1
HESI PN Exit Exam
280+ Practice
Questions
Comprehensive Review for
the NCLEX-PN
Examination, 7th Edition
, 2
Question 1
A client with diabetes mellitus type 1 is experiencing nausea, vomiting, and abdominal
pain. The client's blood glucose is 650 mg/dL, and the serum potassium is 5.6 mEq/L.
Arterial blood gases show pH 7.15, PaCO₂ 30 mmHg, and HCO₃⁻ 14 mEq/L. The PN
should recognize that these findings are consistent with which condition?
A. Hyperglycemic hyperosmolar state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Lactic acidosis
D. Respiratory acidosis
Correct Answer: B
Rationale: The client's presentation with hyperglycemia (650 mg/dL), metabolic
acidosis (pH 7.15, HCO₃⁻ 14), and Kussmaul respirations (PaCO₂ 30) is classic for DKA.
Hyperkalemia is common in DKA due to acidotic shifts. HHS typically presents with
extreme hyperglycemia (>600 mg/dL) but without significant ketosis or acidosis. Lactic
acidosis and respiratory acidosis do not present with this combination of findings.
Question 2
The PN is caring for a client with heart failure who is receiving intravenous furosemide.
Which assessment finding indicates that the medication is achieving its desired
therapeutic effect?
A. Increased blood pressure
B. Weight loss of 2 pounds in 24 hours
C. Heart rate increase from 80 to 96 bpm
D. Decreased urine output
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart failure.
Weight loss of 1-2 pounds in 24 hours indicates effective diuresis and fluid removal.
Blood pressure should decrease, not increase, with fluid volume reduction. Increased
heart rate may indicate hypovolemia or worsening heart failure. Decreased urine output
indicates ineffective diuresis or renal impairment.
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Question 3
A client who is 6 hours post-operative following a right total knee arthroplasty has a
continuous passive motion (CPM) device in place. The PN notes that the device is set at
60 degrees of flexion. Which action should the PN take?
A. Decrease the flexion to 30 degrees
B. Increase the flexion to 90 degrees
C. Maintain the current setting
D. Discontinue the CPM device
Correct Answer: C
Rationale: The typical CPM protocol for total knee arthroplasty starts at 0-60 degrees
of flexion on the first post-operative day, with gradual increases as tolerated. The
current setting of 60 degrees is appropriate. Increasing to 90 degrees or decreasing to
30 degrees would be premature. Discontinuing the device would interfere with
rehabilitation goals.
Question 4
The PN is caring for a client with a newly placed tracheostomy. Which finding indicates
that the tracheostomy tube is patent?
A. The client is able to speak in full sentences
B. The client has a productive cough
C. The PN auscultates breath sounds bilaterally
D. The client's oxygen saturation is 94% on room air
Correct Answer: C
Rationale: Bilateral breath sounds indicate that air is moving through the
tracheostomy tube and into both lungs, confirming patency. Clients with tracheostomies
typically cannot speak if the cuff is inflated. A productive cough does not confirm tube
patency. Oxygen saturation may be normal even with partial obstruction due to
compensatory mechanisms.
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Question 5
A client with chronic kidney disease (CKD) has a serum creatinine of 4.8 mg/dL and a
BUN of 62 mg/dL. Which dietary restriction should the PN reinforce with this client?
A. Increased potassium intake
B. Increased protein intake
C. Restricted fluid intake
D. Restricted carbohydrate intake
Correct Answer: C
Rationale: Clients with CKD often require fluid restriction due to decreased urinary
output and risk of fluid overload. Protein is typically restricted in CKD to reduce
nitrogenous waste accumulation. Potassium may need to be restricted, not increased,
due to risk of hyperkalemia. Carbohydrates are not typically restricted in CKD unless the
client also has diabetes.
Question 6
The PN is providing post-operative care to a client who underwent a thyroidectomy. The
PN places a tracheostomy set and suction equipment at the bedside. What complication
does this intervention anticipate?
A. Laryngeal nerve damage
B. Hemorrhage
C. Thyroid storm
D. Airway obstruction
Correct Answer: D
Rationale: The primary complication following thyroidectomy is airway obstruction
due to edema, hematoma, or laryngeal spasm. Having tracheostomy equipment at the
bedside allows immediate intervention if respiratory distress occurs. While laryngeal
nerve damage, hemorrhage, and thyroid storm are potential complications, the bedside
equipment specifically prepares for airway compromise.
