HESI LPN
PN Exit Exam 2023 Quizlet
1. While ambulating in the hallway following an appendectomy yesterday, a client complains of chest tightness and shortness of breath. Which action should the nurse implement first?
- A. Administer sublingual nitroglycerin
- B. Assist the client back to the room
- C. Have the client sit down in the hall
- D. Obtain a 12-lead electrocardiogram
Correct answer: C
Rationale: Having the client sit down in the hallway is the first action the nurse should implement. This is crucial to prevent further strain on the heart and to provide a safer environment for assessment and potential emergency intervention. Administering sublingual nitroglycerin (Choice A) may be appropriate later but should not precede ensuring the client's immediate safety. Assisting the client back to the room (Choice B) may not be advisable if the client is experiencing chest tightness and shortness of breath. Obtaining a 12-lead electrocardiogram (Choice D) is important but would not be the initial action to address the client's immediate symptoms.
2. A client with a prescription for a transcutaneous electrical nerve stimulator (TENS) unit for pain management asks how it works. What information should the nurse reinforce?
- A. The discharge of electricity will distract the client's focus from the pain
- B. An infusion of medication in the spinal canal will block pain perception
- C. Pain perception in the cerebral cortex is dulled by the unit's discharge of an electrical stimulus
- D. A mild electrical stimulus on the skin surface closes the gates of nerve conduction for severe pain
Correct answer: D
Rationale: The correct answer is D. TENS works by delivering a mild electrical stimulus that can block pain signals from reaching the brain, effectively reducing the perception of pain. Choice A is incorrect because TENS does not distract from pain but rather interferes with pain signals. Choice B is incorrect as TENS does not involve infusing medication into the spinal canal. Choice C is also incorrect because TENS does not target the cerebral cortex to dull pain perception but rather works at the level of nerve conduction.
3. A client who is receiving chemotherapy has developed stomatitis. Which instruction should the nurse provide the UAP who is assisting with the care of this client?
- A. Keep the room environment free of unpleasant odors
- B. Gather supplies for protective environmental precautions
- C. Assist the client with feeding at meal times
- D. Provide gentle and meticulous mouth care
Correct answer: D
Rationale: Providing gentle and meticulous mouth care is critical for a client with stomatitis as it helps prevent further irritation and infection of the mucous membranes. Keeping the room environment free of unpleasant odors (Choice A) is important for the client's comfort but not directly related to managing stomatitis. Gathering supplies for protective environmental precautions (Choice B) is not relevant to addressing stomatitis. Assisting the client with feeding at meal times (Choice C) is important for overall care but does not specifically target the care needed for stomatitis.
4. The UAP reports to the PN that a client refused to bathe for the third consecutive day. Which action is best for the PN to take?
- A. Explain the importance of good hygiene to the client
- B. Ask family members to encourage the client to bathe
- C. Reschedule the bath for the following day
- D. Ask the client why the bath was refused
Correct answer: D
Rationale: The best action for the PN to take when a client refuses to bathe is to ask the client why the bath was refused. Understanding the client's reasons for refusing a bath is crucial as it helps to address any underlying issues, such as fear, discomfort, or physical limitations. By communicating directly with the client, the PN can provide appropriate care tailored to the client's needs. Choices A, B, and C do not directly address the root cause of the refusal and may not effectively resolve the issue.
5. The nurse is caring for a client with pericarditis. Which of the following nursing interventions will promote comfort for the client?
- A. Auscultating the client's heart sounds
- B. Provide the client with a diversionary activity
- C. Encourage deep breathing
- D. Maintain a patent intravenous access
Correct answer: B
Rationale: Providing a diversionary activity is the most appropriate nursing intervention to promote comfort for a client with pericarditis. This intervention helps to distract the patient and reduce discomfort by focusing their attention elsewhere. Auscultating heart sounds, while important for monitoring the condition, does not directly address the client's comfort. Encouraging deep breathing can be beneficial for some conditions but may not be specifically aimed at promoting comfort in pericarditis. Maintaining a patent intravenous access is essential for treatment access and management of the condition, but it does not directly promote comfort for the client.
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