PN HESI EXIT EXAM– QUESTIONS AND ANSWERS | VERIFIED
AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A licensed practical nurse is caring for an adult client diagnosed with type 1 diabetes
mellitus who is admitted to the medical-surgical unit with diabetic ketoacidosis. The client's
initial laboratory results reveal a serum potassium level of 3.2 mEq/L. Which clinical
action should the nurse prioritize before initiating the prescribed intravenous regular
insulin infusion?
A. Administer a sublingual glucose paste to elevate blood glucose levels immediately.
B. Verify that intravenous potassium replacement therapy has been initiated or ordered.
C. Draw a repeat arterial blood gas panel to assess for concurrent metabolic alkalosis.
D. Discontinue all oral fluid intake and place the client on strict NPO status.
ANSWER: B. Verify that intravenous potassium replacement therapy has been initiated or
ordered.
Insulin drives potassium from the extracellular fluid into the intracellular space, which
further drops serum potassium levels. If insulin is administered to a client with hypokalemia
(potassium below 3.5 mEq/L), it can precipitate life-threatening cardiac dysrhythmias.
Therefore, potassium must be repleted prior to or concurrently with insulin therapy. Option A
is contraindicated because the client is in DKA with hyperglycemia. Option C is unnecessary
at this exact moment. Option D is standard for acute DKA but does not address the immediate,
life-threatening electrolyte imbalance.
2. A licensed practical nurse is reviewing the plan of care for an older adult client admitted
with dehydration and confusion. Which nursing intervention is most effective for
preventing healthcare-associated falls in this vulnerable population?
A. Apply a vest restraint securely while the client is sitting in a geriatric chair.
B. Place the client in a room located directly across from the central nursing station.
C. Administer a scheduled dose of a short-acting benzodiazepine at bedtime.
D. Instruct the client to call for assistance before attempting to get out of bed.
ANSWER: B. Place the client in a room located directly across from the central nursing
station.
Environmental modifications and enhanced observation, such as placing confused clients
near the nurses' station, are evidence-based interventions for fall prevention that do not
restrict freedom. Option A uses a physical restraint, which increases injury risks and requires
strict legal justification. Option C involves sedating medications that frequently worsen acute
,confusion and increase fall risks in older adults. Option D is ineffective for a confused client
who lacks cognitive retention and executive judgment.
3. A licensed practical nurse is administering morning medications to a client prescribed
digoxin for chronic heart failure. Prior to dispensing the medication, what specific
assessment must the nurse perform?
A. Measure the client's radial pulse for a full 60 seconds.
B. Auscultate the apical pulse at the fifth intercostal space, midclavicular line, for one full
minute.
C. Check the client's most recent serum sodium and chloride laboratory panels.
D. Assess the client for bilateral upper extremity muscle tremors.
ANSWER: B. Auscultate the apical pulse at the fifth intercostal space, midclavicular line,
for one full minute.
Digoxin is a cardiac glycoside that slows conduction through the atrioventricular node and
increases myocardial contractility. Nurses must auscultate the apical pulse for one full minute
prior to administration and withhold the dose if the pulse rate is below 60 beats per minute in
an adult. Radial pulses can be inaccurate if pulse deficits exist. Serum potassium (not sodium)
is critical, and tremors are not primary signs of toxicity.
4. A licensed practical nurse is assisting a registered nurse with the admission of a client
diagnosed with active pulmonary tuberculosis. Which type of personal protective
equipment and room placement must be instituted immediately?
A. Standard precautions with a private room and surgical mask.
B. Contact precautions with a dedicated medical equipment cart.
C. Airborne precautions with a negative pressure isolation room and an N95 respirator.
D. Droplet precautions with protective eye shields and a standard face mask.
ANSWER: C. Airborne precautions with a negative pressure isolation room and an N95
respirator.
Tuberculosis is transmitted via droplet nuclei that remain suspended in the air. Consequently,
clients with suspected or active pulmonary TB require placement in an airborne infection
isolation room featuring negative pressure ventilation, and healthcare workers must wear fit-
tested N95 respirators. Standard, contact, and droplet precautions are insufficient for airborne
pathogens.
5. A licensed practical nurse is reinforcing discharge instructions for a client who has
received a new prescription for warfarin following deep vein thrombosis treatment. Which
dietary instruction is essential for the nurse to emphasize?
