PN HESI Exit Exam
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Free PN HESI Exit Exam Questions
A 76-year-old male was brought into the emergency department (ED) by his daughter. She reports that he has not been feeling well, and she became worried when she had a phone conversation with him. She stated, "He sounded confused and not himself." The nurse wants to use the SPICES framework with the client. Which of the following best describes the SPICES framework and its purpose?
- A list of laboratory values that nurses can use to diagnose Alzheimer's disease in older adults.
- A series of questions that nurses can use to identify early signs of illness in older adults.
- A group of exercises that nurses can use to prevent musculoskeletal abnormalities in older adults.
- A guide that nurses can use to manage dehydration in older adults.
Explanation
Correct Answer: B) A series of questions that nurses can use to identify early signs of illness in older adults.
The SPICES framework is a standardized geriatric assessment tool consisting of a series of questions designed to help nurses identify common syndromes and early signs of illness in older adults. SPICES stands for Sleep disorders, Problems with eating or feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown. It is particularly relevant for this 76-year-old presenting with new onset confusion and a change in baseline behavior. It is not a laboratory tool, an exercise program, or a single-condition management guide.
Which nurse's behavior is a breach of client confidentiality according to the Health Insurance Portable Accountability Act (HIPPA) regulations
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A daily report sheet with the information of the team's clients is taken home.
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Privileged health information (PH) is mailed through the US postal service
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A client is called by both the first and last name in a public waiting room.
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The ambulance health care provider is given information about the client's history
Explanation
Mailing PHI is not automatically a HIPAA violation. HIPAA permits the transmission of health information via postal mail if proper precautions are taken, such as using sealed envelopes or encrypted formats. It becomes a breach only if mailed insecurely or to the wrong recipient. Therefore, mailing PHI is allowed under HIPAA, provided reasonable safeguards are in place.
While using a client’s full name in public may raise privacy concerns, it is not automatically a HIPAA violation. HIPAA permits the use of limited identifiers in appropriate healthcare settings if it’s necessary for communication. However, excessive or unnecessary disclosure of patient details in public should be avoided. Facilities are encouraged to minimize identifiers, but this practice alone does not constitute a breach.
Sharing relevant health information with ambulance personnel is entirely appropriate under HIPAA. This falls under the "treatment" provision, where PHI can be disclosed to other healthcare providers involved in the patient's care. Since ambulance staff are considered part of the care team, this type of information sharing is lawful and necessary for patient safety and continuity of care.
A 76-year-old male was brought into the emergency department (ED). Orders include supplemental oxygen via nasal cannula titrated to keep oxygen saturation greater than 94%, chest x-ray confirming pneumonia with consolidation in the right lower lobe, and a 1 liter 0.9% sodium chloride IV bolus over 1 hour. The client's oxygen was being weaned when the nurse noticed signs of hypoxia returning. Which of the following best explains the cause of the client's hypoxia?
- The client's hypoxia was likely caused by atrial fibrillation and increased metabolic demand due to chest wall trauma.
- The client's hypoxia was likely caused by hypovolemia and increased metabolic demand due to musculoskeletal abnormalities.
- The client's hypoxia was likely caused by left-sided heart failure and increased metabolic demand due to fever.
- The client's hypoxia was likely caused by hyperventilation and increased metabolic demand due to wound healing.
Explanation
Correct Answer: C) The client's hypoxia was likely caused by left-sided heart failure and increased metabolic demand due to fever.
In this 76-year-old with confirmed pneumonia, the two most likely contributors to hypoxia upon oxygen weaning are left-sided heart failure and fever. Pneumonia can precipitate or worsen left-sided heart failure in older adults by increasing cardiac workload — left-sided heart failure causes fluid accumulation in the pulmonary circulation, impairing gas exchange and reducing oxygen saturation. Additionally, the client's fever of 99°F (37.2°C) increases the body's metabolic demand and oxygen consumption, making it harder to maintain adequate oxygenation without supplemental support. Atrial fibrillation, hypovolemia, hyperventilation, chest wall trauma, musculoskeletal abnormalities, and wound healing do not align with the clinical findings presented in this case.
