EXIT HESI - PN EXAM PRACTICE QUESTIONS
AND CORRECT ANSWERS
Question 1
A nurse who has recently completed orientation is beginning work in the labor and
delivery unit for the first time. When making assignments, which client should the
charge nurse assign to this new nurse?
A.A primigravida who is 8 cm dilated after 14 hours of labor
B.A client scheduled for a repeat cesarean birth at 38 weeks' gestation
C.A client being induced for fetal demise at 20 weeks' gestation
D.A multiparous client who is dilated 5 cm and 50% effaced
Correct Answer
D
The new nurse should be assigned the least complicated client to gain experience
and confidence, as well as protect client safety. Of the clients available for
assignment, (D) is progressing well and is the least complicated. (A, B and C) have
actual or potential complications and should be assigned to a more experienced
nurse.
Question 2
Which assessment finding for a client with peritoneal dialysis requires immediate
intervention by the nurse?
A.The color of the dialysate outflow is opaque yellow.
B.The dialysate outflow is greater than the inflow.
C.The inflow dialysate feels warm to the touch.
D.The inflow dialysate contains potassium chloride.
Correct Answer
A
Opaque or cloudy dialysate outflow is an early sign of peritonitis. The nurse should
obtain a specimen for culture, assess the client, and notify the health care provider
(A). (B and C) are desired. (D) is commonly done to prevent hypokalemia.
Page 1 of 151
,Question 3
The nurse should encourage a laboring client to begin pushing at which point?
A.When the cervix is completely effaced
B.When the client describes the need to have a bowel movement
C.When the cervix is completely dilated
D.When the anterior or posterior lip of the cervix is palpable
Correct Answer
C
Pushing begins with the second stage of labor, when the cervix is completely dilated
at 10 cm (C). If pushing begins before the cervix is completely dilated (A, B, and D),
the cervix can become edematous and may never dilate completely, necessitating
an operative delivery. The most effective pushing occurs when the cervix is
completely dilated and the woman feels the urge to push (Ferguson's reflex).
Question 4
The charge nurse working in the surgical department is making shift assignments. The
shift personnel include an RN with 12 years of nursing experience, an RN with 2 years
of nursing experience, and an RN with 3 months of nursing experience. Which client
should the charge nurse assign to the RN with 3 months of experience?
A.A client who is 2 days postoperative with a right total knee replacement
B.A client who is scheduled for a sigmoid colostomy surgery today
C.A client who has a surgical abdominal wound with dehiscence
D.A client who is 1 day postoperative following a right-sided mastectomy
Correct Answer
A
(A) is the least critical client and should be assigned to the RN with the least
experience. A client with a knee replacement is probably ambulating and able to
perform self-care, and a physical therapist is likely to be assisting with the client's
care. (B) will require a high level of nursing care when returned from surgery. (C)
means that there is a separation or rupture of the wound, which requires an
experienced nurse to provide care. (D) requires extensive teaching and should be
assigned to a more experienced nurse.
Page 2 of 151
,Question 5
A client with small cell carcinoma of the lung has also developed syndrome of
inappropriate antidiuretic hormone (SIADH). Which outcome finding is the priority for
this client?
A.Reduced peripheral edema
B.Urinary output of at least 70 mL/hr
C.Decrease in urine osmolarity
D.Serum sodium level of 137 mEq/L
Correct Answer
D
Syndrome of inappropriate antidiuretic hormone (SIADH) results from an abnormal
production or sustained secretion of antidiuretic hormone, causing fluid retention,
hyponatremia, and central nervous system (CNS) fluid shifts. The client's
normalization of the serum sodium level (normal is 135 to 145 mEq/L) (D) is the
most important outcome because sudden and severe hyponatremia caused by fluid
overload can result in heart failure. Fluid retention of SIADH contributes to daily
weight gain, which can predispose to peripheral edema (A), but the higher priority
outcome is the effect on serum electrolyte levels. Although (B and C) are findings
associated with resolving SIADH, they do not have the priority of (D).
Question 6
Six hours following thoracic surgery, a client has the following arterial blood gas
(ABG) findings: pH, 7.50; Paco2, 30 mm Hg; HCO3, 25 mEq/L; Pao2, 96 mm Hg. Which
intervention should the nurse implement based on these results?
A.Increase the oxygen flow rate from 4 to 10 L/min per nasal cannula.
B.Assess the client for pain and administer pain medication as prescribed.
C.Encourage the client to take short shallow breaths for 5 minutes.
D.Prepare to administer sodium bicarbonate IV over 30 minutes.
