a 2 month old infant has both a cleft lip and palate which will be repaired in stages in the immediate postoperative period for a cleft lip repair whi
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Nursing Elites

HESI LPN

Community Health HESI Test Bank 2023

1. In the immediate postoperative period for a cleft lip repair in a 2-month-old infant, which nursing approach should be the priority?

Correct answer: A

Rationale: The correct nursing approach in the immediate postoperative period for a cleft lip repair in an infant is to remove protective arm devices one at a time for short periods with supervision. This approach helps prevent injury to the surgical site while ensuring the infant's comfort and safety. Choice B is incorrect as initiating oral feedings immediately after surgery may not be appropriate and could compromise the surgical site. Choice C is incorrect as introducing parents to the suture line cleansing protocol is important but not the immediate priority. Choice D is incorrect as positioning the infant on the back after feedings is not specific to the immediate postoperative period for a cleft lip repair.

2. During a home visit for a family with a new baby, what should the nurse assess first?

Correct answer: A

Rationale: Assessing feeding patterns is the priority during a home visit for a family with a new baby because it is crucial for the health and growth of the newborn. By evaluating the feeding patterns, the nurse can ensure that the baby is receiving adequate nutrition and address any feeding issues promptly. While sleeping arrangements, support system, and immunization status are important aspects to assess during a home visit, they are not as critical as ensuring the newborn's nutritional needs are being met.

3. Which one of the following statements, if made by the client, indicates teaching about Inderal (propranolol) has been effective?

Correct answer: D

Rationale: The correct answer is D. Stopping Inderal (propranolol) abruptly can cause rebound hypertension, angina, and even a myocardial infarction (heart attack), so it is crucial to taper off the medication under medical supervision. Choices A, B, and C are incorrect because they do not reflect the serious consequences associated with abrupt discontinuation of propranolol.

4. Which of the following would be the best strategy for the nurse to use when teaching insulin injection techniques to a newly diagnosed client with diabetes?

Correct answer: D

Rationale: The best strategy for the nurse to use when teaching insulin injection techniques to a newly diagnosed client with diabetes is to observe a return demonstration. This method ensures that the client can correctly perform the technique. Providing written pre and post tests (choice A) may assess knowledge but not application. Asking questions during practice (choice B) may help with understanding but not necessarily with the actual performance. Allowing another diabetic to assist (choice C) may provide peer support but does not guarantee correct technique demonstration.

5. Which of the following is a voluntary organization?

Correct answer: D

Rationale: The American Diabetes Association (ADA) is a voluntary organization that relies on voluntary contributions and membership fees. NIH (National Institutes of Health), FDA (Food and Drug Administration), and CDC (Centers for Disease Control and Prevention) are governmental agencies and not voluntary organizations. Therefore, the correct answer is D.

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