HESI LPN
HESI Mental Health 2023
1. A client with schizophrenia is being discharged with a prescription for risperidone (Risperdal). What is the most important information for the nurse to provide?
- A. You need to have regular blood tests while taking this medication.
- B. Report any muscle stiffness or unusual movements immediately.
- C. Avoid foods high in tyramine while taking this medication.
- D. This medication may cause weight loss.
Correct answer: B
Rationale: The correct answer is B: "Report any muscle stiffness or unusual movements immediately." This information is crucial because muscle stiffness or unusual movements may indicate extrapyramidal symptoms (EPS), a potential side effect of risperidone that requires immediate attention. Choice A is less critical as regular blood tests are important but not as urgent as identifying EPS. Choice C is irrelevant as tyramine interactions are not associated with risperidone. Choice D is incorrect as weight gain is more common than weight loss with risperidone.
2. During the health assessment of a school-age child, on which problem would the nurse focus more attention based on the child's developmental level?
- A. Infections
- B. Poisonings
- C. Risk-taking behaviors
- D. Accidents and injuries
Correct answer: D
Rationale: During the school-age years, children are more physically active and curious, which increases their risk of accidents and injuries. This developmental stage is characterized by increased exploration and engagement in physical activities. While infections and poisonings are important health concerns, school-age children are more likely to be affected by accidents and injuries due to their active nature. Risk-taking behaviors may become more prevalent in adolescence rather than during the school-age period, making it a less likely focus for the nurse during the health assessment of a school-age child.
3. A client with chronic obstructive pulmonary disease (COPD) is prescribed tiotropium. The nurse should instruct the client to report which potential side effect?
- A. Dry mouth
- B. Blurred vision
- C. Nausea
- D. Tachycardia
Correct answer: A
Rationale: The correct answer is A: Dry mouth. Tiotropium, a commonly prescribed medication for COPD, can cause dry mouth as a side effect. While it may not be severe, clients should report it if it becomes bothersome. Dry mouth is a common side effect of tiotropium due to its anticholinergic properties. Blurred vision, nausea, and tachycardia are not typically associated with tiotropium use in the context of COPD.
4. Who should document care?
- A. The LPNs should document the care that they provided and the care that was given by unlicensed assistive staff.
- B. The registered nurse must document all of the care that is provided by the nursing assistants because they are accountable for all care.
- C. All staff members should document all of the care that they have provided.
- D. All staff should document all of the care that they have provided but the registered nurse, as the only independent practitioner, signs it.
Correct answer: C
Rationale: All staff members should document the care they provided as part of their accountability and to ensure accurate and comprehensive records. In healthcare settings, it is essential for all staff to document the care they deliver for continuity of care and legal purposes. The registered nurse may sign off on the documentation for oversight purposes, but the responsibility of documenting care extends to all staff involved in patient care. Choices A and B incorrectly limit the responsibility to specific roles, while choice D inaccurately suggests that only the registered nurse signs off on the documentation, overlooking the importance of comprehensive documentation by all staff members involved.
5. A public health nurse is working with a community to develop a disaster response plan. Which of the following is the priority action?
- A. Identifying available resources and services
- B. Conducting disaster drills
- C. Educating the community about disaster preparedness
- D. Developing a communication plan
Correct answer: A
Rationale: Identifying available resources and services is the priority action when developing a disaster response plan. This step is crucial as it helps the community understand what resources and services are already in place and what additional support may be needed during a disaster. Conducting disaster drills, educating the community about disaster preparedness, and developing a communication plan are important steps in disaster preparedness but come after identifying available resources and services. Without knowing the available resources, it would be challenging to effectively plan and respond to a disaster.