HESI LPN
HESI PN Exit Exam 2024
1. A client with a chest tube following a pneumothorax is concerned about the continuous bubbling in the water seal chamber. What should the nurse explain to the client?
- A. Continuous bubbling in the water seal chamber indicates an air leak.
- B. Continuous bubbling is normal and expected with a chest tube.
- C. Bubbling will stop when the lung has fully expanded.
- D. The nurse should notify the healthcare provider immediately.
Correct answer: A
Rationale: Continuous bubbling in the water seal chamber of a chest tube system indicates an air leak. An air leak can prevent the lung from fully re-expanding and may lead to complications like a recurrent pneumothorax. Therefore, it is crucial to investigate and address the air leak promptly. Choices B and C are incorrect because continuous bubbling is not normal and does not indicate lung expansion. Choice D is incorrect because the nurse should first assess and then report the issue to the healthcare provider.
2. A client is recovering from a right-sided mastectomy and is concerned about lymphedema. What should the nurse include in the discharge teaching to minimize this risk?
- A. Encourage wearing tight clothing on the affected arm.
- B. Advise against lifting heavy objects with the affected arm.
- C. Recommend the client sleep on the affected side.
- D. Suggest frequent massage of the affected arm.
Correct answer: B
Rationale: The correct answer is B: Advise against lifting heavy objects with the affected arm. Lifting heavy objects with the affected arm can increase the risk of lymphedema. It is important for clients to avoid activities that strain the affected arm to minimize the risk of developing lymphedema. Choices A, C, and D are incorrect because wearing tight clothing on the affected arm, sleeping on the affected side, and frequent massage of the affected arm can potentially worsen lymphedema or impede the recovery process. Tight clothing can impede lymphatic flow, sleeping on the affected side can restrict circulation, and frequent massage can exacerbate swelling in the arm.
3. Which type of isolation is required for a patient with measles?
- A. Contact isolation
- B. Airborne isolation
- C. Droplet isolation
- D. Reverse isolation
Correct answer: B
Rationale: The correct answer is B: Airborne isolation. Measles is highly contagious and can be transmitted through airborne particles, so airborne isolation is necessary to prevent its spread. Choice A, Contact isolation, is incorrect because measles is not primarily transmitted through direct contact. Choice C, Droplet isolation, is also incorrect as measles is not transmitted through large droplets but through smaller airborne particles. Choice D, Reverse isolation, is used to protect a patient from outside infections, not to prevent the spread of a contagious disease like measles.
4. The client diagnosed with HIV is taught by the nurse that the condition is transmitted through
- A. the infection passed from a mother to her baby
- B. Tears
- C. human bites
- D. insect bites
Correct answer: A
Rationale: HIV can be transmitted from a mother to her baby during childbirth or breastfeeding, making choice A the correct answer. Tears, human bites, and insect bites are not common modes of HIV transmission. While human bites can potentially transmit the virus, it is less common compared to mother-to-child transmission.
5. Which of the following is NOT a second-line agent used for the treatment of Tuberculosis?
- A. Amikacin
- B. Moxifloxacin
- C. Rifabutin
- D. Cycloserine
Correct answer: C
Rationale: The correct answer is C, Rifabutin. Rifabutin is actually a first-line drug used in the treatment of tuberculosis. Choices A, B, and D (Amikacin, Moxifloxacin, and Cycloserine) are considered second-line agents for tuberculosis treatment. These drugs are used when the first-line medications are either ineffective or cannot be tolerated by the patient.
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