HESI PN Exit Exam Version 2– Practical Nursing
Comprehensive Exit Assessment Updated and Latest
Questions and Correct Answers with Rationale
1. A practical nurse (PN) is preparing to administer regular and NPH insulin to a client. What is the correct
sequence for mixing these medications?
A. Draw up the NPH insulin first, followed by the regular insulin.
B. Mix them in two separate syringes and administer them at different sites.
C. Draw up the regular insulin first, followed by the NPH insulin.
D. Shake the NPH vial vigorously before drawing up the medication.
Ans: C
Rationale: The practical nurse must follow the clear-to-cloudy rule when mixing insulin to prevent
contamination. Regular insulin is clear and should always be drawn into the syringe before the cloudy
NPH insulin. If the NPH insulin were to contaminate the regular insulin vial, it would change the onset
and peak of the regular insulin. The nurse should first inject air into the NPH vial without touching the
solution. Then, the nurse injects air into the regular vial and withdraws the needed amount. After that,
the nurse withdraws the NPH insulin to complete the total dose. This process ensures the accuracy and
safety of the medication administration. It is a fundamental skill for PN-level nursing care and diabetes
management.
2. A client with a new diagnosis of hypertension is being educated on the DASH diet. Which food choice
indicates a need for further teaching?
A. Fresh steamed broccoli
B. Low-fat yogurt with berries
C. Whole grain brown rice
,D. Canned chicken noodle soup
Ans: D
Rationale: The DASH diet focuses on reducing sodium intake to lower blood pressure in hypertensive
patients. Canned soups are notoriously high in sodium and should be avoided or strictly limited. Fresh
vegetables like broccoli are excellent choices due to their low sodium and high fiber content. Whole
grains provide necessary nutrients without the added salt found in processed foods. Low-fat dairy is
encouraged in the DASH diet because it provides calcium and protein with minimal saturated fat. The
nurse must identify that processed foods are the primary source of excess sodium in the American diet.
Educating the client on reading labels is a critical component of nursing intervention. Consistent dietary
adherence is necessary to achieve long-term cardiovascular health goals.
3. The PN is caring for a client who is 4 hours post-abdominal surgery. Which assessment finding requires
immediate notification to the healthcare provider?
A. Urine output of 20 mL per hour for the last two hours
B. Absent bowel sounds in all four quadrants
C. Small amount of serosanguinous drainage on the dressing
D. Reports of pain rated at 6 on a scale of 0 to 10
Ans: A
Rationale: A urine output of less than 30 mL per hour is a sign of potential renal failure or hypovolemia
and requires immediate attention. Serosanguinous drainage is a normal finding in the early postoperative
period. Absent bowel sounds are common immediately after abdominal surgery due to the effects of
anesthesia. Pain is expected after surgery and should be managed, but it is not as urgent as low kidney
perfusion. The PN should monitor the client for signs of shock or dehydration when urine output is low.
Prompt intervention can prevent permanent renal damage or complications from poor perfusion.
,Reporting this finding ensures that the provider can adjust fluids or order diagnostic tests. Patient safety
is the priority when interpreting vital signs and output metrics.
4. A PN is teaching a client about a new prescription for warfarin. Which statement by the client shows they
understand the dietary requirements?
A. I will eat a large salad with spinach every single day.
B. I should avoid all foods that contain Vitamin K forever.
C. I can drink as much cranberry juice as I want while taking this.
D. I will keep my intake of green leafy vegetables consistent.
Ans: D
Rationale: The key to managing warfarin therapy is maintaining a consistent intake of Vitamin K.
Vitamin K is the antagonist to warfarin and sudden increases or decreases can affect the INR levels.
Clients do not need to avoid Vitamin K entirely, but they must not fluctuate their intake. Eating a large
salad every day is fine only if they do it every day, but consistency is the priority. Drastic changes can lead
to either excessive bleeding or the formation of clots. Cranberry juice can actually interact with warfarin
and should be consumed in moderation. The PN must emphasize regular blood monitoring to ensure the
dosage remains within the therapeutic range. Proper education reduces the risk of life-threatening
bleeding complications for the client.
5. When assessing a 6-month-old infant, which developmental milestone should the PN expect the child to
have achieved?
A. Walking while holding onto furniture
B. Sitting up steadily without support
C. Rolling from back to abdomen
, D. Speaking two or three recognizable words
Ans: C
Rationale: By six months of age, most infants should be able to roll over in both directions. Walking
while holding onto furniture, or cruising, usually happens closer to 9 or 10 months. Sitting without
support is a milestone that is often mastered around 7 to 8 months, though some start earlier. Speaking
recognizable words typically occurs around the age of one year. The PN must know these milestones to
identify potential developmental delays in pediatric patients. Early identification of delays allows for
quicker referral to specialists for intervention. Rolling is a major gross motor skill that demonstrates
increasing muscle strength and coordination. Understanding pediatric growth and development is
essential for provide effective family-centered care.
6. An older adult client is at risk for falls. Which intervention should the PN implement first to ensure
safety?
A. Apply soft wrist restraints to prevent the client from getting up.
B. Place the call bell within the client’s reach.
C. Keep all four side rails in the up position at all times.
D. Administer a sedative to keep the client resting in bed.
Ans: B
Rationale: Ensuring the call bell is within reach is a primary, non-invasive safety intervention for fall
prevention. Restraints should only be used as a last resort and require a specific medical order. Keeping
all four side rails up is actually considered a form of restraint in many facilities and can increase injury
risk if the client tries to climb over them. Sedatives increase the risk of falls due to confusion and
dizziness in the elderly population. The PN should also ensure the bed is in the lowest position to
minimize injury. Proper lighting and a clutter-free environment are also vital components of a fall
Comprehensive Exit Assessment Updated and Latest
Questions and Correct Answers with Rationale
1. A practical nurse (PN) is preparing to administer regular and NPH insulin to a client. What is the correct
sequence for mixing these medications?
