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Walden University — HESI PN Exit Exam 2024
4202 NP ISEH
PN Practical Nurse Comprehensive Review | NCLEX-PN Preparation
A HIGHER DEGREE OF GOOD — WALDEN UNIVERSITY
HESI PN
HESI PN EXIT EXAM 2024 — Comprehensive Review
MED-SURG, MATERNITY, PEDIATRICS, MENTAL HEALTH, FUNDAMENTALS & LEADERSHIP
INSTITUTION Walden University — HESI/Elsevier COURSE CODE HESI PN Exit Examination 2024
PROGRAM Practical Nurse (PN) — NCLEX-PN Licensure ACADEMIC YEAR
EXAM TITLE HESI PN Exit Exam — 2024 Comprehensive TOTAL QUESTIONS 100+ Questions (Selected Key Items)
SUBJECT AREAS All NCLEX-PN Client Needs Categories FORMAT Multiple Choice, SATA, Ordered Response & Calculation
EXAMINATION INSTRUCTIONS
▸ This comprehensive review covers all major NCLEX-PN client needs categories: Safe and Effective Care Environment, Health Promotion, Psychosocial Integrity, and Physiological Integrity.
▸ Medical-Surgical Nursing, Maternity/Newborn, Pediatrics, Mental Health, Fundamentals, and Leadership/Delegation are all testable content areas.
▸ Medication calculations require numeric answers; round as specified. SATA questions require selecting ALL correct options.
▸ Correct answers and clinical rationales appear below each question for NCLEX-PN board review purposes.
▸ All content reflects current NCLEX-PN test plan (2023) and evidence-based nursing practice standards.
SECTION I — MEDICAL-SURGICAL NURSING, PHARMACOLOGY & EMERGENCY CARE Questions 1 – 20
1. A gravida 1 para 0 client is transferred to the recovery room following a normal vaginal delivery. The PN observes that the client is shaking uncontrollably and states she's cold. What action should the PN
take?
A. Notify the healthcare provider immediately
B. Apply a light warm blanket and assure her that this is normal following delivery
C. Administer an antipyretic as prescribed
D. Obtain a STAT complete blood count
CORRECT ANSWER B — Apply a light warm blanket; postpartum shaking chills are a common, benign phenomenon caused by hormonal shifts and vasomotor changes after delivery
RATIONALE Postpartum shaking chills occur in 25-50% of deliveries and are self-limiting. They result from: rapid hormonal changes (progesterone drop), vasomotor instability, epidural anesthesia effects, and the body's
reaction to the physical exertion of labor. They typically resolve within 30-60 minutes. A warm blanket provides comfort. The PN should monitor for true fever (>100.4°F), which may indicate infection. This is
NOT a sign of hemorrhage or infection in isolation. Reassuring the client reduces anxiety.
2. The PN is assessing an older client with left-sided heart failure. What intervention is most important for the PN to implement?
A. Palpate peripheral pulses
B. Auscultate all lung fields
C. Measure abdominal girth
D. Assess for peripheral edema
CORRECT ANSWER B — Auscultate all lung fields; left-sided heart failure causes pulmonary congestion (crackles, dyspnea, orthopnea)
RATIONALE Left-sided heart failure causes blood to back up into the pulmonary circulation → pulmonary edema. Auscultation of lung fields is the priority to assess for crackles (rales), diminished breath sounds, and
wheezes indicating fluid accumulation. Peripheral pulses (A), abdominal girth (C), and peripheral edema (D) are more relevant to RIGHT-sided heart failure. The mnemonic "LEFT = LUNGS, RIGHT = REST of
body."
3. A full-term 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. Which immediate intervention should the PN take?
A. Begin chest compressions
B. Turn the infant to the right side
C. Administer oxygen via face mask
D. Suction oral and nasal passages
CORRECT ANSWER D — Suction oral and nasal passages first; clearing the airway is the priority per ABCs
RATIONALE Cyanosis after regurgitation suggests airway obstruction from aspirated material. The PRIORITY is to clear the airway — suction oral and nasal passages immediately. The ABCs: Airway → Breathing →
Circulation. Turning to the side (B) helps drain secretions but suctioning is more definitive. Oxygen (C) and compressions (D) may follow if respiratory status does not improve after airway clearance.
4. An older client who had a colon resection 8 days ago is straining at stool. The PN observes a wound followed by appearance of bowel on the skin. Which complication has occurred?
A. Dehiscence
B. Evisceration — complete wound separation with protrusion of abdominal organs
C. Hematoma
D. Seroma
CORRECT ANSWER B — Evisceration; complete wound separation with protrusion of viscera (bowel) through the wound
RATIONALE Evisceration is a SURGICAL EMERGENCY. Immediate actions: (1) Stay with the client, call for help. (2) Cover protruding organs with sterile gauze/saline-moistened towels (do NOT attempt to reinsert). (3) Keep
the client supine with knees flexed to reduce abdominal tension. (4) Monitor vital signs for shock. (5) Prepare for emergency surgery. Dehiscence (A) is wound separation WITHOUT organ protrusion. Straining
at stool increases intra-abdominal pressure, precipitating wound complications.
