HESI LPN
Community Health HESI Exam
1. During a large community disaster, a man states that the blast threw him out of a second-story window. Which action should the nurse implement first?
- A. Logroll the client to his side and assess for back injuries
- B. Perform a complete neurological assessment
- C. Open the client's airway immediately
- D. Place the nurse's hands around the client's neck to stabilize
Correct answer: D
Rationale: In this situation, the nurse should first stabilize the client's neck to prevent potential spinal cord injuries. Logrolling the client or performing other assessments should only be done after ensuring spinal stabilization. Opening the airway immediately is important in cases of airway obstruction, but stabilizing the neck takes priority in this scenario. Performing a complete neurological assessment may delay immediate stabilization, which is crucial in suspected spinal injuries.
2. A client with heart failure is being taught by a nurse on reducing daily sodium intake. Which factor is most crucial in determining the client’s ability to learn new dietary habits?
- A. The client's involvement in planning the change
- B. The cost of the dietary changes
- C. The availability of low-sodium foods
- D. The client’s previous dietary knowledge
Correct answer: D
Rationale: The client’s previous dietary knowledge is the most critical factor in determining the ability to learn new dietary habits. Understanding the client's existing dietary knowledge helps tailor the teaching to build upon what they already know. While client involvement in planning changes can increase adherence and motivation, the foundational knowledge is essential for effective learning. The cost of dietary changes and the availability of low-sodium foods are important considerations but not as crucial as the client's existing knowledge.
3. After spinal fusion surgery, a client reports numbness and tingling in the legs. What should the nurse do first?
- A. Assess the client’s neurovascular status in the lower extremities.
- B. Reposition the client to relieve pressure on the spine.
- C. Administer prescribed pain medication.
- D. Notify the healthcare provider immediately.
Correct answer: A
Rationale: After spinal fusion surgery, numbness and tingling in the legs may indicate nerve compression or damage. The priority action for the nurse is to assess the client’s neurovascular status in the lower extremities. This assessment will help determine the cause and severity of the symptoms, guiding further interventions. Repositioning the client may be necessary for comfort, but assessing neurovascular status is the initial step. Administering pain medication should only follow the assessment to address any discomfort. Notifying the healthcare provider immediately is not the first action unless there are emergent signs requiring urgent intervention.
4. A client with chronic alcoholism is admitted with a decreased serum magnesium level. Which snack option should the nurse recommend to this client?
- A. Cheddar cheese and crackers
- B. Carrot and celery sticks
- C. Beef bologna sausage slices
- D. Dry roasted almonds
Correct answer: D
Rationale: Dry roasted almonds are the most suitable snack option for a client with chronic alcoholism and a decreased serum magnesium level because they are high in magnesium. Magnesium is essential in addressing the deficiency. Cheddar cheese and crackers (Choice A) do not contain as much magnesium as almonds. Carrot and celery sticks (Choice B) are healthy choices but do not provide a significant amount of magnesium. Beef bologna sausage slices (Choice C) are not a good choice as processed meats are not rich in magnesium.
5. The healthcare professional is creating a class for older adults in the community. Which information about laxative use in older adults would be important to include?
- A. Laxatives are not effective in older adults
- B. All laxatives are exactly the same
- C. Over-the-counter laxatives are misused
- D. Laxatives can cause potassium retention
Correct answer: C
Rationale: It is important to include information about the misuse of over-the-counter laxatives in older adults as they often misuse these medications, which can lead to dependency and other health issues. Option A is incorrect as laxatives can be effective in older adults when used appropriately. Option B is incorrect because not all laxatives are the same, they have different mechanisms of action and side effects. Option D is incorrect because laxatives can actually cause electrolyte imbalances like potassium depletion rather than retention.