HESI-Style LPN-to-ADN Entrance Exam Prep
Mobility Focus: Comprehensive Mobility & Safe
Patient Handling Competency Assessment for
LPN-to-ADN Transition questions and Answers
Question 1: Delegation & Supervision (Safety)
The LPN is leading the care team. The RN instructs the LPN to delegate the ambulation
of a 78-year-old patient with left-sided weakness to a CNA. The patient is currently
receiving continuous IV heparin and has a fall risk bracelet. Which action by the LPN
demonstrates the correct RN-level delegation and supervision?
A. Tell the CNA to use a stand-assist lift and to keep the IV pump unplugged during the
transfer to avoid electric shock.
B. Instruct the CNA to use a gait belt and to ambulate the patient to the bathroom and
back, then check on them in 15 minutes.
C. Assess the patient’s current hemodynamic stability and weight-bearing status
BEFORE instructing the CNA to proceed.
D. Delegate the task to the CNA and document the time of delegation in the nursing
notes.
Rationale: C is correct. The RN (and LPN in the RN role) must assess the
patient first before delegating. The patient is on heparin (bleeding risk), so a fall could
be catastrophic. The CNA should never be delegated a task without the RN first
determining if it is safe to perform. The LPN must assess vitals, level of consciousness,
and muscle strength.
A is unsafe (NEVER unplug a pump during transfer as it may drain the battery; you
unplug from the wall but keep it on the pole).
B is unsafe delegation because you did not assess first.
D is incorrect because delegation requires supervision and evaluation, not just
documentation.
Question 2: Pathophysiology & Complication Prevention
An immobile patient is placed on a scheduled turning schedule. The LPN observes that
the patient's heels are red and non-blanchable. The LPN creates a new intervention.
, Which intervention should be prioritized to prevent the progression of this tissue
damage?
A. Apply tapered heel elevation boots to float the heels off the bed.
B. Massage the erythematous area with lotion to promote circulation.
C. Increase the turning schedule from q2h to q1h for one shift.
D. Place a sheepskin pad directly under the heels for cushioning.
Rationale: A is correct. Non-blanchable erythema is a Stage 1 pressure injury. The
priority is to offload the pressure. Heel boots float the heels, completely removing the
pressure point.
B is contraindicated; massaging red areas can cause deep tissue trauma and capillary
rupture.
C is good, but does not address the heel specifically if they are still resting on the
mattress during side-lying positions.
D (Sheepskin) reduces friction but does not offload pressure effectively enough for a
Stage 1 injury.
Question 3: Orthostatic Hypotension (RN Assessment)
You are preparing to assist a post-operative patient out of bed for the first time. Which
assessment finding would contraindicate ambulation at this time and require you to re-
evaluate the plan?
A. Heart rate increases from 72 to 88 bpm upon sitting upright.
B. Patient reports mild dizziness that resolves after 30 seconds of dangling.
C. Systolic blood pressure drops from 138 to 102 mmHg upon standing, with reports of
"tunnel vision."
D. Respiratory rate remains at 18 breaths/min during the dangling phase.
Rationale: C is correct. A drop in systolic BP > 20 mmHg (or 10 mmHg diastolic) with
symptoms (tunnel vision) is severe orthostatic hypotension. This indicates cerebral
hypoperfusion; ambulation is unsafe. You would sit the patient back down, reassess, and
possibly notify the provider for a fluid bolus or medication adjustment.
A is a normal compensatory response (increase in HR).
B is mild and expected; allow time to adjust.
D is a normal finding.
, Question 4: Mechanical Lift Application (Clinical Judgment)
You are using a full-body mechanical sling lift to transfer a 220-lb patient from the bed
to a chair. The patient is alert but anxious and has a contracture of the right knee,
preventing full extension. What is the most appropriate RN action to ensure safety and
prevent injury?
A. Place the sling under the patient by log-rolling them to each side, ensuring the sling
is centered beneath them.
B. Apply the sling with the top edge at the patient's shoulders and the bottom edge at
the popliteal space.
C. Sedate the patient with PRN lorazepam to reduce anxiety before lifting to prevent
sudden movements.
D. Use a stand-assist lift instead because the patient is alert.
Rationale: A is correct. For a full-body sling, it must be centered from shoulders
to tailbone (not knees) to distribute weight safely. Log-rolling is the safest way to place
it for a heavy patient.
B is incorrect; the bottom edge goes to the lower buttocks/sacrum, not behind the
knees. The knee contracture makes placing it behind the knees dangerous (pulling on
the joint).
