HESI LPN EXIT EXAM MERGED 2025-2026 | Actual Exam
Prep | Comprehensive Q&A | Verified Answers | Pass
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SECTION 1: MEDICAL-SURGICAL NURSING (45 Questions)
Q1: A client with a history of heart failure is admitted with acute dyspnea, orthopnea,
and frothy pink sputum. Vital signs: BP 168/94 mmHg, HR 118 bpm, RR 32/min, SpO₂
84% on room air. Which action should the LPN implement first?
A. Administer furosemide (Lasix) 40 mg IV push
B. Apply oxygen via non-rebreather mask at 10-15 L/min
C. Insert an indwelling urinary catheter
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale: This client presents with acute pulmonary edema, a life-threatening
manifestation of decompensated heart failure. The priority intervention follows the
ABCs (Airway, Breathing, Circulation). The client has severe hypoxemia (SpO₂ 84%) and
respiratory distress (RR 32, frothy pink sputum). High-flow oxygen via non-rebreather
mask is immediately required to correct hypoxemia and reduce the work of breathing.
Option A (furosemide) is appropriate for fluid removal but does not address the
immediate life-threatening hypoxia—diuretics can be administered after oxygenation is
stabilized. Option C (catheter insertion) is inappropriate as a first priority and invasive
procedures should not precede stabilization of vital functions. Option D (ECG) provides
,diagnostic information but does not treat the immediate physiological crisis. HESI
Strategy: Always prioritize physiological stability over diagnostic procedures or
non-urgent interventions. The ABC framework is fundamental to HESI prioritization
questions.
Q2: A client is receiving digoxin (Lanoxin) 0.25 mg daily for atrial fibrillation. Which
findings require immediate notification of the healthcare provider? (Select All That
Apply)
A. Serum digoxin level of 1.8 ng/mL
B. New onset of nausea and vomiting
C. Heart rate of 52 bpm
D. Visual disturbances described as "yellow halos around lights"
E. Potassium level of 3.2 mEq/L
Correct Answers: B, C, D, E
Rationale: Digoxin toxicity is a serious adverse effect with potentially fatal cardiac
arrhythmias. Therapeutic digoxin levels are 0.5-2.0 ng/mL (Option A is therapeutic, not
toxic). Signs of toxicity include: gastrointestinal symptoms (anorexia, nausea, vomiting,
diarrhea—Option B), cardiac manifestations (bradycardia <60 bpm, various
arrhythmias—Option C requires holding dose and notifying provider), neurologic
symptoms (headache, confusion, visual disturbances including yellow-green
halos—Option D is pathognomonic for digoxin toxicity), and electrolyte imbalances
(hypokalemia potentiates digoxin toxicity—Option E increases risk and requires
correction). The LPN should hold the digoxin dose, check the apical pulse for 1 full
minute, and immediately notify the provider for bradycardia, visual changes, or
,suspected toxicity. HESI Strategy: Remember the classic digoxin toxicity triad: GI upset
+ cardiac irregularities + visual disturbances. Potassium levels are critical because
hypokalemia increases myocardial sensitivity to digoxin.
Q3: A client with deep vein thrombosis (DVT) is receiving heparin sodium via continuous
IV infusion. The aPTT result is 95 seconds (control 30-40 seconds, therapeutic range
1.5-2.5 times control or 45-80 seconds). Which action should the LPN take?
A. Increase the heparin infusion rate per protocol
B. Continue the current infusion rate and document findings
C. Stop the heparin infusion and notify the healthcare provider immediately
D. Draw a stat PT/INR level
Correct Answer: C
Rationale: The aPTT of 95 seconds exceeds the therapeutic range (45-80 seconds or
1.5-2.5 times control), indicating supratherapeutic anticoagulation with increased
bleeding risk. The LPN must immediately stop the heparin infusion and notify the
provider. Heparin has a short half-life (1-2 hours), so stopping the infusion quickly
reduces anticoagulant effect. The provider will likely order a reduced infusion rate once
the aPTT trends downward. Option A would worsen the bleeding risk. Option B is unsafe
because the client is at risk for hemorrhage. Option D is incorrect because PT/INR
monitors warfarin therapy, not heparin (aPTT is the correct monitoring parameter for
heparin). HESI Strategy: For anticoagulation monitoring, know: aPTT = heparin; PT/INR =
warfarin. Supratherapeutic anticoagulation requires stopping the medication and
notifying the provider—never continue or increase a dose when bleeding risk is elevated.
