ESTUDYR
HESI NCLEX -PN EXAMINATION REVIEW UPDATED EXAM WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1. A 43-year-old female post-thyroidectomy (Graves’) is prescribed thyroid replacement.
Which signs/symptoms of thyroid hormone toxicity should be reported promptly?
A. Tinnitus and dizziness
B. Tachycardia and chest pain ✔
C. Dry skin and intolerance to cold
D. Weight gain and increased appetite
Rationale: Thyroid hormone excess can cause sympathetic overactivity — tachycardia
and chest pain may indicate cardiovascular toxicity and need urgent evaluation.
2. The dosing of an intravenous heparin infusion is guided primarily by which lab value?
A. Prothrombin time (PT)
B. Fibrin split products
C. Platelet count
D. Partial thromboplastin time (aPTT) ✔
Rationale: aPTT monitors unfractionated heparin anticoagulant effect and guides
infusion rate adjustments.
3. For a client on vancomycin who needs peak and trough levels, when should the PN
obtain the trough specimen?
A. 60 minutes after the dose is administered
B. Immediately before the next antibiotic dose is given ✔
C. When the next blood glucose check is due
D. 30 minutes before the next dose
Rationale: Trough is drawn just prior to the next dose to measure the lowest serum
concentration.
4. A client taking prednisone for rheumatoid arthritis — which aspect of care should be
emphasized?
A. Reducing the dose of insulin
B. Monitoring for hyperkalemia
C. Monitoring for substance abuse
D. Treating infections promptly ✔
Rationale: Glucocorticoids suppress immunity and mask infection signs; early
detection/treatment is essential.
,ESTUDYR
5. A client asks why they take glipizide orally. Best PN response:
A. Glipizide is oral insulin and acts like intermediate insulin.
B. Glipizide is oral insulin and processed same as insulin.
C. Glipizide is not oral insulin and requires some endogenous beta-cell function to
work. ✔
D. Glipizide is not oral insulin but works when injectable insulin fails.
Rationale: Sulfonylureas (glipizide) stimulate residual pancreatic beta cells to secrete
insulin; they are ineffective if beta-cell function is absent.
6. After carbidopa-levodopa for Parkinson disease, which outcome indicates therapeutic
response?
A. Decreased blood pressure
B. Lessening of tremors ✔
C. Increased salivation
D. Increased attention span
Rationale: Levodopa-carbidopa restores dopaminergic activity, reducing tremor and
motor symptoms.
7. Which client condition would cause the PN not to vaccinate with influenza vaccine and
consult charge nurse?
A. History of congestive heart failure
B. History of allergy to eggs ✔
C. History of prior pneumococcal vaccination
D. History of end-stage renal disease
Rationale: Severe egg allergy (depending on vaccine type and facility policy) may
contraindicate standard influenza vaccine — consult provider/charge nurse.
8. A client on hydrochlorothiazide presents with muscle weakness and cramps. Which
condition likely causes these changes?
A. Hypolipidemia
B. Hypermagnesemia
C. Hyperchloremia
D. Hyponatremia ✔
Rationale: Thiazides can cause electrolyte disturbances including hyponatremia and
hypokalemia; hyponatremia contributes to weakness/cramps.
9. A client with oral thrush lost their medication (bottle broke). Which medication refill
requires contacting the HCP?
A. Ampicillin
, ESTUDYR
B. Ciprofloxacin
C. Neomycin sulfate
D. Nystatin ✔
Rationale: Nystatin (topical/oral antifungal) is the indicated therapy for thrush; a
refill/prescription may be required.
10. A client with PRN nitroglycerin for angina — which statement needs clarification?
A. I will take one tablet every 5 minutes, up to three tablets.
B. I should take one tablet at onset of angina and stop activity.
C. I need to replace nitroglycerin every 3–6 months.
D. I should ensure that I chew the pill completely before swallowing it. ✔
Rationale: Sublingual nitroglycerin should be placed under tongue — it is not chewed.
Chewing is for some other meds (e.g., aspirin).
11. A client on rifampin reports orange urine after 3 weeks. The nurse should:
A. Notify HCP.
B. Inform the client this is not harmful. ✔
C. Assess for nephrotoxicity signs.
D. Monitor recent creatinine results.
Rationale: Rifampin commonly causes orange-red discoloration of body fluids; it’s
harmless but should be explained.
12. After a positive PPD, primary prophylaxis for latent TB exposure is usually:
A. Isoniazid (INH) ✔
B. Rifampin
C. Acyclovir
D. Griseofulvin
Rationale: Isoniazid is commonly used for latent TB prophylaxis.
13. A 3-year-old monitored after accidental phenytoin ingestion — nurse is instructed to
monitor the gait. Which adverse effect are they monitoring?
A. Ataxia ✔
B. Nystagmus
C. Gingival hyperplasia
D. Paradoxical excitement
Rationale: Phenytoin toxicity can cause cerebellar signs including ataxia (impaired
coordination).
