema solution to flow downward by gravity along the
natural curve of the sigmoid colon and descending colon, promoting optimal retention and distribution of
the solution. This position aligns with the anatomical pathway of the colon on the left side of the abdomen.
11. A client is receiving oxygen via nasal cannula at 2 L/min. The nurse should monitor for
which complication associated with oxygen therapy?
A. Oxygen toxicity
B. Carbon dioxide narcosis
C. Absorption atelectasis
D. Dry nasal mucosa
Correct Answer: D
Rationale: Nasal cannula oxygen at low flow rates (1–6 L/min) commonly causes dry nasal mucosa
because the oxygen is not humidified at these low flow rates. Oxygen toxicity, CO2 narcosis, and absorption
atelectasis are complications associated with high-flow or high-concentration oxygen therapy, not low-
flow nasal cannula use.
12. When performing a sterile dressing change, the nurse accidentally touches the edge of the
sterile field with a non-sterile glove. Which action should the nurse take?
A. Continue the procedure, as the edge contamination is minor
B. Remove the contaminated item and continue with the remaining sterile items
C. Consider the entire field contaminated and set up a new sterile field
D. Apply a new pair of sterile gloves over the contaminated ones
Correct Answer: C
Rationale: Sterile technique requires that any breach of the sterile field, including edge contamination,
means the entire field must be considered contaminated. A new sterile field must be established to prevent
introducing microorganisms into the client's wound. Continuing with a contaminated field puts the client
at risk for infection.
13. The nurse is assessing a client's peripheral pulses. Which finding should the nurse report
to the provider immediately?
A. Pulse rate of 88 beats per minute in a resting adult
B. Absent dorsalis pedis pulse in a client with a cast
C. Bounding radial pulse of 2+ bilaterally
D. Pulse deficit of 2 between apical and radial pulses
Correct Answer: B
Rationale: An absent pulse distal to a cast may indicate impaired circulation and potential compartment
syndrome, which is a medical emergency requiring immediate intervention. A pulse deficit of 2 can be
significant but is not as immediately life-threatening as absent pulses suggesting vascular compromise. A
rate of 88 bpm is within normal limits.
14. Which principle should the nurse follow when using a restraints on a client?
A. Apply restraints tightly to prevent the client from escaping
B. Tie restraints to the side rails of the bed
C. Remove restraints every 2 hours to assess circulation and range of motion
3
, D. Use restraints as a first-line intervention for confused clients
Correct Answer: C
Rationale: Restraints must be removed at least every 2 hours to assess circulation, skin integrity, and
range of motion, and to offer nutrition, hydration, and toileting. Restraints should be applied snugly but
allow for two-finger width. They must be tied to the bed frame, not side rails, and used only as a last resort
when less restrictive interventions have failed.
15. The nurse is assisting a client with a bed bath. Which action demonstrates proper
infection control technique?
A. Washing from the feet to the face
B. Using the same washcloth for the perineal area and face
C. Washing from the cleanest area to the dirtiest area
D. Using cold water to prevent skin breakdown
Correct Answer: C
Rationale: During bathing, the nurse should wash from the cleanest area (face) to the dirtiest area
(perineum) to prevent cross-contamination. Separate washcloths should be used for the face and perineum.
Warm water is used for comfort and to promote circulation, and washing should proceed from the face
downward.
DOMAIN 2: MEDICAL-SURGICAL NURSING (Q16–Q30)
16. A client with heart failure reports increasing shortness of breath and has gained 2.3 kg (5
lbs) over the past 3 days. Which assessment finding should the nurse anticipate?
A. Decreased jugular venous distension
B. Crackles in the lung bases bilaterally
C. Bradycardia
D. Decreased blood pressure
Correct Answer: B
Rationale: A weight gain of 2.3 kg over 3 days indicates significant fluid retention, a hallmark of
worsening heart failure. The excess fluid accumulates in the lungs as pulmonary congestion, producing
crackles in the bilateral lung bases. Jugular venous distension would increase, not decrease, and
tachycardia rather than bradycardia is expected.
17. A client with a suspected myocardial infarction is experiencing chest pain. Which
medication should the nurse administer first?
