HESI LPN
HESI Fundamentals Exam Test Bank
1. When caring for an older adult client who becomes agitated when asked to remove dentures before surgery, which of the following responses should the nurse make?
- A. "What worries you about being without your teeth?"
- B. "You need to follow the preoperative instructions and remove your dentures."
- C. "It's important to remove dentures to ensure proper fitting of the mask during anesthesia."
- D. "I will explain why dentures need to be removed before surgery."
Correct answer: A
Rationale: The correct response is to ask the client about their concerns regarding being without their teeth. This approach helps address the client's anxiety and provides insight into the reason for their agitation. Choice B is authoritarian and does not address the client's emotional needs. Choice C focuses on the technical aspect of surgery and does not address the client's emotional state. Choice D implies a one-way communication without addressing the client's feelings or concerns.
2. The client with a new diagnosis of type 2 diabetes is being taught about diet management by the nurse. Which statement by the client indicates effective learning?
- A. I should not avoid all carbohydrates
- B. I can eat whatever I want as long as I take my medication
- C. I need to eat regular meals and snacks to maintain my blood sugar levels
- D. I will decrease my intake of sugary foods to prevent low blood sugar
Correct answer: C
Rationale: Choice C is the correct answer because eating regular meals and snacks is crucial for maintaining stable blood sugar levels in individuals with diabetes. This approach helps prevent spikes and drops in blood sugar, promoting better management of the condition. Choices A, B, and D are incorrect. Avoiding all carbohydrates is not recommended as they are a major energy source and can be part of a balanced diet; eating whatever one wants while relying solely on medication can lead to uncontrolled blood sugar levels and complications; decreasing sugary foods intake can actually contribute to high blood sugar levels rather than preventing low blood sugar.
3. A nurse manager is using the technique of brainstorming to help solve a problem. One nurse criticizes another nurse’s contribution and begins to find objections to the suggestion. The nurse manager's best response is to
- A. Let’s move on to a new action that deals with the problem.
- B. I think you need to reserve judgment until after all suggestions are offered.
- C. Very well thought out. Your analytic skills and interest are incredible.
- D. Let’s move to the ‘what if…’ as related to these objections for an exploration of spin-off ideas.
Correct answer: D
Rationale: Encouraging the group to explore 'what if' scenarios based on the objections helps to maintain a positive and creative brainstorming atmosphere, while also validating the concerns raised by the nurse. Choice A is dismissive and does not address the issue at hand. Choice B suggests postponing judgment, which may not resolve the tension caused by the criticism. Choice C is complimentary but does not address the critical feedback provided by the nurse, missing an opportunity to turn objections into opportunities for further exploration.
4. A client who had a right total shoulder replacement is being prepared for discharge. What should the nurse emphasize to the client to prevent complications?
- A. Avoid lifting objects with the right arm until cleared by the surgeon.
- B. Perform shoulder exercises to regain strength.
- C. Use a sling at all times, even during sleep.
- D. Apply heat to the shoulder to reduce stiffness.
Correct answer: A
Rationale: The correct answer is to avoid lifting objects with the right arm until cleared by the surgeon. After a total shoulder replacement, it is essential to protect the new joint to prevent dislocation or injury. Lifting heavy objects prematurely can lead to complications. While performing shoulder exercises is important for strength, they should be done as per the healthcare provider's instructions to avoid strain on the new joint. Using a sling at all times, as in choice C, is not necessary once the client has regained enough strength and mobility. Applying heat, as in choice D, may not be recommended post-surgery; cold therapy is often preferred to reduce swelling and pain.
5. A 17-year-old adolescent is brought to the emergency department by both parents because the adolescent has been coughing and running a fever with flu-like symptoms for the past 24 hours. Which intervention should the nurse implement first?
- A. Obtain a chest X-ray per protocol.
- B. Place a mask on the client’s face.
- C. Assess the client’s temperature.
- D. Determine the client’s blood pressure
Correct answer: B
Rationale: The correct intervention for the nurse to implement first is to place a mask on the client's face. This is crucial to prevent the potential spread of infectious agents to others in the emergency department, considering the presenting symptoms of coughing and fever. Placing a mask helps in containing respiratory secretions and reducing the risk of airborne transmission. Assessing the client’s temperature or blood pressure can be done after ensuring infection control measures. Obtaining a chest X-ray would be a secondary intervention once immediate infection control is addressed.