Correct Answer
B
These ABGs reveal respiratory alkalosis (B), and treatment depends on the
underlying cause. Because the client is only 6 hours postoperative, he or she should
be assessed for pain because treating the pain will correct the underlying problem.
A Pao2 of 96 mm Hg does not indicate the need for an increase in oxygen
administration (A). The Paco2 indicates mild hyperventilation, so (C) is not indicated.
In addition, it is very difficult to change one's breathing pattern. The use of sodium
bicarbonate (D) is indicated for the treatment of metabolic acidosis, not respiratory
alkalosis.
Page 3 of 151
, Question 7
According to Erikson, which client should the nurse identify as having difficulty
completing the developmental stage of older adults?
A.A 60-year-old man who tells the nurse that he is feeling fine and really does not
need any help from anyone
B.A 78-year-old widower who has come to the mental health clinic for counseling
after the recent death of his wife
C.An 81-year-old woman who states that she enjoys having her grandchildren visit
but is usually glad when they go home
D.A 75-year-old woman who wishes her friends were still alive so she could change
some of the choices she made over the years
Correct Answer
D
The older woman who wishes she could change the choices she has made in her
lifetime is expressing despair and is still searching for integrity (D). The nurse uses
Erikson stages of development over the life span to assess an older client's
adjustment to aging and plans teaching strategies to assist the clients attain
integrity versus despair. (A, B, and C) are normal developmental tasks of older
adults.
Question 8
A 50-year-old man arrives at the clinic with complaints of pain on ejaculation. Which
action should the nurse implement?
A.Teach the client testicular self-examination (TSE).
B.Assess for the presence of blood in the urine.
C.Ask about scrotal pain or blood in the semen.
D.Inquire about a history of kidney stones.
Correct Answer
C
Orchitis is an acute testicular inflammation resulting from recurrent urinary tract
infection, recurrent sexually transmitted disease (STD), or an indwelling urethral
urinary catheter causing pain on ejaculation, scrotal pain, blood in the semen, and
penile discharge, so the nurse should determine the presence of other symptoms
(C). Although all men should practice TSE, the client's symptoms are suggestive of
an inflammatory syndrome rather than testicular cancer (A). Although hematuria (B)
is associated with renal disease or calculi (D), the client's pain is associated with
ejaculate, not urine.
Page 4 of 151
AND CORRECT ANSWERS
Question 1
A nurse who has recently completed orientation is beginning work in the labor and
delivery unit for the first time. When making assignments, which client should the
charge nurse assign to this new nurse?
A.A primigravida who is 8 cm dilated after 14 hours of labor
B.A client scheduled for a repeat cesarean birth at 38 weeks' gestation
C.A client being induced for fetal demise at 20 weeks' gestation
D.A multiparous client who is dilated 5 cm and 50% effaced
Correct Answer
D
The new nurse should be assigned the least complicated client to gain experience
and confidence, as well as protect client safety. Of the clients available for
assignment, (D) is progressing well and is the least complicated. (A, B and C) have
actual or potential complications and should be assigned to a more experienced
nurse.
Question 2
Which assessment finding for a client with peritoneal dialysis requires immediate
intervention by the nurse?
A.The color of the dialysate outflow is opaque yellow.
B.The dialysate outflow is greater than the inflow.
C.The inflow dialysate feels warm to the touch.
D.The inflow dialysate contains potassium chloride.
Correct Answer
A
Opaque or cloudy dialysate outflow is an early sign of peritonitis. The nurse should
obtain a specimen for culture, assess the client, and notify the health care provider
(A). (B and C) are desired. (D) is commonly done to prevent hypokalemia.
Page 1 of 151
,Question 3
The nurse should encourage a laboring client to begin pushing at which point?
A.When the cervix is completely effaced
B.When the client describes the need to have a bowel movement
C.When the cervix is completely dilated
D.When the anterior or posterior lip of the cervix is palpable
Correct Answer
C
Pushing begins with the second stage of labor, when the cervix is completely dilated
at 10 cm (C). If pushing begins before the cervix is completely dilated (A, B, and D),
the cervix can become edematous and may never dilate completely, necessitating
an operative delivery. The most effective pushing occurs when the cervix is
completely dilated and the woman feels the urge to push (Ferguson's reflex).
Question 4
The charge nurse working in the surgical department is making shift assignments. The
shift personnel include an RN with 12 years of nursing experience, an RN with 2 years
of nursing experience, and an RN with 3 months of nursing experience. Which client
should the charge nurse assign to the RN with 3 months of experience?
