HESI PN EXIT
EXAM NEW
PACKAGE
,1. At the end of a 12-hour shift the PN observes the urine in a client’s drainage. What action should the PN take next?
Note the most recent white blood count
2. Thirty minutes after receiving IV morphine, a postoperative male client continue to rate his pain...what action should
the PN implement first?
Implement complementary pain relief methods
3. The PN is assisting a female client to obtain a voided specimen for uri. .meatus. Which intervention is performed next?
Initiate the urine stream?
4. An 8-year old is placed in 90-90 traction for a fractured femur that resulted from. .further action by the PN?
Weights are touching the foot of the bed
5. The PN is reviewing diet instructions with a female client who has hyper. .she has increased her intakes of protein and
calories. What action should the PN take?
Encourage the client to continue the dietary changes she has made
6. The PN reviews the procedure for measuring fluid intake and output glomerulonephritis and is
Preparing for discharge from the hospital. What... -why the fluid measurements need to be recoded
7. The nurse is changing the dressing on a client’s wound. The nurse understands which of the following symptoms
indicate a wound infection?
Redness over 1 cm wide on per wound skin and tenderness
8. The nurse is developing a teaching plan for a client who is going home with a tracheostomy tube. Which of the
following is the MOST important part of the teaching plan?
The family of a client should know what to do in a case of emergency, i.e.: clogged tracheostomy tube and how to
suction the client.
9. A 64-year-old male client comes to the provider’s office and complains of both legs hurting him when he walks a
few blocks in his neighborhood. He states “When I sit down for a while, the pain eases off, but if I start walking
a few blocks more, the pain comes back. The nurse recognizes this symptom may be related to peripheral
vascular disease and is called what?
Intermittent claudication
10. A narrowing and hardening of the arteries is called:
Arteriosclerosis
11. A client has clusters of small vesicles over the thoracic region and describes severe pain and itching of the
affected areas. Herpes zoster is diagnosed, and the client will be treated with which of these medications?
Acyclovir (Zorivax)
12. When administrating oxygen to clients with conditions such as emphysema, it is important for the nurse to
remember which one of the following facts as most important
The drive to breathe may be dependent on low levels of oxygen in the blood
13. The nurse is preparing to instruct the client with pneumonia on managing the disease after discharge from the
hospital. Which of the following is consistent with appropriate discharge planning for this client?
Take all medications until they are finished, as ordered by MD
14. Immediately after sustaining severe burn wounds, the nurse would anticipate the client’s initial nutritional needs
would usually be met by which of these methods?
Total parenteral nutrition (TPN)
15. Which of the following measures should the nurse take when care for a client with TB in an acute care facility?
Double-bag and dispose of client secretions as infectious waste
16. The most important nursing intervention for the nurse to remember in administrating Digoxin to a client is to?
Take apical pule and withhold med is pulse is <60
17. The nurse is performing a respiratory assessment on a new client who has come to the clinic. On inspection of
the anterior and posterior chest, she notices the symmetry of the chest is equal from front to back and from
, shoulder to shoulder like the shape of a barrel. The nurse knows the most common lung disease process causing
this change in chest symmetry is?
COPD
18. A nurse is reinforcing health teaching regarding skin cancer to a group of clients. Which of the following should
the nurse identify as the leading cause of skin cancer?
Sun exposure
19. Which of the following is potassium sparing diuretic?
Aldactone
20. There are many types of wound dressings and therapies in evidence-based wound care. The wound vac has been
around many years and is one of the best ways to heal a wound 60% faster than conventional dressings because?
(select all that apply)
-Negative pressure increases epithelial cell multiplications forming granulation tissue
-Reduces edema in the wound and improves blood flow
21. A nurse is collecting data from a client who present to the provider’s office for evaluation pf multiple nevi.
Which of the following findings should the nurse report to the provider as a possible sign of malignancy?
Irregular borders
22. Which breath sounds are usually heard over the anterior third of the chest near the sternum and also scapular
posteriorly, and have inspiration and expiration of equal duration?
