HESI LPN
Fundamentals of Nursing HESI
1. During a patient assessment, which principle should be a priority?
- A. Foot care is always important.
- B. Daily bathing is always important.
- C. Hygiene needs are always important.
- D. Critical thinking is always important.
Correct answer: D
Rationale: During a patient assessment, critical thinking is a priority because a patient's condition can change rapidly, necessitating continuous critical thinking and adaptation of nursing interventions. While foot care, daily bathing, and hygiene needs are important components of patient care, they may not always take precedence over critical thinking, which guides the nurse in making timely and appropriate decisions based on the patient's current condition and needs. Therefore, critical thinking stands out as the most crucial principle during patient assessments.
2. An adult female client with type 1 diabetes mellitus is receiving NPH insulin 35 units in the morning. Which finding should the nurse document as evidence that the amount of insulin is inadequate?
- A. States that her feet are constantly cold and numb
- B. A wound on the ankle that starts to drain and becomes painful
- C. Consecutive evening serum glucose greater than 260 mg/dL
- D. Reports nausea in the morning but still able to eat breakfast
Correct answer: C
Rationale: The correct answer is C. Consistently high evening glucose levels indicate that the current insulin dosage is inadequate to maintain proper glucose control. Choice A is incorrect because cold and numb feet are more indicative of peripheral vascular disease rather than inadequate insulin dosage. Choice B describes a wound that may be related to poor circulation or neuropathy but not necessarily inadequate insulin dosage. Choice D suggests gastrointestinal issues that are not directly related to insulin dosage adequacy.
3. Prior to administering an oral dose of methylprednisolone, what is most important for the nurse to do?
- A. Administer the medication with a glass of milk
- B. Notify the healthcare provider of the finding
- C. Begin tapering the drug dose per protocol
- D. Teach the clients about foods high in calcium
Correct answer: A
Rationale: Administering methylprednisolone with food or milk is important as it can help reduce gastrointestinal side effects associated with the medication. This practice is commonly recommended to minimize stomach upset and irritation that may occur when taking methylprednisolone on an empty stomach. Therefore, it is crucial for the nurse to provide the medication with a glass of milk to enhance patient comfort and adherence to the treatment regimen. Choice B is incorrect as there is no indication in the question stem that suggests a need to notify the healthcare provider before administering the medication with food or milk. Choice C is incorrect because tapering the drug dose per protocol is not the immediate action needed prior to administering the first dose of methylprednisolone. Choice D is irrelevant to the administration of methylprednisolone and not the most important action to take before giving the medication.
4. What role do fats play in the human body?
- A. They provide a concentrated source of energy.
- B. They are the building blocks of enzymes and hormones.
- C. They are essential for brain function and development.
- D. They aid in the digestion of food.
Correct answer: D
Rationale: Fats play various essential roles in the human body, one of which is aiding in the digestion of food. While fats do provide a concentrated source of energy, the primary source is carbohydrates. Proteins are the building blocks of enzymes and hormones, not fats. Essential fatty acids found in fats are vital for brain function and development, but this is not the primary role of fats in the body.
5. The nurse uses the DRG (Diagnosis Related Group) manual to
- A. Classify nursing diagnoses from the client's health history
- B. Identify findings related to a medical diagnosis
- C. Determine reimbursement for a medical diagnosis
- D. Implement nursing care based on case management protocol
Correct answer: C
Rationale: The DRG manual is used to determine the reimbursement rate for medical diagnoses and treatments under the prospective payment system used by healthcare facilities. Choice A is incorrect because the DRG manual is not used to classify nursing diagnoses, but rather to group medical diagnoses for billing purposes. Choice B is incorrect as the DRG manual is not used to identify findings related to medical diagnoses, but rather to standardize payments for medical services. Choice D is incorrect as the DRG manual is not used to implement nursing care based on case management protocol, but rather to set reimbursement rates.