HESI PN EXIT EXAM MEGA-REVIEW:
300 PRACTICE QUESTIONS WITH
RATIONALES FOR NEXT-GEN
NCLEX-PN SUCCESS | WITH
VERIFIED ANSWERS | A+GRADED
[MOST RECENT!!]
1. A client with heart failure reports sudden weight gain of 3 lbs in 24 hours and
ankle swelling. What is the PN's priority action?
• A) Restrict fluids to 1,000 mL/day
• B) Auscultate lung sounds
• C) Teach low-sodium diet
• D) Weigh the client again in the morning
Correct Answer: B) Auscultate lung sounds
Rationale: Sudden weight gain and edema indicate fluid volume overload, which can
lead to pulmonary congestion. The priority is to assess lung sounds for crackles,
which would indicate worsening heart failure and require immediate intervention.
2. A post-op client has a Jackson-Pratt (JP) drain. Which finding requires
immediate notification of the healthcare provider?
• A) 50 mL serosanguinous drainage in 8 hours
• B) Drainage changes from pink to bright red
• C) Drain site has small amount of crusting
• D) Client reports mild discomfort at site
Correct Answer: B) Drainage changes from pink to bright red
Rationale: A change from serosanguinous to bright red drainage suggests active
,bleeding. This requires immediate HCP notification. Serosanguinous drainage,
crusting, and mild discomfort are expected post-op findings.
3. A client with schizophrenia is experiencing auditory hallucinations. What is
the best therapeutic response?
• A) "I know the voices are real to you, but I don't hear them."
• B) "Stop paying attention to those voices."
• C) "Tell me exactly what the voices are saying."
• D) "Take your medication and the voices will go away."
Correct Answer: A) "I know the voices are real to you, but I don't hear them."
Rationale: This response validates the client's experience without reinforcing the
hallucination. It is reality-based and therapeutic. Arguing, dismissing, or focusing too
much on content is not helpful.
4. The PN is reinforcing teaching about insulin self-administration. Which client
statement indicates a need for further teaching?
• A) "I will rotate injection sites within the same area."
• B) "I will draw up NPH insulin first, then regular insulin."
• C) "I will keep unopened vials in the refrigerator."
• D) "I will massage the site after injection to help absorption."
Correct Answer: D) "I will massage the site after injection to help absorption."
Rationale: Massaging the injection site can increase absorption unpredictably and
cause bruising. Clients should avoid massaging. The other statements are correct
practices.
5. A client on warfarin has an INR of 4.5. What is the PN's priority action?
• A) Administer vitamin K as ordered
• B) Hold the next dose and notify HCP
• C) Check for signs of bleeding
• D) Administer protamine sulfate
,Correct Answer: B) Hold the next dose and notify HCP
Rationale: Therapeutic INR for most conditions is 2.0–3.0. An INR of 4.5 is elevated
and increases bleeding risk. The PN should hold the dose and notify the HCP for
further orders. Protamine is for heparin, not warfarin.
6. A client with COPD has an oxygen saturation of 88% on room air. Which
oxygen delivery device is most appropriate?
• A) Simple face mask at 6 L/min
• B) Non-rebreather mask at 10 L/min
• C) Nasal cannula at 2 L/min
• D) Venturi mask at 24%
Correct Answer: C) Nasal cannula at 2 L/min
Rationale: COPD clients rely on hypoxic drive; high-flow oxygen can suppress their
respiratory drive. Low-flow oxygen via nasal cannula (1–3 L/min) is safest to achieve
target SpO₂ of 88–92%.
7. A laboring client's fetal heart rate drops to 90 bpm during a contraction and
returns to baseline after the contraction ends. What type of deceleration is this?
• A) Early deceleration
• B) Late deceleration
• C) Variable deceleration
• D) Prolonged deceleration
Correct Answer: A) Early deceleration
Rationale: Early decelerations mirror contractions, start at the onset, and return to
baseline by the end. They are benign and caused by fetal head compression. Late
decelerations are worrisome and indicate uteroplacental insufficiency.
8. A post-partum client reports a gush of blood and a firm, displaced uterus to
the right. What should the PN do first?
• A) Massage the uterus
• B) Assist the client to void
, • C) Call the healthcare provider
• D) Administer oxytocin
Correct Answer: B) Assist the client to void
Rationale: A firm uterus that is displaced suggests a full bladder pushing the uterus
upward and to the side, preventing contraction. Emptying the bladder usually allows
the uterus to return to midline and contract effectively.
9. A child with dehydration is receiving IV fluids. Which assessment finding
indicates fluid volume overload?
• A) Increased urine output
• B) Decreased heart rate
• C) Crackles in lung bases
• D) Skin turgor improving
Correct Answer: C) Crackles in lung bases
Rationale: Crackles indicate pulmonary congestion from fluid overload. Increased
urine output and improved skin turgor are signs of effective rehydration, not
overload.
10. The PN is caring for a client with a nasogastric (NG) tube to low
intermittent suction. Which electrolyte imbalance is a priority to monitor?
• A) Hyperkalemia
• B) Hyponatremia
• C) Hypokalemia
• D) Hypercalcemia
Correct Answer: C) Hypokalemia
Rationale: NG suction removes gastric contents rich in potassium and hydrogen
ions, leading to hypokalemia and metabolic alkalosis. Potassium levels must be
monitored closely.
11. A client with Alzheimer's disease is wandering into other clients' rooms.
What is the best intervention?
