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Exam (elaborations)

HESI PN FUNDAMENTALS V2 EXAM

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HESI PN V2 FUNDAMENTALS EXAM 1) 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? A The nurse also should have instituted a plan to increase activity. B The nurse provided supportive nursing care for the well-being of the client. C Debridement of the pressure ulcer should have been done before the dressing was applied. D Treatment should not have been instituted until the health care provider's prescriptions were received. Correct Answer: B 2) 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. B Call security from the room. C Find out if there is anyone else in the room. D Ask security to make sure the room is safe Correct Answer: D 3) To ensure the safety of a client who is receiving a continuous intravenous normal saline infusion, the LPN should change the administration set every: A 4 to 8 hours B 12 to 24 hours C 24 to 48 hours D 72 to 96 hours Correct Answer: D 4) 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. A Ask the client what is the client's acceptable level of pain. B Eliminate all activities that precipitate the pain. C Administer the pain medications regularly around the clock. D Use a different pain scale each time to promote patient education. E Assess the client's pain every 15 minutes Correct Answer: A, C 5) 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. A Allergy to the medication B Itching in the ear canal C Drainage from the ear canal D Tympanic membrane rupture E Partial hearing loss in the affected ear

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Institution
HESI V2
Course
HESI V2

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HESI PN V2 FUNDAMENTALS EXAM


1) 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?

A The nurse also should have instituted a plan to increase activity.

B The nurse provided supportive nursing care for the well-being of the client.

C Debridement of the pressure ulcer should have been done before the dressing was
applied.

D Treatment should not have been instituted until the health care provider's
prescriptions were received.



Correct Answer: B



2) 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.

B Call security from the room.

C Find out if there is anyone else in the room.

D Ask security to make sure the room is safe



Correct Answer: D



3) To ensure the safety of a client who is receiving a continuous intravenous normal
saline infusion, the LPN should change the administration set every:

A 4 to 8 hours

B 12 to 24 hours

,C 24 to 48 hours

D 72 to 96 hours

Correct Answer: D



4) 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.

A Ask the client what is the client's acceptable level of pain.

B Eliminate all activities that precipitate the pain.

C Administer the pain medications regularly around the clock.

D Use a different pain scale each time to promote patient education.

E Assess the client's pain every 15 minutes



Correct Answer: A, C



5) 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.

A Allergy to the medication

B Itching in the ear canal

C Drainage from the ear canal

D Tympanic membrane rupture

E Partial hearing loss in the affected ear

Correct Answer: A,C,D



6) What clinical indicators should the LPN/LVN expect a client with hyperkalemia
to exhibit? Select all that apply.

A Tetany

, B Seizures

C Diarrhea

D Weakness

E Dysrhythmias

Correct Answer: C,D,E



7) A health care provider has prescribed isoniazid (Laniazid) for a client. Which
instruction should the LPN give the client about this medication?

A Prolonged use can cause dark concentrated urine.

B The medication is best absorbed when taken on an empty stomach.

C Take the medication with aluminum hydroxide to minimize GI upset.

D Drinking alcohol daily can cause drug-induced hepatitis



Correct Answer: D



8) 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?

A Low in fat

B High in iron

C High in fluids

D Low in residue

Correct Answer: C



9) 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?

A Tell the neighboring client to stop singing.

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Institution
HESI V2
Course
HESI V2

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Uploaded on
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Written in
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