HESI LPN
HESI Fundamentals Test Bank
1. A nurse is caring for a group of clients. How should the nurse prevent the spread of infection?
- A. Place a client with TB in a negative pressure room.
- B. Use standard precautions only.
- C. Place a client with TB in a private room.
- D. Use barrier precautions only.
Correct answer: A
Rationale: The correct answer is to place a client with TB in a negative pressure room. Tuberculosis (TB) is an airborne infectious disease, and placing the client in a negative pressure room helps prevent the spread of the infection by containing and filtering the air within the room. Standard precautions (Choice B) are important for preventing the spread of infection in general, but specific precautions are needed for airborne diseases like TB. Placing the client in a private room (Choice C) may not provide adequate ventilation and containment of airborne pathogens. Using barrier precautions (Choice D) alone is not sufficient for preventing the airborne transmission of TB.
2. When obtaining a urine specimen for a culture and sensitivity from an indwelling catheter, the nurse should:
- A. Cleanse the entry port prior to withdrawing urine.
- B. Use a sterile syringe to collect urine from the collection bag.
- C. Obtain the specimen from the drainage tubing.
- D. Replace the catheter before obtaining the specimen.
Correct answer: A
Rationale: The correct procedure when obtaining a urine specimen from an indwelling catheter for culture and sensitivity is to cleanse the entry port before withdrawing urine. This step helps reduce the risk of contamination and ensures the accuracy of the results. Option B is incorrect because using a sterile syringe to collect urine from the collection bag is not the recommended method for obtaining a catheter specimen. Option C is incorrect as obtaining the specimen from the drainage tubing is not the appropriate technique for collecting a urine sample from an indwelling catheter. Option D is incorrect because replacing the catheter before obtaining the specimen is not necessary and may introduce unnecessary complications.
3. A health care provider has prescribed isoniazid (Laniazid) for a client. Which instruction should the LPN give the client about this medication?
- A. Prolonged use does not typically cause dark concentrated urine.
- B. It is not necessary to take the medication on an empty stomach for optimal absorption.
- C. Avoid taking the medication with aluminum hydroxide to minimize GI upset.
- D. Drinking alcohol daily can cause drug-induced hepatitis.
Correct answer: D
Rationale: The correct answer is D. When taking isoniazid, alcohol consumption should be avoided as it can increase the risk of liver damage, potentially leading to drug-induced hepatitis. Choices A, B, and C are incorrect. Prolonged use of isoniazid does not typically cause dark concentrated urine; it is not necessary to take the medication on an empty stomach for optimal absorption; and it is not recommended to take isoniazid with aluminum hydroxide to minimize GI upset.
4. When evaluating care of an immobilized patient, which action will the nurse take?
- A. Focus on whether the interdisciplinary team is satisfied with the care.
- B. Compare the patient's actual outcomes with the outcomes in the care plan.
- C. Involve primarily the patient's family and health care team to determine goal achievement.
- D. Use objective data solely in determining whether interventions have been successful.
Correct answer: B
Rationale: When evaluating the care of an immobilized patient, the nurse should focus on assessing outcomes and response to nursing care. By comparing the patient's actual outcomes with the outcomes identified during planning, the nurse can determine the effectiveness of the interventions implemented. This process allows for a comprehensive evaluation of the care provided. Choice A is incorrect because the satisfaction of the interdisciplinary team does not directly reflect the patient's outcomes and response to care. Choice C is incorrect as it mainly focuses on the involvement of the patient's family and healthcare team, which may not provide a holistic evaluation of the patient's care. Choice D is incorrect as relying solely on objective data may lead to overlooking important subjective aspects of the patient's response and outcomes, which are also crucial in evaluating care effectively.
5. The mother of a 2 year-old hospitalized child asks the nurse's advice about the child's screaming every time the mother gets ready to leave the hospital room. What is the best response by the nurse?
- A. I think you or your partner needs to stay with the child while in the hospital.
- B. Oh, that behavior will stop in a few days.
- C. Keep in mind that for the age this is a normal response to being in the hospital.
- D. You might want to 'sneak out' of the room once the child falls asleep.
Correct answer: C
Rationale: The nurse should reassure the mother that the child's behavior is normal for their age and situation.
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