During a home visit, the nurse assesses the skin of a client with eczema who reports that an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms?
- An old friend with eczema came for a visit.
- A grandson and his new dog recently visited.
- Corticosteroid cream was applied to eczema.
- Recently received an influenza immunization.
Explanation
Correct Answer: B) A grandson and his new dog recently visited.
Eczema (atopic dermatitis) is commonly triggered by allergens, and animal dander is one of the most potent and well-documented triggers. The introduction of a new dog into the client's environment is the most likely cause of the recent exacerbation, making this the most clinically relevant information for identifying the trigger.
Contact with another person who has eczema does not transmit or trigger the condition, as eczema is not contagious. Corticosteroid cream is a treatment for eczema, not a trigger. While some individuals may react to vaccines, an influenza immunization is far less likely to cause a skin exacerbation compared to direct allergen exposure from animal dander.
The client returned from appendectomy surgery last night at approximately 2100. The client was admitted for observation due to a delay in waking from anesthesia. The client is currently resting in bed. The incision dressing is dry and intact, and no bleeding is noted. The client tolerated clear liquids post recovery and has advanced to a soft diet. The client ambulated around the unit this morning and tolerated activity well. Bowel sounds are present in all 4 quadrants, and per client report, she has passed flatus. Pain is tolerated with analgesia PO.
Which findings confirm the client is stable and ready for discharge? Select all that apply.
- Incision dressing is dry and intact with no bleeding noted
- Client was admitted for observation due to delayed waking from anesthesia
- Client has advanced from clear liquids to a soft diet
- Client ambulated around the unit and tolerated activity well
- Bowel sounds present in all 4 quadrants and flatus passed
- Pain is tolerated with oral analgesia
- Client is currently resting in bed
Explanation
Correct Answers: A) Dry and intact incision dressing, C) Advanced to soft diet, D) Tolerated ambulation well, E) Bowel sounds present in all 4 quadrants with flatus passed, and F) Pain tolerated with oral analgesia
Dry and intact incision dressing with no bleeding confirms wound integrity and absence of postoperative hemorrhage or infection, a key discharge criterion following appendectomy.
Advancement to a soft diet demonstrates that the gastrointestinal tract is recovering appropriately, the client can tolerate oral intake without nausea or vomiting, and nutritional needs can be met at home.
Tolerating ambulation well confirms the client has sufficient strength, stability, and cardiovascular reserve to safely manage activities of daily living independently upon discharge.
Bowel sounds present in all 4 quadrants and passage of flatus confirm the return of normal gastrointestinal motility following bowel manipulation during surgery — a critical discharge milestone after abdominal surgery.
Pain tolerated with oral analgesia confirms that pain is adequately controlled with medications the client can continue taking at home, eliminating the need for continued IV pain management and inpatient monitoring.
A Client is admitted to the hospital with second and third-degree burns to the face and neck. How should the nurse best position the client to maximize the function of the neck and face and prevent contracture
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The neck extended backward using a rolled towel behind the neck
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Prone position using pillows to support both arms outward from the torso
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Side-lying position using pillows to support the abdomen and back
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The neck forward using pillows under the head and sandbags on both sides
Explanation
The correct answer is: The neck extended backward using a rolled towel behind the neck.
Explanation:
When a client has second and third-degree burns to the face and neck, proper positioning is critical to prevent contractures and promote optimal healing. Contractures occur when the skin and underlying tissues heal in a shortened position, leading to permanent deformity and loss of function. To prevent contractures in the neck and face, the nurse should maintain the neck in an extended position. This helps prevent the neck from flexing forward, which could result in a contracture.
Using a rolled towel behind the neck helps maintain this extended position, reducing the risk of contractures and promoting better healing of the burned tissues.
