HESI LPN
Adult Health Exam 1 Chamberlain
1. The client with hypertension is being taught about lifestyle modifications. What topic is most important?
- A. Stress management
- B. Salt intake reduction
- C. Regular physical activity
- D. Weight loss
Correct answer: B
Rationale: Reducing salt intake is crucial for managing hypertension. Excessive salt consumption can lead to fluid retention, increasing blood pressure. While stress management, regular physical activity, and weight loss are beneficial for overall health, reducing salt intake is the most important lifestyle modification for controlling hypertension. Stress management may help reduce overall stress levels but does not directly impact blood pressure as salt intake does. Regular physical activity and weight loss can also benefit blood pressure control, but the immediate impact of reducing salt intake is more significant.
2. The client with chronic kidney disease (CKD) is being educated about dietary modifications. Which dietary restriction should the nurse emphasize the most?
- A. Limit intake of high-fiber foods
- B. Restrict protein intake
- C. Avoid dairy products
- D. Increase fluid intake
Correct answer: B
Rationale: The most crucial dietary restriction to emphasize for a client with chronic kidney disease (CKD) is to restrict protein intake. By restricting protein intake, the workload on the kidneys is reduced, which helps slow the progression of CKD. While high-fiber foods are generally beneficial, they may need to be limited in some individuals with CKD due to potassium concerns, making choice A less critical. Avoiding dairy products may be necessary in some cases to control phosphorus levels, but it is not as vital as restricting protein intake. Increasing fluid intake is essential for kidney health, but it is not the most critical dietary modification for clients with CKD.
3. A client with hypothyroidism is being treated with levothyroxine (Synthroid). What is the most important information for the nurse to provide to the client?
- A. Take the medication on an empty stomach
- B. Monitor for signs of hyperthyroidism
- C. Expect to see results within a week
- D. Avoid exposure to sunlight
Correct answer: B
Rationale: The most important information for the nurse to provide to a client with hypothyroidism being treated with levothyroxine is to monitor for signs of hyperthyroidism. Too much levothyroxine can lead to symptoms of hyperthyroidism, indicating an overdose. Choice A is incorrect as levothyroxine is usually taken on an empty stomach to ensure optimal absorption. Choice C is inaccurate as it may take weeks to months to see the full effects of levothyroxine therapy due to the need for dosage adjustments. Choice D is unrelated to levothyroxine therapy and is not a crucial concern for this specific medication.
4. The unlicensed assistive personnel (UAP) reports to the nurse that a client refused to bathe for the third consecutive day. What action is best for the nurse to take?
- A. Ask the client why the bath was refused
- B. Ask family members to encourage the client to bathe
- C. Explain the importance of good hygiene to the client
- D. Reschedule the bath for the following day
Correct answer: A
Rationale: The correct action for the nurse to take is to ask the client why the bath was refused. Understanding the client's reasons for refusal can guide appropriate interventions, respecting client autonomy while addressing any underlying issues. Choice B is not the best course of action as involving family members may not address the client's specific concerns. Choice C, while important, may not directly address the immediate refusal to bathe. Choice D does not address the underlying reasons for the refusal and may not lead to a resolution.
5. When assisting a client to obtain a sputum specimen, the nurse observes the client cough and spit a large amount of frothy saliva in the specimen collection cup. What action should the nurse implement next?
- A. Advise the client that suctioning will be used to obtain another specimen
- B. Re-instruct the client in coughing techniques to obtain another specimen
- C. Provide the client a glass of water and mouthwash to rinse the mouth
- D. Label the container and place the container in a biohazard transport bag
Correct answer: C
Rationale: After observing the client cough and produce frothy saliva in the collection cup, the nurse should provide the client with a glass of water and mouthwash to rinse the mouth. This action helps clear the mouth of contaminants, ensuring a more accurate sputum specimen for diagnostic testing. Option A is incorrect because suctioning is not the appropriate next step in this situation. Option B is unnecessary as re-instructing the client in coughing techniques may not address the immediate issue of contaminated saliva in the specimen. Option D is premature since labeling and transporting the container should only be done after obtaining a valid specimen.
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