nurse is caring for a client who has pharyngeal diphtheritransmission precautions
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Nursing Elites

HESI LPN

HESI Fundamentals Exam

1. A client has pharyngeal diphtheria. What transmission precautions are necessary?

Correct answer: A

Rationale: Pharyngeal diphtheria is primarily spread through droplet transmission, which occurs when an infected person coughs, sneezes, or talks, releasing respiratory droplets containing the bacteria. Therefore, the correct precaution for caring for a client with pharyngeal diphtheria is droplet precautions. Droplet precautions help prevent the transmission of respiratory pathogens over short distances via respiratory droplets. Contact precautions are used for diseases spread through direct or indirect contact with the patient or their environment. Airborne precautions are used for diseases that spread through small droplets suspended in the air. Standard precautions are basic infection prevention practices applying to all patient care.

2. The nurse is preparing to administer a blood transfusion to a client. Which action should the LPN/LVN take to ensure the client's safety?

Correct answer: D

Rationale: To ensure the client's safety during a blood transfusion, it is crucial to verify the blood product with another nurse before administration. This step helps confirm the correct blood type and prevents transfusion reactions. While checking the client's identification and blood type (Choice A) is important, the ultimate responsibility lies with confirming the blood product before administration. Monitoring vital signs (Choice B) is necessary during a transfusion but does not directly address verifying the blood product. Administering blood through a peripheral IV line (Choice C) is a common practice but does not specifically ensure that the correct blood product is being administered, which is essential for the client's safety.

3. When planning interventions for a group of clients who are obese, what can the nurse do to improve their commitment to a long-term goal of weight loss?

Correct answer: B

Rationale: To improve clients' commitment to a long-term goal of weight loss, attempting to develop their self-motivation is crucial. Self-motivation is essential for sustaining behavior changes over time. Providing a strict diet plan (choice A) may not address the root motivation needed for long-term success. While rewards (choice C) can be motivating, relying solely on external rewards may not foster the intrinsic motivation required for sustained weight loss. Encouraging group exercise (choice D) is beneficial, but without addressing individual motivation, it may not lead to long-term commitment to weight loss goals.

4. A client who is lactating is being taught about taking medications by a nurse. Which of the following actions should the nurse recommend to minimize the entry of medication into breast milk?

Correct answer: C

Rationale: Taking medications immediately after breastfeeding helps minimize the amount of medication that enters breast milk. By doing so, there is a longer interval between the medication intake and the next breastfeeding session, reducing the concentration of the medication in breast milk. Options A and B are incorrect as drinking water with medication or using medications with a short half-life do not directly minimize the entry of medication into breast milk. Option D is unnecessary and wasteful as pumping and discarding breast milk before feeding is not as effective as timing medication intake with breastfeeding to reduce medication transfer into breast milk.

5. A nurse is providing teaching to an older adult client about home safety. Which of the following information should the nurse include?

Correct answer: A

Rationale: The correct answer is A: 'Keep a nightlight on in the bathroom.' This safety measure is crucial for older adults to prevent falls by enhancing visibility during nighttime bathroom visits. Choice B is incorrect because setting the room temperature to 68 degrees Fahrenheit may not be universally suitable for all older adults, as individual preferences vary. Choice C is incorrect as placing throw rugs over electrical cords poses a tripping hazard rather than enhancing safety. Choice D is incorrect as using chairs without armrests may not provide adequate support and stability for older adults, increasing the risk of falls.

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