HESI LPN
HESI CAT Exam Quizlet
1. A 10-year-old who has terminal brain cancer asks the nurse, 'What will happen to my body when I die?' How should the nurse respond?
- A. The heart will stop beating, and you will stop breathing.
- B. You will go to sleep and not wake up.
- C. Your body will stop functioning, and you will no longer feel pain.
- D. You will feel very tired, and your body will shut down slowly.
Correct answer: C
Rationale: The correct answer is C because it provides a truthful yet sensitive response to the child's question. Saying that the body will stop functioning and that there will be no more pain helps the child understand what to expect without unnecessary details or causing distress. Choice A is too technical and may not be suitable for a child. Choice B might give the impression of a peaceful passing, which may not always be the case. Choice D introduces the concept of feeling tired, which might not be accurate or helpful in this context.
2. Parents who have one male child with sickle cell anemia are concerned about having more children with the disease. What client teaching should the nurse provide?
- A. All future children will be carriers, but will not necessarily have the disease
- B. There is a chance that each future child will have the disease
- C. Only male children cannot inherit the sickle cell disease trait
- D. Only one out of four of their children will definitely manifest the disease
Correct answer: B
Rationale: The correct answer is B. Each child has a 25% chance of having sickle cell anemia if both parents are carriers of the trait. Choice A is incorrect because not all future children will be carriers; some may have the disease. Choice C is incorrect as both male and female children can inherit the sickle cell disease trait. Choice D is incorrect as the chance is not fixed at one out of four; each child has an independent 25% chance of having the disease.
3. In the Emergency Department, a female client discloses that she was raped last night. Which question is most important for the nurse to ask?
- A. Does she know the person who raped her?
- B. Has she taken a bath since the rape occurred?
- C. Is the place where she lives a safe place?
- D. Did she report the rape to the police department?
Correct answer: A
Rationale: The most important question for the nurse to ask in this situation is whether the client knows the person who raped her. This question is crucial for assessing additional safety concerns, providing appropriate support, and determining the need for forensic evidence collection. Choices B, C, and D are not as critical in the immediate assessment and response to a rape victim. Asking about bathing, the safety of her home, or reporting to the police may be important but are secondary to identifying the perpetrator for safety and legal reasons.
4. After changing to a new brand of laundry detergent, an adult male reports that he has a fine itchy rash. Which assessment finding warrants immediate intervention by the nurse?
- A. Bilateral Wheezing
- B. Urticaria
- C. Peripheral edema
- D. Elevated blood pressure
Correct answer: B
Rationale: The correct answer is B: Urticaria. An itchy rash following a change in detergent may indicate an allergic reaction, specifically urticaria (hives), which requires immediate attention. Urticaria can be a sign of a severe allergic reaction, such as anaphylaxis. Bilateral wheezing (choice A) may suggest respiratory issues like asthma but is not directly related to the skin rash. Peripheral edema (choice C) and elevated blood pressure (choice D) are not typically associated with an allergic reaction to laundry detergent and would not be the priority assessment findings in this scenario.
5. The nurse assesses a 5-year-old child who has been experiencing frequent headaches and vomiting. The nurse notices that the child is lethargic and has a positive Brudzinski sign. Which action should the nurse implement first?
- A. Perform a complete neurological examination
- B. Measure the child’s head circumference
- C. Check the child’s blood glucose level
- D. Notify the healthcare provider immediately
Correct answer: D
Rationale: The correct action for the nurse to implement first is to notify the healthcare provider immediately. The presence of lethargy and a positive Brudzinski sign in a child experiencing frequent headaches and vomiting may indicate a serious condition like meningitis. Prompt notification of the healthcare provider is crucial for timely evaluation and initiation of appropriate treatment. Choice A is incorrect because while a neurological examination may be necessary, it is not the priority when a potentially serious condition like meningitis is suspected. Choice B is incorrect as measuring the child's head circumference is not the most immediate action to take in this situation. Choice C is also incorrect as checking the child's blood glucose level, although important in some cases, is not the priority when a child presents with symptoms suggestive of meningitis.
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