PN HESI EXIT EXAM – REAL EXAM 2 TEST
BANK 150 VERIFIED QUESTIONS WITH
CORRECT ANSWERS & DETAILED
RATIONALES
1. A client with heart failure has crackles in the lungs and +3 pedal edema.
Which dietary restriction is most important?
A. Low-fat
B. Low-sodium
C. Low-carbohydrate
D. Low-protein
☑ Correct Answer: B. Low-sodium
Rationale: Sodium causes fluid retention, which worsens heart failure symptoms
including pulmonary crackles (fluid in lungs) and peripheral edema. Low-sodium
diet reduces intravascular volume, decreases preload, and improves breathing.
Low-fat/carb/protein are not directly related to fluid management in HF.
2. A client on warfarin has an INR of 4.5. What should the PN do first?
A. Administer vitamin K
B. Hold the next warfarin dose
C. Notify the healthcare provider
D. Check for bleeding
☑ Correct Answer: D. Check for bleeding
Rationale: INR 4.5 is above therapeutic range (usually 2-3 for most conditions),
,indicating high bleeding risk. The priority is to assess for active bleeding (gums,
skin, urine, stool, mental status changes). After assessment, notify HCP; vitamin K
and holding dose may be ordered.
3. A diabetic client has a blood glucose of 48 mg/dL and is unconscious. What
should the PN give?
A. Orange juice orally
B. Glucagon IM
C. ½ cup of soda
D. Insulin IV
☑ Correct Answer: B. Glucagon IM
Rationale: Unconscious client cannot safely swallow oral glucose (aspiration
risk). Glucagon (1 mg IM/subcut) stimulates liver glycogenolysis, raising glucose
rapidly. IV dextrose is an alternative if IV access exists, but glucagon is given by
PN. Insulin would worsen hypoglycemia.
4. A post-op client has a temperature of 102°F (38.9°C) on day 2. What is the
most likely cause?
A. Dehydration
B. Atelectasis
C. Wound infection
D. Blood transfusion reaction
☑ Correct Answer: B. Atelectasis
Rationale: Post-op days 1-3 fever is most commonly due to atelectasis from
,shallow breathing, anesthesia, and immobility. Wound infection typically occurs
day 3-5. Transfusion reaction occurs during/within hours of transfusion.
Dehydration may cause mild temp elevation but not typically 102°F.
5. A client with COPD has an oxygen saturation of 88%. Which action is
correct?
A. Increase O2 to 4 L/min
B. Apply a non-rebreather mask
C. Keep O2 at 2 L/min
D. Remove O2 completely
☑ Correct Answer: C. Keep O2 at 2 L/min
Rationale: COPD clients may rely on hypoxic drive (low O2 stimulates
breathing). High O2 (≥3 L/min) can cause respiratory depression, hypercapnia, and
apnea. Target SpO2 88-92% in COPD. 2 L/min is appropriate; increasing could be
dangerous.
6. A client with a new colostomy has a purple stoma. What should the PN do?
A. Document as normal
B. Apply warm compress
C. Notify HCP immediately
D. Massage gently
☑ Correct Answer: C. Notify HCP immediately
Rationale: A healthy stoma is moist and pink/red. Purple, dark red, or black
indicates ischemia or necrosis due to compromised blood supply. This is a surgical
, emergency that may require stoma revision. Warm compress and massage are
ineffective and delay treatment.
7. Which finding in a client with a cast on the right leg requires immediate
action?
A. Mild swelling
B. Capillary refill 2 seconds
C. Numbness in toes
D. Pain 3/10
☑ Correct Answer: C. Numbness in toes
Rationale: Numbness, paresthesia, pallor, pulselessness, paralysis, or pain out of
proportion are signs of compartment syndrome or nerve compression. Mild
swelling and mild pain are expected post-casting. Immediate action includes
notifying HCP and preparing for cast removal/fasciotomy.
8. A client with tuberculosis is started on rifampin. What teaching is most
important?
A. Take with antacids
B. Urine and tears may turn orange
C. Avoid sunlight
D. Increase potassium intake
☑ Correct Answer: B. Urine and tears may turn orange
Rationale: Rifampin causes harmless orange-red discoloration of body fluids
(urine, sweat, tears, saliva). Clients must be warned to prevent alarm and
BANK 150 VERIFIED QUESTIONS WITH
CORRECT ANSWERS & DETAILED
RATIONALES
1. A client with heart failure has crackles in the lungs and +3 pedal edema.
Which dietary restriction is most important?
