HESI LPN
Medical Surgical Assignment Exam HESI Quizlet
1. What are the clinical manifestations of otitis media?
- A. Earache, wheezing, vomiting
- B. Coughing, rhinorrhea, headache
- C. Fever, irritability, pulling on ear
- D. Wheezing, cough, drainage in ear canal
Correct answer: C
Rationale: The correct answer is C: Fever, irritability, pulling on the ear. Clinical manifestations of otitis media commonly include fever, irritability, and children may show signs of pulling or rubbing their ears. Choices A, B, and D are incorrect. Choice A includes wheezing and vomiting, which are not typical symptoms of otitis media. Choice B includes coughing, rhinorrhea, and headache, which are more commonly associated with upper respiratory infections rather than otitis media. Choice D includes wheezing, cough, and drainage in the ear canal, which are not typical clinical manifestations of otitis media.
2. Which nursing intervention is most important for the nurse to implement when caring for an older client who is legally blind?
- A. Keep the room well-lit at all times.
- B. Speak to the client each time the nurse enters the room.
- C. Ensure the client wears glasses at all times.
- D. Provide written instructions in large print.
Correct answer: B
Rationale: The correct answer is to speak to the client each time the nurse enters the room. This intervention is crucial for orienting and reassuring the client, promoting safety, and facilitating communication. Keeping the room well-lit (Choice A) can be helpful but is not as essential as direct verbal communication. Ensuring the client wears glasses (Choice C) may not be feasible or necessary for someone who is legally blind. Providing written instructions in large print (Choice D) is not effective for a client with visual impairments.
3. A client with chronic kidney disease is advised to follow a low-phosphorus diet. Which food should the client avoid?
- A. Milk
- B. Apples
- C. Carrots
- D. Rice
Correct answer: A
Rationale: Correct Answer: Milk. Milk is high in phosphorus and should be avoided in a low-phosphorus diet for clients with chronic kidney disease. Choice B (Apples), C (Carrots), and D (Rice) are not significant sources of phosphorus and can be included in moderation in a low-phosphorus diet. Apples and carrots are generally considered healthy choices for most individuals, while rice is a staple food that is low in phosphorus and can be part of a renal diet.
4. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 liters per minute via a nasal cannula. Which assessment finding indicates a potential complication of oxygen therapy?
- A. Increased respiratory rate
- B. Decreased level of consciousness
- C. Improved oxygen saturation
- D. Complaints of dry mouth
Correct answer: B
Rationale: In clients with COPD, oxygen therapy can lead to a decrease in the respiratory drive caused by the removal of the hypoxic drive. This can result in carbon dioxide retention, leading to a decreased level of consciousness. Options A, C, and D are incorrect because an increased respiratory rate is typically a sign of hypoxia, improved oxygen saturation is a positive response to oxygen therapy, and complaints of dry mouth are not directly related to oxygen therapy complications in this scenario.
5. What is the priority patient problem for the parents of a newborn born with cleft lip and palate?
- A. Parental role conflict
- B. Risk for delayed growth and development
- C. Risk for impaired attachment
- D. Anticipatory grieving
Correct answer: C
Rationale: The correct answer is C: Risk for impaired attachment. Parents of a newborn with cleft lip and palate may face challenges in bonding with their child due to the physical appearance, impacting attachment. Promoting bonding between parents and the infant is crucial in this situation. Choice A (Parental role conflict) is incorrect as it focuses on conflicting roles rather than the attachment issue. Choice B (Risk for delayed growth and development) is not the priority issue in this scenario as the immediate concern is establishing a healthy attachment. Choice D (Anticipatory grieving) is not the priority patient problem as it pertains more to the emotional response to an anticipated loss, which is not the primary concern at this stage.
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