HESI LPN
Adult Health Exam 1 Chamberlain
1. A client with a history of hypertension is prescribed lisinopril. Which potential side effect should the nurse monitor for?
- A. Hypokalemia
- B. Hyperglycemia
- C. Persistent cough
- D. Tachycardia
Correct answer: C
Rationale: The correct answer is C: Persistent cough. Lisinopril is an ACE inhibitor commonly associated with a persistent dry cough as a side effect. This cough is thought to result from increased bradykinin levels. Choices A, B, and D are incorrect. Hypokalemia is not a common side effect of lisinopril; in fact, it may lead to hyperkalemia. Hyperglycemia is not a typical side effect of lisinopril use. Tachycardia is also not a common side effect associated with ACE inhibitors like lisinopril.
2. The wife is observed shaving her husband's beard with a safety razor. What should the nurse do?
- A. Advise the wife to shave against the hair growth
- B. Teach the wife to keep the skin loose to avoid cuts
- C. Encourage the wife to continue shaving her husband
- D. Demonstrate the correct procedure to the wife
Correct answer: C
Rationale: In this situation, the nurse should encourage the wife to continue shaving her husband. The rationale behind this is that the wife is already performing the task, so abrupt interference may lead to potential harm or emotional distress. It is crucial for the nurse to carefully observe the situation and assess for any safety concerns. While teaching proper techniques (Choice B) is important, it can be addressed later in a non-critical manner to prevent skin irritation and injury. Advising to shave against the hair growth (Choice A) may cause skin irritation and cuts. Although demonstrating the correct procedure (Choice D) may be helpful, it is essential to consider the current dynamics and respect the wife's autonomy in caring for her husband.
3. A client with a history of asthma is experiencing wheezing and shortness of breath. What is the priority nursing intervention?
- A. Administer a bronchodilator as prescribed
- B. Encourage the client to drink fluids
- C. Place the client in an upright position
- D. Assess the client's peak flow rate
Correct answer: A
Rationale: Administering a bronchodilator as prescribed is the priority nursing intervention for a client experiencing wheezing and shortness of breath due to asthma. Bronchodilators help relieve bronchoconstriction, allowing better airflow and improving breathing. Encouraging the client to drink fluids may be beneficial in certain situations, but it is not the priority when the client is in respiratory distress. Placing the client in an upright position, not supine, can facilitate easier breathing by allowing the chest to expand fully. While assessing the client's peak flow rate is important in asthma management, in this acute situation, the priority is to provide immediate relief by administering the bronchodilator.
4. A client with a diagnosis of deep vein thrombosis (DVT) is receiving anticoagulant therapy. Which instruction should the nurse provide to the client?
- A. Avoid walking as much as possible
- B. Report any signs of bleeding to the healthcare provider
- C. Take aspirin for additional pain relief
- D. Wear compression stockings at night
Correct answer: B
Rationale: Reporting signs of bleeding is essential while on anticoagulant therapy to prevent complications.
5. A client with a diagnosis of tuberculosis (TB) is being discharged home. Which instruction is most important for the nurse to provide?
- A. Avoid close contact with others until treatment is complete.
- B. Take all prescribed medications as directed.
- C. Schedule a follow-up appointment with the healthcare provider.
- D. Wear a mask when in public places.
Correct answer: B
Rationale: The most important instruction for a client with tuberculosis (TB) is to take all prescribed medications as directed. This is crucial to prevent the development of drug-resistant TB. While avoiding close contact with others until treatment is complete (Choice A) is important to prevent the spread of TB, ensuring the client completes the prescribed medication regimen is the priority. Scheduling a follow-up appointment (Choice C) is important for monitoring but not as critical as medication adherence. Wearing a mask in public places (Choice D) can help reduce the spread of TB but is not as essential as taking medications as prescribed.
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