HESI LPN Entrance Exam - Questions and Answers

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HESI LPN Entrance Exam - Questions and Answers A client's daughter phones the charge nurse to report that the night nurse did not provide good care for her mother. What response should the nurse make... ? A. Ask for a description of what happened during the night A client who had a lobectomy two days ago has 2 chest tubes, each attached to a water-sealed drainage system, Pleur-Evac. The nurse observes that in the last 8 hours the serosanguineous fluid has diminished to output in the drainage chamber. What is the most likely outcome of this observation? B. Change the Pleur-Evac system and re-assess output in the empty chamber A client with diabetes is admitted with a 1cm size ulcer on the left great toe. The nurse observes that the left foot has a dusky color. In planning the client's care, which intervention should the nurse implement first? D. Check the client's dorsalis pedis and posterior tibialis pulse point A client with Meningitis is in a coma and Nursing care includes seizure precautions. To help prevent seizure activity, what interventions should the nurse implement? D. Maintain a quiet calm darkened environment A client with recurrent urinary tract infections (UTI) is being discharged. What instruction is appropriate for the nurse to include in the discharge teaching plan? A. Drink 3 quarts of water daily During CPR, when attempting to ventilate a client's lungs, the nurse notes that the chest is not rising. What action should the nurse take first? A. Reposition the head to ensure an open airway During immediate postoperative period, which condition has the highest priority when planning Nursing care? B. Respiratory obstruction During preoperative preparation, the nurse should offer the client which explanation about why deep breathing exercising with an incentive spirometer are necessary after surgery? A. "Deep breathing exercises using spirometer will help prevent postoperative complications." During the past 30 days an elderly client has exhibited a progressively decreasing appetite, is spending increasing amounts of the daytime hours in bed, and refuses to participate in planned daytime activities. Which action should the nurse take? D. Record the findings and report the symptoms to the charge nurse During vital sign assessment of a client, the nurse counts the left radial pulse at 88, and the pulse oximeter clipped to a finger on the left hand records a pulse rate of 68 with an oxygen saturation of 95%. What is the best initial action by the nurse? B. Reposition the oximeter clip An elderly client at an adult daycare center with Type2 Diabetes Mellitus becomes unresponsive verbally and then tells the nurse, "I just don't feel right" Which initial action should the nurse take? C. Give 4 ounces of apple juice An elderly client in the early postoperative period requires close monitoring due to aging and multisystem changes. The nurse monitors respirations and auscultates breath sounds frequently. What other intervention should the nurse implement related to the client's decreased vital capacity? A. Evaluate pulse oxygen saturation An elderly client is admitted for evaluation of Alzheimer's disease. At 2AM, the nurse finds the client trying to open the emergency door. What is the most appropriate response for the nurse to make in this situation? A. "This is the emergency door. Are you looking for the bathroom?" An elderly female client tells the nurse that she does not do regular Breast Self Examinations (BSE) because she is too old. The nurse's response to the client is based on what information? A. The incidence of breast cancer increases with age An elderly male client is planning to vacation with a group of senior citizens. He is concerned about developing constipation during the airplane flight. He share this concern with the nurse at the retirement home. Which recommendation is best for the nurse to provide? C Increase the fluid intake in your diet An elderly postoperative client has the Nursing diagnosis, "Impaired mobility related to fear of falling." Which desired outcome best directs Nursing actions for this client? C. The client will ambulate with assistance q4h A female client complains to the nurse about being admitted to a semi-private room and expresses her displeasure because she requested a private room prior to admission. What response is best for the nurse to provide this client? C. Your healthcare provider must provide a written request to get you a private room A female client is being prepared for a speculum exam. In which position should the nurse place the client? C. Lithotomy A female client with no family history of Breast Cancer (BA) asks the nurse how often she should obtain a Mammogram. Which additional client information should the nurse obtain before answering this client's question? C. Breastfeeding history The first day after a cesarean section (C-Section), when being assisted to the bathroom for the first time, a primavera client experiences a sudden gush of vaginal blood and notices that several blood clots are in the toilet. What action should the nurse take? C. Check fundal consistency and continue to monitor the lochial flow amount Following a left leg above the knee amputation (AKA), a client voices several complaints. Which statement should be reported to the charge nurse immediately? C. I've been feeling so light headed Following an open reduction of the tibia, the nurse notes fresh bleeding on the client's cast. Which intervention should the nurse implement? C. Outline the area with ink and check it q15 minutes to see if the area has increased The healthcare provider prescribes an IV solution of clindamycin (Cleocin) 850mg in 75 mL of D2W to infuse over 30 minutes. The drop factor is 15 gtt/mL. The nurse should regulate the IV to deliver how many gtt/minute? (Enter numeric value only. if rounding is required round to the nearest whole number) 75mL X 15gtt/mL = 38 The healthcare provider prescribes erythromycin (ilosone) 300 mg PO QID. The medication label reads, "ilosone 100mg/5mL" How many mL should the nurse administer at each does? (Enter the numeric value only) 15 The healthcare provider tells the family of a 6-year old child with a malignant brain tumor that the tumor is metastasizing and the child's condition is terminal. How can the nurse best help the family cope with this news? C. Listen to the family's reactions and reflect and their fears and concerns The home health nurse observes an elderly male client attempt to open a child-proof medication container. When he is unsuccessful in opening the container, he throws it across the room and curses loudly. What action should the nurse implement? D. Describe other types of medication containers that are available A hospitalized toddler who is recovering from a sickle cell crisis holds a toy and say's "mine". According to Erikson's theory of psychosocial development, this child's behavior is a demonstration of which developmental stage? A. Autonomy vs. Shame and doubt. In assisting a client perform pursed lip breathing, the nurse should ensure that the client performs which action? A. Inhale through the nose with the mouth shut and exhale through pursed lips In assisting a client to obtain a sputum specimen, the nurse observes the client cough and spit a large amount of frothy saliva in the specimen collection cup. What action should the nurse implement next? B. Re-instruct the client in coughing techniques to obtain another specimen In caring for a client following a below the knee amputation (BKA) which task is best for the nurse to delegate to the unlicensed assistive personnel (UAP) who is assisting with the care of this client? A. Empty and measure the drainage in the suction drainage device In counting a client's radial pulse, the nurse notes the pulse is weak and irregular. To record the most accurate heart rate, what should the nurse take? C. Count the apical pulse rate for sixty seconds In describing the "at risk" individual for developing Breast Cancer, the nurse should recognize that which client is at the highest risk? The woman who is... C. a 32-year-old whose mother had breast cancer In obtaining an orthostatic vital sign measurement, what action should the nurse take first? C. Instruct the client to lie supine In preparing a client for a lumbar puncture, what action should the nurse implement? C. Teach the client to cough and deep breathing exercises A male client admitted the morning of his scheduled surgery tells the nurse that he drank a glass of water during the night. What intervention will the nurse implement first? B. Determine the amount of water and exact time it was taken [Show More]

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