HESI LPN
Fundamentals HESI
1. The client is receiving discharge instructions for a new antihypertensive medication. Which statement by the client indicates a need for further teaching?
- A. I will stop taking the medication if I experience dizziness.
- B. I will monitor my blood pressure regularly.
- C. I will avoid drinking alcohol while taking this medication.
- D. I will rise slowly from a sitting to a standing position.
Correct answer: A
Rationale: The correct answer is A. Stopping antihypertensive medication abruptly can lead to rebound hypertension, which can be dangerous. Clients should never discontinue their medication without consulting their healthcare provider first. Choice B is correct because monitoring blood pressure is essential when taking antihypertensive medication to ensure it stays within the target range. Choice C is correct as alcohol can potentiate the hypotensive effects of antihypertensive medications. Choice D is correct as orthostatic hypotension can occur, so rising slowly helps prevent dizziness and falls. Therefore, choice A is the statement that indicates a need for further teaching.
2. A postoperative client will need to perform daily dressing changes after discharge. Which outcome statement best demonstrates the client's readiness to manage his wound care after discharge?
- A. Asks relevant questions regarding the dressing change.
- B. States he will be able to complete the wound care regimen.
- C. Demonstrates the wound care procedure correctly.
- D. Has all the necessary supplies for wound care.
Correct answer: C
Rationale: The correct answer is C. Demonstrating the wound care procedure correctly indicates the client's readiness to independently manage wound care. This action shows practical understanding and application of the necessary skills. Choice A, asking relevant questions, is important but does not directly demonstrate the ability to perform the procedure. Choice B, stating the ability to complete the regimen, is a good intention but does not confirm practical competence. Choice D, having necessary supplies, is essential but does not ensure the client's ability to execute proper wound care.
3. A nurse is talking with caregivers of a 12-year-old child. Which of the following issues verbalized by the caregivers should the nurse identify as the priority?
- A. “We just don’t understand why our child can’t keep up with the other kids in simple activities like running and jumping.”
- B. “Our child keeps trying to find ways around our household rules. They always want to make deals with us.”
- C. “We think our child is trying too hard to excel in math just to get the top grades in the class.”
- D. “Our child likes to sing and worries it will make the other kids want to laugh.”
Correct answer: A
Rationale: The correct answer is A. Difficulty in keeping up with physical activities like running and jumping may indicate an underlying physical or developmental issue that requires prompt assessment. This could be related to musculoskeletal problems, coordination difficulties, or other health concerns that need further evaluation. Choices B, C, and D, while important, do not address a potential physical or developmental issue that could impact the child's overall well-being. Addressing the child's physical limitations should be the priority to ensure appropriate support and intervention.
4. A client with asthma is prescribed a corticosteroid inhaler. Which instruction should the nurse provide to the client to prevent a common side effect of this medication?
- A. Use the inhaler only when experiencing asthma symptoms.
- B. Rinse the mouth with water after using the inhaler.
- C. Increase fluid intake while using the inhaler.
- D. Avoid eating or drinking for 30 minutes after using the inhaler.
Correct answer: B
Rationale: The correct instruction for the client using a corticosteroid inhaler to prevent a common side effect is to rinse the mouth with water after using the inhaler. Corticosteroid inhalers can lead to oral thrush, a fungal infection in the mouth. Rinsing the mouth helps reduce the risk of developing oral thrush. Choices A, C, and D are incorrect because using the inhaler only when experiencing symptoms, increasing fluid intake, or avoiding eating/drinking for 30 minutes after use are not directly related to preventing oral thrush, which is the common side effect associated with corticosteroid inhalers.
5. A client reports insomnia. Which of the following actions should the nurse perform shortly before bedtime?
- A. Provide a late supper
- B. Offer a wet washcloth for the client to wash their face
- C. Perform range of motion exercises
- D. Prepare a hot cocoa or tea for the client
Correct answer: B
Rationale: Offering a wet washcloth for the client to wash their face is a soothing and calming activity that can help the client relax before bedtime, promoting better sleep. Providing a late supper can lead to indigestion and disrupt sleep. Performing range of motion exercises may increase alertness rather than promoting relaxation. Preparing a hot cocoa or tea containing caffeine close to bedtime can interfere with falling asleep.
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