HESI LPN
HESI Practice Test for Fundamentals
1. A client is immobile due to a cast, and a nurse is assisting in the use of a fracture bedpan. Which of the following actions should the nurse take?
- A. Place the shallow end of the fracture pan under the client’s buttocks.
- B. Encourage the client to remain immobile on the fracture pan for 20 minutes.
- C. Keep the bed flat while the client is on the fracture pan.
- D. Hyperextend the client’s back while the fracture pan is in place.
Correct answer: A
Rationale: The correct action when using a fracture bedpan for an immobile client is to place the shallow end of the pan under the client's buttocks. This positioning helps in proper collection of feces without causing discomfort or injury. Encouraging the client to try to defecate for 20 minutes (Choice B) is inappropriate and unrealistic, as defecation should not be forced or timed. Keeping the bed flat (Choice C) is incorrect as elevating the head of the bed can help promote proper positioning for bedpan use. Hyperextending the client's back (Choice D) is contraindicated and can lead to discomfort and potential injury to the client.
2. During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, 'I am pleased about the adjustment but somewhat concerned about my child’s reaction to me.' How should the nurse respond?
- A. The child is repressing feelings for the parent.
- B. Routines have been established, and the child feels safe.
- C. The child has given up fighting and accepts the separation.
- D. Behavior has improved because the child feels better physically.
Correct answer: C
Rationale: The correct answer is C: 'The child has given up fighting and accepts the separation.' This response indicates that the child is emotionally withdrawing due to the separation from the parent during hospitalization. Choice A is incorrect because the child's behavior does not necessarily suggest repressed feelings for the parent. Choice B is incorrect as feeling safe due to established routines does not fully explain the child's behavior. Choice D is incorrect because while feeling better physically may contribute to improved behavior, it does not address the emotional aspect of the child's reaction to the parent.
3. After placing a client at 26-weeks gestation in the lithotomy position, the client complains of dizziness and becomes pale and diaphoretic. What action should the nurse implement?
- A. Instruct the client to take deep breaths.
- B. Place a wedge under the client's hip.
- C. Place the client in the Trendelenburg position.
- D. Remove the client's legs from the stirrups.
Correct answer: B
Rationale: Placing a wedge under the client's hip is the correct action in this scenario. This helps relieve the pressure on the vena cava, which can become compressed in the lithotomy position during pregnancy, improving circulation and reducing symptoms like dizziness and pallor. Instructing the client to take deep breaths (Choice A) may not address the underlying cause of the symptoms. Placing the client in the Trendelenburg position (Choice C) would worsen the situation by further compressing the vena cava. Removing the client's legs from the stirrups (Choice D) may provide temporary relief but does not address the root cause of the issue.
4. When transferring a client to a long-term care facility, what information should the nurse include in the handoff report?
- A. Frequency of previous vital sign measurements
- B. Number of family members who have visited
- C. Time of the client's last bath
- D. Effectiveness of the last dose of pain medication
Correct answer: D
Rationale: The correct answer is D: 'Effectiveness of the last dose of pain medication.' When transferring a client to a long-term care facility, it is crucial to provide information on the effectiveness of the last dose of pain medication to ensure continuity of care and appropriate pain management. This information helps the receiving facility understand the client's current pain status and plan future interventions accordingly. Choices A, B, and C are less relevant for the handoff report in this scenario. The frequency of previous vital sign measurements may be important, but the immediate effectiveness of pain medication takes precedence. The number of family members who have visited and the time of the client's last bath are not as critical for the receiving facility's immediate care planning compared to pain management details.
5. What does a positive correlation between two variables indicate?
- A. One variable causes the other.
- B. Both variables move in the same direction.
- C. Both variables move in opposite directions.
- D. There is no relationship between the variables.
Correct answer: B
Rationale: A positive correlation between two variables indicates that they move in the same direction. This means that as one variable increases (or decreases), the other variable also increases (or decreases). Choice A is incorrect because correlation does not imply causation; it only shows a relationship between variables. Choice C is incorrect as it describes a negative correlation where variables move in opposite directions. Choice D is incorrect as a positive correlation implies a relationship between the variables.