HESI LPN
HESI Fundamentals Test Bank
1. A healthcare professional in a provider's office is reviewing the laboratory findings of a client who reports chills and aching joints. Which of the following findings should the healthcare professional identify as an indication that the client has an infection?
- A. WBC 15,000/mm³
- B. Hemoglobin 12 g/dL
- C. Platelet count 300,000/mm³
- D. Sodium 140 mEq/L
Correct answer: A
Rationale: An elevated white blood cell count (WBC 15,000/mm³) is a common indicator of infection as the body increases WBC production to fight off pathogens. In conditions like infections, inflammation, or stress, the WBC count can rise. The other options, hemoglobin, platelet count, and sodium levels, are not typically specific indicators of infection. Hemoglobin measures the oxygen-carrying capacity of red blood cells, platelet count assesses clotting ability, and sodium levels indicate electrolyte balance.
2. When planning to insert a peripheral IV catheter for an older adult client, which of the following actions should the nurse plan to take?
- A. Insert the catheter at a 45° angle
- B. Place the client's arm in a dependent position
- C. Shave excess hair from the insertion site
- D. Initiate IV therapy in the veins of the hand
Correct answer: B
Rationale: Placing the client's arm in a dependent position is the correct action when inserting a peripheral IV catheter for an older adult client. This position helps veins dilate due to gravity, facilitating easier insertion of the IV catheter. Choice A is incorrect because catheters are typically inserted at a lower angle, around 10-30 degrees. Choice C is unnecessary unless excessive hair impedes the insertion process. Choice D is incorrect as veins in the hand are generally smaller and more prone to complications, making them less ideal for IV therapy in older adults.
3. A nurse is admitting a client who has an abdominal wound with a large amount of purulent drainage. Which of the following types of transmission precautions should the nurse initiate?
- A. Protective environment
- B. Airborne precautions
- C. Droplet precautions
- D. Contact precautions
Correct answer: D
Rationale: The correct answer is D: Contact precautions. When a client has an abdominal wound with purulent drainage, contact precautions are necessary to prevent the spread of infection through direct contact. Protective environment precautions are used for immunocompromised clients, airborne precautions are for diseases transmitted by airborne particles, and droplet precautions are for diseases transmitted by respiratory droplets. In this case, the focus is on preventing direct contact transmission, making contact precautions the most appropriate choice. Protective environment, airborne, and droplet precautions are not indicated in this scenario because the primary concern is the direct contact transmission of pathogens through the wound drainage.
4. The healthcare provider is caring for a client with a history of deep vein thrombosis (DVT). Which symptom would be most concerning?
- A. Pain in the affected leg
- B. Redness and warmth in the affected leg
- C. Shortness of breath
- D. Swelling in the affected leg
Correct answer: C
Rationale: Shortness of breath is the most concerning symptom in a client with a history of deep vein thrombosis (DVT) because it could indicate a pulmonary embolism. A pulmonary embolism is a serious complication of DVT where a blood clot travels to the lungs and can be life-threatening. Immediate medical attention is required to prevent further complications. Pain, redness, warmth, and swelling in the affected leg are common symptoms of DVT itself but do not pose the same level of immediate danger as the potential for a pulmonary embolism.
5. A client scheduled for abdominal surgery reports being worried. Which of the following actions should the nurse take?
- A. Offer information on a relaxation technique and ask if the client is interested in trying it.
- B. Request a social worker to see the client to discuss meditation.
- C. Attempt to use biofeedback techniques with the client.
- D. Tell the client many people feel the same way before surgery and to think of something else.
Correct answer: A
Rationale: Offering relaxation techniques addresses the client's immediate concern by providing a proactive approach to managing anxiety. It shows empathy and offers a practical solution. Requesting a social worker for meditation (Choice B) may not be the most direct response to the client's immediate worry. Attempting biofeedback (Choice C) may not be suitable without the client's interest or consent. Telling the client to think of something else (Choice D) dismisses the client's feelings and does not provide constructive support.
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