HESI LPN
HESI Fundamentals Exam
1. A nurse in an outpatient surgical center is admitting a client for a laparoscopic procedure. The client has a prescription for preoperative diazepam. Prior to administering the medication, which of the following actions is the nurse’s priority?
- A. Teaching the client about the purpose of the medication
- B. Giving the medication at the administration time the provider prescribed
- C. Identifying the client’s medication allergies
- D. Documenting the client’s anxiety level
Correct answer: C
Rationale: The correct answer is C: Identifying the client's medication allergies. This is the priority action before administering any medication to prevent allergic reactions or adverse effects. Teaching the client about the medication's purpose is important for client understanding but not as critical as ensuring the absence of allergies. While giving medication at the prescribed time is crucial, verifying allergies takes precedence to ensure patient safety. Documenting the client's anxiety level is relevant for holistic care but is not the priority compared to ensuring safe medication administration.
2. What causes Down's syndrome?
- A. Alcohol abuse by the mother at the time of conception.
- B. Sex-linked chromosomal abnormalities.
- C. An extra chromosome on the 21st pair.
- D. Drug abuse by the mother during pregnancy.
Correct answer: C
Rationale: Down's syndrome, also known as trisomy 21, is caused by the presence of an extra chromosome on the 21st pair. Choice A is incorrect as alcohol abuse is not the cause of Down's syndrome. Choice B is incorrect because Down's syndrome is not related to sex-linked chromosomal abnormalities. Choice D is also incorrect as drug abuse by the mother during pregnancy is not the cause of Down's syndrome.
3. The nurse is caring for a client who is experiencing a panic attack. Which intervention should the nurse implement first?
- A. Stay with the client and remain calm.
- B. Encourage the client to express their feelings.
- C. Teach the client deep-breathing exercises.
- D. Administer prescribed anti-anxiety medication.
Correct answer: A
Rationale: The priority intervention is to stay with the client and remain calm (A). This provides immediate support and reassurance. Encouraging the client to express their feelings (B) and teaching deep-breathing exercises (C) are important but should come after ensuring the client's immediate safety and comfort. Administering medication (D) might be necessary, but the nurse should first focus on providing a calming presence to help the client feel safe and supported during the panic attack.
4. When the client asks the nurse if they have ever been with someone when they died, what is the nurse’s best response?
- A. “Yes, I have. Do you have some questions about dying?”
- B. “Several times. Now, let’s get your dressing changed.”
- C. “A few times. It was peaceful and there was no pain.”
- D. “Yes, but you’re doing great. Are you concerned about dying?”
Correct answer: A
Rationale: Choice A is the best response as it acknowledges the client's question and opens the door for further discussion about dying if the client wishes to. It shows empathy and encourages the client to express any concerns they may have. Choices B and C do not directly address the client's question or offer an opportunity for him to explore his concerns. Choice D acknowledges the experience but fails to address the client's question directly and does not encourage further discussion.
5. A 35-year-old male client on the psychiatric ward of a general hospital believes that someone is trying to poison him. The nurse understands that a client's delusions are most likely related to his
- A. early childhood experiences involving authority issues.
- B. anger about being hospitalized.
- C. low self-esteem.
- D. phobic fear of food.
Correct answer: C
Rationale: The correct answer is C: low self-esteem. Delusions of persecution, like being poisoned, are often rooted in underlying issues of low self-esteem and trust. Option A is incorrect because the delusion is not necessarily related to early childhood experiences involving authority issues. Option B is incorrect as there is no information provided that suggests the client's delusion is driven by anger about being hospitalized. Option D is incorrect as the delusion is about being poisoned, not a phobic fear of food.