HESI LPN
Leadership and Management HESI Quizlet
1. A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?
- A. Kussmaul's respirations and a fruity odor on the breath
- B. Shallow respirations and severe abdominal pain
- C. Decreased respirations and increased urine output
- D. Cheyne-Stokes respirations and foul-smelling urine
Correct answer: A
Rationale: In diabetic ketoacidosis (DKA), as the condition progresses, the body tries to compensate for the acidic environment by increasing the respiratory rate, leading to Kussmaul's respirations. The accumulation of ketones in the body causes a fruity odor on the breath. Option A is correct because Kussmaul's respirations and a fruity odor on the breath are classic signs of DKA. Option B is incorrect because shallow respirations are not typically seen in DKA, and severe abdominal pain is more commonly associated with conditions like pancreatitis. Option C is incorrect as decreased respirations are not a typical finding in DKA, and increased urine output is more commonly seen in conditions like diabetes insipidus. Option D is incorrect because Cheyne-Stokes respirations are not characteristic of DKA, and foul-smelling urine is not a prominent symptom in this condition.
2. A client is receiving lidocaine IV at 3 mg/minute. The pharmacy dispenses a 500 ml IV solution of normal saline (NS) with 2 grams of lidocaine. The nurse should regulate the infusion pump to deliver how many ml/hour?
- A. 18
- B. 27
- C. 36
- D. 45
Correct answer: D
Rationale: The infusion rate is calculated based on the concentration of lidocaine and the prescribed rate of infusion. First, convert lidocaine's weight to milligrams (2 grams = 2000 mg). Then, use the formula: (Total volume in ml * dose in mg) / 60 minutes. For this case, (500 ml * 2000 mg) / 60 minutes = 45 ml/hour. Therefore, the correct answer is D. Choices A, B, and C are incorrect as they do not reflect the accurate calculation based on the provided concentration and infusion rate.
3. A nurse is caring for an infant born with exstrophy of the bladder. What does the nurse determine is the greatest risk for this infant?
- A. Infection
- B. Dehydration
- C. Urinary retention
- D. Intestinal obstruction
Correct answer: A
Rationale: Infection is the greatest risk for an infant with exstrophy of the bladder due to the exposure of the bladder and surrounding tissues. The exposed bladder increases the risk of infection as it lacks the protective covering of the skin. Dehydration (Choice B) may occur but is not the greatest risk compared to infection. Urinary retention (Choice C) is less likely due to the nature of the condition. Intestinal obstruction (Choice D) is not directly associated with exstrophy of the bladder.
4. An 18-year-old gravida 1, at 41-weeks gestation, is undergoing an oxytocin (Pitocin) induction and has an epidural catheter in place for pain control. With each of the last three contractions, the nurse notes a late deceleration. The client is repositioned, and oxygen provided, but the late decelerations continue to occur with each contraction. What action should the nurse take first?
- A. Prepare for immediate cesarean birth
- B. Turn off the oxytocin (Pitocin) infusion
- C. Notify the anesthesiologist that the epidural infusion needs to be disconnected
- D. Apply an internal fetal monitoring device and continue to monitor carefully
Correct answer: B
Rationale: In the scenario described, the nurse notes late decelerations during contractions despite repositioning and oxygen administration. Late decelerations are often associated with uteroplacental insufficiency, which can be exacerbated by increased uterine activity stimulated by oxytocin. The initial action to manage late decelerations is to turn off the oxytocin infusion to reduce uterine stimulation. This step aims to improve fetal oxygenation and prevent further stress on the fetus. Immediate cesarean birth may be necessary if the late decelerations persist or worsen despite discontinuing the oxytocin infusion. Notifying the anesthesiologist to disconnect the epidural infusion or applying an internal fetal monitoring device are not the first-line interventions for managing late decelerations.
5. What is the most common initial symptom of juvenile idiopathic arthritis?
- A. Joint swelling and pain
- B. Skin rash
- C. Gastrointestinal bleeding
- D. Neurological deficits
Correct answer: A
Rationale: The correct answer is A: Joint swelling and pain. These are the most common initial symptoms of juvenile idiopathic arthritis, typically affecting multiple joints. Skin rash (choice B), gastrointestinal bleeding (choice C), and neurological deficits (choice D) are not typical initial symptoms of juvenile idiopathic arthritis. Skin rash may be seen in other conditions like dermatitis or systemic lupus erythematosus, gastrointestinal bleeding may be associated with conditions like inflammatory bowel disease, and neurological deficits could be indicative of conditions like multiple sclerosis.