HESI LPN
HESI PN Exit Exam 2023
1. When administering an analgesic to a client with low back pain, which intervention should the practical nurse implement to promote the effectiveness of the medication?
- A. Massage the lower back and position the client in proper alignment
- B. Encourage the client to ambulate frequently and take deep breaths
- C. Assist the client in performing passive and active range of motion exercises
- D. Give medication with a full glass of water and offer high-fiber foods
Correct answer: A
Rationale: Massaging the lower back and positioning the client in proper alignment can help relieve muscle tension and enhance the effectiveness of analgesics by providing additional comfort and promoting better pain management. This intervention directly addresses the site of pain and can improve the medication's efficacy. Choices B, C, and D are incorrect because while they may have benefits in other situations, they are not directly related to promoting the effectiveness of analgesics in clients with low back pain. Encouraging ambulation and deep breathing, assisting with range of motion exercises, and offering water and high-fiber foods are important for overall patient care but are not specific to enhancing analgesic effectiveness in this context.
2. What is the primary purpose of performing range-of-motion (ROM) exercises?
- A. To improve cardiovascular fitness
- B. To prevent muscle atrophy and joint contractures
- C. To increase respiratory function
- D. To enhance cognitive function
Correct answer: B
Rationale: The primary purpose of performing range-of-motion (ROM) exercises is to prevent muscle atrophy and joint contractures. These exercises are crucial in maintaining joint mobility and muscle flexibility, especially in patients who are immobilized or have limited mobility. Improving cardiovascular fitness (Choice A) involves different types of exercises that target the heart and blood vessels, not specifically ROM exercises. Increasing respiratory function (Choice C) is typically achieved through breathing exercises and activities that enhance lung capacity. Enhancing cognitive function (Choice D) is usually addressed through cognitive exercises and activities that stimulate brain function.
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. A nurse is reviewing the basal body temperature method with a couple. Which of the following statements would indicate that the teaching has been successful?
- A. I don't need to buy a special type of thermometer.
- B. I need to wait 5 minutes after smoking a cigarette before I take my temperature.
- C. I need to take my temperature before I get out of bed in the morning.
- D. I need to take my temperature at least once every day.
Correct answer: C
Rationale: The correct answer is C. Basal body temperature must be taken before getting out of bed in the morning to get an accurate reading, as even slight activity can raise body temperature and affect the results. Choice A is incorrect because a special type of thermometer is not required for basal body temperature measurement. Choice B is incorrect because smoking can affect body temperature, but the timing mentioned is not relevant to basal body temperature measurement. Choice D is incorrect because while it is essential to take the temperature consistently each day, the duration of temperature measurement is not specified, making this choice less specific compared to the correct answer.
5. The UAP is caring for a male resident of a long-term care facility who has an external urinary catheter. Which finding should the PN instruct the UAP to report immediately?
- A. Swollen and discolored penile shaft
- B. Prepuce extends over the head of the penis
- C. Leaking urine around the top of the catheter
- D. Moist and excoriated perineal skin folds
Correct answer: A
Rationale: The correct answer is A: Swollen and discolored penile shaft. Swelling and discoloration of the penile shaft may indicate an infection or other complications requiring immediate attention. Prompt reporting allows for timely intervention to prevent further harm to the client. Choice B is incorrect because the prepuce extending over the head of the penis is not an urgent issue. Choice C, leaking urine around the catheter, may require intervention but is not as urgent as the swelling and discoloration described in choice A. Choice D, moist and excoriated perineal skin folds, also needs attention but is not as concerning as the potential complications indicated by the findings in choice A.
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