HESI LPN
Adult Health 1 Exam 1
1. While caring for a client's postoperative dressing, the nurse observes purulent wound drainage. Previously, the wound was inflamed and tender but without drainage. Which is the most important action for the nurse to take?
- A. Determine if the drainage has an unpleasant odor.
- B. Monitor the client's white blood cell count (WBC).
- C. Request a culture and sensitivity of the wound.
- D. Cleanse the wound with a sterile saline solution.
Correct answer: C
Rationale: Requesting a culture and sensitivity of the wound is the most crucial action in this scenario. This will help identify the specific organism causing the infection and determine its sensitivity to antibiotics, guiding appropriate antibiotic therapy. Option A is less critical as odor alone may not provide enough information about the type of infection. Monitoring the client's white blood cell count (WBC) in option B is important but not as immediate as obtaining a wound culture. Cleansing the wound with a sterile saline solution in option D is necessary but should follow after obtaining the culture results to ensure proper treatment.
2. A 3-year-old child is being discharged after being treated for dehydration. What should be included in the discharge teaching?
- A. Monitor for signs of infection
- B. Monitor for signs of dehydration
- C. Monitor for signs of hypovolemia
- D. Monitor for signs of malnutrition
Correct answer: B
Rationale: The correct answer is to monitor for signs of dehydration. After treatment for dehydration, it is crucial to educate caregivers about recognizing early signs of dehydration to prevent its recurrence. Monitoring for dehydration ensures that appropriate measures can be taken promptly if signs reappear. Choices A, C, and D are incorrect because infection, hypovolemia, and malnutrition, while important considerations in healthcare, are not the primary focus after treating dehydration in a 3-year-old child.
3. The client has expressive aphasia and needs assistance to communicate. Which method should the LPN use to best support the client's ability to express basic needs?
- A. Use a picture board with common needs.
- B. Encourage the client to speak slowly.
- C. Write down what the client says.
- D. Use hand gestures to communicate.
Correct answer: A
Rationale: The correct answer is to use a picture board with common needs. Clients with expressive aphasia have difficulty speaking but can often understand and use visual aids effectively. Using a picture board helps the client communicate basic needs more easily. Encouraging the client to speak slowly (choice B) may not be effective as the issue lies with expressive language, not speed. Writing down what the client says (choice C) may not always be possible or helpful for immediate communication as it does not address the communication barrier directly. Using hand gestures (choice D) may not be as clear or universally understood as a picture board, which can cause confusion and misinterpretation.
4. When washing soiled hands, what should the nurse do after wetting the hands and applying soap?
- A. Rub hands palm to palm
- B. Interlace the fingers
- C. Dry hands with a paper towel
- D. Turn off the water faucet
Correct answer: A
Rationale: After wetting the hands and applying soap, the nurse should rub hands palm to palm. Rubbing hands palm to palm helps create friction and effectively clean the hands by spreading the soap and reaching all areas. Interlacing the fingers, drying hands with a paper towel, and turning off the water faucet should come after rubbing hands palm to palm in the handwashing process. Interlacing the fingers can be done to ensure the backs of the hands are cleaned, drying hands with a paper towel is the final step to ensure hands are dry, and turning off the water faucet helps save water.
5. What dietary modification is important for a child with celiac disease?
- A. Increase dairy intake
- B. Avoid gluten-containing foods
- C. Decrease protein intake
- D. Increase fiber intake
Correct answer: B
Rationale: The correct answer is B: Avoid gluten-containing foods. For a child with celiac disease, it is crucial to eliminate gluten from their diet to manage the condition effectively. Gluten triggers an immune response in individuals with celiac disease, leading to symptoms and damage to the small intestine. Choices A, C, and D are incorrect because increasing dairy intake, decreasing protein intake, or increasing fiber intake are not specific dietary modifications for managing celiac disease.