HESI PN Exit Examination
4202 • NP ISEH
★ ★
PN Practical Nurse — NCLEX-PN Readiness Assessment 2024
STANDARDIZED NURSING ASSESSMENT — PREPARING FOR NCLEX-PN SUCCESS
HESI 2024
HESI PN EXIT EXAM 2024
COMPREHENSIVE PRACTICAL NURSE EXIT EXAMINATION: MED-SURG, MATERNITY, PEDS, MENTAL HEALTH & FUNDAMENTALS
INSTITUTION HESI (Health Education Systems, Inc.) — Elsevier COURSE CODE HESI PN Exit Examination 2024
PROGRAM Practical Nurse (PN) — NCLEX-PN Licensure Preparation ACADEMIC YEAR
EXAM TITLE HESI PN Exit Examination — 2024 Version TOTAL QUESTIONS 60+ Questions
SUBJECT AREAS Med-Surg, Maternity, Peds, Mental Health, Fundamentals FORMAT Multiple Choice, SATA, Ordered Response & Calculation
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Medical-Surgical Nursing — postoperative care, diabetes management, cardiac, respiratory, and neurological disorders are emphasized.
▸ Maternity and Newborn — labor and delivery, postpartum assessment, and neonatal care are core competencies.
▸ Pediatrics — growth and development, croup, scoliosis screening, and hospitalization are testable content.
▸ Mental Health — therapeutic communication, schizophrenia, OCD, substance use, and crisis intervention are included.
▸ Fundamentals — safety, infection control, documentation, delegation, and scope of practice are essential.
▸ Medication calculations require numeric answers; round as specified.
▸ Correct answers and clinical rationales appear below each question for NCLEX-PN board review purposes.
▸ All content reflects current NCLEX-PN test plan and evidence-based nursing practice standards.
SECTION I — MEDICAL-SURGICAL NURSING & POSTOPERATIVE CARE Questions 1 – 15
1. An elderly client who is 12 hours postoperative for a hernia repair suddenly becomes agitated, staggers out into the corridor and demands to be set free. After assisting the client back to bed and
administering pain medication, which intervention is best for the practical nurse (PN) to implement?
A. Notify the healthcare provider and request a prescription for restraints to minimize the client's danger to self.
B. Raise the side rails and notify the family to come sit with the client to reorient and cooperate.
C. Administer prescribed narcotic antagonist to reverse the effects of any analgesic accumulation.
D. Instruct a UAP to keep the upper side rails up and check on the client every 15 minutes until the client is resting.
CORRECT ANSWER C — Administer prescribed narcotic antagonist; agitation/confusion in an elderly postoperative patient may indicate opioid toxicity/accumulation
RATIONALE Acute onset agitation and confusion in an elderly postoperative patient receiving opioids should raise suspicion for opioid accumulation/toxicity. Elderly patients have decreased renal function and reduced
drug clearance, making them susceptible to drug accumulation. Narcotic antagonists (naloxone/Narcan) reverse opioid effects. Restraints (A) are a last resort and require a provider order — they do not
address the underlying cause. Family presence (B) may help but does not address the physiological cause. UAP monitoring (D) is insufficient for an acute change in mental status. The PN should assess for
other signs of opioid toxicity: respiratory depression, pinpoint pupils, and decreased level of consciousness.
2. A male client attends a community support program for mentally impaired and chemical abusing clients. The client tells the practical nurse (PN) that his drugs of choice are cocaine and heroin. What is
the greatest health risk for the client?
A. Hepatitis — IV drug use carries high risk for hepatitis B and C transmission
B. Glaucoma
C. Diabetes
D. Hypotension
CORRECT ANSWER A — Hepatitis; IV drug use (heroin) carries the greatest risk for bloodborne infections: hepatitis B, hepatitis C, and HIV
RATIONALE Intravenous drug use is the primary risk factor for transmission of bloodborne pathogens. Sharing needles and injection equipment exposes users to hepatitis B, hepatitis C (the most common bloodborne
infection among IV drug users — prevalence 50-90%), and HIV. Hepatitis C can lead to chronic liver disease, cirrhosis, and hepatocellular carcinoma. Glaucoma (B), diabetes (C), and hypotension (D) are not
directly linked to IV drug use. The PN should educate about harm reduction: needle exchange programs, never sharing injection equipment, vaccination for hepatitis A and B, and regular testing. Referral to
substance use treatment is essential.
3. The practical nurse (PN) is charting vital signs on a hand-written flow sheet and realizes that an error has been made. What should the PN do to rectify the error?
