HESI LPN
Fundamentals of Nursing HESI
1. A nurse manager is reviewing with nurses on the unit the care of a client who has had a seizure. Which of the following statements by a nurse requires further instruction?
- A. “I will place the client on their side.”
- B. “I will go to the nurses’ station for assistance.”
- C. “I will note the time that the seizure begins.”
- D. “I will prepare to insert an airway.”
Correct answer: B
Rationale: The correct answer is B. Going to the nurses’ station for assistance during a seizure is inappropriate as immediate care is necessary. Placing the client on their side helps maintain an open airway and prevents aspiration. Noting the time the seizure begins is crucial for monitoring and documentation. Preparing to insert an airway may be necessary if the client's airway becomes compromised. Therefore, the nurse's statement about going to the nurses' station for assistance is the only incorrect response as it delays essential care.
2. A healthcare professional is planning teaching for a group of adolescents who each recently had surgical placement of an ostomy. Which of the following methods should the healthcare professional use as a psychomotor approach to learning?
- A. Practice sessions
- B. Demonstrations
- C. Written instructions
- D. Group discussions
Correct answer: A
Rationale: Practice sessions are an effective psychomotor approach to learning for adolescents with ostomies as they involve hands-on practice of ostomy care skills, which can help reinforce learning through active engagement. Demonstrations (choice B) can be helpful in providing visual guidance but may not offer the same level of active participation and practice as practice sessions. Written instructions (choice C) may be useful for reference but may not be as effective in developing psychomotor skills. Group discussions (choice D) focus more on verbal exchange and may not directly address the need for hands-on skill development required in managing ostomies. Therefore, practice sessions are the most suitable method for enhancing psychomotor learning in this scenario.
3. A client tells the nurse, “I have to check with my partner and see if they think I am ready to go home.” The nurse responds, “How do you feel about going home today?” Which clarifying technique is the nurse using to enhance communication with the client?
- A. Pacing
- B. Reflecting
- C. Paraphrasing
- D. Restating
Correct answer: B
Rationale: Reflecting is the correct answer as it involves echoing back the client’s feelings and concerns, helping them explore their thoughts. In this scenario, the nurse mirrors the client's statement to encourage the client to delve deeper into their emotions. Pacing involves matching the rate and flow of communication, paraphrasing is restating in different words, and restating is repeating what the client said without adding new information. Therefore, choices A, C, and D are not the appropriate clarifying technique demonstrated in the situation described.
4. A nurse reviews an immobilized patient's laboratory results and discovers hypercalcemia. Which condition will the nurse monitor for most closely in this patient?
- A. Hypostatic pneumonia
- B. Renal stones
- C. Pressure ulcers
- D. Thrombus formation
Correct answer: B
Rationale: The correct answer is B: Renal stones. Renal calculi are calcium stones that can form in the renal pelvis or pass through the ureters. Immobilized patients, who have hypercalcemia, are at increased risk for developing renal stones. Monitoring for signs and symptoms of renal stones is crucial in this patient population. Choices A, C, and D are incorrect because although they are potential complications in immobilized patients, they are not directly associated with hypercalcemia and do not match the scenario described in the question.
5. A 3-year-old child diagnosed with celiac disease attends a daycare center. Which of the following would be an appropriate snack?
- A. Cheese crackers
- B. Peanut butter sandwich
- C. Potato chips
- D. Vanilla cookies
Correct answer: C
Rationale: The correct answer is potato chips. As a child with celiac disease needs to avoid gluten, potato chips are a suitable snack choice as they are typically gluten-free. Cheese crackers (Choice A) and vanilla cookies (Choice D) contain gluten, which should be avoided by individuals with celiac disease. While peanut butter sandwiches (Choice B) could be gluten-free depending on the bread used, it is not the best choice as cross-contamination is a concern in shared environments like daycare centers.
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