HESI LPN
Mental Health HESI Practice Questions
1. An LPN/LVN is caring for a suicidal client. The appropriate nursing intervention in dealing with this client is to:
- A. Demonstrate confidence in the client's ability to deal with stressors
- B. Provide hope and reassurance that the problems will resolve themselves
- C. Display an attitude of detachment, confrontation, and efficiency
- D. Provide authority, action, and participation
Correct answer: D
Rationale: When caring for a suicidal client, providing authority, taking action, and encouraging the client's participation in their care are essential. Choice A is incorrect as it may not be sufficient for the critical situation of a suicidal client. Choice B, while offering hope, may not address the immediate risk of harm. Choice C's attitude of detachment and confrontation can be counterproductive in establishing trust and rapport with the client. Therefore, the most appropriate intervention is to provide authority, take action to ensure safety, and involve the client in the care process.
2. What should be included in the teaching plan for parents of an infant diagnosed with phenylketonuria (PKU)?
- A. Mental retardation occurs if PKU is untreated.
- B. Testing for PKU is done immediately after birth.
- C. Treatment for PKU includes lifelong dietary management.
- D. PKU is transmitted as an autosomal recessive trait.
Correct answer: A
Rationale: The correct answer is A: 'Mental retardation occurs if PKU is untreated.' Phenylketonuria (PKU) is a metabolic disorder that results in the inability to metabolize phenylalanine properly. Without proper dietary management, high levels of phenylalanine can lead to severe mental retardation and other neurological problems. Therefore, educating parents about the importance of early and consistent treatment to prevent mental retardation is crucial. Choice B is incorrect because testing for PKU is typically done shortly after birth, not immediately. Choice C is incorrect because treatment for PKU primarily involves strict dietary management to control phenylalanine intake, not lifelong medications. Choice D is incorrect because PKU is inherited in an autosomal recessive pattern, not as an autosomal dominant gene.
3. A client with a diagnosis of schizophrenia is experiencing auditory hallucinations. What is the most appropriate nursing intervention?
- A. Ask the client to describe the voices and what they are saying.
- B. Tell the client that the voices are not real.
- C. Encourage the client to engage in reality-based activities.
- D. Ask the client to focus on positive thoughts instead of the voices.
Correct answer: C
Rationale: The most appropriate nursing intervention for a client with schizophrenia experiencing auditory hallucinations is to encourage them to engage in reality-based activities. This intervention helps manage auditory hallucinations by redirecting the client's focus away from the hallucinations. Choice A is not recommended as it may exacerbate the hallucinations or distress the client. Choice B is incorrect because denying the reality of the voices can invalidate the client's experiences. Choice D, asking the client to focus on positive thoughts, may not be effective in addressing the auditory hallucinations directly.
4. The nurse enters the room of a client who is awaiting surgery for appendicitis. The unlicensed assistive personnel (UAP) has helped the client to a position of comfort with the right leg flexed and has applied a heating pad to the client’s abdomen to relieve the client’s pain. Which action should the nurse implement first?
- A. Remove the heating pad.
- B. Reposition the client’s right leg.
- C. Monitor for signs of inflammation.
- D. Assess the client’s pain level.
Correct answer: A
Rationale: The correct action for the nurse to implement first is to remove the heating pad. Heating pads should not be used for suspected appendicitis as they can mask symptoms and potentially worsen inflammation. Choice B is not the priority as the position of comfort chosen by the UAP may be appropriate. Monitoring for signs of inflammation (Choice C) is important but not the initial action to address the immediate issue of the heating pad. Assessing the client's pain level (Choice D) can be done after removing the heating pad to evaluate the effectiveness of pain relief measures.
5. The LPN/LVN is caring for a client who is experiencing alcohol withdrawal. Which intervention should the nurse implement first?
- A. Administer a PRN dose of lorazepam (Ativan).
- B. Monitor the client's vital signs.
- C. Place the client on seizure precautions.
- D. Encourage the client to express feelings about withdrawal.
Correct answer: B
Rationale: When caring for a client experiencing alcohol withdrawal, the first intervention the nurse should implement is to monitor the client's vital signs. Vital sign monitoring is crucial to assess for any potential complications such as hypertension, tachycardia, fever, or other signs of autonomic hyperactivity. Administering medication like lorazepam (Ativan) would come after assessing the vital signs to determine the need for pharmacological intervention. Placing the client on seizure precautions is important, but assessing vital signs takes precedence to ensure immediate safety. Encouraging the client to express feelings about withdrawal is a supportive intervention but does not address the immediate physiological risk associated with alcohol withdrawal.