an 8 year old child is placed in 90 90 traction for a fractured femur the nurse notices that the weights are touching the foot of the bed what action
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HESI LPN

HESI PN Exit Exam 2024

1. An 8-year-old child is placed in 90-90 traction for a fractured femur. The nurse notices that the weights are touching the foot of the bed. What action should the nurse take?

Correct answer: C

Rationale: The nurse should ensure that the weights in traction are not touching the foot of the bed. This is crucial to maintain proper alignment and effectiveness of the traction. When the weights touch the bed, it can compromise the traction's function and delay healing. Choices A, B, and D are incorrect as they do not address the issue of ensuring that the weights are not touching the bed, which is essential for the traction to work effectively.

2. After adding feeding solution to a client's tube feeding system as seen in the picture, what action should the PN take next?

Correct answer: B

Rationale: After adding feeding solution, obtaining a piston syringe and irrigation set is necessary to flush the feeding tube and ensure patency before starting the feeding. This helps prevent blockages and ensures proper delivery of the nutritional solution. Option A is incorrect because removing air from the solution bag is not the immediate next step after adding the feeding solution. Option C is incorrect as recording the solution added as fluid intake is important but not the immediate next step. Option D is incorrect as calculating the rate of flow of the solution is not the next step after adding the feeding solution.

3. The client diagnosed with HIV is taught by the nurse that the condition is transmitted through

Correct answer: A

Rationale: HIV can be transmitted from a mother to her baby during childbirth or breastfeeding, making choice A the correct answer. Tears, human bites, and insect bites are not common modes of HIV transmission. While human bites can potentially transmit the virus, it is less common compared to mother-to-child transmission.

4. Which of the following best describes the role of insulin in the body?

Correct answer: B

Rationale: The correct answer is B: Insulin facilitates the movement of glucose into cells. Insulin is a hormone that helps regulate blood sugar levels by promoting the uptake of glucose from the bloodstream into cells, where it can be used for energy production. Choice A is incorrect because insulin doesn't break down glucose but rather helps cells take up glucose. Choice C is incorrect as insulin does not directly convert glucose into fat; excess glucose is stored as fat by other processes. Choice D is incorrect as insulin does not increase the breakdown of protein into amino acids; its primary role is in glucose metabolism.

5. While providing oral care for a client who is unconscious, the nurse positions the client laterally and uses a basin to collect secretions. Which intervention is best for the nurse to implement?

Correct answer: B

Rationale: Using oral swabs with normal saline is the best intervention in this scenario as it effectively cleans the oral cavity without causing irritation or dryness, which is crucial for an unconscious client. Swabbing the oral cavity with a washcloth may not provide thorough cleaning, and it can potentially cause irritation. Providing a Yankauer tip for oral suction is not necessary unless there are excessive secretions that need to be suctioned. Supporting the head with a small pillow, although important for comfort, is not directly related to oral care in an unconscious client.

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