HESI LPN TO ADN ENTRANCE EXAM 2025
2026 COMPLETE PRACTICE QUESTIONS
RATIONALES AND NURSING ADMISSION
STUDY GUIDE
HESI LPN-to-ADN Entrance Exam
A nurse is preparing to ambulate a client who had cardiac surgery 48
hours ago. What action should the nurse take to ensure the client best
tolerates the activity?
A. Remove the telemetry monitor during the walk.
B. Provide the client with a walker for stability.
C. Premedicate the client with an analgesic 30 minutes prior.
D. Encourage the client to use a spirometer just before walking.
Rationale: Pain management is the priority for mobility. Managing
postoperative pain allows the client to exert more effort during
ambulation and prevents complications like atelectasis.
1. A client with Type 2 Diabetes has a syncopal episode two days after
a hysterectomy. Vital signs are stable, but the blood glucose is 325
mg/dL. Which intervention is first?
A. Notify the healthcare provider immediately.
B. Administer regular insulin per sliding scale.
C. Give the client 4 ounces of orange juice.
D. Recheck the blood glucose in one hour.
Rationale: Hyperglycemia in a post-surgical client can delay
wound healing and increase infection risk. Following the
established sliding scale is the immediate nursing action.
2. A 3-week-old infant is admitted for surgical repair of Pyloric
Stenosis. Which intervention should the nurse implement for
hydration in the immediate postoperative period?
A. Maintain NPO status for 24 hours.
B. Initiate small nipple feedings with glucose water.
C. Administer bolus IV normal saline at 20 mL/kg.
D. Offer full-strength formula immediately.
Rationale: Post-pyloromyotomy care involves early, small,
, frequent feedings of clear liquids (glucose water) to ensure the
surgical site is patent before advancing to formula.
3. A nurse is caring for a client receiving an IV magnesium infusion.
Which assessment finding requires the nurse to stop the infusion
immediately?
A. Absent patellar reflex.
B. Diarrhea.
C. Premature ventricular contractions.
D. Increased blood pressure.
Rationale: Absent deep tendon reflexes (DTRs) are a sign of
magnesium toxicity, which can lead to respiratory depression
and cardiac arrest.
4. A client with chronic renal failure reports a 10-pound weight loss
and difficulty taking calcium supplements. The serum calcium is
6.9 mg/dL. What is the first nursing action?
A. Assess for depressed deep tendon reflexes.
B. Call the physician to report the level.
C. Check the serum albumin level.
D. Initiate seizure precautions.
Rationale: Since calcium is highly protein-bound, a low serum
calcium may be "false" if albumin is also low. Corrected calcium
must be calculated before aggressive treatment.
5. A client with Type 2 Diabetes says, "I am so frustrated; I cannot
stick to the diet I am supposed to." What is the most helpful
supportive intervention?
A. Schedule a revisit with the dietician.
B. Obtain a consult for behavioral therapy.
C. Instruct the client to maintain a 24-hour food log.
D. Encourage the client to increase daily exercise.
Rationale: Behavioral therapy addresses the psychological
barriers to lifestyle changes, which is more effective than
repeated education when a client expresses frustration and
inability to comply.
6. To prevent pacemaker dislodgement following a right subclavian
insertion, what instruction should the nurse give the client?
A. Keep the right arm above the head during sleep.
B. Limit the movement and abduction of the right arm.
C. Avoid wearing a shirt with buttons or zippers.
, D. Remain on bed rest for the first 48 hours.
Rationale: Excessive movement or abduction of the arm on the
side of the insertion can pull the newly placed leads out of the
heart tissue.
7. A nurse assesses a client with multiple myeloma and finds a serum
calcium level of 13 mg/dL. Which action is the priority?
A. Provide a diet high in calcium.
B. Encourage fluid intake and monitor hydration.
C. Administer calcium gluconate IV.
D. Assess the client for Trousseau's sign.
Rationale: This client is experiencing hypercalcemia. Increasing
fluids helps the kidneys excrete excess calcium and prevents stone
formation.
8. Which client is at the highest risk for developing bacterial cystitis?
A. A young male with a history of kidney stones.
B. An older female not using estrogen replacement.
C. A middle-aged male with high blood pressure.
D. A pregnant female in her second trimester.
Rationale: Postmenopausal women not on estrogen have
decreased vaginal flora (lactobacilli), which allows for the
overgrowth of E. coli, the primary cause of UTIs.
9. A child with a fever of unknown origin (FUO) begins vomiting. The
temperature is 101.8°F. The last antipyretic dose was 5 hours ago.
