the nurse is assessing a client with a stage 2 skin ulcer which of the following treatments is most effective to promote healing
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Nursing Elites

HESI LPN

HESI Fundamentals Study Guide

1. The clinician is assessing a client with a Stage 2 skin ulcer. Which of the following treatments is most effective to promote healing?

Correct answer: D

Rationale: Applying a hydrocolloid or foam dressing is the most effective treatment to promote healing for a Stage 2 skin ulcer. These dressings create a moist environment that supports healing and prevents further tissue damage. Option A (covering the wound with a dry dressing) can lead to drying out the wound bed, hindering healing. Option B (using hydrogen peroxide soaks) can be too harsh and may damage the surrounding healthy tissue. Option C (leaving the area open to dry) can delay healing as it does not provide the necessary moist environment for optimal wound healing.

2. When should discharge planning for a client experiencing an exacerbation of heart failure be initiated?

Correct answer: A

Rationale: Discharge planning for a client with an exacerbation of heart failure should begin during the admission process. Initiating discharge planning early ensures a smooth transition and continuity of care for the client. Option B, after the client is stabilized, is not ideal because planning should start early to address potential barriers to discharge. Option C, when the client expresses readiness to go home, may be too late as discharge planning is a proactive process. Option D, just before the expected discharge date, does not allow enough time for comprehensive planning and coordination of post-discharge care needs.

3. The healthcare provider prescribes the diuretic metolazone (Zaroxolyn) 7.5 mg PO. Zaroxolyn is available in 5 mg tablets. How much should the LPN/LVN plan to administer?

Correct answer: C

Rationale: To administer 7.5 mg of metolazone (Zaroxolyn), the LPN/LVN should plan to give 1 1/2 tablets since each tablet contains 5 mg. Choice A (1/2 tablet) would not provide the full prescribed dose. Choice B (1 tablet) would only deliver 5 mg, which is less than the prescribed dose. Choice D (2 tablets) would exceed the prescribed dose, resulting in 10 mg instead of the required 7.5 mg. Therefore, the correct answer is to administer 1 1/2 tablets to achieve the prescribed 7.5 mg.

4. The nurse is teaching a client with newly diagnosed type 1 diabetes about insulin administration. Which statement by the client indicates a need for further teaching?

Correct answer: C

Rationale: The correct answer is C because insulin needles should be disposed of after a single use to prevent infection. Reusing the same needle for three days can lead to infection and is not a safe practice. Choices A, B, and D demonstrate good understanding of insulin administration and diabetes management, so they do not indicate a need for further teaching.

5. An older adult client just diagnosed with colon cancer asks the nurse what the primary care provider is going to do. The provider will be making rounds within the hour. Which of the following nursing actions is appropriate?

Correct answer: A

Rationale: Assisting the client in preparing questions is the most appropriate action as it helps ensure that all concerns are addressed during the provider's visit. By helping the client write down questions, the nurse empowers the client to actively participate in their care and communicate effectively with the provider. Reassuring the client, while well-intentioned, may not address the specific questions or fears the client has. Explaining the procedure in detail may not be what the client is seeking at this moment, as their primary concern is about the provider's actions. Directing the client to search for information online is not recommended as it may lead to confusion or misinformation, and the information may not be tailored to the client's specific situation.

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