5. A client receiving an epidural anesthesia during labor. What is the most important adverse effect the PN should assess for following administration?
A. Maternal hypertension
B. Maternal hypotension
C. Tachycardia
D. Hyperreflexia
CORRECT ANSWER B — Maternal hypotension; sympathetic blockade from epidural → vasodilation → decreased venous return
RATIONALE Epidural anesthesia blocks sympathetic nerves, causing vasodilation below the block level. This reduces systemic vascular resistance and can cause significant maternal hypotension, which decreases
uteroplacental perfusion. Prevention: IV fluid bolus before placement, left lateral positioning. Monitor BP every 1-2 min × 15 min after placement. Treat with IV fluids and left uterine displacement.
6. A client with coronary artery disease is admitted with intermittent chest pain. Lab results indicate elevated troponin I and CK-MB levels. What should the PN consider the most significant risk for this
client on the second day of admission?
A. Deep vein thrombosis
B. Cardiac dysrhythmias — elevated troponin/CK-MB indicate myocardial damage
C. Pulmonary embolism
D. Wound infection
CORRECT ANSWER B — Cardiac dysrhythmias; elevated cardiac biomarkers confirm myocardial infarction → damaged myocardium is electrically unstable → highest risk for lethal arrhythmias (V-fib, V-tach) in first 48
hours
RATIONALE After MI, necrotic myocardium creates electrical instability. The highest risk period for sudden cardiac death from ventricular fibrillation/tachycardia is the first 24-48 hours. The PN should: monitor continuous
telemetry, ensure emergency equipment (defibrillator) is at bedside, monitor electrolytes (hypokalemia/hypomagnesemia increase risk), and report any rhythm changes immediately.
7. The healthcare provider prescribes epinephrine 0.3 mg subQ STAT for a child having an allergic reaction to a bee sting. The medication is labeled 1 mg/mL. How many mL should the PN administer?
A. 0.3 mL
B. 0.5 mL
C. 1.0 mL
D. 3.0 mL
CORRECT ANSWER A — 0.3 mL; 0.3 mg ÷ 1 mg/mL = 0.3 mL
RATIONALE Epinephrine 1:1000 concentration = 1 mg/mL. Desired dose: 0.3 mg. Volume = 0.3 mg ÷ 1 mg/mL = 0.3 mL. Administer IM (vastus lateralis preferred for children). Epinephrine is the FIRST-LINE treatment for
anaphylaxis. Monitor for tachycardia, hypertension, and injection site reactions.
Walden University — HESI PN Exit Exam 2024
4202 NP ISEH
PN Practical Nurse Comprehensive Review | NCLEX-PN Preparation
A HIGHER DEGREE OF GOOD — WALDEN UNIVERSITY
HESI PN
HESI PN EXIT EXAM 2024 — Comprehensive Review
MED-SURG, MATERNITY, PEDIATRICS, MENTAL HEALTH, FUNDAMENTALS & LEADERSHIP
INSTITUTION Walden University — HESI/Elsevier COURSE CODE HESI PN Exit Examination 2024
PROGRAM Practical Nurse (PN) — NCLEX-PN Licensure ACADEMIC YEAR
EXAM TITLE HESI PN Exit Exam — 2024 Comprehensive TOTAL QUESTIONS 100+ Questions (Selected Key Items)
SUBJECT AREAS All NCLEX-PN Client Needs Categories FORMAT Multiple Choice, SATA, Ordered Response & Calculation
EXAMINATION INSTRUCTIONS
▸ This comprehensive review covers all major NCLEX-PN client needs categories: Safe and Effective Care Environment, Health Promotion, Psychosocial Integrity, and Physiological Integrity.
▸ Medical-Surgical Nursing, Maternity/Newborn, Pediatrics, Mental Health, Fundamentals, and Leadership/Delegation are all testable content areas.
▸ Medication calculations require numeric answers; round as specified. SATA questions require selecting ALL correct options.
▸ Correct answers and clinical rationales appear below each question for NCLEX-PN board review purposes.
▸ All content reflects current NCLEX-PN test plan (2023) and evidence-based nursing practice standards.
SECTION I — MEDICAL-SURGICAL NURSING, PHARMACOLOGY & EMERGENCY CARE Questions 1 – 20
1. A gravida 1 para 0 client is transferred to the recovery room following a normal vaginal delivery. The PN observes that the client is shaking uncontrollably and states she's cold. What action should the PN
take?
A. Notify the healthcare provider immediately
B. Apply a light warm blanket and assure her that this is normal following delivery
C. Administer an antipyretic as prescribed
D. Obtain a STAT complete blood count
CORRECT ANSWER B — Apply a light warm blanket; postpartum shaking chills are a common, benign phenomenon caused by hormonal shifts and vasomotor changes after delivery
RATIONALE Postpartum shaking chills occur in 25-50% of deliveries and are self-limiting. They result from: rapid hormonal changes (progesterone drop), vasomotor instability, epidural anesthesia effects, and the body's
reaction to the physical exertion of labor. They typically resolve within 30-60 minutes. A warm blanket provides comfort. The PN should monitor for true fever (>100.4°F), which may indicate infection. This is
NOT a sign of hemorrhage or infection in isolation. Reassuring the client reduces anxiety.
