HESI LPN-ADN Entrance Exam Mobility Focus 2026/2027 –
Elsevier Evolve – Comprehensive Mobility & Safe Patient
Handling Competency Assessment for LPN-to-ADN Transition
— 298 Questions
Section 1: Mobility and Immobility (Questions 1-30)
1 A patient with a history of osteoporosis and recent hip replacement is prescribed bed rest with limited
weight-bearing. Which nursing intervention is most critical to prevent the development of a deep vein
thrombosis (DVT) while maintaining patient safety?
A) Apply sequential compression devices (SCDs) and encourage ankle pumps every 2 hours.
B) Administer low-molecular-weight heparin as ordered and perform passive range of motion exercises.
C) Reposition the patient every 2 hours and use a trapeze bar for active movement.
D) Apply graduated compression stockings and elevate the foot of the bed 15 degrees.
Answer: B
Rationale: Low-molecular-weight heparin is a pharmacological DVT prophylaxis, and passive range of motion
exercises maintain circulation without risking dislocation of the hip replacement. SCDs and ankle pumps (A) are
helpful but not the most critical; repositioning (C) and compression stockings (D) are less effective for DVT
prevention in this context.
2 During a patient transfer from bed to stretcher using a friction-reducing device, the patient suddenly reports
sharp pain in the lower back. What is the nurse's priority action?
A) Stop the transfer immediately and assess the patient's pain and vital signs.
B) Complete the transfer quickly to minimize time in an awkward position.
C) Administer prescribed analgesic and continue transfer after 5 minutes.
D) Document the incident and notify the charge nurse after transfer completion.
Answer: A
Rationale: Sudden sharp pain during transfer may indicate injury (e.g., muscle strain or vertebral fracture). The
priority is to stop the transfer to prevent further harm and assess the patient. Continuing (B or C) risks exacerbating
injury; documentation (D) is secondary to immediate assessment.
3 A patient with a spinal cord injury at T4 is being mobilized to a wheelchair. Which of the following is the most
important consideration to prevent autonomic dysreflexia?
A) Ensure the patient's bladder is empty before transfer.
B) Use a slide board for transfer to reduce friction.
C) Maintain the patient's head in a neutral position.
D) Monitor blood pressure every 15 minutes during mobilization.
Answer: A
Rationale: Autonomic dysreflexia is often triggered by a distended bladder or bowel. Ensuring an empty bladder
before mobilization is a key preventive measure. Slide boards (B) reduce friction but do not prevent dysreflexia;
head position (C) is less relevant; monitoring BP (D) detects but does not prevent.
4 A patient with left-sided weakness from a stroke is being taught to use a cane. Which instruction best promotes
safe ambulation?
,A) Hold the cane in the right hand and advance the cane simultaneously with the left leg.
B) Hold the cane in the left hand and advance the cane simultaneously with the right leg.
C) Hold the cane in the right hand and advance the cane, then the left leg, then the right leg.
D) Hold the cane in the left hand and advance the cane, then the right leg, then the left leg.
Answer: A
Rationale: For a patient with left-sided weakness, the cane is held in the stronger (right) hand. The cane and weaker
leg (left) move together to provide a stable base of support. Option B is incorrect because the cane should be on the
stronger side; options C and D describe a three-point gait but with incorrect hand placement.
5 A patient on prolonged bed rest develops a non-productive cough, tachypnea, and low-grade fever. Which
complication is most likely, and what is the priority nursing intervention?
A) Atelectasis; encourage deep breathing and incentive spirometry every 2 hours.
B) Pneumonia; administer prescribed antibiotics and obtain sputum culture.
C) Pulmonary embolism; prepare for immediate CT angiography and anticoagulation.
D) Hypostatic pneumonia; reposition patient every 2 hours and increase fluids.
Answer: A
Rationale: The triad of non-productive cough, tachypnea, and low-grade fever in an immobile patient is classic for
atelectasis. Incentive spirometry and deep breathing are first-line interventions to re-expand alveoli. Pneumonia (B)
would likely have productive cough; pulmonary embolism (C) would present with sudden dyspnea and chest pain;
hypostatic pneumonia (D) is an older term and less specific.
6 A patient with an indwelling urinary catheter is on strict bed rest. Which intervention is most effective in
preventing catheter-associated urinary tract infection (CAUTI) related to immobility?
A) Ensure the drainage bag is always below the level of the bladder.
B) Provide perineal care with antiseptic solution twice daily.
C) Encourage increased oral fluid intake to 2000 mL per day.
D) Replace the catheter every 7 days to reduce biofilm formation.
