HESI Specialty and Exit Exam Nightingale College - PN
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Free HESI Specialty and Exit Exam Nightingale College - PN Questions
While assessing a client, the practical nurse (PN) observes that the client has a frequent productive cough. Which follow-up assessment should the PN complete first?
- Note sputum characteristics.
- Monitor white blood cell count.
- Measure vital signs.
- Assess for dependent edema.
Explanation
Correct Answer: C) Measure vital signs.
When a client presents with a frequent productive cough, measuring vital signs is the priority first action as it provides a comprehensive and immediate overview of the client's overall physiological stability. Vital signs — including temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure — help the PN quickly identify signs of infection, respiratory compromise, or systemic deterioration that require urgent intervention. While noting sputum characteristics is an important follow-up, it is secondary to first establishing the client's baseline hemodynamic and respiratory status. Monitoring white blood cell count requires a laboratory order, and assessing for dependent edema, while relevant to cardiopulmonary conditions, is not the immediate priority.
Select the 3 possible conditions that could have the symptom of clubbed nails for this client.
- Chronic obstructive pulmonary disease (COPD)
- Flu
- Lung cancer
- Pneumonia
- Chronic bronchitis
Explanation
Correct Answers: A, C, and E
A) Chronic obstructive pulmonary disease (COPD) — COPD is a chronic condition causing persistent airflow limitation and prolonged hypoxia. Long-term oxygen deprivation leads to compensatory changes in the nail bed, resulting in clubbing. Given the client's history of long-term smoking and respiratory infections, COPD is highly likely.
C) Lung cancer — Lung cancer is strongly associated with nail clubbing, particularly due to chronic hypoxia and paraneoplastic syndromes. The client's extensive smoking history significantly increases his risk for lung cancer, making this a clinically relevant association.
E) Chronic bronchitis — Chronic bronchitis, often caused by long-term smoking, leads to persistent airway inflammation and reduced oxygenation over time, which can result in nail clubbing as a manifestation of chronic hypoxia.
When caring for an older adult client, the practical nurse (PN) notices a small, black mole on the posterior aspect of the client's calf. Which action should the PN take?
- Ask the healthcare provider to consult a dermatologist.
- Nothing, this is a normal skin change in the older client.
- Ask the client if the mole always looked this way.
- Document the presence and appearance of the mole.
Explanation
Correct Answer: D) Document the presence and appearance of the mole.
The PN's primary responsibility upon identifying a skin finding such as a black mole is to accurately document its presence, location, size, color, shape, and appearance. This creates an objective baseline for future comparison and allows the healthcare provider to determine the need for further evaluation. While consulting a dermatologist may eventually be warranted, that decision rests with the healthcare provider, not the PN. Ignoring the finding is inappropriate, and asking the client without documenting is insufficient as a standalone action.
A college student arrives at the clinic for a physical examination and asks the practical nurse (PN) how he should perform testicular self-examination (TSE). Which information should the PN provide?
- Examine the testicles during bathing.
- Manipulate the testicles upon rising.
- Inspect the testicles using a mirror.
- Compare both testicles concurrently.
Explanation
Correct Answer: A) Examine the testicles during bathing.
The recommended time to perform a TSE is during or after a warm bath or shower, when the scrotal skin is relaxed and the testicles are easier to palpate. This allows for more accurate detection of any lumps, changes in size, or abnormalities. Manipulating testicles upon rising, using a mirror for inspection only, or comparing both simultaneously are not the standard evidence-based instructions for TSE.
The practical nurse (PN) is performing a focused assessment of an adolescent girl's spine. The PN should ask the adolescent to assume which position?
- Stand against a wall with hands stretched out.
- Lateral with a pillow between legs.
- Stand upright and bend forward at the waist.
- Recumbent with the head elevated.
Explanation
Correct Answer: C) Stand upright and bend forward at the waist.
The Adams Forward Bend Test is the standard screening technique used to assess the spine for scoliosis in adolescents. The client is asked to stand upright and then bend forward at the waist with arms hanging down. This position allows the PN to observe any asymmetry, rib humping, or lateral curvature of the spine that may indicate scoliosis — a condition most commonly identified during adolescence. The other positions do not allow for adequate spinal curvature assessment.
During the interviewing process, which action(s) should the practical nurse (PN) take when assessing a client's mood and affect? Select all that apply.
- Ask why a client feels a certain way.
- Pay specific attention to a client's facial expressions.
- Mimic and mirror the client's behavior during the assessment.
- Assess the client's verbal and non-verbal communication.
- Maintain good eye contact while interviewing a client.
Explanation
Correct Answers: A, B, D, and E
A) Ask why a client feels a certain way — directly questioning the client about their emotional state provides subjective data essential to understanding mood. B) Pay specific attention to facial expressions — facial expressions are key indicators of affect and emotional state, revealing congruence or incongruence between what the client says and how they feel. D) Assess verbal and non-verbal communication — a comprehensive mood and affect assessment requires observing both what the client says and how they say it, including body language, tone, and gestures. E) Maintain good eye contact — appropriate eye contact establishes therapeutic rapport, encourages open communication, and allows the PN to observe facial affect more accurately. C is incorrect because mimicking and mirroring a client's behavior is unprofessional and inappropriate during a clinical assessment, as it may be perceived as mocking and can undermine the therapeutic relationship.
Which method is best for the practical nurse (PN) to use in determining early development of ascites in the client?
- Inspection of the abdomen for enlargement.
- Weigh client daily at same time with same scale.
- Successive measurements of abdominal girth.
- Percuss the abdomen for sounds of dullness.
Explanation
Correct Answer: C) Successive measurements of abdominal girth.
Successive (serial) measurements of abdominal girth using a measuring tape at the same anatomical landmark is the most accurate and sensitive method for detecting early development of ascites. It provides objective, quantifiable data that can track subtle fluid accumulation over time before it becomes visually apparent. While daily weights and percussion for dullness are also used, abdominal girth measurements are the most direct and specific method for monitoring ascites progression.
The practical nurse (PN) learns in report that a client has hypoactive bowel sounds. Which technique should the PN use to confirm this information?
- Observation
- Interview
- Palpation
- Auscultation
Explanation
Correct Answer: D) Auscultation
Bowel sounds are assessed by listening to the abdomen using a stethoscope — a technique called auscultation. To confirm hypoactive bowel sounds, the nurse must place the stethoscope over all four quadrants of the abdomen and listen for the frequency and character of intestinal sounds. Hypoactive bowel sounds are diminished or infrequent, indicating decreased peristalsis, commonly seen after surgery, with opioid use, or in paralytic ileus.
The practical nurse (PN) observes that a client is experiencing melena. Which serum laboratory test should the PN monitor in response to this finding?
- Hemoglobin.
- Blood urea nitrogen (BUN).
- White blood cells (WBC).
- Glucose.
Explanation
Correct Answer: A) Hemoglobin.
Melena — dark, tarry stools — is a sign of upper gastrointestinal bleeding. The most critical laboratory value to monitor is hemoglobin, as ongoing blood loss will cause it to drop, indicating the severity of hemorrhage and guiding the need for transfusion or urgent intervention. BUN may also rise with GI bleeding due to blood protein digestion, but hemoglobin most directly reflects the impact of blood loss on the client's oxygen-carrying capacity and overall safety.
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.
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