HESI PREP

Which anticholinergic agent is used for bradydysrhythmias?

atropine ------Atropine (A) is an anticholinergic drug that increases the heart rate and is used in bradydysrhythmias.

When taking the blood pressure of a client, how should the practical nurse (PN) position the client's upper arm?

at the level of the heart

The practical nurse (PN) is reviewing dietary recommendations for a client who is newly diagnosed as hypertensive. Which information is most important for the practical nurse (PN) to reinforce?

check sodium content on all canned foods ----The most valuable dietary modifications for a client with hypertension is reducing sodium intake.Canned foods contain high levels of sodium, so the client should review the salt content on labels of canned products and limit this intake.

What action should the practical nurse (PN) implement first for a client with a head injury and clear nasal drainage?

check the nasal drainage with a glucose test strip ----The PN needs to determine if the fluid is cerebrospinal fluid (CSF). Glucose is present in CSF, so the use of a glucose test strip provides a quick bedside screen. If the nasal discharge is CSF, the client is at risk for meningitis.

An unlicensed assistive personnel (UAP) reports a blood pressure (BP) reading of 148/88 for a 10-year-old child who is above the 95th percentile on the growth chart. What intervention should the practical nurse (PN) implement?

check the size of the bp cuff used ----The size of a BP cuff should be checked (A) because a cuff that is too small for a child above the 95th percentile is mostly likely to result in a falsely elevated reading

Which finding in a newborn is most important for the practical nurse (PN) to report?

clinical jaundice evident on the forehead within 24 hours of birth ----Jaundice is clinically visible when bilirubin levels reach 5 to 7 mg/dl and appears in a cephalocaudal manner, first noticed in the head and then progresses gradually to the thorax, abdomen, and extremities. Clinical jaundice that is evident within 24 hours of birth

A female client with terminal cancer is tearful and is becoming increasingly withdrawn from her family and the nursing staff. She refuses medications, treatments, food, and frequently says, "Why is God doing this to me?" Which intervention should the practical nurse implement?

contact her religious advisor to help her face death

Which action should the practical nurse implement to ensure that a hospitalized toddler takes a prescribed dose of an oral medication?

convey to the child in simple terms what the medication is for and how it is given

The practical nurse (PN) is assessing a client who is admitted with a history of heart failure (HF) and a recent onset of dependent edema. Which finding is most important for the PN to report?

crackles in the lungs---A client with a history of HF is at risk for cardiac decompensation, so signs of fluid overload, such as dependent edema and crackles in the lungs

What action should the practical nurse implement to facilitate speech for a client who has a fenestrated tracheostomy tube?

determine the client's ability to swallow ----- A fenestrated tracheostomy tube has an opening or hole on the posterior aspect of the outer cannula that allows airflow over the vocal cords and speech in a client who is spontaneously breathing. A fenestrated tube does not have a cuff, so the client's risk for aspiration should be determined.

Which information related to a client's history of benign prostatic hypertrophy (BPH) should the practical nurse (PN) report to the healthcare provider?

difficulty with urination ----An increase in the size of the prostate gland caused by BPH compresses the urethra, resulting in difficulty initiating the urinary stream. This should be reported to the healtcare provider.

During a prenatal visit, expectant parents ask the practical nurse (PN) how to safely transport a newborn home in a car seat. What information should the PN provide?

A car seat should be in the rear facing position in the back seat

The practical nurse (PN) is reinforcing the discharge instructions for a female client with cystitis. Which statement indicates to the PN that the client understands measures to prevent urinary tract infections (UTI)?

Every 2-3 hours during waking hours, I will drink a glass of water and empty my bladder

The practical nurse (PN) is reviewing the medication dosage instructions with a parent whose child is taking levothyroxine (Synthroid). What statement reveals that the parent understands the correct procedure?

I give the medication at 8am every day

A male client diagnosed with schizophrenia reveals to the practical nurse (PN) that voices have told him he is in danger. He believes he is safe only if he stays in his room and wears the same clothes. He goes on, "They're so loud they frighten me. Don't you hear them?" What is the best response for the PN to provide?

