HESI LPN
Adult Health Exam 1 Chamberlain
1. During the shift change report at an acute care hospital, the charge nurse assigns the Licensed Practical Nurse (LPN) to care for a client. Which task is within the LPN's scope?
- A. Administering IV medication
- B. Conducting initial client assessments
- C. Providing wound care for a stage III pressure ulcer
- D. Teaching a diabetic client about insulin administration
Correct answer: C
Rationale: The correct answer is C. LPNs are trained to provide basic nursing care such as wound care. Providing wound care for a stage III pressure ulcer falls within the LPN's scope of practice. Administering IV medication (choice A) requires a higher level of skill and is usually the responsibility of registered nurses. Conducting initial client assessments (choice B) demands more advanced training and is typically performed by registered nurses. Teaching a diabetic client about insulin administration (choice D) involves patient education and is usually within the scope of registered nurses or other healthcare professionals with specific training in diabetic care.
2. The nurse is caring for a client with an intravenous infusion of normal saline. The client reports pain and swelling at the IV site. What is the nurse’s priority action?
- A. Slow the rate of infusion
- B. Apply a warm compress to the site
- C. Discontinue the IV infusion
- D. Elevate the affected arm
Correct answer: C
Rationale: The correct answer is to discontinue the IV infusion (Choice C). Pain and swelling at the IV site can indicate infiltration or phlebitis, which are serious complications that require immediate action. Slowing the rate of infusion (Choice A) may not address the underlying issue and can potentially worsen the condition. Applying a warm compress (Choice B) may provide temporary relief but does not address the need to discontinue the infusion. Elevating the affected arm (Choice D) is not the priority in this situation; discontinuing the infusion takes precedence to prevent further harm.
3. The client with a diagnosis of hypertension is being taught about lifestyle changes. Which recommendation is most important to include?
- A. Increase sodium intake.
- B. Engage in regular physical activity.
- C. Avoid foods high in fat.
- D. Limit fluid intake to 1 liter per day.
Correct answer: B
Rationale: Engaging in regular physical activity is crucial for individuals with hypertension as it helps lower blood pressure and improve cardiovascular health. Physical activity is known to have a significant impact on reducing hypertension and overall cardiovascular risk. Choice A, increasing sodium intake, is incorrect as reducing sodium is typically recommended for hypertension to help lower blood pressure. Choice C, avoiding foods high in fat, is beneficial for overall health but not the most crucial recommendation for hypertension management. Choice D, limiting fluid intake to 1 liter per day, is not a standard recommendation for hypertension unless advised by a healthcare provider for specific cases. Therefore, the most important recommendation for the client with hypertension is to engage in regular physical activity.
4. A client who is 24 weeks pregnant presents with a complaint of feeling dizzy when lying on her back. What is the best response by the nurse?
- A. Advise the client to lie on her side
- B. Encourage the client to drink more fluids
- C. Suggest the client elevate her legs when lying down
- D. Recommend the client take short walks throughout the day
Correct answer: A
Rationale: The correct answer is to advise the client to lie on her side. Lying on the side can prevent the compression of the vena cava, which can cause dizziness in pregnant women. Encouraging the client to drink more fluids (Choice B) may be beneficial for other conditions but is not the best response for dizziness when lying on her back. Suggesting the client elevate her legs when lying down (Choice C) is not directly related to the issue described by the client. Recommending the client take short walks throughout the day (Choice D) may be helpful for other pregnancy-related symptoms but is not the most appropriate action for dizziness when lying on her back.
5. What action should the nurse implement in caring for a client following an electroencephalogram (EEG)?
- A. Monitor the client's vital signs every 4 hours
- B. Assess the client's lower extremities for sensation
- C. Instruct the client to maintain bed rest
- D. Wash any paste from the client's hair and scalp
Correct answer: D
Rationale: The correct action the nurse should implement after an EEG is to wash any paste from the client's hair and scalp. This is crucial to prevent irritation and infection at the EEG site. Monitoring vital signs every 4 hours is not specifically indicated after an EEG. Assessing the client's lower extremities for sensation is unrelated to caring for a client post-EEG. While rest may be recommended after the procedure, there is no standard requirement for a specific duration of bed rest.
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