A. Morphine sulfate
B. Nitroglycerin sublingual
C. Aspirin 325 mg chewable
D. Oxygen 2 L via nasal cannula
Correct Answer: C
Rationale: Aspirin should be administered first because it provides rapid antiplatelet effects by inhibiting
thromboxane A2 production, which helps prevent further clot formation in the coronary artery. While
nitroglycerin, oxygen, and morphine are all part of the MONA protocol, aspirin's antiplatelet action is
critical for limiting infarct size and improving outcomes.
18. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy.
The nurse should maintain the oxygen flow rate at which level?
A. 1–2 L/min via nasal cannula
B. 6–8 L/min via nasal cannula
C. 10–12 L/min via simple face mask
D. 15 L/min via non-rebreather mask
Correct Answer: A
Rationale: Clients with COPD rely on their hypoxic drive to stimulate breathing. Administering high-flow
oxygen can suppress the hypoxic drive, leading to CO2 retention and respiratory failure. Low-flow oxygen
(1–2 L/min) provides adequate oxygenation while preserving the hypoxic drive to breathe.
19. A client with diabetes mellitus has a blood glucose level of 42 mg/dL. Which action should
the nurse take first?
4
Elsevier Comprehensive Nursing Competency Assessment for NCLEX-RN Readiness
Domains: Fundamental Nursing Skills | Medical-Surgical Nursing | Pharmacology | Maternal-Newborn
Nursing | Pediatric Nursing | Mental Health Nursing | Leadership & Management | Community Health
Nursing | NGN Item Types Integration | Scenario-Based Clinical Judgment
EXAM INFORMATION
Total Questions: 150
Testing Time: 180–210 minutes
Passing Score: 850–900
Format: Multiple-Choice and NGN-Style Questions
Instructions: Select the single best answer unless otherwise indicated. For Select All That Apply questions,
choose all correct options. For ordered response questions, arrange items in the correct sequence. Read
each question carefully and apply clinical judgment frameworks (ABCs, Maslow's hierarchy, NCSBN
Clinical Judgment Measurement Model).
DOMAIN 1: FUNDAMENTAL NURSING SKILLS (Q1–Q15)
1. Which action should the nurse take first when donning personal protective equipment
(PPE) before entering the room of a client on contact precautions?
A. Put on the gown
B. Put on the mask
C. Perform hand hygiene
D. Put on gloves
Correct Answer: C
Rationale: Hand hygiene must always be performed before donning any PPE. This is the first step in the
PPE sequence to prevent contamination. After hand hygiene, the correct order is gown, mask, and finally
gloves.
2. A client has a fever of 39.2°C (102.6°F). Which vital sign change should the nurse anticipate
as a direct result of the elevated temperature?
A. Decreased pulse rate
B. Decreased respiratory rate
C. Increased pulse rate
D. Increased blood pressure
Correct Answer: C
Rationale: For every 1°C increase in body temperature above normal, the pulse rate typically increases by
10 beats per minute. This physiological response, known as tachycardia, occurs because increased
metabolic demands from fever require greater cardiac output to deliver oxygen to tissues.
3. The nurse is preparing to transfer a client from the bed to a wheelchair. Which action is
essential to ensure client safety during the transfer?
A. Position the wheelchair at a 90-degree angle to the bed
B. Place the wheelchair on the client's weaker side
C. Lock the wheels of the wheelchair and bed
D. Instruct the client to bear weight on the weaker leg first
Correct Answer: C
Rationale: Locking the wheels of both the bed and wheelchair is essential to prevent movement during the
transfer, which could cause the client to fall. The wheelchair should be positioned on the client's stronger
side, and the client should bear weight on the stronger leg.
4. Which technique should the nurse use when performing surgical hand antisepsis?
1
, A. Wash hands for 30 seconds using regular soap
B. Hold hands above elbows during and after scrubbing
C. Keep hands below elbows at all times
D. Turn off the faucet with bare hands after scrubbing
Correct Answer: B
Rationale: During surgical hand antisepsis, hands must be held above the elbows so that water flows from
the cleanest area (fingertips) downward, preventing recontamination. Hands should never be held below
elbows during or after scrubbing, as this allows water to flow from contaminated to clean areas.