A.A client who is 2 days postoperative with a right total knee replacement
B.A client who is scheduled for a sigmoid colostomy surgery today
C.A client who has a surgical abdominal wound with dehiscence
D.A client who is 1 day postoperative following a right-sided mastectomy
Correct Answer
A
(A) is the least critical client and should be assigned to the RN with the least
experience. A client with a knee replacement is probably ambulating and able to
perform self-care, and a physical therapist is likely to be assisting with the client's
care. (B) will require a high level of nursing care when returned from surgery. (C)
means that there is a separation or rupture of the wound, which requires an
experienced nurse to provide care. (D) requires extensive teaching and should be
assigned to a more experienced nurse.
Page 2 of 151
,Question 5
A client with small cell carcinoma of the lung has also developed syndrome of
inappropriate antidiuretic hormone (SIADH). Which outcome finding is the priority for
this client?
A.Reduced peripheral edema
B.Urinary output of at least 70 mL/hr
C.Decrease in urine osmolarity
D.Serum sodium level of 137 mEq/L
Correct Answer
D
Syndrome of inappropriate antidiuretic hormone (SIADH) results from an abnormal
production or sustained secretion of antidiuretic hormone, causing fluid retention,
hyponatremia, and central nervous system (CNS) fluid shifts. The client's
normalization of the serum sodium level (normal is 135 to 145 mEq/L) (D) is the
most important outcome because sudden and severe hyponatremia caused by fluid
overload can result in heart failure. Fluid retention of SIADH contributes to daily
weight gain, which can predispose to peripheral edema (A), but the higher priority
outcome is the effect on serum electrolyte levels. Although (B and C) are findings
associated with resolving SIADH, they do not have the priority of (D).
Question 6
Six hours following thoracic surgery, a client has the following arterial blood gas
(ABG) findings: pH, 7.50; Paco2, 30 mm Hg; HCO3, 25 mEq/L; Pao2, 96 mm Hg. Which
intervention should the nurse implement based on these results?
A.Increase the oxygen flow rate from 4 to 10 L/min per nasal cannula.
B.Assess the client for pain and administer pain medication as prescribed.
C.Encourage the client to take short shallow breaths for 5 minutes.
D.Prepare to administer sodium bicarbonate IV over 30 minutes.
Correct Answer
B
These ABGs reveal respiratory alkalosis (B), and treatment depends on the
underlying cause. Because the client is only 6 hours postoperative, he or she should
be assessed for pain because treating the pain will correct the underlying problem.
A Pao2 of 96 mm Hg does not indicate the need for an increase in oxygen
administration (A). The Paco2 indicates mild hyperventilation, so (C) is not indicated.
In addition, it is very difficult to change one's breathing pattern. The use of sodium
bicarbonate (D) is indicated for the treatment of metabolic acidosis, not respiratory
alkalosis.
Page 3 of 151
, Question 7
According to Erikson, which client should the nurse identify as having difficulty
completing the developmental stage of older adults?
A.A 60-year-old man who tells the nurse that he is feeling fine and really does not
need any help from anyone
B.A 78-year-old widower who has come to the mental health clinic for counseling
after the recent death of his wife
C.An 81-year-old woman who states that she enjoys having her grandchildren visit
but is usually glad when they go home
D.A 75-year-old woman who wishes her friends were still alive so she could change
some of the choices she made over the years
Correct Answer
D
The older woman who wishes she could change the choices she has made in her
lifetime is expressing despair and is still searching for integrity (D). The nurse uses
Erikson stages of development over the life span to assess an older client's
adjustment to aging and plans teaching strategies to assist the clients attain
integrity versus despair. (A, B, and C) are normal developmental tasks of older
adults.
Question 8
A 50-year-old man arrives at the clinic with complaints of pain on ejaculation. Which
action should the nurse implement?
A.Teach the client testicular self-examination (TSE).
B.Assess for the presence of blood in the urine.
C.Ask about scrotal pain or blood in the semen.
D.Inquire about a history of kidney stones.
Correct Answer
C
Orchitis is an acute testicular inflammation resulting from recurrent urinary tract
infection, recurrent sexually transmitted disease (STD), or an indwelling urethral
urinary catheter causing pain on ejaculation, scrotal pain, blood in the semen, and
penile discharge, so the nurse should determine the presence of other symptoms
(C). Although all men should practice TSE, the client's symptoms are suggestive of
an inflammatory syndrome rather than testicular cancer (A). Although hematuria (B)
is associated with renal disease or calculi (D), the client's pain is associated with
ejaculate, not urine.
Page 4 of 151
