HESI PN EXIT EXAM PRACTICE EXAMINATION 2026–
2027 — NGN & CLINICAL JUDGMENT STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
This original practice examination is designed for practical/vocational
nursing students preparing for the HESI PN Exit Exam and the NCLEX-
PN® licensure examination. The 100-question test integrates
fundamentals, medical-surgical nursing, pharmacology, maternal-
newborn, pediatrics, mental health, leadership, and community health,
with emphasis on Next Generation NCLEX clinical judgment case
scenarios. Questions are written at the application and analysis level to
mirror the cognitive complexity of high-stakes PN exit examinations. The
2026–2027 edition incorporates current evidence-based practice,
patient safety standards, and LPN/LVN scope of practice. Use this
comprehensive review to assess readiness, identify knowledge gaps, and
strengthen critical thinking for first-attempt success. This is an
independent educational resource, not affiliated with or endorsed by
HESI or Evolve.
Table of Contents
I. Fundamentals of Nursing and Safety
II. Medical-Surgical Nursing and Complex Care
III. Pharmacology and Medication Safety
IV. Maternal-Newborn and Women’s Health
V. Pediatric Nursing and Developmental Care
VI. Mental Health and Psychosocial Integrity
,VII. Leadership, Delegation, and Management of Care
VIII. Next Generation NCLEX Case Scenarios
1. A practical nurse is caring for a client with acute pancreatitis who
is NPO and receiving IV fluids. Which laboratory finding is the best
indicator of nutritional improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a
level of 22 mg/dL indicates adequate protein synthesis. Amylase and
lipase reflect pancreatic inflammation, not nutrition. Blood glucose
indicates glucose control.
2. A practical nurse is reviewing a telemetry strip. The PR interval
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
, 3. A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value requires immediate notification before
administering the dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias. The
provider should be notified before giving the dose. Other values are
within normal limits.
4. A practical nurse is teaching a client with a new colostomy about
stoma care. Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
5. A client is receiving a continuous heparin infusion. The aPTT is 105
seconds (therapeutic 60–80 seconds). The client has no active
bleeding. What is the nurse’s best action?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
, hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
protocol. Protamine is for severe hemorrhage. Vitamin K reverses
warfarin, not heparin. Continuing the rate increases bleeding risk.
6. A postpartum client who delivered a 9-pound infant 2 hours ago
has a boggy uterus displaced to the right, heavy lochia rubra, and
perineal pad saturation in 15 minutes. What is the priority nursing
intervention?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder
distention. Empty the bladder first, then massage the fundus.
Methylergonovine may be given if massage fails. Trendelenburg and ice
are not priorities.
7. A practical nurse is caring for a client 24 hours after a femoral-
popliteal bypass graft. The client reports severe pain in the
affected leg, and the foot is pale, cool, and mottled with absent
pedal pulses. What should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the RN or provider immediately of suspected graft
occlusion
2027 — NGN & CLINICAL JUDGMENT STUDY GUIDE |
LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
This original practice examination is designed for practical/vocational
nursing students preparing for the HESI PN Exit Exam and the NCLEX-
PN® licensure examination. The 100-question test integrates
fundamentals, medical-surgical nursing, pharmacology, maternal-
newborn, pediatrics, mental health, leadership, and community health,
with emphasis on Next Generation NCLEX clinical judgment case
scenarios. Questions are written at the application and analysis level to
mirror the cognitive complexity of high-stakes PN exit examinations. The
2026–2027 edition incorporates current evidence-based practice,
patient safety standards, and LPN/LVN scope of practice. Use this
comprehensive review to assess readiness, identify knowledge gaps, and
strengthen critical thinking for first-attempt success. This is an
independent educational resource, not affiliated with or endorsed by
HESI or Evolve.
