HESI LPN
HESI CAT Exam Quizlet
1. A client with diabetes mellitus tells the nurse that she uses cranberry juice to help prevent urinary tract infection. What instruction should the nurse provide?
- A. Ensure to drink sugar-free cranberry juice
- B. Drinking cranberry juice does not prevent infection
- C. Cranberries do not affect insulin levels
- D. Excessive cranberry juice consumption can lead to constipation
Correct answer: B
Rationale: The correct answer is B: Drinking cranberry juice does not prevent urinary tract infections and should not be relied upon as a preventive measure. While cranberry juice is often associated with preventing UTIs, there is limited scientific evidence to support this claim. Choice A is incorrect because the sugar content in cranberry juice is not the main concern when discussing its role in preventing UTIs. Choice C is incorrect as there is no significant evidence to suggest cranberries affecting insulin levels. Choice D is incorrect as constipation is not a typical side effect of consuming cranberry juice; however, excessive consumption may lead to gastrointestinal discomfort.
2. An older male was recently admitted to the rehabilitation unit with unilateral neglect syndrome as a result of a cerebrovascular accident (CVA). Which action should the nurse include in the plan of care?
- A. Provide additional light in the room to promote sensory stimulation
- B. Teach the client to turn his head from side to side for visual scanning
- C. Place a clock and calendar in the room to improve orientation
- D. Use hand and arm gestures to improve communication and comprehension
Correct answer: B
Rationale: Teaching the client to turn his head from side to side for visual scanning is essential in addressing unilateral neglect syndrome caused by a cerebrovascular accident. This action helps improve visual awareness and assists the client in overcoming the neglect of one side of the body. Providing additional light for sensory stimulation (Choice A) may not directly address the issue of unilateral neglect. Placing a clock and calendar in the room (Choice C) may be helpful for orientation but does not specifically target unilateral neglect. Using hand and arm gestures for communication (Choice D) may aid in communication but does not directly address the visual scanning deficits associated with unilateral neglect syndrome.
3. The nurse is assessing a first-day postpartum client. Which finding is most indicative of a postpartum infection?
- A. Oral temperature of 100.2°F (37.9°C)
- B. Blood pressure of 122/74 mmHg
- C. Moderate amount of foul-smelling lochia
- D. White blood count of 19,000/mm³ (19x10^9/L SI units)
Correct answer: C
Rationale: A foul-smelling lochia is indicative of a postpartum infection, such as endometritis. Foul-smelling lochia suggests the presence of infection due to the breakdown of tissue by bacteria, leading to the malodor. An oral temperature elevation and an elevated white blood cell count are nonspecific and can be present in various conditions other than postpartum infections, making them less indicative. A blood pressure within normal limits is not typically associated with postpartum infections.
4. The healthcare provider receives a report on four clients who are complaining of increased pain. Which client requires immediate attention by the healthcare provider?
- A. Burning pain due to a Morton’s neuroma
- B. Sharp pain related to a crushed femur
- C. Paresthesia of fingers due to carpal tunnel syndrome
- D. Stinging pain related to plantar fasciitis
Correct answer: B
Rationale: Sharp pain related to a crushed femur indicates a severe condition and potential serious complications that require immediate attention. Crushed femur can lead to severe bleeding, nerve damage, or compartment syndrome, which are critical and life-threatening. The other choices, although painful, are less likely to present immediate life-threatening issues. Morton’s neuroma, carpal tunnel syndrome, and plantar fasciitis are painful conditions but are not typically associated with urgent, life-threatening complications like a crushed femur.
5. A 17-year-old adolescent is brought to the emergency department by both parents because the adolescent has been coughing and running a fever with flu-like symptoms for the past 24 hours. Which intervention should the nurse implement first?
- A. Obtain a chest X-ray per protocol.
- B. Place a mask on the client’s face.
- C. Assess the client’s temperature.
- D. Determine the client’s blood pressure
Correct answer: B
Rationale: The correct intervention for the nurse to implement first is to place a mask on the client's face. This is crucial to prevent the potential spread of infectious agents to others in the emergency department, considering the presenting symptoms of coughing and fever. Placing a mask helps in containing respiratory secretions and reducing the risk of airborne transmission. Assessing the client’s temperature or blood pressure can be done after ensuring infection control measures. Obtaining a chest X-ray would be a secondary intervention once immediate infection control is addressed.
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