“PN HESI Exit Exam: 2025–2026 Comprehensive
Practice Set (140 Key Scenarios & Rationales —
Fourth-Degree Perineal Laceration Focus)”
A nurse is assisting with the plan of care for a client following a
transurethral resection of the prostate. Which of the following interventions should the nurse
include in the plan of care? - CORRECT ANSWER✔✔✔,, The nurse should irrigate the bladder using
strict sterile technique and maintain closed catheter drainage system to minimize the rick of
infection.
A nurse is reviewing a client's electronic medical record and finds that an assistive per sonnel
recorder the client's temperature as 35.3 degrees Celsius (95.5 degrees F) 2 hrs earlier. Which of the
following actions should the nurse take first? - CORRECT ANSWER✔✔✔,, check the clients temp
A nurse is receiving change-of-
shift report for four clients. Which of the following clients should the nurse see first? - CORRECT
ANSWER✔✔✔,, A client whose urinary output was 100mL for the past 12 hrs
A nurse in reinforcing teaching about weight loss with a female older adult client who is overweight.
Which of the following statements should the nurse include in teaching? - CORRECT
ANSWER✔✔✔,, keep fat intake to no more that 30% of daily caloric intake.
A nurse is collecting data from a client who has iron deficiency anemia. Which of the following
findings should the nurse expect? - CORRECT ANSWER✔✔✔,, difficulty concentrating
A Nurse is collecting data from an older adult client who is 48 hr postoperative following abdominal
surgery. The provider writes a prescription to advance the client to a re gular Diet. For which of the
following findings should the nurse notify the provider? - CORRECT ANSWER✔✔✔,, The client has
absent bowel sounds
A parent brings her adolescent son to an urgent care center and states. "He is high on something and
needs help" The client is
,exhibiting agitation and paranoia and reports visual hallucinations. The nurse should suspect
intoxication with which of the following substances? - CORRECT
ANSWER✔✔✔,, Methamphetamines
A nurse notices an assistive personnel taking a nap in the break room during he meal t ime. The AP
appears drowsy while performing routine tasks. Which of the following a ctions should the nurse
take? - CORRECT ANSWER✔✔✔,,Report the observations about the ap to the unit's nurse manager.
A nurse is reinforcing teaching with a client who has a fluid volume deficit about selec ting foods that
have a high water content. The nurse should include that which of the following raw foods contains
the highest amount of water per 1 cup serving? - CORRECT ANSWER✔✔✔,, cherry tomatoes
The nurse is position a client who is scheduled for a lumbar puncture. The nurse should assist the
client into which of the following positions? - CORRECT ANSWER✔✔✔,, lateral recumbent
A nurse is talking with a client whose son died in a motor- vehicle crash 2 weeks ago. The client states
"I really thought I'd be back to my usual routines by now, but I can't think of anythingelse except my
son is gone" Which of the following responses should the nurse make? - CORRECT
ANSWER✔✔✔,,Grieving for your son is hard work. It will take as much time as you need to come to
terms with your loss.
A nurse is assisting with monitoring a client who is at 40 weeks of gestation and is in active labor. The
nurse recognizes late deceleration on the fetal monitor tracing. Whichof the following actions should
the nurse take? - CORRECT ANSWER✔✔✔,, Place the client in the lateral position.
A nurse manager is providing an in-
service on hand hygiene to assistive personnel. which of the following information should the nurse
manager include in the in-service? - CORRECT ANSWER✔✔✔,, Remove rings when washing hands
with soap and water
A nurse is reinforcing home safety instructions with the parent of a newborn. Which of the following
statements should the nurse include in the instructions? - CORRECT ANSWER✔✔✔,, Place your
baby's crib away from heat vents.
A nurse is preparing to administer a client's morning medications.
, Which of the follow ing actions should the nurse take to verify the client's identity? - CORRECT
ANSWER✔✔✔,, Scan the facility identification board.
A nurse is caring for a client following a bronchoscopy procedure. Which of the following actions
should the nurse perform first? - CORRECT ANSWER✔✔✔,, check for a gag reflex
While administering a medication to a client, a nurse notices a trayed electrical cord connecting the
client's continuous passive motion machine to the electrical outlet. Which of the following actions
should the nurse take? - CORRECT ANSWER✔✔✔,, Remove the device from the client's room.
A nurse is caring for a client who is 4 hr postoperative following a total thyroidectomy. Which of the
following manifestations should the nurse report to the provider as indicating possible
hypocalcemia? - CORRECT ANSWER✔✔✔,, Tingling of fingers
A nurse is caring for a client who has a Penrose drain. To ensure proper placement an d functioning
of the drain, which of the following should the nurse expect to observe? - CORRECT
ANSWER✔✔✔,, The safety pin is present at the distal end of the drain.
A community health nurse is helping to reinforce teaching about hepatitis A with a group of
employees at a childcare facility.
Which of the following characteristics should t he nurse identify as an external factor that can
impede learning for the participants? - CORRECT ANSWER✔✔✔,, Poor lighting in the learning
setting
A nurse is observing newly licensed nurse who is providing tracheostomy care for a client. The nurse
identifies proper performance of the procedure when the newly licensed nurse selects which of the
following solutions to clean the inner cannula? - CORRECT ANSWER✔✔✔,, hydrogen peroxide
A nurse is caring for a client who has right sided heart failure. The client's partner exp resses concern
the the client will die. Which of the following responses should the nurse make? - CORRECT
ANSWER✔✔✔,,"It is difficult to see someone so sick. Whathave you been told about your partner's
prognosis?"
