HESI LPN
HESI Fundamentals Study Guide
1. The healthcare professional is preparing to administer a medication through a nasogastric (NG) tube. Which action should the healthcare professional take to ensure proper administration?
- A. Flush the tube with 30 ml of water before and after medication administration.
- B. Administer the medication with food to prevent nausea.
- C. Verify tube placement by aspirating stomach contents.
- D. Dilute the medication with normal saline before administration.
Correct answer: A
Rationale: Flushing the NG tube with water before and after medication administration is essential to ensure the tube is patent and prevent clogging. This action helps in clearing the tube and ensures that the medication is delivered properly. Administering medication with food (Choice B) may not be appropriate for all medications and can interfere with their absorption. Verifying tube placement by aspirating stomach contents (Choice C) is important but does not directly relate to ensuring proper medication administration. Diluting the medication with normal saline (Choice D) is not a standard practice for administering medications through an NG tube.
2. The healthcare provider is caring for a client with dehydration. Which assessment finding indicates that the client is responding to treatment?
- A. Dry mucous membranes
- B. Increased urine output
- C. Decreased heart rate
- D. Elevated blood pressure
Correct answer: B
Rationale: Increased urine output is the correct assessment finding that indicates the client is responding to treatment for dehydration. When a client is dehydrated, their urine output tends to decrease as the body tries to conserve fluids. Therefore, an increase in urine output suggests that the client's hydration status is improving. Dry mucous membranes (Choice A) are a sign of dehydration and would not indicate a positive response to treatment. Decreased heart rate (Choice C) and elevated blood pressure (Choice D) are not specific indicators of hydration status in a client with dehydration.
3. A nurse is counseling an older adult who describes having difficulty with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority?
- A. “I spent my whole life dreaming about retirement, and now I wish I had my job back.”
- B. “It’s been so stressful for me to have to depend on my child to help around the house.”
- C. “I just heard my friend Al die. That’s the third one in 3 months.”
- D. “I keep forgetting which medications I have taken during the day.”
Correct answer: C
Rationale: The correct answer is C. The statement expressing the loss of friends is the priority issue as it indicates potential grief and emotional distress. Losing multiple friends within a short period can have a profound impact on an older adult's emotional well-being. Option A expresses regret but does not indicate an immediate emotional crisis. Option B focuses on stress related to dependence, which is important but not as urgent as coping with loss. Option D highlights a memory concern, which is significant but does not address the emotional impact of loss.
4. During a physical assessment on a toddler, what should be the first action?
- A. Perform traumatic procedures
- B. Use minimal physical contact
- C. Proceed from head to toe
- D. Explain the exam in detail
Correct answer: B
Rationale: The correct first action when performing a physical assessment on a toddler is to use minimal physical contact. This approach helps the toddler become comfortable and reduces anxiety during the assessment. Traumatic procedures (Choice A) should never be the first action as they can cause distress. Proceeding from head to toe (Choice C) is a common sequence in physical assessments but does not address the initial need to establish trust and comfort. Explaining the exam in detail (Choice D) is important but should come after establishing a rapport through minimal physical contact.
5. A patient has damage to the cerebellum. Which disorder is most important for the nurse to assess?
- A. Impaired balance
- B. Hemiplegia
- C. Muscle sprain
- D. Lower extremity paralysis
Correct answer: A
Rationale: When the cerebellum is damaged, it leads to impaired balance. The cerebellum plays a crucial role in coordinating movements and maintaining balance. Therefore, assessing the patient's balance is essential in determining the extent of cerebellar damage. Options B, C, and D are incorrect because hemiplegia refers to paralysis of one side of the body, muscle sprain is a soft tissue injury, and lower extremity paralysis involves loss of function in the lower limbs. These conditions are not directly associated with damage to the cerebellum.
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