14. Lactulose is administered — which outcome indicates therapeutic effect?
A. Increased urine output
HESI NCLEX -PN EXAMINATION REVIEW UPDATED EXAM WITH
MOST TESTED QUESTIONS AND ANSWERS | GRADED A+ |
ASSURED SUCCESS WITH DETAILED RATIONALES
1. A 43-year-old female post-thyroidectomy (Graves’) is prescribed thyroid replacement.
Which signs/symptoms of thyroid hormone toxicity should be reported promptly?
A. Tinnitus and dizziness
B. Tachycardia and chest pain ✔
C. Dry skin and intolerance to cold
D. Weight gain and increased appetite
Rationale: Thyroid hormone excess can cause sympathetic overactivity — tachycardia
and chest pain may indicate cardiovascular toxicity and need urgent evaluation.
2. The dosing of an intravenous heparin infusion is guided primarily by which lab value?
A. Prothrombin time (PT)
B. Fibrin split products
C. Platelet count
D. Partial thromboplastin time (aPTT) ✔
Rationale: aPTT monitors unfractionated heparin anticoagulant effect and guides
infusion rate adjustments.
3. For a client on vancomycin who needs peak and trough levels, when should the PN
obtain the trough specimen?
A. 60 minutes after the dose is administered
B. Immediately before the next antibiotic dose is given ✔
C. When the next blood glucose check is due
D. 30 minutes before the next dose
Rationale: Trough is drawn just prior to the next dose to measure the lowest serum
concentration.
4. A client taking prednisone for rheumatoid arthritis — which aspect of care should be
emphasized?
A. Reducing the dose of insulin
B. Monitoring for hyperkalemia
C. Monitoring for substance abuse
D. Treating infections promptly ✔
Rationale: Glucocorticoids suppress immunity and mask infection signs; early
detection/treatment is essential.
,ESTUDYR
5. A client asks why they take glipizide orally. Best PN response:
A. Glipizide is oral insulin and acts like intermediate insulin.
B. Glipizide is oral insulin and processed same as insulin.
C. Glipizide is not oral insulin and requires some endogenous beta-cell function to
work. ✔
D. Glipizide is not oral insulin but works when injectable insulin fails.
Rationale: Sulfonylureas (glipizide) stimulate residual pancreatic beta cells to secrete
insulin; they are ineffective if beta-cell function is absent.
6. After carbidopa-levodopa for Parkinson disease, which outcome indicates therapeutic
response?
A. Decreased blood pressure
B. Lessening of tremors ✔
C. Increased salivation
D. Increased attention span
Rationale: Levodopa-carbidopa restores dopaminergic activity, reducing tremor and
motor symptoms.
7. Which client condition would cause the PN not to vaccinate with influenza vaccine and
consult charge nurse?
A. History of congestive heart failure
B. History of allergy to eggs ✔
C. History of prior pneumococcal vaccination
D. History of end-stage renal disease
Rationale: Severe egg allergy (depending on vaccine type and facility policy) may
contraindicate standard influenza vaccine — consult provider/charge nurse.
8. A client on hydrochlorothiazide presents with muscle weakness and cramps. Which
condition likely causes these changes?
A. Hypolipidemia
B. Hypermagnesemia
C. Hyperchloremia
D. Hyponatremia ✔
Rationale: Thiazides can cause electrolyte disturbances including hyponatremia and
hypokalemia; hyponatremia contributes to weakness/cramps.
9. A client with oral thrush lost their medication (bottle broke). Which medication refill
requires contacting the HCP?
A. Ampicillin
, ESTUDYR
B. Ciprofloxacin
C. Neomycin sulfate
D. Nystatin ✔
Rationale: Nystatin (topical/oral antifungal) is the indicated therapy for thrush; a
refill/prescription may be required.
10. A client with PRN nitroglycerin for angina — which statement needs clarification?
A. I will take one tablet every 5 minutes, up to three tablets.
B. I should take one tablet at onset of angina and stop activity.
C. I need to replace nitroglycerin every 3–6 months.
D. I should ensure that I chew the pill completely before swallowing it. ✔
Rationale: Sublingual nitroglycerin should be placed under tongue — it is not chewed.
Chewing is for some other meds (e.g., aspirin).
11. A client on rifampin reports orange urine after 3 weeks. The nurse should:
A. Notify HCP.
B. Inform the client this is not harmful. ✔
C. Assess for nephrotoxicity signs.
D. Monitor recent creatinine results.
Rationale: Rifampin commonly causes orange-red discoloration of body fluids; it’s
harmless but should be explained.
12. After a positive PPD, primary prophylaxis for latent TB exposure is usually:
A. Isoniazid (INH) ✔
B. Rifampin
C. Acyclovir
D. Griseofulvin
Rationale: Isoniazid is commonly used for latent TB prophylaxis.
13. A 3-year-old monitored after accidental phenytoin ingestion — nurse is instructed to
monitor the gait. Which adverse effect are they monitoring?
A. Ataxia ✔
B. Nystagmus
C. Gingival hyperplasia
D. Paradoxical excitement
Rationale: Phenytoin toxicity can cause cerebellar signs including ataxia (impaired
coordination).
14. Lactulose is administered — which outcome indicates therapeutic effect?
A. Increased urine output
