HESI LPN
HESI CAT Exam 2022
1. The nurse is preparing to administer an oral antibiotic to a client with unilateral weakness, ptosis, mouth drooping, and aspiration pneumonia. What is the priority nursing assessment that should be done before administering this medication?
- A. Ask the client about soft food preferences
- B. Auscultate the client’s breath sounds
- C. Obtain and record the client’s vital signs
- D. Determine which side of the body is weak
Correct answer: B
Rationale: The correct answer is to auscultate the client’s breath sounds. Assessing breath sounds is crucial in this scenario as it helps ensure that the client can safely swallow the oral antibiotic without aspirating. Unilateral weakness, ptosis, mouth drooping, and aspiration pneumonia indicate potential swallowing difficulties, making it essential to assess breath sounds for any signs of respiratory issues. Asking about food preferences (choice A) may be relevant later but is not the priority before administering the medication. While obtaining vital signs (choice C) is important, assessing breath sounds takes precedence in this case. Determining which side of the body is weak (choice D) is not the priority assessment before administering the oral antibiotic.
2. The mother of a school-age child calls the school to ask when her daughter can return to school after treatment for Pediculosis capitis. What is the nurse’s best response?
- A. When all live lice are eliminated by the treatment
- B. Two weeks after the last treatment
- C. As soon as the itching stops
- D. After the treatment kills all the live lice
Correct answer: D
Rationale: The correct answer is 'After the treatment kills all the live lice.' The child can return to school once all live lice are eliminated to prevent the spread of Pediculosis capitis. This is essential as live lice are highly contagious. Choices A, B, and C are incorrect. Waiting for the itching to stop or for an epidemic to subside does not ensure that all live lice are eradicated, which is crucial to prevent reinfestation and transmission.
3. The nurse is preparing to administer an IM dose of vitamin B1 (Thiamine) to a male client experiencing acute alcohol withdrawal and peripheral neuritis. The client belligerently states, “What do you think you’re doing?†How should the nurse respond?
- A. “I cannot give you this medication until you calm down.â€
- B. “This shot will help relieve the pain in your feet.â€
- C. “Would you prefer to learn to administer your own shot?â€
- D. “You will feel calmer and less jittery after this shot.â€
Correct answer: B
Rationale: The correct response is to provide a relevant explanation to the client. Choice B, “This shot will help relieve the pain in your feet,†is the best answer because it directly addresses the client's concern about the purpose of the medication. By explaining the potential benefit of the injection, the nurse can alleviate the client's anxiety and increase their cooperation during the procedure. Choice A is incorrect as it dismisses the client's question and may escalate the situation. Choice C is not suitable as it deviates from addressing the client's immediate query. Choice D is incorrect because it fails to specifically address the client's concern regarding the medication's purpose.
4. Following a thyroidectomy, a client experiences tetany. The nurse should expect to administer which intravenous medication?
- A. Sodium iodide solution
- B. Levothyroxine sodium (Synthroid)
- C. Calcium gluconate
- D. Propranolol (Inderal)
Correct answer: C
Rationale: Following a thyroidectomy, tetany can occur due to hypoparathyroidism, leading to low calcium levels. Therefore, the nurse should administer calcium gluconate intravenously to raise the calcium levels. Choice A, Sodium iodide solution, is incorrect as it is used for thyroid conditions, not for treating tetany. Choice B, Levothyroxine sodium (Synthroid), is incorrect as it is a thyroid hormone replacement and does not address low calcium levels. Choice D, Propranolol (Inderal), is incorrect as it is a beta-blocker used for conditions like hypertension and not indicated for tetany after thyroidectomy.
5. The nurse notes that an older adult client has a moist cough that increases in severity during and after meals. Based on this finding, what action should the nurse take?
- A. Encourage the client to perform deep breathing exercises daily.
- B. Offer the client additional clear fluids frequently.
- C. Collect a sputum specimen immediately.
- D. Request a consultation to confirm dysphagia
Correct answer: D
Rationale: The correct answer is D. The moist cough that worsens during and after meals suggests possible dysphagia, a condition related to swallowing difficulties. Requesting a consultation for dysphagia is essential for an accurate diagnosis and appropriate management. Encouraging the client to perform deep breathing exercises (choice A) may not address the underlying issue of dysphagia. Offering additional clear fluids (choice B) may not be appropriate for someone with swallowing difficulties. Collecting a sputum specimen (choice C) is not the priority in this scenario as the focus should be on identifying and managing the swallowing problem.
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