Answer: A
Rationale: Keeping the drainage bag below the bladder prevents urine backflow, which is a primary cause of
CAUTI. Perineal care (B) is important but not the most effective; increased fluids (C) help but do not directly
prevent CAUTI; routine catheter replacement (D) is not recommended and may increase infection risk.
7 A patient who has been immobile for 3 weeks is starting a mobility program. Which finding would indicate the
need to postpone the activity?
A) Resting heart rate of 88 beats per minute.
B) Blood pressure drop from 120/80 to 100/60 upon standing.
C) Oxygen saturation of 95% on room air.
D) Patient reports mild dizziness that resolves within 30 seconds.
Answer: B
Rationale: A drop in systolic BP >20 mmHg upon standing indicates orthostatic hypotension, which increases fall
risk and requires postponement until further evaluation. A resting HR of 88 (A) is within normal limits; O2 sat 95%
(C) is acceptable; mild dizziness that resolves quickly (D) may be tolerated but still warrants caution.
8 When using a mechanical lift to transfer a patient from bed to chair, which action demonstrates correct use of
the device?
A) Position the lift sling under the patient from the side after log-rolling.
B) Raise the patient to a sitting position before attaching the sling to the lift.
,C) Use the smallest sling size available to ensure a snug fit.
D) Lower the patient onto the chair while the lift is still moving forward.
Answer: A
Rationale: The sling is correctly placed by log-rolling the patient to position it under the body. Raising the patient to
sitting (B) before sling attachment is unsafe; smallest sling size (C) may cause discomfort or pressure points;
lowering while moving (D) risks loss of control and patient injury.
9 A patient with a history of falls is being taught to use a walker. Which observation indicates the need for further
instruction?
A) The patient places the walker about one step ahead before moving.
B) The patient stands with the walker's back legs at the level of the feet.
C) The patient looks down at the feet while walking with the walker.
D) The patient moves the walker forward, then steps with the weaker leg, then the stronger leg.
Answer: C
Rationale: Looking down while walking increases fall risk and indicates improper technique; the patient should look
ahead. Placing the walker one step ahead (A) is correct; back legs at foot level (B) is proper positioning; stepping
pattern (D) is appropriate for a walker.
10 A patient develops a stage 2 pressure injury on the sacrum after 10 days of bed rest. Which intervention should
the nurse prioritize to prevent further deterioration?
A) Apply a transparent film dressing and reposition every 2 hours.
B) Use a pressure-reducing mattress and maintain a turning schedule.
C) Clean the wound with hydrogen peroxide and apply a wet-to-dry dressing.
D) Place a donut-shaped cushion under the sacrum to offload pressure.
Answer: B
Rationale: Pressure reduction and regular repositioning are the cornerstones of pressure injury prevention and
treatment. Transparent film dressing (A) is for stage 1; hydrogen peroxide (C) is cytotoxic and not recommended;
donut cushions (D) can increase pressure on surrounding tissue and are contraindicated.
11 A patient with a spinal cord injury at T4 level develops autonomic dysreflexia during a bed-to-stretcher
transfer. Which immediate action by the nurse is most critical to prevent complications?
A) Administer a prescribed antihypertensive medication.
B) Elevate the head of the bed to 90 degrees and lower the stretcher.
C) Check the patient's bladder for distention and catheter patency.
D) Loosen any constrictive clothing and remove the transfer board.
Answer: C
Rationale: The most common trigger for autonomic dysreflexia is bladder distention or bowel impaction. In this
scenario, the transfer may have dislodged the catheter or caused kinking, leading to bladder distention. Promptly
checking and relieving the bladder can rapidly reduce blood pressure. Antihypertensives are a secondary measure if
nonpharmacologic interventions fail.
12 A patient who has been on strict bed rest for 5 days is to be mobilized. Which finding would indicate that the
patient has developed orthostatic hypotension and that mobilization should be stopped?
A) Heart rate increases from 72 to 88 beats per minute.
B) Systolic blood pressure drops by 25 mm Hg upon standing.
C) Patient reports mild dizziness that resolves after 1 minute.
D) Respiratory rate increases from 16 to 20 breaths per minute.
, Answer: B
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mm Hg or diastolic
of 10 mm Hg within 3 minutes of standing. A 25 mm Hg drop is significant and warrants cessation of mobilization.
Mild dizziness (option C) may be expected but should not be ignored; however, the BP drop is definitive. A slight
HR increase is a normal compensatory response.
13 A patient with a history of osteoporosis is being transferred from bed to chair using a mechanical lift. Which
action by the nurse best ensures patient safety?
