HESI LPN
Fundamentals of Nursing HESI
1. The healthcare provider is assessing a client with suspected tuberculosis. Which symptom would be most concerning?
- A. Night sweats
- B. Weight loss
- C. Cough with bloody sputum
- D. Fatigue
Correct answer: C
Rationale: Cough with bloody sputum is a hallmark symptom of tuberculosis and is highly concerning as it indicates active disease. Hemoptysis (coughing up blood) is associated with tuberculosis infection in the lungs. While night sweats and weight loss are common symptoms of tuberculosis, they are less specific than coughing with bloody sputum. Fatigue is a nonspecific symptom that can be present in various conditions and is not specific to tuberculosis.
2. During an assessment, a healthcare professional is evaluating the body alignment of a standing patient. Which finding will the healthcare professional report as normal?
- A. When observed laterally, the spinal curves align in a reversed 'S' pattern.
- B. When observed posteriorly, the hips and shoulders form an 'S' pattern.
- C. The arms should be crossed over the chest or in the lap.
- D. The feet should be close together with toes pointed out.
Correct answer: A
Rationale: During a standing assessment, the healthcare professional should observe the patient laterally. In a normal body alignment, the head is erect, and the spinal curves align in a reversed 'S' pattern, aiding in maintaining balance and posture. Choice B is incorrect because hips and shoulders should be level and not form an 'S' pattern when observed posteriorly. Choice C is incorrect as the position of the arms is not a key indicator of body alignment. Choice D is incorrect as the feet should be shoulder-width apart with toes pointing forward for optimal balance and stability.
3. A nurse on a medical-surgical unit is washing her hands prior to assisting with a surgical procedure. Which of the following actions by the nurse demonstrates proper surgical hand-washing techniques?
- A. The nurse washes with her hands held higher than her elbows.
- B. The nurse uses a brush to scrub under her nails.
- C. The nurse washes for at least 30 seconds.
- D. The nurse uses alcohol-based hand rub only.
Correct answer: A
Rationale: Proper surgical hand-washing technique involves keeping the hands higher than the elbows to prevent contamination. Washing with hands held lower than the elbows can lead to potential contamination. Using a brush to scrub under the nails is not recommended as it can cause microabrasions, increasing infection risk. While washing for at least 30 seconds is a good practice for thorough hand hygiene, hand positioning is critical during surgical hand-washing. Using alcohol-based hand rub alone is insufficient for surgical hand-washing as it may not effectively remove dirt, debris, and transient microorganisms.
4. A nurse is counseling an older adult who describes having difficulty with several issues. Which of the following problems verbalized by the client should the nurse identify as the priority?
- A. “I spent my whole life dreaming about retirement, and now I wish I had my job back.”
- B. “It’s been so stressful for me to have to depend on my child to help around the house.”
- C. “I just heard my friend Al die. That’s the third one in 3 months.”
- D. “I keep forgetting which medications I have taken during the day.”
Correct answer: C
Rationale: The correct answer is C. The statement expressing the loss of friends is the priority issue as it indicates potential grief and emotional distress. Losing multiple friends within a short period can have a profound impact on an older adult's emotional well-being. Option A expresses regret but does not indicate an immediate emotional crisis. Option B focuses on stress related to dependence, which is important but not as urgent as coping with loss. Option D highlights a memory concern, which is significant but does not address the emotional impact of loss.
5. A home health nurse who has attended a training session for the therapeutic use of aromatherapy with essential oils is planning to use this modality with some of her clients. For which of the following clients should the nurse consult the provider before using this complementary therapy?
- A. A client who has asthma.
- B. A client who has diabetes.
- C. A client who has hypertension.
- D. A client who has a history of depression.
Correct answer: A
Rationale: The correct answer is A: a client who has asthma. Essential oils have the potential to trigger asthma symptoms due to their strong scents and chemical components. Consulting with the healthcare provider is crucial before using aromatherapy with essential oils to ensure the safety and well-being of the client with asthma. Choices B, C, and D do not pose immediate risks with aromatherapy use, making them less of a priority for consultation compared to asthma. Clients with diabetes, hypertension, or depression do not have the same immediate risks associated with the use of aromatherapy as clients with asthma. However, it is still advisable for the nurse to be aware of any potential interactions or contraindications with these conditions and consult with the provider if needed.
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