PN HESI Exit Exam
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Free PN HESI Exit Exam Questions
The LPN/LVN is taking blood pressure of a client admitted with a possible myocardial infarction. When taking the client's BP at the brachial artery, the nurse should place the client's arm in which position
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Slightly above the level of the heart
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At the level of the heart
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At the level of comfort for the client
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Below the level of the heart
Explanation
Correct Answer:
At the level of the heart
Explanation:
When taking blood pressure measurements, it is crucial that the client’s arm is positioned at the level of the heart to ensure the most accurate reading. This alignment is essential because the heart acts as the reference point in the circulatory system, and the brachial artery should be in the same horizontal plane as the right atrium of the heart. If the arm is positioned too high or too low relative to the heart, the reading can become distorted due to gravitational effects on blood pressure. For example, if the arm is above heart level, gravity will reduce the pressure, leading to a falsely low reading. Conversely, if the arm is below heart level, gravity will increase pressure in the arteries, resulting in a falsely high reading. Proper positioning at heart level eliminates these errors and ensures an accurate blood pressure measurement.
Why Other Options Are Wrong:
Slightly above the level of the heart
This is incorrect because positioning the arm slightly above heart level can cause a falsely low blood pressure reading. Gravity will cause a decrease in the pressure measured in the arm when it is elevated above heart level. Even a slight misalignment can result in inaccurate data that could affect clinical decisions, especially in the context of diagnosing or managing hypertension.
At the level of comfort for the client
While comfort is important in healthcare, accuracy in clinical measurements takes precedence. Allowing the client to position their arm in a way that is comfortable but not aligned with the heart could result in a misleading blood pressure reading. Comfort should not compromise the precision required for medical assessments, and the arm must be at heart level to get an accurate result.
Below the level of the heart
Placing the arm below heart level is also incorrect because this position will increase the pressure measured in the arteries due to the effects of gravity, leading to a falsely high blood pressure reading. This misplacement can lead to overestimation of blood pressure, which could result in unnecessary interventions or mismanagement of a client's cardiovascular health.
A LPN/LVN is caring for a client with Multiple Sclerosis (MS) who is receiving an immunosuppressant. Which action is most important for the nurse to implement to evaluate for adverse effects from this particular medication
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Observe the client's skin for bruising
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Auscultate the client's bowel sounds
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Monitor the clients intake and output
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Note changes in the client's weight
Explanation
Although monitoring bowel sounds is essential, especially in clients on immunosuppressants who may experience gastrointestinal (GI) side effects, skin bruising is a more critical sign of a life-threatening issue, such as bleeding or thrombocytopenia. Therefore, this should not be the first priority when bruising could indicate a more immediate problem.
While monitoring intake and output is an important part of any comprehensive assessment, the more pressing concern in this case is the risk of bleeding and bruising, which can occur due to the decreased platelet count associated with immunosuppressant medications. Monitoring intake and output is necessary but is not the most urgent action in this scenario.
Changes in weight are important but are typically assessed over time and do not indicate an immediate or urgent problem compared to bruising. Weight changes are less likely to reflect an acute issue such as bleeding, which may require immediate intervention.
The LPN/LVN is standing at the clinic desk when a mother and preschool child approach. The mother tells the nurse that her child has a fever and rash. What action should the nurse take
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Take the child immediately to a different part of the clinic
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Have them wait in the waiting area away from the other children
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Tell the mother to return to the clinic when the rash subsides
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Place them first on the list to see the healthcare practitioner
Explanation
Keeping the child in the same waiting area—even separated from others—does not provide sufficient protection against airborne or droplet-transmitted infections. Shared air space or surfaces may still allow disease transmission. Proper isolation in a separate room is the safest and most appropriate response.
Delaying care could result in missed diagnosis, delayed treatment, and continued exposure to others in the community. Rashes accompanied by fever can indicate serious conditions requiring immediate medical evaluation, not postponement. Also, deferring care does not address the current potential risk to others already in the clinic.
