PN HESI Exit Exam Actual Exam
Questions and Answers with Rationales
2026/2027 | NGN Format | Practical
Nursing Predictor | Pass Guarantee
Question 1 The practical nurse is caring for a client with type 1 diabetes mellitus who is
receiving regular insulin. The client’s blood glucose is 52 mg/dL. Which action should the PN
take first?
A. Administer glucagon IM B. Give 15 g of fast-acting carbohydrate C. Check the client’s
airway and breathing D. Notify the registered nurse immediately
Answer: B Rationale: A blood glucose of 52 mg/dL indicates hypoglycemia. The first action is
to provide 15 g of fast-acting carbohydrate (juice, glucose tablets) if the client is conscious and
able to swallow. Airway/breathing check is priority only if the client is unresponsive.
Question 2 The practical nurse is reinforcing teaching to a client who is newly diagnosed with
hypertension. Which statement by the client indicates the need for further teaching?
A. “I will limit my salt intake to less than 2,300 mg per day.” B. “I can continue to eat bacon and
sausage for breakfast.” C. “I should try to exercise for 30 minutes most days of the week.” D. “I
will take my blood pressure medication every day as prescribed.”
Answer: B Rationale: Bacon and sausage are high in sodium and saturated fat, which should be
limited in hypertension. The client needs further teaching about dietary restrictions.
Question 3 The practical nurse is caring for a client who had a total hip replacement 24 hours
ago. Which finding should the PN report immediately to the registered nurse?
A. Pain rated 5/10 relieved by prescribed analgesic B. Calf swelling and tenderness on the
operative side C. Temperature of 99.2°F (37.3°C) D. Urinary output of 40 mL in the last hour
Answer: B Rationale: Calf swelling and tenderness are classic signs of deep vein thrombosis
(DVT), a common postoperative complication after hip surgery. Immediate reporting is required.
,Question 4 A client with pneumonia is receiving oxygen at 4 L/min via nasal cannula. The client
becomes increasingly lethargic. What is the priority action by the PN?
A. Increase the oxygen flow rate to 6 L/min B. Place the client in high-Fowler’s position C.
Obtain vital signs and notify the RN D. Encourage the client to cough and deep breathe
Answer: C Rationale: Increased lethargy may indicate CO₂ retention or worsening hypoxia.
The PN should obtain vital signs and notify the RN for further assessment (possible need for
ABGs or change in oxygen therapy).
Question 5 The practical nurse is caring for a client receiving IV heparin for deep vein
thrombosis. The aPTT is 120 seconds (therapeutic range 60–80 seconds). What is the priority
action?
A. Continue the infusion at the current rate B. Hold the heparin infusion and notify the RN C.
Increase the infusion rate per protocol D. Administer protamine sulfate
Answer: B Rationale: The aPTT is supratherapeutic, indicating increased bleeding risk. The
priority is to hold the infusion and notify the RN/physician for dose adjustment.
Question 6 A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory
value should the PN monitor most closely?
A. Serum sodium B. Serum potassium C. Serum creatinine D. Serum magnesium
Answer: B Rationale: Furosemide is a loop diuretic that causes significant potassium loss.
Hypokalemia is a common and serious adverse effect that can lead to dysrhythmias.
Question 7 A client with type 2 diabetes is prescribed metformin. Which adverse effect should
the PN teach the client to report immediately?
A. Nausea and metallic taste B. Muscle pain, difficulty breathing, and extreme tiredness C.
Headache and dizziness D. Increased thirst and urination
Answer: B Rationale: These are signs of lactic acidosis – a rare but life-threatening
complication of metformin, especially in renal impairment or acute illness.
, Question 8 The PN is reinforcing discharge teaching to a client who had a total knee
replacement. Which statement by the client indicates understanding?
A. “I can resume driving when I am off narcotic pain medication.” B. “I should keep my leg
elevated above heart level at all times.” C. “I will avoid crossing my legs and use a raised toilet
seat.” D. “I can bear full weight on my new knee immediately.”
Answer: C Rationale: Avoiding leg crossing and using a raised toilet seat help prevent hip
dislocation and maintain proper alignment after lower extremity joint replacement.
Question 9 A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at
2 L/min via nasal cannula. The client becomes increasingly lethargic. What is the priority action
by the PN?
A. Increase the oxygen flow rate to 4 L/min B. Place the client in high-Fowler’s position C.
Obtain vital signs and notify the RN D. Encourage the client to cough and deep breathe
Answer: C Rationale: Increased lethargy in a COPD client receiving oxygen may indicate CO₂
retention (hypercapnic respiratory failure). Vital signs and RN notification are needed for
possible ABGs and oxygen adjustment.
Question 10 Which of the following is the priority nursing diagnosis for a client admitted with
acute exacerbation of heart failure?
A. Activity Intolerance B. Excess Fluid Volume C. Ineffective Airway Clearance D. Impaired
Gas Exchange
Answer: B
Rationale: Acute decompensated heart failure is characterized by fluid overload (pulmonary
edema, peripheral edema, JVD). Excess Fluid Volume is the priority diagnosis.
Question 11 A client is receiving total parenteral nutrition (TPN). Which laboratory value
should the PN monitor most closely for a potential complication?
