HESI Specialty and Exit Exam Nightingale College - PN
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Free HESI Specialty and Exit Exam Nightingale College - PN Questions
After repositioning an older adult client from the right to the left side, the practical nurse (PN) observes a reddened area on the client's right hip over the area of the greater trochanter. Which action should the PN take?
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Offer the client fluids and a high protein snack.
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Compare range of motion of the client's legs.
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Determine the ability of the tissue to blanch.
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Assess elasticity of the surrounding tissue.
Explanation
Correct Answer: C) Determine the ability of the tissue to blanch.
When a reddened area is observed over a bony prominence, the priority action is to assess whether the tissue blanches with fingertip pressure. Blanchable redness indicates a reactive hyperemia response — a normal physiological response to pressure — while non-blanchable redness indicates a Stage 1 pressure injury requiring immediate intervention. This distinction directly guides the PN's next steps in care and documentation. The other options, while relevant to overall care, do not address the immediate priority of assessing tissue integrity.
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?
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Review the client's hemoglobin level
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Administer oxygen via nasal cannula
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Measure the client's blood pressure
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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) 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.
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Sense of lack of control.
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Emotional and physical fatigue.
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Guided meditation and mental imagery.
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Negative experiences managing pain.
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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.
The practical nurse (PN) is reviewing morning laboratory values for a female adult client. Which findings indicate abnormal values that should be reported to the healthcare provider? Select all that apply.
Reference Range: WBC [5,000–10,000/mm³] | Hgb [12–16 g/dL] | Hct [37–47%] | K+ [3.5–5.0 mEq/L] | Sodium [136–145 mEq/L]
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Hematocrit of 44% (0.44 volume fraction).
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Serum potassium 2.5 mEq/L (2.5 mmol/L).
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Hemoglobin 13 grams/dL (130 g/L).
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Serum sodium 125 mEq/L (125 mmol/L).
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White blood cell count 15,000/mm³ (15 x 10⁹/L).
Explanation
Correct Answers: B, D, and E
B) Serum potassium 2.5 mEq/L — below the normal range of 3.5–5.0 mEq/L, indicating hypokalemia, which can cause life-threatening cardiac arrhythmias. D) Serum sodium 125 mEq/L — below the normal range of 136–145 mEq/L, indicating hyponatremia, which can cause neurological complications including seizures. E) WBC 15,000/mm³ — above the normal range of 5,000–10,000/mm³, indicating leukocytosis, which may signal infection or inflammation.
The practical nurse (PN) is doing a focused assessment for a young adult client. Which information provides the best indication of the individual's nutritional status?
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Status of current appetite.
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A 24 hour diet history.
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Condition of hair, nails, and skin.
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History of a recent weight loss.
Explanation
Correct Answer: C) Condition of hair, nails, and skin.
The physical condition of hair, nails, and skin provides objective, observable evidence of nutritional status over time. Deficiencies in key nutrients such as proteins, vitamins, and minerals manifest visibly through brittle nails, hair loss, and skin changes. While appetite, diet history, and weight loss are relevant, they reflect short-term or subjective data. Physical findings offer the most reliable and objective indication of overall nutritional status.
A 25-year-old male comes to the emergency department having difficulty breathing which has worsened over the last twenty-four hours. Nurses' notes reveal decreased lung sounds in the right lower base, dullness on percussion, decreased chest expansion on the right side, and a non-productive cough for two days. Vital signs show a temperature of 99°F, heart rate 86 beats/minute, respiratory rate 24 breaths/minute, and oxygen saturation 94% on room air. Which condition is this client most likely experiencing?
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Lobar pneumonia
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Pleural effusion
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Acute bronchitis
Explanation
Correct Answer: B) Pleural effusion
Pleural effusion is an abnormal accumulation of fluid in the pleural space. The combination of decreased lung sounds, dullness on percussion over the right lower base, decreased chest expansion on the affected side, and use of accessory muscles are classic hallmark findings of pleural effusion. The fluid in the pleural space dampens sound transmission, restricts lung expansion, and compromises oxygenation — explaining the client's oxygen saturation of 94% and elevated respiratory rate of 24 breaths/minute, both of which indicate early respiratory compromise requiring close monitoring and prompt intervention.
The day shift practical nurse (PN) is performing a focused assessment on a client who had a thoracentesis the evening before. The PN should alert the healthcare provider if the client exhibits which finding?
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Uneven chest movements.
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Gag reflex that has not returned.
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Decrease in the baseline of the heart rate.
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Nasal congestion.
Explanation
Correct Answer: A) Uneven chest movements.
Following a thoracentesis — a procedure in which fluid is drained from the pleural space — uneven chest movements are a critical and alarming finding that may indicate pneumothorax, a serious complication where air enters the pleural space causing lung collapse. This requires immediate notification of the healthcare provider. A gag reflex that has not returned is relevant after procedures involving sedation or throat instrumentation, not thoracentesis. A decrease in heart rate baseline and nasal congestion are not directly related to post-thoracentesis complications.
While conducting a mental status examination of a newly admitted male client, the practical nurse (PN) notes that his head is lowered and he shows no emotion or expression when speaking. Based on these observations, which documentation should the PN include?
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Depressed mood.
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Flat affect.
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Diminished level of consciousness.
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Impaired verbalization.
Explanation
Correct Answer: B) Flat affect.
Flat affect is the clinical term used to describe the absence or near-absence of emotional expression — characterized by a lack of facial expression, monotone voice, and minimal emotional reactivity. The client's lowered head and complete absence of emotion or expression during speech are the defining features of flat affect. Depressed mood refers to a subjective feeling of sadness reported by the client, not an observed behavior. Diminished consciousness and impaired verbalization are not supported by the clinical findings described.
In which client situation should the practical nurse (PN) assess for the presence of Cheyne-Stokes respirations?
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During an allergic reaction.
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When death is imminent.
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With elevated blood glucose.
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After strenuous exercise.
Explanation
Correct Answer: B) When death is imminent.
Cheyne-Stokes respirations — a pattern of breathing characterized by progressively deeper and faster breaths followed by a gradual decrease and periods of apnea — are most commonly associated with end-of-life states, severe brain injury, heart failure, and imminent death. This abnormal breathing pattern reflects significant neurological or cardiopulmonary compromise. Allergic reactions, elevated blood glucose, and post-exercise states produce different respiratory patterns and are not associated with Cheyne-Stokes respirations.
The practical nurse shines a pen light over a client's pupil and observes the pupil constrict briskly. Which action should the PN take next?
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Instruct the client to close both eyes, then repeat the assessment.
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Notify the charge nurse of the assessment finding immediately.
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Shine the light over the other pupil and observe the response.
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Hold the light over the pupil until it dilates back to the original size.
Explanation
Correct Answer: C) Shine the light over the other pupil and observe the response.
Brisk constriction of the pupil in response to a penlight is a normal finding. The next logical step in a complete pupillary assessment is to test the other eye in the same manner to ensure bilateral equal and reactive responses. A full assessment requires evaluating both pupils individually. Notifying the charge nurse is unnecessary as this is a normal finding, closing the eyes is not part of standard pupillary assessment, and holding the light until dilation serves no clinical purpose.
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