HESI LPN-to-ADN Mobility Exam – Comprehensive Mobility &
Safe Patient Handling Competency Assessment (Elsevier Evolve) |
Study Guide & Practice Questions
This document is a comprehensive study resource designed for students preparing for the HESI
LPN-to-ADN Mobility Exam through Elsevier Evolve. It focuses on essential mobility and
patient-handling competencies required for successful transition from practical nursing to
associate degree nursing programs. Key topics include body mechanics, safe patient transfers,
assistive devices, range-of-motion exercises, positioning techniques, fall prevention, mobility
impairments, pressure injury prevention, rehabilitation principles, and evidence-based patient
safety practices. The guide includes practice questions, answer rationales, and competency-
focused review material to help learners strengthen clinical judgment and prepare for mobility-
related nursing assessments. HESI Mobility Exams are part of Elsevier's nursing assessment
solutions used to evaluate readiness and support student success.
Question 1
An LPN-to-ADN transition student is caring for an older adult patient who is 12 hours
postoperative following a total hip arthroplasty (THA) using a posterior approach. Which
nursing action is a priority to prevent structural dislocation of the new prosthesis?
A) Assist the patient to log-roll toward the operative side every 2 hours.
B) Maintain an abduction pillow between the patient’s legs while turning and resting.
C) Elevate the head of the bed to 90 degrees during meals to prevent aspiration.
D) Instruct the patient to cross their ankles while sitting upright in a high-backed chair.
Answer: B) Maintain an abduction pillow between the patient’s legs while turning
and resting.
Rationale: Following a posterior total hip arthroplasty, maintaining hip abduction is
critical to prevent the femoral head from slipping out of the acetabulum. Turning the
patient without an abduction pillow or elevating the head of the bed past 90 degrees
causes hip flexion and adduction, which increases the risk of dislocation. Crossing the
ankles or legs is strictly forbidden for the same reason. [1]
Question 2
,A nurse is assigning tasks to an experienced Licensed Practical Nurse (LPN) and an
assistive personnel (AP) on an orthopedic unit. Which patient assignment must the
nurse retain, rather than delegate, to ensure safe mobility assessment?
A) An active LPN applying a scheduled passive motion (CPM) machine to a stable
postoperative total knee arthroplasty patient.
B) An AP assisting a patient who is 3 days postoperative following a laminectomy to
ambulate down the hallway with a walker.
C) An LPN reinforcing pre-arranged crutch-walking instructions to a patient scheduled
for discharge later in the afternoon.
D) A newly admitted patient with a compound femur fracture who requires an initial
assessment of neurovascular status and skeletal traction alignment.
Answer: D) A newly admitted patient with a compound femur fracture who
requires an initial assessment of neurovascular status and skeletal traction
alignment.
Rationale: Under the scope of practice rules for the registered nurse (ADN level), the
initial assessment, evaluation, and nursing judgment of an unstable, newly admitted
patient cannot be delegated. LPNs can reinforce teaching and monitor stable traction,
while APs can ambulate stable patients. However, the comprehensive neurovascular
evaluation of a fresh compound fracture is a core RN duty. [1]
Question 3
The nurse evaluates a patient who was placed in Spencer skeletal traction 4 hours ago
for a fractured femur. The patient reports severe, unrelenting muscle spasms in the
affected thigh, and the nurse notes that the traction weights are currently resting flat on
the floor. Which action should the nurse take first?
A) Administer the prescribed PRN muscle relaxant, cyclobenzaprine, intravenously.
B) Physically lift the traction weights and gently place them onto the patient’s bed
sheets.
C) Inspect the traction ropes, pulleys, and knots, and smoothly align the weights so they
hang freely.
D) Call the orthopedic surgeon immediately to report suspected compartment
syndrome.
Answer: C) Inspect the traction ropes, pulleys, and knots, and smoothly align the
weights so they hang freely.
Rationale: For skeletal traction to work and prevent severe muscle spasms, the weights
must hang freely at all times and never touch the floor or bed frame. If weights touch the
floor, traction is lost, causing severe spasms due to bone misalignment. The nurse
should fix the alignment problem first. If pain or spasms continue after fixing the
alignment, the nurse should assess for neurovascular compromise and contact the
provider.
