PN HESI Exit Exam
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Free PN HESI Exit Exam Questions
A client is having a Radical Mastectomy. What is the position of choice during the immediate postoperative period
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Side-lying on the operative side with the bed flat
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Supine with the arm on the operative side in a dependent position
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Semi-Fowler's position with the arm on the operative side elevated
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Sim's position with the arm on the operative side in a dependent position
Explanation
The correct answer is: Semi-Fowler's position with the arm on the operative side elevated.
Explanation for the correct answer:
After a radical mastectomy, the immediate postoperative position of choice is semi-Fowler's position, typically set at an angle of 30 to 45 degrees. This position helps in reducing the risk of respiratory distress and promotes proper circulation. Additionally, elevating the arm on the operative side is essential to help with venous return, reducing swelling, and promoting proper lymphatic drainage. Elevating the arm helps prevent the accumulation of lymph fluid and reduces the risk of lymphedema, a common concern after breast surgery.
Why the other options are incorrect:
Side-lying on the operative side with the bed flat:
This position is not ideal as it places direct pressure on the surgical site, which could increase the risk of complications like bleeding, disruption of the surgical area, or discomfort. Additionally, lying on the operative side increases swelling and is not recommended unless directed by the healthcare provider.
Supine with the arm on the operative side in a dependent position:
Placing the arm in a dependent position (below the heart) increases the risk of swelling and fluid accumulation in the arm, which can lead to lymphedema. Elevating the arm is important for promoting lymphatic drainage and reducing swelling, so this position would not be beneficial.
Sim's position with the arm on the operative side in a dependent position:
Similar to the previous incorrect answer, placing the arm in a dependent position in Sim's position increases the likelihood of swelling and lymphedema. This position does not facilitate optimal circulation or lymphatic drainage, making it unsuitable for the postoperative period.
The scope of practice for the practical nurse includes which client assessments
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An agitated client with bilateral wrist restraints
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New admission of a client with deep vein thrombosis
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Return of a postanesthetic client following a colon resection
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Transfer of a client with sepsis from a long-term care facility
Explanation
Explanation of the Correct Answer:
A new admission with deep vein thrombosis (DVT) is an appropriate assignment for a licensed practical nurse (LPN). This falls within the LPN’s scope of practice, which includes monitoring client conditions, administering prescribed medications such as anticoagulants, and performing focused assessments. LPNs are trained to observe for signs of complications, such as limb swelling, redness, or pain, and report any indications of a pulmonary embolism, like sudden chest pain or difficulty breathing. While an RN usually conducts the initial comprehensive admission assessment, the LPN can assist by gathering relevant health data, documenting initial observations, and implementing the care plan for a stable condition like DVT. This scenario aligns well with the education and responsibilities of the LPN and does not require the complex clinical judgment reserved for RNs.
Explanation of Incorrect Options:
Agitated client with bilateral wrist restraints
This situation involves behavioral and safety considerations that often exceed the LPN’s independent assessment scope. The client’s agitation may stem from psychiatric conditions, medication effects, or acute medical changes—all requiring the advanced judgment and evaluation skills of an RN. Additionally, clients in restraints need frequent assessments to monitor for physical and psychological harm, which includes evaluating circulation, skin condition, and mental status. While LPNs may assist with routine care and documentation, the comprehensive assessment of an agitated or restrained client should be completed by an RN. A common misconception is that restraint care is purely procedural, when it actually demands nuanced clinical decision-making.
Postanesthetic client following a colon resection
Clients returning from surgery and anesthesia are considered high acuity due to the risks of respiratory depression, hemodynamic instability, and postoperative complications. These clients require immediate, detailed assessments that are within the RN’s scope of practice. RNs are trained to evaluate airway status, consciousness, and surgical site conditions, and to manage any rapid changes in condition. LPNs may assist with follow-up care after the initial RN assessment, but the responsibility for initial post-anesthesia evaluations lies with the RN. A frequent misunderstanding is underestimating the complexities of post-op care, which demand rapid response and advanced clinical reasoning.