I know these voices are very real to you, but I don't hear them (When asked to validate the hallucination, the PN should respond with the reality that the nurse is not experiencing the same stimuli as the client)

For which client should the practical nurse implement the Glasgow Coma Scale (GCS) assessment?

a client with a closed head injury who refuses to follow verbal commands

Which client requires the most immediate assessment by the practical nurse?

a young adult post appendectomy with an increase in wound drainage ---A client who is post-appendectomy with a sudden increase in wound drainage (B) should be assessed immediately for potential wound dehiscence.

Which intervention is most important for the practical nurse to implement when suctioning the nasopharyngeal airways for a child after cardiac surgery?

administer supplemental oxygen before and after suctioning -----Hypoxia increases the cardiac workload after cardiac surgery, so supplemental oxygen should be administered with a manual resuscitation bag before and after suctioning (D) to prevent hypoxia

A child with acute streptococcal pharyngitis is prescribed amoxicillin (Amoxil) suspension. The mother asks the practical nurse (PN) when her child can return to school. Which information should the PN provide?

after the child has taken antibiotics for 24 hours -----Spread of infection of streptococcal disease is common in families, classrooms, and day care centers. After 24 hours of antibiotic therapy

The practical nurse (PN) is working in the eye clinic where several clients are waiting to be seen. Which client should the PN place in the ophthalmologist's examination room first?

an adult male with a sudden onset of a curtain across field of vision today ---A sudden onset of loss of vision as if a curtain fell across the visual field is a classic symptom of retinal detachment (C) that requires emergency treatment.

A client with atherosclerosis is trying to stop cigarette smoking and is using a nicotine patch. Which information should the practical nurse (PN) reinforce with this client?

an increased risk for heart attack occurs with smoking while using the patch (Nicotine in cigarette smoke along with the additive effect of the nicotine patch concomitantly increases vasoconstriction and increases mean arterial pressure, which increases the risk for a myocardial infarction. The priority is to reinforce the information about additional nicotine that contributes to hypertension.)

Which client is the best assignment for the practical nurse (PN)?

an older adult client with dehydration who needs assistance with feeding ---Client acuity determines client care assignments that should be aligned with the PN's scope of practice. The best assignment for the PN in this group of clients is the client with non-complex health needs, such as requiring assistance with nutrition and feeding.

The practical nurse (PN) receives report for four clients. While providing care, which client should the PN observe closely for hypernatremia?

an older client with quadriplegia who is disoriented today --------An older client with quadraplegia has a limited ability to respond to stimuli, such as a decreased sense of thirst which is an initial response to hypernatremia that manifests with mental confusion, is an early sign of hypernatremia.

The practical nurse (PN) is caring for a client with chronic kidney disease (CKD). What information should the PN reinforce about medication management?

antihypertensive drugs should always be used as directed ------Blood pressure control is essential for a client with CKD because hypertension and cardiovascular disease occur with the progression of CKD. Other options are not indicated in CKD.

What action should the practical nurse (PN) take when implementing daily focused assessments for this assigned group of 4 clients?

apply a bp cuff on client's forearm when the upper arm cannot be used

A client is wearing a continuous 24-hour Holter monitor for evaluation of heart rhythm disturbances. What information should the practical nurse (PN) reinforce with this client?

keep a diary of activities as long as the monitor is worn -----Nursing care for a client with a Holter monitor includes preparation of the skin, placement of the electrodes and leads, and activities of daily living, so the client should be informed of the importance of keeping an accurate record of activities and symptoms.

The practical nurse (PN) is reviewing the medical record for an infant with hydrocephalus. Which focused assessment finding should the PN document?

increased head circumference ----due to the increase in cerebrospinal fluid (CSF), which should be identified during a focused assessment and documented in the medical record.

The practical nurse (PN) is reviewing the effects of nonsteroidal antiinflammatory drugs (NSAIDs) with a client who has acute gastritis. What information is correct about the action of NSAIDs?

inhibits the synthesis of prostaglandins that normally protect the stomach lining. -------NSAIDs inhibit the synthesis of prostaglandins which protect the stomach lining (B) leaving the gastric mucosa more susceptible to damage.

