HESI PN Comprehensive Nursing Exam | ACTUAL
EXAM | Complete Questions & Verified Answers |
Latest Update | Already Graded A
A postoperative client who received morphine 30 minutes ago reports nausea and
severe itching. The PN’s priority action is to
1. A. administer promethazine 12.5 mg IV push
B. assess respiratory rate and oxygen saturation
C. apply cool compresses to itchy areas
D. document the reaction and notify the surgeon
Correct Answer: B
Rationale: Morphine-induced histamine release can cause pruritus, but the most
life-threatening complication is respiratory depression. The PN must first assess
respiratory status (rate, depth, SpO₂) to rule out hypoventilation before giving any
additional CNS-depressant antiemetics such as promethazine. Cool compresses are
comfort measures that do not address airway safety. Documentation and notification
occur after the client is stable.
A client with chronic renal failure is prescribed epoetin alfa 4 000 units subcutaneous
three times weekly. Which laboratory value best indicates the medication is effective?
2. A. Hemoglobin 10.2 g/dL (baseline 8.4 g/dL)
B. Serum potassium 5.1 mEq/L
C. Blood urea nitrogen 68 mg/dL
D. Platelet count 180 000/mm³
,Correct Answer: A
Rationale: Epoetin alfa stimulates red-blood-cell production; rising hemoglobin
documents therapeutic effect. Elevated potassium or BUN reflects worsening renal
function, not drug efficacy. Platelet count is unaffected by erythropoietin.
The PN is caring for a 6-h-old newborn who has acrocyanosis and a respiratory rate of
58/min. The most appropriate PN action is to
3. A. apply 100 % oxygen via face mask
B. place the infant in a radiant warmer and dry skin
C. obtain a stat blood glucose
D. document findings and continue routine monitoring
Correct Answer: D
Rationale: Acrocyanosis and RR 40–60/min are normal transitional findings in first 24 h.
Aggressive oxygen can damage retinas; warming and drying treat cold stress, not
acrocyanosis; routine monitoring suffices unless central cyanosis or distress develops.
A client on lithium carbonate 300 mg BID reports mild diarrhea and a fine hand tremor.
Lithium level is 1.2 mEq/L. The PN should
4. A. withhold the next dose and recheck level in 6 h
B. encourage 2 000 mL oral fluids daily
C. notify provider for dose reduction
D. give diphenhydramine 25 mg PO for tremor
Correct Answer: B
Rationale: Level 1.2 mEq/L is high-normal; early signs of toxicity appear ≥1.5 mEq/L.
Mild GI effects and tremor respond to adequate hydration that maintains sodium and
,renal clearance. Withholding or reducing dose is premature; diphenhydramine masks
symptoms.
When teaching a client with heart failure about daily weights, the PN instructs the client
to notify the provider for a weight gain of
5. A. 0.5 kg (1 lb) in 1 week
B. 1 kg (2 lb) in 1 day
C. 2 kg (4 lb) in 1 month
D. 3 kg (6 lb) in 6 weeks
Correct Answer: B
Rationale: A 1 kg (2 lb) overnight gain indicates fluid retention of ~1 L and possible
acute decompensation. Smaller gradual gains are expected with chronic disease.
A client receiving total parenteral nutrition (TPN) through a central line complains of
sudden shortness of breath and chest pain. The PN notes the infusion pump is alarming
“high pressure.” The PN’s first action is to
6. A. place client in high-Fowler position and give 100 % O₂
B. stop the TPN infusion immediately
C. obtain stat chest x-ray
D. auscultate breath sounds bilaterally
Correct Answer: B
Rationale: Sudden respiratory distress with pump high-pressure alarm suggests
catheter-related air embolus or clot. Stopping the infusion prevents more air/clot from
entering circulation; then position client left lateral Trendelenburg if air embolus
suspected. Oxygen and x-ray follow initial safety measure.
, A 2-year-old is admitted with suspected intussusception. Which stool characteristic
should the PN expect?
7. A. Pale, fatty, foul-smelling
B. Currant-jelly–like mucus
C. Watery green with blood streaks
D. Hard pellets with streaks of blood
Correct Answer: B
Rationale: Intussusception causes venous congestion and mucosal sloughing,
producing classic currant-jelly stools. Pale fatty stools suggest malabsorption; hard
pellets indicate constipation.
The PN is delegating morning hygiene to assistive personnel (AP). Which client should
the PN keep for personal care?
8. A. 68-year-old 1 day post-hip replacement with continuous passive motion
machine
B. 45-year-old admitted 8 h ago with new left-sided weakness
C. 30-year-old diabetic with stable blood sugars awaiting discharge
D. 55-year-old 2 days post-mastectomy with JP drain intact
Correct Answer: B
Rationale: New neurological deficit requires ongoing neuro checks that are PN
responsibility; unstable status precludes delegation. Other clients are stable or post-op
day ≥1 with predictable needs.