Client with sepsis transferred from a long-term care facility
Sepsis is a time-sensitive, potentially life-threatening condition requiring intensive monitoring and prompt interventions. Upon transfer, this client needs a comprehensive assessment—including lab analysis, initiation of intravenous treatments, and continuous evaluation—tasks that fall under the RN’s role. While LPNs can provide ongoing support and care for stable clients, they are not authorized to independently assess or admit clients with systemic, unstable conditions. The key issue here is acuity: although the client is being transferred, the seriousness of the diagnosis necessitates RN-level intervention. It's a common error to focus on the setting of transfer rather than the severity of the condition.
An elderly male client is planning to vacation with a group of senior citizens. He is concerned about developing constipation during the airplane flight. He share this concern with the nurse at the retirement home. Which recommendation is best for the nurse to provide
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Use an over the counter stool softener when needed
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Eat a high protein diet
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Increase the fluid intake in your diet
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Decrease the fat content in your diet
Explanation
The correct answer is:
Increase the fluid intake in your diet
Explanation for the Correct Answer:
Increasing fluid intake is the most effective and practical strategy to prevent constipation, especially during air travel. Airplane cabin environments are typically low in humidity, which can lead to dehydration—a common cause of constipation. Adequate hydration helps soften stool, making it easier to pass, and supports normal gastrointestinal motility. This is especially important for older adults, who are more susceptible to constipation due to decreased physical activity, slower digestion, and medication side effects. Encouraging increased water consumption is a safe, natural, and preventative measure that addresses the root cause of constipation.
Why the Other Options Are Wrong:
Use an over-the-counter stool softener when needed
Stool softeners may be useful for managing existing constipation but should not be used routinely for prevention. Over-reliance can lead to reduced bowel function and does not address underlying causes like dehydration or low fiber intake.
Eat a high-protein diet
High-protein diets, especially those low in fiber, can actually increase the risk of constipation. A balanced diet rich in fiber, rather than focusing on protein, is more beneficial for bowel regularity.
Decrease the fat content in your diet
While excessive unhealthy fat can contribute to poor digestion, simply reducing fat intake does not effectively prevent constipation. In fact, healthy fats can aid in stool passage. Fluid and fiber intake are more critical factors.
The nurse is developing a plan of care (POC) for a client who reports frequent urination and who is newly diagnosed with type 2 diabetes mellitus. Which outcome should the nurse include in the POC for this client?
Reference Range: Glycosylated hemoglobin A1C (HbA1C) [Good diabetic control: less than 7.0%]
- The nurse will monitor the client's skin condition for color changes.
- The client's family will state signs and symptoms about the disease.
- The client's HbA1C will be less than 7% in 3 months.
- The client will express acceptance of their newly diagnosed health status.
Explanation
Correct Answer: C) The client's HbA1C will be less than 7% in 3 months.
A well-written nursing outcome must be client-centered, measurable, realistic, and time-bound. An HbA1C of less than 7% in 3 months directly reflects good glycemic control, aligns with the established reference range, and provides a concrete, measurable target for evaluating the effectiveness of diabetes management.
Monitoring skin condition is a nursing intervention, not a client outcome. Having the family state signs and symptoms focuses on the family rather than the client and is not the priority outcome for this diagnosis. Expressing acceptance addresses psychosocial adaptation but is not the most critical or measurable outcome for a newly diagnosed diabetic with frequent urination.
A client comes to the antepartal clinic and tells the LPN/LVN that she is 6 weeks pregnant. Which sign is she most likely to report
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Decreased sexual libido
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Amenorrhea
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Quickening
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Nocturia
Explanation
The correct answer is:
B. Amenorrhea
B. Amenorrhea – Correct
Amenorrhea, or the absence of menstruation, is typically the first and most common sign of pregnancy that a client reports. At 6 weeks of pregnancy, the client will usually have missed one or more menstrual periods. This is considered a presumptive sign of pregnancy, meaning it is reported by the client but not directly observed by the healthcare provider. It occurs due to hormonal changes, specifically increased levels of human chorionic gonadotropin (hCG), progesterone, and estrogen, which prevent the menstrual cycle from continuing.
