ELSEVIER / HESI ASSESSMENT
HESI LPN-to-ADN Entrance Exam
LPN-to-RN Bridge Program Admission
Official Practice Exam · 2026/2027 Edition
Questions: 100 Minutes: 90 Passing Score: 80% Format: NGN
TABLE OF CONTENTS
Section 1: Medical-Surgical Nursing (Q1–Q30)
Section 2: Pediatric Nursing (Q31–Q50)
Section 3: Maternity / Obstetric Nursing (Q51–Q70)
Section 4: Psychiatric / Mental Health Nursing (Q71–Q85)
Section 5: Nursing Fundamentals & Professional Issues (Q86–Q100)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. A scenario-based format is
used throughout the exam to assess clinical judgment and critical thinking. Each question includes a rationale
explaining the correct answer and why the most commonly chosen incorrect answer is wrong. A passing score of 80%
or higher is required for admission to the LPN-to-RN Bridge Program. Manage your time carefully - you have 90 minutes
to complete all 100 questions.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 1 of 52
, Section 1: Medical-Surgical Nursing — 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of atrial fibrillation presents to the emergency department
with sudden onset of left-sided weakness and slurred speech that began 45 minutes ago. His
blood pressure is 178/96 mmHg and his heart rate is 92 bpm irregularly irregular. What is the
nurse's priority action at this time?
A. Administer tissue plasminogen activator (tPA) immediately
B. Start anticoagulant therapy with heparin infusion
C. Obtain a STAT non-contrast CT scan of the head
D. Lower blood pressure with IV labetalol to prevent hemorrhagic conversion
Correct Answer: C
Rationale:
The priority is to determine whether the stroke is ischemic or hemorrhagic before any treatment. A CT scan
must be performed first to rule out hemorrhage, as administering tPA to a patient with hemorrhagic stroke
would be life-threatening. Blood pressure management and anticoagulation are secondary considerations
after imaging confirms the stroke type.
Q2 Question 2 of 100
A 55-year-old female with chronic heart failure is admitted with worsening dyspnea, bilateral
crackles throughout lung fields, and 3+ pitting edema in both lower extremities. Her current
medications include lisinopril 10 mg daily and furosemide 20 mg daily. The physician adds
spironolactone 25 mg daily to her regimen. The nurse should monitor closely for which
electrolyte imbalance?
A. Hyponatremia due to increased sodium excretion from dual diuretic therapy
B. Hypokalemia resulting from combined loop and potassium-sparing diuretic effects
C. Hyperkalemia caused by additive potassium-retaining effects of ACE inhibitor and
spironolactone
D. Hypocalcemia secondary to enhanced calcium excretion with spironolactone addition
Correct Answer: C
Rationale:
Both lisinopril (an ACE inhibitor) and spironolactone (a potassium-sparing diuretic) reduce aldosterone
activity, leading to potassium retention. When used together, the risk of hyperkalemia is significantly
increased and requires close monitoring. Hypokalemia is the opposite effect and would be expected with
loop diuretics alone, not with this combination.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 2 of 52
,Q3 Question 3 of 100
A 72-year-old male with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula at home. His daughter calls the clinic reporting that her father
has become increasingly confused and drowsy over the past hour. She mentions that she
turned the oxygen up to 5 L/min because he looked short of breath. What condition should
the nurse suspect first?
A. Oxygen toxicity causing cerebral vasoconstriction and altered mental status
B. Acute exacerbation of COPD with worsening bronchospasm
C. Carbon dioxide narcosis resulting from suppression of the hypoxic drive
D. Pulmonary embolism triggered by increased blood flow from supplemental oxygen
Correct Answer: C
Rationale:
Patients with severe COPD rely on a hypoxic drive to stimulate breathing because their chemoreceptors
have become insensitive to carbon dioxide. Delivering high-flow oxygen blunts this drive, causing CO2
retention and narcosis, which manifests as confusion and drowsiness. Oxygen toxicity is unlikely at 5 L/min
and develops over much longer periods.
Q4 Question 4 of 100
A 45-year-old male is admitted with a diagnosis of acute pancreatitis. He reports severe
epigastric pain that radiates to his back and is worse after eating. His serum amylase is three
times the upper limit of normal and his lipase is elevated at five times normal. Which nursing
intervention is most appropriate to relieve his pain?
