HESI LPN
Community Health HESI Exam
1. Which of the following would be the best strategy for the nurse to use when teaching insulin injection techniques to a newly diagnosed client with diabetes?
- A. Provide written pre and post tests
- B. Ask questions during practice
- C. Allow another diabetic to assist
- D. Observe a return demonstration
Correct answer: D
Rationale: The best strategy for the nurse to use when teaching insulin injection techniques to a newly diagnosed client with diabetes is to observe a return demonstration. This method ensures that the client can correctly perform the technique. Providing written pre and post tests (choice A) may assess knowledge but not application. Asking questions during practice (choice B) may help with understanding but not necessarily with the actual performance. Allowing another diabetic to assist (choice C) may provide peer support but does not guarantee correct technique demonstration.
2. A child with a fever is prescribed acetaminophen. What should the nurse teach the parents about administering this medication?
- A. Administer the medication with food
- B. Measure the dose with a household spoon
- C. Measure the dose with a proper measuring device
- D. Administer the medication only when the child has a high fever
Correct answer: C
Rationale: The correct answer is to measure the dose with a proper measuring device. Using a proper measuring device ensures accurate dosing, which is crucial to avoid under or overdosing. Administering the medication with food (Choice A) is not necessary for acetaminophen. Using a household spoon (Choice B) can lead to inaccurate dosing due to variations in spoon sizes. Administering the medication only when the child has a high fever (Choice D) is not appropriate as acetaminophen can be used for fever management regardless of the fever intensity.
3. When assessing a client several hours after surgery, the nurse observes that the client grimaces and guards the incision while moving in bed. The client is diaphoretic, has a radial pulse rate of 110 beats/min, and a respiratory rate of 35 breaths/min. What assessment should the nurse perform first?
- A. Apical heart rate
- B. IV site and fluids
- C. Pain scale
- D. Temperature
Correct answer: C
Rationale: The client’s grimacing and guarding suggest pain; assessing the pain scale is crucial for addressing the discomfort. Pain management is a priority to ensure the client's well-being and comfort. Checking the apical heart rate, IV site and fluids, or temperature can be important but addressing the client's pain takes precedence in this scenario. The elevated pulse rate and respiratory rate could be indicative of pain, making the pain scale assessment essential to guide appropriate interventions.
4. A nurse is reviewing the correct use of a fire extinguisher with a client. Which of the following actions should the nurse direct the client to take first?
- A. Remove the safety pin from the extinguisher.
- B. Aim the extinguisher at the base of the fire.
- C. Squeeze the handle to release the extinguishing agent.
- D. Sweep the extinguisher from side to side.
Correct answer: A
Rationale: The correct first step in using a fire extinguisher is to remove the safety pin. This action enables the extinguisher to be activated and used effectively. Choice B, aiming the extinguisher at the base of the fire, comes after removing the safety pin. Choice C, squeezing the handle to release the extinguishing agent, and choice D, sweeping the extinguisher from side to side, are subsequent steps in using a fire extinguisher and should follow removing the safety pin.
5. The healthcare provider is caring for a client with a chest tube following a pneumothorax. Which assessment finding should be reported to the healthcare provider immediately?
- A. Continuous bubbling in the water seal chamber
- B. Absence of drainage in the collection chamber
- C. Tidaling in the water seal chamber
- D. Presence of subcutaneous emphysema around the insertion site
Correct answer: A
Rationale: Continuous bubbling in the water seal chamber should be reported to the healthcare provider immediately. This finding may indicate an air leak, which can compromise the effectiveness of the chest tube in re-expanding the lung. Absence of drainage in the collection chamber (choice B) may signify that the chest tube is blocked, but it does not pose an immediate threat to the client's condition. Tidaling in the water seal chamber (choice C) is an expected finding and indicates proper functioning of the chest tube system. Presence of subcutaneous emphysema around the insertion site (choice D) suggests air leakage but is not as urgent as continuous bubbling in the water seal chamber.