Rank the sequence of physiological changes that a newborn must initiate and adapt to extrauterine life after Cesarean delivery? (Arrange in the order from most critical on top to least on the bottom.)

initiation of respiration, maintenance of body temp, closure of fetal circulatory shunts, response of immune defense system

The practical nurse (PN) is talking with an adult male client who says that he is satisfied with how he has lived his life. According to Erikson's staging theory, this client is in which stage?

integrity vs despair

A client with acute pancreatitis has a low serum calcium level. The practical nurse (PN) observes that the lips, nose, and side of the face contract after the client's face is cleansed with a cloth. Which electronic documentation describes these findings?

ckvostek's sign noted (Chvostek's sign (C) indicating low serum calcium is manifested by spasms of the muscles innervated by the facial nerve, which is elicited by tapping the client's face lightly below the temple)

Which client information determines the best assignment for the practical nurse (PN)?

client with dependent edema is scheduled for discharge to home care ---Non-complex client acuity determines client care assignments that should be aligned with the PN's scope of practice. The PN should be assigned to a stable client with residual dependent edema who is preparing for discharge. Clients with complex diagnosis and higher acuity would require the expert skills of the RN.

Based on these clients' laboratory results, which client should be assigned to the practical nurse (PN)?

client with serum calcium of 9.5 mg/dl (Client who has a serum calcium (9.5 mg/dl) within normal limits is least likely to experience complications and is the best assignment for the PN.)

The practical nurse (PN) is monitoring a client who is admitted in active labor. After reviewing the nursing admission assessment, the PN determines the client's membranes have been ruptured for 36 hours. The PN should monitor the client for which risk factor?

intrauterine infection -----microorganisms from the vagina can ascend into the amniotic sac and cause chorioamnionitis and placentitis

The caregiver of an 88-year-old client tells the practical nurse (PN) that the client takes frequent naps during the day and awakens frequently during the night. Which information should the PN provide?

it is normal for an aging client to awaken more often during the night and nap during the day

A client with deep partial-thickness and full-thickness burns of the face and chest is receiving wound care using the "open method." The plan of care includes the nursing diagnosis, "Risk for infection related to impaired tissue integrity." Based on the expected outcome, "Client remains free of infections," which nursing intervention should the practical nurse (PN) implement?

wear a gown, cap, mask, and gloves during direct client care

An older male client who takes several medications comes to the clinic complaining of loss of appetite and fatigue. He tells the practical nurse (PN), "Things look blurred, yellow, and sometimes have rings around them." Which medication should be withheld until further assessment of laboratory tests is obtained?

digoxin (Lanoxin) -----Blurred, yellowed vision with halos, anorexia, and fatigue are common findings of digoxin toxicity (A). Digoxin is used to manage heart failure, a common chronic illness in older clients.

The practical nurse (PN) performs a random blood glucose test for a client with a history of hypoglycemia and complains of dizziness. After test completion, which action should the PN perform first?

dispose of lancet and test strip in proper receptacle

The practical nurse (PN) is assisting an adult female client with perineal care. Which position should the PN assist the client to take?

dorsal recumbent

Which site should the practical nurse (PN) avoid when administering IM immunizations to toddlers?

dorsogluteal ----The IM dorsogluteal (B) site should be avoided in infants, toddlers, and smaller preschoolers due to the risk of damaging the sciatic nerve.

The unlicensed assistive personnel (UAP) asks the practical nurse (PN) how to position a client for tube feedings?

elevate the HOB ---The head should be elevated 45 degrees before and one hour after feeding to reduce the possibility of aspiration. The other options do not address the concept of safety and risk for aspiration.

The practical nurse (PN) is caring for an older female client who has left-sided weakness after a cerebrovascular accident. The client states that she wants to do her own sponge bath. Which action should the PN implement?

encourage her to do what she can and assist her when she needs help -----Encouraging the client to be as independent as possible, with assistance as needed, helps the client regain a sense of independence and prevents problems associated with inactivity. The client should be encouraged to do self care as tolerated and assistance should be provided when the client is unable

A client with advanced cirrhosis is prescribed lactulose (Cephulac) 30 ml QID. The client complains that the medicine is causing diarrhea. Which therapeutic response of the medication should the PN provide the client?

excretes ammonia to improve cerebral function -----Lactulose causes the movement of serum ammonia, which accumulates due to hepatic dysfunction in cirrhosis, into the gut resulting in diarrhea due to the osmotic movement of water. The primary use in advanced cirrhosis is to reduce serum ammonia levels. The other options are not therapeutic actions for lactulose.

