PN HESI EXIT EXAM – HEALTH EDUCATION SYSTEMS INCORPORATED (HESI) /
ELSEVIER | COMPREHENSIVE EXAM PRACTICE & ACTUAL STUDY GUIDE |
2026/2027 LATEST UPDATE | 120+ PRACTICE QUESTIONS, VERIFIED ANSWERS &
RATIONALES
TABLE OF CONTENTS
i. Clinical Judgment and Prioritization
ii. Medical-Surgical Nursing
iii. Pharmacology and Medication Safety
iv. Maternal-Newborn Nursing
v. Pediatric Nursing
vi. Mental Health Nursing
vii. Community Health and Health Promotion
viii. Leadership, Delegation, Ethics, and Professional Practice
ix. Emergency and Critical Care Nursing
x. Safety, Infection Prevention, and Evidence-Based Practice
DESCRIPTION
This comprehensive PN HESI Exit Exam practice resource is designed to strengthen
clinical judgment, prioritization, pharmacology, medical-surgical nursing, maternal-
newborn care, pediatrics, mental health, community health, leadership, safety, and
professional practice. It emphasizes application, analysis, interpretation,
prioritization, and decision-making rather than simple recall. Students should
expect challenging scenarios reflecting the level of knowledge and judgment
expected of practical nurses preparing for comprehensive exit examinations and
professional practice. The complete resource contains 100+ practice questions and
answers with concise rationales to reinforce clinical reasoning. (Purchase and
instantly get a downloadable and editable PDF.)
Question 1
A practical nurse is caring for four clients on a medical-surgical unit. Which client
should the nurse assess first?
A. A client with heart failure who has gained 1 kg (2.2 lb) overnight and reports
increasing ankle edema.
,B. A client with pneumonia whose temperature is 38.2°C (100.8°F) and who requests
acetaminophen.
C. A client with chronic obstructive pulmonary disease who is newly confused and
has an oxygen saturation of 82%.
D. A client with diabetes mellitus whose premeal glucose is 246 mg/dL (13.7
mmol/L).
🔴 Correct Answer: C. A client with chronic obstructive pulmonary disease who is
newly confused and has an oxygen saturation of 82%.
🔵 Explanation: New neurological changes accompanied by severe hypoxemia
indicate an immediate threat to oxygenation and cerebral function. Airway and
breathing take priority over less immediately life-threatening findings. The nurse
should promptly assess respiratory status and initiate appropriate oxygenation
measures according to the client's prescription and clinical protocol.
Question 2
A client receiving IV furosemide for acute pulmonary edema has a potassium level
of 2.8 mEq/L (2.8 mmol/L). Which action by the nurse is the priority?
A. Administer the scheduled furosemide dose.
B. Encourage the client to increase oral fluid intake.
C. Notify the healthcare provider about the potassium level.
D. Place the client in a supine position.
🔴 Correct Answer: C. Notify the healthcare provider about the potassium level.
🔵 Explanation: Furosemide can cause significant potassium loss. A potassium level
of 2.8 mEq/L represents clinically important hypokalemia and increases the risk for
dysrhythmias, particularly in an acutely ill client. The nurse should report the result
promptly and anticipate potassium replacement or modification of therapy.
Question 3
A client with diabetes mellitus is prescribed insulin lispro before meals. The client's
meal tray has not arrived, and the prescribed insulin is due. What should the nurse
do?
A. Administer the insulin because the dose is already prescribed.
B. Administer half of the insulin dose and reassess glucose later.
,C. Hold the insulin until the meal is available and clarify timing as necessary.
D. Replace insulin lispro with the client's long-acting insulin.
🔴 Correct Answer: C. Hold the insulin until the meal is available and clarify
timing as necessary.
🔵 Explanation: Insulin lispro is rapid-acting insulin intended for administration in
close association with meals. Giving it when food is unavailable can cause acute
hypoglycemia. The nurse should coordinate insulin administration with meal
availability and follow the prescribed timing parameters.
Question 4
A client receiving warfarin therapy has an international normalized ratio (INR) of 5.8
and reports bleeding gums. Which action is most appropriate?
A. Administer the scheduled warfarin dose.
B. Encourage increased intake of foods high in vitamin K immediately.
C. Hold the medication and notify the healthcare provider.
D. Administer aspirin to reduce the risk of thrombosis.
🔴 Correct Answer: C. Hold the medication and notify the healthcare provider.
