HESI Fundamentals Test Bank

Questions 92

HESI LPN

HESI LPN Test Bank

HESI Fundamentals Test Bank Questions

Question 1 of 5

After preparing and lubricating the enema set, what is the correct sequence of steps a nurse should follow when administering a large volume enema to a client?

Correct Answer: B

Rationale: The correct sequence for administering a large volume enema is as follows: 1. Insert the enema tube into the rectum, 2. Administer the enema solution, 3. Clamp the tube, 4. Remove the tube, 5. Wrap the end with tissue. Therefore, the nurse should remove the enema tube from the client's rectum after administering the enema solution. Choices A, C, and D are incorrect because the enema tube should be removed from the rectum after the administration of the solution, not before or during the process.

Question 2 of 5

A nurse is reviewing evidence-based practice principles about the administration of oxygen therapy with a newly licensed nurse. Which of the following actions should the nurse include?

Correct Answer: A

Rationale: The correct answer is A. Regulating oxygen flow at no more than 6 L/min via nasal cannula is a safe practice to prevent potential complications such as oxygen toxicity. Option B suggesting administering oxygen at a higher flow rate for better saturation is incorrect as it can lead to adverse effects. Option C is incorrect because using a high-flow nasal cannula for all clients is not necessary and should be based on individual client needs. Option D is incorrect as adjusting oxygen flow solely based on client comfort without considering the prescribed flow rate can compromise the effectiveness of oxygen therapy.

Question 3 of 5

Nurse talking with a client's partner. She is having frustrations about managing responsibilities and care. What type of role performance stress is this?

Correct Answer: A

Rationale: Role overload occurs when a person feels overwhelmed by the demands placed upon them.

Question 4 of 5

A client had a mastectomy 6 months ago and expresses a decreased desire for sexual relations, stating "My body is so different now." Which of the following responses should the nurse make?

Correct Answer: B

Rationale: In this situation, the appropriate response is to reflect on the client's feelings and explore their experience. Choice A may unintentionally dismiss the client's concerns by not addressing their emotional needs. Choice C suggests a spa treatment as a solution without addressing the underlying emotional issues. Choice D implies that the client's feelings will resolve with time, which may not be helpful in addressing the client's current emotional state.

Question 5 of 5

During a neurological assessment, a healthcare provider is evaluating a client's balance. Which of the following examinations should the provider use for this purpose?

Correct Answer: A

Rationale: The Romberg test is utilized to assess the client's balance and proprioception by having them stand with their eyes closed. This test helps evaluate sensory ataxia, a condition where an individual's balance is affected due to impaired sensory input. Deep tendon reflexes (Choice B) are assessed by tapping a tendon with a reflex hammer to evaluate the integrity of the spinal cord and peripheral nerves; this is not directly related to balance assessment. The Mini-Mental State Examination (Choice C) is a cognitive screening tool used to assess cognitive impairment or dementia, not balance. The Babinski reflex (Choice D) is elicited by stroking the sole of the foot to assess neurologic function, particularly in the corticospinal tract, and is not specific to balance evaluation.

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