HESI Specialty and Exit Exam Nightingale College - PN

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Free HESI Specialty and Exit Exam Nightingale College - PN Questions

1.

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

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.
2.

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?

  • Lobar pneumonia

  • Pleural effusion

  • Acute bronchitis

Explanation

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.
3.

When assessing a client's neurological status at 0800, the practical nurse (PN) determines that the client is oriented to person, place, time, and situation. At 1200, the client is oriented to person and place only. How should the PN document the client's neurological status at 1200 in the electronic health record (EHR)?

  • Disoriented.

  • Oriented to person and place.

  • Decreased level of consciousness.

  • Increasing confusion.

Explanation

Explanation
Correct Answer: B) Oriented to person and place.
Accurate clinical documentation requires objective, specific, and factual language. The most precise way to document the client's neurological status is to state exactly what the client is oriented to — in this case, person and place only. This clearly communicates the change from the earlier assessment (oriented x4) to the current status (oriented x2) without making assumptions or using vague or interpretive terms. "Disoriented," "decreased level of consciousness," and "increasing confusion" are subjective or interpretive terms that lack the specificity required for accurate EHR documentation.
4.

The practical nurse (PN) is auscultating the lung fields of a client exhibiting a low-pitched, grating sound during inspiration and expiration. The PN notes that coughing does not clear the sound. Which term best describes this lung sound?

  • Pleural friction rub.

  • Wheezing.

  • Coarse rhonchi.

  • Stridor.

Explanation

Explanation
Correct Answer: A) Pleural friction rub.
A pleural friction rub is characterized by a low-pitched, coarse, grating sound heard during both inspiration and expiration, caused by inflamed pleural surfaces rubbing against each other. Crucially, it is not cleared by coughing, which distinguishes it from rhonchi. Wheezing is high-pitched and musical, rhonchi are low-pitched but clear with coughing, and stridor is a high-pitched sound heard predominantly on inspiration associated with upper airway obstruction.
5.

The practical nurse (PN) is performing daily assessment of a client who is admitted for a transient ischemic attack (TIA). Which technique should the PN implement to evaluate the client's upper extremity strength?

  • Request the client to reach for a spoon on the breakfast tray.

  • Tell the client to touch themselves on the nose with a forefinger 5 times.

  • Have the client use both hands to grip and squeeze the PN's hands.

  • Ask the client to extend both arms to the side and move in small to larger circles.

Explanation

Explanation
Correct Answer: C) Have the client use both hands to grip and squeeze the PN's hands.
Bilateral hand grip strength testing is the standard clinical technique for evaluating upper extremity strength. It allows the PN to directly compare grip strength bilaterally and detect any unilateral weakness — a critical assessment in TIA clients where subtle motor deficits may indicate neurological compromise or stroke progression. Reaching for a spoon tests coordination, nose-touching assesses cerebellar function, and arm circles evaluate range of motion — none of these specifically measure upper extremity strength.
6.

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

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.
7.

The nurse observes the practical nurse (PN) stroke the lateral side of the sole and across the ball of the foot with the end of a reflex hammer. The client's toes curl downward. Which action should the PN perform next?

  • Continue by stroking down the medial side of the sole of the foot.

  • Repeat the same motion with the flat portion of the reflex hammer.

  • Notify the healthcare provider of the presence of a positive Babinski reflex.

  • Record the normal response of plantar flexion in the record.

Explanation

Explanation
Correct Answer: D) Record the normal response of plantar flexion in the record.
Downward curling (plantar flexion) of the toes in response to stroking the lateral sole is the normal adult response to the Babinski test. This is a negative Babinski sign and indicates intact corticospinal tract function. The PN should document this as a normal finding. A positive Babinski reflex — which would require reporting — is characterized by upward fanning/extension of the toes, not downward curling. There is no need to repeat the test or notify the provider for a normal response.
8.

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

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.
9.

The practical nurse (PN) is interviewing a male client who arrives at the clinic seeking treatment. The client is alert, oriented, and cognitively able to verbalize his needs. Which information is most important for the PN to explore with the client?

  • Head to toe general assessment.

  • Chief complaint.

  • Current medical treatments.

  • Health history.

Explanation

Explanation
Correct Answer: B) Chief complaint.
The chief complaint is always the first and most important information to obtain when a client presents for treatment. It identifies the primary reason the client sought care — in their own words — and directs the focus of the entire assessment. Since the client is alert, oriented, and able to communicate, obtaining the chief complaint takes priority over conducting a full head-to-toe assessment, reviewing medical treatments, or gathering health history, all of which are secondary to first understanding why the client came to the clinic.
10.

The practical nurse (PN) is doing a focused assessment on the client for bowel sounds.
Which intervention(s) would be indicated to assess bowel sounds? Select all that apply.

  • Turn the suction off while auscultating.

  • Use a warmed bell of the stethoscope and place it lightly over the four quads.

  • Palpate the abdomen before auscultating.

  • Auscultate at least 5 minutes of continuous listening before determining that bowel sounds are absent.

  • Place the stethoscope in the ears with the earpieces pointing towards the ears.

Explanation

Explanation
Correct Answers: A, D, E
A) Turn the suction off while auscultating — The nurse's notes document that the client has an NGT connected to low intermittent suction (LIS). The suction machine produces noise that can interfere with accurate bowel sound assessment, so it must be turned off temporarily during auscultation.
D) Auscultate at least 5 minutes of continuous listening before determining that bowel sounds are absent — The nurse's notes confirm that no bowel sounds were heard in all 4 quadrants. Standard practice requires listening for a minimum of 5 minutes per quadrant before documenting absent bowel sounds to avoid a premature or inaccurate conclusion.
E) Place the stethoscope in the ears with the earpieces pointing towards the ears — Correct stethoscope placement with earpieces angled forward toward the ear canals ensures optimal sound transmission and accurate assessment.

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