🔵 Explanation: An INR of 5.8 with active bleeding indicates excessive
anticoagulation and an increased risk of serious hemorrhage. The scheduled warfarin
should not be administered until the prescribing clinician evaluates the situation.
Further treatment may include vitamin K depending on bleeding severity and clinical
circumstances.
Question 5
A postpartum client has a boggy uterus and heavy vaginal bleeding. The nurse finds
the fundus displaced to the right. Which intervention should the nurse
perform first?
A. Prepare the client for emergency surgery.
B. Massage the fundus and assess for bladder distention.
C. Administer the prescribed opioid analgesic.
D. Place the client in a high-Fowler position.
, 🔴 Correct Answer: B. Massage the fundus and assess for bladder distention.
🔵 Explanation: A boggy uterus indicates uterine atony, a major cause of postpartum
hemorrhage. Fundal massage promotes uterine contraction, while rightward
displacement suggests bladder distention may interfere with uterine contraction. The
nurse should rapidly intervene while continuing to assess blood loss and
hemodynamic status.
Question 6
A newborn develops central cyanosis while feeding. Which assessment finding
requires the nurse's immediate intervention?
A. Respiratory rate of 64/min with nasal flaring.
B. Heart rate of 142/min.
C. Axillary temperature of 36.7°C (98.1°F).
D. Acrocyanosis of the hands and feet.
🔴 Correct Answer: A. Respiratory rate of 64/min with nasal flaring.
🔵 Explanation: Tachypnea with nasal flaring indicates significant respiratory distress.
Central cyanosis is abnormal in a newborn and suggests inadequate oxygenation. The
nurse should stop feeding, assess airway and breathing, provide appropriate support,
and notify the neonatal care team promptly.
Question 7
A child with suspected epiglottitis is sitting upright, drooling, and leaning forward.
Which action should the nurse avoid?
A. Keeping emergency airway equipment readily available.
B. Allowing the child to remain in a position of comfort.
C. Providing oxygen as tolerated.
D. Inspecting the throat with a tongue blade.
🔴 Correct Answer: D. Inspecting the throat with a tongue blade.
🔵 Explanation: Manipulation of the pharynx in a child with suspected epiglottitis can
precipitate sudden airway obstruction. The child should be kept calm and in a
position of comfort while emergency airway support is prepared.
Question 8
ELSEVIER | COMPREHENSIVE EXAM PRACTICE & ACTUAL STUDY GUIDE |
2026/2027 LATEST UPDATE | 120+ PRACTICE QUESTIONS, VERIFIED ANSWERS &
RATIONALES
TABLE OF CONTENTS
i. Clinical Judgment and Prioritization
ii. Medical-Surgical Nursing
iii. Pharmacology and Medication Safety
iv. Maternal-Newborn Nursing
v. Pediatric Nursing
vi. Mental Health Nursing
vii. Community Health and Health Promotion
viii. Leadership, Delegation, Ethics, and Professional Practice
ix. Emergency and Critical Care Nursing
x. Safety, Infection Prevention, and Evidence-Based Practice
DESCRIPTION
This comprehensive PN HESI Exit Exam practice resource is designed to strengthen
clinical judgment, prioritization, pharmacology, medical-surgical nursing, maternal-
newborn care, pediatrics, mental health, community health, leadership, safety, and
professional practice. It emphasizes application, analysis, interpretation,
prioritization, and decision-making rather than simple recall. Students should
expect challenging scenarios reflecting the level of knowledge and judgment
expected of practical nurses preparing for comprehensive exit examinations and
professional practice. The complete resource contains 100+ practice questions and
answers with concise rationales to reinforce clinical reasoning. (Purchase and
instantly get a downloadable and editable PDF.)
Question 1
A practical nurse is caring for four clients on a medical-surgical unit. Which client
should the nurse assess first?
A. A client with heart failure who has gained 1 kg (2.2 lb) overnight and reports
increasing ankle edema.
,B. A client with pneumonia whose temperature is 38.2°C (100.8°F) and who requests
acetaminophen.
C. A client with chronic obstructive pulmonary disease who is newly confused and
has an oxygen saturation of 82%.
D. A client with diabetes mellitus whose premeal glucose is 246 mg/dL (13.7
mmol/L).
🔴 Correct Answer: C. A client with chronic obstructive pulmonary disease who is
newly confused and has an oxygen saturation of 82%.
