a nurse observes an assistive personnel ap reprimanding a client for not using the urinal properly the ap tells the client that diapers will be used n
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Nursing Elites

HESI LPN

Fundamentals of Nursing HESI

1. A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells the client that diapers will be used next time the urinal is used improperly. Which of the following torts is the AP committing?

Correct answer: A

Rationale: The correct answer is A: Assault. Assault involves making threats or using actions that cause the client to fear harm. In this scenario, the AP's threat to use diapers next time the urinal is used improperly constitutes as assault. Choice B, Battery, involves intentional harmful or offensive touching without consent, which is not evident in the scenario. Choice C, False imprisonment, refers to restraining or restricting a client's freedom of movement, which is not occurring in this situation. Choice D, Invasion of privacy, involves violating a client's right to privacy, which is also not applicable here.

2. The nurse receives a report that a client with an indwelling urinary catheter has an output of 150 mL for the previous 6-hour shift. Which intervention should the nurse implement first?

Correct answer: A

Rationale: The correct answer is to check the drainage tubing for a kink. A kink in the tubing can obstruct urine flow, potentially causing the low output. By addressing this first, the nurse can ensure that there are no physical obstructions hindering urine drainage. Reviewing the intake and output record is important, but addressing a possible kink in the tubing takes precedence as it directly affects urine flow. Notifying the healthcare provider should be considered after assessing and resolving immediate issues. Giving the client water to drink may be appropriate, but addressing a kink in the tubing is the priority to ensure proper function of the urinary catheter.

3. The nurse is preparing a handout on infant feeding to be distributed to families visiting the clinic. Which notation should be included in the teaching materials?

Correct answer: A

Rationale: The correct answer is A. Introducing solid foods one at a time, starting with cereal, is recommended to monitor for any food allergies or intolerances in infants. Choice B is incorrect as finely ground meat should be introduced later due to the risk of choking and is not necessary for iron intake. Choice C is incorrect as egg white should be avoided early due to the risk of allergies. Choice D is incorrect as solid foods should not be mixed with formula in a bottle to prevent overfeeding and promote healthy eating habits.

4. During a home safety assessment for a client receiving supplemental oxygen, which observation should the nurse identify as proper safety protocol?

Correct answer: A

Rationale: The correct answer is A. Using non-acetone nail polish remover is crucial for clients on supplemental oxygen as acetone is flammable and poses a safety risk. Acetone can react with oxygen, increasing the fire hazard. Choices B, C, and D are incorrect. Electric razors can generate sparks, which are dangerous near oxygen due to the risk of ignition. While cleaning oxygen equipment is important, the type of nail polish remover used is more critical for immediate safety. Wool blankets can create static electricity, increasing the risk of fire around oxygen due to its flammability.

5. A client with rheumatoid arthritis is prescribed methotrexate. What information should the LPN include when teaching the client about this medication?

Correct answer: D

Rationale: The correct answer is D: 'Report any signs of infection to the healthcare provider immediately.' Methotrexate is an immunosuppressant medication commonly used to treat rheumatoid arthritis. It can lower the immune system's ability to fight infections, making it crucial for clients to promptly report any signs of infection to prevent serious complications. Choices A, B, and C are incorrect because avoiding sunlight, taking the medication with food, and increasing fluid intake are not specific to methotrexate therapy and are not primary concerns associated with this medication.

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