HESI Specialty and Exit Exam Nightingale College - PN
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Free HESI Specialty and Exit Exam Nightingale College - PN Questions
When assessing a client for vertigo, which technique should the practical nurse (PN) use?
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Assess orientation to person, place, and time.
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Listen for changes in speech patterns.
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Inquire about sensations of spinning around.
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Measure blood pressure while standing.
Explanation
Correct Answer: C) Inquire about sensations of spinning around.
Vertigo is defined as the subjective sensation of rotational movement or spinning — either of oneself or the surrounding environment. The most direct and appropriate assessment technique is to ask the client about sensations of spinning, as this is the hallmark symptom of vertigo. Assessing orientation evaluates cognitive status, listening for speech changes assesses neurological or cranial nerve function, and measuring blood pressure while standing screens for orthostatic hypotension — none of these specifically assess for vertigo.
Which method is best for the practical nurse (PN) to use in determining early development of ascites in the client?
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Inspection of the abdomen for enlargement.
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Weigh client daily at same time with same scale.
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Successive measurements of abdominal girth.
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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) 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?
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Pleural friction rub.
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Wheezing.
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Coarse rhonchi.
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Stridor.
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.
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?
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Stand against a wall with hands stretched out.
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Lateral with a pillow between legs.
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Stand upright and bend forward at the waist.
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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.
In completing a focused assessment of a client with liver problems, which assessment technique should the practical nurse use to check for the presence of jaundice?
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Auscultation.
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Observation.
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Percussion.
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Palpation.
Explanation
Correct Answer: B) Observation.
Jaundice is a visible yellowing of the skin, sclera (whites of the eyes), and mucous membranes caused by elevated bilirubin levels, which is characteristic of liver dysfunction. It is detected through direct observation/inspection — no instruments or physical manipulation are required. Auscultation assesses sounds, percussion evaluates density, and palpation detects tenderness or organ enlargement, none of which identify jaundice.
The practical nurse (PN) wants to assess heart sounds at the apical site of a bedfast client who is lying in a supine position. The PN is unable to palpate the PMI (point of maximal impulse). Which is the best initial nursing action?
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Position the client on the left side and reassess.
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Document the lack of an apical pulse in the medical record.
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Assess the client for signs of diminished cardiac output.
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Count the pulse rate and volume at the radial site.
Explanation
Correct Answer: A) Position the client on the left side and reassess.
The PMI is most easily palpated when the client is positioned in the left lateral decubitus (left side-lying) position, as this brings the heart closer to the chest wall. When the PMI cannot be located in the supine position, the best initial action is to reposition the client to the left side and attempt palpation again before drawing any clinical conclusions. Documenting an absent apical pulse without further assessment is premature and potentially inaccurate. Assessing for diminished cardiac output and checking the radial pulse are secondary actions that are not indicated until repositioning and reassessment have been performed.
A female client tells the practical nurse (PN) that she quit smoking five years ago, but prior to that time she smoked a pack of cigarettes daily for thirty years. How should the PN document the client's pack-years? (Enter the numerical value only.)
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30
Explanation
Correct Answer: 30
Pack-years are calculated using the following formula:
Number of packs per day × Number of years smoked = Pack-years
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?
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Decrease the amount of pressure used to hold the stethoscope.
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Continue to hold the stethoscope firmly in place with one hand.
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Rotate the end piece of the stethoscope.
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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.
An older adult male client reports nocturia with difficulty starting his urine stream. Which focused assessment should the practical nurse (PN) perform to obtain further information?
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Inspect the urethral meatus for discharge.
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Observe the scrotum for swelling.
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Palpate the inguinal area for a bulge.
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Question the client about urinary dribbling and frequency.
Explanation
Correct Answer: D) Question the client about urinary dribbling and frequency.
Nocturia and difficulty initiating a urine stream in an older adult male are classic symptoms of benign prostatic hyperplasia (BPH). The most appropriate follow-up focused assessment is to further explore urinary symptoms by asking about dribbling and frequency, as these symptoms collectively form the clinical picture of lower urinary tract obstruction. This subjective data gathering directly guides further assessment and provider notification. Inspecting for discharge, observing the scrotum, and palpating the inguinal area address different urological concerns unrelated to the presenting symptoms.
When checking a client's peripheral pulses, the practical nurse (PN) is unable to palpate the dorsalis pedis pulse. Which follow-up action should the PN take?
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Assess level of consciousness.
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Obtain a doppler stethoscope.
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Measure the blood pressure.
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Elevate both feet on a pillow.
Explanation
Correct Answer: B) Obtain a doppler stethoscope.
When a peripheral pulse cannot be detected by palpation, the next step is to use a doppler stethoscope, which amplifies blood flow sounds and can detect pulses too weak or deep to feel manually. This allows the PN to confirm whether blood flow is present in the extremity and assess for peripheral vascular compromise. Assessing level of consciousness, measuring blood pressure, and elevating the feet do not address the immediate need to confirm the presence or absence of the dorsalis pedis pulse.
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