HESI LPN
HESI PN Exit Exam
1. When assisting an older male client recovering from a stroke to ambulate with a cane, where should the nurse place the cane in relation to the client's body?
- A. In front of the body to lean on while stepping forward
- B. On the opposite side of the affected extremity
- C. Approximately one foot away from the body to stabilize balance
- D. On the same side as the affected extremity
Correct answer: B
Rationale: The correct answer is B: 'On the opposite side of the affected extremity.' Placing the cane on the opposite side of the affected extremity provides maximum support and stability during ambulation for a client recovering from a stroke. This positioning helps to offload weight from the affected side and improves balance. Choice A is incorrect because placing the cane in front of the body can lead to incorrect weight distribution and instability. Choice C is incorrect as placing the cane one foot away from the body may not provide adequate support and can compromise balance. Choice D is incorrect as placing the cane on the same side as the affected extremity does not offer the necessary balance and support needed for safe ambulation.
2. The PN and UAP enter a client's room and find the client lying on the bed. The PN determines that the client is unresponsive. Which instruction should the PN give the UAP first?
- A. Obtain emergency help
- B. Feel for a carotid pulse
- C. Bring a glucometer to the room
- D. Check the blood pressure
Correct answer: A
Rationale: The correct answer is to instruct the UAP to obtain emergency help first. When a client is unresponsive, it could indicate a life-threatening condition that requires immediate intervention. Ensuring emergency help is on the way is the priority to address the potentially critical situation. Feeling for a carotid pulse, bringing a glucometer, or checking the blood pressure are important assessments but should come after taking steps to secure immediate assistance.
3. A nurse who receives a patient in the operative suite prior to the actual surgery is in charge of the patient’s care. Which of the following is NOT a task related to the nurse’s intraoperative care?
- A. Go over the surgical procedure with the patient before he or she is anesthetized
- B. Strictly adhere to asepsis during all intraoperative procedures
- C. Provide emotional support to the patient and their family
- D. Monitor the patient’s physical status
Correct answer: A
Rationale: The correct answer is A. Going over the surgical procedure with the patient is typically done preoperatively, not intraoperatively. Intraoperative tasks of a nurse involve strictly adhering to asepsis during procedures, monitoring the patient's physical status, and providing emotional support to the patient and their family during the surgery. Choices B, C, and D are all tasks that are directly related to the nurse's responsibilities during the intraoperative phase of care.
4. Which condition is most commonly associated with a "bull's eye" rash?
- A. Lyme disease
- B. Rocky Mountain spotted fever
- C. Syphilis
- D. Toxoplasmosis
Correct answer: A
Rationale: The correct answer is A: Lyme disease. The "bull's eye" rash, or erythema migrans, is a hallmark of early Lyme disease, caused by the bacterium Borrelia burgdorferi. Choice B, Rocky Mountain spotted fever, presents with a different type of rash. Choice C, Syphilis, typically presents with a painless ulcer and rash but not a "bull's eye" rash. Choice D, Toxoplasmosis, does not typically present with a "bull's eye" rash.
5. Which of the following best describes the role of insulin in the body?
- A. Insulin helps break down glucose into energy for the body
- B. Insulin facilitates the movement of glucose into cells
- C. Insulin converts excess glucose into fat for storage
- D. Insulin increases the breakdown of protein into amino acids
Correct answer: B
Rationale: The correct answer is B: Insulin facilitates the movement of glucose into cells. Insulin is a hormone that helps regulate blood sugar levels by promoting the uptake of glucose from the bloodstream into cells, where it can be used for energy production. Choice A is incorrect because insulin doesn't break down glucose but rather helps cells take up glucose. Choice C is incorrect as insulin does not directly convert glucose into fat; excess glucose is stored as fat by other processes. Choice D is incorrect as insulin does not increase the breakdown of protein into amino acids; its primary role is in glucose metabolism.
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