HESI LPN
Community Health HESI Practice Exam
1. When admitting a client with Parkinson's disease to the home healthcare service, which nursing diagnosis should have priority in planning care?
- A. Impaired physical mobility related to muscle rigidity and weakness.
- B. Ineffective coping related to depression and dysfunction due to disease progression.
- C. Ineffective breathing pattern related to respiratory muscle weakness.
- D. Fear related to constant possibility of experiencing seizures.
Correct answer: A
Rationale: The correct answer is A: 'Impaired physical mobility related to muscle rigidity and weakness.' For a client with Parkinson's disease, impaired physical mobility is a priority nursing diagnosis because of the characteristic motor symptoms such as muscle rigidity, bradykinesia, and postural instability. Addressing impaired physical mobility is crucial to enhance the client's quality of life. Choices B, C, and D are not the priority nursing diagnoses for a client with Parkinson's disease. Ineffective coping (Choice B) and fear of seizures (Choice D) may be concerns but are not the priority. Ineffective breathing pattern (Choice C) is not typically associated with Parkinson's disease.
2. The nurse is caring for a client on mechanical ventilation. When performing endotracheal suctioning, the nurse will avoid hypoxia by
- A. Inserting a fenestrated catheter with a whistle tip without suction
- B. Completing the suction pass in 30 seconds with a pressure of 150 mm Hg
- C. Hyperoxygenating with 100% O2 for 1 to 2 minutes before and after each suction pass
- D. Minimizing the suction pass to 60 seconds while slowly rotating the lubricated catheter
Correct answer: C
Rationale: Hyperoxygenating the client before and after suctioning helps prevent hypoxia by ensuring adequate oxygen levels during the procedure, which briefly interrupts the client's normal breathing pattern. Choice A is incorrect because inserting a fenestrated catheter with a whistle tip without suction would not prevent hypoxia. Choice B is incorrect as completing the suction pass in 30 seconds with a pressure of 150 mm Hg may lead to hypoxia. Choice D is incorrect as minimizing the suction pass to 60 seconds may not provide enough time for effective suctioning and could lead to hypoxia.
3. Manny Pacquiao, a Filipino and world boxing champion, used to advertise a muscle pain-relieving drug popularly known in the Philippine market. What can be an equally effective medicinal alternative, especially in far-flung communities and provinces, to relieve muscles and joint pains and prove to be non-costly?
- A. Sambong
- B. Lagundi
- C. Akapulko
- D. Yerba Buena
Correct answer: D
Rationale: Yerba Buena is a suitable alternative for muscle and joint pain relief, particularly in remote areas due to its cost-effectiveness and proven efficacy. Sambong is more commonly used for urinary tract problems, Lagundi is known for respiratory conditions, and Akapulko is primarily used for skin diseases, making them less effective alternatives for muscle and joint pain relief.
4. A client with cirrhosis of the liver is experiencing ascites. The nurse should implement which of the following interventions?
- A. Restrict fluid intake
- B. Increase sodium intake
- C. Encourage high-protein diet
- D. Administer diuretics
Correct answer: D
Rationale: Corrected Rationale: Ascites, the accumulation of fluid in the abdominal cavity, is a common complication of cirrhosis. Diuretics are the primary intervention to manage ascites by promoting the excretion of excess fluid from the body, thus reducing abdominal swelling. Restricting fluid intake (Choice A) would not be appropriate as it may lead to dehydration. Increasing sodium intake (Choice B) is contraindicated as it can worsen fluid retention. Encouraging a high-protein diet (Choice C) is not directly related to managing ascites.
5. A public health nurse is working with a community to develop a disaster response plan. Which of the following is the priority action?
- A. Identifying available resources and services
- B. Conducting disaster drills
- C. Educating the community about disaster preparedness
- D. Developing a communication plan
Correct answer: A
Rationale: Identifying available resources and services is the priority action when developing a disaster response plan. This step is crucial as it helps the community understand what resources and services are already in place and what additional support may be needed during a disaster. Conducting disaster drills, educating the community about disaster preparedness, and developing a communication plan are important steps in disaster preparedness but come after identifying available resources and services. Without knowing the available resources, it would be challenging to effectively plan and respond to a disaster.
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