HESI LPN
HESI CAT Exam 2024
1. In what order should the unit manager implement interventions to address the UAP’s behavior after they leave the unit without notifying the staff?
- A. Note date and time of the behavior.
- B. Discuss the issue privately with the UAP.
- C. Plan for scheduled break times.
- D. Evaluate the UAP for signs of improvement.
Correct answer: A
Rationale: The correct order for the unit manager to implement interventions to address the UAP's behavior is to first note the date and time of the behavior. Proper documentation is crucial as it provides a factual record of the incident. This documentation can be used to address the behavior effectively and to track any patterns or improvements in the future. Discussing the issue with the UAP privately (choice B) should come after documenting the behavior. Planning for scheduled break times (choice C) is unrelated to the situation described and does not address the UAP's behavior of leaving without notifying the staff. Evaluating the UAP for signs of improvement (choice D) can only be done effectively after the behavior has been addressed and interventions have been implemented.
2. The unlicensed assistive personnel (UAP) has applied a gown and gloves and secured the tops of the gloves over the gown sleeves. What action should the nurse take?
- A. Confirm that the gown is tied securely at the neck and waist
- B. Remind the UAP to wash hands frequently while in the room
- C. Assist the UAP with application of the face mask or face shield
- D. Help the UAP reposition the gown sleeve over the gloves edges
Correct answer: D
Rationale: Proper application of personal protective equipment (PPE) is crucial to maintain infection control. In this scenario, the nurse should help the UAP reposition the gown sleeve over the gloves' edges. This action ensures that the gown properly covers the gloves, reducing the risk of contamination. Choices A, B, and C are incorrect because the primary concern is to address the improper application of PPE by repositioning the gown sleeves over the gloves, not checking other aspects of PPE or reminding about hand hygiene.
3. The nurse is preparing to send a client to the cardiac catheterization lab for an angioplasty. Which client report is most important for the nurse to explore further prior to the start of the procedure?
- A. Verbalizes a fear of being in a confined space.
- B. Drank a glass of water in the past 2 hours.
- C. Reports left chest wall pain prior to admission.
- D. Experiences facial swelling after eating crab
Correct answer: C
Rationale: The correct answer is C. Left chest wall pain could indicate ongoing cardiac issues or instability, which needs to be assessed before proceeding with the procedure. This pain could be related to the heart and may suggest a potential risk during the angioplasty. Options A, B, and D do not directly relate to cardiac complications during the procedure, making them less urgent for immediate assessment. Fear of confined spaces, drinking water, and facial swelling after eating crab are not immediate risks to the client's safety in the context of a cardiac catheterization procedure.
4. In the Emergency Department, a female client discloses that she was raped last night. Which question is most important for the nurse to ask?
- A. Does she know the person who raped her?
- B. Has she taken a bath since the rape occurred?
- C. Is the place where she lives a safe place?
- D. Did she report the rape to the police department?
Correct answer: A
Rationale: The most important question for the nurse to ask in this situation is whether the client knows the person who raped her. This question is crucial for assessing additional safety concerns, providing appropriate support, and determining the need for forensic evidence collection. Choices B, C, and D are not as critical in the immediate assessment and response to a rape victim. Asking about bathing, the safety of her home, or reporting to the police may be important but are secondary to identifying the perpetrator for safety and legal reasons.
5. A nurse is preparing to administer an intramuscular (IM) injection to a client. What is the most appropriate site to use for an IM injection in an adult?
- A. Dorsal gluteal muscle
- B. Vastus lateralis muscle
- C. Rectus femoris muscle
- D. Deltoid muscle
Correct answer: B
Rationale: The correct answer is B: Vastus lateralis muscle. The vastus lateralis muscle is a recommended site for IM injections in adults due to its size and accessibility. The dorsal gluteal muscle is not recommended for IM injections in adults due to the proximity to major nerves and blood vessels, increasing the risk of injury. The rectus femoris muscle is not a common site for IM injections in adults. The deltoid muscle is typically used for IM injections in small-volume medications or vaccines, especially in adults.
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