Why the other options are Not Correct:
Prone position using pillows to support both arms outward from the torso: Although prone positioning can be helpful for certain body areas to prevent pressure ulcers, it is not ideal for burns to the face and neck. This position may exacerbate the flexion of the neck, which could increase the risk of contractures. The goal is to maintain extension of the neck.
Side-lying position using pillows to support the abdomen and back: While this position can be used to prevent pressure ulcers on the sides of the body, it does not directly address the concern of preventing neck contractures. It may not help maintain the neck in extension, which is essential for preventing contractures in the neck and face.
The neck forward using pillows under the head and sandbags on both sides: This position increases the risk of developing a contracture by encouraging the neck to heal in a flexed position. A forward flexed neck should be avoided, as it can lead to permanent shortening of the neck muscles and tissues.
The LPN/LVN is administering amiodarone (Cordarone) to a client who has been admitted with Atrial Fibrillation (AFIB). What therapeutic response should the nurse anticipate
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Conversion of irregular heart rate to regular heart rhythm
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Pulse oximetry readings within normal range during activity
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Peripheral pulse points with adequate capillary refill
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Increase exercise tolerance without shortness of breath
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 natural method to prevent constipation, particularly during air travel when the risk of dehydration is higher due to dry cabin air. Adequate hydration helps keep the stool soft and supports normal bowel function. This is especially important for older adults, who are more prone to constipation because of decreased physical activity and slower gastrointestinal motility. Drinking sufficient water during flights helps counteract the dehydrating effects of air travel and promotes regular bowel movements.
Why the Other Options Are Wrong:
Use an over-the-counter stool softener when needed
While stool softeners may provide relief from occasional constipation, they are not ideal for routine prevention. Relying on them can lead to dependency and does not address the underlying cause, such as dehydration or low fluid intake.
Eat a high-protein diet
A high-protein diet, especially if low in fiber, can actually contribute to constipation. Preventing constipation is better achieved through a diet rich in fiber and fluids rather than focusing solely on protein.
Decrease the fat content in your diet
Reducing dietary fat may benefit overall health, but it does not play a direct or significant role in preventing constipation. In fact, healthy fats can aid in digestion and support smoother bowel movements.
After the report, the LPN/LVN receives the laboratory values for 4 clients. Which client requires the nurse's immediate intervention
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short of breath after a shower and has a hemoglobin of 8 grams
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Bleeding from a finger stick and has a prothrombin time of 30 seconds
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Febrile and has a WBC count of 14,000/mm3
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Trembling and has a glucose level of 50 mg/dL
Explanation
The correct answer is:
Trembling and has a glucose level of 50 mg/dL.
Explanation for the Correct Answer:
A glucose level of 50 mg/dL is significantly below normal and indicates hypoglycemia, a condition that requires immediate intervention. The symptom of trembling confirms that the client is experiencing an active hypoglycemic episode, which can quickly progress to confusion, seizures, or loss of consciousness if not addressed promptly. Hypoglycemia affects the brain directly due to its dependence on glucose for energy. The priority nursing action is to administer a fast-acting glucose source, such as oral glucose tablets or juice if the client is alert, or IV dextrose if they are not. This scenario represents an acute, life-threatening complication and takes precedence over all other listed conditions due to the urgency of restoring blood glucose to a safe range.
Why the Other Options Are Wrong:
Short of breath after a shower and has a hemoglobin of 8 grams:
A hemoglobin level of 8 g/dL indicates moderate anemia, which can lead to fatigue, pallor, and shortness of breath. While this finding is clinically significant, it does not typically pose an immediate threat to life. The condition develops gradually, and interventions such as iron supplementation, dietary modifications, or transfusion can be considered based on the underlying cause. It does not demand emergency intervention like hypoglycemia does.
