HESI LPN
HESI Fundamentals Exam Test Bank
1. A healthcare provider has inserted an indwelling catheter for a male patient. Where should the healthcare provider tape the catheter to prevent pressure on the client's urethra at the penoscrotal junction?
- A. Lower abdomen
- B. Upper thigh
- C. Penoscrotal junction
- D. Mid-abdomen
Correct answer: A
Rationale: Taping the catheter to the lower abdomen is the correct placement to prevent pressure on the urethra at the penoscrotal junction. Securing the catheter at the lower abdomen helps in reducing discomfort and minimizes the risk of trauma to the urethra. Placing the catheter on the upper thigh or penoscrotal junction can lead to tension on the catheter and potential discomfort for the patient. Taping the catheter to the mid-abdomen is not recommended as it does not provide the necessary support to prevent pressure on the urethra at the penoscrotal junction.
2. The healthcare provider prescribes the diuretic metolazone (Zaroxolyn) 7.5 mg PO. Zaroxolyn is available in 5 mg tablets. How much should the LPN/LVN plan to administer?
- A. 1/2 tablet.
- B. 1 tablet.
- C. 1 1/2 tablets.
- D. 2 tablets.
Correct answer: C
Rationale: To administer 7.5 mg of metolazone (Zaroxolyn), the LPN/LVN should plan to give 1 1/2 tablets since each tablet contains 5 mg. Choice A (1/2 tablet) would not provide the full prescribed dose. Choice B (1 tablet) would only deliver 5 mg, which is less than the prescribed dose. Choice D (2 tablets) would exceed the prescribed dose, resulting in 10 mg instead of the required 7.5 mg. Therefore, the correct answer is to administer 1 1/2 tablets to achieve the prescribed 7.5 mg.
3. The healthcare provider is caring for a patient with a spinal cord injury and notices that the patient's hips have a tendency to rotate externally when the patient is supine. Which device will the healthcare provider use to help prevent injury secondary to this rotation?
- A. Hand rolls
- B. A trapeze bar
- C. A trochanter roll
- D. Hand-wrist splints
Correct answer: C
Rationale: A trochanter roll is the correct choice as it is used to prevent external rotation of the hips when the patient is in a supine position. Hand rolls (Choice A) are incorrect because they are used to prevent contractures of the fingers, wrist, and hand. A trapeze bar (Choice B) is not the correct option as it helps patients change positions in bed and aids with movement, not specifically for hip rotation. Hand-wrist splints (Choice D) are also incorrect as they are used to maintain the functional position of the wrist and hand, not to address hip rotation.
4. When assessing a client's skin as part of a comprehensive physical examination, what finding should a nurse expect?
- A. Capillary refill less than 3 seconds
- B. 1+ pitting edema in both feet
- C. Pale nail beds in both hands
- D. Thick skin on the soles of the feet
Correct answer: A
Rationale: The correct answer is A: Capillary refill less than 3 seconds. This finding is considered normal and indicates good peripheral perfusion. Pitting edema (choice B) and pale nail beds (choice C) are abnormal findings that may suggest underlying health issues. Thick skin on the soles of the feet (choice D) is not an expected normal finding during a skin assessment and could be indicative of a callus or other skin condition.
5. The nurse is preparing to administer insulin to a client with type 1 diabetes. Which assessment finding would require the nurse to hold the insulin and contact the healthcare provider?
- A. Blood glucose of 100 mg/dL
- B. Client reports feeling shaky
- C. Client ate only half of breakfast
- D. Client is sweating
Correct answer: A
Rationale: A blood glucose of 100 mg/dL is relatively low for administering insulin, especially if the client has not eaten adequately; further assessment and contacting the provider are necessary. Hypoglycemia can be a serious concern when administering insulin, and a blood glucose level of 100 mg/dL indicates a risk of hypoglycemia. Holding the insulin and contacting the healthcare provider is crucial to prevent hypoglycemia-related complications. Choices B, C, and D are not immediate concerns for holding insulin as they do not directly indicate a risk of hypoglycemic events.
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