A. Draw one line through the entry and insert the correct information, then initial and date.
B. Chart the correct information in the next column.
C. Obliterate the entry and insert the correct information.
D. Notify the charge nurse that the entry needs to be revised.
CORRECT ANSWER A — Draw ONE line through the error, write "error," initial and date; never obliterate, erase, or use correction fluid
RATIONALE Correct documentation error procedure: (1) Draw a SINGLE line through the erroneous entry (the original text must remain legible). (2) Write "error" or "mistaken entry." (3) Initial and date the correction. (4)
Enter the correct information. NEVER: obliterate, erase, scratch out, or use correction fluid/tape (C) — this suggests fraud or concealment. Charting in the next column (B) does not correct the original error.
The charge nurse does not need to correct the PN's documentation (D) — the PN who made the error corrects it. The medical record is a legal document; corrections must be transparent and traceable.
4. The Charge nurse brings a #18 catheter with a 30 mL balloon to the practical nurse (PN) who is preparing to insert a catheter in a female client who weighs 50kg. Which action should the PN take first?
A. Ask the client if she has previously been catheterized.
B. Obtain a 30 mL syringe and a vial of sterile water.
C. Consult with the charge nurse about the catheter — a #18 French with 30 mL balloon is too large for routine catheterization.
D. Position the client and observe the urinary meatus.
CORRECT ANSWER C — Consult the charge nurse; a #18 French catheter with a 30 mL balloon is too large and inappropriate for routine female catheterization
RATIONALE Standard indwelling catheter for routine adult female catheterization: #14-16 French with a 5-10 mL balloon. A #18 French is larger than routine, and a 30 mL balloon is a HEMOSTASIS balloon (used after
prostate surgery/TURP, not routine catheterization). Using an inappropriately sized catheter can cause urethral trauma, pain, and tissue damage. The PN must recognize this equipment error and consult the
charge nurse BEFORE proceeding. The correct equipment for a routine adult female: #14-16 French Foley catheter with 5-10 mL balloon, sterile catheterization kit, and sterile water (not saline) for balloon
inflation. The PN should question any order or equipment that seems incorrect before proceeding.
5. The practical nurse (PN) is caring for a client newly diagnosed with diabetes mellitus (DM). Which finding is an early sign of hypoglycemia?
A. Bradycardia
B. Tremors — early sign of hypoglycemia from sympathetic nervous system activation
C. Polyuria
D. Difficulty swallowing
CORRECT ANSWER B — Tremors (along with diaphoresis, tachycardia, anxiety, hunger, and pallor) are EARLY signs of hypoglycemia from sympathetic activation
RATIONALE Hypoglycemia triggers the sympathetic nervous system (fight-or-flight response), producing EARLY warning signs: tremor, diaphoresis (sweating), tachycardia, anxiety, hunger, pallor, and palpitations. These
are catecholamine-mediated symptoms. As hypoglycemia worsens, NEUROGLYCOPENIC symptoms develop: confusion, visual disturbances, seizures, and loss of consciousness. Polyuria (C) is a sign of
HYPERglycemia. Bradycardia (A) is not a typical hypoglycemia finding (tachycardia is). Difficulty swallowing (D) is not a classic sign. The mnemonic "TIRED": Tachycardia, Irritability, Restlessness, Excessive
hunger, Diaphoresis. Treatment: "Rule of 15" — give 15g fast-acting carbohydrate, recheck in 15 minutes, repeat if still <70 mg/dL.
6. The practical nurse (PN) is preparing cefazolin 400mg IM for a client with positive infection. The available vial is labeled Cefazolin 1 gram and the instructions for reconstitution state: for IM add 2mL
sterile water for injection. Total volume after reconstitution is 2.5mL. After reconstitution, how many mL should be administered to the client?
A. 0.5 mL
B. 1 mL
C. 1.5 mL
D. 2 mL
CORRECT ANSWER B — 1 mL; 1 g (1000 mg) in 2.5 mL = 400 mg/mL → 400 mg ÷ 400 mg/mL = 1 mL
RATIONALE Dosage calculation: After reconstitution, 1 gram (1000 mg) cefazolin is in 2.5 mL total volume. Concentration = 1000 mg / 2.5 mL = 400 mg/mL. To administer 400 mg: 400 mg ÷ 400 mg/mL = 1 mL. Formula:
(Desired dose / Available dose) × Volume = (400 mg / 1000 mg) × 2.5 mL = 0.4 × 2.5 = 1 mL. The PN must verify the calculation, use the correct syringe (3 mL syringe for IM), and administer in the appropriate IM
site (ventrogluteal preferred for adults). Always double-check math for medication calculations.
, 7. The practical nurse (PN) heard adventitious breath sounds while auscultating the lungs of an older adult who is receiving an IV of 5% dextrose in water (D5W) at 100mL/hour. Which action should the PN
take next?
