the rn is making a home visit to a female client with end stage heart disease she has a living will and states she will never go back to the hospital
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Nursing Elites

HESI LPN

Community Health HESI Exam

1. The RN is making a home visit to a female client with end-stage heart disease. She has a living will and states she will never go back to the hospital. During the visit, the RN notes that the client is pale and SOB while speaking. The RN discovers 3+ edema in both ankles and bilateral pulmonary crackles. Which intervention should the RN implement first?

Correct answer: B

Rationale: Obtaining a peripheral O2 saturation reading is the priority intervention in this scenario. It helps assess the client's oxygenation status quickly, which is crucial in a client with signs of respiratory distress, such as shortness of breath and bilateral pulmonary crackles. Ordering a chest X-ray (Choice A) may be necessary later but does not address the immediate need for oxygen assessment. Obtaining an order for a complete blood count (Choice C) is not the priority in this situation as it does not directly address the client's respiratory distress. Instructing the patient to stay in bed (Choice D) does not address the underlying issue of potential hypoxia and respiratory compromise.

2. A public health nurse is working with a community to develop a disaster response plan. Which of the following is the priority action?

Correct answer: A

Rationale: Identifying available resources and services is the priority action when developing a disaster response plan. This step is crucial as it helps the community understand what resources and services are already in place and what additional support may be needed during a disaster. Conducting disaster drills, educating the community about disaster preparedness, and developing a communication plan are important steps in disaster preparedness but come after identifying available resources and services. Without knowing the available resources, it would be challenging to effectively plan and respond to a disaster.

3. Which of these tests with frequency would the nurse expect to monitor for the evaluation of clients with poor glycemic control in persons aged 18 and older?

Correct answer: A

Rationale: Glycosylated hemoglobin (A1c) testing every 3 months is recommended for clients with poor glycemic control to monitor their average blood sugar levels and adjust treatment as necessary. Choice A is correct as it aligns with the guideline of performing A1c testing every 3 months. Choice B is incorrect because testing at least twice a year may not provide adequate monitoring for clients with poor glycemic control. Choice C is incorrect as it only mentions testing at 3-month intervals without specifying the importance of A1c testing. Choice D is incorrect as it includes unnecessary tests like glucose tolerance test and does not emphasize the importance of more frequent A1c monitoring for clients with poor glycemic control.

4. A 16-year-old client is admitted to a psychiatric unit with a diagnosis of attempted suicide. The nurse is aware that the most frequent cause for suicide in adolescents is

Correct answer: D

Rationale: Feelings of alienation or isolation are common triggers for suicidal behavior in adolescents. This sense of being disconnected or isolated from others can lead to despair and hopelessness, increasing the risk of suicidal ideation. Choices A, B, and C are less commonly associated with suicide in adolescents. Progressive failure to adapt may contribute to stress, but it is not typically the primary cause of suicide. Feelings of anger or hostility, while negative emotions, do not always lead to suicidal behavior in adolescents. Reunion wish or fantasy is not a recognized primary cause of suicide in this age group.

5. Which of the following statements is not correct regarding family planning?

Correct answer: D

Rationale: The correct answer is D because the ultimate goal of family planning is not solely to prevent pregnancies but to promote individual and family well-being. Family planning encompasses various aspects such as helping individuals and families make informed choices about the number and spacing of their children, access to healthcare services, and overall reproductive health. Option A is correct as making family planning services available to those who need them is essential for promoting reproductive health. Option B is also correct as it emphasizes the role of parents in making decisions about having children. Option C is correct as family planning indeed aims to improve the welfare of individuals and families. Therefore, option D is not correct as the ultimate goal of family planning is not limited to preventing pregnancies, but it includes broader aspects of promoting health and well-being.

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