The child has a prescription for oral or rectal acetaminophen. What
should the nurse do?
A. Administer the oral elixir immediately.
B. Make the child NPO and administer the suppository.
C. Wait one hour and recheck the temperature.
D. Encourage oral fluids to prevent dehydration.
Rationale: Because the child is actively vomiting, oral medication
is contraindicated. The rectal route provides safe antipyretic
delivery while maintaining NPO status to prevent further
vomiting. [1, 2, 3, 4, 5]
11. A client with a diagnosis of heart failure is prescribed furosemide.
Which finding indicates the medication is having the desired
effect?
A. Decreased heart rate.
B. Decreased crackles in the lung bases.
, C. Increased serum potassium.
D. Increased blood pressure.
Rationale: Furosemide is a loop diuretic used to reduce fluid
volume. A decrease in pulmonary congestion (crackles) indicates
the reduction of fluid overload.
12.A nurse is caring for a client with a nasogastric (NG) tube to low
intermittent suction. The client reports feeling nauseated. What is
the first action the nurse should take?
A. Notify the healthcare provider.
B. Check the tube for kinks or obstructions.
C. Administer an antiemetic as prescribed.
D. Irrigate the tube with 30 mL of normal saline.
Rationale: The most common cause of nausea in a client with an
NG tube is tube displacement or blockage. Assessing the
equipment is the first step in troubleshooting.
13.A client is admitted with a suspected bowel obstruction. Which
assessment finding should the nurse report to the healthcare
provider immediately?
A. Hypoactive bowel sounds.
B. A rigid, board-like abdomen.
C. Cramping abdominal pain.
D. Nausea and vomiting.
Rationale: A rigid, board-like abdomen is a classic sign of
peritonitis, which is a medical emergency indicating potential
perforation.
14.While caring for a client with a chest tube, the nurse notes that the
bubbling in the water-seal chamber has stopped. What is the likely
cause?
A. A leak in the system.
B. The suction is set too high.
C. The lung has fully re-expanded.
D. The client is experiencing a pneumothorax.
Rationale: Bubbling stops when the lung is re-expanded or if
there is an obstruction in the tube. If the lung is expanded, the air
has been removed from the pleural space.
15. A client is receiving a blood transfusion and develops hives and
itching. What is the nurse's priority action?
A. Slow the infusion rate.
2026 COMPLETE PRACTICE QUESTIONS
RATIONALES AND NURSING ADMISSION
STUDY GUIDE
HESI LPN-to-ADN Entrance Exam
A nurse is preparing to ambulate a client who had cardiac surgery 48
hours ago. What action should the nurse take to ensure the client best
tolerates the activity?
A. Remove the telemetry monitor during the walk.
B. Provide the client with a walker for stability.
C. Premedicate the client with an analgesic 30 minutes prior.
D. Encourage the client to use a spirometer just before walking.
Rationale: Pain management is the priority for mobility. Managing
postoperative pain allows the client to exert more effort during
ambulation and prevents complications like atelectasis.
1. A client with Type 2 Diabetes has a syncopal episode two days after
a hysterectomy. Vital signs are stable, but the blood glucose is 325
mg/dL. Which intervention is first?
A. Notify the healthcare provider immediately.
B. Administer regular insulin per sliding scale.
C. Give the client 4 ounces of orange juice.
D. Recheck the blood glucose in one hour.
Rationale: Hyperglycemia in a post-surgical client can delay
wound healing and increase infection risk. Following the
established sliding scale is the immediate nursing action.
2. A 3-week-old infant is admitted for surgical repair of Pyloric
Stenosis. Which intervention should the nurse implement for
hydration in the immediate postoperative period?
A. Maintain NPO status for 24 hours.
B. Initiate small nipple feedings with glucose water.
C. Administer bolus IV normal saline at 20 mL/kg.
D. Offer full-strength formula immediately.
Rationale: Post-pyloromyotomy care involves early, small,
, frequent feedings of clear liquids (glucose water) to ensure the
surgical site is patent before advancing to formula.
3. A nurse is caring for a client receiving an IV magnesium infusion.
Which assessment finding requires the nurse to stop the infusion
immediately?
A. Absent patellar reflex.
B. Diarrhea.
C. Premature ventricular contractions.
D. Increased blood pressure.
Rationale: Absent deep tendon reflexes (DTRs) are a sign of
magnesium toxicity, which can lead to respiratory depression
and cardiac arrest.
4. A client with chronic renal failure reports a 10-pound weight loss
and difficulty taking calcium supplements. The serum calcium is
6.9 mg/dL. What is the first nursing action?
