a nurse is caring for a client who is unconscious and whose partner is their health care surrogate the partner wishes to discontinue the clients feedi

HESI LPN

HESI Leadership and Management Test Bank

1. A nurse is caring for a client who is unconscious and whose partner is their health care surrogate. The partner wishes to discontinue the client's feeding tube, but another family member tells the nurse that they want the client to continue receiving treatment. Which of the following responses should the nurse make?

A. You should contact the provider about your wishes for your family member.
B. We'll need to have the nursing supervisor review the client's advance directives.
C. You should speak with the facility's ethics committee about your concerns.
D. As the health care surrogate, the client's partner can make this decision.

Correct answer: D

Rationale: The correct response is D because the health care surrogate, as designated by the client, has the legal authority to make healthcare decisions on behalf of the client when they are unable to do so. This authority includes decisions about treatment continuation or withdrawal. Option A is incorrect as the family member's wishes do not override the legal authority of the health care surrogate. Option B is not the most appropriate action in this situation as the advance directives are already clear by the designation of a health care surrogate. Option C is not necessary at this stage since the health care surrogate can make the decision without involving the ethics committee.

2. How many calories per kilogram does an average full-term infant require when the infant is around 1-2 months old?

A. 140 calories per kilogram per day
B. 120 calories per kilogram per day
C. 100 calories per kilogram per day
D. 160 calories per kilogram per day

Correct answer: B

Rationale: An average full-term infant requires about 120 calories per kilogram per day at 1-2 months old. This amount is essential for their growth and development during this critical stage. Choices A, C, and D are incorrect as they provide calorie amounts that are either too high or too low for an average full-term infant at 1-2 months old, which could potentially lead to health issues or inadequate nutrition.

3. When reinforcing teaching and instructing the patient, which basic principle of teaching should you follow?

A. Sequence the instruction from the least complex to the most complex.
B. Assume that the patient knows little or nothing about the topic.
C. Tell the patient to call their significant other so you can instruct them.
D. Use medically oriented terms so the patient will be able to speak with the doctor.

Correct answer: A

Rationale: The correct principle of teaching to follow when reinforcing teaching and instructing the patient is to sequence the instruction from the least complex to the most complex. This approach facilitates learning by building upon simpler concepts before moving to more advanced ones. Choice B is incorrect because assuming the patient knows little or nothing about the topic may not always be accurate and can be patronizing. Choice C is incorrect as it does not focus on the direct teaching approach to the patient. Choice D is incorrect as using medically oriented terms may confuse the patient rather than facilitate understanding.

4. What is idiopathic thrombocytopenia purpura?

A. Highly similar to disseminated intravascular coagulation (DIC).
B. Caused by the overproduction of platelets.
C. A bleeding disorder that is characterized by too few platelets.
D. Treated with immune system-boosting medications.

Correct answer: C

Rationale: Idiopathic thrombocytopenic purpura is a bleeding disorder characterized by a low number of platelets in the blood. This condition is not highly similar to disseminated intravascular coagulation (DIC), which involves abnormal clotting throughout the body (coagulation), leading to depletion of platelets. Choice B is incorrect because idiopathic thrombocytopenic purpura is actually characterized by a decrease in platelet count, not an overproduction. While immune system-boosting medications may be used in some cases, the primary treatment for idiopathic thrombocytopenic purpura focuses on increasing platelet counts or managing symptoms.

5. A nurse in the emergency department is assessing a client who is unconscious following a motor-vehicle crash. The client requires immediate surgery. Which of the following actions should the nurse take?

A. Transport the client to the operating room without verifying informed consent
B. Ask the anesthesiologist to sign the consent
C. Obtain telephone consent from the facility administrator before the surgery
D. Delay the surgery until the nurse can obtain informed consent

Correct answer: A

Rationale: In emergency situations where a client is unconscious and requires immediate surgery, implied consent applies. Implied consent allows healthcare providers, including nurses, to proceed with necessary treatment or surgery without formally verifying informed consent. Choice A is correct because the priority in this scenario is to ensure the client receives timely medical intervention to address life-threatening conditions. Choices B, C, and D are incorrect because in emergencies, waiting to obtain formal consent can delay critical treatment, risking the client's health and well-being.