HESI PN Fundamental V2: Questions& Answers:
Updated Solution
During the initial physical assessment of a newly admitted client with
a pressure ulcer, a LPN observes that the client's skin is dry and scaly.
The nurse applies emollients and reinforces the dressing on the pressure
ulcer. Legally, were the nurse's actions adequate? - ANSWERThe nurse provided
supportive nursing care for the well-being of the
client.
A visitor comes to the nursing station and tells the nurse that a client
and his relative had a fight and that the client is now lying unconscious
on the floor. What is the most important action the LPN/LVN needs to take?
A Ask the client if he is okay. - ANSWERAsk security to make sure the room is safe
To ensure the safety of a client who is receiving a continuous
intravenous normal saline infusion, the LPN should change the
administration set every - ANSWER72 to 96 hours
A LPN/LVN is taking care of a client who has severe back pain as a result
of a work injury. What nursing considerations should be made when
determining the client's plan of care? Select all that apply. - ANSWERAsk the client
what is the client's acceptable level of pain.
Administer the pain medications regularly around the clock
The LPN/LVN is preparing to administer eardrops to a client that has
impacted cerumen. Before administering the drops, the nurse will assess
the client for which contraindications? Select all that apply - ANSWERAllergy to the
medication
Drainage from the ear canal
Tympanic membrane rupture
What clinical indicators should the LPN/LVN expect a client with
hyperkalemia to exhibit? Select all that apply - ANSWERDiarrhea
Weakness
Dysrhythmias
A health care provider has prescribed isoniazid (Laniazid) for a
client. Which instruction should the LPN give the client about this
medication? - ANSWERDrinking alcohol daily can cause drug-induced hepatitis
To minimize the side effects of the vincristine (Oncovin) that a client
is receiving, what does the LPN/LVN expect the dietary plan to include? -
ANSWERHigh in fluids
A postoperative client says to the nurse, "My neighbor, I mean the
, person in the next room, sings all night and keeps me awake." The
neighboring client has dementia and is awaiting transfer to a nursing
home. How can the LPN/LVN best handle this situation? - ANSWERMove the
neighboring client to a room at the end of the hall
The nurse is providing postoperative care to a client who had a
submucosal resection (SMR) for a deviated septum. The LPN should
monitor for what complication associated with this type of surgery? -
ANSWERExpectoration of blood
A nurse is reviewing a plan of care for a client who was admitted
with dehydration as a result of prolonged watery diarrhea. Which
prescription should the LPN/LVN question - ANSWERParenteral albumin (Albuminar)
A client is to have mafenide (Sulfamylon) cream applied to burned
areas. For which serious side effect of mafenide therapy should the
LPN/LVN monitor this client? - ANSWERMetabolic acidosis
A LPN is preparing to administer an ophthalmic medication to a
client. What techniques should the nurse use for this procedure? Select
all that apply. - ANSWERA Clean the eyelid and eyelashes.
.
C Apply clean gloves before beginning of procedure.
E Press on the nasolacrimal duct after instilling the solution.
The LPN/LVN recognizes that which are important components of a
neurovascular assessment? Select all that apply. - ANSWERB Capillary refill
E Pulse and skin temperature
F Movement and sensation
A client reaches the point of acceptance during the stages of dying.
What response should the LPN/LVN expect the client to exhibit? -
ANSWERDetachment
A dying client is coping with feelings regarding impending death.
The nurse bases care on the theory of death and dying by Kübler-Ross.
During which stage of grieving should the LPN/LVN primarily use
nonverbal interventions? - ANSWERAcceptance
When a client files a lawsuit against a LPN for malpractice, the
client must prove that there is a link between the harm suffered and
actions performed by the nurse that were negligent. This is known as: -
ANSWERProximate cause
Updated Solution
During the initial physical assessment of a newly admitted client with
a pressure ulcer, a LPN observes that the client's skin is dry and scaly.
The nurse applies emollients and reinforces the dressing on the pressure
ulcer. Legally, were the nurse's actions adequate? - ANSWERThe nurse provided
supportive nursing care for the well-being of the
client.
A visitor comes to the nursing station and tells the nurse that a client
and his relative had a fight and that the client is now lying unconscious
on the floor. What is the most important action the LPN/LVN needs to take?
A Ask the client if he is okay. - ANSWERAsk security to make sure the room is safe
To ensure the safety of a client who is receiving a continuous
intravenous normal saline infusion, the LPN should change the
administration set every - ANSWER72 to 96 hours
A LPN/LVN is taking care of a client who has severe back pain as a result
of a work injury. What nursing considerations should be made when
determining the client's plan of care? Select all that apply. - ANSWERAsk the client
what is the client's acceptable level of pain.
Administer the pain medications regularly around the clock
The LPN/LVN is preparing to administer eardrops to a client that has
impacted cerumen. Before administering the drops, the nurse will assess
the client for which contraindications? Select all that apply - ANSWERAllergy to the
medication
Drainage from the ear canal
Tympanic membrane rupture
What clinical indicators should the LPN/LVN expect a client with
hyperkalemia to exhibit? Select all that apply - ANSWERDiarrhea
Weakness
Dysrhythmias
A health care provider has prescribed isoniazid (Laniazid) for a
client. Which instruction should the LPN give the client about this
medication? - ANSWERDrinking alcohol daily can cause drug-induced hepatitis
To minimize the side effects of the vincristine (Oncovin) that a client
is receiving, what does the LPN/LVN expect the dietary plan to include? -
ANSWERHigh in fluids
A postoperative client says to the nurse, "My neighbor, I mean the
, person in the next room, sings all night and keeps me awake." The
neighboring client has dementia and is awaiting transfer to a nursing
home. How can the LPN/LVN best handle this situation? - ANSWERMove the
neighboring client to a room at the end of the hall
The nurse is providing postoperative care to a client who had a
submucosal resection (SMR) for a deviated septum. The LPN should
monitor for what complication associated with this type of surgery? -
ANSWERExpectoration of blood
A nurse is reviewing a plan of care for a client who was admitted
with dehydration as a result of prolonged watery diarrhea. Which
prescription should the LPN/LVN question - ANSWERParenteral albumin (Albuminar)
A client is to have mafenide (Sulfamylon) cream applied to burned
areas. For which serious side effect of mafenide therapy should the
LPN/LVN monitor this client? - ANSWERMetabolic acidosis
A LPN is preparing to administer an ophthalmic medication to a
client. What techniques should the nurse use for this procedure? Select
all that apply. - ANSWERA Clean the eyelid and eyelashes.
.
C Apply clean gloves before beginning of procedure.
E Press on the nasolacrimal duct after instilling the solution.
The LPN/LVN recognizes that which are important components of a
neurovascular assessment? Select all that apply. - ANSWERB Capillary refill
E Pulse and skin temperature
F Movement and sensation
A client reaches the point of acceptance during the stages of dying.
What response should the LPN/LVN expect the client to exhibit? -
ANSWERDetachment
A dying client is coping with feelings regarding impending death.
The nurse bases care on the theory of death and dying by Kübler-Ross.
During which stage of grieving should the LPN/LVN primarily use
nonverbal interventions? - ANSWERAcceptance
When a client files a lawsuit against a LPN for malpractice, the
client must prove that there is a link between the harm suffered and
actions performed by the nurse that were negligent. This is known as: -
ANSWERProximate cause