A nurse in a long-term care facility is assisting with an in-service for newly hired assistive personnel
about legal issues within the facility. Which of the following should the nurse include as an example
Practice Set (140 Key Scenarios & Rationales —
Fourth-Degree Perineal Laceration Focus)”
A nurse is assisting with the plan of care for a client following a
transurethral resection of the prostate. Which of the following interventions should the nurse
include in the plan of care? - CORRECT ANSWER✔✔✔,, The nurse should irrigate the bladder using
strict sterile technique and maintain closed catheter drainage system to minimize the rick of
infection.
A nurse is reviewing a client's electronic medical record and finds that an assistive per sonnel
recorder the client's temperature as 35.3 degrees Celsius (95.5 degrees F) 2 hrs earlier. Which of the
following actions should the nurse take first? - CORRECT ANSWER✔✔✔,, check the clients temp
A nurse is receiving change-of-
shift report for four clients. Which of the following clients should the nurse see first? - CORRECT
ANSWER✔✔✔,, A client whose urinary output was 100mL for the past 12 hrs
A nurse in reinforcing teaching about weight loss with a female older adult client who is overweight.
Which of the following statements should the nurse include in teaching? - CORRECT
ANSWER✔✔✔,, keep fat intake to no more that 30% of daily caloric intake.
A nurse is collecting data from a client who has iron deficiency anemia. Which of the following
findings should the nurse expect? - CORRECT ANSWER✔✔✔,, difficulty concentrating
A Nurse is collecting data from an older adult client who is 48 hr postoperative following abdominal
surgery. The provider writes a prescription to advance the client to a re gular Diet. For which of the
following findings should the nurse notify the provider? - CORRECT ANSWER✔✔✔,, The client has
absent bowel sounds
A parent brings her adolescent son to an urgent care center and states. "He is high on something and
needs help" The client is
,exhibiting agitation and paranoia and reports visual hallucinations. The nurse should suspect
intoxication with which of the following substances? - CORRECT
ANSWER✔✔✔,, Methamphetamines
A nurse notices an assistive personnel taking a nap in the break room during he meal t ime. The AP
appears drowsy while performing routine tasks. Which of the following a ctions should the nurse
take? - CORRECT ANSWER✔✔✔,,Report the observations about the ap to the unit's nurse manager.
A nurse is reinforcing teaching with a client who has a fluid volume deficit about selec ting foods that
have a high water content. The nurse should include that which of the following raw foods contains
the highest amount of water per 1 cup serving? - CORRECT ANSWER✔✔✔,, cherry tomatoes
The nurse is position a client who is scheduled for a lumbar puncture. The nurse should assist the
client into which of the following positions? - CORRECT ANSWER✔✔✔,, lateral recumbent
A nurse is talking with a client whose son died in a motor- vehicle crash 2 weeks ago. The client states
"I really thought I'd be back to my usual routines by now, but I can't think of anythingelse except my
son is gone" Which of the following responses should the nurse make? - CORRECT
ANSWER✔✔✔,,Grieving for your son is hard work. It will take as much time as you need to come to
terms with your loss.
A nurse is assisting with monitoring a client who is at 40 weeks of gestation and is in active labor. The
nurse recognizes late deceleration on the fetal monitor tracing. Whichof the following actions should
the nurse take? - CORRECT ANSWER✔✔✔,, Place the client in the lateral position.
A nurse manager is providing an in-
service on hand hygiene to assistive personnel. which of the following information should the nurse
manager include in the in-service? - CORRECT ANSWER✔✔✔,, Remove rings when washing hands
with soap and water
A nurse is reinforcing home safety instructions with the parent of a newborn. Which of the following
statements should the nurse include in the instructions? - CORRECT ANSWER✔✔✔,, Place your
baby's crib away from heat vents.
A nurse is preparing to administer a client's morning medications.
, Which of the follow ing actions should the nurse take to verify the client's identity? - CORRECT
ANSWER✔✔✔,, Scan the facility identification board.
A nurse is caring for a client following a bronchoscopy procedure. Which of the following actions
should the nurse perform first? - CORRECT ANSWER✔✔✔,, check for a gag reflex
While administering a medication to a client, a nurse notices a trayed electrical cord connecting the
client's continuous passive motion machine to the electrical outlet. Which of the following actions
should the nurse take? - CORRECT ANSWER✔✔✔,, Remove the device from the client's room.
A nurse is caring for a client who is 4 hr postoperative following a total thyroidectomy. Which of the
following manifestations should the nurse report to the provider as indicating possible
hypocalcemia? - CORRECT ANSWER✔✔✔,, Tingling of fingers
A nurse is caring for a client who has a Penrose drain. To ensure proper placement an d functioning
of the drain, which of the following should the nurse expect to observe? - CORRECT
ANSWER✔✔✔,, The safety pin is present at the distal end of the drain.
A community health nurse is helping to reinforce teaching about hepatitis A with a group of
employees at a childcare facility.
Which of the following characteristics should t he nurse identify as an external factor that can
impede learning for the participants? - CORRECT ANSWER✔✔✔,, Poor lighting in the learning
setting
A nurse is observing newly licensed nurse who is providing tracheostomy care for a client. The nurse
identifies proper performance of the procedure when the newly licensed nurse selects which of the
following solutions to clean the inner cannula? - CORRECT ANSWER✔✔✔,, hydrogen peroxide
A nurse is caring for a client who has right sided heart failure. The client's partner exp resses concern
the the client will die. Which of the following responses should the nurse make? - CORRECT
ANSWER✔✔✔,,"It is difficult to see someone so sick. Whathave you been told about your partner's
prognosis?"
A nurse in a long-term care facility is assisting with an in-service for newly hired assistive personnel
about legal issues within the facility. Which of the following should the nurse include as an example