🔵 Explanation: New neurological changes accompanied by severe hypoxemia
indicate an immediate threat to oxygenation and cerebral function. Airway and
breathing take priority over less immediately life-threatening findings. The nurse
should promptly assess respiratory status and initiate appropriate oxygenation
measures according to the client's prescription and clinical protocol.
Question 2
A client receiving IV furosemide for acute pulmonary edema has a potassium level
of 2.8 mEq/L (2.8 mmol/L). Which action by the nurse is the priority?
A. Administer the scheduled furosemide dose.
B. Encourage the client to increase oral fluid intake.
C. Notify the healthcare provider about the potassium level.
D. Place the client in a supine position.
🔴 Correct Answer: C. Notify the healthcare provider about the potassium level.
🔵 Explanation: Furosemide can cause significant potassium loss. A potassium level
of 2.8 mEq/L represents clinically important hypokalemia and increases the risk for
dysrhythmias, particularly in an acutely ill client. The nurse should report the result
promptly and anticipate potassium replacement or modification of therapy.
Question 3
A client with diabetes mellitus is prescribed insulin lispro before meals. The client's
meal tray has not arrived, and the prescribed insulin is due. What should the nurse
do?
A. Administer the insulin because the dose is already prescribed.
B. Administer half of the insulin dose and reassess glucose later.
,C. Hold the insulin until the meal is available and clarify timing as necessary.
D. Replace insulin lispro with the client's long-acting insulin.
🔴 Correct Answer: C. Hold the insulin until the meal is available and clarify
timing as necessary.
🔵 Explanation: Insulin lispro is rapid-acting insulin intended for administration in
close association with meals. Giving it when food is unavailable can cause acute
hypoglycemia. The nurse should coordinate insulin administration with meal
availability and follow the prescribed timing parameters.
Question 4
A client receiving warfarin therapy has an international normalized ratio (INR) of 5.8
and reports bleeding gums. Which action is most appropriate?
A. Administer the scheduled warfarin dose.
B. Encourage increased intake of foods high in vitamin K immediately.
C. Hold the medication and notify the healthcare provider.
D. Administer aspirin to reduce the risk of thrombosis.
🔴 Correct Answer: C. Hold the medication and notify the healthcare provider.
🔵 Explanation: An INR of 5.8 with active bleeding indicates excessive
anticoagulation and an increased risk of serious hemorrhage. The scheduled warfarin
should not be administered until the prescribing clinician evaluates the situation.
Further treatment may include vitamin K depending on bleeding severity and clinical
circumstances.
Question 5
A postpartum client has a boggy uterus and heavy vaginal bleeding. The nurse finds
the fundus displaced to the right. Which intervention should the nurse
perform first?
A. Prepare the client for emergency surgery.
B. Massage the fundus and assess for bladder distention.
C. Administer the prescribed opioid analgesic.
D. Place the client in a high-Fowler position.
, 🔴 Correct Answer: B. Massage the fundus and assess for bladder distention.
🔵 Explanation: A boggy uterus indicates uterine atony, a major cause of postpartum
hemorrhage. Fundal massage promotes uterine contraction, while rightward
displacement suggests bladder distention may interfere with uterine contraction. The
nurse should rapidly intervene while continuing to assess blood loss and
hemodynamic status.
Question 6
A newborn develops central cyanosis while feeding. Which assessment finding
requires the nurse's immediate intervention?
A. Respiratory rate of 64/min with nasal flaring.
B. Heart rate of 142/min.
C. Axillary temperature of 36.7°C (98.1°F).
D. Acrocyanosis of the hands and feet.
🔴 Correct Answer: A. Respiratory rate of 64/min with nasal flaring.
🔵 Explanation: Tachypnea with nasal flaring indicates significant respiratory distress.
Central cyanosis is abnormal in a newborn and suggests inadequate oxygenation. The
nurse should stop feeding, assess airway and breathing, provide appropriate support,
and notify the neonatal care team promptly.
Question 7
A child with suspected epiglottitis is sitting upright, drooling, and leaning forward.
Which action should the nurse avoid?
A. Keeping emergency airway equipment readily available.
B. Allowing the child to remain in a position of comfort.
C. Providing oxygen as tolerated.
D. Inspecting the throat with a tongue blade.
🔴 Correct Answer: D. Inspecting the throat with a tongue blade.
🔵 Explanation: Manipulation of the pharynx in a child with suspected epiglottitis can
precipitate sudden airway obstruction. The child should be kept calm and in a
position of comfort while emergency airway support is prepared.
Question 8