A. Draw up the NPH insulin first, followed by the regular insulin.
B. Mix them in two separate syringes and administer them at different sites.
C. Draw up the regular insulin first, followed by the NPH insulin.
D. Shake the NPH vial vigorously before drawing up the medication.
Ans: C
Rationale: The practical nurse must follow the clear-to-cloudy rule when mixing insulin to prevent
contamination. Regular insulin is clear and should always be drawn into the syringe before the cloudy
NPH insulin. If the NPH insulin were to contaminate the regular insulin vial, it would change the onset
and peak of the regular insulin. The nurse should first inject air into the NPH vial without touching the
solution. Then, the nurse injects air into the regular vial and withdraws the needed amount. After that,
the nurse withdraws the NPH insulin to complete the total dose. This process ensures the accuracy and
safety of the medication administration. It is a fundamental skill for PN-level nursing care and diabetes
management.
2. A client with a new diagnosis of hypertension is being educated on the DASH diet. Which food choice
indicates a need for further teaching?
A. Fresh steamed broccoli
B. Low-fat yogurt with berries
C. Whole grain brown rice
,D. Canned chicken noodle soup
Ans: D
Rationale: The DASH diet focuses on reducing sodium intake to lower blood pressure in hypertensive
patients. Canned soups are notoriously high in sodium and should be avoided or strictly limited. Fresh
vegetables like broccoli are excellent choices due to their low sodium and high fiber content. Whole
grains provide necessary nutrients without the added salt found in processed foods. Low-fat dairy is
encouraged in the DASH diet because it provides calcium and protein with minimal saturated fat. The
nurse must identify that processed foods are the primary source of excess sodium in the American diet.
Educating the client on reading labels is a critical component of nursing intervention. Consistent dietary
adherence is necessary to achieve long-term cardiovascular health goals.
3. The PN is caring for a client who is 4 hours post-abdominal surgery. Which assessment finding requires
immediate notification to the healthcare provider?
A. Urine output of 20 mL per hour for the last two hours
B. Absent bowel sounds in all four quadrants
C. Small amount of serosanguinous drainage on the dressing
D. Reports of pain rated at 6 on a scale of 0 to 10
Ans: A
Rationale: A urine output of less than 30 mL per hour is a sign of potential renal failure or hypovolemia
and requires immediate attention. Serosanguinous drainage is a normal finding in the early postoperative
period. Absent bowel sounds are common immediately after abdominal surgery due to the effects of
anesthesia. Pain is expected after surgery and should be managed, but it is not as urgent as low kidney
perfusion. The PN should monitor the client for signs of shock or dehydration when urine output is low.
Prompt intervention can prevent permanent renal damage or complications from poor perfusion.
,Reporting this finding ensures that the provider can adjust fluids or order diagnostic tests. Patient safety
is the priority when interpreting vital signs and output metrics.
4. A PN is teaching a client about a new prescription for warfarin. Which statement by the client shows they
understand the dietary requirements?
A. I will eat a large salad with spinach every single day.
B. I should avoid all foods that contain Vitamin K forever.
C. I can drink as much cranberry juice as I want while taking this.
D. I will keep my intake of green leafy vegetables consistent.
Ans: D
Rationale: The key to managing warfarin therapy is maintaining a consistent intake of Vitamin K.
Vitamin K is the antagonist to warfarin and sudden increases or decreases can affect the INR levels.
Clients do not need to avoid Vitamin K entirely, but they must not fluctuate their intake. Eating a large
salad every day is fine only if they do it every day, but consistency is the priority. Drastic changes can lead
to either excessive bleeding or the formation of clots. Cranberry juice can actually interact with warfarin
and should be consumed in moderation. The PN must emphasize regular blood monitoring to ensure the
dosage remains within the therapeutic range. Proper education reduces the risk of life-threatening
bleeding complications for the client.
5. When assessing a 6-month-old infant, which developmental milestone should the PN expect the child to
have achieved?
A. Walking while holding onto furniture
B. Sitting up steadily without support
C. Rolling from back to abdomen
, D. Speaking two or three recognizable words
Ans: C
Rationale: By six months of age, most infants should be able to roll over in both directions. Walking
while holding onto furniture, or cruising, usually happens closer to 9 or 10 months. Sitting without
support is a milestone that is often mastered around 7 to 8 months, though some start earlier. Speaking
recognizable words typically occurs around the age of one year. The PN must know these milestones to
identify potential developmental delays in pediatric patients. Early identification of delays allows for
quicker referral to specialists for intervention. Rolling is a major gross motor skill that demonstrates
increasing muscle strength and coordination. Understanding pediatric growth and development is
essential for provide effective family-centered care.
6. An older adult client is at risk for falls. Which intervention should the PN implement first to ensure
safety?
A. Apply soft wrist restraints to prevent the client from getting up.
B. Place the call bell within the client’s reach.
C. Keep all four side rails in the up position at all times.
D. Administer a sedative to keep the client resting in bed.
Ans: B
Rationale: Ensuring the call bell is within reach is a primary, non-invasive safety intervention for fall
prevention. Restraints should only be used as a last resort and require a specific medical order. Keeping
all four side rails up is actually considered a form of restraint in many facilities and can increase injury
risk if the client tries to climb over them. Sedatives increase the risk of falls due to confusion and
dizziness in the elderly population. The PN should also ensure the bed is in the lowest position to
minimize injury. Proper lighting and a clutter-free environment are also vital components of a fall
