Rationals - Exit HESI PN V2 updated exam
2025/2026
rationale - ANSWER-The PN should observe the UAP's ability to safely feed a client
at risk for aspiration. Once the UP's ability to safely perform the skill has been
established, the UAP should identify and report if a client develops a
compromised airway.
rationale - ANSWER-Behavioral modification programs are most successful when
the desired behavior is rewarded with a client-specific preference. The practical
nurse (PN) should provide a positive reinforcement that will motivate the client.
rationale - ANSWER-Chronic kidney disease (CKD) is a progressive, irreversible loss
of kidney function, decreasing glomerular filtration rate (GFR), and the kidney's
inability to excrete metabolic waste products and water, resulting in fluid
overload, elevated blood pressure, and changes in mental status. In the plan of
care, weigh every morning should be implemented by the PN to evaluate fluid
retention and overload that can affect cardiac workload
rationale - ANSWER-The PN should interpret a loud, harsh murmur upon
auscultation with a palpable systolic thrill as a normal finding for a 9-month-old
with VSD. A VSD is an abnormal opening between the right and left ventricle. The
harsh murmur and thrill is produced by the vibrations in the heart caused by the
back and flow of blood
, rationale - ANSWER-The PN should interpret a loud, harsh murmur upon
auscultation with a palpable systolic thrill as a normal finding for a 9-month-old
with VSD. A VSD is an abnormal opening between the right and left ventricle. The
harsh murmur and thrill is produced by the vibrations in the heart caused by the
back and flow of blood.
rationale - ANSWER-Hair usually grows back after chemotherapy, but the color
and texture may change. Often hair is curly after chemotherapy.
rationale - ANSWER-The unlicensed assistive personnel (UP) can be assigned to
measure nasogastric output and replace a full canister when needed.
rationale - ANSWER-Clostridium difficile is spread by touch requiring the
implementation of contact precautions. The PN should use non-sterile gloves
when providing direct client care.
The other actions are not necessary with contact precautions
rationale - ANSWER-A fully oriented person is oriented to person, place, time, and
situation (oriented x4). A person who is only oriented to one of these elements is
at risk for injury. The
PN should provide instructions to the UP about additional support for the client.
rationale - ANSWER-For a client who had a stroke and has right-sided weakness,
safe practice mandates that the client is ambulated with assistance on the client's
affected side
2025/2026
rationale - ANSWER-The PN should observe the UAP's ability to safely feed a client
at risk for aspiration. Once the UP's ability to safely perform the skill has been
established, the UAP should identify and report if a client develops a
compromised airway.
rationale - ANSWER-Behavioral modification programs are most successful when
the desired behavior is rewarded with a client-specific preference. The practical
nurse (PN) should provide a positive reinforcement that will motivate the client.
rationale - ANSWER-Chronic kidney disease (CKD) is a progressive, irreversible loss
of kidney function, decreasing glomerular filtration rate (GFR), and the kidney's
inability to excrete metabolic waste products and water, resulting in fluid
overload, elevated blood pressure, and changes in mental status. In the plan of
care, weigh every morning should be implemented by the PN to evaluate fluid
retention and overload that can affect cardiac workload
rationale - ANSWER-The PN should interpret a loud, harsh murmur upon
auscultation with a palpable systolic thrill as a normal finding for a 9-month-old
with VSD. A VSD is an abnormal opening between the right and left ventricle. The
harsh murmur and thrill is produced by the vibrations in the heart caused by the
back and flow of blood
, rationale - ANSWER-The PN should interpret a loud, harsh murmur upon
auscultation with a palpable systolic thrill as a normal finding for a 9-month-old
with VSD. A VSD is an abnormal opening between the right and left ventricle. The
harsh murmur and thrill is produced by the vibrations in the heart caused by the
back and flow of blood.
rationale - ANSWER-Hair usually grows back after chemotherapy, but the color
and texture may change. Often hair is curly after chemotherapy.
rationale - ANSWER-The unlicensed assistive personnel (UP) can be assigned to
measure nasogastric output and replace a full canister when needed.
rationale - ANSWER-Clostridium difficile is spread by touch requiring the
implementation of contact precautions. The PN should use non-sterile gloves
when providing direct client care.
The other actions are not necessary with contact precautions
rationale - ANSWER-A fully oriented person is oriented to person, place, time, and
situation (oriented x4). A person who is only oriented to one of these elements is
at risk for injury. The
PN should provide instructions to the UP about additional support for the client.
rationale - ANSWER-For a client who had a stroke and has right-sided weakness,
safe practice mandates that the client is ambulated with assistance on the client's
affected side