A. Document the findings and monitor the client.
B. Report the findings to the charge nurse — adventitious sounds + IV fluids may indicate fluid overload.
C. Slow the D5W infusion rate to 50 mL/hour.
D. Review the last balance of intake and output.
CORRECT ANSWER B — Report to the charge nurse; adventitious breath sounds (crackles) in a patient receiving IV fluids may indicate fluid volume overload, especially in older adults
RATIONALE Adventitious breath sounds (crackles/rales) in an older adult receiving IV fluids at 100 mL/hr raise concern for fluid volume overload/pulmonary edema. Older adults have decreased cardiac reserve and are at
increased risk for fluid overload. The PN must REPORT this finding immediately to the charge nurse for further assessment and possible intervention (reducing IV rate, administering diuretics). The PN should
NOT independently change the IV rate (C — requires a provider order). Simply documenting (A) without reporting delays intervention. Reviewing I&O (D) provides useful data but reporting comes first. Other
signs of fluid overload: dyspnea, orthopnea, JVD, peripheral edema, and increased BP.
8. While caring for a client one day following a thyroidectomy, the practical nurse (PN) notes that the client's voice is hoarse. What action should the PN take?
A. Ensure that the drainage device is compressed.
B. Administer humidified oxygen per nasal cannula.
C. Obtain a cup of ice chips for the client.
D. Notify the unit charge nurse of the findings.
CORRECT ANSWER B — Administer humidified oxygen; hoarseness after thyroidectomy is common due to edema near the vocal cords; humidified oxygen soothes and supports breathing
RATIONALE Hoarseness after thyroidectomy is expected due to surgical manipulation near the recurrent laryngeal nerve and laryngeal edema. It is usually temporary. Humidified oxygen (B) is appropriate — it moistens
the airway, reduces irritation, and supports oxygenation. The PN should also: assess for stridor (airway obstruction — emergency), monitor for signs of hypocalcemia (Chvostek's/Trousseau's signs —
parathyroid injury), and keep emergency tracheostomy equipment at bedside. Hoarseness alone, without respiratory distress, is not an emergency requiring immediate charge nurse notification (D). Ice chips
(C) are appropriate for sore throat but humidified oxygen addresses the respiratory concern. A compressed drainage device (A) is for wound drainage, not hoarseness.
9. The practical nurse (PN) is reviewing a client's recent ophthalmic screening test results. Findings of optic neuropathy, loss of peripheral vision, and increased intraocular pressure are consistent with
which medical condition?
A. Cataracts
B. Glaucoma — optic neuropathy + increased IOP + peripheral vision loss = classic triad
C. Macular Edema
D. Diabetic Retinopathy
CORRECT ANSWER B — Glaucoma; characterized by optic nerve damage (neuropathy), elevated intraocular pressure, and progressive peripheral vision loss ("tunnel vision")
RATIONALE Glaucoma is a group of eye diseases characterized by: (1) Optic neuropathy — damage to the optic nerve (visible on fundoscopic exam as cup-to-disc ratio >0.5). (2) Increased intraocular pressure (IOP >21
mmHg) — the primary modifiable risk factor. (3) Progressive peripheral vision loss — initially asymptomatic, progressing to "tunnel vision" and eventual blindness if untreated. Treatment: prostaglandin
analogs (latanoprost — first-line), beta-blockers (timolol), alpha-agonists, carbonic anhydrase inhibitors, and laser surgery. Cataracts (A) cause clouding of the lens with gradual vision loss but not increased
IOP or peripheral field loss. Macular edema (C) causes central vision loss. Diabetic retinopathy (D) causes retinal hemorrhage and neovascularization. Pilocarpine is a miotic used for glaucoma — the client in
the source misunderstood its purpose.
10. The healthcare provider prescribed Octreotide 150mcg/day subcutaneously for a client with dumping syndrome. The medication is available in 0.2mg/mL vials. How many mL should the practical nurse
(PN) administer?
A. 0.5 mL
B. 0.75 mL
C. 1.0 mL
D. 1.5 mL
CORRECT ANSWER B — 0.75 mL; 150 mcg = 0.15 mg; 0.15 mg ÷ 0.2 mg/mL = 0.75 mL
RATIONALE Dosage calculation: Convert 150 mcg to mg: 150 mcg ÷ 1000 = 0.15 mg. Available concentration: 0.2 mg/mL. Volume = Desired dose / Concentration = 0.15 mg ÷ 0.2 mg/mL = 0.75 mL. Alternatively: (150 mcg /
200 mcg) × 1 mL = 0.75 mL. Octreotide is a somatostatin analog used for dumping syndrome, acromegaly, and GI bleeding. Subcutaneous administration requires a small-gauge needle (25-27G) and site
rotation. The PN must verify the calculation, use a 1 mL syringe for accuracy, and document the dose administered.
11. While changing the dressing of a client who is immobile, the practical nurse (PN) observes a red and swollen wound with moderate amount of yellow and green drainage and a foul odor. Before reporting
this finding to the healthcare provider, the PN should evaluate which of the client's laboratory values?