A. Eliminate all green leafy vegetables entirely from your daily diet.
B. Maintain a consistent, steady daily intake of foods rich in vitamin K.
,C. Double your intake of dairy products and calcium-fortified juices.
D. Increase your consumption of garlic, ginger, and ginkgo biloba supplements.
ANSWER: B. Maintain a consistent, steady daily intake of foods rich in vitamin K.
Vitamin K antagonizes the anticoagulant effect of warfarin. Rather than eliminating vitamin
K entirely, clients must maintain a consistent daily intake to stabilize international normalized
ratio (INR) levels. Option A causes extreme dietary restrictions that are unnecessary and
difficult to maintain. Option C is unrelated to warfarin metabolism. Option D introduces
herbal and dietary substances that increase bleeding risks.
6. A licensed practical nurse is caring for a client diagnosed with chronic renal failure who
exhibits muscle twitching, numbness around the lips, and a positive Trousseau sign. Which
laboratory abnormality should the nurse anticipate?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: B. Hypocalcemia
Chronic renal failure impairs the kidney's ability to activate vitamin D and excrete
phosphorus, leading to hyperphosphatemia and reciprocal hypocalcemia. Clinical
manifestations of hypocalcemia include neuromuscular irritability such as muscle twitching,
circumoral paresthesia, and positive Trousseau and Chvostek signs. Options A, C, and D do
not classically present with these specific neuromuscular signs.
7. A licensed practical nurse is collecting data on an adult client who sustained a severe
burn injury over 30 percent of total body surface area. During the first 24 hours of
emergent burn management, which intravenous fluid type is primarily prescribed?
A. 0.45 percent sodium chloride solution
B. Lactated Ringer's solution
C. Five percent dextrose in water
D. Three percent sodium chloride solution
ANSWER: B. Lactated Ringer's solution
Lactated Ringer's solution is an isotonic crystalloid fluid of choice during the emergent phase
of burn resuscitation because its electrolyte composition closely mirrors blood plasma, helping
to restore intravascular volume and correct acidosis. Options A and C are hypotonic and will
worsen intravascular fluid depletion. Option D is hypertonic and rarely indicated in primary
burn resuscitation protocols.
, 8. A licensed practical nurse is monitoring a client receiving a blood transfusion of packed
red blood cells. Thirty minutes into the infusion, the client reports chills, lower back pain,
and dyspnea. What is the nurse's immediate priority action?
A. Slow the rate of the blood transfusion by half and recheck vital signs in 15 minutes.
B. Stop the transfusion immediately and infuse normal saline through a separate IV line.
C. Administer the prescribed oral diphenhydramine and apply a warm thermal blanket.
D. Notify the blood bank to verify the client's identification band numbers.
ANSWER: B. Stop the transfusion immediately and infuse normal saline through a separate
IV line.
The client's symptoms (chills, lower back pain, dyspnea) indicate an acute hemolytic
transfusion reaction, which is an emergency. The first step is to stop the transfusion
immediately, disconnect the blood tubing, and maintain vascular access using normal saline
through new tubing to infuse maintenance fluids and support blood pressure. Slowing the
infusion or giving antihistamines delays essential emergency intervention.
9. A licensed practical nurse is caring for a client who is post-operative day one following a
thyroidectomy. When performing a focused assessment, the nurse notes a harsh, high-
pitched crowing sound during inspiration. What is the nurse's immediate clinical priority?
A. Encourage the client to perform deep breathing and coughing exercises.
B. Administer the prescribed intravenous pain medication immediately.
C. Notify the registered nurse and healthcare provider while ensuring a tracheostomy tray is at
the bedside.
D. Elevate the head of the bed to a flat position to promote cerebral blood flow.
ANSWER: C. Notify the registered nurse and healthcare provider while ensuring a
tracheostomy tray is at the bedside.
Stridor (a high-pitched crowing sound) indicates acute laryngeal edema and respiratory
obstruction, which is a life-threatening complication following neck surgery. Immediate
medical and nursing intervention is required, and emergency airway equipment (tracheostomy
tray) must be readily accessible. Flat positioning will worsen edema, and coughing or delaying
notification places the client at extreme risk of asphyxiation.
10. A licensed practical nurse is reviewing the diagnostic laboratory profile of a client
admitted with acute pancreatitis. Which enzyme elevation is most specific to the diagnosis
of this condition?