2. The PN is assessing an older client with left-sided heart failure. What intervention is most important for the PN to implement?
A. Palpate peripheral pulses
B. Auscultate all lung fields
C. Measure abdominal girth
D. Assess for peripheral edema
CORRECT ANSWER B — Auscultate all lung fields; left-sided heart failure causes pulmonary congestion (crackles, dyspnea, orthopnea)
RATIONALE Left-sided heart failure causes blood to back up into the pulmonary circulation → pulmonary edema. Auscultation of lung fields is the priority to assess for crackles (rales), diminished breath sounds, and
wheezes indicating fluid accumulation. Peripheral pulses (A), abdominal girth (C), and peripheral edema (D) are more relevant to RIGHT-sided heart failure. The mnemonic "LEFT = LUNGS, RIGHT = REST of
body."
3. A full-term 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. Which immediate intervention should the PN take?
A. Begin chest compressions
B. Turn the infant to the right side
C. Administer oxygen via face mask
D. Suction oral and nasal passages
CORRECT ANSWER D — Suction oral and nasal passages first; clearing the airway is the priority per ABCs
RATIONALE Cyanosis after regurgitation suggests airway obstruction from aspirated material. The PRIORITY is to clear the airway — suction oral and nasal passages immediately. The ABCs: Airway → Breathing →
Circulation. Turning to the side (B) helps drain secretions but suctioning is more definitive. Oxygen (C) and compressions (D) may follow if respiratory status does not improve after airway clearance.
4. An older client who had a colon resection 8 days ago is straining at stool. The PN observes a wound followed by appearance of bowel on the skin. Which complication has occurred?
A. Dehiscence
B. Evisceration — complete wound separation with protrusion of abdominal organs
C. Hematoma
D. Seroma
CORRECT ANSWER B — Evisceration; complete wound separation with protrusion of viscera (bowel) through the wound
RATIONALE Evisceration is a SURGICAL EMERGENCY. Immediate actions: (1) Stay with the client, call for help. (2) Cover protruding organs with sterile gauze/saline-moistened towels (do NOT attempt to reinsert). (3) Keep
the client supine with knees flexed to reduce abdominal tension. (4) Monitor vital signs for shock. (5) Prepare for emergency surgery. Dehiscence (A) is wound separation WITHOUT organ protrusion. Straining
at stool increases intra-abdominal pressure, precipitating wound complications.
5. A client receiving an epidural anesthesia during labor. What is the most important adverse effect the PN should assess for following administration?
A. Maternal hypertension
B. Maternal hypotension
C. Tachycardia
D. Hyperreflexia
CORRECT ANSWER B — Maternal hypotension; sympathetic blockade from epidural → vasodilation → decreased venous return
RATIONALE Epidural anesthesia blocks sympathetic nerves, causing vasodilation below the block level. This reduces systemic vascular resistance and can cause significant maternal hypotension, which decreases
uteroplacental perfusion. Prevention: IV fluid bolus before placement, left lateral positioning. Monitor BP every 1-2 min × 15 min after placement. Treat with IV fluids and left uterine displacement.
6. A client with coronary artery disease is admitted with intermittent chest pain. Lab results indicate elevated troponin I and CK-MB levels. What should the PN consider the most significant risk for this
client on the second day of admission?
A. Deep vein thrombosis
B. Cardiac dysrhythmias — elevated troponin/CK-MB indicate myocardial damage
C. Pulmonary embolism
D. Wound infection
CORRECT ANSWER B — Cardiac dysrhythmias; elevated cardiac biomarkers confirm myocardial infarction → damaged myocardium is electrically unstable → highest risk for lethal arrhythmias (V-fib, V-tach) in first 48
hours
RATIONALE After MI, necrotic myocardium creates electrical instability. The highest risk period for sudden cardiac death from ventricular fibrillation/tachycardia is the first 24-48 hours. The PN should: monitor continuous
telemetry, ensure emergency equipment (defibrillator) is at bedside, monitor electrolytes (hypokalemia/hypomagnesemia increase risk), and report any rhythm changes immediately.
7. The healthcare provider prescribes epinephrine 0.3 mg subQ STAT for a child having an allergic reaction to a bee sting. The medication is labeled 1 mg/mL. How many mL should the PN administer?
A. 0.3 mL
B. 0.5 mL
C. 1.0 mL
D. 3.0 mL
CORRECT ANSWER A — 0.3 mL; 0.3 mg ÷ 1 mg/mL = 0.3 mL
RATIONALE Epinephrine 1:1000 concentration = 1 mg/mL. Desired dose: 0.3 mg. Volume = 0.3 mg ÷ 1 mg/mL = 0.3 mL. Administer IM (vastus lateralis preferred for children). Epinephrine is the FIRST-LINE treatment for
anaphylaxis. Monitor for tachycardia, hypertension, and injection site reactions.
