HESI LPN
HESI PN Exit Exam 2024
1. The practical nurse is caring for a client who had a total laryngectomy, left radical neck dissection, and tracheostomy. The client is receiving nasogastric tube feedings via an enteral pump. Today the rate of feeding is increased from 50 ml/hr to 75 ml/hr. What parameter should the PN use to evaluate the client's tolerance to the rate of the feeding?
- A. Daily weight
- B. Gastric residual volumes
- C. Bowel sounds
- D. Urinary and stool output
Correct answer: B
Rationale: Monitoring gastric residual volumes helps to assess how well the client is tolerating the increased feeding rate. High residuals may indicate delayed gastric emptying, which could lead to complications like aspiration. This helps in adjusting the feeding plan as necessary. Daily weight (Choice A) is not the most appropriate parameter to evaluate tolerance to feeding rate changes. Bowel sounds (Choice C) and urinary/stool output (Choice D) are important assessments but do not directly indicate tolerance to enteral feeding rate changes.
2. In which type of cardiomyopathy does septal involvement occur?
- A. Congestive
- B. Dilated
- C. Hypertrophic
- D. Restrictive
Correct answer: C
Rationale: Septal involvement is a characteristic feature of hypertrophic cardiomyopathy, where the septal wall of the heart thickens. This thickening can obstruct blood flow out of the heart, leading to complications such as arrhythmias and heart failure. This differentiates it from other types of cardiomyopathy. In congestive cardiomyopathy (choice A), the heart's chambers become enlarged and weakened, but there is no specific mention of septal involvement. Dilated cardiomyopathy (choice B) involves dilation and impaired contraction of the heart chambers, not specifically septal thickening. Restrictive cardiomyopathy (choice D) is characterized by stiffening of the heart muscle, affecting its ability to fill properly, without direct involvement of the septum.
3. While caring for a client with a new tracheostomy, the nurse notices that the client is attempting to speak but is unable to. What should the nurse explain to the client regarding their inability to speak?
- A. Speaking is not possible because the tracheostomy tube blocks the vocal cords.
- B. The tracheostomy tube prevents air from reaching the vocal cords, making speech difficult.
- C. The client will regain the ability to speak once the tracheostomy tube is removed.
- D. The tracheostomy tube must be replaced with a speaking valve for the client to speak.
Correct answer: B
Rationale: The correct answer is B. The tracheostomy tube bypasses the vocal cords, preventing air from reaching them, which is necessary for speech. This makes speaking difficult but not impossible. Removing the tracheostomy tube does not automatically restore the ability to speak (choice C). While a speaking valve can be added later to allow speech, initially, the tracheostomy tube itself hinders air from reaching the vocal cords, making speech difficult (choice D is incorrect). Choice A is incorrect as the tracheostomy tube does not block the vocal cords directly; instead, it prevents air from reaching them.
4. The HCP gives a pregnant woman a prescription for one prenatal vitamin with iron daily and tells her that she needs to increase foods in her diet because her hemoglobin is 8.2 grams/dL. When a list of iron-rich foods is given to the client, she tells the PN that she is a vegetarian and does not eat anything that "bleeds." Which instruction should the PN provide?
- A. All below
- B. Increase green leafy vegetables in the diet
- C. Oatmeal is a good choice for breakfast
- D. Add lentils and black beans to soup
Correct answer: A
Rationale: Vegetarians can increase their iron intake through plant-based sources such as green leafy vegetables, oatmeal, and legumes, which are rich in iron.
5. A male client attends a community support program for mentally impaired and chemically abusing clients. The client tells the PN that his drugs of choice are cocaine and heroin. What is the greatest health risk for this client?
- A. Hypertension
- B. Hepatitis
- C. Glaucoma
- D. Diabetes
Correct answer: B
Rationale: The correct answer is B: Hepatitis. Hepatitis is the greatest health risk for this client due to the potential for contracting the disease through needle-sharing, common among drug users. This can lead to serious liver complications. While hypertension, glaucoma, and diabetes are all important health concerns, they are not directly associated with the drug abuse mentioned in the scenario.
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