A) Position the sling under the patient's thighs and shoulders only.
B) Use a full-body sling with head support to distribute forces evenly.
C) Elevate the head of the bed to 45 degrees before lifting.
D) Ask the patient to assist by pushing with their legs.
Answer: B
Rationale: In osteoporosis, bones are fragile and susceptible to fracture. A full-body sling with head support
provides even distribution of forces, minimizing stress on any single bone. Partial slings (option A) or asking the
patient to push (option D) can cause undue stress on weakened vertebrae or hips. Elevating the head (option C) is
not the primary safety measure.
14 A patient with left-sided hemiparesis is learning to use a cane. Which gait pattern should the nurse teach to
maximize stability?
A) Advance the cane and the left foot simultaneously, then the right foot.
B) Advance the cane and the right foot simultaneously, then the left foot.
C) Advance the cane first, then the left foot, then the right foot.
D) Advance the cane first, then the right foot, then the left foot.
Answer: B
Rationale: For hemiparesis, the cane is held in the hand opposite the weak leg (right hand for left leg weakness). The
sequence is: advance cane and weak leg (left) together, then advance strong leg (right). This provides a broad base
of support. Options A and C would have the cane on the same side as the weak leg, which is incorrect. Option D is
a 3-point gait but for bilateral weakness.
15 A patient with a lower extremity fracture has a cast that extends from the groin to the toes. Which nursing
intervention is most effective in preventing disuse muscle atrophy?
A) Encourage isometric exercises of the quadriceps and gluteal muscles.
B) Perform passive range of motion of the toes every 2 hours.
C) Apply a heating pad to the casted limb to promote blood flow.
D) Administer prescribed muscle relaxants to reduce spasticity.
Answer: A
Rationale: Isometric exercises (contracting muscles without moving the joint) maintain muscle strength and prevent
atrophy without disrupting fracture alignment. Passive ROM (option B) does not actively contract muscles. Heat
(option C) may increase swelling, and muscle relaxants (option D) do not prevent atrophy.
16 During a two-person assist transfer of a patient with a weak right side, which instruction should the nurse give
to the patient to promote active participation and safety?
A) Place your hands on the nurses' shoulders and push yourself up.
B) Cross your arms over your chest and keep your head upright.
C) Use your strong leg to push off the bed while the nurses lift.
D) Hold onto the walker positioned in front of you during the transfer.
Elsevier Evolve – Comprehensive Mobility & Safe Patient
Handling Competency Assessment for LPN-to-ADN Transition
— 298 Questions
Section 1: Mobility and Immobility (Questions 1-30)
1 A patient with a history of osteoporosis and recent hip replacement is prescribed bed rest with limited
weight-bearing. Which nursing intervention is most critical to prevent the development of a deep vein
thrombosis (DVT) while maintaining patient safety?
A) Apply sequential compression devices (SCDs) and encourage ankle pumps every 2 hours.
B) Administer low-molecular-weight heparin as ordered and perform passive range of motion exercises.
C) Reposition the patient every 2 hours and use a trapeze bar for active movement.
D) Apply graduated compression stockings and elevate the foot of the bed 15 degrees.
Answer: B
Rationale: Low-molecular-weight heparin is a pharmacological DVT prophylaxis, and passive range of motion
exercises maintain circulation without risking dislocation of the hip replacement. SCDs and ankle pumps (A) are
helpful but not the most critical; repositioning (C) and compression stockings (D) are less effective for DVT
prevention in this context.
2 During a patient transfer from bed to stretcher using a friction-reducing device, the patient suddenly reports
sharp pain in the lower back. What is the nurse's priority action?
A) Stop the transfer immediately and assess the patient's pain and vital signs.
B) Complete the transfer quickly to minimize time in an awkward position.
C) Administer prescribed analgesic and continue transfer after 5 minutes.
D) Document the incident and notify the charge nurse after transfer completion.
Answer: A
Rationale: Sudden sharp pain during transfer may indicate injury (e.g., muscle strain or vertebral fracture). The
priority is to stop the transfer to prevent further harm and assess the patient. Continuing (B or C) risks exacerbating
injury; documentation (D) is secondary to immediate assessment.
3 A patient with a spinal cord injury at T4 is being mobilized to a wheelchair. Which of the following is the most
important consideration to prevent autonomic dysreflexia?
A) Ensure the patient's bladder is empty before transfer.
B) Use a slide board for transfer to reduce friction.
C) Maintain the patient's head in a neutral position.
D) Monitor blood pressure every 15 minutes during mobilization.
