HESI PN EXIT EXAM NGN 400 CORRECT QUESTIONS AND
VERIFIED ANSWER WITH RATIONALE ALREADY GRADED
A+ NEW!!!!!!!!!!!!!!!!!!!!
1. A client with type 1 diabetes mellitus is exhibiting rapid breathing, fruity breath
odor, and lethargy. Which arterial blood gas value should the nurse expect?
A) pH 7.30, PaCO2 50, HCO3 24
B) pH 7.48, PaCO2 28, HCO3 22
C) pH 7.25, PaCO2 30, HCO3 16
D) pH 7.50, PaCO2 48, HCO3 30
Answer: C
Rationale: This client is in diabetic ketoacidosis (DKA), which causes metabolic
acidosis with low pH, low bicarbonate, and compensatory respiratory alkalosis
(low PaCO2). Option C shows metabolic acidosis with compensation.
2. A postoperative client reports sudden chest pain and dyspnea. The nurse notes
tachycardia and hypotension. What is the priority action?
A) Administer oxygen via nasal cannula
B) Notify the healthcare provider
C) Place the client in Trendelenburg position
D) Prepare for IV heparin
Answer: A
Rationale: These symptoms suggest a pulmonary embolism. The priority is to
administer oxygen to correct hypoxemia, then notify the provider and prepare for
anticoagulation.
3. A client with heart failure is prescribed furosemide. Which laboratory value
requires immediate notification of the healthcare provider?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.0 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium of
3.0 mEq/L is critically low and increases the risk of cardiac arrhythmias.
4. A client with chronic obstructive pulmonary disease (COPD) has a prescription
for oxygen at 2 L/min via nasal cannula. Which assessment finding indicates the
therapy is effective?
A) Respiratory rate increases from 22 to 26
B) Pulse oximetry increases from 88% to 94%
C) PaCO2 increases from 50 to 55 mmHg
D) The client reports headache and confusion
Answer: B
Rationale: The goal of oxygen therapy in COPD is to maintain SpO2 above 90%
without causing significant CO2 retention. An increase from 88% to 94% indicates
improved oxygenation.
5. A client with cirrhosis is noted to have spider angiomas, palmar erythema, and
ascites. Which laboratory finding is most consistent with this condition?
A) Elevated albumin
B) Elevated ammonia
C) Decreased prothrombin time
D) Decreased bilirubin
Answer: B
Rationale: Cirrhosis leads to portosystemic shunting and impaired urea cycle
function, resulting in elevated ammonia levels. Albumin is decreased, PT is
prolonged, and bilirubin is elevated.
6. A client is receiving a blood transfusion and develops chills, fever, and low back
pain 30 minutes after initiation. What is the nurse’s priority action?
A) Slow the transfusion rate
B) Administer diphenhydramine
C) Stop the transfusion and infuse normal saline
D) Obtain a urine specimen for analysis
Answer: C
Rationale: These symptoms indicate a febrile non-hemolytic or hemolytic
transfusion reaction. The priority is to stop the transfusion and maintain IV access
with normal saline to prevent further complications.
7. A client with major depressive disorder is prescribed phenelzine. Which dietary
item should the nurse instruct the client to avoid?
A) Apples
,B) Bananas
C) Aged cheese
D) White bread
Answer: C
Rationale: Phenelzine is an MAOI. Aged cheese contains tyramine, which can
cause a hypertensive crisis when combined with MAOIs.
8. A client with pneumonia has a prescription for ceftriaxone. Which laboratory
result should the nurse monitor most closely?
A) Serum creatinine
B) White blood cell count
C) Hemoglobin
D) Platelet count
Answer: A
Rationale: Ceftriaxone is excreted renally and can cause nephrotoxicity. Serum
creatinine and BUN should be monitored for renal impairment.
9. A client with congestive heart failure is on a low-sodium diet. Which food
choice by the client indicates understanding of the diet?
A) Canned vegetable soup
B) Pickles
C) Fresh grilled chicken breast
D) Processed cheese sandwich
Answer: C
Rationale: Fresh grilled chicken breast is naturally low in sodium. Canned soups,
pickles, and processed cheeses are high in sodium.