,Question 4
A nurse is preparing to transfer an obese, non-weight-bearing patient from the bed to a
motorized wheelchair. The patient has a mobility score indicating zero trunk stability.
According to safe patient handling guidelines, which equipment selection is most
appropriate?
A) A mechanical battery-powered ceiling lift with a heavy-duty full-body sling.
B) A nylon friction-reducing slide board assisted by three experienced healthcare staff
members.
C) A stand-assist lift device paired with a secure lumbar transfer belt.
D) A dual-handled canvas gait belt utilized by two nurses executing an under-axilla pivot
lift.
Answer: A) A mechanical battery-powered ceiling lift with a heavy-duty full-body
sling.
Rationale: Safe patient handling guidelines dictate that a mechanical full-body lift
(ceiling or floor model) must be used for a patient who is non-weight-bearing and lacks
trunk stability. Stand-assist devices require the patient to bear weight and hold handles.
Slide boards are for lateral transfers (bed to stretcher) rather than seated wheelchair
transfers. Manual lifting with a gait belt poses a severe injury risk to both the patient and
staff.
Question 5
During a neurovascular assessment of a patient with a full circumferential fiberglass leg
cast for a tibial fracture, the nurse notes sluggish capillary refill (>4 seconds), cool skin
temperature, diminished pedal pulses, and paresthesia. The patient states that the pain
is a 9/10 and is not relieved by the oxycodone administered 45 minutes ago. Which
condition should the nurse suspect?
A) Deep Vein Thrombosis (DVT)
B) Compartment Syndrome
C) Rheumatoid Osteoarthritis
D) Acute Disuse Osteoporosis
Answer: B) Compartment Syndrome
Rationale: Compartment syndrome is a surgical emergency characterized by increased
pressure within a confined muscle space, often caused by a tight cast or severe
swelling. It presents as the "6 Ps": pain out of proportion to the injury and unrelieved by
opioids, paresthesia (tingling), pallor, poikilothermia (coolness), pulselessness, and
paralysis. Immediate intervention, such as bivalving the cast or a fasciotomy, is required
to prevent tissue death.
, Question 6
A transition nurse is instructing a patient with left-sided hemiplegia on the correct
technique for climbing stairs using a single-ended cane. Which sequence should the
nurse teach the patient to ensure safe mobility?
A) Lead with the cane first, followed by the left leg, then advance the right leg up.
B) Advance the left leg up first, followed by the right leg, then lift the cane up.
C) Advance the right leg up first, followed by the left leg and the cane together.
D) Move the cane and the left leg up together, then slide the right leg up to meet them.
Answer: C) Advance the right leg up first, followed by the left leg and the cane
together.
Rationale: The clinical memory aid for stair climbing with an assistive device is "Up with
the good, down with the bad." The patient has left-sided weakness (hemiplegia),
meaning the right leg is the strong ("good") leg. When moving up stairs, the patient
should step up with the un-affected right leg first to lift their body weight. Then, they
bring the weak left leg and the cane up to the same step.
Question 7
The nurse checks on a patient with a newly applied plaster cast for a fractured ulna.
Which safe handling intervention should the nurse perform during the first 24 hours
while the cast is curing?
A) Cover the wet plaster cast with a heavy wool blanket to speed up the chemical drying
process.
B) Use only the palms of the hands, rather than the fingertips, when moving or
supporting the cast.
C) Keep the casted arm resting in a dependent position below the level of the patient's
heart.
D) Apply a localized heating pad directly over the fracture site to minimize cast
dampness.
Answer: B) Use only the palms of the hands, rather than the fingertips, when
moving or supporting the cast.
Rationale: Plaster casts take 24 to 72 hours to dry completely. Handling a wet cast with
fingertips creates indentations that cause localized pressure points on the patient's skin,
leading to tissue ischemia and skin breakdown. The nurse should use only flat palms to
move the arm. The cast must remain uncovered to air-dry, and it should be elevated
above heart level to minimize swelling.
