LPN HESI Entrance Exam Test Bank 2026/2027 – Elsevier
Evolve / ATI Testing Standards – Comprehensive Academic
Readiness Assessment for Practical/Vocational Nursing Program
Admission — 300 Questions
Section 1: Fundamentals of Nursing (Questions 1-34)
1 A nurse is preparing to administer a blood transfusion to a patient with a history of multiple transfusions. Which
of the following actions is most critical to prevent a transfusion reaction?
A) Administer the blood through a Y-tubing with normal saline.
B) Verify patient identity with two identifiers and check blood compatibility.
C) Pre-medicate with diphenhydramine and acetaminophen.
D) Monitor vital signs every 15 minutes during the first hour.
Answer: B
Rationale: Verifying patient identity and blood compatibility is the most critical step to prevent transfusion
reactions, as mismatched blood can cause fatal hemolytic reactions. Option A is correct technique but not the
primary prevention. Pre-medication (C) may reduce mild allergic reactions but does not prevent hemolytic
reactions. Monitoring (D) is important for early detection but not prevention.
2 A patient with a pressure ulcer on the sacrum has a wound culture positive for methicillin-resistant
Staphylococcus aureus (MRSA). Which nursing action is most appropriate to prevent transmission to other
patients?
A) Place the patient in a private room with contact precautions.
B) Use sterile gloves for wound care and dispose of dressings in regular trash.
C) Wear a surgical mask when within three feet of the patient.
D) Limit visitors to immediate family only.
Answer: A
Rationale: Contact precautions, including a private room, are indicated for MRSA to prevent transmission via direct
contact or contaminated surfaces. Option B is incorrect because contaminated dressings must be disposed of as
biohazard waste. Surgical masks (C) are not required for MRSA unless there is respiratory involvement. Limiting
visitors (D) is not a standard precaution.
3 A nurse is calculating the intake for a patient receiving continuous enteral feeding at 50 mL/hr via a feeding
pump. The patient also receives 100 mL of water every 4 hours for flush. How much total intake (in mL) should
the nurse document for an 8-hour shift?
A) 500 mL
B) 600 mL
C) 700 mL
D) 800 mL
Answer: B
Rationale: The enteral feeding provides 50 mL/hr × 8 hr = 400 mL. The flush is 100 mL every 4 hours, so over 8
hours, there are two flushes: 100 mL × 2 = 200 mL. Total intake = 400 + 200 = 600 mL. Option A (500 mL) omits
one flush. Option C (700 mL) assumes three flushes. Option D (800 mL) overestimates both.
,4 A patient with a history of heart failure is receiving furosemide 40 mg intravenously. Which laboratory value is
most important for the nurse to monitor before administration?
A) Serum sodium level of 138 mEq/L
B) Serum potassium level of 3.2 mEq/L
C) Serum creatinine level of 1.0 mg/dL
D) Serum glucose level of 110 mg/dL
Answer: B
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. A potassium level of 3.2 mEq/L is below
normal (3.5-5.0 mEq/L) and increases the risk of cardiac dysrhythmias. Option A (sodium 138) is within normal
limits. Option C (creatinine 1.0) is normal. Option D (glucose 110) is slightly elevated but not a contraindication.
5 A nurse is teaching a patient with a new colostomy about dietary modifications. Which statement by the patient
indicates a need for further teaching?
A) I will avoid foods that cause gas, such as beans and broccoli.
B) I should increase my intake of high-fiber foods to prevent constipation.
C) I will chew my food thoroughly to aid digestion.
D) I need to drink at least 8 glasses of water per day.
Answer: B
Rationale: High-fiber foods can cause blockage in a colostomy, especially in the early postoperative period. Patients
are typically advised to avoid high-fiber foods initially and gradually reintroduce them. Options A, C, and D are
appropriate recommendations. Gas-producing foods (A) should be avoided to prevent discomfort. Chewing
thoroughly (C) aids digestion. Adequate hydration (D) prevents constipation.
6 A nurse is assessing a patient who has just undergone a lumbar puncture. Which finding requires immediate
intervention?
A) Patient reports a mild headache when sitting up.
B) Clear fluid is noted on the dressing over the puncture site.