Answer: A
Rationale: Autonomic dysreflexia is often triggered by a distended bladder or bowel. Ensuring an empty bladder
before mobilization is a key preventive measure. Slide boards (B) reduce friction but do not prevent dysreflexia;
head position (C) is less relevant; monitoring BP (D) detects but does not prevent.
4 A patient with left-sided weakness from a stroke is being taught to use a cane. Which instruction best promotes
safe ambulation?
,A) Hold the cane in the right hand and advance the cane simultaneously with the left leg.
B) Hold the cane in the left hand and advance the cane simultaneously with the right leg.
C) Hold the cane in the right hand and advance the cane, then the left leg, then the right leg.
D) Hold the cane in the left hand and advance the cane, then the right leg, then the left leg.
Answer: A
Rationale: For a patient with left-sided weakness, the cane is held in the stronger (right) hand. The cane and weaker
leg (left) move together to provide a stable base of support. Option B is incorrect because the cane should be on the
stronger side; options C and D describe a three-point gait but with incorrect hand placement.
5 A patient on prolonged bed rest develops a non-productive cough, tachypnea, and low-grade fever. Which
complication is most likely, and what is the priority nursing intervention?
A) Atelectasis; encourage deep breathing and incentive spirometry every 2 hours.
B) Pneumonia; administer prescribed antibiotics and obtain sputum culture.
C) Pulmonary embolism; prepare for immediate CT angiography and anticoagulation.
D) Hypostatic pneumonia; reposition patient every 2 hours and increase fluids.
Answer: A
Rationale: The triad of non-productive cough, tachypnea, and low-grade fever in an immobile patient is classic for
atelectasis. Incentive spirometry and deep breathing are first-line interventions to re-expand alveoli. Pneumonia (B)
would likely have productive cough; pulmonary embolism (C) would present with sudden dyspnea and chest pain;
hypostatic pneumonia (D) is an older term and less specific.
6 A patient with an indwelling urinary catheter is on strict bed rest. Which intervention is most effective in
preventing catheter-associated urinary tract infection (CAUTI) related to immobility?
A) Ensure the drainage bag is always below the level of the bladder.
B) Provide perineal care with antiseptic solution twice daily.
C) Encourage increased oral fluid intake to 2000 mL per day.
D) Replace the catheter every 7 days to reduce biofilm formation.
Answer: A
Rationale: Keeping the drainage bag below the bladder prevents urine backflow, which is a primary cause of
CAUTI. Perineal care (B) is important but not the most effective; increased fluids (C) help but do not directly
prevent CAUTI; routine catheter replacement (D) is not recommended and may increase infection risk.
7 A patient who has been immobile for 3 weeks is starting a mobility program. Which finding would indicate the
need to postpone the activity?
A) Resting heart rate of 88 beats per minute.
B) Blood pressure drop from 120/80 to 100/60 upon standing.
C) Oxygen saturation of 95% on room air.
D) Patient reports mild dizziness that resolves within 30 seconds.
Answer: B
Rationale: A drop in systolic BP >20 mmHg upon standing indicates orthostatic hypotension, which increases fall
risk and requires postponement until further evaluation. A resting HR of 88 (A) is within normal limits; O2 sat 95%
(C) is acceptable; mild dizziness that resolves quickly (D) may be tolerated but still warrants caution.
8 When using a mechanical lift to transfer a patient from bed to chair, which action demonstrates correct use of
the device?
A) Position the lift sling under the patient from the side after log-rolling.
B) Raise the patient to a sitting position before attaching the sling to the lift.
,C) Use the smallest sling size available to ensure a snug fit.
D) Lower the patient onto the chair while the lift is still moving forward.
Answer: A
Rationale: The sling is correctly placed by log-rolling the patient to position it under the body. Raising the patient to
sitting (B) before sling attachment is unsafe; smallest sling size (C) may cause discomfort or pressure points;
lowering while moving (D) risks loss of control and patient injury.
9 A patient with a history of falls is being taught to use a walker. Which observation indicates the need for further
instruction?
A) The patient places the walker about one step ahead before moving.
B) The patient stands with the walker's back legs at the level of the feet.
C) The patient looks down at the feet while walking with the walker.
D) The patient moves the walker forward, then steps with the weaker leg, then the stronger leg.
Answer: C
Rationale: Looking down while walking increases fall risk and indicates improper technique; the patient should look
ahead. Placing the walker one step ahead (A) is correct; back legs at foot level (B) is proper positioning; stepping
pattern (D) is appropriate for a walker.
10 A patient develops a stage 2 pressure injury on the sacrum after 10 days of bed rest. Which intervention should
the nurse prioritize to prevent further deterioration?