Bronchovesicular
23. Frank is a 4 year old paraplegic client with cerebral palsy who was admitted to the hospital with complications
from the H1N1 virus. The nurse who was admitting him noted that he had an area of redness on his right
malleolus that was non-blanchable. The nurse correctly identified this area as what stage of a pressure ulcer?
Stage 1
24. A client has a prescription to discontinue intravenous therapy when the liter that is infusing at 150 mL per hour
is...1200 the PN notes that there are 750 ml of solution remaining. At what time should the nurse expect to
discontinue the intravenous therapy?
1700
25. The PN is caring for a client who had a total laryngectomy, left radical neck dissection...client is receiving
nasogastric tube feedings via an internal pump. Today the rate of the feeding was increased. .ml/hr. What
parameter should the PN use to evaluate the clients tolerate to the rate of the feeding?
Gastric residual volumes
26. A new mother is breastfeeding her newborn for the first time after delivery and complains of nipple pain...Based
on the client complaint, what action should the PN take?
Ensure that all the areolar tissue of the nipple is in the infants’ mouth.
27. Which site should the PN use when administering an injection of Rho (D) Immune negative postpartum client?
Deltoid
28. A client begins an antidepressant drug during the second day of hospitalization. Which assessment is most
important for the LPN/LVN to include in this client's plan of care while the client is taking the antidepressant?
Mood
29. Based on the documentation in the medical record, which action should the LPN/LVN implement next?
Give the rubella vaccine subcutaneously
30. A client is admitted to the hospital with a diagnosis of Pneumonia. Which intervention should the LPN/LVN
implement to prevent complications associated with Pneumonia?
Encourage mobilization and ambulation
31. Which nursing activity is within the scope of practice for the practical nurse?
Observe a client rotate the subcutaneous site for an insulin pump
, 32. After morning dressing changes are completed, a male client who has paraplegia contaminates his ischial
decubiti dressing with a diarrheal stool. What activity is best for the nurse to assign to the unlicensed assistive
personnel?
Provide perianal care and collect clean linens for the dressing change
33. Which ethnic group aged 45-74 has a higher chance of coronary artery disease than men and women in the same
age group?
African American
34. There are certain risk factors associated with cardiovascular disease. Which of these would be considered an
alterable risk factor?
Physical activity
35. A severe potential surgical complication from an aortic aneurysm repair is?
Hemorrhage
36. Every in-patient facility should have a type of scoring tool for nurses to assess their clients for risk of pressure
ulcers. One of the most common and research-based tools currently used is called what?
Braden Scale
37. A nurse is conducting a health and wellness seminar for a local community center. Cardiac care is the topic and
the nurse is reviewing different types of cardiac infections including endocarditis. Which of the following puts
the client most at risk for endocarditis?
Dental caries
38. Increasing the protein vitamin C, and iron in the diet will enhance tissue regeneration. Which one of the
following food combinations would the nurse recommend to a client to assist healing of a venous stasis ulcer?
Roast beef and spinach salad
39. A client is admitted to the hospital. The nurse needs to document the client’s weight in kilograms. The client
weighs 156 pounds. How many kilograms does the client weigh?
70.9 kg
40. While inserting an indwelling urinary catheter into a female client the catheter slips into the clients’
vagina. What would the PN do?
Keep the catheter in the vagina and insert a new catheter through the urethral meatus
41. Six hours after removing a client’s indwelling urinary catheter the client has not voided ad is expressing
discomfort from a distended bladder. What action would the PN take?
Obtain an order for intermittent urinary catheterization
42. During a health history the PN learns that an older client had the chickenpox virus as a child. Which
immunization would be indicated for the client at this time?
Vaccination for shingles
43. The PN is reviewing the state nurse practice act. What information will be included within
the document?
Legal requirements for PN
44. The LPN/LVN is assessing an older resident of a long-term care facility who has a history of Benign Prostatic
Hypertrophy and identifies that the client's bladder is distended. The healthcare provider prescribes post-voided
residual catheterization over the next 24 hours and placement of an indwelling catheter if the residual volume
exceeds 100 mL. The client's PO intake is 600 mL, and fifteen minutes ago, the client voided 90 mL. What
action should the nurse take?