A female client who is newly diagnosed with Type 2 diabetes tells the practical nurse (PN) that she hates to exercise and asks whether just following her 1000-calorie diet will control her diabetes. Which response should the PN provide that offers the best information?

exercise facilitates weight loss and decreases peripheral insulin resistance -----Exercise increases insulin sensitivity and has a direct effect on lowering the blood glucose levels. Dietary compliance and regular exercise contribute to weight loss, which also decreases insulin resistanc

An older male client with chronic pain due to degenerative joint disease frequently cries at night because he cannot go to sleep. Which additional finding would the practical nurse (PN) mostly likely observe in this client?

fatigue, depression, helplessness, and anger

The practical nurse (PN) is caring for an older client with an infection. Which finding should the PN anticipate as a delayed response in this client?

fever ----An early systemic immune response is fever, but older clients are at risk for an impaired immune response related to chronic illness or polypharmacy, such as antiinflammatory steroids. This older client may manifest fever after presenting with fatigue, malaise, and confusion.

The practical nurse (PN) is planning to attend an educational offering for continuing education units (CEUs) or contact hours. In order to qualify for CEUs, the PN must recognize that the offering should include which essential element?

has measurable outcome objectives

At the scene of a motor vehicle collision, the practical nurse (PN) stops to render assistance to a victim who has bleeding injuries of the face and neck. Which action should the PN implement after establishing that the victim is unresponsive?

immobilize the head and neck ----Cervical spine trauma should be suspected in any client with significant upper torso, face, head, or neck trauma, so cervical immobilization should be applied

The practical nurse (PN) is caring for a client with dementia. Which finding should the PN report to the charge nurse that indicates the client's condition is getting worse

loss of contact with environment (Dementia is a client's loss of cognitive abilities, including judgment, abstract thought, memory, language, and the ability to think and understand the environment. An individual with dementia loses the ability to recognize and respond to the environment as the disease progresses)

Which nursing action for a client who had a near-drowning experience is within the scope of the practical nurse (PN)?

maintain cervical spine precautions during client transfers to a stretcher ----Rationale Stabilizing the client's spine (B) during transfer to a stretcher is a basic nursing skill that is within the scope of practice for a PN.

The practical nurse (PN) is providing wound care for a newly admitted client with partial to full-thickness burns of the torso. Place the steps in the order of first to last implementation. (Arrange from first on top to last on the bottom.)

maintain room tempt above 76F, administer prescribed opioid analgesic, don gown mask and gloves, cleanse wounds with sterile normal saline, apply topical Silver sulfadiazine

The practical nurse (PN) is caring for a school-aged child with Reye's syndrome. What action is most important for the PN to implement?

monitor I & O -----Reye's syndrome is characterized by a nonspecific encephalopathy with fatty degeneration of the liver and is triggered by a virus, particularly influenza or varicella, in association with the concurrent use of salicylates. Fluid management focused on monitoring and treating increased intracranial pressure (ICP) is crucial, so monitoring intake and output (C) is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema

What therapeutic response should the practical nurse (PN) monitor for in a client who is taking medications for tuberculosis?

negative sputum cultures and chest xray -----Therapeutic effectiveness of antitubercular drugs is supported by clinical findings indicating negative sputum cultures for the acid fast bacilli and improved chest radiographs

A client with hypothyroidism receives a prescription for thyroid hormone replacement. Which sign(s) of overdose should practical nurse (PN) reinforce with the client? (Select all that apply.)

nervousness, irritability, difficulty sleeping

Which client receiving infusion therapy is the best assignment for the practical nurse (PN)?

older adult client who is confused and has peripheral saline lock that should to be flushed every 8 hrs -----Client acuity is affected by unstable health alterations that require multisystem organ assessment and determines client care assignments that should be aligned with the PN or RN scope of practice. An older adult client with a saline lock that is routinely flushed for patency every 8h is a non-complex care assignment within the scope of practice for the PN.

