The Ultimate and Complete HESI LPN to ADN Entrance and Exit Exam Study
Guide 2025, Covering Comprehensive Nursing Fundamentals, Medical-
Surgical Nursing, Pharmacology, Maternal and Pediatric Nursing, Mental
Health Concepts, Critical Thinking and Clinical Judgment, Dosage
Calculations, Patient Care Prioritization, Practice Questions with Verified
Answers and Detailed Rationales, Real Exam Scenarios, Step-by-Step
Strategies, and Proven Methods to Successfully Pass the HESI LPN to ADN
Transition Exam on the First Attempt
**Question 1: **A nurse is preparing to administer a medication via the intravenous route. Which action
should the nurse take first to ensure patient safety?
A. Check the patient's allergy band.
B. Verify the physician's order.
C. Wash hands thoroughly.
D. Explain the procedure to the patient.
CORRECT ANSWER: B. Verify the physician's order.
RATIONALE: The first step in medication administration is verifying the order to ensure the right
medication, dose, route, and time. While hand hygiene and allergy checks are critical, they follow
verification of the legal order.
**Question 2: **A patient with chronic obstructive pulmonary disease (COPD) is prescribed oxygen
therapy. What is the primary reason for maintaining low-flow oxygen in this population?
A. To prevent oxygen toxicity.
B. To avoid suppressing the hypoxic drive.
C. To reduce the risk of fire.
D. To ensure cost-effectiveness.
CORRECT ANSWER: B. To avoid suppressing the hypoxic drive.
RATIONALE: Patients with chronic COPD may rely on low oxygen levels (hypoxic drive) to stimulate
breathing. High concentrations of oxygen can suppress this drive, leading to respiratory depression.
**Question 3: **Which assessment finding indicates that a patient is experiencing fluid volume
overload?
A. Decreased blood pressure.
B. Dry mucous membranes.
C. Distended neck veins.
D. Poor skin turgor.
CORRECT ANSWER: C. Distended neck veins.
RATIONALE: Distended neck veins (jugular venous distension) are a classic sign of fluid volume
overload. Decreased BP, dry membranes, and poor turgor indicate fluid volume deficit.
,**Question 4: **A nurse is caring for a patient with a nasogastric (NG) tube connected to suction. What
is the priority nursing intervention?
A. Irrigate the tube with tap water every hour.
B. Monitor electrolyte levels regularly.
C. Secure the tube to the patient's gown.
D. Allow the patient to eat ice chips.
CORRECT ANSWER: B. Monitor electrolyte levels regularly.
RATIONALE: NG suction can lead to significant loss of electrolytes, particularly potassium and sodium.
Monitoring levels is priority to prevent imbalances. Ice chips are usually restricted unless ordered.
**Question 5: **When performing a sterile dressing change, which action by the nurse breaks sterile
technique?
A. Holding sterile items above waist level.
B. Opening the sterile package away from the body.
C. Reaching over the sterile field to grab a supply.
D. Pouring solution from a height of 4 inches.
CORRECT ANSWER: C. Reaching over the sterile field to grab a supply.
RATIONALE: Reaching over a sterile field contaminates it because particles from the arms or clothing
can fall onto the sterile surface. All other options maintain sterility.
**Question 6: **A patient is admitted with suspected deep vein thrombosis (DVT). Which intervention is
contraindicated?
A. Elevating the affected leg.
B. Applying warm compresses.
C. Massaging the affected leg.
D. Administering anticoagulants.
CORRECT ANSWER: C. Massaging the affected leg.
RATIONALE: Massaging the leg can dislodge the clot, causing a pulmonary embolism. Elevation,
warmth, and anticoagulants are appropriate interventions.
**Question 7: **Which finding should a nurse report immediately in a patient receiving digoxin
(Lanoxin)?
A. Heart rate of 58 beats per minute.
B. Blood pressure of 130/80 mmHg.
C. Potassium level of 4.0 mEq/L.
D. Respiratory rate of 16 breaths per minute.
CORRECT ANSWER: A. Heart rate of 58 beats per minute.