A. Serum blood glucose (BG) level.
B. Culture for sensitive organisms.
C. C-reactive protein level — elevated CRP indicates inflammation/infection.
D. Serum albumin.
CORRECT ANSWER C — C-reactive protein (CRP); elevated CRP is a sensitive marker of inflammation and infection
RATIONALE The wound assessment reveals classic signs of infection: redness (erythema), swelling (edema), purulent drainage (yellow/green), and foul odor. Before reporting to the provider, the PN should gather relevant
lab data. C-reactive protein (CRP) is an acute-phase reactant produced by the liver in response to inflammation — it rises rapidly with infection and is a valuable marker of infection severity and treatment
response. Blood glucose (A) is relevant (elevated glucose impairs wound healing) but CRP is more specific to infection. Culture results (B) take 48-72 hours — they are not immediately available. Serum
albumin (D) reflects nutritional status, not acute infection. The PN should also check WBC count and erythrocyte sedimentation rate (ESR).
12. The practical nurse (PN) is caring for an older client who is receiving chemotherapy for lung cancer. Which findings are the highest priority for the PN to report to the charge nurse? Reference Ranges:
BUN [Adult: 10 to 20 mg/dL], Platelets: [150,000 to 400,000/mm3]
A. Decreased deep tendon reflexes.
B. Blood urea nitrogen 75 mg/dL — severely elevated, indicating renal impairment.
C. Platelet count 135,000/mm3 — thrombocytopenia increases bleeding risk in chemotherapy patient.
D. Periodic nausea and vomiting.
CORRECT ANSWER C — Platelet count 135,000/mm3 (thrombocytopenia); chemotherapy causes myelosuppression → increased bleeding risk
RATIONALE A platelet count of 135,000/mm3 is below the normal range (150,000-400,000) — this is THROMBOCYTOPENIA. Chemotherapy causes bone marrow suppression (myelosuppression), reducing production of all
blood cells. Thrombocytopenia increases bleeding risk — the PN must report this immediately. BUN of 75 (B) is also severely elevated (normal 10-20) and concerning, but the source prioritizes the platelet
count. Decreased DTRs (A) are not a priority finding. Nausea/vomiting (D) is expected with chemotherapy. The PN should also monitor for signs of bleeding: petechiae, easy bruising, bleeding gums, and occult
blood. Thrombocytopenic precautions: soft toothbrush, electric razor, avoid IM injections, minimize venipunctures.
13. Which nursing intervention has the highest priority for preventing infection in a client with partial-thickness and full thickness burns?
A. Using careful handwashing techniques — the single most effective infection prevention measure.
B. Applying a topical antibacterial cream.
C. Administering of plasma expanders.
D. Limiting visitors to the burned client.
CORRECT ANSWER A — Careful handwashing; the single most important infection control measure for ALL patients, including burn patients
RATIONALE Hand hygiene is universally the most effective infection prevention intervention — this applies to burn patients as well. Burn patients are at extremely high infection risk because the skin barrier is destroyed.
While topical antibacterials (B — silver sulfadiazine, mafenide acetate) are essential burn wound care, they are applied AFTER hand hygiene and are a secondary prevention measure. Plasma expanders (C)
treat hypovolemia, not infection. Limiting visitors (D) is important but secondary to hand hygiene. The PN must practice meticulous hand hygiene before and after all patient contact, wound care, and dressing
changes. Sterile technique is used for burn wound care. Infection is the leading cause of death in burn patients who survive the initial resuscitation.
14. The practical nurse (PN) is providing care for a client who is receiving an intravenous antibiotic to treat an infection. Which assessment findings require the most immediate action by the PN?
A. Warm skin with elastic turgor.
B. Low grade fever with diaphoresis.
C. Dry mouth with thirst.
D. Hives with pruritus — signs of an allergic reaction; requires immediate action.
CORRECT ANSWER D — Hives with pruritus (urticaria); this is a sign of an allergic reaction to the antibiotic and requires immediate intervention
RATIONALE Hives (urticaria) and pruritus during IV antibiotic administration indicate an ALLERGIC REACTION. The PN must: (1) STOP the infusion immediately. (2) Assess airway/breathing (risk of anaphylaxis). (3) Notify
the RN/provider. (4) Monitor vital signs. (5) Anticipate orders for antihistamines (diphenhydramine) or epinephrine if anaphylaxis develops. Warm skin (A) is normal. Low-grade fever (B) may indicate the
infection or a drug reaction but is not immediately life-threatening. Dry mouth (C) is a minor side effect. Allergic reactions to antibiotics (especially penicillins, cephalosporins, and sulfonamides) can progress
rapidly to anaphylaxis — early recognition and intervention are critical.