Which client should the practical nurse (PN) identify as the priority for a focused assessment?

older female with pneumonia who is newly confused to person

Which pathophysiological findings are characteristic in children with cystic fibrosis (CF)? (Select all that apply.)

pancreatic enzyme deficiency, hypochloremia and hyponatremia, viscous respiratory secretions -----CF is characterized by exocrine gland dysfunction that produces thick, tenacious respiratory secretions (F), pancreatic enzyme deficiencies (D), and abnormally elevated chloride and sodium concentrations in the sweat (E

A client who delivered a 7 pound 8 ounce infant 3 hours ago has a soft, boggy uterus located above the umbilicus. What action should the practical nurse implement next?

perform fundal massage -----A soft, boggy uterus places the client at increased risk for postpartum hemorrhage, so the PN should perform fundal massage to contract the uterus.

A male client scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the practical nurse (PN) if he will ever be able to speak. Which response is best for the PN to provide?

permanent removal of the voice box requires rehabilitation for esophageal speech (The PN should inform the client that a total laryngectomy includes removal of the larynx and pre-epiglottis region resulting in a permanent tracheostomy and loss of normal speech abilities. Rehabilitation is required to learn to speak using a voice prosthesis, esophageal speech or an electrolarynx.)

Which factor should the practical nurse (PN) consider prior to providing morning hygiene care to a male client who is of Middle-Eastern descent ?

personal preference

The practical nurse (PN) is administering a dissolved medication via a nasogastric tube (NGT). After putting on gloves and attaching the irrigation syringe to the NGT, in which order should the PN implement the actions? (Arrange from first on top to last on the bottom.)

pinch the tubing to pour 15-30ml of tap water in the syringe barrel, release the tubing slowly to allow the solution to flow, observe the client for indications of intolerance during instillation, add the medication solution after pinching the tubing

The practical nurse (PN) is caring for a 2-year-old child with Wilms' tumor. Which intervention is most important for the PN to implement?

place a sign in the room stating no abdominal palpation ---abdominal palpation in a child with Wilms' tumor can cause the cancer to spread throughout the peritoneum, so it should be prohibited by placing a sign in the child's room.

The practical nurse (PN) is planning care for a client who is admitted with a Braden scale score of 2 in each of the six subcategories. Toward which goal in the client's care should the PN focus nursing interventions?

prevention of pressure ulcers -----The Braden scale measures degrees of sensory perception, moisture, activity, mobility, nutrition, friction, and shear that indicate a client's risk for skin breakdown. A score of 12 indicates the client's plan of care should include a goal that focuses on the prevention of skin breakdow

An infant is admitted to the hospital with a diagnosis of pyloric stenosis. Which finding should the practical nurse (PN) expect to find in the client's history?

projectile vomiting ---- Projectile vomiting is a classic symptom of pyloric stenosis, which blocks the exit of gastric contents and causes emesis to be vomited with considerable force. Other options are not characteristic with pyloric stenosis

Which interventions should the practical nurse (PN) implement in the postoperative period for a client who had surgery for cancer of the oral cavity? (Select all that apply.)

provide meticulous oral hygiene, obtain daily weight to determine need for NGT feedings, observe for temporary or permanent loss of taste -----Postoperative problems related to excision of a cancerous lesion in the oval cavity include the risk for infection, delayed wound healing in the oral mucosa, and gustatory deficits, if the client's tongue is resected or biopsied. Meticulous oral hygiene reduces oral flora and minimizes the risk for infection. Monitoring daily weight provides information about the client's need for supplemental NGT feedings to improve nutritional intake for healing and recovery. Observing for temporary or permanent loss of taste may indicate trauma of the tongue and glossopharyngeal nerve.

What action should the practical nurse (PN) implement when administering ear drops to a 2-year-old child?

pull the pinna back and down to instill the drops

A client who has been taking furosemide (Lasix) for the past two months is 2 days postoperative for a suprapubic prostatectomy. After breakfast, the client is in the bathroom straining to have a bowel movement when he calls the practical nurse (PN) complaining of sudden onset of shortness of breath and acute chest pain. Which condition should the practical nurse (PN) assess the client?

pulmonary embolism (The client's postoperative status and possible dehydration related to recent use of Lasix places the client at risk for pulmonary embolism, which is a postoperative complication characterized by acute chest pain and shortness of breath precipitated by straining on stool.)

