HESI LPN-to-RN Entrance 2026/2027 Exam practice set with the
correct answer and rationale immediately after each question
1. The nurse is caring for four clients. Which client should the nurse assess first?
A. Client with chronic arthritis reporting pain of 5/10
B. Client with pneumonia who has an oxygen saturation of 86%
C. Client requesting assistance with bathing
D. Client waiting for discharge instructions
Answer: B. Client with pneumonia who has an oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia. Airway and breathing
take priority.
2. Which assessment finding requires immediate intervention?
A. Respiratory rate of 18/min
B. Heart rate of 82/min
C. New onset of confusion
D. Temperature of 37°C (98.6°F)
Answer: C. New onset of confusion
Rationale: Acute confusion may indicate hypoxia, poor perfusion, infection, metabolic
disturbance, or another serious condition.
3. A client reports chest pressure radiating to the left arm. What should the nurse do first?
A. Encourage ambulation
B. Assess vital signs and initiate an appropriate cardiac assessment
C. Offer a large meal
D. Ask the client to return later
Answer: B. Assess vital signs and initiate an appropriate cardiac assessment
Rationale: Chest pressure with radiation can indicate acute coronary syndrome and requires
prompt assessment.
4. Which position is generally best for a client experiencing difficulty breathing?
A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Sims'
Answer: B. High-Fowler's
Rationale: Upright positioning promotes lung expansion and can decrease the work of
breathing.
5. Which finding is most concerning in a client receiving oxygen?
A. Oxygen saturation of 96%
,B. Mild dry nasal passages
C. Increasing drowsiness and decreased respiratory rate
D. Respiratory rate of 18/min
Answer: C. Increasing drowsiness and decreased respiratory rate
Rationale: Decreased respiratory rate and altered consciousness can indicate respiratory
depression and require immediate assessment.
6. Which intervention helps prevent postoperative atelectasis?
A. Prolonged bed rest
B. Incentive spirometry
C. Restricting fluids for all clients
D. Avoiding coughing
Answer: B. Incentive spirometry
Rationale: Incentive spirometry encourages deep inspiration and helps keep alveoli expanded.
7. Which finding is commonly associated with hypoxia?
A. Restlessness
B. Increased appetite
C. Warm skin only
D. Increased urine output
Answer: A. Restlessness
Rationale: Early hypoxia may cause restlessness, anxiety, and difficulty concentrating before
more severe manifestations develop.
8. Which client is at greatest risk for aspiration?
A. Alert client who eats independently
B. Client with impaired swallowing and decreased level of consciousness
C. Client with intact gag reflex
D. Client who ambulates independently
Answer: B. Client with impaired swallowing and decreased level of consciousness
Rationale: Impaired swallowing and decreased consciousness increase the risk of food or
secretions entering the airway.
9. Which action is appropriate when administering oral medication to a client with
dysphagia?
A. Give all medications together without assessment
B. Assess swallowing ability and use an appropriate formulation
C. Place pills directly at the back of the throat
D. Give medication while the client is lying flat
, Answer: B. Assess swallowing ability and use an appropriate formulation
Rationale: Dysphagia increases aspiration risk, so swallowing ability and medication
formulation must be considered.
10. Which finding suggests fluid volume deficit?
A. Peripheral edema
B. Crackles
C. Dry mucous membranes and tachycardia
D. Weight gain
Answer: C. Dry mucous membranes and tachycardia
Rationale: Fluid volume deficit can cause dry mucous membranes, tachycardia, hypotension,
concentrated urine, and weight loss.
11. Which assessment is most useful for monitoring fluid balance?
A. Daily weight
B. Height
C. Hair color
D. Pupil size
Answer: A. Daily weight
Rationale: Daily weight is a sensitive indicator of changes in fluid status.
12. A client gains 2 kg over a short period. The nurse should suspect approximately:
A. 200 mL of fluid retention
B. 500 mL of fluid retention
C. 2 L of fluid retention
D. 10 L of fluid retention
Answer: C. 2 L of fluid retention
Rationale: Approximately 1 kg of acute weight change corresponds to about 1 liter of fluid.
13. Which finding is associated with fluid volume excess?
A. Poor skin turgor
B. Crackles and peripheral edema
C. Dry tongue
D. Concentrated urine
Answer: B. Crackles and peripheral edema
Rationale: Excess fluid can cause pulmonary congestion and peripheral edema.
