HESI LPN
Adult Health 2 Exam 1
1. A client with a diagnosis of anemia is being discharged with a prescription for ferrous sulfate. What should the nurse include in the teaching plan?
- A. Take the medication with milk to enhance absorption
- B. Expect stools to be dark in color
- C. Take the medication before bedtime
- D. Avoid foods high in vitamin C
Correct answer: B
Rationale: The correct answer is B: 'Expect stools to be dark in color.' Dark stools are a common side effect of iron supplementation due to the unabsorbed iron, and this is not a cause for concern. Choice A is incorrect because taking iron with milk can decrease its absorption due to calcium binding. Choice C is incorrect as there are no specific recommendations to take ferrous sulfate before bedtime. Choice D is also incorrect as vitamin C actually enhances iron absorption and should not be avoided.
2. What is the function of the cervix in reproduction?
- A. Accepts and interprets signals of sexual stimuli
- B. Secretes mucus to facilitate sperm transport
- C. Serves as the site for union of ovum and sperm
- D. Receives the penis during intercourse
Correct answer: B
Rationale: The cervix functions in reproduction by secreting mucus that facilitates the transport of sperm to the uterus. Choice A is incorrect because the cervix does not interpret signals of sexual stimuli. Choice C is incorrect as the site for the union of ovum and sperm is the fallopian tube. Choice D is incorrect as the cervix is not involved in receiving the penis during intercourse.
3. 4 hours after administration of 20U of regular insulin, the client becomes shaky and diaphoretic. What action should the nurse take?
- A. Encourage the client to eat crackers and milk
- B. Administer a PRN dose of 10U of regular insulin
- C. Give the client crackers and milk
- D. Record the client's reaction in the diabetic flow sheet
Correct answer: C
Rationale: The correct action for the nurse to take when a client becomes shaky and diaphoretic after insulin administration, indicating hypoglycemia, is to provide the client with carbohydrates like crackers and milk. Carbohydrates help raise blood glucose levels quickly. Encouraging the client to eat crackers and milk (Choice A) is the appropriate immediate action to address the hypoglycemia. Administering more insulin (Choice B) would worsen hypoglycemia, and recording the reaction (Choice D) is important but not the immediate action needed to treat the hypoglycemia.
4. When caring for a client with a tracheostomy, what is the most important assessment to perform?
- A. Check the client's oxygen saturation
- B. Assess the tracheostomy site for signs of infection
- C. Monitor the client's respiratory rate
- D. Ensure the tracheostomy ties are secure
Correct answer: A
Rationale: The most important assessment to perform when caring for a client with a tracheostomy is to check the client's oxygen saturation. This assessment is crucial as it ensures that the client is receiving adequate oxygen through the tracheostomy. Monitoring oxygen saturation provides immediate information on the client's respiratory status and the effectiveness of the airway management. Assessing the tracheostomy site for signs of infection is important but not as critical as ensuring adequate oxygenation. Monitoring the respiratory rate is also essential but does not directly assess the effectiveness of oxygenation. Ensuring tracheostomy ties are secure is important for maintaining the device but does not directly evaluate the client's oxygenation status.
5. A client with chronic obstructive pulmonary disease (COPD) is using a metered-dose inhaler (MDI). What technique should the nurse emphasize?
- A. The importance of using a spacer
- B. How to synchronize breaths with inhaler activation
- C. Regular cleaning of the inhaler
- D. All of the above
Correct answer: D
Rationale: In managing COPD with a metered-dose inhaler (MDI), the nurse should emphasize all of the techniques mentioned. Using a spacer can help improve drug delivery and reduce the risk of oral thrush. Synchronizing breaths with inhaler activation ensures proper medication delivery to the lungs. Regular cleaning of the inhaler prevents blockages and ensures optimal functioning. Therefore, all these techniques are important for effective COPD management, making 'All of the above' the correct answer. Choices A, B, and C are all crucial components of proper MDI technique in COPD, so they are not individually sufficient without the others.
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