HESI LPN EXIT EXAM IV PROCTORED
EXAM /QUESTIONS AND ANSWERS
WITH RATIONALE /2026-2027 GRADED
A+
1. Post-void Residual (PVR) Assessment
A client is voiding frequent small amounts 24 hours following removal of an indwelling
catheter, and a post-voided residual volume assessment is prescribed. Which
explanation should the PN provide?
Answer: The catheterized volume determines the need to re-insert the indwelling
catheter.
Rationale: PVR measures how much urine remains after voiding to assess bladder
emptying and determine if re-catheterization is needed.
2. Auditory Hallucinations
A client with schizophrenia reports hearing voices. Which question is most important for
the PN to ask?
Answer: What are the voices saying?
Rationale: The content of hallucinations helps determine risk of harm to self or others.
3. Hypocalcemia
A client with malabsorption syndrome has low serum calcium. The PN should monitor
for which sign?
, Answer: Tetany (muscle spasms, twitching, numbness).
Rationale: Hypocalcemia causes neuromuscular irritability leading to tetany.
4. Evisceration – Delegation to UAP
While turning a client with an abdominal incision, the incision eviscerates. Which task is
best to assign to the UAP?
Answer: Gather supplies.
Rationale: The PN must stay with the client, cover the wound with sterile saline gauze,
and monitor vitals; UAP can assist by getting supplies.
5. Delegation to UAP (Select All That Apply)
Which tasks can the PN assign to UAP? (Select all that apply)
Answers:
Transport a urine culture to the lab.
Empty a bedside drainage unit for a client with an indwelling catheter.
Rationale: These are routine, non-judgment tasks. Teaching and irrigation require
nursing skills.
6. Enoxaparin Dosage
Order: enoxaparin 30 mg subcutaneously every 12 hours. Available: 30 mg/0.3 mL
prefilled syringe. How many mL per day?
Answer: 0.6 mL
Rationale: 30 mg twice daily = 60 mg/day. (60/30) × 0.3 = 0.6 mL.
, 7. Sleep Disturbance
A client asks for help with sleep pattern disturbance. What should the PN obtain first?
Answer: The client's current and previous sleep habits and cycles.
Rationale: Baseline assessment guides individualized interventions.
8. Postpartum Episiotomy Pain
A client reports pain in her midline episiotomy stitches. What should the PN do first?
Answer: Observe suture line for separation and hematoma.
Rationale: Assessment precedes intervention to rule out complications.
9. Vitamin K Foods (Select All That Apply)
Which foods are good sources of Vitamin K?
Answers:
Broccoli
Spinach
Rationale: Leafy green vegetables are rich in Vitamin K.
10. Diabetes – Long-Term Complications
An older client with type 2 DM asks how to minimize complications. Which instruction is
most important?
, Answer: Report any foot injury or sore that does not heal promptly.
Rationale: Neuropathy and poor circulation make foot wounds high-risk for
amputation.
11. Infant Thrush – Nystatin Administration
How should the PN administer nystatin suspension to an infant with oral candidiasis?
Answer: Apply with a gloved finger directly over the infected oral areas.
Rationale: Direct application ensures coating of mucosa.
12. Patient on Phone During Med Pass
A client is on the phone when the PN enters to give meds. What should the PN do?
Answer: Wait for the client to excuse themselves, then observe them taking the
medication.
Rationale: Ensures safety and adherence.
13. Burn Patient – Urine Output
A burn client has urine output of 20 mL/hr. What should the PN do?
Answer: Report immediately.
Rationale: Minimum expected is 30 mL/hr; 20 mL/hr indicates hypovolemia/shock.
14. Cane Use After Stroke
Where should the PN teach the client to hold the cane?
EXAM /QUESTIONS AND ANSWERS
WITH RATIONALE /2026-2027 GRADED
A+
1. Post-void Residual (PVR) Assessment
A client is voiding frequent small amounts 24 hours following removal of an indwelling
catheter, and a post-voided residual volume assessment is prescribed. Which
explanation should the PN provide?
Answer: The catheterized volume determines the need to re-insert the indwelling
catheter.
Rationale: PVR measures how much urine remains after voiding to assess bladder
emptying and determine if re-catheterization is needed.
2. Auditory Hallucinations
A client with schizophrenia reports hearing voices. Which question is most important for
the PN to ask?
Answer: What are the voices saying?
Rationale: The content of hallucinations helps determine risk of harm to self or others.
3. Hypocalcemia
A client with malabsorption syndrome has low serum calcium. The PN should monitor
for which sign?
, Answer: Tetany (muscle spasms, twitching, numbness).
Rationale: Hypocalcemia causes neuromuscular irritability leading to tetany.
4. Evisceration – Delegation to UAP
While turning a client with an abdominal incision, the incision eviscerates. Which task is
best to assign to the UAP?
Answer: Gather supplies.
Rationale: The PN must stay with the client, cover the wound with sterile saline gauze,
and monitor vitals; UAP can assist by getting supplies.
5. Delegation to UAP (Select All That Apply)
Which tasks can the PN assign to UAP? (Select all that apply)
Answers:
Transport a urine culture to the lab.
Empty a bedside drainage unit for a client with an indwelling catheter.
Rationale: These are routine, non-judgment tasks. Teaching and irrigation require
nursing skills.
6. Enoxaparin Dosage
Order: enoxaparin 30 mg subcutaneously every 12 hours. Available: 30 mg/0.3 mL
prefilled syringe. How many mL per day?
Answer: 0.6 mL
Rationale: 30 mg twice daily = 60 mg/day. (60/30) × 0.3 = 0.6 mL.
, 7. Sleep Disturbance
A client asks for help with sleep pattern disturbance. What should the PN obtain first?
Answer: The client's current and previous sleep habits and cycles.
Rationale: Baseline assessment guides individualized interventions.
8. Postpartum Episiotomy Pain
A client reports pain in her midline episiotomy stitches. What should the PN do first?
Answer: Observe suture line for separation and hematoma.
Rationale: Assessment precedes intervention to rule out complications.
9. Vitamin K Foods (Select All That Apply)
Which foods are good sources of Vitamin K?
Answers:
Broccoli
Spinach
Rationale: Leafy green vegetables are rich in Vitamin K.
10. Diabetes – Long-Term Complications
An older client with type 2 DM asks how to minimize complications. Which instruction is
most important?
, Answer: Report any foot injury or sore that does not heal promptly.
Rationale: Neuropathy and poor circulation make foot wounds high-risk for
amputation.
11. Infant Thrush – Nystatin Administration
How should the PN administer nystatin suspension to an infant with oral candidiasis?
Answer: Apply with a gloved finger directly over the infected oral areas.
Rationale: Direct application ensures coating of mucosa.
12. Patient on Phone During Med Pass
A client is on the phone when the PN enters to give meds. What should the PN do?
Answer: Wait for the client to excuse themselves, then observe them taking the
medication.
Rationale: Ensures safety and adherence.
13. Burn Patient – Urine Output
A burn client has urine output of 20 mL/hr. What should the PN do?
Answer: Report immediately.
Rationale: Minimum expected is 30 mL/hr; 20 mL/hr indicates hypovolemia/shock.
14. Cane Use After Stroke
Where should the PN teach the client to hold the cane?
