a newborn presents with a pronounced cephalic hematoma following a birth in the posterior position which nursing diagnosis should guide the plan of ca
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Nursing Elites

HESI LPN

Community Health HESI Test Bank 2023

1. A newborn presents with a pronounced cephalic hematoma following a birth in the posterior position. Which nursing diagnosis should guide the plan of care?

Correct answer: C

Rationale: The correct nursing diagnosis to guide the plan of care for a newborn with a pronounced cephalic hematoma following a birth in the posterior position is 'Parental anxiety related to knowledge deficit.' This is appropriate because the parents may be worried about the appearance and potential complications of the cephalic hematoma. They may require education and reassurance from the nurse. Choices A, B, and D are incorrect because they do not address the emotional needs of the parents and the knowledge deficit they may have regarding the condition.

2. A client with acute pancreatitis is experiencing severe abdominal pain. The nurse should implement which of the following interventions?

Correct answer: B

Rationale: The correct intervention for a client with acute pancreatitis experiencing severe abdominal pain is to administer opioid analgesics. Opioids are effective in managing the severe pain associated with acute pancreatitis. Encouraging oral intake may exacerbate the symptoms and is contraindicated due to the need for bowel rest. Applying a heating pad to the abdomen can worsen inflammation and should be avoided. Placing the client in a supine position may not provide relief and could potentially lead to increased discomfort.

3. The nurse has just admitted a client with severe depression. From which focus should the nurse identify a priority nursing diagnosis?

Correct answer: D

Rationale: In severe depression, the priority nursing diagnosis is safety. Individuals with severe depression are at risk of self-harm or suicide. Ensuring the client's safety by implementing measures to prevent harm to themselves or others is crucial. While nutrition, elimination, and activity are important aspects of care, ensuring the client's immediate safety takes precedence in this situation.

4. Which client has the highest risk for developing community-acquired pneumonia?

Correct answer: C

Rationale: The correct answer is C because homeless individuals who are alcoholics and smoke have a higher risk of developing community-acquired pneumonia due to factors like poor living conditions, compromised immune systems, and increased exposure to infections. Choice A is less likely as the teacher's profession, while involving contact with children, may not pose as high a risk as the factors in choice C. Choice B may have respiratory issues but does not have the same risk factors as choice C. Choice D, the aerobics instructor, may have a healthy lifestyle but skipping meals and a restrictive diet do not directly correlate with a higher risk of pneumonia compared to the risk factors in choice C.

5. What does the acronym ICD stand for in medical terminology?

Correct answer: A

Rationale: The correct answer is A: International Classification of Diseases. The ICD is a system used worldwide to classify and code various health conditions and diseases. This system helps in standardizing the documentation and coding of diseases, which is essential for epidemiology, research, and healthcare management. Choices B, C, and D are incorrect as they do not represent the widely recognized meaning of the acronym ICD in medical terminology.

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