A. Serum potassium B. Blood glucose C. Serum creatinine D. Hemoglobin
Answer: B
Questions and Answers with Rationales
2026/2027 | NGN Format | Practical
Nursing Predictor | Pass Guarantee
Question 1 The practical nurse is caring for a client with type 1 diabetes mellitus who is
receiving regular insulin. The client’s blood glucose is 52 mg/dL. Which action should the PN
take first?
A. Administer glucagon IM B. Give 15 g of fast-acting carbohydrate C. Check the client’s
airway and breathing D. Notify the registered nurse immediately
Answer: B Rationale: A blood glucose of 52 mg/dL indicates hypoglycemia. The first action is
to provide 15 g of fast-acting carbohydrate (juice, glucose tablets) if the client is conscious and
able to swallow. Airway/breathing check is priority only if the client is unresponsive.
Question 2 The practical nurse is reinforcing teaching to a client who is newly diagnosed with
hypertension. Which statement by the client indicates the need for further teaching?
A. “I will limit my salt intake to less than 2,300 mg per day.” B. “I can continue to eat bacon and
sausage for breakfast.” C. “I should try to exercise for 30 minutes most days of the week.” D. “I
will take my blood pressure medication every day as prescribed.”
Answer: B Rationale: Bacon and sausage are high in sodium and saturated fat, which should be
limited in hypertension. The client needs further teaching about dietary restrictions.
Question 3 The practical nurse is caring for a client who had a total hip replacement 24 hours
ago. Which finding should the PN report immediately to the registered nurse?
A. Pain rated 5/10 relieved by prescribed analgesic B. Calf swelling and tenderness on the
operative side C. Temperature of 99.2°F (37.3°C) D. Urinary output of 40 mL in the last hour
Answer: B Rationale: Calf swelling and tenderness are classic signs of deep vein thrombosis
(DVT), a common postoperative complication after hip surgery. Immediate reporting is required.
,Question 4 A client with pneumonia is receiving oxygen at 4 L/min via nasal cannula. The client
becomes increasingly lethargic. What is the priority action by the PN?
A. Increase the oxygen flow rate to 6 L/min B. Place the client in high-Fowler’s position C.
Obtain vital signs and notify the RN D. Encourage the client to cough and deep breathe
Answer: C Rationale: Increased lethargy may indicate CO₂ retention or worsening hypoxia.
The PN should obtain vital signs and notify the RN for further assessment (possible need for
ABGs or change in oxygen therapy).
Question 5 The practical nurse is caring for a client receiving IV heparin for deep vein
thrombosis. The aPTT is 120 seconds (therapeutic range 60–80 seconds). What is the priority
action?
A. Continue the infusion at the current rate B. Hold the heparin infusion and notify the RN C.
Increase the infusion rate per protocol D. Administer protamine sulfate
Answer: B Rationale: The aPTT is supratherapeutic, indicating increased bleeding risk. The
priority is to hold the infusion and notify the RN/physician for dose adjustment.
Question 6 A client with heart failure is prescribed furosemide 40 mg IV. Which laboratory
value should the PN monitor most closely?
A. Serum sodium B. Serum potassium C. Serum creatinine D. Serum magnesium
Answer: B Rationale: Furosemide is a loop diuretic that causes significant potassium loss.
Hypokalemia is a common and serious adverse effect that can lead to dysrhythmias.
Question 7 A client with type 2 diabetes is prescribed metformin. Which adverse effect should
the PN teach the client to report immediately?
A. Nausea and metallic taste B. Muscle pain, difficulty breathing, and extreme tiredness C.
Headache and dizziness D. Increased thirst and urination
Answer: B Rationale: These are signs of lactic acidosis – a rare but life-threatening
complication of metformin, especially in renal impairment or acute illness.
, Question 8 The PN is reinforcing discharge teaching to a client who had a total knee
replacement. Which statement by the client indicates understanding?
A. “I can resume driving when I am off narcotic pain medication.” B. “I should keep my leg
elevated above heart level at all times.” C. “I will avoid crossing my legs and use a raised toilet
seat.” D. “I can bear full weight on my new knee immediately.”
Answer: C Rationale: Avoiding leg crossing and using a raised toilet seat help prevent hip
dislocation and maintain proper alignment after lower extremity joint replacement.
Question 9 A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at
2 L/min via nasal cannula. The client becomes increasingly lethargic. What is the priority action
by the PN?
A. Increase the oxygen flow rate to 4 L/min B. Place the client in high-Fowler’s position C.
Obtain vital signs and notify the RN D. Encourage the client to cough and deep breathe
Answer: C Rationale: Increased lethargy in a COPD client receiving oxygen may indicate CO₂
retention (hypercapnic respiratory failure). Vital signs and RN notification are needed for
possible ABGs and oxygen adjustment.
Question 10 Which of the following is the priority nursing diagnosis for a client admitted with
acute exacerbation of heart failure?
A. Activity Intolerance B. Excess Fluid Volume C. Ineffective Airway Clearance D. Impaired
Gas Exchange
Answer: B
Rationale: Acute decompensated heart failure is characterized by fluid overload (pulmonary
edema, peripheral edema, JVD). Excess Fluid Volume is the priority diagnosis.
Question 11 A client is receiving total parenteral nutrition (TPN). Which laboratory value
should the PN monitor most closely for a potential complication?
A. Serum potassium B. Blood glucose C. Serum creatinine D. Hemoglobin
Answer: B