10. A client is 2 days post-mastectomy and is refusing to look at the surgical site.
Which nursing intervention is most appropriate?
A) Encourage the client to look at the site immediately
B) Tell the client that the site looks fine
C) Acknowledge the client's feelings and allow time to adjust
D) Ask the family to persuade the client
Answer: C
Rationale: Body image disturbance is common after mastectomy. The nurse should
acknowledge the client’s feelings and allow gradual adjustment without forcing.
11. A client with hypertension is prescribed lisinopril. Which side effect should the
nurse teach the client to report immediately?
A) Dry cough
, B) Dizziness
C) Swelling of the lips and tongue
D) Headache
Answer: C
Rationale: Angioedema (swelling of lips, tongue, or face) is a life-threatening side
effect of ACE inhibitors like lisinopril and requires immediate medical attention.
12. A client with peptic ulcer disease reports black, tarry stools. Which action
should the nurse take first?
A) Administer an antacid
B) Check vital signs
C) Offer a clear liquid diet
D) Obtain a stool sample
Answer: B
Rationale: Black, tarry stools indicate possible upper GI bleeding. Checking vital
signs (especially blood pressure and heart rate) for signs of hypovolemia is the
priority.
13. A client with asthma is prescribed albuterol via metered-dose inhaler. Which
finding indicates the medication is effective?
A) Increased wheezing
B) Decreased respiratory rate
C) Improved peak expiratory flow rate
D) Increased heart rate
Answer: C
Rationale: Albuterol is a bronchodilator. An improved peak expiratory flow rate
indicates effective bronchodilation and improved airflow.
14. A client who is postpartum day 1 has a fundus that is firm and midline at the
umbilicus. The client has moderate lochia rubra. Which action should the nurse
take?
A) Notify the healthcare provider immediately
B) Massage the fundus vigorously
C) Document the findings as normal
D) Administer oxytocin
Answer: C
Rationale: A firm, midline fundus at the umbilicus with moderate lochia rubra is a
normal finding on postpartum day 1.
VERIFIED ANSWER WITH RATIONALE ALREADY GRADED
A+ NEW!!!!!!!!!!!!!!!!!!!!
1. A client with type 1 diabetes mellitus is exhibiting rapid breathing, fruity breath
odor, and lethargy. Which arterial blood gas value should the nurse expect?
A) pH 7.30, PaCO2 50, HCO3 24
B) pH 7.48, PaCO2 28, HCO3 22
C) pH 7.25, PaCO2 30, HCO3 16
D) pH 7.50, PaCO2 48, HCO3 30
Answer: C
Rationale: This client is in diabetic ketoacidosis (DKA), which causes metabolic
acidosis with low pH, low bicarbonate, and compensatory respiratory alkalosis
(low PaCO2). Option C shows metabolic acidosis with compensation.
2. A postoperative client reports sudden chest pain and dyspnea. The nurse notes
tachycardia and hypotension. What is the priority action?
A) Administer oxygen via nasal cannula
B) Notify the healthcare provider
C) Place the client in Trendelenburg position
D) Prepare for IV heparin
Answer: A
Rationale: These symptoms suggest a pulmonary embolism. The priority is to
administer oxygen to correct hypoxemia, then notify the provider and prepare for
anticoagulation.
3. A client with heart failure is prescribed furosemide. Which laboratory value
requires immediate notification of the healthcare provider?
A) Serum sodium 138 mEq/L
B) Serum potassium 3.0 mEq/L
C) Serum calcium 9.5 mg/dL
D) Serum magnesium 2.0 mEq/L
Answer: B
,Rationale: Furosemide is a loop diuretic that causes potassium loss. A potassium of
3.0 mEq/L is critically low and increases the risk of cardiac arrhythmias.
4. A client with chronic obstructive pulmonary disease (COPD) has a prescription
for oxygen at 2 L/min via nasal cannula. Which assessment finding indicates the
therapy is effective?
A) Respiratory rate increases from 22 to 26
B) Pulse oximetry increases from 88% to 94%
C) PaCO2 increases from 50 to 55 mmHg
D) The client reports headache and confusion
Answer: B
Rationale: The goal of oxygen therapy in COPD is to maintain SpO2 above 90%
without causing significant CO2 retention. An increase from 88% to 94% indicates
improved oxygenation.