Safe Patient Handling Competency Assessment (Elsevier Evolve) |
Study Guide & Practice Questions
This document is a comprehensive study resource designed for students preparing for the HESI
LPN-to-ADN Mobility Exam through Elsevier Evolve. It focuses on essential mobility and
patient-handling competencies required for successful transition from practical nursing to
associate degree nursing programs. Key topics include body mechanics, safe patient transfers,
assistive devices, range-of-motion exercises, positioning techniques, fall prevention, mobility
impairments, pressure injury prevention, rehabilitation principles, and evidence-based patient
safety practices. The guide includes practice questions, answer rationales, and competency-
focused review material to help learners strengthen clinical judgment and prepare for mobility-
related nursing assessments. HESI Mobility Exams are part of Elsevier's nursing assessment
solutions used to evaluate readiness and support student success.
Question 1
An LPN-to-ADN transition student is caring for an older adult patient who is 12 hours
postoperative following a total hip arthroplasty (THA) using a posterior approach. Which
nursing action is a priority to prevent structural dislocation of the new prosthesis?
A) Assist the patient to log-roll toward the operative side every 2 hours.
B) Maintain an abduction pillow between the patient’s legs while turning and resting.
C) Elevate the head of the bed to 90 degrees during meals to prevent aspiration.
D) Instruct the patient to cross their ankles while sitting upright in a high-backed chair.
Answer: B) Maintain an abduction pillow between the patient’s legs while turning
and resting.
Rationale: Following a posterior total hip arthroplasty, maintaining hip abduction is
critical to prevent the femoral head from slipping out of the acetabulum. Turning the
patient without an abduction pillow or elevating the head of the bed past 90 degrees
causes hip flexion and adduction, which increases the risk of dislocation. Crossing the
ankles or legs is strictly forbidden for the same reason. [1]
Question 2
,A nurse is assigning tasks to an experienced Licensed Practical Nurse (LPN) and an
assistive personnel (AP) on an orthopedic unit. Which patient assignment must the
nurse retain, rather than delegate, to ensure safe mobility assessment?
A) An active LPN applying a scheduled passive motion (CPM) machine to a stable
postoperative total knee arthroplasty patient.
B) An AP assisting a patient who is 3 days postoperative following a laminectomy to
ambulate down the hallway with a walker.
C) An LPN reinforcing pre-arranged crutch-walking instructions to a patient scheduled
for discharge later in the afternoon.
D) A newly admitted patient with a compound femur fracture who requires an initial
assessment of neurovascular status and skeletal traction alignment.
Answer: D) A newly admitted patient with a compound femur fracture who
requires an initial assessment of neurovascular status and skeletal traction
alignment.
Rationale: Under the scope of practice rules for the registered nurse (ADN level), the
initial assessment, evaluation, and nursing judgment of an unstable, newly admitted
patient cannot be delegated. LPNs can reinforce teaching and monitor stable traction,
while APs can ambulate stable patients. However, the comprehensive neurovascular
evaluation of a fresh compound fracture is a core RN duty. [1]
Question 3
The nurse evaluates a patient who was placed in Spencer skeletal traction 4 hours ago
for a fractured femur. The patient reports severe, unrelenting muscle spasms in the
affected thigh, and the nurse notes that the traction weights are currently resting flat on
the floor. Which action should the nurse take first?
A) Administer the prescribed PRN muscle relaxant, cyclobenzaprine, intravenously.
B) Physically lift the traction weights and gently place them onto the patient’s bed
sheets.
C) Inspect the traction ropes, pulleys, and knots, and smoothly align the weights so they
hang freely.
D) Call the orthopedic surgeon immediately to report suspected compartment
syndrome.
Answer: C) Inspect the traction ropes, pulleys, and knots, and smoothly align the
weights so they hang freely.
Rationale: For skeletal traction to work and prevent severe muscle spasms, the weights
must hang freely at all times and never touch the floor or bed frame. If weights touch the
floor, traction is lost, causing severe spasms due to bone misalignment. The nurse
should fix the alignment problem first. If pain or spasms continue after fixing the
alignment, the nurse should assess for neurovascular compromise and contact the
provider.