4202 • NP ISEH
★ ★
PN Practical Nurse — NCLEX-PN Readiness Assessment 2024
STANDARDIZED NURSING ASSESSMENT — PREPARING FOR NCLEX-PN SUCCESS
HESI 2024
HESI PN EXIT EXAM 2024
COMPREHENSIVE PRACTICAL NURSE EXIT EXAMINATION: MED-SURG, MATERNITY, PEDS, MENTAL HEALTH & FUNDAMENTALS
INSTITUTION HESI (Health Education Systems, Inc.) — Elsevier COURSE CODE HESI PN Exit Examination 2024
PROGRAM Practical Nurse (PN) — NCLEX-PN Licensure Preparation ACADEMIC YEAR
EXAM TITLE HESI PN Exit Examination — 2024 Version TOTAL QUESTIONS 60+ Questions
SUBJECT AREAS Med-Surg, Maternity, Peds, Mental Health, Fundamentals FORMAT Multiple Choice, SATA, Ordered Response & Calculation
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Medical-Surgical Nursing — postoperative care, diabetes management, cardiac, respiratory, and neurological disorders are emphasized.
▸ Maternity and Newborn — labor and delivery, postpartum assessment, and neonatal care are core competencies.
▸ Pediatrics — growth and development, croup, scoliosis screening, and hospitalization are testable content.
▸ Mental Health — therapeutic communication, schizophrenia, OCD, substance use, and crisis intervention are included.
▸ Fundamentals — safety, infection control, documentation, delegation, and scope of practice are essential.
▸ Medication calculations require numeric answers; round as specified.
▸ Correct answers and clinical rationales appear below each question for NCLEX-PN board review purposes.
▸ All content reflects current NCLEX-PN test plan and evidence-based nursing practice standards.
SECTION I — MEDICAL-SURGICAL NURSING & POSTOPERATIVE CARE Questions 1 – 15
1. An elderly client who is 12 hours postoperative for a hernia repair suddenly becomes agitated, staggers out into the corridor and demands to be set free. After assisting the client back to bed and
administering pain medication, which intervention is best for the practical nurse (PN) to implement?
A. Notify the healthcare provider and request a prescription for restraints to minimize the client's danger to self.
B. Raise the side rails and notify the family to come sit with the client to reorient and cooperate.
C. Administer prescribed narcotic antagonist to reverse the effects of any analgesic accumulation.
D. Instruct a UAP to keep the upper side rails up and check on the client every 15 minutes until the client is resting.
CORRECT ANSWER C — Administer prescribed narcotic antagonist; agitation/confusion in an elderly postoperative patient may indicate opioid toxicity/accumulation
RATIONALE Acute onset agitation and confusion in an elderly postoperative patient receiving opioids should raise suspicion for opioid accumulation/toxicity. Elderly patients have decreased renal function and reduced
drug clearance, making them susceptible to drug accumulation. Narcotic antagonists (naloxone/Narcan) reverse opioid effects. Restraints (A) are a last resort and require a provider order — they do not
address the underlying cause. Family presence (B) may help but does not address the physiological cause. UAP monitoring (D) is insufficient for an acute change in mental status. The PN should assess for
other signs of opioid toxicity: respiratory depression, pinpoint pupils, and decreased level of consciousness.
2. A male client attends a community support program for mentally impaired and chemical abusing clients. The client tells the practical nurse (PN) that his drugs of choice are cocaine and heroin. What is
the greatest health risk for the client?
A. Hepatitis — IV drug use carries high risk for hepatitis B and C transmission
B. Glaucoma
C. Diabetes
D. Hypotension
CORRECT ANSWER A — Hepatitis; IV drug use (heroin) carries the greatest risk for bloodborne infections: hepatitis B, hepatitis C, and HIV
RATIONALE Intravenous drug use is the primary risk factor for transmission of bloodborne pathogens. Sharing needles and injection equipment exposes users to hepatitis B, hepatitis C (the most common bloodborne
infection among IV drug users — prevalence 50-90%), and HIV. Hepatitis C can lead to chronic liver disease, cirrhosis, and hepatocellular carcinoma. Glaucoma (B), diabetes (C), and hypotension (D) are not
directly linked to IV drug use. The PN should educate about harm reduction: needle exchange programs, never sharing injection equipment, vaccination for hepatitis A and B, and regular testing. Referral to
substance use treatment is essential.
3. The practical nurse (PN) is charting vital signs on a hand-written flow sheet and realizes that an error has been made. What should the PN do to rectify the error?
