HESI LPN
Fundamentals HESI
1. A nurse is preparing change of shift report after the night shift using one SBAR communication tool. Which of the following data should the nurse include when reporting background information?
- A. “Blood pressure 160/92 mm Hgâ€
- B. “Start the first dose of penicillin at 1200â€
- C. “Pain rating of 5 on a scale from 0 to 10â€
- D. “Code status: do-not-resuscitateâ€
Correct answer: B
Rationale: The correct answer is B. When providing background information in a shift report using the SBAR communication tool, the nurse should include details related to medication administration and orders. This helps ensure continuity of care and accurate handover of responsibilities. Choices A, C, and D do not typically fall under background information for shift reports. A blood pressure reading, pain rating, and code status are more relevant to the patient's current condition and status, rather than background information about medications or orders.
2. A client with an aggressive form of prostate cancer declines to discuss concerns after the provider briefly discusses treatment options and leaves the room. Which of the following statements should the nurse make?
- A. “I am available to talk if you should change your mind.â€
- B. “I understand you do not want to discuss it further.â€
- C. “You should talk to the provider if you have more questions.â€
- D. “I will be back later to discuss your concerns.â€
Correct answer: A
Rationale: The nurse should offer support without pressuring the client. Stating, “I am available to talk if you should change your mind,†acknowledges the client's decision while leaving the door open for future discussions. Choice B is incorrect as it assumes the client's decision is final without offering further support. Choice C directs the client back to the provider without addressing the nurse's availability. Choice D commits to a future discussion without considering the client's current preference.
3. A nurse is providing education about cultural and religious traditions and rituals related to death for the assistive personnel on the unit. Which of the following information should the nurse include?
- A. People who practice Judaism stay with the body of the deceased until burial.
- B. People who practice Islam avoid cremation of the body.
- C. People who practice Buddhism prefer to have a brief funeral service.
- D. People who practice Hinduism prefer to have the body embalmed before cremation.
Correct answer: A
Rationale: The correct answer is A. In Judaism, it is customary for the body to be attended to by family or members of the community until burial. This practice is rooted in the belief of providing respect and care to the deceased individual. Choices B, C, and D are incorrect because they do not accurately reflect the cultural and religious traditions related to death for people who practice Islam, Buddhism, and Hinduism, respectively. People who practice Islam generally avoid cremation and opt for burial, Buddhists may have varying funeral service preferences, and Hindus often practice cremation without embalming the body.
4. A nurse is caring for a group of clients. Which of the following actions should the nurse take to prevent the spread of infection?
- A. Carry a client's soiled linens out of the room in a mesh linen bag
- B. Place a client who has tuberculosis in a room with negative-pressure airflow
- C. Provide disposable plates and utensils for a client who is HIV-positive
- D. Dispose of a client's blood-saturated dressing in a biohazard bag
Correct answer: B
Rationale: A client who has tuberculosis requires airborne precautions, including placing the client in a room with negative-pressure airflow to reduce the risk of infection transmission. Choices A, C, and D are incorrect. Carrying soiled linens in a mesh bag, providing disposable plates and utensils for an HIV-positive client, and disposing of blood-saturated dressing in a biohazard bag do not specifically address preventing the spread of tuberculosis, which requires airborne precautions.
5. A healthcare professional reviewing a client’s health record notes a new prescription for lisinopril 10 mg PO once daily. The healthcare professional should identify this as which of the following types of prescription?
- A. Single
- B. Stat
- C. Routine
- D. Now
Correct answer: C
Rationale: A prescription for once-daily medication is considered routine as it is meant for regular, daily administration to maintain therapeutic levels in the body. Single prescriptions are for one-time use only. Stat prescriptions are for immediate administration in urgent situations, while now prescriptions are also for immediate use but may have varying levels of urgency depending on the patient's condition. In this case, since the prescription is for once daily use, it falls under the category of routine prescription.
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