5. A client with cirrhosis is noted to have spider angiomas, palmar erythema, and
ascites. Which laboratory finding is most consistent with this condition?
A) Elevated albumin
B) Elevated ammonia
C) Decreased prothrombin time
D) Decreased bilirubin
Answer: B
Rationale: Cirrhosis leads to portosystemic shunting and impaired urea cycle
function, resulting in elevated ammonia levels. Albumin is decreased, PT is
prolonged, and bilirubin is elevated.
6. A client is receiving a blood transfusion and develops chills, fever, and low back
pain 30 minutes after initiation. What is the nurse’s priority action?
A) Slow the transfusion rate
B) Administer diphenhydramine
C) Stop the transfusion and infuse normal saline
D) Obtain a urine specimen for analysis
Answer: C
Rationale: These symptoms indicate a febrile non-hemolytic or hemolytic
transfusion reaction. The priority is to stop the transfusion and maintain IV access
with normal saline to prevent further complications.
7. A client with major depressive disorder is prescribed phenelzine. Which dietary
item should the nurse instruct the client to avoid?
A) Apples
,B) Bananas
C) Aged cheese
D) White bread
Answer: C
Rationale: Phenelzine is an MAOI. Aged cheese contains tyramine, which can
cause a hypertensive crisis when combined with MAOIs.
8. A client with pneumonia has a prescription for ceftriaxone. Which laboratory
result should the nurse monitor most closely?
A) Serum creatinine
B) White blood cell count
C) Hemoglobin
D) Platelet count
Answer: A
Rationale: Ceftriaxone is excreted renally and can cause nephrotoxicity. Serum
creatinine and BUN should be monitored for renal impairment.
9. A client with congestive heart failure is on a low-sodium diet. Which food
choice by the client indicates understanding of the diet?
A) Canned vegetable soup
B) Pickles
C) Fresh grilled chicken breast
D) Processed cheese sandwich
Answer: C
Rationale: Fresh grilled chicken breast is naturally low in sodium. Canned soups,
pickles, and processed cheeses are high in sodium.
10. A client is 2 days post-mastectomy and is refusing to look at the surgical site.
Which nursing intervention is most appropriate?
A) Encourage the client to look at the site immediately
B) Tell the client that the site looks fine
C) Acknowledge the client's feelings and allow time to adjust
D) Ask the family to persuade the client
Answer: C
Rationale: Body image disturbance is common after mastectomy. The nurse should
acknowledge the client’s feelings and allow gradual adjustment without forcing.
11. A client with hypertension is prescribed lisinopril. Which side effect should the
nurse teach the client to report immediately?
A) Dry cough
, B) Dizziness
C) Swelling of the lips and tongue
D) Headache
Answer: C
Rationale: Angioedema (swelling of lips, tongue, or face) is a life-threatening side
effect of ACE inhibitors like lisinopril and requires immediate medical attention.
12. A client with peptic ulcer disease reports black, tarry stools. Which action
should the nurse take first?
A) Administer an antacid
B) Check vital signs
C) Offer a clear liquid diet
D) Obtain a stool sample
Answer: B
Rationale: Black, tarry stools indicate possible upper GI bleeding. Checking vital
signs (especially blood pressure and heart rate) for signs of hypovolemia is the
priority.
13. A client with asthma is prescribed albuterol via metered-dose inhaler. Which
finding indicates the medication is effective?
A) Increased wheezing
B) Decreased respiratory rate
C) Improved peak expiratory flow rate
D) Increased heart rate
Answer: C
Rationale: Albuterol is a bronchodilator. An improved peak expiratory flow rate
indicates effective bronchodilation and improved airflow.
14. A client who is postpartum day 1 has a fundus that is firm and midline at the
umbilicus. The client has moderate lochia rubra. Which action should the nurse
take?
A) Notify the healthcare provider immediately
B) Massage the fundus vigorously
C) Document the findings as normal
D) Administer oxytocin
Answer: C
Rationale: A firm, midline fundus at the umbilicus with moderate lochia rubra is a
normal finding on postpartum day 1.