A. Decreased sexual libido – Incorrect
Pregnancy may cause fluctuations in sexual libido, but it is not a common or consistent early sign at 6 weeks. Some clients experience increased libido due to hormonal changes, while others may have a decrease due to nausea, fatigue, or emotional changes. However, it is not a defining or reliable indicator of pregnancy.
C. Quickening – Incorrect
Quickening refers to the first fetal movements felt by the pregnant person. This usually occurs between 16 and 20 weeks of pregnancy, not as early as 6 weeks. It is also considered a presumptive sign but too early for the client to report at this stage.
D. Nocturia – Incorrect
Nocturia, or frequent nighttime urination, may develop as the uterus begins to expand and exert pressure on the bladder, but it typically occurs later in the first trimester or early in the second trimester. It is not the most likely sign the client would report at 6 weeks of pregnancy.
Summary:
The correct answer is B. Amenorrhea because the absence of menstruation is the most common and earliest sign reported by clients who are 6 weeks pregnant. Other signs, like quickening and nocturia, occur later, while libido changes are inconsistent and not a primary indicator of pregnancy.
The nurse is caring for a client with hypertension, gastroesophageal reflux, and osteoarthritis. While performing a bedside assessment the nurse observes the client is alert and oriented to person, place, time, and situation, but is exhibiting signs of jaundice. The nurse should notify the healthcare provider (HCP) about which scheduled medication?
- Prednisone.
- Omeprazole.
- Captopril.
- Acetaminophen.
Explanation
Correct Answer: D) Acetaminophen.
Jaundice is a yellow discoloration of the skin and sclerae caused by elevated bilirubin levels, indicating liver dysfunction or damage. Acetaminophen (Tylenol) is well known for its potential to cause hepatotoxicity, particularly when taken in doses exceeding 4 g/day, in patients with pre-existing liver disease, or in those who consume alcohol. Signs of liver damage from acetaminophen include jaundice, elevated liver enzymes, and right upper quadrant tenderness. The nurse must notify the HCP immediately, as acetaminophen may need to be discontinued or the dose adjusted. Prednisone, omeprazole, and captopril are not primarily associated with jaundice or hepatotoxicity in this clinical context.
The nurse is assessing a client who is one day postoperative parathyroidectomy and finds that the client is experiencing stridor. After notifying the healthcare provider (HCP), the nurse should prepare for which procedure?
- Nasogastric tube (NGT) insertion.
- Pacemaker placement.
- Tracheostomy placement.
- Central line insertion.
Explanation
Correct Answer: C) Tracheostomy placement.
Stridor following parathyroidectomy indicates laryngeal edema or vocal cord spasm, which can rapidly progress to complete airway obstruction — a life-threatening emergency. Preparing for a tracheostomy is the priority as it provides a secure, definitive airway bypass when upper airway patency is compromised.
NGT insertion addresses gastrointestinal access and is irrelevant to airway compromise. Pacemaker placement is indicated for cardiac dysrhythmias, not respiratory emergencies. Central line insertion provides vascular access but does not address the immediate airway threat posed by post-parathyroidectomy stridor.
Which of the following interventions should the nurse implement to reduce age-related risk factors? (Select all that apply.)
- Encourage the client to use good hand hygiene to reduce the risk for infection.
- Provide appropriate non-slip footwear to reduce the risk for falls.
- Discontinue metformin to reduce the risk for infection.
- Dim the lights in the room to reduce the risk for falls.
- Assess the skin beneath the nasal cannula and blood pressure cuff regularly to reduce the risk for skin breakdown.
- Apply restraints to reduce the risk for falls.
- Use an indwelling urinary catheter to reduce the risk for skin breakdown.