EXAM NEW
PACKAGE
,1. At the end of a 12-hour shift the PN observes the urine in a client’s drainage. What action should the PN take next?
Note the most recent white blood count
2. Thirty minutes after receiving IV morphine, a postoperative male client continue to rate his pain...what action should
the PN implement first?
Implement complementary pain relief methods
3. The PN is assisting a female client to obtain a voided specimen for uri. .meatus. Which intervention is performed next?
Initiate the urine stream?
4. An 8-year old is placed in 90-90 traction for a fractured femur that resulted from. .further action by the PN?
Weights are touching the foot of the bed
5. The PN is reviewing diet instructions with a female client who has hyper. .she has increased her intakes of protein and
calories. What action should the PN take?
Encourage the client to continue the dietary changes she has made
6. The PN reviews the procedure for measuring fluid intake and output glomerulonephritis and is
Preparing for discharge from the hospital. What... -why the fluid measurements need to be recoded
7. The nurse is changing the dressing on a client’s wound. The nurse understands which of the following symptoms
indicate a wound infection?
Redness over 1 cm wide on per wound skin and tenderness
8. The nurse is developing a teaching plan for a client who is going home with a tracheostomy tube. Which of the
following is the MOST important part of the teaching plan?
The family of a client should know what to do in a case of emergency, i.e.: clogged tracheostomy tube and how to
suction the client.
9. A 64-year-old male client comes to the provider’s office and complains of both legs hurting him when he walks a
few blocks in his neighborhood. He states “When I sit down for a while, the pain eases off, but if I start walking
a few blocks more, the pain comes back. The nurse recognizes this symptom may be related to peripheral
vascular disease and is called what?
Intermittent claudication
10. A narrowing and hardening of the arteries is called:
Arteriosclerosis
11. A client has clusters of small vesicles over the thoracic region and describes severe pain and itching of the
affected areas. Herpes zoster is diagnosed, and the client will be treated with which of these medications?
Acyclovir (Zorivax)
12. When administrating oxygen to clients with conditions such as emphysema, it is important for the nurse to
remember which one of the following facts as most important
The drive to breathe may be dependent on low levels of oxygen in the blood
13. The nurse is preparing to instruct the client with pneumonia on managing the disease after discharge from the
hospital. Which of the following is consistent with appropriate discharge planning for this client?
Take all medications until they are finished, as ordered by MD
14. Immediately after sustaining severe burn wounds, the nurse would anticipate the client’s initial nutritional needs
would usually be met by which of these methods?
Total parenteral nutrition (TPN)
15. Which of the following measures should the nurse take when care for a client with TB in an acute care facility?
Double-bag and dispose of client secretions as infectious waste
16. The most important nursing intervention for the nurse to remember in administrating Digoxin to a client is to?
Take apical pule and withhold med is pulse is <60
17. The nurse is performing a respiratory assessment on a new client who has come to the clinic. On inspection of
the anterior and posterior chest, she notices the symmetry of the chest is equal from front to back and from
, shoulder to shoulder like the shape of a barrel. The nurse knows the most common lung disease process causing
this change in chest symmetry is?
COPD
18. A nurse is reinforcing health teaching regarding skin cancer to a group of clients. Which of the following should
the nurse identify as the leading cause of skin cancer?
Sun exposure
19. Which of the following is potassium sparing diuretic?
Aldactone
20. There are many types of wound dressings and therapies in evidence-based wound care. The wound vac has been
around many years and is one of the best ways to heal a wound 60% faster than conventional dressings because?
(select all that apply)
-Negative pressure increases epithelial cell multiplications forming granulation tissue
-Reduces edema in the wound and improves blood flow
21. A nurse is collecting data from a client who present to the provider’s office for evaluation pf multiple nevi.
Which of the following findings should the nurse report to the provider as a possible sign of malignancy?
Irregular borders
22. Which breath sounds are usually heard over the anterior third of the chest near the sternum and also scapular
posteriorly, and have inspiration and expiration of equal duration?