A pregnant client at 28 weeks gestation reports “my fingers feel tingly.” The PN notes
bilateral carpal tunnel–type discomfort. The most appropriate response is to
EXAM | Complete Questions & Verified Answers |
Latest Update | Already Graded A
A postoperative client who received morphine 30 minutes ago reports nausea and
severe itching. The PN’s priority action is to
1. A. administer promethazine 12.5 mg IV push
B. assess respiratory rate and oxygen saturation
C. apply cool compresses to itchy areas
D. document the reaction and notify the surgeon
Correct Answer: B
Rationale: Morphine-induced histamine release can cause pruritus, but the most
life-threatening complication is respiratory depression. The PN must first assess
respiratory status (rate, depth, SpO₂) to rule out hypoventilation before giving any
additional CNS-depressant antiemetics such as promethazine. Cool compresses are
comfort measures that do not address airway safety. Documentation and notification
occur after the client is stable.
A client with chronic renal failure is prescribed epoetin alfa 4 000 units subcutaneous
three times weekly. Which laboratory value best indicates the medication is effective?
2. A. Hemoglobin 10.2 g/dL (baseline 8.4 g/dL)
B. Serum potassium 5.1 mEq/L
C. Blood urea nitrogen 68 mg/dL
D. Platelet count 180 000/mm³
,Correct Answer: A
Rationale: Epoetin alfa stimulates red-blood-cell production; rising hemoglobin
documents therapeutic effect. Elevated potassium or BUN reflects worsening renal
function, not drug efficacy. Platelet count is unaffected by erythropoietin.
The PN is caring for a 6-h-old newborn who has acrocyanosis and a respiratory rate of
58/min. The most appropriate PN action is to
3. A. apply 100 % oxygen via face mask
B. place the infant in a radiant warmer and dry skin
C. obtain a stat blood glucose
D. document findings and continue routine monitoring
Correct Answer: D
Rationale: Acrocyanosis and RR 40–60/min are normal transitional findings in first 24 h.
Aggressive oxygen can damage retinas; warming and drying treat cold stress, not
acrocyanosis; routine monitoring suffices unless central cyanosis or distress develops.
A client on lithium carbonate 300 mg BID reports mild diarrhea and a fine hand tremor.
Lithium level is 1.2 mEq/L. The PN should
4. A. withhold the next dose and recheck level in 6 h
B. encourage 2 000 mL oral fluids daily
C. notify provider for dose reduction
D. give diphenhydramine 25 mg PO for tremor
Correct Answer: B
Rationale: Level 1.2 mEq/L is high-normal; early signs of toxicity appear ≥1.5 mEq/L.
Mild GI effects and tremor respond to adequate hydration that maintains sodium and
,renal clearance. Withholding or reducing dose is premature; diphenhydramine masks
symptoms.
When teaching a client with heart failure about daily weights, the PN instructs the client
to notify the provider for a weight gain of
5. A. 0.5 kg (1 lb) in 1 week
B. 1 kg (2 lb) in 1 day
C. 2 kg (4 lb) in 1 month
D. 3 kg (6 lb) in 6 weeks
Correct Answer: B
Rationale: A 1 kg (2 lb) overnight gain indicates fluid retention of ~1 L and possible
acute decompensation. Smaller gradual gains are expected with chronic disease.
A client receiving total parenteral nutrition (TPN) through a central line complains of
sudden shortness of breath and chest pain. The PN notes the infusion pump is alarming
“high pressure.” The PN’s first action is to
6. A. place client in high-Fowler position and give 100 % O₂
B. stop the TPN infusion immediately
C. obtain stat chest x-ray
D. auscultate breath sounds bilaterally
Correct Answer: B
Rationale: Sudden respiratory distress with pump high-pressure alarm suggests
catheter-related air embolus or clot. Stopping the infusion prevents more air/clot from
entering circulation; then position client left lateral Trendelenburg if air embolus
suspected. Oxygen and x-ray follow initial safety measure.
, A 2-year-old is admitted with suspected intussusception. Which stool characteristic
should the PN expect?
7. A. Pale, fatty, foul-smelling
B. Currant-jelly–like mucus
C. Watery green with blood streaks
D. Hard pellets with streaks of blood
Correct Answer: B
Rationale: Intussusception causes venous congestion and mucosal sloughing,
producing classic currant-jelly stools. Pale fatty stools suggest malabsorption; hard
pellets indicate constipation.
The PN is delegating morning hygiene to assistive personnel (AP). Which client should
the PN keep for personal care?
8. A. 68-year-old 1 day post-hip replacement with continuous passive motion
machine
B. 45-year-old admitted 8 h ago with new left-sided weakness
C. 30-year-old diabetic with stable blood sugars awaiting discharge
D. 55-year-old 2 days post-mastectomy with JP drain intact
Correct Answer: B
Rationale: New neurological deficit requires ongoing neuro checks that are PN
responsibility; unstable status precludes delegation. Other clients are stable or post-op
day ≥1 with predictable needs.
A pregnant client at 28 weeks gestation reports “my fingers feel tingly.” The PN notes
bilateral carpal tunnel–type discomfort. The most appropriate response is to