A. Draw one line through the entry and insert the correct information, then initial and date.
B. Chart the correct information in the next column.
C. Obliterate the entry and insert the correct information.
D. Notify the charge nurse that the entry needs to be revised.
CORRECT ANSWER A — Draw ONE line through the error, write "error," initial and date; never obliterate, erase, or use correction fluid
RATIONALE Correct documentation error procedure: (1) Draw a SINGLE line through the erroneous entry (the original text must remain legible). (2) Write "error" or "mistaken entry." (3) Initial and date the correction. (4)
Enter the correct information. NEVER: obliterate, erase, scratch out, or use correction fluid/tape (C) — this suggests fraud or concealment. Charting in the next column (B) does not correct the original error.
The charge nurse does not need to correct the PN's documentation (D) — the PN who made the error corrects it. The medical record is a legal document; corrections must be transparent and traceable.
4. The Charge nurse brings a #18 catheter with a 30 mL balloon to the practical nurse (PN) who is preparing to insert a catheter in a female client who weighs 50kg. Which action should the PN take first?
A. Ask the client if she has previously been catheterized.
B. Obtain a 30 mL syringe and a vial of sterile water.
C. Consult with the charge nurse about the catheter — a #18 French with 30 mL balloon is too large for routine catheterization.
D. Position the client and observe the urinary meatus.
CORRECT ANSWER C — Consult the charge nurse; a #18 French catheter with a 30 mL balloon is too large and inappropriate for routine female catheterization
RATIONALE Standard indwelling catheter for routine adult female catheterization: #14-16 French with a 5-10 mL balloon. A #18 French is larger than routine, and a 30 mL balloon is a HEMOSTASIS balloon (used after
prostate surgery/TURP, not routine catheterization). Using an inappropriately sized catheter can cause urethral trauma, pain, and tissue damage. The PN must recognize this equipment error and consult the
charge nurse BEFORE proceeding. The correct equipment for a routine adult female: #14-16 French Foley catheter with 5-10 mL balloon, sterile catheterization kit, and sterile water (not saline) for balloon
inflation. The PN should question any order or equipment that seems incorrect before proceeding.
5. The practical nurse (PN) is caring for a client newly diagnosed with diabetes mellitus (DM). Which finding is an early sign of hypoglycemia?
A. Bradycardia
B. Tremors — early sign of hypoglycemia from sympathetic nervous system activation
C. Polyuria
D. Difficulty swallowing
CORRECT ANSWER B — Tremors (along with diaphoresis, tachycardia, anxiety, hunger, and pallor) are EARLY signs of hypoglycemia from sympathetic activation
RATIONALE Hypoglycemia triggers the sympathetic nervous system (fight-or-flight response), producing EARLY warning signs: tremor, diaphoresis (sweating), tachycardia, anxiety, hunger, pallor, and palpitations. These
are catecholamine-mediated symptoms. As hypoglycemia worsens, NEUROGLYCOPENIC symptoms develop: confusion, visual disturbances, seizures, and loss of consciousness. Polyuria (C) is a sign of
HYPERglycemia. Bradycardia (A) is not a typical hypoglycemia finding (tachycardia is). Difficulty swallowing (D) is not a classic sign. The mnemonic "TIRED": Tachycardia, Irritability, Restlessness, Excessive
hunger, Diaphoresis. Treatment: "Rule of 15" — give 15g fast-acting carbohydrate, recheck in 15 minutes, repeat if still <70 mg/dL.
6. The practical nurse (PN) is preparing cefazolin 400mg IM for a client with positive infection. The available vial is labeled Cefazolin 1 gram and the instructions for reconstitution state: for IM add 2mL
sterile water for injection. Total volume after reconstitution is 2.5mL. After reconstitution, how many mL should be administered to the client?
A. 0.5 mL
B. 1 mL
C. 1.5 mL
D. 2 mL
CORRECT ANSWER B — 1 mL; 1 g (1000 mg) in 2.5 mL = 400 mg/mL → 400 mg ÷ 400 mg/mL = 1 mL
RATIONALE Dosage calculation: After reconstitution, 1 gram (1000 mg) cefazolin is in 2.5 mL total volume. Concentration = 1000 mg / 2.5 mL = 400 mg/mL. To administer 400 mg: 400 mg ÷ 400 mg/mL = 1 mL. Formula:
(Desired dose / Available dose) × Volume = (400 mg / 1000 mg) × 2.5 mL = 0.4 × 2.5 = 1 mL. The PN must verify the calculation, use the correct syringe (3 mL syringe for IM), and administer in the appropriate IM
site (ventrogluteal preferred for adults). Always double-check math for medication calculations.
, 7. The practical nurse (PN) heard adventitious breath sounds while auscultating the lungs of an older adult who is receiving an IV of 5% dextrose in water (D5W) at 100mL/hour. Which action should the PN
take next?
