HESI LPN
Adult Health Exam 1 Chamberlain
1. A client is diagnosed with Angina Pectoris. Which factor in the client's history is likely related to the anginal pain?
- A. Smokes one pack of cigarettes daily
- B. Drinks two beers daily
- C. Works in a job that requires exposure to the sun
- D. Eats while lying in bed
Correct answer: A
Rationale: The correct answer is A: 'Smokes one pack of cigarettes daily.' Smoking is a major risk factor for angina and other cardiovascular diseases due to its impact on blood vessels. Choice B, 'Drinks two beers daily,' is not directly associated with angina pectoris. While excessive alcohol consumption can contribute to heart problems, it is not a primary risk factor for angina. Choice C, 'Works in a job that requires exposure to the sun,' is not typically related to angina pectoris. Sun exposure is more closely linked to skin-related conditions. Choice D, 'Eats while lying in bed,' is also not a common risk factor for angina. While certain eating habits can impact heart health, this specific behavior is not directly associated with angina pectoris.
2. When using a metered-dose inhaler (MDI), which step is most important for ensuring effective medication delivery?
- A. Exhale completely before using the inhaler
- B. Inhale quickly while pressing down on the inhaler
- C. Shake the inhaler for 10 seconds before use
- D. Hold breath for 5 seconds after inhaling
Correct answer: A
Rationale: The correct step to ensure effective medication delivery when using a metered-dose inhaler (MDI) is to exhale completely before using the inhaler. This action helps create more space in the lungs for the medication to reach deeply into the airways. Inhaling quickly while pressing down on the inhaler (Choice B) may cause the medication to impact the throat rather than reaching the lungs. Shaking the inhaler for 10 seconds before use (Choice C) is important to mix the medication but not the most crucial step for effective delivery. While holding the breath for 5 seconds after inhaling (Choice D) can help the medication stay in the lungs momentarily, exhaling completely before inhalation is more critical for optimal drug deposition.
3. Based on the Nursing diagnosis of 'Potential for infection related to second and third degree burns,' which intervention has the highest priority?
- A. Application of topical antibacterial cream
- B. Use of careful hand washing technique
- C. Administration of plasma expanders
- D. Limiting visitors to the burned client
Correct answer: B
Rationale: The highest priority intervention in this scenario is B, the use of careful hand washing technique. Proper hand hygiene is essential in preventing infection, especially in individuals with compromised skin integrity like those with burns. By practicing careful hand washing, healthcare providers reduce the risk of introducing harmful pathogens to the burn wound, thus lowering the chances of infections. Choice A, application of topical antibacterial cream, is important but should follow ensuring proper hand hygiene. Choice C, administration of plasma expanders, is not directly associated with preventing burn-related infections. Choice D, limiting visitors, is significant for infection control, but ensuring proper hand hygiene outweighs this intervention in terms of priority.
4. A client with a history of hypertension is prescribed lisinopril. Which potential side effect should the nurse monitor for?
- A. Hypokalemia
- B. Hyperglycemia
- C. Persistent cough
- D. Tachycardia
Correct answer: C
Rationale: The correct answer is C: Persistent cough. Lisinopril is an ACE inhibitor commonly associated with a persistent dry cough as a side effect. This cough is thought to result from increased bradykinin levels. Choices A, B, and D are incorrect. Hypokalemia is not a common side effect of lisinopril; in fact, it may lead to hyperkalemia. Hyperglycemia is not a typical side effect of lisinopril use. Tachycardia is also not a common side effect associated with ACE inhibitors like lisinopril.
5. During a tonic-clonic seizure, what is the nurse's priority intervention?
- A. Insert an oral airway
- B. Administer oxygen via nasal cannula
- C. Restrain the client's arms and legs
- D. Protect the client's head from injury
Correct answer: D
Rationale: During a tonic-clonic seizure, the nurse's priority intervention is to protect the client's head from injury. This is crucial to prevent trauma, as head injuries can be severe during a seizure. Inserting an oral airway may cause injury or obstruction during the seizure and is not recommended. Administering oxygen via nasal cannula can be done after ensuring the client's safety. Restraining the client's arms and legs is also not recommended as it can lead to further injury or harm.
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