HESI Fundamental Practice Exam

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A client is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take?

  • A. Reassure the client that this is an expected response to grief.
  • B. Ignore the client's anger and continue with the plan of care.
  • C. Tell the client that anger is not going to help his situation.
  • D. Encourage the client to express his anger.
Correct Answer: A

Rationale: When a client is expressing anger about a diagnosis, it is essential for the nurse to validate the client's feelings. Choice A is correct because reassuring the client that anger is an expected response to grief acknowledges the client's emotions and encourages expression, fostering a therapeutic relationship. This validation helps the client feel understood and supported during a challenging time. Choice B is incorrect as ignoring the client's anger can lead to feelings of neglect and hinder effective communication, which is crucial for providing holistic care. Choice C is inappropriate because telling the client that anger is not helpful dismisses the client's emotions and can further escalate the situation, potentially damaging the nurse-client relationship. Choice D is not the best option as it does not involve acknowledging the client's feelings or providing support and validation, which are vital in promoting emotional well-being and trust between the client and the nurse.

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A charge nurse is explaining the various stages of the lifespan to a group of newly licensed nurses. Which of the following examples should the charge nurse include as a developmental task for a young adult?

  • A. Becoming actively involved in providing guidance to the next generation.
  • B. Adjusting to major changes in roles and relationships due to losses.
  • C. Devoting time to establishing an occupation.
  • D. Finding oneself 'sandwiched' between and being responsible for two generations.
Correct Answer: C

Rationale: The correct answer is C: Devoting time to establishing an occupation. Young adults typically focus on building their careers and personal identities, making establishing an occupation a crucial developmental task for this age group. Choices A, B, and D do not align with the typical developmental tasks of young adults. Choice A relates more to middle adulthood where individuals take on mentoring roles, choice B is more characteristic of the tasks associated with adjusting to late adulthood, and choice D is more relevant to middle adulthood when individuals may find themselves caring for both their own children and aging parents.

A dying client is coping with feelings regarding impending death. The nurse bases care on the theory of death and dying by K¼bler-Ross. During which stage of grieving should the LPN/LVN primarily use nonverbal interventions?

  • A. Anger
  • B. Denial
  • C. Bargaining
  • D. Acceptance
Correct Answer: D

Rationale: Nonverbal interventions are primarily used during the acceptance stage according to K¼bler-Ross's theory of death and dying. During the acceptance stage, the individual is more likely to be reflective and less communicative, making nonverbal interventions more effective. Choices A, B, and C are incorrect because anger, denial, and bargaining are stages that precede the acceptance stage in K¼bler-Ross's model, where verbal communication and processing emotions play a more significant role.

The client is preparing for discharge following treatment for heart failure. Which statement by the client indicates a need for further teaching?

  • A. I will weigh myself every day at the same time.
  • B. I will call my doctor if my legs swell more.
  • C. I will take my water pill only when I feel short of breath.
  • D. I will limit the amount of salt in my diet.
Correct Answer: C

Rationale: The correct answer is C. Taking water pills (diuretics) only when feeling short of breath is incorrect. Diuretics should be taken regularly as prescribed to manage fluid retention. Option A is correct as daily weight monitoring helps track for fluid retention. Option B is correct as worsening leg swelling should prompt contacting the healthcare provider. Option D is correct as limiting salt intake is essential in managing heart failure. Therefore, option C is the statement that indicates a need for further teaching.

When ambulating a frail, older adult client, the nurse should:

  • A. Use the transfer belt if the client is unsteady
  • B. Walk beside the client without support
  • C. Encourage the client to use a walker
  • D. Hold the client's arm for support
Correct Answer: A

Rationale: Using a transfer belt if the client is unsteady is essential to provide added safety and support during ambulation. This device helps the nurse assist the client in maintaining balance and prevents falls. Walking beside the client without support (choice B) may not offer enough assistance for a frail, older adult who is unsteady. Encouraging the client to use a walker (choice C) could be helpful in some cases, but if the client is unsteady during ambulation, additional support like a transfer belt is more appropriate. Holding the client's arm for support (choice D) may not provide enough stability and safety compared to using a transfer belt.

A client who has a new prescription for warfarin (Coumadin) is receiving discharge instructions. Which statement indicates the client understands the teaching?

  • A. I will take my warfarin at the same time every day.
  • B. I should increase my intake of green leafy vegetables.
  • C. I should use a soft-bristled toothbrush while taking this medication.
  • D. I should avoid drinking alcohol while taking this medication.
Correct Answer: C

Rationale: The correct answer is C: 'I should use a soft-bristled toothbrush while taking this medication.' Using a soft-bristled toothbrush is crucial as it helps prevent bleeding gums, which is a potential side effect of warfarin therapy. Option A about taking warfarin at the same time every day is a good practice but does not directly relate to preventing side effects. Option B suggesting an increase in green leafy vegetables can interfere with warfarin's anticoagulant effects due to their vitamin K content. Option D advising to avoid alcohol is generally recommended but is not directly related to the specific side effects of warfarin.

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