HESI LPN
PN Exit Exam 2023 Quizlet
1. An older client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The PN notes that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the PN to implement?
- A. Ask family members to remain with the client in the evenings from 5 to 8 pm
- B. Administer a prescribed PRN benzodiazepine at the onset of a confused state
- C. Ensure that the client is assigned to a room close to the nurses' station
- D. Postpone administration of nighttime medications until after 11 pm
Correct answer: C
Rationale: Sundowning, a phenomenon where dementia symptoms worsen in the evening, can be managed by ensuring the client is close to the nurses' station for frequent monitoring and quick intervention, if necessary. This reduces the risk of harm and helps manage agitation. Asking family members to remain with the client may not always be feasible and does not address the need for close monitoring. Administering benzodiazepines should not be the first-line intervention for sundowning as it can increase the risk of falls and other adverse effects. Postponing medication administration may disrupt the client's routine and potentially worsen symptoms.
2. An adult female client with type 1 diabetes mellitus is receiving NPH insulin 35 units in the morning. Which finding should the nurse document as evidence that the amount of insulin is inadequate?
- A. States that her feet are constantly cold and numb
- B. A wound on the ankle that starts to drain and becomes painful
- C. Consecutive evening serum glucose greater than 260 mg/dL
- D. Reports nausea in the morning but still able to eat breakfast
Correct answer: C
Rationale: The correct answer is C. Consistently high evening glucose levels indicate that the current insulin dosage is inadequate to maintain proper glucose control. Choice A is incorrect because cold and numb feet are more indicative of peripheral vascular disease rather than inadequate insulin dosage. Choice B describes a wound that may be related to poor circulation or neuropathy but not necessarily inadequate insulin dosage. Choice D suggests gastrointestinal issues that are not directly related to insulin dosage adequacy.
3. When caring for a patient with a chest tube, which nursing action is most important?
- A. Clamping the chest tube every 2 hours to prevent air leaks
- B. Keeping the drainage system below chest level
- C. Emptying the drainage system every hour to prevent backflow
- D. Removing the chest tube when drainage decreases significantly
Correct answer: B
Rationale: The most crucial nursing action when caring for a patient with a chest tube is to keep the drainage system below chest level (choice B). This position helps ensure proper drainage and prevents backflow of fluid or air into the pleural space, promoting optimal functioning of the chest tube. Clamping the chest tube every 2 hours (choice A) is incorrect as it can obstruct the drainage system and lead to complications. Emptying the drainage system every hour (choice C) is unnecessary unless there are specific clinical indications. Removing the chest tube when drainage decreases significantly (choice D) is also incorrect as the decision should be based on overall clinical assessment rather than drainage amount alone.
4. To accommodate a patient who is an Orthodox Jew, you would assure that her diet does not include which of the following?
- A. Any combination of meat and milk at the same meal
- B. Fish with scales
- C. Salmon
- D. Grape juice
Correct answer: A
Rationale: The correct answer is A. Orthodox Jewish dietary laws prohibit mixing meat and dairy in the same meal, so to accommodate an Orthodox Jew, you should ensure that their diet does not include any combination of meat and milk at the same meal. Choices B, C, and D are not prohibited in a kosher diet. Fish with scales, including salmon, are typically kosher, and grape juice is also permissible under kosher guidelines if certified. Therefore, options B, C, and D are acceptable in an Orthodox Jewish diet, while option A contradicts their dietary laws.
5. At 1200, the practical nurse learns that a client's 0900 dose of an anticonvulsant was not given. The next scheduled dose is at 2100. Which action should the PN take?
- A. Administer half of the missed dose immediately
- B. Administer the missed dose as soon as possible
- C. Give the missed dose with the next scheduled dose
- D. Withhold the missed dose unless seizure activity occurs
Correct answer: B
Rationale: Administering the missed dose as soon as possible is crucial in this situation. Missing an anticonvulsant dose can lead to breakthrough seizures, which are harmful to the client. Administering the missed dose promptly helps maintain the therapeutic level of the medication and reduces the risk of seizure activity. Giving half the dose may not provide adequate protection against seizures. Delaying the dose until the next scheduled time increases the time the client is without the medication, potentially increasing the risk of seizures. Withholding the missed dose unless seizure activity occurs is not recommended, as prevention is key in managing anticonvulsant therapy.
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