Table of Contents
I. Fundamentals of Nursing and Safety
II. Medical-Surgical Nursing and Complex Care
III. Pharmacology and Medication Safety
IV. Maternal-Newborn and Women’s Health
V. Pediatric Nursing and Developmental Care
VI. Mental Health and Psychosocial Integrity
,VII. Leadership, Delegation, and Management of Care
VIII. Next Generation NCLEX Case Scenarios
1. A practical nurse is caring for a client with acute pancreatitis who
is NPO and receiving IV fluids. Which laboratory finding is the best
indicator of nutritional improvement over the past 3 days?
A) Serum amylase 180 U/L
B) Serum prealbumin 22 mg/dL
C) Blood glucose 150 mg/dL
D) Serum lipase 220 U/L
Correct Answer: B
Prealbumin has a short half-life and reflects recent nutritional status; a
level of 22 mg/dL indicates adequate protein synthesis. Amylase and
lipase reflect pancreatic inflammation, not nutrition. Blood glucose
indicates glucose control.
2. A practical nurse is reviewing a telemetry strip. The PR interval
progressively lengthens until a QRS complex is dropped. The
pattern repeats. What rhythm is present?
A) First-degree AV block
B) Second-degree AV block type I (Wenckebach)
C) Second-degree AV block type II (Mobitz II)
D) Third-degree AV block
Correct Answer: B
Wenckebach is characterized by progressive PR prolongation until a
non-conducted P wave. First-degree has a constant prolonged PR
without dropped beats. Mobitz II has constant PR with sudden dropped
QRS. Third-degree has AV dissociation.
, 3. A client with heart failure is prescribed furosemide 40 mg IV push.
Which laboratory value requires immediate notification before
administering the dose?
A) Serum potassium 3.1 mEq/L
B) Serum sodium 138 mEq/L
C) Serum calcium 9.0 mg/dL
D) Serum magnesium 2.0 mEq/L
Correct Answer: A
Furosemide causes potassium loss; a potassium of 3.1 mEq/L is
hypokalemic and increases the risk of cardiac dysrhythmias. The
provider should be notified before giving the dose. Other values are
within normal limits.
4. A practical nurse is teaching a client with a new colostomy about
stoma care. Which observation indicates a healthy stoma?
A) Dark purple and dry
B) Beefy red and moist
C) Pale pink and dry
D) Blue-tinged and cool
Correct Answer: B
A healthy stoma is moist and beefy red due to adequate blood supply.
Dark purple or blue-tinged indicates ischemia. Pale and dry suggests
poor perfusion.
5. A client is receiving a continuous heparin infusion. The aPTT is 105
seconds (therapeutic 60–80 seconds). The client has no active
bleeding. What is the nurse’s best action?
A) Stop the heparin and administer protamine sulfate
B) Decrease the infusion rate per protocol and recheck aPTT in 6
, hours
C) Continue the current rate and monitor for petechiae
D) Administer vitamin K subcutaneously
Correct Answer: B
A supratherapeutic aPTT without bleeding requires a rate reduction per
protocol. Protamine is for severe hemorrhage. Vitamin K reverses
warfarin, not heparin. Continuing the rate increases bleeding risk.
6. A postpartum client who delivered a 9-pound infant 2 hours ago
has a boggy uterus displaced to the right, heavy lochia rubra, and
perineal pad saturation in 15 minutes. What is the priority nursing
intervention?
A) Administer methylergonovine intramuscularly
B) Perform fundal massage after ensuring the bladder is empty
C) Place the client in Trendelenburg position
D) Apply an ice pack to the perineum
Correct Answer: B
A displaced, boggy uterus suggests uterine atony likely due to bladder
distention. Empty the bladder first, then massage the fundus.
Methylergonovine may be given if massage fails. Trendelenburg and ice
are not priorities.
7. A practical nurse is caring for a client 24 hours after a femoral-
popliteal bypass graft. The client reports severe pain in the
affected leg, and the foot is pale, cool, and mottled with absent
pedal pulses. What should the nurse do first?
A) Elevate the leg on two pillows
B) Notify the RN or provider immediately of suspected graft
occlusion