A. Serum amylase
B. Serum lipase
C. Creatine kinase MB
D. Alanine aminotransferase
AND WELL DETAILED ANSWERS PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A licensed practical nurse is caring for an adult client diagnosed with type 1 diabetes
mellitus who is admitted to the medical-surgical unit with diabetic ketoacidosis. The client's
initial laboratory results reveal a serum potassium level of 3.2 mEq/L. Which clinical
action should the nurse prioritize before initiating the prescribed intravenous regular
insulin infusion?
A. Administer a sublingual glucose paste to elevate blood glucose levels immediately.
B. Verify that intravenous potassium replacement therapy has been initiated or ordered.
C. Draw a repeat arterial blood gas panel to assess for concurrent metabolic alkalosis.
D. Discontinue all oral fluid intake and place the client on strict NPO status.
ANSWER: B. Verify that intravenous potassium replacement therapy has been initiated or
ordered.
Insulin drives potassium from the extracellular fluid into the intracellular space, which
further drops serum potassium levels. If insulin is administered to a client with hypokalemia
(potassium below 3.5 mEq/L), it can precipitate life-threatening cardiac dysrhythmias.
Therefore, potassium must be repleted prior to or concurrently with insulin therapy. Option A
is contraindicated because the client is in DKA with hyperglycemia. Option C is unnecessary
at this exact moment. Option D is standard for acute DKA but does not address the immediate,
life-threatening electrolyte imbalance.
2. A licensed practical nurse is reviewing the plan of care for an older adult client admitted
with dehydration and confusion. Which nursing intervention is most effective for
preventing healthcare-associated falls in this vulnerable population?
A. Apply a vest restraint securely while the client is sitting in a geriatric chair.
B. Place the client in a room located directly across from the central nursing station.
C. Administer a scheduled dose of a short-acting benzodiazepine at bedtime.
D. Instruct the client to call for assistance before attempting to get out of bed.
ANSWER: B. Place the client in a room located directly across from the central nursing
station.
Environmental modifications and enhanced observation, such as placing confused clients
near the nurses' station, are evidence-based interventions for fall prevention that do not
restrict freedom. Option A uses a physical restraint, which increases injury risks and requires
strict legal justification. Option C involves sedating medications that frequently worsen acute
,confusion and increase fall risks in older adults. Option D is ineffective for a confused client
who lacks cognitive retention and executive judgment.
3. A licensed practical nurse is administering morning medications to a client prescribed
digoxin for chronic heart failure. Prior to dispensing the medication, what specific
assessment must the nurse perform?
A. Measure the client's radial pulse for a full 60 seconds.
B. Auscultate the apical pulse at the fifth intercostal space, midclavicular line, for one full
minute.
C. Check the client's most recent serum sodium and chloride laboratory panels.
D. Assess the client for bilateral upper extremity muscle tremors.
ANSWER: B. Auscultate the apical pulse at the fifth intercostal space, midclavicular line,
for one full minute.
Digoxin is a cardiac glycoside that slows conduction through the atrioventricular node and
increases myocardial contractility. Nurses must auscultate the apical pulse for one full minute
prior to administration and withhold the dose if the pulse rate is below 60 beats per minute in
an adult. Radial pulses can be inaccurate if pulse deficits exist. Serum potassium (not sodium)
is critical, and tremors are not primary signs of toxicity.
4. A licensed practical nurse is assisting a registered nurse with the admission of a client
diagnosed with active pulmonary tuberculosis. Which type of personal protective
equipment and room placement must be instituted immediately?
A. Standard precautions with a private room and surgical mask.
B. Contact precautions with a dedicated medical equipment cart.
C. Airborne precautions with a negative pressure isolation room and an N95 respirator.
D. Droplet precautions with protective eye shields and a standard face mask.
ANSWER: C. Airborne precautions with a negative pressure isolation room and an N95
respirator.
Tuberculosis is transmitted via droplet nuclei that remain suspended in the air. Consequently,
clients with suspected or active pulmonary TB require placement in an airborne infection
isolation room featuring negative pressure ventilation, and healthcare workers must wear fit-
tested N95 respirators. Standard, contact, and droplet precautions are insufficient for airborne
pathogens.
5. A licensed practical nurse is reinforcing discharge instructions for a client who has
received a new prescription for warfarin following deep vein thrombosis treatment. Which
dietary instruction is essential for the nurse to emphasize?
