HESI PN EXIT EXAM PREP 2026/2027
QUESTIONS AND ANSWERS
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the client’s oxygen saturation is 88% and the client is
experiencing mild dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Administer a PRN dose of albuterol.
C. Notify the healthcare provider immediately.
D. Place the client in a high-Fowler’s position.
Answer: D
Conceptual Explanation: Positioning is the least invasive first action to improve lung
expansion. Increasing oxygen in COPD patients must be done cautiously to avoid
suppressing the hypoxic drive.
2. A client is prescribed digoxin for heart failure. Which laboratory value should the nurse
monitor most closely to prevent digoxin toxicity?
A. Serum potassium
,B. Serum calcium
C. Serum sodium
D. Serum magnesium
Answer: A
Conceptual Explanation: Hypokalemia (low potassium) sensitizes the myocardium to
digoxin, significantly increasing the risk of toxicity.
3. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which finding requires immediate intervention?
A. New onset of confusion and petechiae on the chest
B. Pain level of 4 on a scale of 0 to 10
C. Small amount of serosanguineous drainage on the dressing
D. Hemoglobin level of 11.2 g/dL
Answer: A
Conceptual Explanation: Confusion and petechiae are classic signs of a fat embolism, a
life-threatening complication following long bone or major joint surgery.
4. The nurse is preparing to administer regular insulin and NPH insulin in the same syringe.
What is the correct sequence of actions?
A. Draw up NPH, then draw up regular insulin.
B. Draw up each in separate syringes and then combine them.
, C. Inject air into regular, inject air into NPH, draw up NPH, then draw up regular.
D. Inject air into NPH, inject air into regular, draw up regular, then draw up NPH.
Answer: D
Conceptual Explanation: The correct sequence is air into NPH (cloudy), air into regular
(clear), draw clear, then draw cloudy (RN - Regular before NPH).
5. A client with a history of schizophrenia is prescribed clozapine. Which laboratory result is
most important for the nurse to review?
A. Blood urea nitrogen (BUN)
B. White blood cell (WBC) count
C. Serum creatinine
D. Liver function tests
Answer: B
Conceptual Explanation: Clozapine can cause agranulocytosis, a severe reduction in
WBCs, making the client highly susceptible to infection.
6. Which assessment finding in a client with a chest tube indicates a potential tension
pneumothorax?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the water level with respiration
C. Bloody drainage in the collection chamber
QUESTIONS AND ANSWERS
1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. The nurse notes the client’s oxygen saturation is 88% and the client is
experiencing mild dyspnea. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Administer a PRN dose of albuterol.
C. Notify the healthcare provider immediately.
D. Place the client in a high-Fowler’s position.
Answer: D
Conceptual Explanation: Positioning is the least invasive first action to improve lung
expansion. Increasing oxygen in COPD patients must be done cautiously to avoid
suppressing the hypoxic drive.
2. A client is prescribed digoxin for heart failure. Which laboratory value should the nurse
monitor most closely to prevent digoxin toxicity?
A. Serum potassium
,B. Serum calcium
C. Serum sodium
D. Serum magnesium
Answer: A
Conceptual Explanation: Hypokalemia (low potassium) sensitizes the myocardium to
digoxin, significantly increasing the risk of toxicity.
3. A nurse is caring for a client who is 24 hours postoperative following a total hip
arthroplasty. Which finding requires immediate intervention?
A. New onset of confusion and petechiae on the chest
B. Pain level of 4 on a scale of 0 to 10
C. Small amount of serosanguineous drainage on the dressing
D. Hemoglobin level of 11.2 g/dL
Answer: A
Conceptual Explanation: Confusion and petechiae are classic signs of a fat embolism, a
life-threatening complication following long bone or major joint surgery.
4. The nurse is preparing to administer regular insulin and NPH insulin in the same syringe.
What is the correct sequence of actions?
A. Draw up NPH, then draw up regular insulin.
B. Draw up each in separate syringes and then combine them.
, C. Inject air into regular, inject air into NPH, draw up NPH, then draw up regular.
D. Inject air into NPH, inject air into regular, draw up regular, then draw up NPH.
Answer: D
Conceptual Explanation: The correct sequence is air into NPH (cloudy), air into regular
(clear), draw clear, then draw cloudy (RN - Regular before NPH).
5. A client with a history of schizophrenia is prescribed clozapine. Which laboratory result is
most important for the nurse to review?
A. Blood urea nitrogen (BUN)
B. White blood cell (WBC) count
C. Serum creatinine
D. Liver function tests
Answer: B
Conceptual Explanation: Clozapine can cause agranulocytosis, a severe reduction in
WBCs, making the client highly susceptible to infection.
6. Which assessment finding in a client with a chest tube indicates a potential tension
pneumothorax?
A. Continuous bubbling in the water-seal chamber
B. Fluctuation of the water level with respiration
C. Bloody drainage in the collection chamber