, Q4: A client with type 1 diabetes mellitus presents with polyuria, polydipsia, fruity breath
odor, Kussmaul respirations, and blood glucose of 480 mg/dL. Arterial blood gas results
show pH 7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L. The LPN should anticipate which
medical diagnosis and priority intervention?
A. Hyperosmolar hyperglycemic state (HHS); administer 0.9% normal saline rapidly
B. Diabetic ketoacidosis (DKA); begin insulin infusion after fluid resuscitation
C. Hypoglycemia; administer 50% dextrose IV push
D. Syndrome of inappropriate antidiuretic hormone (SIADH); implement fluid restriction
Correct Answer: B
Rationale: The clinical presentation is classic for diabetic ketoacidosis (DKA):
hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.35, low HCO₃⁻), compensatory
respiratory alkalosis (low PaCO₂ from Kussmaul respirations), and ketosis (fruity breath
from acetone). Priority interventions follow the DKA protocol: (1) Aggressive IV fluid
resuscitation with 0.9% saline to restore perfusion and correct dehydration, (2) Regular
insulin infusion only AFTER initial fluid resuscitation (insulin before fluids can cause
rapid intracellular glucose shift and cardiovascular collapse), (3) Potassium monitoring
and replacement (insulin drives potassium intracellularly), (4) Bicarbonate
administration only if pH <7.0. Option A describes HHS (no ketosis, higher glucose, no
acidosis). Option C is opposite of needed treatment. Option D is unrelated. HESI
Strategy: DKA = acidosis + ketosis + hyperglycemia; HHS = hyperglycemia without
acidosis. Never give insulin before fluids in DKA—this is a critical safety point.
Q5: A client is 2 hours postoperative following abdominal surgery. The LPN notes the
following vital signs: BP 92/58 mmHg, HR 118 bpm, RR 24/min, temperature 36.1°C
Prep | Comprehensive Q&A | Verified Answers | Pass
Guaranteed - A+ Graded
SECTION 1: MEDICAL-SURGICAL NURSING (45 Questions)
Q1: A client with a history of heart failure is admitted with acute dyspnea, orthopnea,
and frothy pink sputum. Vital signs: BP 168/94 mmHg, HR 118 bpm, RR 32/min, SpO₂
84% on room air. Which action should the LPN implement first?
A. Administer furosemide (Lasix) 40 mg IV push
B. Apply oxygen via non-rebreather mask at 10-15 L/min
C. Insert an indwelling urinary catheter
D. Obtain a 12-lead ECG
Correct Answer: B
Rationale: This client presents with acute pulmonary edema, a life-threatening
manifestation of decompensated heart failure. The priority intervention follows the
ABCs (Airway, Breathing, Circulation). The client has severe hypoxemia (SpO₂ 84%) and
respiratory distress (RR 32, frothy pink sputum). High-flow oxygen via non-rebreather
mask is immediately required to correct hypoxemia and reduce the work of breathing.
Option A (furosemide) is appropriate for fluid removal but does not address the
immediate life-threatening hypoxia—diuretics can be administered after oxygenation is
stabilized. Option C (catheter insertion) is inappropriate as a first priority and invasive
procedures should not precede stabilization of vital functions. Option D (ECG) provides
,diagnostic information but does not treat the immediate physiological crisis. HESI
Strategy: Always prioritize physiological stability over diagnostic procedures or
non-urgent interventions. The ABC framework is fundamental to HESI prioritization
questions.