A. Encourage oral intake of clear liquids to maintain hydration and stimulate gut motility
B. Administer oral pancreatic enzyme supplements with each meal to improve digestion
C. Maintain NPO status and administer IV analgesics as prescribed
D. Apply a heating pad to the abdomen to promote vasodilation and comfort
Correct Answer: C
Rationale:
In acute pancreatitis, the pancreas must be rested to prevent further autodigestion. NPO status eliminates
stimulation of pancreatic enzyme secretion, and IV analgesics manage the severe pain without activating
the gastrointestinal tract. Oral intake and pancreatic enzymes would stimulate the pancreas and worsen the
condition.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
A 60-year-old female with type 2 diabetes mellitus is scheduled for a coronary artery bypass
graft (CABG) surgery tomorrow morning. Her current morning blood glucose is 210 mg/dL.
The nurse understands that which glycemic management approach is most appropriate for
this patient preoperatively?
A. Withhold all diabetic medications and monitor glucose every 12 hours until surgery
B. Administer the usual dose of metformin the evening before surgery to maintain control
C. Initiate a sliding-scale insulin protocol and monitor glucose frequently before and after
surgery
D. Administer half the usual dose of insulin to prevent intraoperative hypoglycemia
Correct Answer: C
Rationale:
Perioperative glycemic control in diabetic surgical patients requires a sliding-scale insulin protocol because
oral hypoglycemics like metformin must be held before surgery due to the risk of lactic acidosis. Frequent
monitoring ensures blood glucose remains within the target range. Withholding all management or giving
half doses risks hyperglycemia or hypoglycemia respectively.
Q6 Question 6 of 100
A 58-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight
loss of 15 pounds over two months, and persistent cough. A chest X-ray reveals a 4 cm
mass in the right upper lobe. A bronchoscopy with biopsy is scheduled. The nurse should
prepare the patient by explaining that after the procedure he must:
A. Resume normal diet immediately after the procedure to maintain nutritional status
B. Lie flat on his back for 6 hours to prevent pneumothorax
C. Remain NPO until the gag reflex returns to prevent aspiration
D. Cough forcefully every hour to clear secretions and prevent pneumonia
Correct Answer: C
Rationale:
Following bronchoscopy, the gag reflex is temporarily suppressed due to local anesthesia. The patient must
remain NPO until the gag reflex returns to prevent aspiration of food or fluids into the airway. Forceful
coughing could disrupt the biopsy site, and lying flat is not a standard requirement.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 4 of 52
HESI LPN-to-ADN Entrance Exam
LPN-to-RN Bridge Program Admission
Official Practice Exam · 2026/2027 Edition
Questions: 100 Minutes: 90 Passing Score: 80% Format: NGN
TABLE OF CONTENTS
Section 1: Medical-Surgical Nursing (Q1–Q30)
Section 2: Pediatric Nursing (Q31–Q50)
Section 3: Maternity / Obstetric Nursing (Q51–Q70)
Section 4: Psychiatric / Mental Health Nursing (Q71–Q85)
Section 5: Nursing Fundamentals & Professional Issues (Q86–Q100)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. A scenario-based format is
used throughout the exam to assess clinical judgment and critical thinking. Each question includes a rationale
explaining the correct answer and why the most commonly chosen incorrect answer is wrong. A passing score of 80%
or higher is required for admission to the LPN-to-RN Bridge Program. Manage your time carefully - you have 90 minutes
to complete all 100 questions.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 1 of 52
, Section 1: Medical-Surgical Nursing — 2026/2027
Q1 Question 1 of 100
A 68-year-old male with a history of atrial fibrillation presents to the emergency department
with sudden onset of left-sided weakness and slurred speech that began 45 minutes ago. His
blood pressure is 178/96 mmHg and his heart rate is 92 bpm irregularly irregular. What is the
nurse's priority action at this time?
A. Administer tissue plasminogen activator (tPA) immediately
B. Start anticoagulant therapy with heparin infusion
C. Obtain a STAT non-contrast CT scan of the head
D. Lower blood pressure with IV labetalol to prevent hemorrhagic conversion
Correct Answer: C
Rationale:
The priority is to determine whether the stroke is ischemic or hemorrhagic before any treatment. A CT scan
must be performed first to rule out hemorrhage, as administering tPA to a patient with hemorrhagic stroke
would be life-threatening. Blood pressure management and anticoagulation are secondary considerations
after imaging confirms the stroke type.
Q2 Question 2 of 100
A 55-year-old female with chronic heart failure is admitted with worsening dyspnea, bilateral
crackles throughout lung fields, and 3+ pitting edema in both lower extremities. Her current
medications include lisinopril 10 mg daily and furosemide 20 mg daily. The physician adds
spironolactone 25 mg daily to her regimen. The nurse should monitor closely for which
electrolyte imbalance?