Bronchovesicular
23. Frank is a 4 year old paraplegic client with cerebral palsy who was admitted to the hospital with complications
from the H1N1 virus. The nurse who was admitting him noted that he had an area of redness on his right
malleolus that was non-blanchable. The nurse correctly identified this area as what stage of a pressure ulcer?
Stage 1
24. A client has a prescription to discontinue intravenous therapy when the liter that is infusing at 150 mL per hour
is...1200 the PN notes that there are 750 ml of solution remaining. At what time should the nurse expect to
discontinue the intravenous therapy?
1700
25. The PN is caring for a client who had a total laryngectomy, left radical neck dissection...client is receiving
nasogastric tube feedings via an internal pump. Today the rate of the feeding was increased. .ml/hr. What
parameter should the PN use to evaluate the clients tolerate to the rate of the feeding?
Gastric residual volumes
26. A new mother is breastfeeding her newborn for the first time after delivery and complains of nipple pain...Based
on the client complaint, what action should the PN take?
Ensure that all the areolar tissue of the nipple is in the infants’ mouth.
27. Which site should the PN use when administering an injection of Rho (D) Immune negative postpartum client?
Deltoid
28. A client begins an antidepressant drug during the second day of hospitalization. Which assessment is most
important for the LPN/LVN to include in this client's plan of care while the client is taking the antidepressant?
Mood
29. Based on the documentation in the medical record, which action should the LPN/LVN implement next?
Give the rubella vaccine subcutaneously
30. A client is admitted to the hospital with a diagnosis of Pneumonia. Which intervention should the LPN/LVN
implement to prevent complications associated with Pneumonia?
Encourage mobilization and ambulation
31. Which nursing activity is within the scope of practice for the practical nurse?
Observe a client rotate the subcutaneous site for an insulin pump
, 32. After morning dressing changes are completed, a male client who has paraplegia contaminates his ischial
decubiti dressing with a diarrheal stool. What activity is best for the nurse to assign to the unlicensed assistive
personnel?
Provide perianal care and collect clean linens for the dressing change
33. Which ethnic group aged 45-74 has a higher chance of coronary artery disease than men and women in the same
age group?
African American
34. There are certain risk factors associated with cardiovascular disease. Which of these would be considered an
alterable risk factor?
Physical activity
35. A severe potential surgical complication from an aortic aneurysm repair is?
Hemorrhage
36. Every in-patient facility should have a type of scoring tool for nurses to assess their clients for risk of pressure
ulcers. One of the most common and research-based tools currently used is called what?
Braden Scale
37. A nurse is conducting a health and wellness seminar for a local community center. Cardiac care is the topic and
the nurse is reviewing different types of cardiac infections including endocarditis. Which of the following puts
the client most at risk for endocarditis?
Dental caries
38. Increasing the protein vitamin C, and iron in the diet will enhance tissue regeneration. Which one of the
following food combinations would the nurse recommend to a client to assist healing of a venous stasis ulcer?
Roast beef and spinach salad
39. A client is admitted to the hospital. The nurse needs to document the client’s weight in kilograms. The client
weighs 156 pounds. How many kilograms does the client weigh?
70.9 kg
40. While inserting an indwelling urinary catheter into a female client the catheter slips into the clients’
vagina. What would the PN do?
Keep the catheter in the vagina and insert a new catheter through the urethral meatus
41. Six hours after removing a client’s indwelling urinary catheter the client has not voided ad is expressing
discomfort from a distended bladder. What action would the PN take?
Obtain an order for intermittent urinary catheterization
42. During a health history the PN learns that an older client had the chickenpox virus as a child. Which
immunization would be indicated for the client at this time?
Vaccination for shingles
43. The PN is reviewing the state nurse practice act. What information will be included within
the document?
Legal requirements for PN
44. The LPN/LVN is assessing an older resident of a long-term care facility who has a history of Benign Prostatic
Hypertrophy and identifies that the client's bladder is distended. The healthcare provider prescribes post-voided
residual catheterization over the next 24 hours and placement of an indwelling catheter if the residual volume
exceeds 100 mL. The client's PO intake is 600 mL, and fifteen minutes ago, the client voided 90 mL. What
action should the nurse take?