RATIONALE: Digoxin slows the heart rate. A pulse below 60 bpm in an adult requires holding the
medication and notifying the provider to prevent toxicity.
,**Question 8: **A nurse is teaching a patient about warfarin (Coumadin) therapy. Which statement by
the patient indicates a need for further teaching?
A. "I will use a soft-bristle toothbrush."
B. "I will avoid eating large amounts of leafy greens."
C. "I will take ibuprofen for headaches."
D. "I will wear a medical alert bracelet."
CORRECT ANSWER: C. "I will take ibuprofen for headaches."
RATIONALE: NSAIDs like ibuprofen increase the risk of bleeding when taken with warfarin.
Acetaminophen is preferred. The other statements show correct understanding.
**Question 9: **What is the most reliable indicator of pain in a non-verbal adult patient?
A. Family report of pain.
B. Physiological changes like increased heart rate.
C. Behavioral indicators such as grimacing.
D. The nurse's intuition.
CORRECT ANSWER: C. Behavioral indicators such as grimacing.
RATIONALE: In non-verbal patients, behavioral cues (grimacing, guarding, restlessness) are the most
reliable indicators. Physiological changes can be caused by other factors.
**Question 10: **A patient with diabetes mellitus is learning about foot care. Which instruction is most
important?
A. Soak feet in hot water daily.
B. Cut toenails straight across.
C. Walk barefoot inside the house.
D. Apply lotion between the toes.
CORRECT ANSWER: B. Cut toenails straight across.
RATIONALE: Cutting nails straight across prevents ingrown toenails and infection. Soaking can
macerate skin, barefoot walking risks injury, and lotion between toes promotes fungal growth.
**Question 11: **Which symptom is characteristic of hypoglycemia in a patient with diabetes?
A. Polyuria.
B. Kussmaul respirations.
C. Diaphoresis and tremors.
D. Fruity breath odor.
CORRECT ANSWER: C. Diaphoresis and tremors.
RATIONALE: Diaphoresis (sweating) and tremors are adrenergic symptoms of low blood sugar. Polyuria,
Kussmaul respirations, and fruity breath are signs of hyperglycemia/ketoacidosis.
, **Question 12: **A nurse is caring for a patient with a chest tube. What should the nurse do if the
drainage system is accidentally disconnected?
A. Clamp the chest tube immediately.
B. Submerge the tube end in sterile water.
C. Reconnect the system quickly without cleaning.
D. Call the physician before taking action.
CORRECT ANSWER: B. Submerge the tube end in sterile water.
RATIONALE: Submerging the tube creates a water seal, preventing air from entering the pleural space
(pneumothorax) until the system is replaced. Clamping is generally avoided unless specifically ordered.
**Question 13: **Which laboratory value is most important to monitor in a patient with chronic kidney
disease (CKD)?
A. Hemoglobin.
B. Potassium.
C. Calcium.
D. White blood cells.
CORRECT ANSWER: B. Potassium.
RATIONALE: Kidneys regulate potassium. In CKD, hyperkalemia is a life-threatening complication that
can cause cardiac arrhythmias.
**Question 14: **A patient is post-operative following a hip replacement. Which position should be
maintained to prevent dislocation?
A. Legs crossed at the ankles.
B. Hips flexed greater than 90 degrees.
C. Legs abducted with a pillow between them.
D. Internal rotation of the affected leg.
CORRECT ANSWER: C. Legs abducted with a pillow between them.
RATIONALE: Abduction prevents adduction across the midline, which is a primary mechanism for hip
dislocation. Flexion >90 degrees and internal rotation are also restricted.
**Question 15: **What is the priority action for a nurse who suspects a patient is having a transfusion
reaction?
A. Slow the infusion rate.
B. Stop the transfusion immediately.
C. Administer antihistamines.
D. Notify the blood bank.
CORRECT ANSWER: B. Stop the transfusion immediately.
RATIONALE: Stopping the infusion prevents further infusion of incompatible blood. The line should be
kept open with saline, then the provider notified.