A. Hyponatremia due to increased sodium excretion from dual diuretic therapy
B. Hypokalemia resulting from combined loop and potassium-sparing diuretic effects
C. Hyperkalemia caused by additive potassium-retaining effects of ACE inhibitor and
spironolactone
D. Hypocalcemia secondary to enhanced calcium excretion with spironolactone addition
Correct Answer: C
Rationale:
Both lisinopril (an ACE inhibitor) and spironolactone (a potassium-sparing diuretic) reduce aldosterone
activity, leading to potassium retention. When used together, the risk of hyperkalemia is significantly
increased and requires close monitoring. Hypokalemia is the opposite effect and would be expected with
loop diuretics alone, not with this combination.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 2 of 52
,Q3 Question 3 of 100
A 72-year-old male with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula at home. His daughter calls the clinic reporting that her father
has become increasingly confused and drowsy over the past hour. She mentions that she
turned the oxygen up to 5 L/min because he looked short of breath. What condition should
the nurse suspect first?
A. Oxygen toxicity causing cerebral vasoconstriction and altered mental status
B. Acute exacerbation of COPD with worsening bronchospasm
C. Carbon dioxide narcosis resulting from suppression of the hypoxic drive
D. Pulmonary embolism triggered by increased blood flow from supplemental oxygen
Correct Answer: C
Rationale:
Patients with severe COPD rely on a hypoxic drive to stimulate breathing because their chemoreceptors
have become insensitive to carbon dioxide. Delivering high-flow oxygen blunts this drive, causing CO2
retention and narcosis, which manifests as confusion and drowsiness. Oxygen toxicity is unlikely at 5 L/min
and develops over much longer periods.
Q4 Question 4 of 100
A 45-year-old male is admitted with a diagnosis of acute pancreatitis. He reports severe
epigastric pain that radiates to his back and is worse after eating. His serum amylase is three
times the upper limit of normal and his lipase is elevated at five times normal. Which nursing
intervention is most appropriate to relieve his pain?
A. Encourage oral intake of clear liquids to maintain hydration and stimulate gut motility
B. Administer oral pancreatic enzyme supplements with each meal to improve digestion
C. Maintain NPO status and administer IV analgesics as prescribed
D. Apply a heating pad to the abdomen to promote vasodilation and comfort
Correct Answer: C
Rationale:
In acute pancreatitis, the pancreas must be rested to prevent further autodigestion. NPO status eliminates
stimulation of pancreatic enzyme secretion, and IV analgesics manage the severe pain without activating
the gastrointestinal tract. Oral intake and pancreatic enzymes would stimulate the pancreas and worsen the
condition.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 3 of 52
, Q5 Question 5 of 100
A 60-year-old female with type 2 diabetes mellitus is scheduled for a coronary artery bypass
graft (CABG) surgery tomorrow morning. Her current morning blood glucose is 210 mg/dL.
The nurse understands that which glycemic management approach is most appropriate for
this patient preoperatively?
A. Withhold all diabetic medications and monitor glucose every 12 hours until surgery
B. Administer the usual dose of metformin the evening before surgery to maintain control
C. Initiate a sliding-scale insulin protocol and monitor glucose frequently before and after
surgery
D. Administer half the usual dose of insulin to prevent intraoperative hypoglycemia
Correct Answer: C
Rationale:
Perioperative glycemic control in diabetic surgical patients requires a sliding-scale insulin protocol because
oral hypoglycemics like metformin must be held before surgery due to the risk of lactic acidosis. Frequent
monitoring ensures blood glucose remains within the target range. Withholding all management or giving
half doses risks hyperglycemia or hypoglycemia respectively.
Q6 Question 6 of 100
A 58-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight
loss of 15 pounds over two months, and persistent cough. A chest X-ray reveals a 4 cm
mass in the right upper lobe. A bronchoscopy with biopsy is scheduled. The nurse should
prepare the patient by explaining that after the procedure he must:
A. Resume normal diet immediately after the procedure to maintain nutritional status
B. Lie flat on his back for 6 hours to prevent pneumothorax
C. Remain NPO until the gag reflex returns to prevent aspiration
D. Cough forcefully every hour to clear secretions and prevent pneumonia
Correct Answer: C
Rationale:
Following bronchoscopy, the gag reflex is temporarily suppressed due to local anesthesia. The patient must
remain NPO until the gag reflex returns to prevent aspiration of food or fluids into the airway. Forceful
coughing could disrupt the biopsy site, and lying flat is not a standard requirement.
HESI LPN-to-ADN — 2026/2027 | Passing Score: 80% | Page 4 of 52