C is incorrect and dangerous (chemical restraint) and would lower the patient's ability to
hold onto the sling straps.
D is incorrect; a stand-assist requires weight-bearing and knee extension, which this
patient cannot do due to the contracture.
Question 5: Patient/Family Teaching (RN Level)
You are discharging a patient with a new right total hip replacement (posterior
approach). Which statement by the patient indicates a need for further teaching
regarding mobility restrictions?
A. "I will use a long-handled reacher to pick up items from the floor."
B. "I will place a pillow between my legs when I sleep on my side."
C. "I will bend at the waist to put on my socks to avoid twisting my hip."
D. "I will sit in a chair with arms to help me push up to stand."
Rationale: C indicates a need for further teaching. Bending at the waist past 90 degrees
(flexion) is contraindicated for posterior hip precautions. They must use a sock aid or
have someone help them.
, A is correct (prevents bending).
B is correct (prevents adduction/internal rotation).
D is correct (prevents flexion/uses arm strength).
Question 7: Delegation & the Unstable Patient
The RN instructs the LPN to supervise a CNA performing passive range-of-motion
(ROM) exercises on a patient with advanced multiple sclerosis. During supervision, the
LPN observes the CNA moving the patient's neck into hyperextension and quickly
rotating the head side-to-side. What is the LPN's immediate priority action?
A. Document the CNA's technique in the employee incident report.
B. Stop the CNA immediately and explain the risk of vertebral artery compression
or spinal cord injury.
C. Allow the CNA to finish the set, then provide corrective teaching privately.
D. Take over the ROM exercises and reassign the CNA to vital signs for the rest of
the shift.
Rationale: B is correct. Patient safety is paramount. Hyperextension and rapid rotation
of the neck are dangerous, especially in MS or cervical instability. The LPN must stop the
unsafe act immediately, correct the technique, and then report the event to the
RN. A (incident report) comes after safety is secured. C is unsafe (do not let a dangerous
technique finish). D is punitive and does not address the teaching deficit.
Question 8: Mobility & Respiratory Complications
A post-operative patient has been on bedrest for 3 days. The LPN auscultates
diminished breath sounds in the bilateral lung bases. The patient's SpO2 is 91% on
room air. Which collaborative intervention should the LPN initiate first?
Mobility Focus: Comprehensive Mobility & Safe
Patient Handling Competency Assessment for
LPN-to-ADN Transition questions and Answers
Question 1: Delegation & Supervision (Safety)
The LPN is leading the care team. The RN instructs the LPN to delegate the ambulation
of a 78-year-old patient with left-sided weakness to a CNA. The patient is currently
receiving continuous IV heparin and has a fall risk bracelet. Which action by the LPN
demonstrates the correct RN-level delegation and supervision?
A. Tell the CNA to use a stand-assist lift and to keep the IV pump unplugged during the
transfer to avoid electric shock.
B. Instruct the CNA to use a gait belt and to ambulate the patient to the bathroom and
back, then check on them in 15 minutes.
C. Assess the patient’s current hemodynamic stability and weight-bearing status
BEFORE instructing the CNA to proceed.
D. Delegate the task to the CNA and document the time of delegation in the nursing
notes.
Rationale: C is correct. The RN (and LPN in the RN role) must assess the
patient first before delegating. The patient is on heparin (bleeding risk), so a fall could
be catastrophic. The CNA should never be delegated a task without the RN first
determining if it is safe to perform. The LPN must assess vitals, level of consciousness,
and muscle strength.
A is unsafe (NEVER unplug a pump during transfer as it may drain the battery; you
unplug from the wall but keep it on the pole).
B is unsafe delegation because you did not assess first.
D is incorrect because delegation requires supervision and evaluation, not just
documentation.
Question 2: Pathophysiology & Complication Prevention
An immobile patient is placed on a scheduled turning schedule. The LPN observes that
the patient's heels are red and non-blanchable. The LPN creates a new intervention.
, Which intervention should be prioritized to prevent the progression of this tissue
damage?
A. Apply tapered heel elevation boots to float the heels off the bed.
B. Massage the erythematous area with lotion to promote circulation.
C. Increase the turning schedule from q2h to q1h for one shift.
D. Place a sheepskin pad directly under the heels for cushioning.
Rationale: A is correct. Non-blanchable erythema is a Stage 1 pressure injury. The
priority is to offload the pressure. Heel boots float the heels, completely removing the
pressure point.
B is contraindicated; massaging red areas can cause deep tissue trauma and capillary
rupture.