C) The patient's heart rate is 88 beats per minute.
D) The patient's blood pressure is 118/76 mm Hg.
Answer: B
Rationale: Clear fluid on the dressing may indicate cerebrospinal fluid (CSF) leakage, which increases the risk of
infection and requires immediate intervention. Option A (mild headache) is common after lumbar puncture due to
CSF loss but is not immediately dangerous. Options C and D are within normal limits.
7 A patient with deep vein thrombosis (DVT) is receiving a heparin infusion. The nurse notes that the activated
partial thromboplastin time (aPTT) is 98 seconds (therapeutic range 60-80 seconds). What is the nurse's priority
action?
A) Increase the heparin infusion rate.
B) Decrease the heparin infusion rate.
C) Administer protamine sulfate.
D) Notify the healthcare provider immediately.
Answer: B
Rationale: An aPTT of 98 seconds is above the therapeutic range, indicating an increased risk of bleeding. The nurse
should decrease the heparin infusion rate per protocol. Option A would worsen the situation. Protamine sulfate (C)
is an antidote for heparin overdose but is reserved for severe bleeding. Notifying the provider (D) is appropriate but
the nurse should first adjust the rate as per standing orders.
,8 A nurse is preparing to administer an intramuscular injection of an oil-based medication. Which needle gauge
and length is most appropriate?
A) 22-gauge, 1-inch needle
B) 25-gauge, 5/8-inch needle
C) 20-gauge, 1.5-inch needle
D) 23-gauge, 1-inch needle
Answer: C
Rationale: Oil-based medications are viscous and require a larger gauge needle (20-gauge) to allow smooth flow. A
1.5-inch length ensures deep intramuscular deposition, especially in larger muscle sites. Options A and D have
smaller gauges, which may clog. Option B (25-gauge, 5/8-inch) is too small and too short for IM injection.
9 A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal cannula at 2 L/min.
The nurse observes that the patient's respiratory rate is 10 breaths per minute and oxygen saturation is 94%.
What is the nurse's best action?
A) Increase the oxygen flow rate to 4 L/min.
B) Decrease the oxygen flow rate to 1 L/min.
C) Continue current oxygen therapy and monitor.
D) Prepare for intubation.
Answer: C
Rationale: In COPD patients, the hypoxic drive is the primary stimulus for breathing. High oxygen levels can
suppress this drive, leading to hypoventilation. The patient's oxygen saturation of 94% is within acceptable range
(88-92% target for COPD), and a respiratory rate of 10 is slightly low but not critical. Increasing oxygen (A) could
worsen hypoventilation. Decreasing (B) may cause hypoxia. Intubation (D) is not indicated.
10 A nurse is evaluating a patient's understanding of a low-sodium diet for hypertension. Which food selection
indicates the patient understands the teaching?
A) Canned tomato soup with crackers
B) Grilled chicken breast with steamed vegetables
C) Ham and cheese sandwich on whole wheat bread
D) Instant noodles with seasoning packet
Answer: B
Rationale: Grilled chicken and steamed vegetables are naturally low in sodium. Options A (canned soup), C (ham
and cheese), and D (instant noodles) are high in sodium due to processing and added salt. The patient's selection of
option B demonstrates understanding of a low-sodium diet.
11 A nurse is assessing a patient's risk for pressure injury using the Braden Scale. The patient is bedridden, has
limited sensory perception, and skin is constantly moist due to incontinence. The patient's Braden score is 11.
Which intervention should the nurse prioritize?
A) Apply a moisture barrier ointment after each incontinence episode
B) Turn and reposition the patient every 2 hours
C) Use a pressure-redistributing mattress overlay
D) Provide a high-protein, high-calorie diet
Answer: B
Rationale: A Braden score of 11 indicates high risk. While all options are important, repositioning every 2 hours is
the most critical intervention to relieve pressure and prevent tissue ischemia. Moisture management and nutrition
are adjunctive, but pressure relief is paramount.
, 12 During a sterile wound dressing change, the nurse accidentally touches the sterile field with an ungloved hand.
What is the most appropriate action?