Guide 2025, Covering Comprehensive Nursing Fundamentals, Medical-
Surgical Nursing, Pharmacology, Maternal and Pediatric Nursing, Mental
Health Concepts, Critical Thinking and Clinical Judgment, Dosage
Calculations, Patient Care Prioritization, Practice Questions with Verified
Answers and Detailed Rationales, Real Exam Scenarios, Step-by-Step
Strategies, and Proven Methods to Successfully Pass the HESI LPN to ADN
Transition Exam on the First Attempt
**Question 1: **A nurse is preparing to administer a medication via the intravenous route. Which action
should the nurse take first to ensure patient safety?
A. Check the patient's allergy band.
B. Verify the physician's order.
C. Wash hands thoroughly.
D. Explain the procedure to the patient.
CORRECT ANSWER: B. Verify the physician's order.
RATIONALE: The first step in medication administration is verifying the order to ensure the right
medication, dose, route, and time. While hand hygiene and allergy checks are critical, they follow
verification of the legal order.
**Question 2: **A patient with chronic obstructive pulmonary disease (COPD) is prescribed oxygen
therapy. What is the primary reason for maintaining low-flow oxygen in this population?
A. To prevent oxygen toxicity.
B. To avoid suppressing the hypoxic drive.
C. To reduce the risk of fire.
D. To ensure cost-effectiveness.
CORRECT ANSWER: B. To avoid suppressing the hypoxic drive.
RATIONALE: Patients with chronic COPD may rely on low oxygen levels (hypoxic drive) to stimulate
breathing. High concentrations of oxygen can suppress this drive, leading to respiratory depression.
**Question 3: **Which assessment finding indicates that a patient is experiencing fluid volume
overload?
A. Decreased blood pressure.
B. Dry mucous membranes.
C. Distended neck veins.
D. Poor skin turgor.
CORRECT ANSWER: C. Distended neck veins.
RATIONALE: Distended neck veins (jugular venous distension) are a classic sign of fluid volume
overload. Decreased BP, dry membranes, and poor turgor indicate fluid volume deficit.
,**Question 4: **A nurse is caring for a patient with a nasogastric (NG) tube connected to suction. What
is the priority nursing intervention?
A. Irrigate the tube with tap water every hour.
B. Monitor electrolyte levels regularly.
C. Secure the tube to the patient's gown.
D. Allow the patient to eat ice chips.
CORRECT ANSWER: B. Monitor electrolyte levels regularly.
RATIONALE: NG suction can lead to significant loss of electrolytes, particularly potassium and sodium.
Monitoring levels is priority to prevent imbalances. Ice chips are usually restricted unless ordered.
**Question 5: **When performing a sterile dressing change, which action by the nurse breaks sterile
technique?
A. Holding sterile items above waist level.
B. Opening the sterile package away from the body.
C. Reaching over the sterile field to grab a supply.
D. Pouring solution from a height of 4 inches.
CORRECT ANSWER: C. Reaching over the sterile field to grab a supply.
RATIONALE: Reaching over a sterile field contaminates it because particles from the arms or clothing
can fall onto the sterile surface. All other options maintain sterility.
**Question 6: **A patient is admitted with suspected deep vein thrombosis (DVT). Which intervention is
contraindicated?
A. Elevating the affected leg.
B. Applying warm compresses.
C. Massaging the affected leg.
D. Administering anticoagulants.
CORRECT ANSWER: C. Massaging the affected leg.
RATIONALE: Massaging the leg can dislodge the clot, causing a pulmonary embolism. Elevation,
warmth, and anticoagulants are appropriate interventions.
**Question 7: **Which finding should a nurse report immediately in a patient receiving digoxin
(Lanoxin)?
A. Heart rate of 58 beats per minute.
B. Blood pressure of 130/80 mmHg.
C. Potassium level of 4.0 mEq/L.
D. Respiratory rate of 16 breaths per minute.
CORRECT ANSWER: A. Heart rate of 58 beats per minute.
