HESI LPN
Adult Health Exam 1
1. A client with hypothyroidism is being treated with levothyroxine (Synthroid). What is the most important information for the nurse to provide to the client?
- A. Take the medication on an empty stomach
- B. Monitor for signs of hyperthyroidism
- C. Expect to see results within a week
- D. Avoid exposure to sunlight
Correct answer: B
Rationale: The most important information for the nurse to provide to a client with hypothyroidism being treated with levothyroxine is to monitor for signs of hyperthyroidism. Too much levothyroxine can lead to symptoms of hyperthyroidism, indicating an overdose. Choice A is incorrect as levothyroxine is usually taken on an empty stomach to ensure optimal absorption. Choice C is inaccurate as it may take weeks to months to see the full effects of levothyroxine therapy due to the need for dosage adjustments. Choice D is unrelated to levothyroxine therapy and is not a crucial concern for this specific medication.
2. A client with a history of congestive heart failure is prescribed digoxin (Lanoxin). Which assessment is most important for the nurse to obtain before administering this medication?
- A. Blood pressure
- B. Heart rate
- C. Respiratory rate
- D. Oxygen saturation
Correct answer: B
Rationale: The correct answer is B: Heart rate. Before administering digoxin to a client with a history of congestive heart failure, the nurse must assess the client's heart rate. Digoxin can cause bradycardia, so monitoring the heart rate is crucial to prevent potential complications. Assessing blood pressure, respiratory rate, and oxygen saturation are important assessments but are not as directly influenced by digoxin as heart rate is in this scenario. Blood pressure can be affected by various factors, including dehydration or other medications. Respiratory rate and oxygen saturation are more related to respiratory function and gas exchange, which are not the primary concerns when administering digoxin to a client with heart failure.
3. What is the primary purpose of a chest tube in a client's care?
- A. To drain air and fluid from the pleural space
- B. To prevent infection in the thoracic cavity
- C. To assist with lung expansion
- D. To monitor intrathoracic pressure
Correct answer: A
Rationale: The correct answer is A: To drain air and fluid from the pleural space. A chest tube is primarily used to remove accumulated air or fluid in the pleural space, preventing lung collapse or compromise of lung function. This intervention aims to re-expand the lung and enhance respiratory function. Choice B is incorrect because preventing infection is not the primary purpose of a chest tube. Choice C is incorrect as lung expansion is a result of draining the pleural space, not the primary goal. Choice D is incorrect as monitoring intrathoracic pressure is not the main objective of a chest tube insertion.
4. A client requires application of an eye shield to the right eye. What should the nurse do in order to apply tape to anchor the shield most effectively?
- A. Place tape from the cheek to the forehead
- B. Secure tape from the nose to the ear
- C. Attach tape from the lower eyelid to the upper forehead
- D. Use circular bandaging around the head
Correct answer: C
Rationale: The correct way to apply tape to anchor an eye shield effectively is to attach the tape from the lower eyelid to the upper forehead. This method provides stability for the shield without putting pressure on the eye itself, thus helping to protect the eye. Choices A, B, and D are incorrect because taping from the cheek to the forehead, securing tape from the nose to the ear, or using circular bandaging around the head may not provide the necessary stability and protection required for the eye shield.
5. The nurse is caring for a client with a diagnosis of bipolar disorder who is taking lithium. What is the most important information the nurse should provide?
- A. Take the medication on an empty stomach.
- B. Monitor sodium intake.
- C. Report any signs of weight gain.
- D. Avoid excessive caffeine intake.
Correct answer: B
Rationale: The correct answer is B: 'Monitor sodium intake.' Sodium levels can affect lithium levels in the body, so it is crucial to maintain a consistent sodium intake to prevent toxicity or subtherapeutic levels. Option A is incorrect because lithium is usually recommended to be taken on an empty stomach to enhance absorption. Option C, reporting signs of weight gain, is relevant but not as critical as monitoring sodium intake. Option D, avoiding excessive caffeine intake, is important for some individuals but not as essential as monitoring sodium levels when taking lithium.
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