in a long term rehabilitation care unit a client with spinal cord injury complains of a pounding headache the client is sitting in a wheelchair watchi
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Nursing Elites

HESI LPN

Community Health HESI Practice Exam

1. In a long term rehabilitation care unit a client with spinal cord injury complains of a pounding headache. The client is sitting in a wheelchair watching television in the assigned room. Further assessment by the nurse reveals excessive sweating, a splotchy rash, pilomotor erection, facial flushing, congested nasal passages and a heart rate of 50. The nurse should do which action next?

Correct answer: C

Rationale: These symptoms suggest autonomic dysreflexia, often triggered by bladder distention.

2. In providing comprehensive family health care, the nurse utilizes four (4) basic processes. These are listed in the order in which they are carried out as follows:

Correct answer: A

Rationale: The correct order for the basic processes in providing comprehensive family health care is assessment, planning, intervention, and evaluation. Assessment is the first step to gather information, followed by planning to set goals and strategies, then intervention to implement the plan, and finally evaluation to assess the outcomes. Choice A is correct as it follows this logical sequence. Choices B, C, and D are incorrect because they do not follow the correct order of these essential processes in nursing care.

3. BCG vaccine is supplied in:

Correct answer: A

Rationale: The correct answer is A. BCG vaccine is commonly supplied in freeze-dried form, not in liquid form. Therefore, choices B and C are incorrect. Option D is also incorrect as the vaccine is not supplied in liquid form in a glass ampule.

4. While explaining an illness to a 10-year-old, what should the nurse keep in mind about the cognitive development at this age?

Correct answer: B

Rationale: Correct answer: At the age of 10, children are in the stage of concrete operational thought, where they can think logically and organize facts. Choice A is incorrect as simple associations of ideas are more characteristic of earlier developmental stages. Choice C is incorrect as while children at this age are developing perspective-taking skills, their interpretations are not solely limited to their own perspective. Choice D is incorrect as while previous experiences influence their thinking, the ability to think logically and organize facts is more prominent in this stage of cognitive development.

5. Which of the following BEST describes the strategies to address the nutrition problems of Filipinos related to non-communicable diseases?

Correct answer: B

Rationale: While considering food preferences of family members is important in promoting adherence to a healthy diet, the best strategies to address nutrition problems related to non-communicable diseases should focus on evidence-based approaches like aiming for an ideal body weight, building healthy nutrition-related practices, and choosing food wisely to improve overall health outcomes.

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