HESI LPN
HESI Fundamentals 2023 Test Bank
1. A nurse on a medical-surgical unit is receiving a change-of-shift report for four clients. Which of the following clients should the nurse see first?
- A. A client who has new onset of dyspnea 24 hours after a total hip arthroplasty
- B. A client who has acute abdominal pain rated 4 on a scale from 0 to 10
- C. A client who has a UTI and low-grade fever
- D. A client who has pneumonia and an oxygen saturation of 96%
Correct answer: A
Rationale: The nurse should prioritize seeing the client who has new onset dyspnea 24 hours after a total hip arthroplasty first. This sudden dyspnea could indicate a serious complication like a pulmonary embolism, which requires immediate assessment and intervention. Acute abdominal pain, a UTI with a low-grade fever, and pneumonia with an oxygen saturation of 96% are important concerns but are not as immediately life-threatening as potential pulmonary embolism indicated by sudden dyspnea postoperatively.
2. A client with rheumatoid arthritis is prescribed sulfasalazine. Which instruction should the nurse include in the client's teaching plan?
- A. Take this medication with meals.
- B. Avoid sunlight while taking this medication.
- C. Report any signs of infection to the healthcare provider.
- D. Take this medication on an empty stomach.
Correct answer: A
Rationale: The correct instruction to include in the client's teaching plan regarding sulfasalazine is to take the medication with meals. Taking sulfasalazine with food helps to minimize gastrointestinal upset, which is a common side effect of the medication. Choice B is incorrect because avoiding sunlight is not specifically related to sulfasalazine. Choice C is important but not directly related to the administration of sulfasalazine. Choice D is incorrect because sulfasalazine should be taken with meals to reduce gastrointestinal side effects.
3. A client with diabetes mellitus type 2 is prescribed linagliptin. The nurse should monitor for which potential adverse effect?
- A. Pancreatitis
- B. Hypoglycemia
- C. Hyperglycemia
- D. Nausea
Correct answer: A
Rationale: When a client with diabetes mellitus type 2 is prescribed linagliptin, the nurse should monitor for pancreatitis as a potential adverse effect. Linagliptin has been associated with rare cases of pancreatitis; therefore, monitoring for signs and symptoms of pancreatitis such as severe abdominal pain, nausea, and vomiting is crucial to ensure timely intervention and management.
4. A nurse is caring for a client postoperatively. When the nurse prepares to change the dressing, the client says it hurts. Which intervention is the nurse’s priority action?
- A. Administer pain medication 45 minutes prior to dressing change.
- B. Change the dressing quickly to minimize pain.
- C. Provide reassurance to the client that the pain will pass.
- D. Use a less painful dressing technique.
Correct answer: A
Rationale: Administering pain medication before the dressing change is the priority action to help manage the client's pain effectively. This intervention ensures that the client is comfortable during the procedure. Changing the dressing quickly may cause more discomfort to the client. Providing reassurance is important but does not address the immediate pain concern. Using a less painful dressing technique may be helpful, but administering pain medication first is the priority to address the client's pain promptly.
5. A client has been admitted to the hospital with severe diarrhea. The nurse should monitor the client for which complication?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Hyperkalemia
- D. Hypercalcemia
Correct answer: A
Rationale: Severe diarrhea can lead to metabolic acidosis due to the loss of bicarbonate. When there is excessive loss of bicarbonate through diarrhea, the pH of the blood decreases, leading to metabolic acidosis. Metabolic alkalosis (Choice B) is not typically associated with severe diarrhea as it involves elevated pH and bicarbonate levels. Hyperkalemia (Choice C) is less likely with severe diarrhea as potassium is often lost along with fluids. Hypercalcemia (Choice D) is not a common complication of severe diarrhea; instead, hypocalcemia may occur due to malabsorption of calcium.