HESI LPN
HESI PN Exit Exam
1. What is the primary role of the sinoatrial (SA) node in the heart?
- A. Pacemaker of the heart
- B. Blood pressure regulation
- C. Electrical conduction delay
- D. Stimulating muscle contraction
Correct answer: A
Rationale: The correct answer is A: Pacemaker of the heart. The SA node, known as the natural pacemaker, initiates the electrical impulses that set the rhythm for the heartbeat. It is responsible for coordinating the heart's contractions by generating electrical signals at regular intervals. Choice B is incorrect as the SA node's primary function is not related to blood pressure regulation. Choice C is incorrect as the SA node does not cause electrical conduction delay but rather initiates and conducts the electrical impulses. Choice D is incorrect as the SA node does not directly stimulate muscle contraction but rather initiates the electrical events that lead to muscle contraction.
2. What dietary considerations must the nurse keep in mind for a patient who is an Orthodox Jew?
- A. They can eat any food unless it is Yom Kippur
- B. They cannot mix meat and dairy
- C. They cannot eat meat on Ash Wednesday
- D. They are vegetarian
Correct answer: B
Rationale: Orthodox Jews follow dietary laws (Kashrut) that prohibit mixing meat and dairy products in the same meal. This restriction is known as 'not mixing milk and meat.' Therefore, choice B is the correct answer. Choices A, C, and D are incorrect because being an Orthodox Jew does not mean they can eat any food unless it is Yom Kippur, avoid meat on Ash Wednesday, or are necessarily vegetarian.
3. For an older postoperative client with the nursing diagnosis 'impaired mobility related to fear of falling,' which desired outcome best directs the nurse's actions for the client?
- A. The client will ambulate with assistance every 4 hours
- B. The physical therapist will instruct the client in the use of a walker
- C. The client will use self-affirmation statements to decrease fear
- D. The nurse will place a gait belt on the client prior to ambulation
Correct answer: C
Rationale: Encouraging the client to use self-affirmation statements is the most appropriate desired outcome in this scenario. By utilizing self-affirmation statements, the client can address their fears directly and build confidence, which can ultimately lead to a reduction in fear of falling. While ambulating with assistance (choice A) is important, the focus here is on addressing the fear itself. Instructing the client in the use of a walker (choice B) and placing a gait belt on the client (choice D) are interventions that may be helpful but do not directly address the client's fear of falling.
4. In obtaining an orthostatic vital sign measurement, what action should the nurse take first?
- A. Count the client's radial pulse
- B. Apply a blood pressure cuff
- C. Instruct the client to lie supine
- D. Assist the client to stand upright
Correct answer: C
Rationale: The correct first action when obtaining an orthostatic vital sign measurement is to instruct the client to lie supine. This allows for establishing a baseline measurement of vital signs before any positional changes. Counting the client's radial pulse (Choice A) is a step that follows after the initial supine position to assess changes in pulse rate. Applying a blood pressure cuff (Choice B) and assisting the client to stand upright (Choice D) are actions that come later in the process after the baseline measurements are obtained in the supine position.
5. What is the first action a healthcare professional should take when a patient’s nasogastric (NG) tube becomes clogged?
- A. Flush the tube with water
- B. Reposition the patient
- C. Attempt to aspirate the clog with a syringe
- D. Administer a medication to dissolve the clog
Correct answer: C
Rationale: When a patient's nasogastric (NG) tube becomes clogged, the first action to take is to attempt to aspirate the clog with a syringe. This is a standard and initial step to clear the blockage in the tube. Flushing the tube with water (Choice A) may not address the specific clog; repositioning the patient (Choice B) is not directly related to clearing the tube. Administering a medication to dissolve the clog (Choice D) should only be considered after simpler methods like aspiration have been attempted.
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