300 PRACTICE QUESTIONS WITH
RATIONALES FOR NEXT-GEN
NCLEX-PN SUCCESS | WITH
VERIFIED ANSWERS | A+GRADED
[MOST RECENT!!]
1. A client with heart failure reports sudden weight gain of 3 lbs in 24 hours and
ankle swelling. What is the PN's priority action?
• A) Restrict fluids to 1,000 mL/day
• B) Auscultate lung sounds
• C) Teach low-sodium diet
• D) Weigh the client again in the morning
Correct Answer: B) Auscultate lung sounds
Rationale: Sudden weight gain and edema indicate fluid volume overload, which can
lead to pulmonary congestion. The priority is to assess lung sounds for crackles,
which would indicate worsening heart failure and require immediate intervention.
2. A post-op client has a Jackson-Pratt (JP) drain. Which finding requires
immediate notification of the healthcare provider?
• A) 50 mL serosanguinous drainage in 8 hours
• B) Drainage changes from pink to bright red
• C) Drain site has small amount of crusting
• D) Client reports mild discomfort at site
Correct Answer: B) Drainage changes from pink to bright red
Rationale: A change from serosanguinous to bright red drainage suggests active
,bleeding. This requires immediate HCP notification. Serosanguinous drainage,
crusting, and mild discomfort are expected post-op findings.
3. A client with schizophrenia is experiencing auditory hallucinations. What is
the best therapeutic response?
• A) "I know the voices are real to you, but I don't hear them."
• B) "Stop paying attention to those voices."
• C) "Tell me exactly what the voices are saying."
• D) "Take your medication and the voices will go away."
Correct Answer: A) "I know the voices are real to you, but I don't hear them."
Rationale: This response validates the client's experience without reinforcing the
hallucination. It is reality-based and therapeutic. Arguing, dismissing, or focusing too
much on content is not helpful.
4. The PN is reinforcing teaching about insulin self-administration. Which client
statement indicates a need for further teaching?
• A) "I will rotate injection sites within the same area."
• B) "I will draw up NPH insulin first, then regular insulin."
• C) "I will keep unopened vials in the refrigerator."
• D) "I will massage the site after injection to help absorption."
Correct Answer: D) "I will massage the site after injection to help absorption."
Rationale: Massaging the injection site can increase absorption unpredictably and
cause bruising. Clients should avoid massaging. The other statements are correct
practices.
5. A client on warfarin has an INR of 4.5. What is the PN's priority action?
• A) Administer vitamin K as ordered
• B) Hold the next dose and notify HCP
• C) Check for signs of bleeding
• D) Administer protamine sulfate
,Correct Answer: B) Hold the next dose and notify HCP
Rationale: Therapeutic INR for most conditions is 2.0–3.0. An INR of 4.5 is elevated
and increases bleeding risk. The PN should hold the dose and notify the HCP for
further orders. Protamine is for heparin, not warfarin.
6. A client with COPD has an oxygen saturation of 88% on room air. Which
oxygen delivery device is most appropriate?
• A) Simple face mask at 6 L/min
• B) Non-rebreather mask at 10 L/min
• C) Nasal cannula at 2 L/min
• D) Venturi mask at 24%
Correct Answer: C) Nasal cannula at 2 L/min
Rationale: COPD clients rely on hypoxic drive; high-flow oxygen can suppress their
respiratory drive. Low-flow oxygen via nasal cannula (1–3 L/min) is safest to achieve
target SpO₂ of 88–92%.
7. A laboring client's fetal heart rate drops to 90 bpm during a contraction and
returns to baseline after the contraction ends. What type of deceleration is this?
• A) Early deceleration
• B) Late deceleration
• C) Variable deceleration
• D) Prolonged deceleration
Correct Answer: A) Early deceleration
Rationale: Early decelerations mirror contractions, start at the onset, and return to
baseline by the end. They are benign and caused by fetal head compression. Late
decelerations are worrisome and indicate uteroplacental insufficiency.
8. A post-partum client reports a gush of blood and a firm, displaced uterus to
the right. What should the PN do first?
• A) Massage the uterus
• B) Assist the client to void
, • C) Call the healthcare provider
• D) Administer oxytocin
Correct Answer: B) Assist the client to void
Rationale: A firm uterus that is displaced suggests a full bladder pushing the uterus
upward and to the side, preventing contraction. Emptying the bladder usually allows
the uterus to return to midline and contract effectively.
9. A child with dehydration is receiving IV fluids. Which assessment finding
indicates fluid volume overload?
• A) Increased urine output
• B) Decreased heart rate
• C) Crackles in lung bases
• D) Skin turgor improving
Correct Answer: C) Crackles in lung bases
Rationale: Crackles indicate pulmonary congestion from fluid overload. Increased
urine output and improved skin turgor are signs of effective rehydration, not
overload.
10. The PN is caring for a client with a nasogastric (NG) tube to low
intermittent suction. Which electrolyte imbalance is a priority to monitor?
• A) Hyperkalemia
• B) Hyponatremia
• C) Hypokalemia
• D) Hypercalcemia
Correct Answer: C) Hypokalemia
Rationale: NG suction removes gastric contents rich in potassium and hydrogen
ions, leading to hypokalemia and metabolic alkalosis. Potassium levels must be
monitored closely.
11. A client with Alzheimer's disease is wandering into other clients' rooms.
What is the best intervention?