RATIONALE: Digoxin slows the heart rate. A pulse below 60 bpm in an adult requires holding the
medication and notifying the provider to prevent toxicity.
,**Question 8: **A nurse is teaching a patient about warfarin (Coumadin) therapy. Which statement by
the patient indicates a need for further teaching?
A. "I will use a soft-bristle toothbrush."
B. "I will avoid eating large amounts of leafy greens."
C. "I will take ibuprofen for headaches."
D. "I will wear a medical alert bracelet."
CORRECT ANSWER: C. "I will take ibuprofen for headaches."
RATIONALE: NSAIDs like ibuprofen increase the risk of bleeding when taken with warfarin.
Acetaminophen is preferred. The other statements show correct understanding.
**Question 9: **What is the most reliable indicator of pain in a non-verbal adult patient?
A. Family report of pain.
B. Physiological changes like increased heart rate.
C. Behavioral indicators such as grimacing.
D. The nurse's intuition.
CORRECT ANSWER: C. Behavioral indicators such as grimacing.
RATIONALE: In non-verbal patients, behavioral cues (grimacing, guarding, restlessness) are the most
reliable indicators. Physiological changes can be caused by other factors.
**Question 10: **A patient with diabetes mellitus is learning about foot care. Which instruction is most
important?
A. Soak feet in hot water daily.
B. Cut toenails straight across.
C. Walk barefoot inside the house.
D. Apply lotion between the toes.
CORRECT ANSWER: B. Cut toenails straight across.
RATIONALE: Cutting nails straight across prevents ingrown toenails and infection. Soaking can
macerate skin, barefoot walking risks injury, and lotion between toes promotes fungal growth.
**Question 11: **Which symptom is characteristic of hypoglycemia in a patient with diabetes?
A. Polyuria.
B. Kussmaul respirations.
C. Diaphoresis and tremors.
D. Fruity breath odor.
CORRECT ANSWER: C. Diaphoresis and tremors.
RATIONALE: Diaphoresis (sweating) and tremors are adrenergic symptoms of low blood sugar. Polyuria,
Kussmaul respirations, and fruity breath are signs of hyperglycemia/ketoacidosis.
, **Question 12: **A nurse is caring for a patient with a chest tube. What should the nurse do if the
drainage system is accidentally disconnected?
A. Clamp the chest tube immediately.
B. Submerge the tube end in sterile water.
C. Reconnect the system quickly without cleaning.
D. Call the physician before taking action.
CORRECT ANSWER: B. Submerge the tube end in sterile water.
RATIONALE: Submerging the tube creates a water seal, preventing air from entering the pleural space
(pneumothorax) until the system is replaced. Clamping is generally avoided unless specifically ordered.
**Question 13: **Which laboratory value is most important to monitor in a patient with chronic kidney
disease (CKD)?
A. Hemoglobin.
B. Potassium.
C. Calcium.
D. White blood cells.
CORRECT ANSWER: B. Potassium.
RATIONALE: Kidneys regulate potassium. In CKD, hyperkalemia is a life-threatening complication that
can cause cardiac arrhythmias.
**Question 14: **A patient is post-operative following a hip replacement. Which position should be
maintained to prevent dislocation?
A. Legs crossed at the ankles.
B. Hips flexed greater than 90 degrees.
C. Legs abducted with a pillow between them.
D. Internal rotation of the affected leg.
CORRECT ANSWER: C. Legs abducted with a pillow between them.
RATIONALE: Abduction prevents adduction across the midline, which is a primary mechanism for hip
dislocation. Flexion >90 degrees and internal rotation are also restricted.
**Question 15: **What is the priority action for a nurse who suspects a patient is having a transfusion
reaction?
A. Slow the infusion rate.
B. Stop the transfusion immediately.
C. Administer antihistamines.
D. Notify the blood bank.
CORRECT ANSWER: B. Stop the transfusion immediately.
RATIONALE: Stopping the infusion prevents further infusion of incompatible blood. The line should be
kept open with saline, then the provider notified.
