HESI LPN
HESI CAT Exam Quizlet
1. Following a thyroidectomy, a client experiences tetany. The nurse should expect to administer which intravenous medication?
- A. Sodium iodide solution
- B. Levothyroxine sodium (Synthroid)
- C. Calcium gluconate
- D. Propranolol (Inderal)
Correct answer: C
Rationale: Following a thyroidectomy, tetany can occur due to hypoparathyroidism, leading to low calcium levels. Therefore, the nurse should administer calcium gluconate intravenously to raise the calcium levels. Choice A, Sodium iodide solution, is incorrect as it is used for thyroid conditions, not for treating tetany. Choice B, Levothyroxine sodium (Synthroid), is incorrect as it is a thyroid hormone replacement and does not address low calcium levels. Choice D, Propranolol (Inderal), is incorrect as it is a beta-blocker used for conditions like hypertension and not indicated for tetany after thyroidectomy.
2. What is the primary focus of postoperative nursing care for the client with colon trauma?
- A. Monitoring for elevated coagulation studies
- B. Observation for and prevention of fistulas
- C. Monitoring for signs of hyponatremia
- D. Observation for and prevention of infection
Correct answer: D
Rationale: The correct answer is D: Observation for and prevention of infection. Postoperative nursing care for a client with colon trauma primarily focuses on preventing infections. Clients with colon trauma are at high risk for infections due to the disruption of the intestinal barrier. Monitoring for signs of infection, maintaining proper wound care, administering antibiotics as prescribed, and implementing strict aseptic techniques are essential in preventing postoperative infections. Choices A, B, and C are incorrect because elevated coagulation studies, fistulas, and hyponatremia are not the primary concerns in the immediate postoperative period for a client with colon trauma.
3. The parents of a 6-year-old child recently diagnosed with Duchenne muscular dystrophy tell the nurse that their child wants to continue attending swimming classes. How should the nurse respond?
- A. Encourage the parents to allow the child to continue attending swimming lessons with supervision
- B. Suggest that the child be encouraged to participate in a team sport to promote socialization
- C. Explain that their child is not mature enough to understand the risks associated with swimming
- D. Provide a list of alternative activities that are less likely to cause the child to experience fatigue
Correct answer: A
Rationale: Encouraging the parents to allow the child to continue attending swimming lessons with supervision is the most appropriate response. Swimming can be beneficial for the child, providing both exercise and enjoyment. Supervision can help manage any risks associated with swimming. Choice B is incorrect because the child's preference for swimming should be respected, and swimming can still offer socialization opportunities. Choice C is incorrect as it undermines the child's capability to understand the situation. Choice D is less appropriate as it does not address the child's interest in swimming and may limit beneficial physical activity.
4. In what order should the nurse perform the steps of a surgical hand scrub prior to entering the operating room?
- A. Rinse from the fingertips to the elbow
- B. Scrape under the nails with a nail pick
- C. Use a soapy brush to scrub the hands
- D. Cleanse the arm with a lathered brush
Correct answer: B
Rationale: The correct order for performing a surgical hand scrub is to first scrape under the nails with a nail pick, then scrub the hands using a soapy brush, cleanse the arms, and finally rinse. This sequence ensures thorough cleaning and minimizes the risk of contamination. Choice A is incorrect because rinsing should be the final step, not the first. Choice C is incorrect as scrubbing the hands comes after scraping under the nails. Choice D is incorrect as cleansing the arms should follow hand scrubbing, not precede it.
5. The healthcare provider explains through an interpreter the risks and benefits of a scheduled surgical procedure to a non-English speaking female client. The client gives verbal consent, and the healthcare provider leaves, instructing the nurse to witness the signature on the consent form. The client and interpreter then speak together in the foreign language for an additional 2 minutes until the interpreter concludes, 'She says it is OK.' What action should the nurse take next?
- A. Clarify the client’s consent through the use of gestures and simple terms
- B. Have the interpreter co-sign the consent to validate the client's understanding
- C. Ask for a full explanation from the interpreter of the witnessed discussion
- D. Have the client sign the consent form and the nurse witness the signature
Correct answer: B
Rationale: Having the interpreter co-sign the consent form is the most appropriate action in this scenario. By having the interpreter co-sign, it ensures an additional layer of verification of the client's understanding and consent, which is crucial when language barriers exist. This step adds a level of confirmation to safeguard that the client's consent is both valid and well-informed. Option A is not sufficient as gestures and simple terms may not fully clarify the client's understanding, especially for complex medical procedures. Option C is unnecessary since the interpreter has already confirmed the client's consent. Option D does not involve the interpreter in validating the client's understanding, which is essential in this situation to ensure effective communication and comprehension between the client and the healthcare team.
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