Bleeding from a finger stick and has a prothrombin time of 30 seconds:
A prolonged prothrombin time (PT) suggests impaired blood clotting, which increases bleeding risk. However, minor bleeding from a finger stick can usually be controlled with direct pressure and does not constitute a medical emergency unless bleeding is uncontrolled or occurs in a critical area. The nurse should report the abnormal PT and monitor for further signs of bleeding, but it is not the most urgent issue on this list.
Febrile and has a WBC count of 14,000/mm³:
A WBC count of 14,000/mm³ indicates an elevated white count, commonly associated with infection or inflammation. While fever and infection warrant close monitoring and possibly antibiotics, this scenario does not represent a critical, life-threatening emergency. The body's immune system is responding, and there is typically a window to assess, diagnose, and initiate appropriate treatment. It is less urgent than a rapidly deteriorating hypoglycemic episode.
A nurse is reviewing the chart of a client presenting with swelling of the knees and hands, a pain rating of 2/10, temperature of 97.6°F, heart rate of 91 beats/minute, and blood pressure of 102/61 mmHg. Which condition is the client most likely experiencing, and what are the priority actions and parameters to monitor?
- Potential Condition: Vascular disease — Actions: Administer diuretic, Begin NSAID for pain control — Monitor: Peripheral edema, Medication side effects
- Potential Condition: Rheumatoid arthritis — Actions: Begin NSAID for pain control, Administer disease modifying antirheumatic medication (DMARDs) — Monitor: Joint mobility, Skin integrity
- Potential Condition: Bone cancer — Actions: Consult a dietician, Prepare client for chemotherapy — Monitor: Signs and symptoms of stomatitis, Medication side effects
Explanation
Correct Answer: B) Potential Condition: Rheumatoid Arthritis — Actions: Begin NSAID for pain control, Administer DMARDs — Monitor: Joint mobility, Skin integrity
The client presents with bilateral swelling of the knees and hands and mild pain (2/10), which are classic hallmarks of Rheumatoid Arthritis (RA) — a systemic autoimmune disorder causing symmetric joint inflammation. NSAIDs reduce inflammation and pain, while DMARDs such as methotrexate slow disease progression. Monitoring joint mobility tracks functional decline, and skin integrity is essential as RA and DMARDs can compromise skin health.
Vascular disease would primarily present with circulatory symptoms such as claudication or ulcers, not symmetric joint swelling. Bone cancer typically presents with severe localized bone pain, systemic symptoms like weight loss, and fatigue — not bilateral joint swelling in the hands and knees.
What length of blood pressure cuff should be the nurse use when obtaining a client's blood pressure
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A cuff that is no longer than the circumference of the extremity should be used
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The length of the blood pressure cuff does not make a difference
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The cuff and its bladder should be nearly encircled in the extremity's circumference
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At least two-thirds the circumference of the extremity should be covered
Explanation
Correct Answer: At least two-thirds the circumference of the extremity should be covered
Proper cuff sizing is critical for obtaining accurate blood pressure readings. The bladder inside the cuff should cover at least two-thirds of the upper arm's circumference. This ensures that enough surface area is compressed to occlude the artery effectively. Using a cuff that is too small or too large can result in incorrect readings—potentially leading to misdiagnosis or improper treatment.
Why the other options are incorrect:
A cuff that is no longer than the circumference of the extremity should be used
This is inaccurate. A cuff that only matches or is shorter than the arm’s circumference may be too small, leading to falsely elevated blood pressure readings. The key is to have a cuff long enough to cover at least two-thirds of the arm's circumference.
The length of the blood pressure cuff does not make a difference
This is incorrect. Cuff size has a significant effect on blood pressure accuracy. Using the wrong cuff size is one of the most common causes of measurement error in clinical practice.
The cuff and its bladder should be nearly encircled in the extremity's circumference
This overstates the requirement. Full encirclement is not necessary; what's essential is that the bladder inside the cuff covers at least two-thirds of the arm’s circumference. Total encirclement is not standard and may not be feasible or required for accurate readings.
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