C is good, but does not address the heel specifically if they are still resting on the
mattress during side-lying positions.
D (Sheepskin) reduces friction but does not offload pressure effectively enough for a
Stage 1 injury.
Question 3: Orthostatic Hypotension (RN Assessment)
You are preparing to assist a post-operative patient out of bed for the first time. Which
assessment finding would contraindicate ambulation at this time and require you to re-
evaluate the plan?
A. Heart rate increases from 72 to 88 bpm upon sitting upright.
B. Patient reports mild dizziness that resolves after 30 seconds of dangling.
C. Systolic blood pressure drops from 138 to 102 mmHg upon standing, with reports of
"tunnel vision."
D. Respiratory rate remains at 18 breaths/min during the dangling phase.
Rationale: C is correct. A drop in systolic BP > 20 mmHg (or 10 mmHg diastolic) with
symptoms (tunnel vision) is severe orthostatic hypotension. This indicates cerebral
hypoperfusion; ambulation is unsafe. You would sit the patient back down, reassess, and
possibly notify the provider for a fluid bolus or medication adjustment.
A is a normal compensatory response (increase in HR).
B is mild and expected; allow time to adjust.
D is a normal finding.
, Question 4: Mechanical Lift Application (Clinical Judgment)
You are using a full-body mechanical sling lift to transfer a 220-lb patient from the bed
to a chair. The patient is alert but anxious and has a contracture of the right knee,
preventing full extension. What is the most appropriate RN action to ensure safety and
prevent injury?
A. Place the sling under the patient by log-rolling them to each side, ensuring the sling
is centered beneath them.
B. Apply the sling with the top edge at the patient's shoulders and the bottom edge at
the popliteal space.
C. Sedate the patient with PRN lorazepam to reduce anxiety before lifting to prevent
sudden movements.
D. Use a stand-assist lift instead because the patient is alert.
Rationale: A is correct. For a full-body sling, it must be centered from shoulders
to tailbone (not knees) to distribute weight safely. Log-rolling is the safest way to place
it for a heavy patient.
B is incorrect; the bottom edge goes to the lower buttocks/sacrum, not behind the
knees. The knee contracture makes placing it behind the knees dangerous (pulling on
the joint).
C is incorrect and dangerous (chemical restraint) and would lower the patient's ability to
hold onto the sling straps.
D is incorrect; a stand-assist requires weight-bearing and knee extension, which this
patient cannot do due to the contracture.
Question 5: Patient/Family Teaching (RN Level)
You are discharging a patient with a new right total hip replacement (posterior
approach). Which statement by the patient indicates a need for further teaching
regarding mobility restrictions?
A. "I will use a long-handled reacher to pick up items from the floor."
B. "I will place a pillow between my legs when I sleep on my side."
C. "I will bend at the waist to put on my socks to avoid twisting my hip."
D. "I will sit in a chair with arms to help me push up to stand."
Rationale: C indicates a need for further teaching. Bending at the waist past 90 degrees
(flexion) is contraindicated for posterior hip precautions. They must use a sock aid or
have someone help them.
, A is correct (prevents bending).
B is correct (prevents adduction/internal rotation).
D is correct (prevents flexion/uses arm strength).
Question 7: Delegation & the Unstable Patient
The RN instructs the LPN to supervise a CNA performing passive range-of-motion
(ROM) exercises on a patient with advanced multiple sclerosis. During supervision, the
LPN observes the CNA moving the patient's neck into hyperextension and quickly
rotating the head side-to-side. What is the LPN's immediate priority action?
A. Document the CNA's technique in the employee incident report.
B. Stop the CNA immediately and explain the risk of vertebral artery compression
or spinal cord injury.
C. Allow the CNA to finish the set, then provide corrective teaching privately.
D. Take over the ROM exercises and reassign the CNA to vital signs for the rest of
the shift.
Rationale: B is correct. Patient safety is paramount. Hyperextension and rapid rotation
of the neck are dangerous, especially in MS or cervical instability. The LPN must stop the
unsafe act immediately, correct the technique, and then report the event to the
RN. A (incident report) comes after safety is secured. C is unsafe (do not let a dangerous
technique finish). D is punitive and does not address the teaching deficit.
Question 8: Mobility & Respiratory Complications
A post-operative patient has been on bedrest for 3 days. The LPN auscultates
diminished breath sounds in the bilateral lung bases. The patient's SpO2 is 91% on
room air. Which collaborative intervention should the LPN initiate first?