5. A client is on fall precautions. Which intervention should the nurse implement to best
prevent falls?
A. Keep the bed in the highest position
B.Raise all side rails at all times
C. Keep the bed in the lowest position with brakes locked
D. Place the call light out of reach to encourage independence
Correct Answer: C
Rationale: Keeping the bed in the lowest position with brakes locked minimizes the distance a client could
fall and prevents the bed from rolling. Side rails in the up position can increase injury risk if the client
attempts to climb over them. The call light should always be within easy reach.
6. The nurse is documenting client care in the electronic health record. Which documentation
entry is most appropriate?
A. 'Client appears to be in pain'
B. 'Client grimacing and guarding right abdomen; rates pain 7/10'
C. 'Client is not doing well today'
D. 'Client probably didn't sleep well last night'
Correct Answer: B
Rationale: Documentation must be objective, specific, measurable, and based on observable data. Option B
uses concrete, measurable findings (grimacing, guarding, pain rating) rather than vague, subjective
interpretations. Options A, C, and D contain subjective interpretations without supporting objective data.
7. A client has a latex allergy. Which action should the nurse take before providing care?
A. Use latex gloves with a powder coating
B. Wear nitrile gloves instead of latex gloves
C. Apply hand lotion before wearing latex gloves
D. Use latex gloves for brief contact only
Correct Answer: B
Rationale: Nitrile gloves are the recommended alternative for clients with latex allergies because they
provide an effective barrier without containing latex proteins. Powdered latex gloves should be avoided as
the powder can aerosolize latex proteins, and even brief latex contact can trigger an allergic reaction.
8. When measuring blood pressure, the nurse obtains a reading of 160/100 mmHg. Which
action should the nurse take first?
A. Administer the prescribed antihypertensive immediately
B. Retake the blood pressure in the same arm after 1–2 minutes
C. Document the reading and notify the provider
D. Place the client in Trendelenburg position
Correct Answer: B
Rationale: When an abnormal blood pressure reading is obtained, the nurse should first verify the
accuracy by retaking the measurement after allowing the client to rest for 1–2 minutes. This helps rule out
factors such as anxiety, improper cuff size, or incorrect positioning that may have caused a falsely elevated
reading.
9. Which intervention should the nurse implement to prevent pressure injuries in a
bedridden client?
A. Reposition the client every 4 hours
B. Massage reddened bony prominences
C. Elevate the head of bed no more than 30 degrees when possible
2
, D. Apply talcum powder to skin folds
Correct Answer: C
Rationale: Elevating the head of bed no more than 30 degrees minimizes shearing forces that contribute to
pressure injury development, particularly on the sacrum. Clients should be repositioned at least every 2
hours, not 4. Massaging reddened areas further damages tissue, and talcum powder can cause moisture
retention and skin irritation.
10. The nurse is administering a cleansing enema to a client. In which position should the
nurse place the client?
A. Supine position
B. Left lateral Sims' position
C. Right lateral Sims' position
D. Prone position
Correct Answer: B
Rationale: The left lateral Sims' position allows the enema solution to flow downward by gravity along the
natural curve of the sigmoid colon and descending colon, promoting optimal retention and distribution of
the solution. This position aligns with the anatomical pathway of the colon on the left side of the abdomen.
11. A client is receiving oxygen via nasal cannula at 2 L/min. The nurse should monitor for
which complication associated with oxygen therapy?
A. Oxygen toxicity
B. Carbon dioxide narcosis
C. Absorption atelectasis
D. Dry nasal mucosa
Correct Answer: D
Rationale: Nasal cannula oxygen at low flow rates (1–6 L/min) commonly causes dry nasal mucosa
because the oxygen is not humidified at these low flow rates. Oxygen toxicity, CO2 narcosis, and absorption
atelectasis are complications associated with high-flow or high-concentration oxygen therapy, not low-
flow nasal cannula use.
12. When performing a sterile dressing change, the nurse accidentally touches the edge of the
sterile field with a non-sterile glove. Which action should the nurse take?