A) Continue the procedure, as the field is still clean
B) Remove the contaminated items and replace the sterile field
C) Apply new sterile gloves and proceed
D) Wipe the contaminated area with alcohol and continue
Answer: B
Rationale: Any break in sterility requires discarding all contaminated items and re-establishing the sterile field.
Continuing compromises asepsis and increases infection risk. Changing gloves alone does not address the
contaminated field.
13 A nurse is preparing to administer a controlled substance. Which step is essential to comply with legal and
safety standards?
A) Verify the medication with another nurse before administration
B) Document the administration immediately after giving the drug
C) Count the remaining doses after administration
D) All of the above
Answer: D
Rationale: Controlled substance administration requires a witness (A), immediate documentation (B), and accurate
inventory count (C) to prevent diversion and ensure accountability. All steps are mandatory.
14 A patient with a nasogastric tube for decompression has a nursing diagnosis of 'Risk for Impaired Skin Integrity
related to tube placement.' Which intervention is most effective in preventing skin breakdown at the nares?
A) Secure the tube with tape directly on the nose
B) Apply a hydrocolloid dressing under the tube
C) Reposition the tube to the opposite nostril every 24 hours
D) Use a commercial tube holder with foam padding
Answer: D
Rationale: Commercial tube holders minimize pressure and friction on the nares, reducing risk of skin breakdown.
Hydrocolloid dressings can be used but may not provide secure anchoring. Repositioning is not standard due to
patient discomfort and risk of dislodgment.
15 A nurse is evaluating a patient's understanding of prescribed antibiotics. Which statement indicates a need for
further teaching?
A) I will take the medication until I feel better
B) I will complete the full course even if symptoms resolve
C) I will take the medication at the same time each day
D) I will report any rash or diarrhea to my provider
Answer: A
Rationale: Antibiotics should be taken for the full prescribed duration, not until symptoms improve, to prevent
resistance. Stopping early can lead to recurrence and resistance. The other statements reflect correct understanding.
16 A nurse is caring for a patient with a new colostomy. The stoma appears dusky and edematous. What is the
nurse's priority action?
A) Document the finding and reassess in 2 hours
B) Notify the healthcare provider immediately
C) Apply a warm compress to the stoma
Evolve / ATI Testing Standards – Comprehensive Academic
Readiness Assessment for Practical/Vocational Nursing Program
Admission — 300 Questions
Section 1: Fundamentals of Nursing (Questions 1-34)
1 A nurse is preparing to administer a blood transfusion to a patient with a history of multiple transfusions. Which
of the following actions is most critical to prevent a transfusion reaction?
A) Administer the blood through a Y-tubing with normal saline.
B) Verify patient identity with two identifiers and check blood compatibility.
C) Pre-medicate with diphenhydramine and acetaminophen.
D) Monitor vital signs every 15 minutes during the first hour.
Answer: B
Rationale: Verifying patient identity and blood compatibility is the most critical step to prevent transfusion
reactions, as mismatched blood can cause fatal hemolytic reactions. Option A is correct technique but not the
primary prevention. Pre-medication (C) may reduce mild allergic reactions but does not prevent hemolytic
reactions. Monitoring (D) is important for early detection but not prevention.
2 A patient with a pressure ulcer on the sacrum has a wound culture positive for methicillin-resistant
Staphylococcus aureus (MRSA). Which nursing action is most appropriate to prevent transmission to other
patients?
A) Place the patient in a private room with contact precautions.
B) Use sterile gloves for wound care and dispose of dressings in regular trash.
C) Wear a surgical mask when within three feet of the patient.
D) Limit visitors to immediate family only.
Answer: A
Rationale: Contact precautions, including a private room, are indicated for MRSA to prevent transmission via direct
contact or contaminated surfaces. Option B is incorrect because contaminated dressings must be disposed of as
biohazard waste. Surgical masks (C) are not required for MRSA unless there is respiratory involvement. Limiting
visitors (D) is not a standard precaution.
3 A nurse is calculating the intake for a patient receiving continuous enteral feeding at 50 mL/hr via a feeding
pump. The patient also receives 100 mL of water every 4 hours for flush. How much total intake (in mL) should
the nurse document for an 8-hour shift?