HESI PN Exit Exam
280+ Practice
Questions
Comprehensive Review for
the NCLEX-PN
Examination, 7th Edition
, 2
Question 1
A client with diabetes mellitus type 1 is experiencing nausea, vomiting, and abdominal
pain. The client's blood glucose is 650 mg/dL, and the serum potassium is 5.6 mEq/L.
Arterial blood gases show pH 7.15, PaCO₂ 30 mmHg, and HCO₃⁻ 14 mEq/L. The PN
should recognize that these findings are consistent with which condition?
A. Hyperglycemic hyperosmolar state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Lactic acidosis
D. Respiratory acidosis
Correct Answer: B
Rationale: The client's presentation with hyperglycemia (650 mg/dL), metabolic
acidosis (pH 7.15, HCO₃⁻ 14), and Kussmaul respirations (PaCO₂ 30) is classic for DKA.
Hyperkalemia is common in DKA due to acidotic shifts. HHS typically presents with
extreme hyperglycemia (>600 mg/dL) but without significant ketosis or acidosis. Lactic
acidosis and respiratory acidosis do not present with this combination of findings.
Question 2
The PN is caring for a client with heart failure who is receiving intravenous furosemide.
Which assessment finding indicates that the medication is achieving its desired
therapeutic effect?
A. Increased blood pressure
B. Weight loss of 2 pounds in 24 hours
C. Heart rate increase from 80 to 96 bpm
D. Decreased urine output
Correct Answer: B
Rationale: Furosemide is a loop diuretic used to reduce fluid volume in heart failure.
Weight loss of 1-2 pounds in 24 hours indicates effective diuresis and fluid removal.
Blood pressure should decrease, not increase, with fluid volume reduction. Increased
heart rate may indicate hypovolemia or worsening heart failure. Decreased urine output
indicates ineffective diuresis or renal impairment.
, 3
Question 3
A client who is 6 hours post-operative following a right total knee arthroplasty has a
continuous passive motion (CPM) device in place. The PN notes that the device is set at
60 degrees of flexion. Which action should the PN take?
A. Decrease the flexion to 30 degrees
B. Increase the flexion to 90 degrees
C. Maintain the current setting
D. Discontinue the CPM device
Correct Answer: C
Rationale: The typical CPM protocol for total knee arthroplasty starts at 0-60 degrees
of flexion on the first post-operative day, with gradual increases as tolerated. The
current setting of 60 degrees is appropriate. Increasing to 90 degrees or decreasing to
30 degrees would be premature. Discontinuing the device would interfere with
rehabilitation goals.
Question 4
The PN is caring for a client with a newly placed tracheostomy. Which finding indicates
that the tracheostomy tube is patent?
A. The client is able to speak in full sentences
B. The client has a productive cough
C. The PN auscultates breath sounds bilaterally
D. The client's oxygen saturation is 94% on room air
Correct Answer: C
Rationale: Bilateral breath sounds indicate that air is moving through the
tracheostomy tube and into both lungs, confirming patency. Clients with tracheostomies
typically cannot speak if the cuff is inflated. A productive cough does not confirm tube
patency. Oxygen saturation may be normal even with partial obstruction due to
compensatory mechanisms.
, 4
Question 5
A client with chronic kidney disease (CKD) has a serum creatinine of 4.8 mg/dL and a
BUN of 62 mg/dL. Which dietary restriction should the PN reinforce with this client?
A. Increased potassium intake
B. Increased protein intake
C. Restricted fluid intake
D. Restricted carbohydrate intake
Correct Answer: C
Rationale: Clients with CKD often require fluid restriction due to decreased urinary
output and risk of fluid overload. Protein is typically restricted in CKD to reduce
nitrogenous waste accumulation. Potassium may need to be restricted, not increased,
due to risk of hyperkalemia. Carbohydrates are not typically restricted in CKD unless the
client also has diabetes.
Question 6
The PN is providing post-operative care to a client who underwent a thyroidectomy. The
PN places a tracheostomy set and suction equipment at the bedside. What complication
does this intervention anticipate?
A. Laryngeal nerve damage
B. Hemorrhage
C. Thyroid storm
D. Airway obstruction
Correct Answer: D
Rationale: The primary complication following thyroidectomy is airway obstruction
due to edema, hematoma, or laryngeal spasm. Having tracheostomy equipment at the
bedside allows immediate intervention if respiratory distress occurs. While laryngeal
nerve damage, hemorrhage, and thyroid storm are potential complications, the bedside
equipment specifically prepares for airway compromise.