A. Assess for depressed deep tendon reflexes.
B. Call the physician to report the level.
C. Check the serum albumin level.
D. Initiate seizure precautions.
Rationale: Since calcium is highly protein-bound, a low serum
calcium may be "false" if albumin is also low. Corrected calcium
must be calculated before aggressive treatment.
5. A client with Type 2 Diabetes says, "I am so frustrated; I cannot
stick to the diet I am supposed to." What is the most helpful
supportive intervention?
A. Schedule a revisit with the dietician.
B. Obtain a consult for behavioral therapy.
C. Instruct the client to maintain a 24-hour food log.
D. Encourage the client to increase daily exercise.
Rationale: Behavioral therapy addresses the psychological
barriers to lifestyle changes, which is more effective than
repeated education when a client expresses frustration and
inability to comply.
6. To prevent pacemaker dislodgement following a right subclavian
insertion, what instruction should the nurse give the client?
A. Keep the right arm above the head during sleep.
B. Limit the movement and abduction of the right arm.
C. Avoid wearing a shirt with buttons or zippers.
, D. Remain on bed rest for the first 48 hours.
Rationale: Excessive movement or abduction of the arm on the
side of the insertion can pull the newly placed leads out of the
heart tissue.
7. A nurse assesses a client with multiple myeloma and finds a serum
calcium level of 13 mg/dL. Which action is the priority?
A. Provide a diet high in calcium.
B. Encourage fluid intake and monitor hydration.
C. Administer calcium gluconate IV.
D. Assess the client for Trousseau's sign.
Rationale: This client is experiencing hypercalcemia. Increasing
fluids helps the kidneys excrete excess calcium and prevents stone
formation.
8. Which client is at the highest risk for developing bacterial cystitis?
A. A young male with a history of kidney stones.
B. An older female not using estrogen replacement.
C. A middle-aged male with high blood pressure.
D. A pregnant female in her second trimester.
Rationale: Postmenopausal women not on estrogen have
decreased vaginal flora (lactobacilli), which allows for the
overgrowth of E. coli, the primary cause of UTIs.
9. A child with a fever of unknown origin (FUO) begins vomiting. The
temperature is 101.8°F. The last antipyretic dose was 5 hours ago.
The child has a prescription for oral or rectal acetaminophen. What
should the nurse do?
A. Administer the oral elixir immediately.
B. Make the child NPO and administer the suppository.
C. Wait one hour and recheck the temperature.
D. Encourage oral fluids to prevent dehydration.
Rationale: Because the child is actively vomiting, oral medication
is contraindicated. The rectal route provides safe antipyretic
delivery while maintaining NPO status to prevent further
vomiting. [1, 2, 3, 4, 5]
11. A client with a diagnosis of heart failure is prescribed furosemide.
Which finding indicates the medication is having the desired
effect?
A. Decreased heart rate.
B. Decreased crackles in the lung bases.
, C. Increased serum potassium.
D. Increased blood pressure.
Rationale: Furosemide is a loop diuretic used to reduce fluid
volume. A decrease in pulmonary congestion (crackles) indicates
the reduction of fluid overload.
12.A nurse is caring for a client with a nasogastric (NG) tube to low
intermittent suction. The client reports feeling nauseated. What is
the first action the nurse should take?
A. Notify the healthcare provider.
B. Check the tube for kinks or obstructions.
C. Administer an antiemetic as prescribed.
D. Irrigate the tube with 30 mL of normal saline.
Rationale: The most common cause of nausea in a client with an
NG tube is tube displacement or blockage. Assessing the
equipment is the first step in troubleshooting.
13.A client is admitted with a suspected bowel obstruction. Which
assessment finding should the nurse report to the healthcare
provider immediately?
A. Hypoactive bowel sounds.
B. A rigid, board-like abdomen.
C. Cramping abdominal pain.
D. Nausea and vomiting.
Rationale: A rigid, board-like abdomen is a classic sign of
peritonitis, which is a medical emergency indicating potential
perforation.
14.While caring for a client with a chest tube, the nurse notes that the
bubbling in the water-seal chamber has stopped. What is the likely
cause?
A. A leak in the system.
B. The suction is set too high.
C. The lung has fully re-expanded.
D. The client is experiencing a pneumothorax.
Rationale: Bubbling stops when the lung is re-expanded or if
there is an obstruction in the tube. If the lung is expanded, the air
has been removed from the pleural space.
15. A client is receiving a blood transfusion and develops hives and
itching. What is the nurse's priority action?
A. Slow the infusion rate.
