HESI PN Exit Exam Version 1– Practical Nursing
Comprehensive Exit Assessment Updated and Latest
Questions and Correct Answers with Rationale
1. A practical nurse is supervising an unlicensed assistive personnel (UAP). Which task is most appropriate
for the nurse to delegate to the UAP?
A. Evaluating a patient’s response to pain medication
B. Teaching a diabetic patient how to perform foot care
C. Assisting a stable patient with a morning bed bath
D. Performing the initial assessment on a new admission
Ans: C
Rationale: Effective delegation requires the practical nurse to understand the scope of practice for all
team members. Tasks that involve clinical judgment or assessment should never be delegated to
unlicensed staff. Assisting with activities of daily living for a stable patient is a primary responsibility of
the UAP. Evaluating pain response requires assessment skills that are within the nurse’s scope. Patient
teaching is a professional nursing responsibility that cannot be offloaded to non-licensed personnel.
Performing an initial assessment is a complex task reserved for the nurse. By delegating appropriately,
the nurse ensures patient safety and efficient care delivery.
2. A patient is prescribed warfarin for atrial fibrillation. Which lab result should the practical nurse monitor
to evaluate the effectiveness of this therapy?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
,D. Hemoglobin and hematocrit levels
Ans: A
Rationale: Warfarin is an oral anticoagulant used to prevent thromboembolic events. The INR is the
standard laboratory value used to monitor its therapeutic effect. The aPTT is used specifically to monitor
heparin therapy, not warfarin. Platelet counts are monitored for heparin-induced thrombocytopenia but
do not reflect warfarin’s action. Hemoglobin and hematocrit are indicators of blood loss but do not
measure the clotting time directly. Achieving a target INR range ensures the patient is protected from
clots while minimizing bleeding risks. The practical nurse plays a vital role in reporting these values to
the provider for dosage adjustments.
3. A patient with chronic obstructive pulmonary disease (COPD) is using an incentive spirometer. Which
instruction should the nurse include in the teaching plan?
A. Inhale slowly and deeply through the mouthpiece
B. Exhale forcefully into the mouthpiece
C. Hold your breath for at least 30 seconds
D. Use the device once every 4 hours while awake
Ans: A
Rationale: Incentive spirometry is designed to promote lung expansion and prevent atelectasis. The
patient should be taught to inhale slowly and deeply to maximize alveolar recruitment. Exhaling into the
device is incorrect because it is an inspiratory exercise. Holding the breath for 30 seconds is unrealistic
and could cause respiratory distress in COPD patients. The recommended frequency is usually 10 breaths
every hour while the patient is awake. Proper technique involves maintaining a steady flow to keep the
ball or piston elevated. Monitoring the patient’s performance allows the nurse to provide corrective
feedback and encourage compliance.
,4. A patient with type 1 diabetes mellitus presents with tremors, diaphoresis, and confusion. What should
be the nurse’s first action?
A. Administer 15 grams of fast-acting carbohydrates
B. Obtain a fingerstick blood glucose reading
C. Call the healthcare provider immediately
D. Administer the scheduled dose of regular insulin
Ans: B
Rationale: The clinical signs of tremors, diaphoresis, and confusion are hallmark indicators of
hypoglycemia. The priority nursing action is to confirm the blood glucose level before initiating
treatment. Administering carbohydrates is appropriate only after confirming low blood sugar or if the
patient’s condition is critical. Calling the provider is necessary but should follow the immediate
assessment of glucose levels. Giving insulin would dangerously lower the glucose level further and could
be fatal. Assessing first follows the nursing process and ensures that interventions are appropriate. Once
hypoglycemia is confirmed, the nurse should follow the facility’s protocol for glucose replacement.
5. Which clinical manifestation should the practical nurse identify as an early sign of digoxin toxicity?
A. Increased urinary output
B. Severe chest pain
C. Anorexia and nausea
D. Sudden hypertension
Ans: C
Rationale: Digoxin is a cardiac glycoside with a narrow therapeutic index. Early signs of toxicity typically
involve the gastrointestinal system, specifically nausea and anorexia. Visual disturbances like seeing
, yellow-green halos are also common indicators. Chest pain is generally related to ischemia rather than
digoxin levels. Increased urinary output is often a desired therapeutic effect of improved cardiac output,
not toxicity. Hypertension is not a typical sign of digitalis overdose; bradycardia is more common. The
nurse must monitor serum digoxin levels and electrolyte balances, particularly potassium. Prompt
recognition of these symptoms allows for the timely withholding of the medication.
6. The nurse is caring for an older adult patient who is at high risk for falls. Which intervention is the most
effective safety measure?
A. Applying bilateral soft wrist restraints
B. Placing the bed in the lowest possible position
C. Keeping all four side rails in the up position
D. Instructing the patient to stay in bed at all times
Ans: B
Rationale: Patient safety is a paramount concern in the care of older adults. Placing the bed in the lowest
position reduces the distance of a potential fall. Restraints should only be used as a last resort and
require a specific medical order. Keeping all four side rails up is often considered a form of restraint and
can increase injury if a patient tries to climb over. Instructing a patient to stay in bed is often ineffective
for those with cognitive impairment. Other strategies include providing non-skid footwear and ensuring
adequate lighting. Regular rounding and the use of bed alarms can further mitigate fall risks. The nurse
should always prioritize the least restrictive environment.
7. A nurse is preparing to enter the room of a patient with active tuberculosis (TB). Which personal
protective equipment (PPE) is essential?
