HESI LPN- ENTRANCE EXAM
The mother of an 8-year-old boy tells the nurse that he fell out of a
tree and hurt his arm and shoulder, which assessment finding is the
most significant indicator of possible child abuse? - ANSWERS-D.
The mother refuses to answer questions about family history
A newborn infant with a tracheoesophageal repair is receiving
Gastrostomy (GT) feedings postoperatively. What intervention should
the nurse implement during the GT feedings? - ANSWERS-A. Offer a
pacifier during the feedings to satiate the sucking reflex associated
with feedings
A new father asks the nurse the reason for placing an ophthalmic
ointment in his newborn's eyes. What information should the PN
provide? - ANSWERS-D. State law mandates all newborns receive
prophylactic treatment to prevent gonorrheal or chlamydial
ophthalmic infection
A new mother is at the clinic with her 4-week old for a well baby
check up. The nurse should tell the mother to anticipate that the infant
will demonstrate which millstone by 2-months of age. - ANSWERS-
B. Consistently returns smiles to mother
The nurse assesses the perineum of a client 12 hours after a normal
vaginal delivery and finds that she has Perineal Hematomas. The
nurse should prepare for which treatment? - ANSWERS-. Cold packs
to the perineum
,The nurse assigns an unlicensed assistive personnel (UAP) to feed a
client who is at risk for aspirations. To ensure that the task is safely
delegated what action should the nurse implement? - ANSWERS-C.
Observe the UAP's ability to implement precautions during feed
The nurse assumes care of a client who was admitted earlier in the
day for a scheduled Hysterectomy in the morning. Which recorded
assessment data obtained by the admitting registered nurse is
objective? (Select all that apply). - ANSWERS-A. Anemia, D.
Orthostatic hypotension
The nurse assess a client receiving a hypertonic full strength tube
feeding that is infusing continuous at 50 mL/hr. Which finding is most
important for the nurse to report to the charge nurse? - ANSWERS-C.
Report of increased hunger
A new protocol for fall prevention is being implemented on the
medical unit. During safety rounds, the nurse identifies that an
unlicensed assistive personnel (UAP) has omitted a vital component
of the protocol. After implementing the missing component, what
should action should the nurse take? - ANSWERS-C. Supervise the
UAP after reviewing the protocol
The nurse can also refer to the external ear as what other known
name... - ANSWERS-A. Pinna
, 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? - ANSWERS-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? - ANSWERS-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? - ANSWERS-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? -
ANSWERS-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? -
ANSWERS-A high pitched cry.
The mother of an 8-year-old boy tells the nurse that he fell out of a
tree and hurt his arm and shoulder, which assessment finding is the
most significant indicator of possible child abuse? - ANSWERS-D.
The mother refuses to answer questions about family history
A newborn infant with a tracheoesophageal repair is receiving
Gastrostomy (GT) feedings postoperatively. What intervention should
the nurse implement during the GT feedings? - ANSWERS-A. Offer a
pacifier during the feedings to satiate the sucking reflex associated
with feedings
A new father asks the nurse the reason for placing an ophthalmic
ointment in his newborn's eyes. What information should the PN
provide? - ANSWERS-D. State law mandates all newborns receive
prophylactic treatment to prevent gonorrheal or chlamydial
ophthalmic infection
A new mother is at the clinic with her 4-week old for a well baby
check up. The nurse should tell the mother to anticipate that the infant
will demonstrate which millstone by 2-months of age. - ANSWERS-
B. Consistently returns smiles to mother
The nurse assesses the perineum of a client 12 hours after a normal
vaginal delivery and finds that she has Perineal Hematomas. The
nurse should prepare for which treatment? - ANSWERS-. Cold packs
to the perineum
,The nurse assigns an unlicensed assistive personnel (UAP) to feed a
client who is at risk for aspirations. To ensure that the task is safely
delegated what action should the nurse implement? - ANSWERS-C.
Observe the UAP's ability to implement precautions during feed
The nurse assumes care of a client who was admitted earlier in the
day for a scheduled Hysterectomy in the morning. Which recorded
assessment data obtained by the admitting registered nurse is
objective? (Select all that apply). - ANSWERS-A. Anemia, D.
Orthostatic hypotension
The nurse assess a client receiving a hypertonic full strength tube
feeding that is infusing continuous at 50 mL/hr. Which finding is most
important for the nurse to report to the charge nurse? - ANSWERS-C.
Report of increased hunger
A new protocol for fall prevention is being implemented on the
medical unit. During safety rounds, the nurse identifies that an
unlicensed assistive personnel (UAP) has omitted a vital component
of the protocol. After implementing the missing component, what
should action should the nurse take? - ANSWERS-C. Supervise the
UAP after reviewing the protocol
The nurse can also refer to the external ear as what other known
name... - ANSWERS-A. Pinna
, 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? - ANSWERS-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? - ANSWERS-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? - ANSWERS-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? -
ANSWERS-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? -
ANSWERS-A high pitched cry.
