HESI LPN
Practice HESI Fundamentals Exam
1. A 73-year-old female client had a hemiarthroplasty of the left hip yesterday due to a fracture resulting from a fall. In reviewing hip precautions with the client, which instruction should the LPN/LVN include in this client's teaching plan?
- A. You will be able to bend at the waist to reach items on the floor in 8 weeks.
- B. Place a pillow between your knees while lying in bed to prevent hip dislocation.
- C. It is safe to use a walker to get out of bed, but you need assistance when walking.
- D. Take pain medication 30 minutes after your physical therapy sessions.
Correct answer: B
Rationale: The correct instruction to include in the teaching plan for a client who had a hemiarthroplasty of the left hip is to 'Place a pillow between your knees while lying in bed to prevent hip dislocation.' This technique helps maintain proper hip alignment and prevents dislocation during the postoperative recovery period. Choice A is incorrect because bending at the waist to reach items on the floor can strain the hip joint and is not recommended following hip surgery. Choice C is incorrect because using a walker alone without assistance can increase the risk of falls and injury, especially in the immediate postoperative period. Choice D is incorrect because pain medication should be taken as prescribed by the healthcare provider, not specifically timed after physical therapy sessions.
2. A client with a diagnosis of generalized anxiety disorder is prescribed diazepam. The nurse should instruct the client that this medication may have which potential side effect?
- A. Drowsiness
- B. Dry mouth
- C. Nausea
- D. Headache
Correct answer: A
Rationale: Correct. Diazepam, a medication commonly used to treat anxiety disorders, can lead to drowsiness as a potential side effect. It is important for clients taking diazepam to be cautious about activities that require alertness, such as driving, due to the risk of drowsiness associated with this medication. Choice B, dry mouth, is not typically associated with diazepam use. Choice C, nausea, is less common as a side effect of diazepam compared to drowsiness. Choice D, headache, is also less common and typically not a significant side effect of diazepam.
3. When observing a newly admitted elderly client with dementia resisting care, what approach should the nurse take to facilitate cooperation?
- A. Use short, simple sentences and maintain a calm demeanor
- B. Involve family members to provide reassurance
- C. Offer choices to empower the client
- D. All of the above
Correct answer: D
Rationale: When dealing with a newly admitted elderly client with dementia who is resistant to care, it is crucial to employ multiple strategies to facilitate cooperation. Using short, simple sentences and maintaining a calm demeanor can help the client better understand instructions and reduce agitation. Involving family members can provide comfort and reassurance to the client, potentially decreasing resistance. Offering choices allows the client to feel a sense of control and autonomy in their care, which can increase cooperation and reduce challenging behaviors. Therefore, a combination of clear communication, family involvement, and providing choices is essential to effectively engage and care for a client with dementia. Choices A, B, and C all play crucial roles in addressing the needs of the client, making 'All of the above' the correct answer.
4. A client is prescribed diazepam for muscle spasms. What instruction should the nurse include in the client's teaching plan?
- A. Avoid drinking alcohol
- B. Take with food to avoid gastrointestinal upset
- C. Increase fluid intake
- D. Take medication with grapefruit juice
Correct answer: A
Rationale: The correct instruction for a client prescribed diazepam for muscle spasms is to avoid drinking alcohol. Diazepam can cause drowsiness and enhance the effects of alcohol, leading to increased sedation and impaired cognitive function. Clients should be advised to avoid alcohol consumption while taking diazepam to prevent these adverse effects and ensure their safety.
5. The nurse is preparing to administer an intramuscular injection to a 6-month-old infant. Which site is most appropriate for this injection?
- A. Deltoid muscle
- B. Ventrogluteal muscle
- C. Dorsogluteal muscle
- D. Vastus lateralis muscle
Correct answer: D
Rationale: The vastus lateralis muscle is the preferred site for intramuscular injections in infants due to its size and safety. The deltoid muscle is typically used for adults and older children. The ventrogluteal muscle is more commonly used in toddlers and older children. The dorsogluteal muscle is not recommended for intramuscular injections in any age group due to its proximity to major nerves and blood vessels, which poses a risk of injury or sciatic nerve damage.