HESI LPN-ADN ENTRANCE EXAM (NORTHERN VIRGINIA COMMUNITY COLLEGE)
2 days after an abdominal hysterectomy, an elderly client with diabetes Mellitus Type II has
a syncopal episode. Her vital signs are within normal limits and her sugar is 325 mg/dL.
what intervention should the nurse implement first?
administer regular insulin per sliding scale
A 3-week-old infant is admitted for surgical repair of Pyloric Stenosis. What interventions
should the nurse expect to implement to establish hydration in the immediate
postoperative period?
nipple feedings with glucose water
a 3 year-old admitted with fever of unknown (FUO) has begun vomiting in the past half hour.
The child's temp. is 101.8F, and the last does of antipyretic medication was given 5 hours
ago. the child has prescriptions of acetaminophen (Tylenol) 160 mg per 5 mL elixir or 16o
mg suppositories PRN fever or pain. what action should the nurse take at this time?
make the child NPO and hold all mediations until the vomiting has stopped.
4 hours after administration of 20U of regular insulin, the client becomes shaky and
diaphoretic. what action should the nurse take?
give the client crackers and milk
a 6-month child with bronchiolitis is admitted to the hospital. In monitoring the respiratory
status of this child, which symptom indicates the nurse that he is experiencing respiratory
distress?
,A high pitched cry.
An 8-year-old recovering from a Celiac Crisis requests a bowl of cereal for breakfast. Which
cereal should the nurse provide?
rice
The charge nurse brings a #18fr urinary catheter (Foley) with a 30 mL balloon to the nurse
who is preparing to insert a catheter in a female client who weighs 50 kg. What action
should the nurse take first?
D. Consult with the charge nurse about the catheter
A child with Chronic Asthma is scheduled for Chest Physiotherapy. When should the nurse
administer the meter-dosed inhaler (MDI) puff of bronchodilator relative to postural
drainage treatments?
After postural drainage
A client asks the nurse to explain the location of the prostate gland. What is the best
response?
A. Close the rectal wall the prostate gland sits behind the symphysis pubis extending
around thebeginning of the urethra
A client at 28 weeks gestation is admitted to the antepartum unit and is being treated for
preterm labor. She has a prescription for brethine (Terbutaline) 250 micrograms
subcutaneously q4h. The medication is available for injection in 1 mg per ML vials. How
many mL should the nurse administer?
, C. 0.25
A client begins an antidepressant drug during the second day of hospitalization. Which
assessment is most important for the nurse to include in this client's plan of care while the
client is taking the antidepressant?
Mood
a client comes to the antepartal clinic and tells the nurse that she is 6 weeks pregnant.
which sign is the most likely to report?
amenorrhea
A client complains of kidney pain. The nurse understands that the kidneys are located
where?
A. On the retroperitoneal posterior abdominal wall at the costovertebral angle
A client has a prescription for a Transcutaneous Electrical Nerve Stimulator (TENS) unit for
pain management during the postoperative period following a lumber Laminectomy. What
information should the nurse reinforce about the action of this adjuvant pain modality?
B. Pain perception in the cerebral cortex is dulled by the unit's discharge of an electrical
stimulus
A client has a prescription for enteric-coated (EC) aspirin 325mg PO daily. The medication
drawer contains one 325mg aspirin. What action should the nurse take?
2 days after an abdominal hysterectomy, an elderly client with diabetes Mellitus Type II has
a syncopal episode. Her vital signs are within normal limits and her sugar is 325 mg/dL.
what intervention should the nurse implement first?
administer regular insulin per sliding scale
A 3-week-old infant is admitted for surgical repair of Pyloric Stenosis. What interventions
should the nurse expect to implement to establish hydration in the immediate
postoperative period?
nipple feedings with glucose water
a 3 year-old admitted with fever of unknown (FUO) has begun vomiting in the past half hour.
The child's temp. is 101.8F, and the last does of antipyretic medication was given 5 hours
ago. the child has prescriptions of acetaminophen (Tylenol) 160 mg per 5 mL elixir or 16o
mg suppositories PRN fever or pain. what action should the nurse take at this time?
make the child NPO and hold all mediations until the vomiting has stopped.
4 hours after administration of 20U of regular insulin, the client becomes shaky and
diaphoretic. what action should the nurse take?
give the client crackers and milk
a 6-month child with bronchiolitis is admitted to the hospital. In monitoring the respiratory
status of this child, which symptom indicates the nurse that he is experiencing respiratory
distress?
,A high pitched cry.
An 8-year-old recovering from a Celiac Crisis requests a bowl of cereal for breakfast. Which
cereal should the nurse provide?
rice
The charge nurse brings a #18fr urinary catheter (Foley) with a 30 mL balloon to the nurse
who is preparing to insert a catheter in a female client who weighs 50 kg. What action
should the nurse take first?
D. Consult with the charge nurse about the catheter
A child with Chronic Asthma is scheduled for Chest Physiotherapy. When should the nurse
administer the meter-dosed inhaler (MDI) puff of bronchodilator relative to postural
drainage treatments?
After postural drainage
A client asks the nurse to explain the location of the prostate gland. What is the best
response?
A. Close the rectal wall the prostate gland sits behind the symphysis pubis extending
around thebeginning of the urethra
A client at 28 weeks gestation is admitted to the antepartum unit and is being treated for
preterm labor. She has a prescription for brethine (Terbutaline) 250 micrograms
subcutaneously q4h. The medication is available for injection in 1 mg per ML vials. How
many mL should the nurse administer?
, C. 0.25
A client begins an antidepressant drug during the second day of hospitalization. Which
assessment is most important for the nurse to include in this client's plan of care while the
client is taking the antidepressant?
Mood
a client comes to the antepartal clinic and tells the nurse that she is 6 weeks pregnant.
which sign is the most likely to report?
amenorrhea
A client complains of kidney pain. The nurse understands that the kidneys are located
where?
A. On the retroperitoneal posterior abdominal wall at the costovertebral angle
A client has a prescription for a Transcutaneous Electrical Nerve Stimulator (TENS) unit for
pain management during the postoperative period following a lumber Laminectomy. What
information should the nurse reinforce about the action of this adjuvant pain modality?
B. Pain perception in the cerebral cortex is dulled by the unit's discharge of an electrical
stimulus
A client has a prescription for enteric-coated (EC) aspirin 325mg PO daily. The medication
drawer contains one 325mg aspirin. What action should the nurse take?
