HESI LPN
HESI Maternal Newborn
1. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?
- A. Urine protein concentration of 200 mg/24 hr.
- B. Creatinine level of 0.8 mg/dL
- C. Hemoglobin level of 14.8 g/dL
- D. Platelet count of 60,000/mm3
Correct answer: D
Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.
2. A client with a history of atrial fibrillation is prescribed amiodarone. The nurse should monitor for which potential side effect?
- A. Pulmonary toxicity
- B. Liver toxicity
- C. Thyroid dysfunction
- D. Bradycardia
Correct answer: A
Rationale: Corrected Rationale: Amiodarone is known to cause pulmonary toxicity, which can manifest as respiratory symptoms. Monitoring for signs such as cough, dyspnea, or chest pain is essential to detect this serious side effect early and prevent further complications. Choices B, C, and D are incorrect because while amiodarone can also cause liver toxicity, thyroid dysfunction, and bradycardia, pulmonary toxicity is the most serious side effect that requires immediate attention due to its potential life-threatening consequences.
3. A nurse educator is presenting a module on basic first aid for newly licensed home health nurses. The client who has heat stroke will have which of the following?
- A. Hypotension
- B. Bradycardia
- C. Clammy skin
- D. Bradypnea
Correct answer: A
Rationale: The correct answer is A: Hypotension. Heat stroke is characterized by elevated body temperature, which can lead to hypotension (low blood pressure) due to dehydration and vasodilation. Bradycardia (slow heart rate) and clammy skin are not typical findings in heat stroke. Bradypnea (slow breathing) is also not a common feature of heat stroke. Therefore, hypotension is the most likely cardiovascular manifestation seen in a client with heat stroke.
4. An LPN/LVN is conducting an initial assessment on a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, the appropriate question to ask is:
- A. With whom do you live?
- B. Who is available to help you?
- C. What leads you to seek help now?
- D. What do you usually do to feel better?
Correct answer: C
Rationale: The correct question to ask when assessing a client's perception of the precipitating event that led to a crisis is 'What leads you to seek help now?' This question directly addresses the client's current situation and triggers that brought them to seek assistance. Choices A and B are more focused on the client's social support system rather than the root cause of the crisis. Choice D addresses coping mechanisms rather than the actual trigger for seeking help.
5. What is a key preventive measure for avoiding urinary tract infections (UTIs) in children?
- A. Restrict fluid intake
- B. Encourage frequent urination
- C. Use topical antibiotics
- D. Increase dietary calcium
Correct answer: B
Rationale: Encouraging frequent urination is a key preventive measure for avoiding urinary tract infections (UTIs) in children. It helps flush bacteria from the urinary tract, reducing the risk of UTIs. Restricting fluid intake (Choice A) is not recommended as it may lead to concentrated urine and increase the risk of UTIs. Using topical antibiotics (Choice C) is not a preventive measure for UTIs and should only be used under medical guidance. Increasing dietary calcium (Choice D) is not directly linked to preventing UTIs in children.