A. Eliminate all green leafy vegetables entirely from your daily diet.
B. Maintain a consistent, steady daily intake of foods rich in vitamin K.
,C. Double your intake of dairy products and calcium-fortified juices.
D. Increase your consumption of garlic, ginger, and ginkgo biloba supplements.
ANSWER: B. Maintain a consistent, steady daily intake of foods rich in vitamin K.
Vitamin K antagonizes the anticoagulant effect of warfarin. Rather than eliminating vitamin
K entirely, clients must maintain a consistent daily intake to stabilize international normalized
ratio (INR) levels. Option A causes extreme dietary restrictions that are unnecessary and
difficult to maintain. Option C is unrelated to warfarin metabolism. Option D introduces
herbal and dietary substances that increase bleeding risks.
6. A licensed practical nurse is caring for a client diagnosed with chronic renal failure who
exhibits muscle twitching, numbness around the lips, and a positive Trousseau sign. Which
laboratory abnormality should the nurse anticipate?
A. Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: B. Hypocalcemia
Chronic renal failure impairs the kidney's ability to activate vitamin D and excrete
phosphorus, leading to hyperphosphatemia and reciprocal hypocalcemia. Clinical
manifestations of hypocalcemia include neuromuscular irritability such as muscle twitching,
circumoral paresthesia, and positive Trousseau and Chvostek signs. Options A, C, and D do
not classically present with these specific neuromuscular signs.
7. A licensed practical nurse is collecting data on an adult client who sustained a severe
burn injury over 30 percent of total body surface area. During the first 24 hours of
emergent burn management, which intravenous fluid type is primarily prescribed?
A. 0.45 percent sodium chloride solution
B. Lactated Ringer's solution
C. Five percent dextrose in water
D. Three percent sodium chloride solution
ANSWER: B. Lactated Ringer's solution
Lactated Ringer's solution is an isotonic crystalloid fluid of choice during the emergent phase
of burn resuscitation because its electrolyte composition closely mirrors blood plasma, helping
to restore intravascular volume and correct acidosis. Options A and C are hypotonic and will
worsen intravascular fluid depletion. Option D is hypertonic and rarely indicated in primary
burn resuscitation protocols.
, 8. A licensed practical nurse is monitoring a client receiving a blood transfusion of packed
red blood cells. Thirty minutes into the infusion, the client reports chills, lower back pain,
and dyspnea. What is the nurse's immediate priority action?
A. Slow the rate of the blood transfusion by half and recheck vital signs in 15 minutes.
B. Stop the transfusion immediately and infuse normal saline through a separate IV line.
C. Administer the prescribed oral diphenhydramine and apply a warm thermal blanket.
D. Notify the blood bank to verify the client's identification band numbers.
ANSWER: B. Stop the transfusion immediately and infuse normal saline through a separate
IV line.
The client's symptoms (chills, lower back pain, dyspnea) indicate an acute hemolytic
transfusion reaction, which is an emergency. The first step is to stop the transfusion
immediately, disconnect the blood tubing, and maintain vascular access using normal saline
through new tubing to infuse maintenance fluids and support blood pressure. Slowing the
infusion or giving antihistamines delays essential emergency intervention.
9. A licensed practical nurse is caring for a client who is post-operative day one following a
thyroidectomy. When performing a focused assessment, the nurse notes a harsh, high-
pitched crowing sound during inspiration. What is the nurse's immediate clinical priority?
A. Encourage the client to perform deep breathing and coughing exercises.
B. Administer the prescribed intravenous pain medication immediately.
C. Notify the registered nurse and healthcare provider while ensuring a tracheostomy tray is at
the bedside.
D. Elevate the head of the bed to a flat position to promote cerebral blood flow.
ANSWER: C. Notify the registered nurse and healthcare provider while ensuring a
tracheostomy tray is at the bedside.
Stridor (a high-pitched crowing sound) indicates acute laryngeal edema and respiratory
obstruction, which is a life-threatening complication following neck surgery. Immediate
medical and nursing intervention is required, and emergency airway equipment (tracheostomy
tray) must be readily accessible. Flat positioning will worsen edema, and coughing or delaying
notification places the client at extreme risk of asphyxiation.
10. A licensed practical nurse is reviewing the diagnostic laboratory profile of a client
admitted with acute pancreatitis. Which enzyme elevation is most specific to the diagnosis
of this condition?
A. Serum amylase
B. Serum lipase
C. Creatine kinase MB
D. Alanine aminotransferase