14. Which electrolyte is especially important for cardiac conduction?
A. Potassium
B. Chloride
C. Phosphate
D. Bicarbonate
correct answer and rationale immediately after each question
1. The nurse is caring for four clients. Which client should the nurse assess first?
A. Client with chronic arthritis reporting pain of 5/10
B. Client with pneumonia who has an oxygen saturation of 86%
C. Client requesting assistance with bathing
D. Client waiting for discharge instructions
Answer: B. Client with pneumonia who has an oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia. Airway and breathing
take priority.
2. Which assessment finding requires immediate intervention?
A. Respiratory rate of 18/min
B. Heart rate of 82/min
C. New onset of confusion
D. Temperature of 37°C (98.6°F)
Answer: C. New onset of confusion
Rationale: Acute confusion may indicate hypoxia, poor perfusion, infection, metabolic
disturbance, or another serious condition.
3. A client reports chest pressure radiating to the left arm. What should the nurse do first?
A. Encourage ambulation
B. Assess vital signs and initiate an appropriate cardiac assessment
C. Offer a large meal
D. Ask the client to return later
Answer: B. Assess vital signs and initiate an appropriate cardiac assessment
Rationale: Chest pressure with radiation can indicate acute coronary syndrome and requires
prompt assessment.
4. Which position is generally best for a client experiencing difficulty breathing?
A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Sims'
Answer: B. High-Fowler's
Rationale: Upright positioning promotes lung expansion and can decrease the work of
breathing.
5. Which finding is most concerning in a client receiving oxygen?
A. Oxygen saturation of 96%
,B. Mild dry nasal passages
C. Increasing drowsiness and decreased respiratory rate
D. Respiratory rate of 18/min
Answer: C. Increasing drowsiness and decreased respiratory rate
Rationale: Decreased respiratory rate and altered consciousness can indicate respiratory
depression and require immediate assessment.
6. Which intervention helps prevent postoperative atelectasis?
A. Prolonged bed rest
B. Incentive spirometry
C. Restricting fluids for all clients
D. Avoiding coughing
Answer: B. Incentive spirometry
Rationale: Incentive spirometry encourages deep inspiration and helps keep alveoli expanded.
7. Which finding is commonly associated with hypoxia?
A. Restlessness
B. Increased appetite
C. Warm skin only
D. Increased urine output
Answer: A. Restlessness
Rationale: Early hypoxia may cause restlessness, anxiety, and difficulty concentrating before
more severe manifestations develop.
8. Which client is at greatest risk for aspiration?
A. Alert client who eats independently
B. Client with impaired swallowing and decreased level of consciousness
C. Client with intact gag reflex
D. Client who ambulates independently
Answer: B. Client with impaired swallowing and decreased level of consciousness
Rationale: Impaired swallowing and decreased consciousness increase the risk of food or
secretions entering the airway.
9. Which action is appropriate when administering oral medication to a client with
dysphagia?
A. Give all medications together without assessment
B. Assess swallowing ability and use an appropriate formulation
C. Place pills directly at the back of the throat
D. Give medication while the client is lying flat
, Answer: B. Assess swallowing ability and use an appropriate formulation
Rationale: Dysphagia increases aspiration risk, so swallowing ability and medication
formulation must be considered.
10. Which finding suggests fluid volume deficit?
A. Peripheral edema
B. Crackles
C. Dry mucous membranes and tachycardia
D. Weight gain
Answer: C. Dry mucous membranes and tachycardia
Rationale: Fluid volume deficit can cause dry mucous membranes, tachycardia, hypotension,
concentrated urine, and weight loss.
11. Which assessment is most useful for monitoring fluid balance?
A. Daily weight
B. Height
C. Hair color
D. Pupil size
Answer: A. Daily weight
Rationale: Daily weight is a sensitive indicator of changes in fluid status.
12. A client gains 2 kg over a short period. The nurse should suspect approximately:
A. 200 mL of fluid retention
B. 500 mL of fluid retention
C. 2 L of fluid retention
D. 10 L of fluid retention
Answer: C. 2 L of fluid retention
Rationale: Approximately 1 kg of acute weight change corresponds to about 1 liter of fluid.
13. Which finding is associated with fluid volume excess?
A. Poor skin turgor
B. Crackles and peripheral edema
C. Dry tongue
D. Concentrated urine
Answer: B. Crackles and peripheral edema
Rationale: Excess fluid can cause pulmonary congestion and peripheral edema.
14. Which electrolyte is especially important for cardiac conduction?
A. Potassium
B. Chloride
C. Phosphate
D. Bicarbonate
