HESI Specialty and Exit Exam Nightingale College - PN
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Free HESI Specialty and Exit Exam Nightingale College - PN Questions
While caring for an older adult client who is sitting in a chair, the practical nurse (PN) observes that the client's lower legs are dusky red in appearance. Which action should the PN implement?
- Review the client's hemoglobin level
- Administer oxygen via nasal cannula
- Measure the client's blood pressure
- Elevate the client's legs and reassess
Explanation
Correct Answer: D) Elevate the client's legs and reassess
Dusky red discoloration of the lower legs in a dependent position is a sign of venous insufficiency and pooling of deoxygenated blood due to gravity. Elevating the legs promotes venous return to the heart, improves circulation, and reduces dependent edema. Reassessing after elevation determines whether the color improves, helping the nurse differentiate between positional venous pooling and a more serious circulatory compromise requiring further intervention.
The practical nurse (PN) listens for heart sounds by firmly pressing the diaphragm of the stethoscope against the client's chest. After hearing normal heart sounds, which action should the PN take to detect extra heart sounds?
- Decrease the amount of pressure used to hold the stethoscope.
- Continue to hold the stethoscope firmly in place with one hand.
- Rotate the end piece of the stethoscope.
- Adjust the earpieces of the stethoscope.
Explanation
Correct Answer: C) Rotate the end piece of the stethoscope.
To detect extra or abnormal heart sounds such as S3, S4, or murmurs — which are often low-pitched — the PN should rotate the end piece of the stethoscope to switch from the diaphragm to the bell. The diaphragm detects high-pitched sounds (normal S1 and S2), while the bell is specifically designed to pick up low-pitched extra heart sounds. Adjusting pressure or earpieces does not change the acoustic properties needed for this assessment.
A client with fluid volume overload is sitting upright in a bedside chair. The practical nurse (PN) observes that the client's neck veins are visible and engorged. Which action should the PN take in response to this finding?
- Assist the client to a supine position in the bed
- Document the presence of jugular vein distention
- Palpate the pulse volume at the site of engorgement
- Apply a warm compress at the site to reduce swelling
Explanation
Correct Answer: B) Document the presence of jugular vein distention
Jugular vein distention (JVD) in an upright or semi-upright position is an abnormal and clinically significant finding indicating elevated central venous pressure — a hallmark sign of fluid volume overload and right-sided heart failure. The nurse's immediate responsibility is to accurately document this objective finding so it can be communicated to the provider for further evaluation and management. In a client already known to have fluid volume overload, JVD confirms worsening venous congestion and requires prompt medical attention.
An adult woman comes into the primary care clinic for her annual physical examination. While obtaining the health history, the client tells the practical nurse (PN) that she had a "bad reaction" when she took penicillin. Which additional information should the PN obtain?
- Do other family members reaction to penicillin?
- Does she have reactions to any other medications?
- How long has it been since she took penicillin?
- What happens when she takes penicillin?
Explanation
Correct Answer: D) What happens when she takes penicillin?
When a client reports a "bad reaction" to a medication, the most critical follow-up is to clarify the exact nature of the reaction. Understanding what actually happened — whether it was a true allergic reaction (e.g., anaphylaxis, hives) or an adverse effect (e.g., nausea, diarrhea) — is essential for accurate allergy documentation and safe future prescribing. Without knowing the specific reaction, no meaningful clinical decision can be made. The other options, while relevant, are secondary to first establishing what the reaction actually was.
The practical nurse (PN) is performing a pain assessment on a client. Which factor(s) have been shown to have an effect on a client's perception of pain and will most likely increase the perception of pain? Select all that apply.
- Sense of lack of control.
- Emotional and physical fatigue.
- Guided meditation and mental imagery.
- Negative experiences managing pain.
- Cardioaerobic exercise.
Explanation
Correct Answers: A, B, and D
A) Sense of lack of control — when clients feel powerless over their pain or treatment, anxiety increases, which amplifies pain perception through the gate control theory of pain. B) Emotional and physical fatigue — fatigue lowers the pain threshold and reduces the client's ability to cope with pain, significantly increasing pain perception. D) Negative experiences managing pain — prior negative experiences with pain management create anticipatory anxiety and fear, which heighten pain sensitivity and perception in subsequent pain episodes.
During data collection, the client informed the practical nurse (PN) that the last bowel movement was three days ago. Which actions should the practical nurse (PN) take next? Select all that apply.
- Measure and record the abdominal girth.
- Determine the client's usual bowel patterns.
- Auscultate the abdomen for bowel sounds.
- Obtain a prescription for an enema or suppository.
