HESI LPN
HESI Fundamentals Exam
1. A client with a history of asthma is experiencing shortness of breath. What is the most appropriate action for the LPN/LVN to take first?
- A. Administer a bronchodilator as prescribed.
- B. Encourage the client to practice deep breathing exercises.
- C. Position the client in high Fowler's position.
- D. Obtain a peak flow reading.
Correct answer: A
Rationale: Administering a bronchodilator as prescribed is the most appropriate initial action for managing asthma-related shortness of breath. Bronchodilators help to open up the airways quickly, providing relief for the client. Encouraging deep breathing exercises may be beneficial in some situations but should not be the first action for acute shortness of breath in asthma. Positioning the client in high Fowler's position can also help improve breathing, but administering the bronchodilator takes precedence. Obtaining a peak flow reading is important in asthma management, but it is not the initial action needed to address acute shortness of breath.
2. A nurse is caring for a group of clients. How should the nurse prevent the spread of infection?
- A. Place a client with TB in a negative pressure room.
- B. Use standard precautions only.
- C. Place a client with TB in a private room.
- D. Use barrier precautions only.
Correct answer: A
Rationale: The correct answer is to place a client with TB in a negative pressure room. Tuberculosis (TB) is an airborne infectious disease, and placing the client in a negative pressure room helps prevent the spread of the infection by containing and filtering the air within the room. Standard precautions (Choice B) are important for preventing the spread of infection in general, but specific precautions are needed for airborne diseases like TB. Placing the client in a private room (Choice C) may not provide adequate ventilation and containment of airborne pathogens. Using barrier precautions (Choice D) alone is not sufficient for preventing the airborne transmission of TB.
3. A healthcare professional is teaching about home safety with a client. Which of the following instructions should the healthcare professional include?
- A. Unplug electronics by holding the plug
- B. Use electrical tape to secure extension cords next to baseboards on the floor
- C. To use a fire extinguisher, aim at the base of the flames
- D. Install slip-resistant rugs on tile floors
Correct answer: B
Rationale: The correct answer is to use electrical tape to secure extension cords next to baseboards on the floor. This practice helps prevent tripping and electrical hazards by keeping cords out of the way. Option A is incorrect as unplugging electronics should be done by holding the plug, not the cord itself. Option C is incorrect because when using a fire extinguisher, it should be aimed at the base of the flames, not at the top. Option D is not directly related to home safety teaching and may not be necessary for all clients, as it suggests an unnecessary change that may not improve safety.
4. The healthcare provider is reviewing the plan of care for a client with a newly placed colostomy. Which outcome would indicate effective client teaching?
- A. Client demonstrates how to irrigate the colostomy.
- B. Client verbalizes understanding of dietary changes.
- C. Client performs ostomy care independently.
- D. Client expresses feelings about the impact of the colostomy.
Correct answer: C
Rationale: The correct answer is C because effective teaching is demonstrated when the client can independently perform ostomy care. This indicates that the client has understood and retained the information provided during teaching. Choices A, B, and D are incorrect because demonstrating how to irrigate the colostomy, verbalizing understanding of dietary changes, and expressing feelings about the impact of the colostomy are important aspects of care but do not directly reflect the client's ability to apply the taught information in a practical setting.
5. The nurse is caring for an older adult patient who has been diagnosed with a stroke. Which intervention will the nurse add to the care plan?
- A. Encourage the patient to perform as many self-care activities as possible.
- B. Provide assistance with a bed bath to promote patient comfort.
- C. Coordinate with physical therapy for gait training.
- D. Instruct the patient to remain on bed rest to prevent fatigue.
Correct answer: A
Rationale: The correct answer is A: Encourage the patient to perform as many self-care activities as possible. For a patient who has had a stroke, promoting independence and engaging in self-care activities help maintain mobility and foster a sense of autonomy. Choices B, C, and D are incorrect because providing assistance with a bed bath, coordinating with physical therapy for gait training, or advising bed rest without indications may not be the best interventions for promoting optimal recovery and independence in a stroke patient.
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