A 34-year-old male client who is admitted to the mental health unit for paranoia is responding to antipsychotic medications. After the healthcare team decides to discharge the client, he tells the practical nurse (PN) that his wife is unfaithful and he plans to "get her for this." How should the PN respond?

report to the team that the client's wife should be informed

After undergoing exploratory laparotomy and bowel resection, a client with a nasogastric tube (NGT) to suction complains of nausea and stomach distention. The practical nurse (PN) irrigates the tube, but the irrigating fluid does not return. What action should the PN implement?

reposition the tube and check for placement

Which finding should the practical nurse report that is the first indication a child with a tracheostomy is experiencing respiratory distress?

restlessness -----Unless respiratory arrest occurs suddenly, signs of hypoxemia and hypercapnia are usually subtle and become more obvious as respiratory distress progresses. A child with a tracheostomy may develop airway obstruction from increased airway secretions, which decreases cerebral oxygenation, initially causing restlessness (B), and should be reported immediately.

Which finding should the practical nurse (PN) report to the healthcare provider that indicates a client with cirrhosis is progressing to hepatic encephalopathy (hepatic coma)?

serum ammonia levels twice the normal value

A client is 24 hours post-endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Which finding should the practical nurse (PN) report to the healthcare provider?

serum amylase elevation 3x above normal value -----ERCP can cause a gallstone to move into the common bile duct, obstructing flow into the duodenum and cause pancreatitis, which is evidenced by an elevation of serum amylase and lipase levels.

The practical nurse (PN) is caring for a client in hospice who is comatose and needs vigorous suctioning. The PN is conflicted about implementing the needed care. What ethical action should the PN do first?

speak with the unit supervisor about the problem

A new father asks the practical nurse (PN) the reason for placing an ophthalmic ointment in his newborn's eyes. What information should the PN provide?

state law mandates all newborns receive prophylactic treatment to prevent gonorrheal or chlamydial ophthalmic infection (Many states mandate prophylactic use of erythromycin ointment in all newborn's eyes within 2 hours of birth because of the risk of blindness from an ophthalmic infection acquired during a vaginal birth, if the mother is infected with a gonorrheal or chlamydial organism)

The practical nurse (PN) is observing a newborn's breathing pattern. Which breathing pattern should the PN document as normal for this full-term newborn?

synchrony chest and abdominal movements

The practical nurse (PN) receives an assignment of four clients. Which action should the PN implement first

take the bp on both arms of a client with moving "ripping" back pain ----may be a symptom of an aortic aneurysm dissection, which creates changes in the blood flow volume between the right and left subclavian arteries. The PN should determine if the client has a difference in arterial blood pressures in both arms (B) and report these findings to the charge nurse

A female client receives a new prescription for an oral contraceptive. Which information should the practical nurse (PN) reinforce with the client?

take the pill at the same time everyday

n older client is admitted with anemia after an episode of acute blood loss. Which assessment finding should the practical nurse (PN) report?

tarry stool last bowel movement (Anemia due to an acute episode of blood loss, such as gastrointestinal bleeding, can cause tarry stools)

A mother calls the clinic to find out what she can do because a note from school has been sent about a reported case of head lice in her child's class. What information should the practical nurse (PN) provide?

tell the child to not share personal grooming items -----Primary prevention should be implemented and includes informing the parent about the mode of transmission for head lice. The mother should instruct her child to not share personal grooming items (D) because direct contact and shared objects play a role in the mode of transmission.

The practical nurse (PN) is caring for a client who is receiving a therapeutic dose of warfarin (Coumadin). The client asks the PN to explain the effect of eating green leafy vegetables. What information should the PN provide?

the high content of vitamin K in leafy green vegetable decreases Coumadin's action -----Coumadin works as an anticoagulant by blocking hepatic utilization of vitamin K in the production of prothrombin, which is a component of the blood clotting cascade. Green leafy vegetables are high in vitamin K, which counteracts the anticoagulant effect of Coumadin

The practical nurse (PN) is caring for a child who is receiving chemotherapy for leukemia. The child's granulocyte count is 250/ mm 3 and the platelet count is 20,000/ mm 3 . Which intervention should the PN implement when performing oral hygiene?

wipe teeth with moistened gauze sponges -----the child is at risk for bleeding and infection. To minimize trauma and the risk of bleeding, the PN should cleanse the teeth with moistened gauze sponges