A. Document the findings and monitor the client.
B. Report the findings to the charge nurse — adventitious sounds + IV fluids may indicate fluid overload.
C. Slow the D5W infusion rate to 50 mL/hour.
D. Review the last balance of intake and output.
CORRECT ANSWER B — Report to the charge nurse; adventitious breath sounds (crackles) in a patient receiving IV fluids may indicate fluid volume overload, especially in older adults
RATIONALE Adventitious breath sounds (crackles/rales) in an older adult receiving IV fluids at 100 mL/hr raise concern for fluid volume overload/pulmonary edema. Older adults have decreased cardiac reserve and are at
increased risk for fluid overload. The PN must REPORT this finding immediately to the charge nurse for further assessment and possible intervention (reducing IV rate, administering diuretics). The PN should
NOT independently change the IV rate (C — requires a provider order). Simply documenting (A) without reporting delays intervention. Reviewing I&O (D) provides useful data but reporting comes first. Other
signs of fluid overload: dyspnea, orthopnea, JVD, peripheral edema, and increased BP.
8. While caring for a client one day following a thyroidectomy, the practical nurse (PN) notes that the client's voice is hoarse. What action should the PN take?
A. Ensure that the drainage device is compressed.
B. Administer humidified oxygen per nasal cannula.
C. Obtain a cup of ice chips for the client.
D. Notify the unit charge nurse of the findings.
CORRECT ANSWER B — Administer humidified oxygen; hoarseness after thyroidectomy is common due to edema near the vocal cords; humidified oxygen soothes and supports breathing
RATIONALE Hoarseness after thyroidectomy is expected due to surgical manipulation near the recurrent laryngeal nerve and laryngeal edema. It is usually temporary. Humidified oxygen (B) is appropriate — it moistens
the airway, reduces irritation, and supports oxygenation. The PN should also: assess for stridor (airway obstruction — emergency), monitor for signs of hypocalcemia (Chvostek's/Trousseau's signs —
parathyroid injury), and keep emergency tracheostomy equipment at bedside. Hoarseness alone, without respiratory distress, is not an emergency requiring immediate charge nurse notification (D). Ice chips
(C) are appropriate for sore throat but humidified oxygen addresses the respiratory concern. A compressed drainage device (A) is for wound drainage, not hoarseness.
9. The practical nurse (PN) is reviewing a client's recent ophthalmic screening test results. Findings of optic neuropathy, loss of peripheral vision, and increased intraocular pressure are consistent with
which medical condition?
A. Cataracts
B. Glaucoma — optic neuropathy + increased IOP + peripheral vision loss = classic triad
C. Macular Edema
D. Diabetic Retinopathy
CORRECT ANSWER B — Glaucoma; characterized by optic nerve damage (neuropathy), elevated intraocular pressure, and progressive peripheral vision loss ("tunnel vision")
RATIONALE Glaucoma is a group of eye diseases characterized by: (1) Optic neuropathy — damage to the optic nerve (visible on fundoscopic exam as cup-to-disc ratio >0.5). (2) Increased intraocular pressure (IOP >21
mmHg) — the primary modifiable risk factor. (3) Progressive peripheral vision loss — initially asymptomatic, progressing to "tunnel vision" and eventual blindness if untreated. Treatment: prostaglandin
analogs (latanoprost — first-line), beta-blockers (timolol), alpha-agonists, carbonic anhydrase inhibitors, and laser surgery. Cataracts (A) cause clouding of the lens with gradual vision loss but not increased
IOP or peripheral field loss. Macular edema (C) causes central vision loss. Diabetic retinopathy (D) causes retinal hemorrhage and neovascularization. Pilocarpine is a miotic used for glaucoma — the client in
the source misunderstood its purpose.
10. The healthcare provider prescribed Octreotide 150mcg/day subcutaneously for a client with dumping syndrome. The medication is available in 0.2mg/mL vials. How many mL should the practical nurse
(PN) administer?
A. 0.5 mL
B. 0.75 mL
C. 1.0 mL
D. 1.5 mL
CORRECT ANSWER B — 0.75 mL; 150 mcg = 0.15 mg; 0.15 mg ÷ 0.2 mg/mL = 0.75 mL
RATIONALE Dosage calculation: Convert 150 mcg to mg: 150 mcg ÷ 1000 = 0.15 mg. Available concentration: 0.2 mg/mL. Volume = Desired dose / Concentration = 0.15 mg ÷ 0.2 mg/mL = 0.75 mL. Alternatively: (150 mcg /
200 mcg) × 1 mL = 0.75 mL. Octreotide is a somatostatin analog used for dumping syndrome, acromegaly, and GI bleeding. Subcutaneous administration requires a small-gauge needle (25-27G) and site
rotation. The PN must verify the calculation, use a 1 mL syringe for accuracy, and document the dose administered.
11. While changing the dressing of a client who is immobile, the practical nurse (PN) observes a red and swollen wound with moderate amount of yellow and green drainage and a foul odor. Before reporting
this finding to the healthcare provider, the PN should evaluate which of the client's laboratory values?