Prioritizing the child for evaluation is beneficial, but without immediate isolation, the child may still expose others while waiting. Triage and prioritization are important, but infection control must come first when dealing with potential communicable diseases.
While caring for a client who has been vomiting, the nurse notes that the client's breath has developed a fruity odor. What assessment should the nurse perform first
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Auscultate the client's bowel sounds
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Determine the client's capillary glucose
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Observe the color of the client's urine
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Measure the client's oxygen saturation
Explanation
The correct answer is:
Determine the client's capillary glucose.
Explanation for the correct answer:
The fruity odor on a client's breath is commonly associated with diabetic ketoacidosis (DKA), which occurs when there is an accumulation of ketones in the blood due to insufficient insulin. When ketones are produced, they can give the breath a distinct fruity smell, often described as similar to acetone or nail polish remover. In the context of a client who is vomiting and possibly has a history of diabetes, this could indicate the presence of DKA. Therefore, the first action should be to determine the client's capillary glucose level to assess for hyperglycemia or DKA.
Why the other options are less appropriate:
Auscultating the client's bowel sounds: While assessing bowel sounds can help identify gastrointestinal issues, the fruity breath odor is more likely to indicate a metabolic condition like DKA, not a GI issue. Thus, auscultating bowel sounds is not the priority in this case.
Observing the color of the client's urine: While urine color can indicate hydration status or renal concerns, the fruity breath odor points to a metabolic condition. Observing urine color does not directly address the potential presence of DKA or hyperglycemia, which should be assessed immediately.
Measuring the client's oxygen saturation: Although it is important to monitor oxygen levels, especially in a vomiting client, the fruity breath odor suggests a metabolic disturbance like DKA. Oxygen saturation should still be checked but is not the immediate priority over addressing the potential for DKA.
The LPN/LVN is assessing an older resident of a long-term care facility who has a history of Benign Prostatic Hypertrophy and identifies that the client's bladder is distended. The healthcare provider prescribes post-voided residual catheterization over the next 24 hours and placement of an indwelling catheter if the residual volume exceeds 100 mL. The client's PO intake is 600 mL, and fifteen minutes ago, the client voided 90 mL. What action should the nurse take
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Stand the client to void and run tap water within hearing distance before catheterizing the client.
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Straight catheterize and if the residual using volume is greater than 100 mL, clamp catheter
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Catheterize q2H and place in an indwelling catheter at the end of the prescribed 24hr period.
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Catheterize with an indwelling catheter and if the residual volume is greater than 100 mL. Inflate the balloon.
Explanation
Correct Answer:
Catheterize with an indwelling catheter and if the residual volume is greater than 100 mL, inflate the balloon
Explanation:
This option directly follows the healthcare provider's instructions, which are aimed at managing urinary retention. When a post-void residual (PVR) volume greater than 100 mL is detected, the provider recommends catheterization with an indwelling catheter. Inflating the balloon after confirming that the residual volume exceeds 100 mL secures the catheter in place, ensuring continuous urinary drainage. This procedure helps prevent further bladder distention, reduces the risk of infection, and facilitates proper monitoring of urinary output. The placement of an indwelling catheter offers a practical solution for managing significant residual urine and helps mitigate complications related to urinary retention.
Why Other Options Are Wrong:
Stand the client to void and run tap water within hearing distance before catheterizing the client
This is incorrect because although these actions can sometimes stimulate natural voiding, they do not address the issue of measuring the post-void residual (PVR) accurately. The provider has specifically instructed catheterization to measure the residual volume, and waiting for natural voiding may lead to further urinary retention and complications, such as bladder distention or discomfort. The instructions require more direct intervention to manage the potential retention.
Straight catheterize and if the residual urine volume is greater than 100 mL, clamp catheter
This is incorrect because the prescription specifically calls for using an indwelling catheter if the residual urine exceeds 100 mL. A straight catheter, by definition, is not intended for continuous use; it is a one-time insertion for obtaining a sample or relieving retention temporarily. Clamping the catheter is not an appropriate action in this situation because the goal is to relieve the urinary retention immediately and not to limit outflow. The indwelling catheter would be necessary for ongoing drainage.