A) 500 mL
B) 600 mL
C) 700 mL
D) 800 mL
Answer: B
Rationale: The enteral feeding provides 50 mL/hr × 8 hr = 400 mL. The flush is 100 mL every 4 hours, so over 8
hours, there are two flushes: 100 mL × 2 = 200 mL. Total intake = 400 + 200 = 600 mL. Option A (500 mL) omits
one flush. Option C (700 mL) assumes three flushes. Option D (800 mL) overestimates both.
,4 A patient with a history of heart failure is receiving furosemide 40 mg intravenously. Which laboratory value is
most important for the nurse to monitor before administration?
A) Serum sodium level of 138 mEq/L
B) Serum potassium level of 3.2 mEq/L
C) Serum creatinine level of 1.0 mg/dL
D) Serum glucose level of 110 mg/dL
Answer: B
Rationale: Furosemide is a loop diuretic that can cause hypokalemia. A potassium level of 3.2 mEq/L is below
normal (3.5-5.0 mEq/L) and increases the risk of cardiac dysrhythmias. Option A (sodium 138) is within normal
limits. Option C (creatinine 1.0) is normal. Option D (glucose 110) is slightly elevated but not a contraindication.
5 A nurse is teaching a patient with a new colostomy about dietary modifications. Which statement by the patient
indicates a need for further teaching?
A) I will avoid foods that cause gas, such as beans and broccoli.
B) I should increase my intake of high-fiber foods to prevent constipation.
C) I will chew my food thoroughly to aid digestion.
D) I need to drink at least 8 glasses of water per day.
Answer: B
Rationale: High-fiber foods can cause blockage in a colostomy, especially in the early postoperative period. Patients
are typically advised to avoid high-fiber foods initially and gradually reintroduce them. Options A, C, and D are
appropriate recommendations. Gas-producing foods (A) should be avoided to prevent discomfort. Chewing
thoroughly (C) aids digestion. Adequate hydration (D) prevents constipation.
6 A nurse is assessing a patient who has just undergone a lumbar puncture. Which finding requires immediate
intervention?
A) Patient reports a mild headache when sitting up.
B) Clear fluid is noted on the dressing over the puncture site.
C) The patient's heart rate is 88 beats per minute.
D) The patient's blood pressure is 118/76 mm Hg.
Answer: B
Rationale: Clear fluid on the dressing may indicate cerebrospinal fluid (CSF) leakage, which increases the risk of
infection and requires immediate intervention. Option A (mild headache) is common after lumbar puncture due to
CSF loss but is not immediately dangerous. Options C and D are within normal limits.
7 A patient with deep vein thrombosis (DVT) is receiving a heparin infusion. The nurse notes that the activated
partial thromboplastin time (aPTT) is 98 seconds (therapeutic range 60-80 seconds). What is the nurse's priority
action?
A) Increase the heparin infusion rate.
B) Decrease the heparin infusion rate.
C) Administer protamine sulfate.
D) Notify the healthcare provider immediately.
Answer: B
Rationale: An aPTT of 98 seconds is above the therapeutic range, indicating an increased risk of bleeding. The nurse
should decrease the heparin infusion rate per protocol. Option A would worsen the situation. Protamine sulfate (C)
is an antidote for heparin overdose but is reserved for severe bleeding. Notifying the provider (D) is appropriate but
the nurse should first adjust the rate as per standing orders.
,8 A nurse is preparing to administer an intramuscular injection of an oil-based medication. Which needle gauge
and length is most appropriate?
A) 22-gauge, 1-inch needle
B) 25-gauge, 5/8-inch needle
C) 20-gauge, 1.5-inch needle
D) 23-gauge, 1-inch needle
Answer: C
Rationale: Oil-based medications are viscous and require a larger gauge needle (20-gauge) to allow smooth flow. A
1.5-inch length ensures deep intramuscular deposition, especially in larger muscle sites. Options A and D have
smaller gauges, which may clog. Option B (25-gauge, 5/8-inch) is too small and too short for IM injection.
9 A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen via nasal cannula at 2 L/min.
The nurse observes that the patient's respiratory rate is 10 breaths per minute and oxygen saturation is 94%.
What is the nurse's best action?
A) Increase the oxygen flow rate to 4 L/min.
B) Decrease the oxygen flow rate to 1 L/min.
