HESI LPN
Adult Health Exam 1 Chamberlain Questions
Question 1 of 5
When counting a client's radial pulse, the nurse notes the pulse is weak and irregular. To record the most accurate heart rate, what should the nurse do?
Correct Answer: C
Rationale: The correct answer is to count the apical pulse rate for sixty seconds. The apical pulse is more accurate, especially when peripheral pulses are weak or irregular. Counting the apical pulse for a full minute provides a more precise heart rate measurement. Option A is incorrect because waiting for thirty minutes is unnecessary and could delay potential interventions. Option B is incorrect because doubling the radial pulse rate may not provide an accurate representation of the heart rate. Option D is incorrect because comparing radial pulses bilaterally does not give the most accurate heart rate measurement; the apical pulse is preferred in this situation.
Question 2 of 5
The nurse is preparing to administer a tuberculin skin test (TST). Which area of the body is the preferred site for this injection?
Correct Answer: B
Rationale: The inner forearm is the preferred site for administering a tuberculin skin test (TST) due to its easy accessibility, minimal hair interference, and good visibility of the injection site, allowing for accurate interpretation of the test results. The deltoid muscle, abdomen, and thigh are not preferred sites for a TST as they may not provide the optimal conditions required for the test. The deltoid muscle is commonly used for intramuscular injections, the abdomen may have varying subcutaneous fat thickness affecting the test, and the thigh may not provide the necessary visibility for accurate reading.
Question 3 of 5
An elderly client is concerned about constipation during a flight. What should the nurse recommend?
Correct Answer: C
Rationale: The correct answer is to recommend increasing fluid intake in the diet. Adequate hydration is essential for preventing constipation, especially during travel when mobility may be reduced. Stool softeners are not the first-line recommendation and should only be used when necessary. Eating a high protein diet or decreasing fat content in the diet may not directly address the issue of constipation related to dehydration during a flight.
Question 4 of 5
The client with high blood pressure is being taught by the nurse to avoid adding salt during cooking. What effect does sodium have on blood pressure?
Correct Answer: C
Rationale: The correct answer is C: 'It causes vasoconstriction of the blood vessels.' Sodium can lead to vasoconstriction, which narrows the blood vessels, increasing resistance to blood flow and subsequently raising blood pressure. Choices A, B, and D are incorrect. Sodium does not decrease blood viscosity, but it can lead to fluid retention, which increases blood volume and pressure. It does not enhance the excretion of potassium; instead, high sodium intake can lead to potassium excretion by the kidneys.
Question 5 of 5
What intervention has the highest priority for a client with a fourth-degree midline laceration following the vaginal delivery of an 8-pound 10-ounce infant?
Correct Answer: A
Rationale: Administering a prescribed stool softener is the highest priority intervention for a client with a fourth-degree midline laceration to prevent straining during bowel movements, which could potentially harm the healing laceration. Stool softeners help in maintaining soft stools, reducing the risk of injury to the suture line. Administering PRN sleep medications, encouraging breastfeeding, or promoting the use of analgesic perineal sprays are important aspects of care but are not the priority in this situation. Stool softeners play a crucial role in preventing complications and promoting healing in such cases, making it the most urgent intervention.
Similar Questions
Join Our Community Today!
Join Over 10,000+ nursing students using Nurselytic. Access Comprehensive study Guides curriculum for HESI-LPN and 3000+ practice questions to help you pass your HESI-LPN exam.
Subscribe for Unlimited Access