- Evaluate the client's dietary intake and eating patterns.
Explanation
Correct Answers: B, C, and E
B) Determine the client's usual bowel patterns — before intervening, the PN must establish what is normal for this client. Some individuals normally have bowel movements every 2–3 days, making three days without a bowel movement potentially within their baseline. C) Auscultate the abdomen for bowel sounds — assessing bowel sounds provides objective data about gastrointestinal motility and helps determine the severity of the situation. E) Evaluate dietary intake and eating patterns — inadequate fiber and fluid intake are primary contributors to constipation and are essential assessment data to guide patient education and intervention.
Practical nurse (PN) reviews data for a 73-year-old client with a history of left-sided stroke whose right side has increasing weakness and a decrease in range of motion (ROM). A focused assessment was done for both active and passive range of motion (ROM) on right side upper extremity joints due to noticeable decline in self care abilities.
Which findings would the PN expect when assessing the right upper extremity of this client? Select all that apply.
- The client is able to move the arm away from the body without difficulty.
- The client is unable to move the arm away from the body at the shoulder.
- The client is able to bend the wrist back toward the forearm.
- The client demonstrates full and equal strength bilaterally.
- The client is only able to straighten the elbow joint.
Explanation
Correct Answers: B, C, and E
B) Unable to move the arm away from the body at the shoulder — Moving the arm away from the body is abduction. Due to right-sided weakness from the left-sided stroke, the client has impaired shoulder abduction on the affected side.
C) Able to bend the wrist back toward the forearm — Bending the wrist back toward the forearm represents wrist flexion, which the nurse's notes confirm the client is able to perform, though with noted decline.
E) Only able to straighten the elbow joint — Straightening a joint is extension. The client retains limited elbow extension but has overall decreased ROM consistent with stroke-related weakness.
The practical nurse (PN) should use observation to assess the client for which clinical manifestation(s)? Select all that apply.
- Stomatitis.
- Jaundice.
- Pallor.
- Hypertension.
- Polyuria.
Explanation
Correct Answers: A, B, and C
A) Stomatitis — inflammation and sores of the oral mucosa are directly visible through inspection of the oral cavity. B) Jaundice — yellowing of the skin and sclera is a visible finding detected through direct observation of the client's skin and eyes. C) Pallor — abnormal paleness of the skin, mucous membranes, and nail beds is assessed through visual inspection.
D is incorrect because hypertension is measured using a blood pressure cuff and sphygmomanometer — it cannot be detected by observation alone. E is incorrect because polyuria (excessive urination) requires measurement of urine output, not visual observation of the client's appearance.
The practical nurse (PN) is collecting data from a client who was seen three days ago for a puncture wound on the left lower calf. Upon return to the clinic, the client reports increased pain, limited range of motion in the left leg, and overall achiness and chills. Which finding(s) indicate possible infection? Select all that apply.
- Purulent drainage.
- Scar tissue.
- Streaking.
- Granulated tissue.
- Increased redness.
Explanation
Correct Answers: A, C, and E
A) Purulent drainage — thick, cloudy, or foul-smelling discharge from a wound is a hallmark sign of bacterial infection. C) Streaking — red lines radiating from the wound site indicate lymphangitis, a serious sign of spreading infection requiring urgent attention. E) Increased redness — erythema around the wound site indicates inflammation and is a classic sign of local infection. B is incorrect because scar tissue represents normal healing. D is incorrect because granulated tissue is healthy tissue formation, indicating normal wound healing rather than infection.
The practical nurse (PN) reviews the laboratory results of an older adult client who is one day postoperative for a right total hip replacement. Which serum value result has the greatest implication for client safety?
Reference Ranges: Hgb [12–16 g/dL] | K+ [3.5–5.0 mEq/L] | Sodium [136–145 mEq/L] | BUN [10–20 mg/dL]
- Hemoglobin 8.9 grams/dL (89 g/L).
- Potassium 3.4 mEq/L (3.4 mmol/L).
- Sodium 130 mEq/L (130 mmol/L).
- Blood urea nitrogen 20 mg/dL (7.14 mmol/L).
Explanation
Correct Answer: A) Hemoglobin 8.9 grams/dL.
In a client who is one day postoperative following a total hip replacement, a hemoglobin of 8.9 g/dL — significantly below the normal range of 12–16 g/dL — has the greatest implication for client safety. This critically low value indicates significant blood loss from surgery and places the client at high risk for hemodynamic instability, impaired tissue oxygenation, and hypovolemic shock. While the sodium of 130 mEq/L is also below normal, the degree of hemoglobin deficit in the context of recent major surgery represents the most immediate threat to this client's safety.
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