,Question 4
A nurse is preparing to transfer an obese, non-weight-bearing patient from the bed to a
motorized wheelchair. The patient has a mobility score indicating zero trunk stability.
According to safe patient handling guidelines, which equipment selection is most
appropriate?
A) A mechanical battery-powered ceiling lift with a heavy-duty full-body sling.
B) A nylon friction-reducing slide board assisted by three experienced healthcare staff
members.
C) A stand-assist lift device paired with a secure lumbar transfer belt.
D) A dual-handled canvas gait belt utilized by two nurses executing an under-axilla pivot
lift.
Answer: A) A mechanical battery-powered ceiling lift with a heavy-duty full-body
sling.
Rationale: Safe patient handling guidelines dictate that a mechanical full-body lift
(ceiling or floor model) must be used for a patient who is non-weight-bearing and lacks
trunk stability. Stand-assist devices require the patient to bear weight and hold handles.
Slide boards are for lateral transfers (bed to stretcher) rather than seated wheelchair
transfers. Manual lifting with a gait belt poses a severe injury risk to both the patient and
staff.
Question 5
During a neurovascular assessment of a patient with a full circumferential fiberglass leg
cast for a tibial fracture, the nurse notes sluggish capillary refill (>4 seconds), cool skin
temperature, diminished pedal pulses, and paresthesia. The patient states that the pain
is a 9/10 and is not relieved by the oxycodone administered 45 minutes ago. Which
condition should the nurse suspect?
A) Deep Vein Thrombosis (DVT)
B) Compartment Syndrome
C) Rheumatoid Osteoarthritis
D) Acute Disuse Osteoporosis
Answer: B) Compartment Syndrome
Rationale: Compartment syndrome is a surgical emergency characterized by increased
pressure within a confined muscle space, often caused by a tight cast or severe
swelling. It presents as the "6 Ps": pain out of proportion to the injury and unrelieved by
opioids, paresthesia (tingling), pallor, poikilothermia (coolness), pulselessness, and
paralysis. Immediate intervention, such as bivalving the cast or a fasciotomy, is required
to prevent tissue death.
, Question 6
A transition nurse is instructing a patient with left-sided hemiplegia on the correct
technique for climbing stairs using a single-ended cane. Which sequence should the
nurse teach the patient to ensure safe mobility?
A) Lead with the cane first, followed by the left leg, then advance the right leg up.
B) Advance the left leg up first, followed by the right leg, then lift the cane up.
C) Advance the right leg up first, followed by the left leg and the cane together.
D) Move the cane and the left leg up together, then slide the right leg up to meet them.
Answer: C) Advance the right leg up first, followed by the left leg and the cane
together.
Rationale: The clinical memory aid for stair climbing with an assistive device is "Up with
the good, down with the bad." The patient has left-sided weakness (hemiplegia),
meaning the right leg is the strong ("good") leg. When moving up stairs, the patient
should step up with the un-affected right leg first to lift their body weight. Then, they
bring the weak left leg and the cane up to the same step.
Question 7
The nurse checks on a patient with a newly applied plaster cast for a fractured ulna.
Which safe handling intervention should the nurse perform during the first 24 hours
while the cast is curing?
A) Cover the wet plaster cast with a heavy wool blanket to speed up the chemical drying
process.
B) Use only the palms of the hands, rather than the fingertips, when moving or
supporting the cast.
C) Keep the casted arm resting in a dependent position below the level of the patient's
heart.
D) Apply a localized heating pad directly over the fracture site to minimize cast
dampness.
Answer: B) Use only the palms of the hands, rather than the fingertips, when
moving or supporting the cast.
Rationale: Plaster casts take 24 to 72 hours to dry completely. Handling a wet cast with
fingertips creates indentations that cause localized pressure points on the patient's skin,
leading to tissue ischemia and skin breakdown. The nurse should use only flat palms to
move the arm. The cast must remain uncovered to air-dry, and it should be elevated
above heart level to minimize swelling.