Catheterize q2H and place an indwelling catheter at the end of the prescribed 24-hour period
This is incorrect because it delays the required intervention. If the residual urine volume is greater than 100 mL, the prescribed action is immediate catheterization with an indwelling catheter to prevent further complications like bladder distention and renal damage. Waiting 24 hours for catheter placement would contradict the healthcare provider's directive and increase the risk of urinary stasis and associated complications.
The practical nurse (PN) finds a client who is assigned to another nurse bleeding from the intravenous (IV) site and the IV tubing and fluid are on the floor. The PN immediately applies a dressing to stop the bleeding. Which action should the PN take next
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Complete the shift documentation for this client and include the findings about the IV.
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Tell the nurse assigned to the client about the event so the findings can be recorded.
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Enter computer documentation of the findings and the application of a dressing.
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Inform the charge nurse that the findings indicate that the client pulled out the IV.
Explanation
Correct Answer: Tell the nurse assigned to the client about the event so the findings can be recorded.
Explanation:
When the PN discovers that the client is bleeding from the intravenous (IV) site and the IV tubing and fluid are on the floor, the immediate priority is to stop the bleeding and provide care, which has already been addressed by applying a dressing. After stabilizing the client, the next essential step is to inform the nurse assigned to the client. This ensures that the nurse responsible for the client can record the event properly in the client's medical records, assess the situation further, and take any necessary actions, such as replacing or properly managing the IV site.
Why the other options are incorrect:
Complete the shift documentation for this client and include the findings about the IV:
While documentation is critical, the PN is not the primary nurse for this client and should not independently document in the client's medical record. The nurse assigned to the client should be the one to handle documentation related to this event.
Enter computer documentation of the findings and the application of a dressing:
The PN should not enter documentation in the client’s medical record independently. This should be done by the nurse assigned to the client, as they are responsible for the client’s overall care, including accurate record-keeping of findings and interventions.
Inform the charge nurse that the findings indicate that the client pulled out the IV:
The PN should avoid making assumptions about the cause of the event. The situation should be reported objectively, focusing on the fact that the client is bleeding from the IV site and that the IV tubing and fluid are on the floor. It is the nurse's responsibility to determine the specifics and any further actions needed.
The LPN/LVN is working on the postpartum unit and is assisting a new mother with her newborn's diaper change. The mother states that the infant fed well and completed the whole bottle of formula. What action should the nurse implement first when the infant begins to spit up during the diaper change
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Bubble or burp the infant by patting the infant's back
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Encourage the mother to avoid over feeding the infant
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Turn the newborn and bulb suction the mouth and nose
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Wipe away the secretions and finish the diaper change
Explanation
Explanation of Incorrect Options:
Burping is an essential feeding-related practice that helps release swallowed air, which can reduce future spitting up. However, if the infant is actively spitting up, especially in a lying position, airway clearance takes precedence. Attempting to burp the infant before clearing the airway could increase the risk of aspiration. This option reflects a misunderstanding of priorities during acute events versus routine care.
While overfeeding may be a contributing factor to spitting up, preventive education should occur after the immediate issue is resolved. Addressing feeding habits is important for long-term care, but it does not provide the urgent intervention needed when the infant’s airway may be compromised. This option misplaces the focus on prevention rather than acute response.
Wiping away visible secretions may seem helpful, but it fails to address the potential internal obstruction of the airway. Proceeding with routine care like diaper changing without first suctioning the airway can be dangerous and neglects a critical nursing responsibility. This response overlooks the infant's immediate physiological needs in favor of task completion.
A client at 28 weeks gestation is admitted to the antepartum unit and is being treated for preterm labor. She has a prescription for brethine (Terbutaline) 250 micrograms subcutaneously q4h. The medication is available for injection in 1 mg per ML vials. How many mL should the nurse administer
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0.025
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0.0025
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0.25
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25.0
Explanation
The correct answer: 0.25.