Explanation
Correct Answer: A, B, and E
A) Hand hygiene is the most effective evidence-based intervention to prevent infection transmission. The client has signs of active respiratory infection (thick green sputum) and is at increased risk due to age-related immune decline (immunosenescence).
B) Older adults are at high risk for falls due to decreased muscle strength, impaired balance, and slowed reflexes. Appropriate non-slip footwear is a safe, standard fall prevention intervention.
E) Medical devices such as nasal cannulas and blood pressure cuffs are common sources of pressure injury in older adults due to fragile, thinning skin. Regular assessment allows early detection and prevention of skin breakdown.
A client presents to the emergency department with muscle aches, headache, fever, and describes a recent loss of taste and smell. The nurse obtains a nasal swab for COVID-19 testing. Which action is most important for the nurse to take?
- Report the COVID-19 result to the local health department according to CDC guidelines.
- Don an N95 respirator mask, face shield, gown, gloves, and shoe coverings prior to returning to the room.
- Explain to the client to inform others that they may have been potentially exposed in the last 14 days.
- Teach the client to wear a mask, hand wash, and social distance to prevent spreading the virus.
Explanation
Correct Answer: B) Don an N95 respirator mask, face shield, gown, gloves, and shoe coverings prior to returning to the room.
The client is presenting with classic symptoms of COVID-19 — a respiratory illness transmitted via airborne and droplet routes. The most important immediate action for the nurse is to implement appropriate personal protective equipment (PPE) before re-entering the room to protect themselves and prevent transmission to others. An N95 respirator, face shield, gown, gloves, and shoe coverings constitute the required airborne and contact precaution PPE for suspected COVID-19. All other options — reporting results, contact tracing, and patient education — are important but are secondary actions that follow once the nurse has ensured their own safety and the safety of others through proper PPE use.
A 26-year-old gravida 4, para 0 had a spontaneous abortion at 9 weeks gestation. At one-house post dilation and curettage (D&C) the LPN/LVN assess the vital signs and vaginal bleeding. The client begins to cry softly. How should the nurse intervene
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Offer to call the social worker to discuss the possibility of abortion
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Reassure the client that the infertility specialist can help
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Express sorrow for the client's grief and offer to sit with her
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Chart the vital signs and amount of vaginal bleeding
Explanation
Correct Answer:
Express sorrow for the client's grief and offer to sit with her
Explanation:
Experiencing a spontaneous abortion is a deeply emotional and often traumatic event for clients, requiring compassionate and immediate emotional support. Expressing sorrow for the client’s grief acknowledges her loss and validates her feelings, which is an essential part of therapeutic communication. Offering to sit with her demonstrates empathy, presence, and a willingness to listen—key components of holistic, patient-centered care. This approach fosters trust, allows the client to express her emotions freely, and helps alleviate feelings of isolation or abandonment during a profoundly vulnerable time. Emotional support should take precedence over clinical tasks when a client is experiencing acute grief.
Why Other Options Are Wrong:
Offer to call the social worker to discuss the possibility of abortion
This is incorrect because the client has already experienced a miscarriage, not a planned abortion. Bringing up the topic of abortion is not only irrelevant but also potentially distressing. It shows a lack of sensitivity to the client’s current emotional state and could cause further confusion or pain. What the client needs now is comfort and understanding—not discussions about options that do not pertain to her current situation.
Reassure the client that the infertility specialist can help
This is incorrect because offering reassurance about future fertility shifts the focus away from the client's immediate emotional needs. While well-intentioned, it can minimize the grief she is experiencing right now. Statements like this may come across as dismissive or as an attempt to “fix” the situation rather than allowing space for mourning and healing.
Chart the vital signs and amount of vaginal bleeding
This is incorrect because, although physical assessments and documentation are essential nursing tasks, they are not the priority in this emotional context. The client is experiencing significant grief, and attending to her emotional well-being is more urgent at this moment. Addressing only the physical aspects of care would overlook the psychosocial dimension, which is central in situations involving loss.
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