C) Continue current oxygen therapy and monitor.
D) Prepare for intubation.
Answer: C
Rationale: In COPD patients, the hypoxic drive is the primary stimulus for breathing. High oxygen levels can
suppress this drive, leading to hypoventilation. The patient's oxygen saturation of 94% is within acceptable range
(88-92% target for COPD), and a respiratory rate of 10 is slightly low but not critical. Increasing oxygen (A) could
worsen hypoventilation. Decreasing (B) may cause hypoxia. Intubation (D) is not indicated.
10 A nurse is evaluating a patient's understanding of a low-sodium diet for hypertension. Which food selection
indicates the patient understands the teaching?
A) Canned tomato soup with crackers
B) Grilled chicken breast with steamed vegetables
C) Ham and cheese sandwich on whole wheat bread
D) Instant noodles with seasoning packet
Answer: B
Rationale: Grilled chicken and steamed vegetables are naturally low in sodium. Options A (canned soup), C (ham
and cheese), and D (instant noodles) are high in sodium due to processing and added salt. The patient's selection of
option B demonstrates understanding of a low-sodium diet.
11 A nurse is assessing a patient's risk for pressure injury using the Braden Scale. The patient is bedridden, has
limited sensory perception, and skin is constantly moist due to incontinence. The patient's Braden score is 11.
Which intervention should the nurse prioritize?
A) Apply a moisture barrier ointment after each incontinence episode
B) Turn and reposition the patient every 2 hours
C) Use a pressure-redistributing mattress overlay
D) Provide a high-protein, high-calorie diet
Answer: B
Rationale: A Braden score of 11 indicates high risk. While all options are important, repositioning every 2 hours is
the most critical intervention to relieve pressure and prevent tissue ischemia. Moisture management and nutrition
are adjunctive, but pressure relief is paramount.
, 12 During a sterile wound dressing change, the nurse accidentally touches the sterile field with an ungloved hand.
What is the most appropriate action?
A) Continue the procedure, as the field is still clean
B) Remove the contaminated items and replace the sterile field
C) Apply new sterile gloves and proceed
D) Wipe the contaminated area with alcohol and continue
Answer: B
Rationale: Any break in sterility requires discarding all contaminated items and re-establishing the sterile field.
Continuing compromises asepsis and increases infection risk. Changing gloves alone does not address the
contaminated field.
13 A nurse is preparing to administer a controlled substance. Which step is essential to comply with legal and
safety standards?
A) Verify the medication with another nurse before administration
B) Document the administration immediately after giving the drug
C) Count the remaining doses after administration
D) All of the above
Answer: D
Rationale: Controlled substance administration requires a witness (A), immediate documentation (B), and accurate
inventory count (C) to prevent diversion and ensure accountability. All steps are mandatory.
14 A patient with a nasogastric tube for decompression has a nursing diagnosis of 'Risk for Impaired Skin Integrity
related to tube placement.' Which intervention is most effective in preventing skin breakdown at the nares?
A) Secure the tube with tape directly on the nose
B) Apply a hydrocolloid dressing under the tube
C) Reposition the tube to the opposite nostril every 24 hours
D) Use a commercial tube holder with foam padding
Answer: D
Rationale: Commercial tube holders minimize pressure and friction on the nares, reducing risk of skin breakdown.
Hydrocolloid dressings can be used but may not provide secure anchoring. Repositioning is not standard due to
patient discomfort and risk of dislodgment.
15 A nurse is evaluating a patient's understanding of prescribed antibiotics. Which statement indicates a need for
further teaching?
A) I will take the medication until I feel better
B) I will complete the full course even if symptoms resolve
C) I will take the medication at the same time each day
D) I will report any rash or diarrhea to my provider
Answer: A
Rationale: Antibiotics should be taken for the full prescribed duration, not until symptoms improve, to prevent
resistance. Stopping early can lead to recurrence and resistance. The other statements reflect correct understanding.
16 A nurse is caring for a patient with a new colostomy. The stoma appears dusky and edematous. What is the
nurse's priority action?
A) Document the finding and reassess in 2 hours
B) Notify the healthcare provider immediately
C) Apply a warm compress to the stoma
