who should document care
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Nursing Elites

HESI LPN

HESI Leadership and Management Test Bank

1. Who should document care?

Correct answer: C

Rationale: All staff members should document the care they provided as part of their accountability and to ensure accurate and comprehensive records. In healthcare settings, it is essential for all staff to document the care they deliver for continuity of care and legal purposes. The registered nurse may sign off on the documentation for oversight purposes, but the responsibility of documenting care extends to all staff involved in patient care. Choices A and B incorrectly limit the responsibility to specific roles, while choice D inaccurately suggests that only the registered nurse signs off on the documentation, overlooking the importance of comprehensive documentation by all staff members involved.

2. Select the type of skeletal fracture that is correctly paired with its description.

Correct answer: D

Rationale: The correct answer is D. An avulsion fracture occurs when a part of the bone is pulled away by a tendon or ligament. Choice A is incorrect because it describes an open fracture where the bone penetrates the skin. Choice B is incorrect as a pathological fracture results from an underlying disease weakening the bone, not physical trauma. Choice C is incorrect as a greenstick fracture involves the bone bending but not completely breaking.

3. A nurse is preparing to discharge a client who has end-stage heart failure. The client's partner tells the nurse she can no longer handle caring for the client. Which of the following actions should the nurse take?

Correct answer: C

Rationale: The nurse should contact the case manager to discuss discharge options and support the client's partner. This action is appropriate as it involves seeking professional guidance and support for the client's partner who is struggling to care for the client. Option A is not the best choice as it solely focuses on involving another family member without addressing the partner's concerns directly. Option B is premature as recommending long-term care should be a well-considered decision involving multiple healthcare professionals. Option D delays the inevitable without providing a solution to the partner's current challenges.

4. What is a cavity containing pus surrounded by inflamed tissue?

Correct answer: B

Rationale: An abscess is defined as a cavity containing pus surrounded by inflamed tissue. Cellulitis is a bacterial skin infection causing redness and swelling, not a cavity. Extravasation is the leakage of fluid from a vessel into surrounding tissues, not a cavity. An adhesion is a band of scar-like tissue that binds two parts together, not a cavity containing pus and inflamed tissue.

5. Which of the following chronic complications is associated with diabetes?

Correct answer: B

Rationale: The correct answer is B. Diabetes is associated with chronic complications such as retinopathy, neuropathy, and coronary artery disease. Choice A includes symptoms rather than chronic complications of diabetes. Choice C lists conditions not typically associated with diabetes. Choice D describes symptoms that may occur in various medical conditions but are not specific chronic complications of diabetes.

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