A) Apply a transparent film dressing and reposition every 2 hours.
B) Use a pressure-reducing mattress and maintain a turning schedule.
C) Clean the wound with hydrogen peroxide and apply a wet-to-dry dressing.
D) Place a donut-shaped cushion under the sacrum to offload pressure.
Answer: B
Rationale: Pressure reduction and regular repositioning are the cornerstones of pressure injury prevention and
treatment. Transparent film dressing (A) is for stage 1; hydrogen peroxide (C) is cytotoxic and not recommended;
donut cushions (D) can increase pressure on surrounding tissue and are contraindicated.
11 A patient with a spinal cord injury at T4 level develops autonomic dysreflexia during a bed-to-stretcher
transfer. Which immediate action by the nurse is most critical to prevent complications?
A) Administer a prescribed antihypertensive medication.
B) Elevate the head of the bed to 90 degrees and lower the stretcher.
C) Check the patient's bladder for distention and catheter patency.
D) Loosen any constrictive clothing and remove the transfer board.
Answer: C
Rationale: The most common trigger for autonomic dysreflexia is bladder distention or bowel impaction. In this
scenario, the transfer may have dislodged the catheter or caused kinking, leading to bladder distention. Promptly
checking and relieving the bladder can rapidly reduce blood pressure. Antihypertensives are a secondary measure if
nonpharmacologic interventions fail.
12 A patient who has been on strict bed rest for 5 days is to be mobilized. Which finding would indicate that the
patient has developed orthostatic hypotension and that mobilization should be stopped?
A) Heart rate increases from 72 to 88 beats per minute.
B) Systolic blood pressure drops by 25 mm Hg upon standing.
C) Patient reports mild dizziness that resolves after 1 minute.
D) Respiratory rate increases from 16 to 20 breaths per minute.
, Answer: B
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mm Hg or diastolic
of 10 mm Hg within 3 minutes of standing. A 25 mm Hg drop is significant and warrants cessation of mobilization.
Mild dizziness (option C) may be expected but should not be ignored; however, the BP drop is definitive. A slight
HR increase is a normal compensatory response.
13 A patient with a history of osteoporosis is being transferred from bed to chair using a mechanical lift. Which
action by the nurse best ensures patient safety?
A) Position the sling under the patient's thighs and shoulders only.
B) Use a full-body sling with head support to distribute forces evenly.
C) Elevate the head of the bed to 45 degrees before lifting.
D) Ask the patient to assist by pushing with their legs.
Answer: B
Rationale: In osteoporosis, bones are fragile and susceptible to fracture. A full-body sling with head support
provides even distribution of forces, minimizing stress on any single bone. Partial slings (option A) or asking the
patient to push (option D) can cause undue stress on weakened vertebrae or hips. Elevating the head (option C) is
not the primary safety measure.
14 A patient with left-sided hemiparesis is learning to use a cane. Which gait pattern should the nurse teach to
maximize stability?
A) Advance the cane and the left foot simultaneously, then the right foot.
B) Advance the cane and the right foot simultaneously, then the left foot.
C) Advance the cane first, then the left foot, then the right foot.
D) Advance the cane first, then the right foot, then the left foot.
Answer: B
Rationale: For hemiparesis, the cane is held in the hand opposite the weak leg (right hand for left leg weakness). The
sequence is: advance cane and weak leg (left) together, then advance strong leg (right). This provides a broad base
of support. Options A and C would have the cane on the same side as the weak leg, which is incorrect. Option D is
a 3-point gait but for bilateral weakness.
15 A patient with a lower extremity fracture has a cast that extends from the groin to the toes. Which nursing
intervention is most effective in preventing disuse muscle atrophy?
A) Encourage isometric exercises of the quadriceps and gluteal muscles.
B) Perform passive range of motion of the toes every 2 hours.
C) Apply a heating pad to the casted limb to promote blood flow.
D) Administer prescribed muscle relaxants to reduce spasticity.
Answer: A
Rationale: Isometric exercises (contracting muscles without moving the joint) maintain muscle strength and prevent
atrophy without disrupting fracture alignment. Passive ROM (option B) does not actively contract muscles. Heat
(option C) may increase swelling, and muscle relaxants (option D) do not prevent atrophy.
16 During a two-person assist transfer of a patient with a weak right side, which instruction should the nurse give
to the patient to promote active participation and safety?
A) Place your hands on the nurses' shoulders and push yourself up.
B) Cross your arms over your chest and keep your head upright.
C) Use your strong leg to push off the bed while the nurses lift.
D) Hold onto the walker positioned in front of you during the transfer.
