the nurse is caring for a client with a history of atrial fibrillation which assessment finding would be most concerning the nurse is caring for a client with a history of atrial fibrillation which assessment finding would be most concerning
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Nursing Elites

HESI LPN

HESI Fundamentals Exam

1. The healthcare provider is caring for a client with a history of atrial fibrillation. Which assessment finding would be most concerning?

Correct answer: C

Rationale: Shortness of breath is the most concerning assessment finding in a client with a history of atrial fibrillation. It can indicate a worsening of the condition, pulmonary edema, or the development of a complication such as heart failure. A blood pressure of 150/90 mmHg, while elevated, is not as immediately concerning as respiratory distress in this context. An irregular heart rhythm is expected in atrial fibrillation and may not necessarily be a new or concerning finding. Fatigue is a common symptom in atrial fibrillation but is not as acutely concerning as shortness of breath, which may indicate compromised oxygenation and circulation.

2. What is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions known as?

Correct answer: A

Rationale: Health literacy refers to the ability to obtain, process, and understand basic health information and services necessary to make informed health decisions. It empowers individuals to navigate the healthcare system, understand medical instructions, and advocate for their own health needs. - Choice B, Health equity, is the concept of everyone having a fair opportunity to attain their full health potential and not being disadvantaged due to their social or economic status. - Choice C, Health disparity, refers to differences in health outcomes or access to healthcare between different populations, often influenced by social, economic, or environmental factors. - Choice D, Health promotion, involves efforts to enhance and protect the health of individuals and communities through education, behavior change, and public health initiatives.

3. An infant is diagnosed with Hirschsprung disease. What nursing intervention is essential before surgery?

Correct answer: D

Rationale: The correct nursing intervention essential before surgery for an infant with Hirschsprung disease is maintaining NPO (nothing by mouth) status. This is important to prevent aspiration during and after the surgical procedure. Administering antibiotics (Choice A) may be necessary in some cases but is not the priority intervention before surgery. Ensuring bowel rest (Choice B) is not directly related to preparing for surgery and may not be the most critical intervention. Performing regular enemas (Choice C) is not recommended before surgery for Hirschsprung disease as it can aggravate the condition.

4. In evaluating your client's level of wellness, which of the following indicators can you see?

Correct answer: C

Rationale: When evaluating a client's level of wellness, indicators such as appropriate nutritional level, sense of personal security, and acceptance of oneself and one's limitations are crucial. Option C, 'Acceptance of oneself and one's limitations,' directly relates to mental wellness and self-awareness, making it a key indicator of overall well-being. Options A, B, and D are not as directly tied to the psychological and emotional aspects of wellness, making them less relevant indicators in this context. Therefore, the correct answer is C.

5. What is a key intervention for a child with a new diagnosis of type 1 diabetes?

Correct answer: A

Rationale: The correct answer is A: Insulin administration. When a child is diagnosed with type 1 diabetes, insulin administration is a crucial intervention. Insulin helps regulate blood glucose levels by enabling cells to take in glucose from the bloodstream. Without sufficient insulin, blood glucose levels can become dangerously high, leading to various complications. Increased dietary fat intake (choice B) is not a recommended intervention for type 1 diabetes management, as it can contribute to weight gain and other health issues. Restricted fluid intake (choice C) is also not appropriate, as adequate hydration is essential for overall health. Routine physical examinations (choice D) are important but are not the primary intervention needed to manage type 1 diabetes.

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