HESI LPN
HESI Fundamentals Exam Test Bank
1. A client has been diagnosed with terminal cancer. Which of the following interventions is a priority?
- A. Teach the client to use progressive relaxation techniques.
- B. Help the client find a local support group.
- C. Discuss the client's prior coping mechanisms.
- D. Develop a list of goals with the client.
Correct answer: D
Rationale: When a client receives a terminal cancer diagnosis, it is crucial to prioritize developing a list of goals with the client. This process helps the client focus on what is important to them, set achievable objectives, and maintain a sense of purpose and control. Teaching relaxation techniques (choice A) may be beneficial for symptom management but is not the priority when confronting a terminal illness. While finding a local support group (choice B) can be valuable for emotional support, it does not directly address setting goals. Discussing prior coping mechanisms (choice C) can provide insights into the client's coping strategies but may not be as essential as establishing future goals in the face of a terminal illness.
2. With an alert of an internal disaster and the need for beds, the charge nurse is asked to list clients who are potential discharges within the next hour. Which client should the charge nurse select?
- A. An elderly client who has had type 2 diabetes for over 20 years, admitted with diabetic ketoacidosis 24 hours ago
- B. An adolescent admitted the prior night with Tylenol intoxication
- C. A middle-aged client with an internal automatic defibrillator and complaints of 'passing out at unknown times' admitted yesterday
- D. A school-age child diagnosed with suspected bacterial meningitis and was admitted at the change of shifts
Correct answer: A
Rationale: The correct answer is A because a client with diabetic ketoacidosis (DKA) that is being well-managed and has shown improvement within 24 hours is more stable and can be considered for discharge sooner than those with more acute or unstable conditions. Choice B is incorrect as Tylenol intoxication may require further monitoring and intervention. Choice C is incorrect as a client with an automatic defibrillator and episodes of passing out needs careful evaluation and monitoring. Choice D is incorrect as suspected bacterial meningitis is a serious condition that typically requires a longer hospital stay for treatment and observation.
3. When planning interventions for a group of clients who are obese, what can the nurse do to improve their commitment to a long-term goal of weight loss?
- A. Developing a strict diet plan
- B. Attempting to develop the clients’ self-motivation
- C. Providing frequent rewards
- D. Encouraging group exercise
Correct answer: B
Rationale: To improve clients' commitment to a long-term goal of weight loss, attempting to develop their self-motivation is crucial. Self-motivation is essential for sustaining behavior changes over time. Providing a strict diet plan (choice A) may not address the root motivation needed for long-term success. While rewards (choice C) can be motivating, relying solely on external rewards may not foster the intrinsic motivation required for sustained weight loss. Encouraging group exercise (choice D) is beneficial, but without addressing individual motivation, it may not lead to long-term commitment to weight loss goals.
4. A client presents to the office with complaints of swelling in the legs, chills, and shortness of breath. During auscultation of the chest, a heart murmur is heard. The client's blood culture reveals a microorganism in the blood. When a microorganism is found in the blood, this condition is called
- A. Bacteremia
- B. Sepsis
- C. Septicemia
- D. Parasitic infection
Correct answer: A
Rationale: When a microorganism is found in the blood, this condition is called bacteremia, which refers to the presence of bacteria in the bloodstream, as indicated by a positive blood culture. If not appropriately treated, bacteremia can progress to septicemia, also known as sepsis. Sepsis is a severe and life-threatening response to an infection, characterized by systemic inflammation and organ dysfunction. Parasitic infections involve pathogens other than bacteria and are not directly related to the scenario described.
5. Which healthcare-associated infection poses the greatest risk for patients?
- A. Pneumonia
- B. Catheter-related infections
- C. Intravenous line infections
- D. C. difficile
Correct answer: B
Rationale: Catheter-related infections pose the greatest risk for patients in healthcare settings. Catheters are invasive devices that can introduce pathogens directly into the bloodstream, leading to severe infections. Pneumonia, intravenous line infections, and C. difficile infections are serious concerns as well, but catheter-related infections are particularly risky due to the direct access they provide for pathogens to enter the body.