A. Continue the procedure, as the edge contamination is minor
B. Remove the contaminated item and continue with the remaining sterile items
C. Consider the entire field contaminated and set up a new sterile field
D. Apply a new pair of sterile gloves over the contaminated ones
Correct Answer: C
Rationale: Sterile technique requires that any breach of the sterile field, including edge contamination,
means the entire field must be considered contaminated. A new sterile field must be established to prevent
introducing microorganisms into the client's wound. Continuing with a contaminated field puts the client
at risk for infection.
13. The nurse is assessing a client's peripheral pulses. Which finding should the nurse report
to the provider immediately?
A. Pulse rate of 88 beats per minute in a resting adult
B. Absent dorsalis pedis pulse in a client with a cast
C. Bounding radial pulse of 2+ bilaterally
D. Pulse deficit of 2 between apical and radial pulses
Correct Answer: B
Rationale: An absent pulse distal to a cast may indicate impaired circulation and potential compartment
syndrome, which is a medical emergency requiring immediate intervention. A pulse deficit of 2 can be
significant but is not as immediately life-threatening as absent pulses suggesting vascular compromise. A
rate of 88 bpm is within normal limits.
14. Which principle should the nurse follow when using a restraints on a client?
A. Apply restraints tightly to prevent the client from escaping
B. Tie restraints to the side rails of the bed
C. Remove restraints every 2 hours to assess circulation and range of motion
3
, D. Use restraints as a first-line intervention for confused clients
Correct Answer: C
Rationale: Restraints must be removed at least every 2 hours to assess circulation, skin integrity, and
range of motion, and to offer nutrition, hydration, and toileting. Restraints should be applied snugly but
allow for two-finger width. They must be tied to the bed frame, not side rails, and used only as a last resort
when less restrictive interventions have failed.
15. The nurse is assisting a client with a bed bath. Which action demonstrates proper
infection control technique?
A. Washing from the feet to the face
B. Using the same washcloth for the perineal area and face
C. Washing from the cleanest area to the dirtiest area
D. Using cold water to prevent skin breakdown
Correct Answer: C
Rationale: During bathing, the nurse should wash from the cleanest area (face) to the dirtiest area
(perineum) to prevent cross-contamination. Separate washcloths should be used for the face and perineum.
Warm water is used for comfort and to promote circulation, and washing should proceed from the face
downward.
DOMAIN 2: MEDICAL-SURGICAL NURSING (Q16–Q30)
16. A client with heart failure reports increasing shortness of breath and has gained 2.3 kg (5
lbs) over the past 3 days. Which assessment finding should the nurse anticipate?
A. Decreased jugular venous distension
B. Crackles in the lung bases bilaterally
C. Bradycardia
D. Decreased blood pressure
Correct Answer: B
Rationale: A weight gain of 2.3 kg over 3 days indicates significant fluid retention, a hallmark of
worsening heart failure. The excess fluid accumulates in the lungs as pulmonary congestion, producing
crackles in the bilateral lung bases. Jugular venous distension would increase, not decrease, and
tachycardia rather than bradycardia is expected.
17. A client with a suspected myocardial infarction is experiencing chest pain. Which
medication should the nurse administer first?
A. Morphine sulfate
B. Nitroglycerin sublingual
C. Aspirin 325 mg chewable
D. Oxygen 2 L via nasal cannula
Correct Answer: C
Rationale: Aspirin should be administered first because it provides rapid antiplatelet effects by inhibiting
thromboxane A2 production, which helps prevent further clot formation in the coronary artery. While
nitroglycerin, oxygen, and morphine are all part of the MONA protocol, aspirin's antiplatelet action is
critical for limiting infarct size and improving outcomes.
18. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy.
The nurse should maintain the oxygen flow rate at which level?
A. 1–2 L/min via nasal cannula
B. 6–8 L/min via nasal cannula
C. 10–12 L/min via simple face mask
D. 15 L/min via non-rebreather mask
Correct Answer: A
Rationale: Clients with COPD rely on their hypoxic drive to stimulate breathing. Administering high-flow
oxygen can suppress the hypoxic drive, leading to CO2 retention and respiratory failure. Low-flow oxygen
(1–2 L/min) provides adequate oxygenation while preserving the hypoxic drive to breathe.
19. A client with diabetes mellitus has a blood glucose level of 42 mg/dL. Which action should
the nurse take first?
4
