HESI LPN
HESI PN Exit Exam 2023
1. While providing oral care for a client who is unconscious, the nurse positions the client laterally and uses a basin to collect secretions. Which intervention is best for the nurse to implement?
- A. Swab the oral cavity with a washcloth
- B. Use oral swabs with normal saline
- C. Provide a Yankauer tip for oral suction
- D. Support the head with a small pillow
Correct answer: B
Rationale: Using oral swabs with normal saline is the best intervention in this scenario as it effectively cleans the oral cavity without causing irritation or dryness, which is crucial for an unconscious client. Swabbing the oral cavity with a washcloth may not provide thorough cleaning, and it can potentially cause irritation. Providing a Yankauer tip for oral suction is not necessary unless there are excessive secretions that need to be suctioned. Supporting the head with a small pillow, although important for comfort, is not directly related to oral care in an unconscious client.
2. Which statement by a mature adult client with advanced prostate cancer best indicates that he has reached a level of acceptance of his prognosis?
- A. I don't have any use for those who say the disease is going to win
- B. I've found the support I need from my faith and family
- C. I think I've had this disease for a long time, but the doctor did not find it
- D. I understand that this is a disease that occurs mostly in older men
Correct answer: B
Rationale: The correct answer is B because finding support in faith and family is a common way for individuals to cope with serious illnesses and come to terms with their prognosis. This statement indicates that the client has found a source of strength and comfort to deal with their situation. Choice A reflects defiance rather than acceptance. Choice C suggests denial or disbelief in the diagnosis. Choice D shows factual knowledge about the disease but does not necessarily indicate acceptance of the prognosis.
3. In what order should the PN implement these steps to provide wound care? (Place in correct order.)
- A. Don procedure gloves
- B. Remove the dressing
- C. Apply prescribed medications to the wound
- D. All of the Above
Correct answer: D
Rationale: The correct answer is 'D - All of the Above.' The PN should first don procedure gloves to maintain aseptic technique, then remove the dressing to assess the wound, and finally apply prescribed medications to the wound. This sequence ensures that non-sterile tasks like donning gloves are done before sterile tasks like applying medications, reducing the risk of wound contamination. Choices A, B, and C are all essential steps in providing effective wound care.
4. During a fire incident in a long-term care facility's kitchen, which task is most crucial for the PN to perform instead of delegating to UAP?
- A. Close the doors to all residents' rooms
- B. Offer comfort and reassurance to each resident
- C. Identify the method for transporting and evacuating each resident
- D. Provide blankets to each resident for use during evacuation
Correct answer: C
Rationale: During a fire emergency, the most critical task for the PN is to identify the method for transporting and evacuating each resident. This task ensures a safe and organized evacuation plan, which is essential for everyone's safety. Delegating this responsibility to an unlicensed assistive personnel (UAP) may lead to errors or delays in the evacuation process. Closing doors to residents' rooms (Choice A) can help contain the fire but is not as urgent as planning the evacuation. While offering comfort and reassurance (Choice B) is important, it should not take precedence over ensuring a safe evacuation. Providing blankets (Choice D) is helpful but does not directly address the primary concern of safely evacuating residents.
5. 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.
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