The HESI RN Exit V4 Exam is one of the final assessments nursing students must pass before sitting for the NCLEX-RN. This comprehensive exam measures critical thinking, clinical judgment, patient safety, and readiness for real-world nursing. Scoring well on the Exit V4 not only boosts your confidence—it ensures you’re truly prepared for your licensure journey.
At Ulosca.com, we empower nursing students across the U.S. with high-quality, exam-aligned content designed by nurse educators. Our expertly crafted materials are trusted by thousands of students to pass their HESI, ATI, and NCLEX exams on the first attempt.
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What to Expect on the Hesi RN Exit V4 Exam
When preparing for the Hesi RN Exit V4 Exam, understanding the format and structure is essential for success.
The exam is computer-based and typically contains 150-175 questions, most of which are multiple-choice, though you may encounter select-all-that-apply, fill-in-the-blank, hot spot, and chart/exhibit questions.
The Hesi Exit Exam Version 4 allocates approximately 4 hours for completion, which gives you about 1-2 minutes per question.
Time management is crucial, as the questions vary in complexity and depth. The exam is adaptive, meaning the difficulty adjusts based on your performance on previous questions.
When it comes to scoring, the V4 Hesi RN Exit Review uses a conversion score with 850 commonly set as the passing benchmark, though this may vary by institution. Your score report will break down performance by nursing specialty areas, allowing you to identify strengths and weaknesses.
The Hesi RN V4 Exam Breakdown includes:
- Clinical judgment questions (approximately 50-60%)
- Knowledge-based questions (approximately 40-50%)
- Professional standards questions (approximately 10%)
Most questions are framed at the application and analysis levels, requiring you to think critically rather than simply recall information. This higher-order thinking makes the exam challenging but also excellent preparation for real clinical decision-making.
Key Topics Covered in the Hesi RN Exit V4 Exam
The Hesi Exit V4 Pharmacology and Pathophysiology Topics form a substantial portion of the exam, reflecting their importance in daily nursing practice. You’ll encounter questions about medication classifications, side effects, nursing considerations, and drug interactions. Pathophysiology questions will test your understanding of disease processes and their clinical manifestations.
The exam places significant emphasis on Critical Thinking in Nursing, requiring you to apply knowledge rather than simply recall facts. You’ll need to prioritize nursing actions, identify the most important assessment data, and determine the most appropriate interventions based on given scenarios.
The Clinical Judgment Scenarios presented will span across major nursing specialties, including:
- Medical-Surgical Nursing (approximately 40-50%)
- Pediatric Nursing (approximately 10-15%)
- Maternity/Women’s Health Nursing (approximately 10-15%)
- Psychiatric/Mental Health Nursing (approximately 10-15%)
- Community Health Nursing (approximately 5-10%)
- Leadership and Management (approximately 5-10%)
Each specialty area incorporates questions about relevant assessments, interventions, evaluations, and patient education. The content distribution reflects the frequency with which new nurses encounter these situations in practice, with medical-surgical nursing comprising the largest portion due to its prevalence in healthcare settings.
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Top 10 Sample Questions for the HESI RN Exit V4 Exam
Question 1: Priority Setting
A nurse is caring for four patients. Which patient should the nurse assess first?
A. A postoperative client reporting pain rated 7/10
B. A client with pneumonia who has a respiratory rate of 28/min
C. A client receiving IV antibiotics with a rash on the arm
D. A client with heart failure reporting shortness of breath when walking
Correct Answer: C
Rationale: The rash may indicate a hypersensitivity reaction to IV antibiotics, which can escalate into anaphylaxis—an immediate threat. This makes the situation the highest priority.
Question 2: Pharmacology
The nurse is administering morphine sulfate IV for a postoperative patient. Which assessment is most important?
A. Urinary output
B. Pupillary response
C. Respiratory rate
D. Heart rate
Correct Answer: C
Rationale: Respiratory depression is the most serious adverse effect of opioids. Monitoring respirations is essential with IV morphine administration.
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Question 3: Delegation
Which task is appropriate to delegate to an experienced UAP?
