HESI LPN
Adult Health 2 Exam 1
1. What is the primary function of neutrophils?
- A. Heparin secretion
- B. Transport oxygen
- C. Phagocytotic action
- D. Antibody formation
Correct answer: C
Rationale: The correct answer is C: Phagocytotic action. Neutrophils are key components of the immune system, primarily involved in the phagocytosis of bacteria and other pathogens. Choice A, Heparin secretion, is incorrect as heparin is primarily secreted by mast cells and basophils. Choice B, Transport oxygen, is incorrect as this is mainly the function of red blood cells. Choice D, Antibody formation, is incorrect as antibody production is primarily carried out by B lymphocytes.
2. What should the nurse prioritize when providing discharge instructions to a client with a new colostomy?
- A. Skin care around the stoma site
- B. The schedule for colostomy bag replacement
- C. Techniques for odor control
- D. Dietary modifications
Correct answer: A
Rationale: Correct answer: Skin care around the stoma site. Proper skin care around the stoma site is crucial for preventing skin irritation and infection, which are common issues for patients with new colostomies. While the schedule for colostomy bag replacement (Option B) is important, it is not the priority during initial discharge instructions. Techniques for odor control (Option C) are relevant but secondary to skin care for a new colostomy. Dietary modifications (Option D) may be discussed later but are not the priority at this stage.
3. What action should the nurse implement in caring for a client following an electroencephalogram (EEG)?
- A. Monitor the client's vital signs every 4 hours
- B. Assess the client's lower extremities for sensation
- C. Instruct the client to maintain bed rest
- D. Wash any paste from the client's hair and scalp
Correct answer: D
Rationale: The correct action the nurse should implement after an EEG is to wash any paste from the client's hair and scalp. This is crucial to prevent irritation and infection at the EEG site. Monitoring vital signs every 4 hours is not specifically indicated after an EEG. Assessing the client's lower extremities for sensation is unrelated to caring for a client post-EEG. While rest may be recommended after the procedure, there is no standard requirement for a specific duration of bed rest.
4. The nurse is assessing a client who has been receiving total parenteral nutrition (TPN) for several days. Which complication should the nurse monitor for?
- A. Hyperglycemia
- B. Hypoglycemia
- C. Hyponatremia
- D. Hypokalemia
Correct answer: B
Rationale: The correct answer is B: Hypoglycemia. When a client is receiving total parenteral nutrition (TPN) with a high glucose content, the risk of hypoglycemia is significant due to sudden increases in insulin release in response to the glucose load. The nurse should monitor for signs and symptoms of hypoglycemia such as shakiness, sweating, palpitations, and confusion. Hyperglycemia (choice A) is not typically a complication of TPN as the high glucose content is more likely to cause hypoglycemia. Hyponatremia (choice C) and hypokalemia (choice D) are electrolyte imbalances that can occur in clients receiving TPN, but hypoglycemia is the more common and immediate concern that the nurse should monitor for.
5. A client who is 24 weeks pregnant presents with a complaint of feeling dizzy when lying on her back. What is the best response by the nurse?
- A. Advise the client to lie on her side
- B. Encourage the client to drink more fluids
- C. Suggest the client elevate her legs when lying down
- D. Recommend the client take short walks throughout the day
Correct answer: A
Rationale: The correct answer is to advise the client to lie on her side. Lying on the side can prevent the compression of the vena cava, which can cause dizziness in pregnant women. Encouraging the client to drink more fluids (Choice B) may be beneficial for other conditions but is not the best response for dizziness when lying on her back. Suggesting the client elevate her legs when lying down (Choice C) is not directly related to the issue described by the client. Recommending the client take short walks throughout the day (Choice D) may be helpful for other pregnancy-related symptoms but is not the most appropriate action for dizziness when lying on her back.
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