HESI Specialty and Exit Exam Nightingale College - PN
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Free HESI Specialty and Exit Exam Nightingale College - PN Questions
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
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.
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?
- Position the client on the left side and reassess.
- Document the lack of an apical pulse in the medical record.
- Assess the client for signs of diminished cardiac output.
- 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.
When auscultating a client's lungs, where should the practical nurse (PN) place the stethoscope first?
- Clavicle.
- Sternum.
- Lung apex.
- Aortic site.
Explanation
Correct Answer: C) Lung apex.
When auscultating the lungs, the standard technique begins at the lung apices — the tops of the lungs located just above the clavicles — and systematically moves downward in a side-to-side comparison pattern. Starting at the apex ensures a complete and systematic assessment of all lung fields from top to bottom. The sternum and clavicle are bony structures that do not allow for adequate lung sound auscultation, and the aortic site is a landmark used for cardiac, not pulmonary, auscultation.
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.
1 pack/day × 30 years = 30 pack-years
The fact that the client quit five years ago is not factored into the calculation — pack-years only measure the total cumulative tobacco exposure during the years the client actively smoked. This measurement is clinically important as it helps quantify a client's lifetime smoking history and assess their risk for smoking-related diseases such as lung cancer, COPD, and cardiovascular disease.
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?
- Depressed mood.
- Flat affect.
- Diminished level of consciousness.
- 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.
Which component(s) of cranial nerve function should the practical nurse (PN) evaluate during the focused assessment? Select all that apply.
- Sticking out and moving the tongue.
- Tactile discrimination and fine touch.
- A Babinski response.
- Distinguishing salty and sweet tastes.
- Symmetrically smiling and frowning.
Explanation
Correct Answers: A, D, and E
A) Sticking out and moving the tongue — assesses Cranial Nerve XII (Hypoglossal), which controls tongue movement. D) Distinguishing salty and sweet tastes — assesses Cranial Nerves VII (Facial) and IX (Glossopharyngeal), which are responsible for taste sensation. E) Symmetrically smiling and frowning — assesses Cranial Nerve VII (Facial), which controls facial expressions. B is incorrect because tactile discrimination and fine touch assess sensory pathways of the peripheral nervous system, not cranial nerve function. C is incorrect because the Babinski response is a reflex test assessing corticospinal tract integrity, not cranial nerve function.
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.
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.
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
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.
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