HESI LPN
HESI PN Exit Exam 2023
1. What is the first step in using an automated external defibrillator (AED) on a patient who has collapsed?
- A. Apply the pads to the chest
- B. Turn on the AED and follow the voice prompts
- C. Check the patient's pulse
- D. Ensure the area is clear before delivering a shock
Correct answer: B
Rationale: The correct answer is B: Turn on the AED and follow the voice prompts. This is the first step in using an AED as the device will guide you through the process of analyzing the heart rhythm and delivering a shock if necessary. Choice A, applying the pads to the chest, comes after turning on the AED. Checking the patient's pulse (Choice C) is not necessary before using an AED as the device is specifically designed to assess the need for defibrillation. Ensuring the area is clear (Choice D) is important for safety but is not the initial step in using an AED.
2. What is the best thing to say to a patient scheduled for cataract surgery who is concerned that the physician works on the correct eye?
- A. You are wearing an ID bracelet that will let the medical team know which eye to work on.
- B. When you are taken to the surgery area, the medical staff will confirm which eye needs the surgery.
- C. The surgeon will mark the correct eye before the cataract surgery based on your medical records.
- D. You will wear an ID bracelet, and the nurse will verify the eye scheduled for surgery by comparing it with your records and marking it with a permanent marker.
Correct answer: D
Rationale: The best response reassures the patient by explaining the process of verifying and marking the correct eye, a safety measure to prevent wrong-site surgery, directly addressing the patient’s concern. Choice A is close but implies the ID bracelet alone determines the correct eye, missing the verification process. Choice B talks about confirmation but lacks details about marking the correct eye. Choice C mentions the surgeon's record but does not specify the direct verification and marking process, unlike Choice D.
3. After spinal fusion surgery, a client reports numbness and tingling in the legs. What should the nurse do first?
- A. Assess the client’s neurovascular status in the lower extremities.
- B. Reposition the client to relieve pressure on the spine.
- C. Administer prescribed pain medication.
- D. Notify the healthcare provider immediately.
Correct answer: A
Rationale: After spinal fusion surgery, numbness and tingling in the legs may indicate nerve compression or damage. The priority action for the nurse is to assess the client’s neurovascular status in the lower extremities. This assessment will help determine the cause and severity of the symptoms, guiding further interventions. Repositioning the client may be necessary for comfort, but assessing neurovascular status is the initial step. Administering pain medication should only follow the assessment to address any discomfort. Notifying the healthcare provider immediately is not the first action unless there are emergent signs requiring urgent intervention.
4. Which action should the PN implement when using standard precautions to provide client care?
- A. Apply sterile gloves to obtain a finger stick blood sample
- B. Wear clean exam gloves to perform perineal catheter care
- C. Replace the needle cap after giving an intramuscular injection
- D. Wear a paper gown to prevent transmission of droplet pathogens
Correct answer: B
Rationale: The correct answer is B. When using standard precautions, healthcare providers should wear clean exam gloves to perform perineal catheter care. This approach helps prevent the transmission of pathogens and ensures the safety of both the client and the healthcare provider. Choice A is incorrect because applying sterile gloves for a finger stick blood sample is unnecessary when non-sterile gloves would suffice. Choice C is incorrect because replacing the needle cap after giving an intramuscular injection is not directly related to standard precautions. Choice D is incorrect because wearing a paper gown is not a standard precaution for preventing the transmission of droplet pathogens.
5. The PN observes a UAP bathing a bedfast client with the bed in the high position. Which action should the PN take?
- A. Remain in the room to supervise the UAP
- B. Determine if the UAP would like assistance
- C. Assume care of the client immediately
- D. Instruct the UAP to lower the bed for safety
Correct answer: D
Rationale: The correct action for the PN to take in this situation is to instruct the UAP to lower the bed for safety. Keeping the bed in the lowest position during care activities is crucial for preventing falls and injuries to both the client and the caregiver. Instructing the UAP to lower the bed addresses the immediate safety concern. Choice A is incorrect because simply supervising the UAP without addressing the unsafe bed height does not ensure the client's safety. Choice B is incorrect as the priority is to address the safety concern rather than offering assistance to the UAP. Choice C is incorrect as assuming care of the client immediately does not address the root issue of the high bed position.
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