A. Surgical mask and gloves
B. Gown, mask, and goggles
Comprehensive Exit Assessment Updated and Latest
Questions and Correct Answers with Rationale
1. A practical nurse is supervising an unlicensed assistive personnel (UAP). Which task is most appropriate
for the nurse to delegate to the UAP?
A. Evaluating a patient’s response to pain medication
B. Teaching a diabetic patient how to perform foot care
C. Assisting a stable patient with a morning bed bath
D. Performing the initial assessment on a new admission
Ans: C
Rationale: Effective delegation requires the practical nurse to understand the scope of practice for all
team members. Tasks that involve clinical judgment or assessment should never be delegated to
unlicensed staff. Assisting with activities of daily living for a stable patient is a primary responsibility of
the UAP. Evaluating pain response requires assessment skills that are within the nurse’s scope. Patient
teaching is a professional nursing responsibility that cannot be offloaded to non-licensed personnel.
Performing an initial assessment is a complex task reserved for the nurse. By delegating appropriately,
the nurse ensures patient safety and efficient care delivery.
2. A patient is prescribed warfarin for atrial fibrillation. Which lab result should the practical nurse monitor
to evaluate the effectiveness of this therapy?
A. International Normalized Ratio (INR)
B. Activated partial thromboplastin time (aPTT)
C. Platelet count
,D. Hemoglobin and hematocrit levels
Ans: A
Rationale: Warfarin is an oral anticoagulant used to prevent thromboembolic events. The INR is the
standard laboratory value used to monitor its therapeutic effect. The aPTT is used specifically to monitor
heparin therapy, not warfarin. Platelet counts are monitored for heparin-induced thrombocytopenia but
do not reflect warfarin’s action. Hemoglobin and hematocrit are indicators of blood loss but do not
measure the clotting time directly. Achieving a target INR range ensures the patient is protected from
clots while minimizing bleeding risks. The practical nurse plays a vital role in reporting these values to
the provider for dosage adjustments.
3. A patient with chronic obstructive pulmonary disease (COPD) is using an incentive spirometer. Which
instruction should the nurse include in the teaching plan?
A. Inhale slowly and deeply through the mouthpiece
B. Exhale forcefully into the mouthpiece
C. Hold your breath for at least 30 seconds
D. Use the device once every 4 hours while awake
Ans: A
Rationale: Incentive spirometry is designed to promote lung expansion and prevent atelectasis. The
patient should be taught to inhale slowly and deeply to maximize alveolar recruitment. Exhaling into the
device is incorrect because it is an inspiratory exercise. Holding the breath for 30 seconds is unrealistic
and could cause respiratory distress in COPD patients. The recommended frequency is usually 10 breaths
every hour while the patient is awake. Proper technique involves maintaining a steady flow to keep the
ball or piston elevated. Monitoring the patient’s performance allows the nurse to provide corrective
feedback and encourage compliance.
,4. A patient with type 1 diabetes mellitus presents with tremors, diaphoresis, and confusion. What should
be the nurse’s first action?
A. Administer 15 grams of fast-acting carbohydrates
B. Obtain a fingerstick blood glucose reading
C. Call the healthcare provider immediately
D. Administer the scheduled dose of regular insulin
Ans: B
Rationale: The clinical signs of tremors, diaphoresis, and confusion are hallmark indicators of
hypoglycemia. The priority nursing action is to confirm the blood glucose level before initiating
treatment. Administering carbohydrates is appropriate only after confirming low blood sugar or if the
patient’s condition is critical. Calling the provider is necessary but should follow the immediate
assessment of glucose levels. Giving insulin would dangerously lower the glucose level further and could
be fatal. Assessing first follows the nursing process and ensures that interventions are appropriate. Once
hypoglycemia is confirmed, the nurse should follow the facility’s protocol for glucose replacement.
5. Which clinical manifestation should the practical nurse identify as an early sign of digoxin toxicity?
A. Increased urinary output
B. Severe chest pain
C. Anorexia and nausea
D. Sudden hypertension
Ans: C
Rationale: Digoxin is a cardiac glycoside with a narrow therapeutic index. Early signs of toxicity typically
involve the gastrointestinal system, specifically nausea and anorexia. Visual disturbances like seeing
, yellow-green halos are also common indicators. Chest pain is generally related to ischemia rather than
digoxin levels. Increased urinary output is often a desired therapeutic effect of improved cardiac output,
not toxicity. Hypertension is not a typical sign of digitalis overdose; bradycardia is more common. The
nurse must monitor serum digoxin levels and electrolyte balances, particularly potassium. Prompt
recognition of these symptoms allows for the timely withholding of the medication.
6. The nurse is caring for an older adult patient who is at high risk for falls. Which intervention is the most
effective safety measure?
A. Applying bilateral soft wrist restraints
B. Placing the bed in the lowest possible position
C. Keeping all four side rails in the up position
D. Instructing the patient to stay in bed at all times
Ans: B
Rationale: Patient safety is a paramount concern in the care of older adults. Placing the bed in the lowest
position reduces the distance of a potential fall. Restraints should only be used as a last resort and
require a specific medical order. Keeping all four side rails up is often considered a form of restraint and
can increase injury if a patient tries to climb over. Instructing a patient to stay in bed is often ineffective
for those with cognitive impairment. Other strategies include providing non-skid footwear and ensuring
adequate lighting. Regular rounding and the use of bed alarms can further mitigate fall risks. The nurse
should always prioritize the least restrictive environment.
7. A nurse is preparing to enter the room of a patient with active tuberculosis (TB). Which personal
protective equipment (PPE) is essential?
A. Surgical mask and gloves
B. Gown, mask, and goggles
