HESI LPN
HESI Mental Health
1. A female client in an acute care facility has been on antipsychotic medications for the past three days. Her psychotic behaviors have decreased and she has had no adverse reactions. On the fourth day, the client's blood pressure increases, she becomes pale and febrile, and demonstrates muscular rigidity. What action should the nurse initiate?
- A. Place the client on seizure precautions and monitor her frequently.
- B. Take the client's vital signs and notify the physician immediately.
- C. Describe the symptoms to the charge nurse and document them in the client's record.
- D. No action is required at this time as these are known side effects of her medications.
Correct answer: B
Rationale: The correct action for the nurse to initiate is to take the client's vital signs and notify the physician immediately. These symptoms may indicate neuroleptic malignant syndrome, a rare but life-threatening reaction to antipsychotic medications, requiring immediate medical attention. Placing the client on seizure precautions and monitoring her frequently (Choice A) is not the most appropriate action in this situation. Describing the symptoms to the charge nurse and documenting them in the client's record (Choice C) delays prompt medical intervention. Choosing not to take any action (Choice D) is dangerous as the symptoms described suggest a serious condition that needs urgent evaluation and treatment.
2. Which of the following is an example of a positive outcome for one of the Leading Health Indicators of Healthy People 2020?
- A. A community has adopted a no smoking policy.
- B. A rural community has a public transportation system.
- C. The high school dropout rate has decreased by 15%.
- D. A county has decreased its divorce rate by 10%.
Correct answer: A
Rationale: The correct answer is A. A community adopting a no smoking policy is a positive outcome for the Leading Health Indicators of Healthy People 2020 as it promotes a healthier environment by reducing exposure to secondhand smoke and decreasing smoking-related illnesses. Choices B, C, and D do not directly align with the goals of the Leading Health Indicators. While public transportation and reduced dropout rates are beneficial for community well-being, they are not specific examples of Leading Health Indicators. Decreasing divorce rates, while potentially beneficial for family stability, is not a focus area of the Leading Health Indicators.
3. A client has been taking simvastatin for 3 days and calls the nurse at the clinic to report extreme muscle tenderness and pain. Which is the most appropriate action?
- A. Notify the health care provider.
- B. Review the medication with the client.
- C. Advise the client to avoid grapefruit juice.
- D. Remind the client to limit physical activity until evaluated by the health care provider.
Correct answer: A
Rationale: Extreme muscle tenderness and pain in a client taking simvastatin could indicate rhabdomyolysis, a serious condition. Promptly notifying the health care provider is crucial to evaluate and manage this potential medical emergency. Reviewing the medication with the client may not address the urgency of the situation. Advising the client to avoid grapefruit juice is not directly related to the client's current symptoms. Reminding the client to limit physical activity until evaluated by the health care provider is not appropriate as the client's symptoms should be assessed by a professional first.
4. What is the primary purpose of a placebo in an experiment?
- A. To reduce the cost of the experiment.
- B. To make the experiment double-blind.
- C. To increase the number of participants.
- D. To serve as a control for comparison with the treatment group.
Correct answer: D
Rationale: The correct answer is D. A placebo serves as a control for comparison with the treatment group, helping to eliminate bias and ensure the results are due to the treatment itself. Placebos are crucial in research to distinguish the actual effect of the treatment from psychological or subjective factors. Choice A is incorrect because the purpose of a placebo is not related to reducing the cost of the experiment. Choice B is incorrect because while placebos are used in double-blind studies, their primary purpose is not to make the experiment double-blind. Choice C is incorrect because the purpose of a placebo is not to increase the number of participants but rather to serve as a comparison group for the treatment being tested.
5. A nurse is teaching the parents of a child with a diagnosis of type 1 diabetes mellitus about blood glucose monitoring. What should the nurse emphasize?
- A. Checking blood glucose levels before meals and at bedtime
- B. Using a lancet device to obtain blood samples
- C. Using urine test strips for monitoring
- D. Recognizing signs of hypoglycemia
Correct answer: A
Rationale: Checking blood glucose levels before meals and at bedtime is essential in managing type 1 diabetes mellitus as it helps in monitoring blood sugar levels at different times of the day and adjusting insulin doses accordingly. Option B about using a lancet device to obtain blood samples is a technique rather than an emphasis on monitoring frequency. Option C suggesting the use of urine test strips is incorrect as urine test strips are not recommended for accurate real-time monitoring of blood glucose levels in type 1 diabetes. Option D, recognizing signs of hypoglycemia, is important but not the primary emphasis when educating about blood glucose monitoring.