HESI LPN
HESI Fundamentals Practice Questions
1. A client with a tracheostomy is being taught by a nurse and their family how to care for the tracheostomy at home. Which of the following should the nurse include in the teaching?
- A. Use tracheostomy covers when outdoors.
- B. Clean the tracheostomy with alcohol.
- C. Replace the tracheostomy tube every week.
- D. Cover the tracheostomy with a wet cloth when sleeping.
Correct answer: A
Rationale: Using tracheostomy covers when outdoors is essential to protect the tracheostomy from dust and debris, reducing the risk of infection. Tracheostomy covers help maintain cleanliness and prevent foreign particles from entering the stoma. Choice B is incorrect because cleaning the tracheostomy with alcohol can be too harsh and drying for the skin surrounding the stoma, leading to skin irritation. Choice C is incorrect as tracheostomy tubes are typically replaced only when clinically indicated or as per the healthcare provider's instructions, not routinely every week, to prevent unnecessary risks and complications. Choice D is incorrect as covering the tracheostomy with a wet cloth when sleeping can create a moist environment ideal for bacterial growth, increasing the risk of infection and skin breakdown. It is important to keep the tracheostomy site clean, dry, and protected to maintain optimal hygiene and prevent complications.
2. The healthcare professional is caring for a client with a peripheral intravenous (IV) line that has infiltrated. What is the most appropriate initial action for the healthcare professional to take?
- A. Apply a warm compress to the affected area.
- B. Discontinue the IV and restart it in another site.
- C. Aspirate the IV line and flush it with normal saline.
- D. Notify the healthcare provider immediately.
Correct answer: B
Rationale: The correct initial action when an IV line infiltrates is to discontinue the IV and restart it in another site. This is crucial to prevent complications such as tissue damage, phlebitis, and infection that can result from the infiltration. Applying a warm compress (Choice A) is not recommended as it can exacerbate the tissue damage caused by the infiltration. Aspirating the IV line and flushing it with normal saline (Choice C) is not appropriate for an infiltrated IV line as it does not address the main issue of infiltration. While notifying the healthcare provider (Choice D) is important, the immediate priority is to discontinue the infiltrated IV to prevent further harm and ensure proper delivery of fluids or medications.
3. A client who has a terminal illness asks several questions about the nurse's religious beliefs related to death and dying. Which of the following actions should the nurse take?
- A. Encourage the client to express their thoughts about death and dying
- B. Share the nurse's personal beliefs about death and dying
- C. Redirect the client to a chaplain or spiritual advisor
- D. Provide a brief overview of common religious beliefs about death and dying
Correct answer: A
Rationale: Encouraging the client to express their thoughts allows them to explore their own feelings and concerns about death. This approach empowers the client to reflect on their beliefs and values without the influence of the nurse's personal beliefs (choice B), which should remain separate in a professional setting. Redirecting the client to a chaplain or spiritual advisor (choice C) may be appropriate if the client seeks specific spiritual guidance. Providing a brief overview of common religious beliefs (choice D) may not address the client's individual questions and concerns.
4. A client who had a stroke requires assistance with morning ADLs. Which of the following interprofessional team members should the nurse consult?
- A. Registered dietitian.
- B. Occupational therapist.
- C. Speech-language pathologist.
- D. Physical therapist.
Correct answer: B
Rationale: The correct answer is B, Occupational therapist. An occupational therapist specializes in assisting clients with daily living activities, making them crucial for a stroke patient requiring help with morning activities of daily living (ADLs). While a registered dietitian (A) may provide nutritional guidance, a speech-language pathologist (C) focuses on communication and swallowing disorders, and a physical therapist (D) primarily deals with mobility and physical rehabilitation. However, none of these professionals directly address the specific needs related to ADLs following a stroke as effectively as an occupational therapist.
5. Following major abdominal surgery, a client postoperative refuses to use the incentive spirometer. What is the nurse's priority?
- A. Determine the reason why the client is refusing to use the incentive spirometer.
- B. Insist that the client use the incentive spirometer.
- C. Administer pain medication to help the client use the spirometer.
- D. Document the refusal in the client’s medical record.
Correct answer: A
Rationale: The nurse's priority in this situation is to determine the reason why the client is refusing to use the incentive spirometer. By understanding the client's concerns or barriers, the nurse can address them effectively and encourage the client to use the spirometer for optimal postoperative recovery. Insisting that the client use the spirometer without understanding the underlying reason may lead to further resistance. Administering pain medication as a solution does not address the root cause of refusal and may not be necessary if pain is not the primary reason for refusal. Documenting the refusal is important but should come after understanding the client's perspective to provide appropriate care and follow-up.
Similar Questions
Access More Features
HESI LPN Basic
$69.99/ 30 days
- 5,000 Questions with answers
- All HESI courses Coverage
- 30 days access
HESI LPN Premium
$149.99/ 90 days
- 5,000 Questions with answers
- All HESI courses Coverage
- 30 days access