Q2: A client is receiving digoxin (Lanoxin) 0.25 mg daily for atrial fibrillation. Which
findings require immediate notification of the healthcare provider? (Select All That
Apply)
A. Serum digoxin level of 1.8 ng/mL
B. New onset of nausea and vomiting
C. Heart rate of 52 bpm
D. Visual disturbances described as "yellow halos around lights"
E. Potassium level of 3.2 mEq/L
Correct Answers: B, C, D, E
Rationale: Digoxin toxicity is a serious adverse effect with potentially fatal cardiac
arrhythmias. Therapeutic digoxin levels are 0.5-2.0 ng/mL (Option A is therapeutic, not
toxic). Signs of toxicity include: gastrointestinal symptoms (anorexia, nausea, vomiting,
diarrhea—Option B), cardiac manifestations (bradycardia <60 bpm, various
arrhythmias—Option C requires holding dose and notifying provider), neurologic
symptoms (headache, confusion, visual disturbances including yellow-green
halos—Option D is pathognomonic for digoxin toxicity), and electrolyte imbalances
(hypokalemia potentiates digoxin toxicity—Option E increases risk and requires
correction). The LPN should hold the digoxin dose, check the apical pulse for 1 full
minute, and immediately notify the provider for bradycardia, visual changes, or
,suspected toxicity. HESI Strategy: Remember the classic digoxin toxicity triad: GI upset
+ cardiac irregularities + visual disturbances. Potassium levels are critical because
hypokalemia increases myocardial sensitivity to digoxin.
Q3: A client with deep vein thrombosis (DVT) is receiving heparin sodium via continuous
IV infusion. The aPTT result is 95 seconds (control 30-40 seconds, therapeutic range
1.5-2.5 times control or 45-80 seconds). Which action should the LPN take?
A. Increase the heparin infusion rate per protocol
B. Continue the current infusion rate and document findings
C. Stop the heparin infusion and notify the healthcare provider immediately
D. Draw a stat PT/INR level
Correct Answer: C
Rationale: The aPTT of 95 seconds exceeds the therapeutic range (45-80 seconds or
1.5-2.5 times control), indicating supratherapeutic anticoagulation with increased
bleeding risk. The LPN must immediately stop the heparin infusion and notify the
provider. Heparin has a short half-life (1-2 hours), so stopping the infusion quickly
reduces anticoagulant effect. The provider will likely order a reduced infusion rate once
the aPTT trends downward. Option A would worsen the bleeding risk. Option B is unsafe
because the client is at risk for hemorrhage. Option D is incorrect because PT/INR
monitors warfarin therapy, not heparin (aPTT is the correct monitoring parameter for
heparin). HESI Strategy: For anticoagulation monitoring, know: aPTT = heparin; PT/INR =
warfarin. Supratherapeutic anticoagulation requires stopping the medication and
notifying the provider—never continue or increase a dose when bleeding risk is elevated.
, Q4: A client with type 1 diabetes mellitus presents with polyuria, polydipsia, fruity breath
odor, Kussmaul respirations, and blood glucose of 480 mg/dL. Arterial blood gas results
show pH 7.28, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L. The LPN should anticipate which
medical diagnosis and priority intervention?
A. Hyperosmolar hyperglycemic state (HHS); administer 0.9% normal saline rapidly
B. Diabetic ketoacidosis (DKA); begin insulin infusion after fluid resuscitation
C. Hypoglycemia; administer 50% dextrose IV push
D. Syndrome of inappropriate antidiuretic hormone (SIADH); implement fluid restriction
Correct Answer: B
Rationale: The clinical presentation is classic for diabetic ketoacidosis (DKA):
hyperglycemia (>250 mg/dL), metabolic acidosis (pH <7.35, low HCO₃⁻), compensatory
respiratory alkalosis (low PaCO₂ from Kussmaul respirations), and ketosis (fruity breath
from acetone). Priority interventions follow the DKA protocol: (1) Aggressive IV fluid
resuscitation with 0.9% saline to restore perfusion and correct dehydration, (2) Regular
insulin infusion only AFTER initial fluid resuscitation (insulin before fluids can cause
rapid intracellular glucose shift and cardiovascular collapse), (3) Potassium monitoring
and replacement (insulin drives potassium intracellularly), (4) Bicarbonate
administration only if pH <7.0. Option A describes HHS (no ketosis, higher glucose, no
acidosis). Option C is opposite of needed treatment. Option D is unrelated. HESI
Strategy: DKA = acidosis + ketosis + hyperglycemia; HHS = hyperglycemia without
acidosis. Never give insulin before fluids in DKA—this is a critical safety point.
Q5: A client is 2 hours postoperative following abdominal surgery. The LPN notes the
following vital signs: BP 92/58 mmHg, HR 118 bpm, RR 24/min, temperature 36.1°C