Explanation for the correct answer:
To calculate the correct dosage for administration, we need to convert the prescribed dose from micrograms (mcg) to milligrams (mg) and then calculate how much volume to administer based on the concentration of the medication in the vial.
Convert the prescribed dose to milligrams:
The prescribed dose is 250 mcg (micrograms).
Since 1000 mcg = 1 mg, we divide the prescribed dose by 1000 to convert it to milligrams: 250 mcg ÷ 1000 = 0.25 mg.
Determine how many mL to administer:
The medication concentration is 1 mg per mL.
To calculate the volume, divide the required dose (in mg) by the concentration: 0.25 mg ÷ 1 mg/mL = 0.25 mL.
So, the correct volume to administer is 0.25 mL, which is C. 0.25.
Why the other options are incorrect:
0.025 – This is too small. It does not correspond to the correct calculation for the prescribed dose of 250 mcg.
0.0025 – This is also too small and does not match the required dose. It’s incorrect for the same reason as A.
25.0 – This volume is excessively large and incorrect. It is much too much compared to the prescribed dosage.
Summary:
The correct volume to administer is 0.25 mL, which corresponds to the required dose of 250 micrograms of Terbutaline, with the available concentration of 1 mg/mL. Therefore, the correct answer is C. 0.25.
In obtaining a series of stool specimens for occult blood, which instructions should the practical nurse (PN) provide the client
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Discard the first specimen obtained, then collect the next three.
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Record the time of day that each specimen was obtained.
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Defecate into the container separately from urinating in the toilet.
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All three specimens will be collected after an enema is given.
Explanation
Correct Answer:
Defecate into the container separately from urinating in the toilet
Why this is Correct:
For accurate occult blood testing, stool specimens must be free from urine contamination. Mixing urine with stool can dilute or interfere with the chemical reaction used in the test, potentially leading to false results. Ensuring the client understands to defecate into a clean container separately maintains the integrity of the sample.
Why Others are Wrong:
Discard the first specimen obtained, then collect the next three: This instruction is incorrect unless specifically ordered. All specimens are usually needed, including the first, because occult blood may not be present in every sample. Discarding any could lead to missed diagnosis.
Record the time of day that each specimen was obtained: Time of collection isn’t a standard requirement for fecal occult blood tests. The focus is on sample quality and ensuring they’re collected on different days, not the specific hour.
All three specimens will be collected after an enema is given: Enemas are not recommended prior to collecting specimens for occult blood. They may wash out or dilute blood in the stool, leading to false negatives and inaccurate test results.
A LPN/LVN is contributing to a care plan for an adolescent female client with Anorexia Nervosa. Which outcome statement or goal would be most appropriate for this client
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She will participate in a daily aerobic exercise program
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She will consume at least 50 percent of all meals
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Her laboratory values will remain within normal limits
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She will develop a positive body image and self-identity
Explanation
Although exercise can be part of a healthy lifestyle, in clients with Anorexia Nervosa, it is often used compulsively to control weight and burn calories. Encouraging aerobic exercise prematurely may reinforce unhealthy behaviors or delay weight restoration. In treatment, exercise is often restricted or closely monitored until the individual has reached a healthy weight and mindset. This goal does not align with early recovery priorities.
While reestablishing regular eating patterns is crucial, setting the bar at only 50% consumption reflects inadequate therapeutic expectations. This may signal a lack of commitment to full nutritional rehabilitation and could allow ongoing disordered eating patterns. A more effective goal would involve gradual progression toward full meal and snack consumption, with support from dietitians and the care team.
Normalizing lab values is an important medical outcome of effective treatment, but it is not a comprehensive goal. Lab values can stabilize even if the client remains psychologically unwell or continues harmful behaviors. Long-term recovery from Anorexia Nervosa requires addressing the underlying cognitive distortions and emotional challenges, particularly those related to self-image and identity.
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