A. Serum blood glucose (BG) level.
B. Culture for sensitive organisms.
C. C-reactive protein level — elevated CRP indicates inflammation/infection.
D. Serum albumin.
CORRECT ANSWER C — C-reactive protein (CRP); elevated CRP is a sensitive marker of inflammation and infection
RATIONALE The wound assessment reveals classic signs of infection: redness (erythema), swelling (edema), purulent drainage (yellow/green), and foul odor. Before reporting to the provider, the PN should gather relevant
lab data. C-reactive protein (CRP) is an acute-phase reactant produced by the liver in response to inflammation — it rises rapidly with infection and is a valuable marker of infection severity and treatment
response. Blood glucose (A) is relevant (elevated glucose impairs wound healing) but CRP is more specific to infection. Culture results (B) take 48-72 hours — they are not immediately available. Serum
albumin (D) reflects nutritional status, not acute infection. The PN should also check WBC count and erythrocyte sedimentation rate (ESR).
12. The practical nurse (PN) is caring for an older client who is receiving chemotherapy for lung cancer. Which findings are the highest priority for the PN to report to the charge nurse? Reference Ranges:
BUN [Adult: 10 to 20 mg/dL], Platelets: [150,000 to 400,000/mm3]
A. Decreased deep tendon reflexes.
B. Blood urea nitrogen 75 mg/dL — severely elevated, indicating renal impairment.
C. Platelet count 135,000/mm3 — thrombocytopenia increases bleeding risk in chemotherapy patient.
D. Periodic nausea and vomiting.
CORRECT ANSWER C — Platelet count 135,000/mm3 (thrombocytopenia); chemotherapy causes myelosuppression → increased bleeding risk
RATIONALE A platelet count of 135,000/mm3 is below the normal range (150,000-400,000) — this is THROMBOCYTOPENIA. Chemotherapy causes bone marrow suppression (myelosuppression), reducing production of all
blood cells. Thrombocytopenia increases bleeding risk — the PN must report this immediately. BUN of 75 (B) is also severely elevated (normal 10-20) and concerning, but the source prioritizes the platelet
count. Decreased DTRs (A) are not a priority finding. Nausea/vomiting (D) is expected with chemotherapy. The PN should also monitor for signs of bleeding: petechiae, easy bruising, bleeding gums, and occult
blood. Thrombocytopenic precautions: soft toothbrush, electric razor, avoid IM injections, minimize venipunctures.
13. Which nursing intervention has the highest priority for preventing infection in a client with partial-thickness and full thickness burns?
A. Using careful handwashing techniques — the single most effective infection prevention measure.
B. Applying a topical antibacterial cream.
C. Administering of plasma expanders.
D. Limiting visitors to the burned client.
CORRECT ANSWER A — Careful handwashing; the single most important infection control measure for ALL patients, including burn patients
RATIONALE Hand hygiene is universally the most effective infection prevention intervention — this applies to burn patients as well. Burn patients are at extremely high infection risk because the skin barrier is destroyed.
While topical antibacterials (B — silver sulfadiazine, mafenide acetate) are essential burn wound care, they are applied AFTER hand hygiene and are a secondary prevention measure. Plasma expanders (C)
treat hypovolemia, not infection. Limiting visitors (D) is important but secondary to hand hygiene. The PN must practice meticulous hand hygiene before and after all patient contact, wound care, and dressing
changes. Sterile technique is used for burn wound care. Infection is the leading cause of death in burn patients who survive the initial resuscitation.
14. The practical nurse (PN) is providing care for a client who is receiving an intravenous antibiotic to treat an infection. Which assessment findings require the most immediate action by the PN?
A. Warm skin with elastic turgor.
B. Low grade fever with diaphoresis.
C. Dry mouth with thirst.
D. Hives with pruritus — signs of an allergic reaction; requires immediate action.
CORRECT ANSWER D — Hives with pruritus (urticaria); this is a sign of an allergic reaction to the antibiotic and requires immediate intervention
RATIONALE Hives (urticaria) and pruritus during IV antibiotic administration indicate an ALLERGIC REACTION. The PN must: (1) STOP the infusion immediately. (2) Assess airway/breathing (risk of anaphylaxis). (3) Notify
the RN/provider. (4) Monitor vital signs. (5) Anticipate orders for antihistamines (diphenhydramine) or epinephrine if anaphylaxis develops. Warm skin (A) is normal. Low-grade fever (B) may indicate the
infection or a drug reaction but is not immediately life-threatening. Dry mouth (C) is a minor side effect. Allergic reactions to antibiotics (especially penicillins, cephalosporins, and sulfonamides) can progress
rapidly to anaphylaxis — early recognition and intervention are critical.