A. Low-fat
B. Low-sodium
C. Low-carbohydrate
D. Low-protein
☑ Correct Answer: B. Low-sodium
Rationale: Sodium causes fluid retention, which worsens heart failure symptoms
including pulmonary crackles (fluid in lungs) and peripheral edema. Low-sodium
diet reduces intravascular volume, decreases preload, and improves breathing.
Low-fat/carb/protein are not directly related to fluid management in HF.
2. A client on warfarin has an INR of 4.5. What should the PN do first?
A. Administer vitamin K
B. Hold the next warfarin dose
C. Notify the healthcare provider
D. Check for bleeding
☑ Correct Answer: D. Check for bleeding
Rationale: INR 4.5 is above therapeutic range (usually 2-3 for most conditions),
,indicating high bleeding risk. The priority is to assess for active bleeding (gums,
skin, urine, stool, mental status changes). After assessment, notify HCP; vitamin K
and holding dose may be ordered.
3. A diabetic client has a blood glucose of 48 mg/dL and is unconscious. What
should the PN give?
A. Orange juice orally
B. Glucagon IM
C. ½ cup of soda
D. Insulin IV
☑ Correct Answer: B. Glucagon IM
Rationale: Unconscious client cannot safely swallow oral glucose (aspiration
risk). Glucagon (1 mg IM/subcut) stimulates liver glycogenolysis, raising glucose
rapidly. IV dextrose is an alternative if IV access exists, but glucagon is given by
PN. Insulin would worsen hypoglycemia.
4. A post-op client has a temperature of 102°F (38.9°C) on day 2. What is the
most likely cause?
A. Dehydration
B. Atelectasis
C. Wound infection
D. Blood transfusion reaction
☑ Correct Answer: B. Atelectasis
Rationale: Post-op days 1-3 fever is most commonly due to atelectasis from
,shallow breathing, anesthesia, and immobility. Wound infection typically occurs
day 3-5. Transfusion reaction occurs during/within hours of transfusion.
Dehydration may cause mild temp elevation but not typically 102°F.
5. A client with COPD has an oxygen saturation of 88%. Which action is
correct?
A. Increase O2 to 4 L/min
B. Apply a non-rebreather mask
C. Keep O2 at 2 L/min
D. Remove O2 completely
☑ Correct Answer: C. Keep O2 at 2 L/min
Rationale: COPD clients may rely on hypoxic drive (low O2 stimulates
breathing). High O2 (≥3 L/min) can cause respiratory depression, hypercapnia, and
apnea. Target SpO2 88-92% in COPD. 2 L/min is appropriate; increasing could be
dangerous.
6. A client with a new colostomy has a purple stoma. What should the PN do?
A. Document as normal
B. Apply warm compress
C. Notify HCP immediately
D. Massage gently
☑ Correct Answer: C. Notify HCP immediately
Rationale: A healthy stoma is moist and pink/red. Purple, dark red, or black
indicates ischemia or necrosis due to compromised blood supply. This is a surgical
, emergency that may require stoma revision. Warm compress and massage are
ineffective and delay treatment.
7. Which finding in a client with a cast on the right leg requires immediate
action?
A. Mild swelling
B. Capillary refill 2 seconds
C. Numbness in toes
D. Pain 3/10
☑ Correct Answer: C. Numbness in toes
Rationale: Numbness, paresthesia, pallor, pulselessness, paralysis, or pain out of
proportion are signs of compartment syndrome or nerve compression. Mild
swelling and mild pain are expected post-casting. Immediate action includes
notifying HCP and preparing for cast removal/fasciotomy.
8. A client with tuberculosis is started on rifampin. What teaching is most
important?
A. Take with antacids
B. Urine and tears may turn orange
C. Avoid sunlight
D. Increase potassium intake
☑ Correct Answer: B. Urine and tears may turn orange
Rationale: Rifampin causes harmless orange-red discoloration of body fluids
(urine, sweat, tears, saliva). Clients must be warned to prevent alarm and