A. Teaching incentive spirometer use
B. Administering subcutaneous insulin
C. Evaluating pain relief after medication
D. Assisting a stable client with morning hygiene
Correct Answer: D
Rationale: UAPs may assist with routine, non-invasive tasks. Teaching, medication administration, and evaluation must be performed by licensed personnel.
Question 4: Patient Education
A client is prescribed warfarin. Which statement indicates understanding?
A. “I will eat more leafy greens.”
B. “I’ll check my INR regularly.”
C. “Aspirin is okay for pain relief.”
D. “No need to tell anyone I’m on warfarin.”
Correct Answer: B
Rationale: Regular INR checks are vital to ensure therapeutic effectiveness and avoid bleeding or clotting risks. Vitamin K in leafy greens reduces warfarin’s effectiveness.
Question 5: Safety & Infection Control
A client with active tuberculosis requires what type of PPE?
A. Surgical mask and gloves
B. Gown, gloves, face shield
C. N95 respirator
D. Standard precautions only
Correct Answer: C
Rationale: TB is airborne, and an N95 respirator is necessary to protect the nurse from inhaling infectious droplets.
Question 6: Maternal-Newborn
A postpartum client is prescribed methylergonovine (Methergine). Which finding requires withholding the medication?
A. Vaginal bleeding
B. Uterine atony
C. Blood pressure 160/100 mm Hg
D. Boggy uterus
Correct Answer: C
Rationale: Methylergonovine is contraindicated in hypertension due to vasoconstriction risk. All other options support use of the medication to control postpartum bleeding.
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Question 7: Mental Health
A client with major depression has taken fluoxetine for two weeks. Which statement is most concerning?
A. “I feel more energetic.”
B. “I don’t feel like eating yet.”
C. “I’m sleeping better now.”
D. “I’ve been thinking about ending it all.”
Correct Answer: D
Rationale: Suicidal ideation is a psychiatric emergency. SSRIs may increase energy before improving mood, increasing risk of follow-through on suicidal thoughts.
Question 8: Pediatrics
What should a parent know when giving liquid iron to a toddler?
A. Mix with milk
B. Give in a bottle
C. Administer with orange juice
D. Expect green stools
Correct Answer: C
Rationale: Vitamin C enhances iron absorption. Milk interferes, and dropper/spoon administration is preferred to avoid staining teeth. Black (not green) stools are a normal side effect.
Question 9: Patient Safety
Which action violates medication safety standards?
A. Asking the patient to state their name
B. Leaving insulin at bedside
C. Scanning medication before giving it
D. Labeling blood sample at bedside
Correct Answer: B
Rationale: Insulin must never be left at the bedside; it requires RN supervision and documentation due to the high risk of dosing errors.
Question 10: Leadership
A nurse manager notes frequent med errors during shift change. What is the first step?
A. Review hospital policy
B. Report to upper management
C. Hold a staff meeting for input
D. Discipline the nurses involved
Correct Answer: C
Rationale: Gathering staff input helps identify workflow issues and fosters team-driven solutions. Premature discipline may hurt morale and miss the root cause.
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Why Choose Ulosca for HESI RN Exam Prep?
At Ulosca, we go beyond basic test prep—we help you master the HESI Exit V4 Exam with confidence and clarity. Here’s what makes us the trusted choice for nursing students nationwide:
- Real HESI-style questions with expert-vetted rationales
- Up-to-date content reflecting NCLEX test plans and latest evidence-based practices
- Smart prep tools like customizable quizzes, performance analytics, and timed mocks
- High success rates, with most users reporting passing scores on their first try
- Easy-to-use platform, accessible anytime, anywhere
Conclusion
The HESI RN Exit V4 Exam is your final checkpoint before becoming a licensed nurse—and Ulosca.com is here to ensure you pass it with confidence. With realistic questions, expert rationales, and smart prep tools tailored to nursing students in the U.S., you’ll not only be prepared for the exam—you’ll be ready for the nursing floor.
Trust Ulosca as your go-to resource for nursing exams. Start your prep today and join the thousands of students who’ve launched their nursing careers with us.